| Hot spot and advancing front of cerebral vascular diseases are the diagnosis and therapy of extra-intracranial atherosclerosis at present. Despite the fact that there have made advanced progress on the study of etiology, genesis, pathological morphous, clinical manifestations, DSA imaging characteristics and intervention in extra-intracranial atherosclerosis, little is known about the atherosclerosis characteristics by DSA imaging , the relation between the atherosclerosis characteristics and clinical feature and their pathogenesis.DSA was examined in 1816 extra-intracranial atherosclerosis and intervention carried out in 92 extra-intracranial stenosis patients. DSA imaging characteristics and its relationships with clinical manifestation were studied. The regularity of complications peri-operation and monitoring of coagulation factors were further discussed.1. DSA imaging characteristics of extra-intracranial atherosclerosis1.1 Distribution of ground form in extra-intracranial atherosclerosisAmong 1816 patients with extra-intracranial atherosclerosis, the incidence of tortuosity was 59.3%, Kinking was 12.9%, coiling was 3.9%, stenosis was 23.9%. In the age group 60-74 years, the incidence of tortuosity, kinking, coiling and stenosis was highest among all the age groups. Compared with the age group 45-59 years, the incidence of tortuosity, kinking and stenosis was higher, and coiling was lower than in the over 75 year old age group .1.2 Characteristics of elongation in extra-intracranial atherosclerosisIn internal carotid arterial system, the incidence of tortuosity was 63.8%, kinking was 57.7%,coiling was 67.6%. The incidence of tortuosity in extracranial internal carotid artery was 49.9%,significantly higher than those of intracranial internal carotid artery , 29.5%. Compared with the right internal carotid artery, the incidence of tortuosity(left 41.8%, right 35.1% ) and kinking (left 51.1%, right 42.2%)were significantly higher than those of right internal carotid artery. In vertebral-basilar arterial system, the incidence of tortuosity was 47.6%, kinking was 59.4%,coiling was 33.8%. The incidence of tortuosity in extracranial vertebral-basilar artery was 57.7% , significantly higher than those of intracranial vertebral-basilar artery , 24.4%. The incidence of tortuosity (left 45.4%; right 35.7%), kinking (left 69.1%; right 25.9%), and coiling (left 70.8%; right 20.8%) of the left right vertebral artery were significantly higher than those of right vertebral artery.1.3 Characteristics of stenosis in extra-intracranial atherosclerosisIn internal carotid arterial system, the incidence of stenosis was as follows: low 50.2% ; intermediate 53.8%; and high 49.1%. Compared with the intracranial internal carotid artery, the extracranial internal carotid artery occurred more intermediate-grade stenosis (intracranial 17.2%; extracranial 75.0%), more high-grade stenosis (intracranial 16.9%; extracranial 77.4%). Compared with the right internal carotid artery, the left internal carotid artery occurred more intermediate stenosis (left 50.0%; right 40.6%). In vertebral-basilar arterial system, the incidence of stenosis was as follows: low 66.7%; intermediate 60.5%; and high 57.5%. Compared with the intracranial vertebral-basilar artery, the extracranial vertebral-basilar artery occurred more intermediate-grade stenosis (intracranial 11.1%; extracranial 86.1%), more high-grade stenosis (intracranial 16.1%; extracranial 82.2%). Compared with the right internal vertebral-basilar artery, the left vertebral-basilar artery occurred low-grade stenosis (left 54.3%; right 32.6%), more high-grade stenosis (left 53.2%; right 43.5%).2. Clinical manifestations of extra-intracranial atherosclerosis2.1 Clinical manifestations of elongation in extra-intracranial atherosclerosisWhen patients with TIA, in tortuosity group , DSA imagings with tortuosity in internal Carotid Arterial System(33.8%)were less than those in vertebral- basilar arterial system(55.9%),in kinking group , DSA imagings with kinking in internal Carotid Arterial System(34.1%)were significantly less than those in vertebral-basilar arterial system (57.6%). When patients with cerebral infarction, DSA imagings with tortuosity,kinking and coiling in internal Carotid Arterial System has significantly more than those in vertebral- basilar arterial system as follows: tortuosity group (internal carotid arterial system: 34.1%; vertebral-basilar arterial system:7.2%), kinking group (internal carotid arterial system: 40.0%; vertebral-basilar arterial system:7.2%), coiling group (internal carotid arterial system: 47.9%, vertebral-basilar arterial system: 16.7%).2.1 Clinical manifestations of stenosis in extra-intracranial atherosclerosisWhen patients with TIA, DSA imagings with low-grade stenosis and intermediate stenosis in internal carotid arterial system has significantly less than those in vertebral-basilar arterial system as follows: low-grade stenosis group (internal carotid arterial system: 32.7%; vertebral-basilar arterial system:49.3%), intermediate stenosis group (internal carotid arterial system: 37.5%; vertebral-basilar arterial system:48.6%).When patients with cerebral infarction, DSA imagings with stenosis in internal carotid arterial system has significantly more than those in vertebral-basilar arterial system as follows: intermediate stenosis group (internal carotid arterial system: 29.7%; vertebral-basilar arterial system: 11.1%), high-grade stenosis group (internal carotid arterial system: 35.8%; vertebral-basilar arterial system: 14.5%).3. Multivariate analysis of risk factors in extra-intracranial atherosclerosisThe OR for the presence of intracranial and extracranial atherosclerosis associated with age, hypertension and diabetes mellitus was separately 3.28(95%CI, 2.16 to 4.75), 3.17(95%CI, 2.12 to 4.69) and 2.82(95%CI, 1.96-3.87).4. Concentrations of inflammatory and hemostatic factors for pre-post intervention in extra-intracranial atherosclorosisHs-CRP,sICAM-1 and IL-6 were significantly different between experimental group and control group. Hs-CRP of the patients achieved the peak level of 6.19±0.52 mg/L within 48 hours. Hs-CRP,sICAM-1 and IL-6 elevated continuously at 1 week of post-operation.In summary, our study indicates that tortuosity and stenosis are the most common types of atherosclerosis characteristics. As to clinical manifestations, TIA and cerebral infarction are most common. There is an obvious relationships between atherosclerosis and aged, hypertension and diabetes mellitus. Hs-CRP,sICAM-1 and IL-6 were the most important inflammatory markers during the period of post-operation. |
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