Clinical Study Of Minor Acute Ischemic Stroke

ObjectiveTo evaluate the application of The Trial of Org10172 in Acute Stroke Treatment(TOAST),ASCO(Atherosclerosis for A,Small vascular disease for S,Cardiac source for C,Other cause for O)and Chinese Ischemic Stroke Subclassification(CISS)in minor acute ischemic stroke(hereinafter referred to as minor stroke).To explore the risk factors of large artery atherosclerosis(LAA)and perforating artery disease(PAD)in minor stroke;To explore the risk factors of poor prognosis of LAA minor stroke.MethodsFrom December 2017 to August 2019,a total of 220 patients diagnosed with minor stroke were screened from the department of neurology of Northern Jiangsu People's Hospital.Baseline demographic and clinical data were collected(including sex,age,Body Mass Index(BMI),smoking,drinking,history of hypertension,history of diabetes,history of hyperlipidemia,history of atrial fibrillation,etc.).After the completion of relevant auxiliary examinations,we continued collect(including fasting blood glucose,glycosylated hemoglobin,systolic blood pressure,diastolic blood pressure,blood lipid related indicators,blood cell analysis,liver and kidney function,homocysteine,electrocardiogram,dynamic electrocardiogram,neck vascular ultrasound,intracranial Doppler blood flow diagram,High Resolution Magnetic Resonance Imaging(HRMRI)),computed tomographic angiography(CTA),digital subtraction angiography,foaming test,etc.).TOAST,ASCO,and CISS classifications were performed on the enrolled patients,and the National Institute of Health Stroke Scale(NIHSS)score was calculated on initial time and on72 hours after onset.The prognosis of 90 days was evaluated by modified Rankin Scale(m RS).Analyzed and compared the consistency and difference of three different classifications of TOAST,ASCO and CISS in the application of minor stroke.Risk factors of LAA and PAD subtypes in CISS classification were analyzed.Patients with LAA subtype were divided into the groups of good prognosis and bad prognosis according to 90 d m RS(0-1 means good prognosis and 2-6 means poor prognosis),and the risk factors of patients with poor prognosis were analyzed later.ResultsCompared with TOAST classification,ASCO-1 etiological subtype reduced the number of patients with undetermined etiology,but the difference between them was not statistically significant(P = 0.060).The number of patients in large artery atherosclerosis(P=0.763)and small-vessel disease(P=0.174)were increased,but there was no statistical significance either.The consistency of the two classification is between good and very good.The CISS classification based on HRMRI compared with TOAST and ASCO-1,the number of patients who were classified as large artery atherosclerosis group increased significantly(P < 0.001;P < 0.001),and the number of patients in small vascular disease group decreased significantly(P < 0.001;P < 0.001).CISS criteria compared with TOAST and ASCO classification,the consistency of each subtype was between medium,good and very good.The subtypes in CISS classification were distributed as follows: LAA(59.1%,130/220),PAD(23.6%,52/220),UE(13.6%,30/220),CS(2.3%,5/220),OE(1.4%,3/220).Risk factors of two main subtypes(LAA and PAD)in CISS classification were analyzed.Univariate analysis showed that the level of uric acid(P=0.029),triglyceride(P=0.037)?age(P=0.017)?BMI(P= 0.049)were higher in the LAA group,and the proportion of patients with hypertension(P=0.027),smoking history(P=0.019)and poor prognosis(P=0.014)were higher in LAA group than in PAD group,the differences are statistically significant.Univariate analysis showed that the incidence of early neurological deterioration(P<0.001),baseline NIHSS(P=0.025)and the level of cholesterol(P = 0.036)in the poor prognosis group were higher than those in the good prognosis group,and the level of lymphocyte(P < 0.001)was lower than those in the good prognosis group.Further multivariate logistic regression analysis showed that early neurological deterioration(P = 0.006)and lower lymphocyte level(P = 0.012)were independent risk factors for short-term poor prognosis of LAA type in minor stroke.Conclusion1?The diagnostic consistency of TOAST,ASCO and CISS classification for each subtype of minor stroke is between moderate and very good,and the three methods can be applied to minor stroke according to different research purposes of researchers.2?In minor stroke,the differences between the subtypes of CISS and TOAST,ASCO mainly focused on undetermined etiology group,large artery atherosclerosis group and small vessel disease group.Compared with TOAST and ASCO,CISS significantly reduced the proportion of patients diagnosed as small vessel disease group and undetermined etiology group,and increased the proportion of patients diagnosed as large artery atherosclerosis group,which enable more accurate etiological diagnosis and provide theoretical basis for the study of risk factors related to minor stroke and secondary prevention3?Among patients with minor stroke,the main subtypes are LAA and PAD,and there are more LAA patients than PAD patients.Compared with PAD patients,higher levels of uric acid,triglyceride,age,BMI,hypertension and patients with smoking history are more likely to be related to the occurrence of LAA.4? The short-term prognosis of patients in LAA and PAD of minor stroke is significantly different.The prognosis of LAA patients is relatively poor.5?Early neurological deterioration and lower level of lymphocytes may be independently related to poor short-term prognosis in patients with LAA group of minor stroke.