| Objective:To investigate the characteristics of etiology factors in Chinese patients with ischemia cerebrovascular disease by digital subtraction angiography. We focused on the incidence rate,distribution ,degree of cervicocranial artery stenosis or occlusion and the patterns of collateral circulation.Methods: A retrospective analysis was conducted of a total of 304 patients with ischemia cerebrovascular disease who had full clinical data in our department from 2004 to 2005.The patients were divided into TIA group(188 patients) and cerebral infarction group(116 patients).All patients were examined by standard cerebral digital subtraction angiography,and the photos were carefully taken.Experienced professors read the photos and identified whether there was cervicocranial artery stenosis.If the stenosis or occlusion was found, the location ,degree ,lengh of the stenosis or occlusion and the patterns of collateral circulation would be analyzed.Results:The DSA results were positive in 227 cases(74.7%),and negative in 77 cases(25.3%).There were 130 positive cases(68.8%) in TIA group and 97 positive cases(82.9%) in cerebral infarction group. The incidence rate of cervicocranial artery stenosis or occlusion in cerebral infarction group was higher than that in the TIA group(P<0.01).Among the 423 lesions(stenoses or occlusions) which were found in the 227 cases,254 lesions(60.0%) occurred in the extracranial arteries and 169 lesions(40.0%) in the intracranial arteries.The stenoses or occlutions were most frequently found at the origin of ICA(35.9%),MCA(15.8%) and the origin of VA(15.9%). There was significant statistic difference in the distribution of cervicocranial artery stenosis or occlusion between TIA group and cerebral infarction group(P<0.01).The occurrence of extracranial or anterior circulation arterial lesions was more frequent in TIA group than that in another group. The occurrence of intracranial or anterior-posterior circulation arterial lesions was more frequent in cerebral infarction group than that inTIA group.We found 102 mild stenoses (42.7%),81 moderate stenoses(33.8%),36 severe stennoses(15.1%) and 20 occlutions( 8.4%) in TIA group.68 mild stenoses(37.0%),37 moderate stenoses(20.1%),35 severe stennoses(19.0%) and 44 occlutions( 23.9%) were found in cerebral infarction group. There was statistic difference in severity of artery stenosis between TIA group and cerebral infarction group(P<0.01).In the 227 positive cases we can identifiy 193 guilty artery,including 104 extracranial artery(53.9%),70 intracranial artery(36.3%) and 19 both intra-and extracranial artery(9.8%).The guilty arteries were most frequently identified as the origin of ICA (34.0%),MCA(23.6%) and the origin of VA(11.3%).There was statistic difference in the distribution of guilty arteries between TIA group and cerebral infarction group when each group was devided into six parts(P<0.05). The occurrence of extracranial posterior circulation guilty arteries was more frequent in TIA group than in another group. The occurrence of intracranial anterior circulation guilty arteries was more frequent in cerebral infarction group than in TIA group.The mean length of guilty artery stenoses was 12.46 ±8.10mm in TIA group,which was 12.43 +6.97mm in cerebral infarction group. There was no statistic difference between them. We found 33 mild stenoses (30.8%),30 moderate stenoses(28.0%),25 severe stennoses(23.4%) and 19 occlutions(17.8%) in the guilty arteries of TIA group.26 mild stenoses(30.2%),15 moderate stenoses(17.4%),20 severe stennoses(23.3%) and 25 occlutions( 29.1%) were found in the guilty arteries of cerebral infarction group. There was no statistic difference in severity of guilty artery stenosis between TIA group and cerebral infarction group(P>0.05).Removed the stenoses or occlutions which can lead to the same collateral circulation,we focused on the rest 298 lesions.Among these cases, 146 collateral pathways were identified by angiography:57(39.0%) through the ACoA,23(15.8%) through the PCoA,54(37.0%)through leptomeningeal pathways, 8 (5.5%) through the intracranial- intracranial pathway and 4(2.7%) through the intracranial- extracranial pathway. 37 lesions (18.3%) led to collateral circulation in the 202 mild and moderate stenoses,and 68 lesions (18.3%) did it in the 96 severe stenoses and occlutions. Theoccurrence of collateral circulation was more frequent in cases with severe stenoses and occlutions than in cases with mild and moderate stenoses (P<0.01). Conclusion: The incidence rate of cervicocranial artery stenosis or occlusion in the patients with cerebral infarction is higher than in the patients with TIA. The occurrence of extracranial arterial stenosis is more frequent than that of intracranial artery in patients with ischemia cerebrovascular disease in our study. The stenoses or occlutions are most frequently found at the origin of ICA,MCA and the origin of VA. In patients with TIA,there are more extracranial or anterior circulation arterial lesions. In patients with cerebral infarction,there are more intracranial or anterior-posterior circulation arterial lesions. The severity of artery stenoses in patients with cerebral infarction is more significant than that in patients with TIA. The occurrence of extracranial guilty artery is more frequent than that of intracranial guilty artery in patients with ischemia cerebrovascular disease in our study. The guilty arteries are most frequently identified as the origin of ICA ,MCA, and the origin of VA. In patients with TIA,there are more extracranial posterior circulation guilty arteries. In patients with cerebral infarction,there are more intracranial anterior circulation guilty arteries. There is no significant relationship between the symptom of patients with ischemia cerebrovascular disease and the severity or length of guilty artery stenosis.The circle of Willis and leptomeningeal pathway are the most frequent collaterals identified by angiography. More severe stenoses lead to more collateral circulations.
|
PDF Full Text Request