Study On Ischemic Stroke In Young Patientswith Isolated Cerebral Artery Stenosis

Objective: This study was initiated to analyze the general clinical data of young patients with ischemic stroke combined with isolated middle cerebral artery(MCA)stenosis,and study their clinical characteristics,discuss the pathogenesis and prognosis.Method:99 ischemic stroke patients combined with isolated MCA stenosis from the Second Affiliated Hospital of Soochow University during 2009.04-2017.12 were enrolled in this study,and the follow-up period was 28 months.Imaging examinations showed only unilateral or bilateral MCA stenosis or occlusion.The age of all patients was less than 55 years.The new cerebral infarction was confirmed by cerebral MRI.We used MRA?CTA or DSA to assess vascular conditions and the modified Rankin scale to evaluate prognosis.Some improved HR-MRI examination.Collateral circulation assessment was based on r LMC score or ASITN/SIR grading.99 patients were divided into different groups according to etiology,age,the narrow circumstances.Then we compared the clinical characteristics and prognosis.According to the degree of MCA stenosis,the rate of stenosis which was less than 70% was definited as moderate stenosis,while more than 70% was definited as severe stenosis.Single factor and multivariate Logistic regression analysis were performed on the patients' gender,age,smoking history and hypertension.Result: The average age of 99 isolation MCA stenosis patients were 42.8 years,average hospitalization NIHSS for three points,MCA stenosis with M1 segment(82 cases,82.8%),the most common stenosis site more to the left(46 cases,46.5%).According to the TOAST classification,atherosclerosis was the most common(62 cases,62.6%).Among the 53 patients who improved the collateral circulation,40 patients had better collateral circulation(75.5%),12 patients had middle branch circulation(22.6%),and only 1(1.9%)of patients with poor collateral circulation.The average risk factor was two,and the average modified Rankin score was one point.In etiology group,the non-atherosclerosis group(37 cases)were younger,more women,had less risk factors,such as hypertension,hyperlipidemia,diabetes than atherosclerosis group(62 cases)(P < 0.05).Double antiplatelet and intensive lipid-lowering theraphy were more frequent in the atherosclerosis group.Compared with age > 40 years old group(65 cases),age ?40 group(34 cases)combined less with hypertension and atherosclerosis,Fasting blood sugar and glycated haemoglobin were more lower(P < 0.05),but homocysteine significantly increased(P < 0.05).Intensive lipid-lowering theraphy were more commom in the unilateral(80 cases)MCA stenosis group than the bilateral(19 cases)group.While admission of NIHSS,arterial stenosis,and prognosis showed no statistical difference between two groups.Multivariate Logistic regression analysis showed that smoking history(P=0.026)was closely associatated with the degree of MCA stenosis.Among them,5 patients improved the HR-MRI examination,and identified the etiology: 3 cases of atherosclerosis,1 case of MMD,1 case of vasculitis.Conclusion:Atherosclerosis was the most common etiology of ischemic stroke caused by isolated MCA stenosis.And the patients with ischemic stroke had a relatively mild age and a better prognosis.Smoking was closely related to the degree of MCA stenosis.High-resolution magnetic resonance imaging(HR-MRI)had certain advantages in the evaluation of MCA narrow vessel wall and its etiological diagnosis.