Clinical Analysis Of Large Artery Atherosclerotic Stroke

Objectives:Epidemiological study shows that there are about 2.4 million cases of new-onset stroke in our country annually,in which ischemic stroke accounts for about 80%,therefore,early prevention and treatment of ischemic cerebrovascular disease become the focus.Large artery atherosclerotic stroke(LAAS)should be paid more attention for its higher morbidity,disability and mortality,early diagnosis and standard treatment can effectively prevent and treat it.The purpose of the research was to provide evidence for prevention and treatment of LAAS by exploring clinical features,risk factors,characteristic of arteriostenosis and prognosis of anterior and posterior circulation infarction of LAAS.Methods: Two hundred and thirty-three patients were enroll in the study who were diagnosed acute LAAS within 7 days in neurological department from November 2014 to September 2016.According to infarction location,163 patients were in internal carotid artery blood supply region(anterior circulation infarction group)and 70 patients in vertebrobasilar artery blood supply region(posterior circulation infarction group).The patients,general data were registered at admission,including age,sex,family history,smoking history,hypertension history and score of m RS.Fasting plasma glucose(FBG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),homocysteine(HCY)、uric acid(UA)and fibrinogen(FIB)were tested at the second day after admittion.The CT or CTA of head and neck was performed with Siemens Flash dual source CT.Head magnetic resonance imaging(MRI),diffusion weighted imaging(DWI)and magnetic resonance angiography(MRA)were completed with Siemens Skyra 3.0T superconductance magnetic resonance.We compared the risk factors and characteristics of the arteriostenosis between anterior and posterior circulation infarction groups,and analyzed characteristics of the stenosis artery in all patients.The patientswere followed up for 90 days to compare difference prognosis between anterior and posterior circulation infarction groups.The data was analyzed by SPSS 21.0 statistic software.Measurement data meeting normal distribution used t test and meeting nonnormal distribution used Mann-Whitney U test,and x2 test were used in enumeration data.Multivariate Logistic regression analysis was used to analyze the risk factors of P<0.05.There was significant difference,when P<0.05.Results:1 General information 233 patients were enrolled in the study,with average age(68.21±11.75),male 139 cases(59.7%),female 94 cases(40.3%).163cases(70%)were enrolled in anterior circulation infarction group and 70 cases(30%)in posterior circulation infarction group.The patients with hypertension in anterior circulation infarction group(80.4%)were significantly more than that in posterior circulation infarction group(67.1%)(P<0.05),There were no significant difference for age,sex,family history of stroke,stroke history and diabetes between the two groups(P>0.05).2 Biochemical criterion There was no significant difference between average of FBG(6.74±2.69),TC(5.04±1.10),LDL-C(3.40±0.93),UA(319.99±100.64)mmol/L,HCY 17.77±15.29)umol/L,FIB(3.34±0.76)mg/L in anterior circulation infarction group and average of FBG(7.17±2.99),TC(5.06±1.12),LDL-C(3.41±0.87),UA(312.73±80.19)mmol/L,HCY(15.16±10.24)umol/L,FIB(3.47±0.76)mg/L in posterior circulation infarction group(P>0.05).3 Analysis of arteriostenosis3.1 Situation of vascular examination 233 patients underwent carotid ultrasound examination.MRI、DWI and MRA were performed in 228 patients,31 patients underwent head and neck CTA at the same time.The other 5patients only underwent head and neck CTA examination.3.2 Distribution characteristic of responsible arteries In anterior circulation infarction group,there were 121 cases(52.0%)with middle cerebral artery stenosis,20 cases(8.6%)with intracranial internal carotid artery stenosis,13cases(5.5%)with extracranial internal carotid artery stenosis,9 cases(3.9%)with anterior cerebral artery stenosis.In posterior circulation infarction group,there were 33 cases(14.2%)with basilar artery stenosis,24 cases(10.3%)with posterior cerebral artery stenosis,and 13 cases(5.5%)with intracranial vertebral artery stenosis.3.3 Divided groups with the number of arteriostenosis Among 233 patients,65 cases(27.9%)showed single arteriostenosis,and 168 cases(72.1%)showed multiple arteriostenosis.Mean age(69.61±10.92)years old,mean LDL-C(3.47±0.90)mmol/L and the proportion of diabetes(43.5%)in multiple artery stenosis group has statistical significance than mean age(64.58±13.07)years old,mean LDL-C(3.21±0.90)mmol/L and the proportion of diabetes(29.2%)in single artery stenosis group(P<0.05).Binary Logistic Regression analysis showed age(OR 1.039,95% CI 1.013~1.066,P<0.05)and diabetes(OR 2.000,95% CI 1.059~3.775,P<0.05)are independent risk factors of multiple arteriostenosis.4 Prognosis In 233 patients,2 patients received intravenous thrombolytic treatment,1 case in anterior circulation infarction group,and the other one in posterior group.231 patients were treated with anti-platelet aggregation drug,lipid-lowering drug,promoting collateral circulation establishment drug.All patients received secondary prevention with anti-platelet aggregation drug,lipid-lowering drug,etc.224 patients were followed up for 90 days,156 cases in the anterior circulation infarction group and 68 cases in the posterior circulation infarction group.9 cases were lost,in which 7 cases died of the cerebral infarction,including 5 cases of anterior circulation infarction and 2cases in posterior group.19 cases underwent recurrence of cerebral infarction,including 10 cases(6.4%)in anterior circulation group and 9 cases(13.2%)in posterior group,without significant difference between the two groups(P>0.05).The m RS score in 56 cases was more than 3 at 90 days after the treatment,with poor prognosis,including 32 cases in the anterior circulation infarction group snd 24 cases in posterior group,with significant difference between two groups(P<0.05).Conclusions:1 LAAS is mainly in internal carotid artery blood supply region,and males are more common.Hypertension is an important risk factor.2 LAAS always exists with multiple arteriostenosis of intracranial and extracranial arteries.Age and diabetes are independent risk factors of intracranial and extracranial multiple arteriostenosis.Supervising diabetes can reduce incidence rate of large arteriostenosis.3 MCA stenosis is commonest in LAAS of anterior circulation,while BA stenosis in LAAS of posterior circulation.Noninvasive examination of MRA/CTA is helpful for early diagnosis of atherosclerotic stenosis,and it can provide objective basis for early prevention and treatment of LAAS.4 LAAS has a high rate of recurrence,disability and mortality,and posterior circulation infarction should be attracted more attention for its poor prognosis.