| Part I :Clinical prognosis of aggressive medical therapy in patients with symptomatic severe atherosclerotic intracranial arterial stenosisPurpose: Intracranial atherosclerotic stenosis is one of the important causes of ischemic stroke,aggressive medical therapy is the first choice for the treatment of intracranial stenosis.The purpose of this study is to investigate the factors affecting the course,outcome and prognosis of medical therapy in patients with moderate to severe atherosclerotic intracranial stenosis.Method: Retrospectively analyse patients with atherosclerotic intracranial arterial stenosis with aggressive medical therapy in our center from January 2013 to December 2015.The clinical and imaging features,treatment and follow-up results of the enrolled cases were summarized.Clinical endpoints were analyzed according to patient related factors and lesion characteristics.The primary endpoints is defined as stroke or death occurring within 30 days of enrollment,or ischemic stroke or percutaneous transluminal angioplasty and stenting in the area of responsible lesion due to the target artery during follow-up(> 30 days).Result: A total of 124 patients met the inclusion criteria,of which 94 were male and 30 were female.The age range is between 33-80 years,the mean age is 61.20±12.21 years old.There were 87 patients with ischemic stroke,and 37 patients with TIA.The clinical follow-up rate of 110 patients was 88.71%.The follow-up time was 12-38 months.The average follow-up time was 21.76±8.14 months,and the median follow-up time was 22.00 months.The primary end point occurred in 10 patients,with a major endpoint event rate of 9.09%.Of these,2 died within 30 days after admission.During the follow-up>30 days,8 patients underwent ischemic revascularization because of the Ischemic stroke with a responsible lesion or a range of responsible vessels.Another 1 had a secondary endpoint after more than 30 days follow up for other causes of ischemic stroke.Univariate analysis was used to determine the impact of patient related factors and lesion characteristics on the incidence of major end events.The results showed a higher probability of major end point events in patients aged>65 years,with compensatory periods of hypoperfusion,and without regular antiplatelet therapy.A total of 73 patients with symptomatic severe hypoperfusion of atherosclerotic intracranial arterial stenosis were selected,the primary endpoint event rate was 12.33%,higher than in other patients(2.70%),but there was no significant difference in the rate of major end points events between the two groups(P=0.191).Conclusion: In patients with atherosclerotic intracranial arterial stenosis who use the aggressive medical therapy,the incidence of major end point events in patients with symptomatic severe hypoperfusion was higher than in other patients.Patients whose age > 65 years old,during decompensation stage of cerebral hypoperfusion had a higher risk of major end events.Part II Clinical prognosis of intracranial stenting for symptomatic severe hypoperfusion atherosclerotic intracranial arterial stenosisPurpose: Intracranial stenting is an important method for the treatment of intracranial arterial stenosis.The purpose of this study was to investigate the clinical outcomes and influencing factors of intracranial stenting for symptomatic severe hypoperfusion atherosclerotic intracranial arterial stenosis and to compare the clinical outcomes with the aggressive medical therapy.Method: Retrospectively analyse patients of symptomatic severe hypoperfusion of atherosclerotic intracranial arterial stenosis with Wingspan,Enterprise and Solitaire stent angioplasty treatment in our center from January 2007 to December 2016.The clinical and imaging features,treatment and follow-up results of the enrolled cases were summarized.Clinical endpoint events were analyzed according to patient related factors and lesion characteristics,and differences between the primary endpoint events of the aggressive medical therapy outcome were compared.The primary endpoints is defined as stroke or death occurring within 30 days of enrollment,or ischemic stroke in the area of responsible lesion due to the target artery during follow-up(> 30 days).Result: A total of 192 patients met the inclusion criteria,of which 147 were male and 45 were female.The age range is between 37-80 years,the average age was 60.41 ± 9.21 years old,there were 124 patients with ischemic stroke,and 68 patients with TIA.The clinical follow-up rate of 158 patients was 82.29%.The follow-up time was 12-98 months.The average follow-up time was 48.79± 25.45 months,and the median follow-up time was 51 months.The primary end point occurred in 10 patients,and the primary endpoint was 5.49%.Of these,7 died within 30 days of admission,ischemic stroke occurred in 3 cases during the follow-up period(>30 days).Another 7 had secondary end events,6 cases had other causes of ischemic stroke during the follow-up period(>30 days),1 cases died of unknown cause.Univariate analysis was used to determine the impact of patient related factors and lesion characteristics on the incidence of major end events.The results showed a significant increase in the incidence of major end point events in patients older than 70 years.Compare the results of aggressive medical therapy and interventional therapy in symptomatic severe hypoperfusion atherosclerotic intracranial arterial stenosis,there was no significant difference in the rate of major end points events between the two groups(12.33% vs 5.49%,P=0.120).However,the incidence of ischemic stroke in the area of responsible lesion due to the target artery in the aggressive medical therapy group was higher than that in the interventional therapy group(9.59% vs 0%,P=0.009)during follow-up period(>30 days).Conclusion: Intracranial stenting is safe and effective in the treatment of symptomatic severe hypoperfusion atherosclerotic intracranial artery stenosis.Patients older than 70 years had a higher rate of primary end events.There was no significant difference in the incidence of major end points between the two groups compared with aggressive medical therapy.However,the interventional therapy can effectively reduce the recurrence rate of ischemic stroke. |
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