High-frequency Ultrasound In Evaluating On Artery Plaques And Vascular Endothelial Function From The Patients With Atherosclerotic Cerebral Infarction Intervened By Fluvastatin

BackgroundsCerebral vascular diseases have been listed as one of ten most common diseases by World Health Organization (WHO) in the 21st century. In China, the prevalence of cerebrovascular disease ranks No. 3, in which ischemic cerebrovascular disease (cerebral infarction) accounts for about 80%. According to clinical and pathological examination, cerebral infarctions were divided into five categories including atherosclerotic cerebral infarction (ATCI), cardiogenic cerebral infarction (CCI), lacunar cerebral infarction (LCI), other determined etiologies and unknown reasons of cerebral infarction. Pathological basis of ATCI, which is characterized by high morbidity, high disability and high mortality, is atherosclerosis. Therefore, it's very important to early detect atherosclerotic lesions, and timely and effectively prevent it in the first and second level.Although angiography, 64-slice CT scan has been used to detect arterial diseases, those methods are not routine ones because of invasive, expensive and some severe complications. Peripheral arterial atherosclerosis can reflect the atherosclerosis and its severity to some extent, therefore, vessel wall morphology and elasticity of peripheral arteries can predict arterial diseases.In recent years, pathology has confirmed inflammation run through the formation and development of the atherosclerosis. The main mechanism of ATCI is acute thrombosis induced by vulnerable plaque rupture which is caused by inflammation. Inflammatory markers from vulnerable plaque including hs-CRP, adhesion molecules (ICAM-1, VCAM-1) etc. have been used to evaluate ATCI.Vascular endothelial, a dynamic organ, can inhibit blood coagulation and leukocyte adhesion to maintain blood flow through various mechanisms. The key steps in the formation of atherosclerosis include monocytes engulfing foam cells, adhering to the activated endothelium and invading subendothelial layer, which of the process was mediated by ICAM-1, VCAM-1.Studies have shown that fluvastatin significantly reduce level of high-density cholesterol and stabilize the atherosclerotic plaque.ObjectivesTo determine the effect of fluvastatin on stabilizing inflammatory vulnerable plaques through inhibiting ICAM-1, VCAM-1 before and after having been treated by fluvastatin in the patients with ATCI. Meanwhile, endothelial function and arterial plaque were studied by high frequency ultrasound in the patients with ATCI before and after having been treated by fluvastatin to clarify high-frequency ultrasound in evaluating on carotid and ophthalmic artery plaques from the patients with ATCI intervened by fluvastatin.MethodsSixty-eight patients with ATCI were divided into two groups, conventional treatment group and fluvastatin treatment group, and 30 healthy men were chosen as controls.The following indexes were detected twice in all patients when they were 2nd day in the hospital and after 3 months.①Carotid artery ultrasound, ophthalmic artery ultrasound (the number of stable and vulnerable plaque; plaque index; arterial intima - media thickness, IMT; systolic peak velocity, PSV; end diastolic velocity, EDV; resistance index, RI and pulsatility index, PI)②Lipids (total cholesterol, TC; triglyceride, TG; low density lipoprotein cholesterol, LDL-c; high-density lipoprotein cholesterol, HDL-c)③Content, mRNA and protein expression of soluble intercellular adhesion molecule -1 (sICAM-1), soluble vascular cell adhesion molecule -1 (sVCAM-1);④Head CT / MRI;⑤Neurological deficit score (NDS). In addition, the normal control group were also detected the same indexes except for NDS. General conditions (blood pressure, blood sugar) were assessed in all of patients with ATCI when they were in the hospital, and some of drugs improving circulation, nervous protection were given in all of patients with ATCI.Results1. Comparison of carotid artery plaque:①Number of total, stable and unstable carotid artery plaques were no difference between two groups of ATCI before treatment (P>0.05). Number of total and unstable carotid artery plaques decreased, number of stable plaques increased, there were significant differences in above index between two groups of ATCI after 3 month treatment (P<0.01).②Plaque index and IMT were no difference between two groups of ATCI before treatment (P> 0.05). There were significant differences in plaque and IMT between two groups of ATCI after 3 month treatment (P<0.01).2. Hemodynamic parameters in carotid artery and ophthalmic artery by ultrasonic exam: There were no significant difference in PSV, EDV, RI and PI between two groups of ATCI before treatment (P>0.05). But PSV and EDV increased, RI and PI decreased in the patients with ATCI after treatment, especially in the patients intervened by fluvastatin, there were significant differences in above index between two groups of ATCI (P<0.01).3. Lipids: There were no significant difference in TC, TG, HDL-c and LDL-c between two groups of ATCI before treatment (P>0.05). Concentrations of TC, TG and LDL-c decreased, and concentration of HDL-c increased in the patients with ATCI after treatment, especially in the patients intervened by fluvastatin, there were significant differences in above index between two groups of ATCI (P<0.0l).4. Contents, mRNA and protein expressions of sICAM-1 and sVCAM-1: There were no significant difference in all of indexes between two groups of ATCI before treatment (P>0.05). Contents, mRNA and protein expressions of sICAM-1 and sVCAM-1 decreased after treatment, especially in the patients intervened by fluvastatin, there were significant differences between two groups of ATCI (P<0.01). Among large, medium and small lesions in the patients with ATCI treated by fluvastatin, sICAM-1 and sVCAM-1 levels were significantly different (P<0.01).5. Drug efficacy: There were no significant difference in NDS between two groups of ATCI before treatment (P>0.05). NDS decreased after treatment, especially in the patients intervened by fluvastatin, there were significant differences between two groups of ATCI (P<0.01).6. Drug adverse reactions: All the patients in the observation period had no significant changes in blood, urine, liver and kidney function and muscle enzymes (P > 0.05); no patient has drug allergy, gastrointestinal reactions, coagulation mechanism damage and other adverse reactions, neither has rhabdomyolysis.ConclusionsFluvastatin plays an active role in the treatment of ATCI through stabilizing the plaque, improving compliance and flexibility of atherosclerotic blood vessels, reducing concentration of LDL-c and protecting function of vascular endothelial. Carotid artery and ophthalmic artery ultrasonography play an important role in both the evaluation of drugs on vascular function and the diagnosis of ATCI.