Risk Factors Of Collateral Circulation In Patients With Cerebral Atherosclerotic Stenosis

Objective:To explore the relationgship between the risk factors for cerebrovascular disease in patients with cerebral artery atherosclerotic stenosis(stenosis ?50%)and the colla-teral circulation.Methods:This research selected 104 patients with acute cerebral infarction and single intracranial atherosclerotic stenosis(more than 50%)by cerebral angiography examination in the department of Neurology,the Fifth Affiliated Hospital of Kunming Medical University,from May 2011 to December 2016.The cerebral artery was divided into moderate stenosis,severe stenosis and occlusion by the degree of cerebral artery stenosis.The patients were divided into two groups by ASITN/SIR blood flow grading system:a worse group(n=48,0-2 grade)and a better group(n=56,3-4 grade).The data of two groups were collected,such as age,gender,degree of vascular stenosis,hypertension,diabetes,dyslipidemia,homocysteine,smoking history,drinking history and so on.To investigate the relationship between the risk factors of cerebrovascular disease(hypertension,diabetes,dyslipidemia,homocysteine,history of smoking.and alcohol consumption)and collateral circulation(collateral blood flow).The patients were divided into 4 groups according to the level of collateral circulation:the collateral circulation was not open group(n=17),the first level collateral circulation group(n=38),the second level collateral circulation group(n=38)and the third level collateral circulation group(n=11).Comparing the difference of risk factors in the 4 groups to explore the relationship between risk factors of cerebral vascular disease and the different levels of collateral circulation.Results:1 In groups with different degrees of stenosis,A better group of collateral circulation has a higher rank than a worse group.The degree of cerebral artery stenosis is positively correlated with collateral circulation by the Spearman correlation analysis.The higher the degree of cerebral artery stenosis,the better the collateral circulation.2 The history of hypertension and smoking were different in the two groups:a worse group and a better group of collateral circulation,and the difference is statistically significant(P<0.05).Age,gender,diabetes,dyslipidemia,triglyceride,high homocyst-eine,total cholesterol,alcohol consumption,low density lipoprotein,high density lipoprotein were also compared between the two groups,but there is not statistically significant in the two group(P>0.05).3 When we use the collateral circulation better or not as the dependent variable and use the history of hypertension and smoking as independent variables to Binary Logistic analysis.Smoking history is not a risk factor for collateral circulation,hypertension is a protect factor for collateral circulation(OR<1).It is conducive to collateral circulation.4 The degree of cerebral artery stenosis is positively correlated with the degree of collateral circulation,The higher degree of cerebral artery stenosis,the higher the level of collateral circulation.5 Comparing the general information in the collateral circulation was not open group,the first level collateral circulation group,the second level collateral circulation group and the third level collateral circulation group.The general information included age,sex,hypertension,total cholesterol,drinking history,triglyceride,homocysteine,low density lipoprotein,diabetes,smoking history and high density lipoprotein have not statistically significant in the four groups(P>0.05).There was significant difference between the 4 groups in dyslipidemia,it means that the distribution of dyslipidemia in the 4 groups was not the same.6 There was not statistically significant in the first level collateral circulation group,the second level collateral circulation group and the third level collateral circulation group,by using two-two comparison to compare dyslipidemia in the 4 groups(P>0.05).There was a same result between the collateral circulation was not open group and the first level collateral circulation group.There was a significant difference about dyslipidemia between the not open group and the second level collateral circulation group,the not open group and the third level collateral circulation group(P<0.05).The rank mean of dyslipidemia in not open circulation group was higher than that in the second and third group,the difference was statistically significant(P<0.05).7 Dyslipidemia was a statistically negativly significant correlation with the second level collateral circulation,which was not conducive to the second level collateral circulation(P<0.05).Dyslipidemia was not associated with the third level collateral circulation(P>0.05).8 These four indicators:total cholesterol,triglyceride,low density lipoprotein and high density lipoprotein,have no significant effect on the different levels of collateral circulation(P>0.05),and the abnormal blood lipid index has an impact on the opening of the collateral circulation.Conclusions:1 This study suggests that the more severe the cerebral artery stenosis in patients with cerebral atherosclerotic stenosis,the better the opening of the collateral circulation and the higher the degree of collateral circulation probably.2 Hypertension is probably conducive to the patency of collateral circulation in patients with atherosclerotic cerebral stenosis.3 High density lipoprotein,low density lipoprotein,total cholesterol and triglycerides can promote abnormal atherosclerosis,increased blood viscosity and slow blood flow which may synergistically aggravate vascular injury.It is not conducive to the development of collateral circulation.4 In this study,we assessed the collateral circulation by using two hierarchical grouping methods,but the risk factors of various cerebrovascular diseases had different effects on the collateral circulation.Therefore,the influence of the risk factors of cerebrovascular disease on collateral circulation opening may be influenced by different classification and grouping methods of collateral circulation opening.5 The risk factors of cerebrovascular disease may be different in the role of collateral circulation in patients with atherosclerotic cerebral stenosis.When the grade of collateral circulation is divided into groups,dyslipidemia is not conducive to the opening of the two grade collateral circulation.However,this study did not show the effects of dyslipidemia on the collateral circulation,the open group,and the first and three degree of collateral circulation.lt is possible that the pathophysiological mechanisms of collateral circulation at different levels are different,leading to the differences in the effects of cerebrovascular disease risk factors on collateral circulation at different levels.