Study On The Influencing Factors Of Early Cerebral Infarction Volume In Patients With Proximal Middle Cerebral Artery Stenosis Or Occlusion

Objectives:To investigate the effects of collateral circulation level,degree of middle cerebral artery stenosis,cerebrovascular disease risk factors,hematological markers,etc.on early cerebral infarct volume in patients with proximal middle cerebral artery stenosis or occlusion.Methods:This is a retrospective analysis of acute ischemic stroke patients with stenosis or occlusion of the proximal middle cerebral artery in our hospital from January 2018 to October 2020.Both the degree of MCA stenosis and collateral status were assessed by head CTA.The MCA was scored according to the NASCET method.There are four grades of mild,moderate,severe stenosis and occlusion.According to the Tan scoring system,the collateral status is divided into four grades of 0,1,2,and 3,as well as two groups of good compensation(2-3 points)and poor compensation(0-1 points).We use the NIHSS score to assess the severity of stroke,the patient was divided into three groups of mild(1-4 points),moderate(5-15 points),and severe(≥16 points).The brain DWI tomogram was reconstructed three-dimensionally by 3D Slicer software and the cerebral infarct volume was obtained.Use multiple linear regression to analyze the influencing factors of early cerebral infarct volume;compare the data difference between the good and the poor collateral status group to explore the influencing factors of the collateral circulation level;compare the difference of infarct volume and collateral status in different stroke severity groups.Results:A total of 86 patients were included in this study.Multiple linear regression analysis was used to establish a model of influencing factors of early cerebral infarction volume in patients with proximal middle cerebral artery stenosis or occlusion.The regression model is statistically significant,F(4,81)=10.688,P<0.001,R~2=0.345,Adjusting R~2=0.313,the results showed that LDL-c/TC%,BUA,collateral circulation grade,MCA stenosis were statistically significant(P<0.05).Among the 86 patients,there were 43 cases in the good collateral circulation group(group A),as well as 43 cases in the poor group(group B).The average cerebral infarct volume in group A was 12.384 cm~3and the average NIHSS score was 4.51points.The average cerebral infarction volume in group B was 35.844 cm~3and the average NIHSS score was 6.58 points.There were statistical differences in brain DWI infarct volume(P=0.004),NIHSS score(P=0.026),and degree of MCA stenosis(P<0.001)between the two groups.In group B,the NIHSS score was higher and cerebral infarction is larger.Comparing the age,gender,a history of smoking,ischemic heart disease,hypertension,diabetes,a history of TIA,a history of stroke,various hematological indicators and other data between the two groups of patients,there was no statistically significant difference(P>0.05).The degree of middle cerebral artery stenosis was included in the binary logistic regression analysis,and it was concluded that the degree of middle cerebral artery stenosis(P<0.001)was an independent influencing factor.Mild,moderate and severe middle cerebral artery stenosis had better collateral status than occlusion(OR=14,95%CI:[3.182,61.599],P<0.001;OR=3.6,95%CI:[1.129,11.478],P=0.030;OR=4.5,95%CI:[1.218,16.622],P=0.024).There were 53 cases,27 cases,and 6 cases in the mild,moderate and severe stroke severity group respectively,of which 33 cases(62.3%),8cases(29.6%),and 2 cases(33.3%)with good collateral circulation correspondingly.There was a statistical difference in the collateral circulation compensation between the three groups(P=0.014).The mild group had the highest rate of good collateral circulation compensation(62.3%).Compared with the moderate to severe group,there was a statistical difference(P=0.011).In the three groups of patients with different stroke severity,the average ln(early cerebral infarction volume)of the patients in the well-compensated collateral circulation group was smaller than that in the poorly compensated group,but only the moderate MCA stenosis group had a statistical difference(P=0.035);The severity of stroke is positively correlated with ln(early cerebral infarction volume)(B=0.362,P=0.001).Conclusions:Collateral status,the degree of middle cerebral artery stenosis,blood uric acid,and the percentage of low-density lipoprotein cholesterol in total cholesterol are independent influencing factors of early cerebral infarction volume in patients with proximal middle cerebral artery stenosis or occlusion.The degree of middle cerebral artery stenosis affects the level of collateral circulation.Patients with poor collateral circulation have a higher NIHSS score on admission,the more severe the stroke,and the larger the volume of early cerebral infarction.