Research Of Collateral Circulation In Patients With Unilateral Middle Cerebral Artery Disease On Cerebral Infarction Volume And Prognosis

Objective: To observe the stenosis of the unilateral middle cerebral artery or the formation of collateral circulation after occlusion,as well as the changes in the volume of cerebral infarction and the prognosis of patients.Methods: From January 2016 to October 2018,the Department of Neurology of Hebei General Hospital received 918 patients with cerebrovascular intervention,including 144 patients with middle cerebral artery disease.51 patients with acute cerebral infarction with unilateral middle cerebral artery stenosis or chronic occlusion were enrolled according to the inclusion exclusion criteria.We recorded the general information of admission,including the age and gender of the patient.We recorded patient vascular risk factors,including diabetes,hypertension,smoking history,drinking history,hyperhomocysteinemia,hyperlipidemia,etc.According to the patient's symptoms and signs,the NIHSS scores and ADL scores were recorded after admission,and the DWI and MRI scans of the cerebral were completed within 7 days.According to the patient DSA data,the middle cerebral artery lesions and collateral circulation were evaluated.Patients were divided into stenosis group and occlusion group according to the condition of middle cerebral artery disease.According to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology(ASITN/SIR)collateral circulation assessment system,it was divided into excellent collateral circulation(ASITN/SIR?3)group and collateral circulation(ASITN/SIR?2)group.The patients were followed up for 6 months after discharge to understand the prognosis and mRs score.The volume of cerebral infarction on DWI images was calculated using PACX software.Statistical analysis was performed using SPSS 21.0.The count data was expressed as a percentage,and the chi-square test was used for analysis.The measurement data is represented by the mean±standard deviation(±SD)of the normal distribution,and the comparison is analyzed by the t test;non-compliance with the normal distribution is represented by the median and upper and lower quartiles[M(Q1,Q3)],and the difference comparison is analyzed by the nonparametric rank sum test.The relationship between the binary variable and multiple independent variables is analyzed by Logistic regression.P<0.05 was statistically significant.Results:1.Normal information :A total of 51 patients were enrolled in the research,including 32 males(62.7%)and 19 females(37.3%),with an age range of(22-74)years and an average age of(50.22±12.41)years.There were 21 patients with smoking history(41.2%),15 patients with alcohol history(29.4%),33 patients with hypertension(64.7%),8 patients with diabetes(15.7%),and 14 patients with hyperlipidemia(27.5%),26(50.9%)with high homocysteinemia.General data of patients with excellent collateral circulation(ASITN/SIR?3)group and collateral circulation(ASITN/SIR?2),age,sex,smoking history,drinking history,diabetes history,hyperlipidemia,high homocyta There was no statistical difference in cystine(P>0.05).There was a statistically significant difference in the history of hypertension(P<0.05).2.Comparison of collateral circulation:Compared with patients with middle cerebral artery stenosis,the cerebral circulation scores were higher in the middle cerebral artery occlusion group,and the collateral circulation scores were statistically different(P<0.05).3.Comparison of cerebral infarction volume,NIHSS scores,ADL scores and prognosis:The cerebral infarction volume,the admission NIHSS scores and the recurrence rate of the collateral circulation group were higher than the excellent collateral circulation group.The admission ADL scores of the excellent collateral circulation group were lower than the other.There is a statistical difference between them(P<0.05).4.Age,gender,smoking history,drinking history,homocysteine,triglyc-eride,low-density lipoprotein and cholesterol were used as independent variables,and collateral circulation and collateral circulation were generally used as dependent variables.Multivariate logistic regression analysis showed that hyperhomocysteinemia was the influencing factor of collateral circulation in patients(P<0.05),and the remaining influencing factors showed no statistical significance.(P>0.05).Conclusions:1.The collateral circulation of patients with middle cerebral artery occlusion was better than that of patients with stenosis,and the collateral circulation open level score was high.2.Patients with good collateral circulation had smaller cerebral infarction volume,lower admission NIHSS scores,higher ADL scores,better prognosis and lower recurrence rate.3.For the patients enrolled in this research,hyperhomocysteinemia affected the establishment of the collateral circulation.Age,gender,smoking history,drinking history,triglycerides,low-density lipoprotein and cholesterol were not associated with the opening of the collateral circulation.