| Objective:To explore the effectiveness,safety and appropriate surgical opportunity of intravascular treatment of intracranial atherosclerotic severe stenosis cerebral infarction in non acute phase,and the correlation between the location of severe stenosis and TCM syndrome types indicated by the results of whole brain angiography,so as to provide more objective reference and theoretical basis for the treatment of intracranial atherosclerotic stenosis with integrated traditional Chinese and western medicine.Methods:Study 1:collected the clinical data of 60 patients with non acute cerebral infarction diagnosed as intracranial Atherosclerosis who were hospitalized in Hunan Provincial Brain Hospital(the Second People’s Hospital of Hunan Province)from September 2020 to September 2022.All patients were responsible for more than 70%of Stenosis.According to different treatment schemes,the patients were randomly divided into two groups,30 people in each group,One group received routine non acute cerebral infarction medical treatment(medication group),and the other group received intravascular therapy combined with medication treatment(intravascular therapy group).Record the general information of the patients,the National Institute of Health Stroke Scale(NIHSS)and Modified Rankin Scale(mRS)scores of both groups of patients from pre-treatment to 6-month follow-up,and the incidence of adverse events(stroke,TIA(transient ischemic attack),and death)during hospitalization for both groups of patients;Record the surgical success rate and vascular recanalization rate of the endovascular treatment group,and conduct statistical analysis of the results.Study 2:All patients with cerebral infarction in study 1 were classified into five syndrome types according to the standard of TCM syndrome differentiation in the fifth edition of Internal medicine of Traditional Chinese Medicine,including wind phlegm entering the collateral,wind phlegm stagnating,phlegm turbid stagnating,wind yang hyperactivity,yin deficiency and wind movement.According to the results of whole brain angiography,the location of severe intracranial vascular stenosis was divided into anterior and posterior circulation blood supply areas,and finally the correlation between the TCM syndrome types of stroke caused by severe intracranial artery stenosis and the location of Stenosis was analyzed.Results:Study 1:1.The study found that there was no significant difference in general information such as gender,age,and cerebrovascular risk factors between the two groups of patients,and they were comparable(P>0.05);2.Endovascular treatment was performed on 32 stenoses in 30 patients,and the success rate of the surgery reached 100%.All patients with stenotic blood vessels restored blood flow and improved blood perfusion.3.Both treatment plans can alleviate patient symptoms,and the vascular treatment group has better improvement in neurological function than the drug group.At discharge,the total effective rate of symptom improvement in the endovascular treatment group was 83.3%,while in the drug group it was 80%;A 6-month follow-up found that the NIHSS score of patients in the endovascular treatment group decreased from 3.41 ± 4.71 points at admission to 1.83 ±3.323 points,while the NIHSS score of patients in the drug group decreased from 4.03 ± 4.909 points at admission to 2.41±5.943 points.4.After a 6-month follow-up,the mRS score of the endovascular treatment group decreased from 1.59 ± 1.367 points at admission to 0.69 ± 1.137 points,while the average mRS score of the drug group decreased from 1.93 ± 1.639 points at admission to 0.80 ± 1.157 points.After endovascular treatment,the patient’s neurological function improved and disability decreased.5.There was one case(3.3%)of perioperative adverse events in the endovascular treatment group,which was manifested as Subarachnoid hemorrhage.During the treatment period,there were 3 cases(10%)of adverse events in the medication group,including 2 cases of stroke(6.7%),1 case of acute cerebral infarction combined with bleeding(3.3%),and 0 death.During the follow-up period,neither group experienced recurrent stroke,TIA,or death.Study 2:1.Among the 60 patients,33(55%)had vascular stenosis located in the anterior circulation and 45%(45%)in the posterior circulation.Among the traditional Chinese medicine syndrome types of all patients,38(63.3%)had the most common wind phlegm disturbance syndrome,followed by 8(12.9%)cases of yin deficiency and wind movement syndrome,6(10%)cases of wind phlegm obstruction syndrome,5(8.3%)cases of wind yang hyperactivity syndrome,and 3(5%)cases of phlegm turbidity stasis syndrome.2.In patients with severe intracranial atherosclerotic stenosis cerebral infarction,the distribution of some TCM syndromes has a certain correlation with the location of vascular stenosis.Among them,the wind phlegm stasis type is more common in the anterior circulation,the yin deficiency and wind movement type is more common in the posterior circulation,and the other syndromes have no obvious correlation with the location of vascular stenosis.Conclusion:1.Intravascular treatment of non acute cerebral infarction with severe stenosis caused by intracranial atherosclerosis is safe and effective.Intravascular treatment 14 days after the onset of acute ischemic cerebral infarction is highly feasible,which can reduce the medium-term recurrence rate and disability rate of stroke.2.There is a correlation between the location of vascular stenosis in patients with severe intracranial artery stenosis and some traditional Chinese medicine syndrome types. |
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