| 1 Background and Objective:Ischemic cerebrovascular disease with high incidence and high morbidity, high mortality and high recurrence rate has become a major disease harm human health. It includes TIA and cerebral infarction, the formation of atherosclerotic plaques and cerebral artery stenosis is an important cause of ischemic cerebrovascular disease.Cerebral artery atherosclerosis offen occurs in intracranial and extracranial, medium and large arteries and the bifurcation of the Department of bending, there are many differences between East and West patients in the characteristics of cerebrovascular disease, risk factors and long-term prognosis. The position and pathological characteristics of intracranial and extracranial atherosclerosis are not exactly the same In United States, the new onset of stroke is mainly caused by extracranial carotid artery stenosis, accounting for 35% to 70%, but in Asian, it reported that intracranial arterial stenosis is an important reason which caused cerebral infarction and TIA. However, a larger sample of domestic research in china is still less. Traditional Chinese Medicine has a long history of stroke treatment. Throughout the process of stroke, from the acute phase to the Sequela, the stroke syndrome changes while the pathogenesis changes occurring. Only by understanding the dynamic evolution of TCM syndromes law, we could fully and completely understand the stroke.Then take decisive and accurate drugs. Therefore, By finding out the features of vascular information and TCM Syndrome in Chinese patients, we can have a better understanding and can prevent the ischemic cerebrovascular disease. Symptoms of cerebral artery stenosis is the main reasons of stroke, endovascular treatment of cranial arterial stenosis technology opens up a new treatment. However, the effectiveness and their safety are still at the exploratory stage. Another research focus in the stent restenosis, TCM prevent the stent restenosis, which can play a Superiority of Chinese medicine compound regulate the body functions and multi-channel, multi-link, and the advantages of multi-target interference is expected to open up a new therapeutic approach. However, how Chinese medicine to intervene, The time window of intervention, methods, outcomes have become pressing problem. The key to solving these problems can not do without TCM syndrome, understanding the syndrome differentiation and grasp of the law is the core of the evolution of the TCM. Therefore, defining the TCM Syndrome perioperative cerebral artery stent, it can provide early and reliable basis for clinical symptoms and signs for TCM prevention of restenosis after stenting.2 Research methodsA retrospective analysis of patients'DSA information who suffered ischemic cerebrovascular disease, and fill stroke TCM syndromes questionnaire, It divided into three sections to discuss above issues:Partâ… :Analysis of digital subtraction angiography (DSA) to define cerebral artery stenosis characteristics in patients with cerebral artery stenosis.Partâ…¡:Analysis the TCM syndrome distribution laws of patients with ischemic cerebrovascular disease, Combining with DSA results, analysis of the correlation between cerebral artery stenosis and TCM Syndrome.Partâ…¢:Evaluation of safety and effectiveness of cerebral artery stent, analysis of TCM Syndrome evolution rule perioperative stent3 resultsPartâ… :362 cases of patients with ischemic cerebrovascular disease, of which 334 cases had cerebral artery stenosis, accounting for 92.3%. In all patients with cerebral artery stenosis,143 patients (42.8%) only had intracranial artery stenosis; 84 patients (25.2%) only had extracranial artery stenosis; there were 107 cases (32%) of patients had intracranial and extracranial artery stenosis.173 patients (51.8%) with anterior circulation stenosis; 58 patients (17.4%) with posterior circulation stenosis; 103 cases (30.8%) of patients with combined stenosis. Extracranial artery stenosis often occurred in:extracranial internal carotid artery 185 (61.7%) extracranial vertebral artery 96 (32%), subclavian artery 19 (6.3%); intracranial arterial stenosis made better position:intracranial internal carotid artery 55 (13.2%), anterior cerebral artery 55 (13.2%), middle cerebral artery 171 (41.2%), posterior cerebral artery 29 (7%), intracranial vertebral artery 54 (12.9%), basilar artery 52 (12.5%).334 cases of cerebral artery stenosis in patients with a total of 84 patients (25.1%) had collateral circulation, mainly for the Willis ring and adjacent pial artery compensatory compensation. Cerebral artery occlusion and collateral circulation in patients with NIHSS score was significantly lower than those without collateral circulation, through statistical analysis, P = 0.01, the difference was statistically significant.362 cases of ischemic cerebrovascular disease, a total of 299 vessels of responsibility. Cerebral infarction and TIA in patients with vascular stenosis distribution and extent of responsibility for the statistical analysis P> 0.05, not statistically significant.For extracranial artery stenosis, hypertensive is related to arterial stenosis (p= 0.025), risk is 5.046; different age group distribution different cranial artery stenosis occurrence and degree, P<0.01, statistically significant.Part II:247 cases of patients suffer acute ischemic stroke, of which 230 cases of patients had cerebral artery stenosis, accounting for 93.1%; 198 cases of patients can be confirmed responsibility vascular stenosis. Alone in patients with intracranial arterial stenosis in 51 cases (45.7%), extracranial artery stenosis alone,51 patients (22.2%), intracranial and extracranial arteries stenosis exist in 74 cases (32.2%); 147 cases of anterior circulation stenosis (63.9%), pure posterior circulation stenosis in 24 patients (10.4%),59 patients unite cycling are narrow (25.7%).Distribution of TCM syndrome evidence with acute ischemic stroke:The most is wind, followed by phlegm, blood stasis again, qi deficiency,the least is syndrome of yin deficiency and yang hyperactivity. In syndrome combine, three-syndrome combination is the most with total of 145 cases (58.7%), followed by the combination of two cards, a total of 52 cases (20.6%), again syndrome for the four combinations, a total of 48 cases (19.4%), document (2 cases, accounting for 0.8%) and five-card (1 case,0.4%), rare combination.The main syndrome of acute ischemic stroke are wind, phlegm, blood stasis, and additional deficiency of qi deficiency and yin deficiency and yang hyperactivity, to form various combinations of syndrome.Logistic regression analysis, history of hypertension is related phlegm; history of diabetes and smoking are fiery evidence related factors; smoking history, coronary heart disease history and previous history of stroke is related to qi deficiency, all were statistically significant.Phlegm with intracranial arterial stenosis alone were significantly higher than that of extracranial artery stenosis, the difference was statistically significant (P= 0.027); pure extracranial artery stenosis incidence of blood stasis was significantly higher than intracranial stenosis, the difference was statistically significant (P= 0.007). Extracranial artery stenosis was significantly associated with blood stasis syndrome (P<0.01), and the rank correlation coefficient of rank correlation rs value prompted 0.975 (P<0.01), was positively correlated. Intracranial arterial stenosis significantly correlated with phlegm (P<0.01), and the rank correlation coefficient of rank correlation rs value prompted 0.896 (P= 0.004), positive correlation.Part III:Before and after extracranial artery stents:the wind syndrome significantly different (P= 0.001), there was significant; phlegm syndrome significantly different (P= 0.01), there statistically significant; blood stasis before and after stent significantly difference (P= 0.011), there was significant; FHP significant difference before and after the stent (P= 0.018), statistically significant, and Ranks results suggest that these four cards significantly reduced after the stent and 2 weeks later, Qi deficiency before and after stent significantly different (P= 0.003), there was significant, and Ranks results suggest that Qi deficiency increased significantly after the stent and 2 weeks later.Before and after intracranial artery stents:the wind permits were significantly different (P= 0.007), statistically significant, blood stasis before and after stent significantly difference (P= 0.042), with statistical significance, Ranks results suggest that these two cards significantly reduced after the stent and 2 weeks laterBefore and after extracranial artery stent:the combination syndrome with significantly different, P= 0.001, statistically significant. Which means that two or three card combination are the most preoperative, after stenting, the two card combination increased, and the three cards, four cards combination reduced; deficiency-excess syndrome combine before and after stent statistically significant, Which means excess syndrome are the most before stent, reduced postoperative,;deficiency syndrome are the lesst,increased postoperative.Stent complications:64 case of patients with extracranial artery stenting, 4 patients had surgical complications,6.2%, both the department of carotid artery stent complications.36 cases of intracranial artery stents were successfully placed, a total of 5 cases (13.9%) had surgery-related complications,2 cases of middle cerebral artery stent,3 cases of basilar artery stent.Follow-up DSA,we found 3of 59 patients with extracranial artery stents restenosis, vertebral artery,2 cases, which restenosis rate is 12.5%; subclavian artery stenosis,1 case, which restenosis rate is 11.1%.27 patients with intracranial artery stents were followed up, for a total of four cases of restenosis was found, all were the middle cerebral artery stents, Winspan stent, the restenosis rate is 30.8%.Syndromes of TCM follow-up:In extracranial artery stent restenosis, one case of restenosis by 50% with the phlegm syndromes + qi deficiency; two cases of restenosis 70%, respectively, with phlegm syndromes+Qi+Blood, phlegm +blood stasis;Between intracranial artery stent restenosis, one case of restenosis of 20% with the phlegm syndromes+ FHP; one case of stenosis of 23% with the blood stasis syndromes; two cases of stenosis were 50%, 1 case with blood stasis Syndrome,1 case of TCM syndrome is phlegm+ qi deficiency.4 Research conclusionsPartâ… The characteristics of arterial stenosis in patients with ischemic cerebrovascular disease1 Ischemic cerebrovascular disease had higher incidence of cranial stenosis and this study cases show pure intracranial stenosis higher than simple extracranial Stenosis.2 Infarction group and TIA group responsibility vascular stenosis had no statistical difference, prompted us should put emphasis to TIA rapid etiological diagnosis, given treatment timely to prevent its progress as cerebral infarction.3 Cerebral artery stenosis is main factors aroused neurologic impairment but collateral circulation played very important protection role,especially Willis ring and neighboring brain soft membrane compensatory. 4 Between various risk factors, extracranial artery stenosis has the relation with hypertension (P= 0.025), OR is 5.046; Between different age group, The distribution and degree of racranial artery stenosis significantly different, P<0.01, statistically significant. The young group prone to intracranial stenosis, but old age group prone extracranial artery stenosis.Part II The Correlation between the distribution of Syndrome and cerebral artery stenosis in patient with acute ischemic cerebrovascular disease.1 Characteristic of TCM syndromes with acute ischemic strokeWind syndrome probability highest (87.4%), three syndromes combination is highest in syndromes combination. Syndromes combination is mainly formed by wind,phlegm,blood stasis, which mutual combination and plus qi deficiency, fiery, YV and YHP, composition various syndromes combinations.2 The correlation between TCM syndromes and risk factorsHypertension History and phlegm had negative correlation; diabetes history and fiery syndrones had negative correlation, smoking history with fiery card correlated; smoking history, CHD history and Qi Deficiency negatively related, past stroke history and Qi Deficiency Syndrome correlated. These results prompt us in Clinical, For undocumented discernible stroke patients, patients'risk factors and clinical certain objective examination can be Contact, reference this study results syndrome differentiation.3 TCM syndromes had relationship with cerebral artery stenosis lesion and extentDistribution and extent of extracranial artery stenosis was positively correlated with blood stasis syndrome, Distribution and degree of intracranial arterial stenosis was positively associated with phlegm.Part III TCM Syndrome Features of perioperative cerebral artery stent1 Perioperative of cerebral artery stent, the rule of TCM syndrome can be found, mainly manifested that empirical reduce and deficiency increase.2 Extracranial artery stent especially carotid stent is safe and effective, intracranial artery stent had higher risk which should cautiously conduct.3 Peventing cranial external stent restenosis by integrative medicine is feasiblea and should undertake further studies. |
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