Study On The Related Factors And Collateral Circulation Compensation Of Acute And Chronic Middle Cerebral Artery Occlusion

Objective:In this study,acute middle cerebral artery occlusion and chronic middle cerebral artery occlusion were taken as the control group,and the basic clinical data,especially imaging information,of the corresponding patients were collected and analyzed.to explore the relevant factors affecting the mode of macrovascular occlusion and the severity of the disease.Comparative analysis of collateral compensation of anterior cerebral artery and posterior cerebral artery in different occlusion modes;At the same time,combined with cranial CT perfusion imaging,the main blood supply branches of PCA in patients with compensated and decompensated cerebral ischemia were analyzed.Method:The patients who were treated in our Hospital from January 2021 to December2022 were confirmed as proximal middle cerebral artery occlusion(M1 segment)by clinical and imaging examination.The sex,age,smoking,drinking history,hypertension,diabetes,various biochemical indexes(TG,TC,HDL,LDL),homocysteine,NIHSS score before and after treatment,ACA lateral compensation and PCA lateral compensation,CTP cerebral ischemic compensation and the corresponding PCA branch vascular bias were collected in detail.SPSS22.0 software was selected for statistical analysis,and univariate chi-square test,nonparametric rank sum test and independent sample T test were used for univariate analysis.The related factors affecting the mode of macrovascular occlusion and the severity of the disease,and the main ways and ways of compensation after acute and chronic MCA occlusion were compared and analyzed.Results:(1)A total of 223 patients were diagnosed with unilateral middle cerebral artery occlusion(M1 segment occlusion)by imaging examination(MRA or CTA or DSA).There were 95 patients with acute middle cerebral artery occlusion and 128 patients with chronic middle cerebral artery occlusion.There was no significant difference in sex,age,location of MCA occlusion and number of aneurysms between the two groups(P > 0.05);There was no significant difference in diabetes mellitus,hypertension,smoking history,hyperhomocysteinemia,TG,TC,HDL and LDL levels.The probability of alcoholism history in AMCAO group was significantly higher than that in CMCAO group.(2)In AMCAO group,the scores of ACA and PCA collateral circulation were statistically significant,and the scores of PCA collateral circulation were concentrated in 3-4 points,which played a major compensatory role.There was significant difference in the scores of ACA and PCA collateral circulation in CMCAO group.The average open water of collateral circulation in ACA and PCA was higher,mainly compensated by ACA.Compared between the two groups,CMCAO group had a better level of ACA compensation,while PCA compensation had more advantages in AMCAO group.There was significant difference between the two groups.(3)The proportion of inferior temporal artery bias in the PCA branch of the compensated group was much higher than that of the decompensated group,and there was significant difference between the two groups(P < 0.05).There was no significant difference in the bias of parietal occipital artery and taloid sulcus artery between the two groups(P > 0.05).Conclusion:The proportion of alcoholic patients with acute MCA occlusion was higher than that of chronic MCA occlusion.PCA collateral circulation compensation plays a major role in acute middle cerebral artery occlusion,while ACA collateral circulation compensation plays a major role in chronic middle cerebral artery occlusion.The proportion of inferior temporal artery bias of PCA branch in cerebral ischemia compensation group was much higher than that in decompensation group.The leptomeningeal anastomosis branch formed by PCA inferior temporal artery branch and MCA temporal branch played a main compensatory role in MCA occlusion.