Therapeutic Effects Between The Percutaneous Transluminal Angioplasty And Stent And Medical Treatment On Patients With Symptomatic Intracranial Vertebral Artery Atherosclerotic Stenosis And Non-disabling Ischemic Cerebrovascular Events

Objective: To investigate the therapeutic effects between the percutaneous transluminal angioplasty and stent(PTAS)and medical treatment on patients with symptomatic intracranial vertebral artery atherosclerotic stenosis and non-disabling ischemic cerebrovascular events.Methods: A total of 107 consecutive inpatients with symptomatic intracranial vertebral artery atherosclerotic stenosis and non-disabling ischemic cerebrovascular events from our department between December 2013 and December 2016 were chosen in our study.Based on the time of admission,economical condition,and principle of free will,the patients were divided into two groups(51 patients with PTAS;56 patients with the medical treatment).The clinical data were collected.Magnetic resonance imaging was performed in all the patients.The scores of National Institute of Health stroke scale(NIHSS)or ABCD2 and mRS were performed.Mini-mental state examination and Montreal cognitive assessment were also assessed by experienced doctors.Then,χ2 test,T-test and so on were used to analyze the therapeutic effects between the PTAS and medical treatment on patients with symptomatic intracranial vertebral artery atherosclerotic stenosis and non-disabling ischemic cerebrovascular events.Results:1.There were 107 patients in our study consist of 51 patients in the group of PTAS and 56 patients in the group of medical treatment.The baseline scores of MMSE was 22.2±2.99 of the group of PTAS and 21.8±3.77 of the group of medical treatment.The baseline scores of MoCA was 20.1±1.98 of the group of PTAS and 19.7±2.28 of the group of medical treatment.There was no significant difference in baseline parameters such as age,the proportion of gender,hypertension,diabetes,coronary heart disease,hyperl ipidemia,a history of stroke,smoking history,drinking history,TIA,scores of mRS,scores of MMSE,scores of MoCA,between the two groups(P>0.05).2.Cerebrovascular events or death were followed up at 1 month,3 month,6 month and 1 year.There were no death case in both group.There was no signifcant difference(P>0.05)between the PTAS and medical treatment groups in the occurrence of the cerebrovascular events at the 1 to 6-month follow-up.Compared with the medical treatment group,the occurrence of the cerebrovascular events was lower in PTAS group at the 1-year follow-up(P<0.05).Further analysis found that the occurrence of the ischemic stroke rather than TIA or hemorrhagic stroke was lower in PTAS group compared with the medical treatment group at the 1-year follow-up(P<0.05).3.The proportion of scores of NIHSS was followed up at 1 month,3 month,6 month and 1 year.There was no signifcant difference(P>0.05)between the PTAS and medical treatment groups in the proportion of scores of NIHSS at the follow-up of different time point.4.The proportion of scores of mRS was followed up at 1 month,3 month,6 month and 1 year.There was no signifcant difference(P>0.05)between the PTAS and medical treatment groups in the proportion of patients with the no obvious or mild disability(the score of mRS≤2)at the 1-month and 3-month follow-up.Compared with the medical treatment group,the proportion of patients with the no obvious or mild disability was higher in PTAS group at the 6-month and 1-year follow-up(P<0.05).5.The scores of MMSE were followed up at 1 month,6 month and 1 year.There was no signifcant difference(P>0.05)between the PTAS and medical treatment groups of the scores of MMSE at the follow-up of different time point..6.The scores of MoCA were followed up at 1 month,6 month and 1 year.There was no signifcant difference(P>0.05)between the PTAS and medical treatment groups of the scores of MoCA at the 1-month and 6-month follow-up.Compared with the medical treatment group,the scores of MoCA were higher in PTAS group at the 1-year follow-up(P<0.05).Conclusion:1.Compared with the medical treatment,PTAS could reduce the risk of cerebrovascular events,especially the ischemic stroke,of the patients with symptomatic intracranial vertebral artery atherosclerotic stenosis and non-disabling ischemic cerebrovascular events.2.Compared with the medical treatment,PTAS could improve the neurological outcome of the patients with symptomatic intracranial vertebral artery atherosclerotic stenosis and non-disabling ischemic cerebrovascular events.3.Compared with the medical treatment,PTAS could improve the long-term cognitive function of the patients with symptomatic intracranial vertebral artery atherosclerotic stenosis and non-disabling ischemic cerebrovascular events.