Optimal Combination Therapy For Intracranial Aortic Stenosis

Objective: To observe the recurrence rate of stroke in patients with acute ischemic stroke(AIS)caused by intracranial aortic stenosis,those who were given the oral medicines of atorvastatin and probucol,or the combination of Butylphthalide capsule,Tongxinluo and cilostazol.Magnetic Resonance Angiography(MRA)was used to evaluate the outcome of intracranial artery stenosis before and after treatment.The changes of blood lipid levels before and after treatment and the safety of 5 drugs in clinical application were also recorded and compared.Methods:During October 2017 and October 2018,a total of 80 consecutive hospitalized patients with AIS in the Department of Neurology Second Hospital of Hebei Medical University were recruited to undergo magnetic resonance angiography(MRA)to measure the intracranial atherosclerosis stenotic degree and all the measured stenosis were responsible vessels for AIS.They were randomly divided into two groups,A and B.A total of 34 patients in group A were given "atorvastatin 20 mg QN,probucol 0.25 g BID" and conventional antihypertensive and hypoglycemic treatment;a total of 46 patients in group B were treated with "butyphthalein soft capsule 0.2g TID,Tongxinluo capsule 0.52 g TID,cilostazol 50 mg QD" based on the treatment plan of group A.After 6 months of follow-up,the outcomes of intracranial arterial stenosis,changes in blood lipid levels,and recurrence rate of AIS were observed in the two groups before and after treatment.The liver and kidney function,myocardial enzymes,electrocardiogram and other adverse reactions were monitored(such as gastrointestinal irritation,muscle pain,etc).Results:1.Comparison of blood lipid levels(1)Before treatmentPlasma concentrations of TC,TG,LDL and HDL in patients with A and B were statistically indistinguishable(P >0.05 Table 2).(2)After treatmentComparison within the group: After treatment in group A,plasma TC,TG,LDL concentrations were lower than before treatment,the difference was statistically significant(P <0.05),plasma HDL concentration changes were not statistically significant(P > 0.05 Table 3).After treatment in group B,plasma TC,TG,LDL concentrations were lower than before treatment,the difference was statistically significant(P <0.05),plasma HDL concentration was higher than before treatment,the difference was statistically significant(P <0.05 see Table 4).Comparison between groups: After treatment,the concentration of TC,TG and LDL in group B was significantly lower than that in group A,and the difference was statistically significant(P <0.05.Table 5).2.Comparison of head MRA resultsAll patients were underwent MRA before treatment and 6 months after treatment.The intracranial atherosclerosis stenotic degree was compared before and after treatment.The improvement rate of group A was 29.41%,and the improvement rate of group B was 57.78%.The improvement rate of group A was significantly lower than that of group B,and the difference was statistically significant(P <0.05.Table 6).3.Comparison of AIS recurrence rateAfter 6 months of treatment,the recurrence rate of AIS with patients in group A was 2.94%.There was no recurrence in group B,and the recurrence rate was 0.The difference was not statistically significant(P >0.05.Table 7).4.Drug safety evaluationIn this experiment,blood tests such as liver and kidney function,muscle enzymes,and other symptoms of gastrointestinal irritation and muscle pain were observed to determine whether or not adverse events occurred,and drug safety was evaluated.Three patients in group A and four patients in group B had elevated liver enzymes,and the elevations of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were less 3 times than normal.So they continue to take the drugs.After 1 month,the blood was re-detected,and ALT and AST returned to normal.One patient in group B developed gastrointestinal irritation,and the patient could not tolerate and withdrew from the experiment.There was no significant difference in the incidence of adverse events between the two groups(P >0.05 see Table 8).Conclusion:For patients with AIS with intracranial aortic stenosis,long-term regular oral administration of atorvastatin,probucol,butylphthalide capsule,cilostazol,and Tongxinluo capsule can prevent or even reverse arteriosclerosis and prevent the recurrence of AIS.And there were not obvious adverse drug reactions.So it is worthy of clinical application.