Comparison Of Interventional Therapy And Drug Therapy For Intracranial Atherosclerotic Stenosis

Objective: To compare the efficacy of intravascular interventional therapy and drug therapy for intracranial atherosclerotic stenosis(ICAS),and to clarify the effectiveness and safety of various treatment methods for ICAS,and further analyze the relevant risk factors of ICAS patients,The distribution characteristics of criminal blood vessels,the characteristics of various intravascular treatment methods,the characteristics of related complications,and the comparison of the efficacy of different criminal blood vessel treatment methods,and provide the basis for related clinical diagnosis and research.Research methods: Retrospective analysis of patients with ICAS admitted in the Department of Neurosurgery or Neurology,Second Affiliated Hospital of Dalian Medical University from March 2017 to March 2020.The main endpoint events,restenosis of criminal vessels,and other data were compared between patients undergoing endovascular intervention and those treated with drugs,and the effectiveness and safety of the two major treatment methods were analyzed.The included patients met the following criteria,after 2 weeks of acute ischemic stroke,imaging showed ICAS,had symptoms of cerebral ischemia related to criminal blood vessels,drug treatment was ineffective and there was hypoperfusion of cerebral tissues in areas associated with responsible blood vessels or no good collateral vessels.Excluded patients met the following criteria,contraindications to antiplatelet drugs such as heparin,aspirin,non-atherosclerotic intracranial vascular disease,atrial fibrillation,aortic disease and other life-threatening vital organ diseases,and expected survival time <2 years.The primary endpoint was defined as a criminal vessel-related stroke or death within 30 days of admission,and a criminal vessel-related cerebral ischemia or hemorrhage event during follow-up(> 30 days).The intravascular interventional treatment group was set as the experimental group,and the drug treatment group was the control group.Collect general clinical data of patients,including gender,age,history of smoking,history of hypertension and diabetes,and NIHSS score(evaluating the severity of neurological impairment at admission).The degree of intracranial arterial stenosis was recorded,and the results of MRA,CTA,and DSA imaging were referenced.The degree of stenosis was calculated according to the WASID(Warfarin-Aspirin Symptomatic Intracranial Disease)study to evaluate the degree of criminal arterial stenosis.Recorded treatment methods: endovascular interventional therapy,including PTBA(percutaneous transluminal balloon angioplasty),and balloon dilation + PTAS(percutaneous transluminal angioplasty and stenting)and drug therapy.After discharge(> 30 days),the patient reviewed the craniocerebral imaging examination(MRI / MRA / CTA / DSA),recorded whether the patient had a primary endpoint event,and restenosis of the criminal vessel.The method was the same as before.Statistical analysis of the collected data was performed using SPSS 25.0 software.Measurement data was expressed as((?)±S).Comparison of measurement data between the two groups was performed using independent sample t test.Comparison of count data was performed using ?~2 test or Fisher exact probability method,with P <0.05 as the difference was statistically significant.Results: A total of 71 cases met the inclusion and exclusion criteria of this study,aged between 41 and 82 years,with an average age of 65.5 ± 9.5 years,36 patients had a history of smoking,63 patients had a history of hypertension,and 50 patients had a history of diabetes.Criminal blood vessel distribution: 27 internal carotid arteries,26 middle cerebral arteries,2 anterior cerebral arteries,11 vertebral intracranial segments,2 basal arteries,3 posterior cerebral arteries.30 patients were treated with endovascular intervention and 41 patients were treated with medication.Among the patients undergoing endovascular intervention,5 patients underwent balloon dilatation alone and 25 patients underwent balloon dilation + PTAS.Comparing the general data of the experimental group with the control group,there was no significant statistical difference in the rest of the data,except for the responsible vessels.During the study period,the primary endpoint event occurred in 16 patients,of which 7 patients received endovascular therapy,9 patients received drug therapy,and 13 patients had criminal vascular restenosis,of which 2 patients received endovascular therapy and 11 patients received medication treatment.Comparing the experimental group with the control group,the incidence of main endpoint events(23.3% / 22.0%,P = 0.89> 0.05)showed no significant statistical difference.PTBA alone compared with balloon dilatation + PTAS and drug treatment(20.0% / 24.0% /22.0%,P = 1.000> 0.05)There was no statistically significant difference in the incidence of primary endpoint events,and the incidence of revascularization stenosis in the experimental group was significantly better than that in the control group(6.7% / 26.8%,P = 0.030 <0.05)The difference was statistically significant.The difference in the incidence of recurrent stenosis of the responsible vessels between PTBA alone and balloon dilatation + PTAS and drug therapy(20.0% / 4.0% / 26.8%,P = 0.039 <0.05)was statistically significant.The incidence rate of the main endpoints of endovascular interventional therapy and drug therapy in patients with internal carotid artery stenosis(16.7% / 26.7%,P = 0.662> 0.05),there was no significant difference.The incidence of primary endpoints of endovascular interventional therapy and drug therapy in patients with middle cerebral artery stenosis(37.5% / 22.2%,P = 0.635> 0.05).Conclusions:Compared with intravascular interventional therapy and drug therapy in patients with ICAS,there is no significant difference in the safety and effectiveness of intravascular interventional therapy and drug therapy.There were no significant differences in the effectiveness and safety of patients with ICAS who received PTBA alone,balloon dilatation + PTAS,and drug therapy.Intravascular interventional therapy in patients with ICAS can effectively reduce the occurrence of responsible restenosis compared with drug therapy.Compared with other treatment methods,balloon dilatation and PTAS can also effectively reduce the occurrence of responsible restenosis.In cases where the responsible vessel is the internal carotid artery,there is no significant difference in the effectiveness and safety of endovascular interventional therapy and drug therapy.There was no significant difference in the effectiveness and safety of endovascular interventional therapy and drug therapy in cases where the responsible vessel was the middle cerebral artery.