| Objective:The purpose of brain atherosclerotic stenosis of ischemic stroke is an important pathogenic factor in carotid artery stenosis> 70% of the patients, the annual stroke rate was as high as 13%. Active treatment of cerebral artery stroke to reduce mortality and disability are important. At present, the main means of commonly used treatment, including stent implantation and drug therapy alone, according to the characteristics of patients with lesions to choose their own appropriate forms of treatment is becoming the focus of attention. The purpose of this study was to explore the brain carotid atherosclerotic stenosis morphology of vascular factors and cerebral infarction, and stent-assisted angioplasty for treatment and drug efficacy and safety of comparative research, to provide a basis for clinical treatment.Methods:From April 2004 to April 2008, I have completed the entire Section 428 cases of cerebral angiography. Which the internal carotid artery system, 260 cases of stenosis of lesions (60.7%), vertebrobasilar system, 224 cases of stenosis of lesions (52.3%), while 56 cases involved (13.1%). The first part of this study for which a simple system of internal carotid artery stenosis> 30% of the patients, a total of 180 cases. According to the results of imaging, there will be likely to cause cerebral infarction and cerebral vascular shape factors were analyzed and found that the Department of the deep perforating branches of open lesions, severe stenosis, and unstable plaque lesions, and eccentric lesions, a narrow distal perfusion abnormalities, such as the five factors on the cerebral infarction were significantly affected, suggesting that cerebral infarction may be the contributing factor.Results:According to the first part of the results of a study by cerebral angiography proved to be a simple system of internal carotid artery stenosis> 30% of patients with 180 cases, which meet the standards of 160 cases selected into the second part of study patients.Sexual division of intent to take, including 58 cases of stent-assisted angioplasty for patients, as surgery group, 50 cases of patients receiving probucol therapy, as probucol treatment group, 50 cases of other patients because of economic reasons stenting failed to trip operation, nor the use of probucol and other lipid-lowering drugs, only to receive conventional drug treatment, we also carried out follow-up, as the control group. Monitoring system, three sets of carotid hemodynamic changes and to observe the 30 days after treatment, 12 months, the incidence of vascular events, stroke and death in severe cases to the end.A total of 58 cases of 66 patients had lesions CCAS stenting, in which a stent placed in 53 patients, two stents in 5 patients. 32 extracranial carotid artery disease in 12 non-expansion, 20 pre-expansion, 3 for expansion of the latter. Intracranial lesions of the use of balloon-expandable stent, a shape in general, not to pre-expansion (Wingspan, except self-expanding stent). Filter protection devices were used in 31 cases, 13 cases of postoperative emboli filter with debris visible to the naked eye. Restenosis rate from an average preoperative to 79.6±10.5% after an average of 12.8±10.1% (p <0.01), vessel diameter changes before and after surgery significantly (2.18±1.25mm, 3.9±0.3mm, p <0.01). Within 30 days after treatment, vascular surgery group events (including TIA, stroke, myocardial infarction, vascular causes of death) 2 cases (2 / 58), in which place of the small fry in the same side, ipsilateral major stroke in 1 case, no TIA and fatal occurrence of stroke and death. Vascular events occurred in the control group a total of 9 cases (9 / 52), including the following: ipsilateral TIA2 cases, the performance of a physical inability to have sex, clinical examination of brain CT made no new infarct, ipsilateral in place of the small fry, ipsilateral major stroke all three cases (of which 1 patient died of myocardial infarction), fatal stroke and death in 1 case. Group of vascular surgery the incidence (3.4%) lower than the control group (17.3%), with statistically significant differences (P<0.05). Probucol treatment group occurred in 10 cases of vascular events, in which case TIA2 ipsilateral, ipsilateral and the place of the small fry in the three cases of stroke, fatal stroke and 1 died, Probucol treatment group the total incidence of vascular events of 20.0% compared with the control group There was no significant difference. Group of vascular surgery the incidence (3.4%) lower than probucol treatment group (20.0%), the difference was statistically significant. 12 months after treatment, the surgery group occurred in a total of eight cases of vascular events (13.6%), including the following: ipsilateral TIA2 cases, two cases of ipsilateral stroke, non-three cases of ipsilateral stroke, fatal stroke and death in 1 case. The control group a total of 19 cases of vascular events (38.0%), including the following: ipsilateral TIA 8 cases, 5 cases of ipsilateral stroke, non-three cases of ipsilateral stroke, three cases of fatal stroke. The two groups overall incidence of vascular events significantly different (13.6% vs 38.0%, P <0.05). Probucol treatment group a total of 9 cases of vascular events, including the following: ipsilateral TIA, ipsilateral stroke, non-three cases of ipsilateral stroke each, compared with the control group were statistically significant differences in surgical treatment group and the probucol group of The incidence of vascular events compared with no statistical difference.Operation-related complications occurred in 35 cases, including over-reperfusion syndrome, acute thrombosis, vascular rupture, one had cerebral vasospasm, carotid sinus response, such as hematoma puncture point. One of the prognosis of patients with a significant adverse impact on three cases of major complications were caused by over-perfusion one cases of intracranial hemorrhage, brain blood vessel rupture, 1 case of acute stent thrombosis in 1 case. A total of 32 cases of secondary complications: response to carotid sinus in 23 cases, five cases of cerebral vasospasm, 3 cases of hematoma puncture point, one cases of femoral artery dissection, but were quickly improved the prognosis of patients with no significant impact. Total incidence of major complications of 5.4%.Conclusions:CCAS of the form factors of vascular disease, as well as 160 cases of surgical treatment of lesions CCAS and drug treatment effect analysis, we draw the following conclusions: with cerebral vascular patterns associated factors include the following: Near the deep perforating branches of the Department of openings lesions, severe stenosis and unstable plaque lesions, eccentric lesions, distal perfusion abnormalities such as stenosis; stenting can be reduced in the short term incidence of stroke, security acceptable; follow-up of 12 months, although probucol treatment can reduce the vascular events, but stenting compared with no significant difference.
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