| Objective:(1)To study the relation between collateral circulation and cerebral perfusion in acute ischemic stroke patients with unilateral middle cerebral artery(MCA) of severe stenosis or occlusion by 320-slice computed tomography angiography(CTA) and computed tomography perfusion image(CTP).(2)To observe the curative effect and prognosis of Sanqi-Tongshu capsule in ischemic stroke patients with middle cerebral artery(MCA) of severe stenosis or occlusion,and to explore its effects of treatment and recurrence prophylactic on the patients with the high-risk of recurrent ischemic stroke.Methods:(1)Select 72 acute ischemic stroke patients with unilateral MCA of severe stenosis or occlusion from the Department of Neurology of Wuhan General Hospital during June 2013 to March 2014,and 320-slice head CTA and CTP were performed in all patients within 1 week after hospitalization.All patients were divided into two groups according the status of collateral circulation.On each perfusion map,several regions of interest(ROI) were manually seted from the homologous region of responsibilityblood vessels to obtain the perfusion parameters,including mean transit time(MTT), time to peak( TTP),cerebral blood flow(CBF),cerebral blood volume(CBV).Comparisons were made between the results of the two groups in general information,cerebral collateral circulation,MTT,TTP, CBF and CBV.(2)120 ischemic stroke patients with unilateral MCA of severe stenosis or occlusion were selected according to the inclusion and exclusion criteria. Based on the different treatments of the patients after discharge, they were divided into two groups, one is the research group composed of 59 patients taking Sanqi-Tongshu capsules and aspirin, the other is the control group composed of 61 patients only taking aspirin.All patients were followed up by telephone which would be asked about their medication compliance and the recovery of neurological function.The curative effect is evaluated by whether there were recurrent stroke symptoms or not.And comparisons were made between the results of the two groups in general information,the recovery of neurological function and the recurrence of stroke.Results:(1)All of the 72 patients had been put into the study.There were 58 cases in the group of patients with collateral circulation whose age was between 20 to 84 years old and 14 cases in the group of patients without collateral circulation.The group of patients with collateral circulation had 38 cases(65.52%) of the MCA occlusion, while there were only 5 cases(35.71%)in the other group,the differences between the two groups was significant(P= 0.041).Patients with collateral circulation had a significantly higher rate of cerebral perfusion compensatory than those without collateral circulation(68.97% vs 21.43%,t=10.595,P=0.001). There were 68 patients with CTP abnormality,and 54 cases of themhad collateral circulation while the other 14 cases didn’t have.The cerebral blood volume [35.00(29.92,41.13)m L/100 g vs 26.25(18.23,37.18)m L/100g] and cerebral blood flow [(2.39±0.73)100g·min vs(1.75±0.72)100g·min] in affected side in patients with collateral circulation were higher than those of the group without collateral circulation.But there was no significant difference between these two groups on compare MTT and TTP.(2)There is no significant difference between these two groups on compare gender,age,hypertension,diabetes,hyperlipidemia, smoking history and history of previous stroke(P>0.05). The recovery of neurological function in the research group improve better than that in the control group.And the rate of recurrent stroke in the research group is much lower than that in the control group,which is statistically significant(13.56% vs 27.87%,P<0.05).Conclusions:(1)320-slice CTA with CTP examination showed that the patients with collateral circulation had a higher rate cerebral perfusion, and the cerebral blood volume and cerebral blood flow were also higher than those without collateral circulation.(2) Compared with the treatment of taking aspirin only,the treatment of taking aspirin and Sanqi-Tongshu capsule can do a better job of inproving the recovery of neurological function and reducing the risk of recurrence of stroke in at-risk patients. |
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