| PART I Clinical characteristics and risk factors of cerebral atherosclerotic stenosis concomitant with intracranial aneurysmsObjective:To analyze the clinical and imaging features of cerebral atherosclerotic stenosis complicated with intracranial aneurysm,and to explore the independent risk factors of concomitant lesions.As well as to provide an evidence for screening of high risk population in patients with cerebral atherosclerotic stenosis complicated with aneurysm.Methods:All images data(CTA,DSA)of the patients who were diagnosed with cerebral atherosclerotic stenosis and admitted to the Cerebrovascular Center of Changhai Hospital from January 2014 to December 2015 were collected.Including patients’ baseline data(age,sex,previous history,etc.),clinical features(history of TIA and stroke,symptoms when admitted,mRS,etc.),and the imaging data of cerebrovascular stenosis(side,position and degree of stenosis,etc.).The size and location of aneurysm,and the relationship between two lesions were analyzed.Single factors analysis and multivariate logistic regression analysis were performed to explore the independent risk factors of intracranial aneurysm in patients with atherosclerotic stenosis.Results:1)From 2014 to 2015,1558 patients with cerebral atherosclerotic stenosis were admitted to our center,of whom 231 were concomitant with intracranial aneurysms,1327 were not.The average age of concomitant lesion patients was 61.52 ± 11.72 years old,female accounted for 44.6% of them(n=103).2)The stenosis characteristics of the case group were analyzed.The main location of the stenosis was the ICA(N=79,34.2%),MCA(N=58,25.1%),and CCA(N=45,19.48%),VBA(N=47,20.35%),ACA(N=2,0.87%);There were 133 mild stenosis,47 moderate stenosis and 51 severe stenosis or above.3)The aneurysm characteristics of the observation group were analyzed.The main size of the aneurysms was 5.91±4.41 mm.The aneurysms mainly located in ICA(n=144,62.3%),MCA(n=27,11.7%)、AcomA(n=21,9.1%)、BA(n=14,6.1%)、VA(n=7,3.0%),ACA(n=7,3.0%)、PCA(n=6,2.6%)、SCA(n=3,1.3%)and PICA(n=2,0.9%).82 cases of aneurysm with a maximum diameter of 3-5mm(35.5%),76 cases of 5-10mm(32.9%),43 cases < 3 mm(18.6%)and 30 cases above 10 mm were 4.3%.4)The relationship between two lesions of case group were analyzed.In 178 cases,the two lesions were located in the same circulation,of which 132 cases were on the ipsilateral side.In the ipsilateral lesions,two lesions were at same artery in 126 cases,of which 89 aneurysms were located at the distal of the stenosis and 22 aneurysm were located at the proximal of the stenosis.37 aneurysms were located at the proximal of the stenosis,of which 6 were adjacent lesion and 31 were not.In 6 cases the two lesion were not at the same vessel.5)The relationship between the degree of stenosis and the rupture of aneurysm in the observation group were not statistically significant(P=0.142).6)Univariate analysis showed that the single risk factors were as follows: gender(P<0.001),age(P<0.001),history of antiplatelet aggregation drugs(P<0.001),history of cerebral infarction(P=0.013),circulation of the stenosis(P=0.024),and unilateral stenosis(P<0.001);By logistic regression analysis,the independent risk factors of cerebral atherosclerotic stenosis concomitant with intracranial aneurysm were as follows: female and young age(aged <60 years old).Conclusion:Cerebral arteriosclerotic stenosis co-occurrence with intracranial aneurysm were not rare,which should be paid serious attention in the prevention and treatment of ischemic stroke.Female and younger age(Age <60y)were independent risk factors of Cerebral arteriosclerotic stenosis co-occurrence with intracranial aneurysm.The retrospective analysis can provide a basis for prospective screening and intervention treatment in the future.Due to the aging of the population,the number of patients with cerebral artery stenosis increased gradually,and the possibility of concurrent aneurysms was often overlooked,which brought certain risk for patients with aneurysm.We can provide sufficient evaluation of the ischemic risk with aneurysm patients and offer scientific basis for safe treatment and prevention strategies.PART II Effect of antiplatelet aggregation drugs on the hemorrhage risk of cerebral artery stenosis complicated with intracranial aneurysmObjective: To explore the effect of antiplatelet drugs on the risk of hemorrhage in patients with cerebral arteriosclerosis stenosis complicated with intracranial aneurysms,and to explore the safety of antiplatelet drugs in patients with concomitant diseases.Methods: Patients with cerebral arteriosclerosis stenosis concomitant with aneurysm and still had an aneurysm untreated when left the hospital,who admitted from January 2011 to December 2015 in the Cerebrovascular Center of Changhai Hospital,were selected into the study.The clinical,imaging features and follow-up data of the patients were extracted,and the antiplatelet drugs prescription on hospital discharge and antiplatelet drugs usage of the patients were recorded.According to the medication compliance when the primary endpoint events occurred or at observing point.The relation between antiplatelet drug usage and clinical main endpoint events were analyzed.The primary endpoint events were defined as rupture or get larger more than 1 mm of the aneurysms were found when follow up.Use Propensity score matching Methods(PSM)to estimate the effect of aspirin on aneurysm rupture,and to compare the survival curve of aspirin group and non-aspirin group with propensity score matching sample by log-rank test.Results: 1)From January 2011 to December 2015,226 patients who met the inclusion criteria were admitted,5 of whom had a history of atrial fibrillation and took warfarin for a long time,2 patients died during hospitalization,11 patients were lost visit,and the remaining 207 patients were included in the study.The average age of the selected patients was 63.4 ± 12.5,of which female were 39.61%(n=82),male 60.39%(n=125).The average follow-up time was 31.84±20.78 months(12-91m),the median follow-up time was 22 months.2)157 Patients were given antiplatelet prescription when they were discharged from hospital.Follow-up study found 145 patients still insist on taking antiplatelet drugs(92.4%),62 Patients did not.3)Primary endpoint events occurred in six cases(2.90%).One patient died of ruptured aneurysm after 6M and one at 8M follow-up.One patient with bilateral CCA mild stenosis accompanied with basilar artery giant aneurysm died of ruptured aneurysm 29 m after discharged of the hospital.In 1 case,the size of aneurysm developed from 3.2 x3.0mm to 4.3 x 4.1mm during after 29 m follow-up.Two patients were followed up for 23 M and 28 M,respectively,and found aneurysm ruptured.Secondary endpoint events occurred in 4 patients,all of whom died from other causes during follow-up.4)Univariate analysis the risk elements of primary endpoint events,in which young age(<60y)and posterior circulation aneurysm was found related to the incidence of primary endpoint events(P < 0.05).5)After the PSM method,the survival curve showed that the duration of follow-up to primary endpoint events happened in aspirin group was longer than that in non-aspirin group,but there was no statistical significance.(2= 1.548,p=0.21).Conclusion: Antiplatelet aggregation drugs are an important means to prevent ischemic stroke in patients with cerebral vascular stenosis.For patients with stenosis and intracranial aneurysms,the rational use of antiplatelet aggregation drugs does not increase the risk of aneurysm rupture. |
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