| Objective:To explore the possible mechanism and risk factors of progressive ischemic stroke(PIS),we studied the progressing-group and non-progressing group by comparing the characteristics of carotid artery atherosclerosis plaque, degree of carotid stenosis, demographic factors and relevant factors with the aims of giving some guidance to clinical treatment, early prediction and selecting efficiently intervention, then to reduce the incidence of PIS.Methods: 197 patients with stroke oneset less than 24 hours enrolled to the department of neurology of the hospital from October 2009 to July 2010. All of the patients were examed with carotid artery color Doppler ultrasonography and CT/MRI. Part One: The patients with reference to the U.S. National Institutes of Health Stroke Scale (NIHSS) score standards and changes in condition were divided into progressing group and non-progressing group. The examiners without cardiovascular and cerebrovascular disease to be selected as the control group at the same time. The progressing group, non-progressing group and control group were compared with characteristics of carotid plaque, carotid artery stenosis and plasma Hcy levels and plasma hs-CRP levels and risk factors. Part Two: The patients were divided into atherosclerosis plaque group and non-atherosclerosis plaque group, and then atherosclerosis plaque group were divided into stable plaque group and instable plaque group, in order to analysis of the risk factors of carotid artery atherosclerosis plaque stability.Results:1,197 cases of ischemic stroke patients, there were 57 cases of progressive ischemic stroke. The overall incidence was 28.93%. 2,The rate of carotid artery plaque in the progressing group was 82.46% (47/57), in which the incidence of unstable plaque was 59.65% (34/57), the rate of carotid artery plaque in the non-progressing group was 61.43% (86/140), in which the incidence of unstable plaque was 11.43% (16/140), the control group was 6.67%(2/30). The characteristics of plaque between the three groups was significant (P<0.01).The rate of severe carotid artery stenosis in the progressing group(56.14%, 32/57) was higher than that in the non-progressing group (31.43%, 44/140) and the control group (0) (P <0.01).3,The rate of moderate to severe carotid stenosis combined unstable plaques in the progressing group (58.49%, 31/53) was higher than that in the non-progressing group (18.37%, 18/98) (P <0.01),the rate of progressive stroke patients with moderate to severe carotid stenosis combined unstable plaques (58.49%, 31/53) than that with mild carotid stenosis combined unstable plaques (0).4,Progressing group, non-progressing group and the control group, the incidence of hypertension, diabetes history in progression group was higher than that in the non-progression group and the control group (P<0.05). The blood lipid, plasma Hcy levels and plasma hs-CRP levels in the progressing group were higher than that in the non-progressing group and the control group (P<0.05).5,The 197 cases of ischemic stroke patients were divided into atherosclerosis plaque group and non-atherosclerosis plaque group, the incidence of hypertension and diabetes in the atherosclerosis plaque group were higher than that in the non-atherosclerosis plaque group (P<0.05). The age, total cholesterol, plasma Hcy levels and plasma hs-CRP levels in the atherosclerosis plaque group were higher than that in the non-atherosclerosis plaque group (P<0.05).6,According to the results of univariate analysis, put the significant factors into binary logistic regression analysis,the formation of plaque primarily correlates with carotid plaque and age, the main plasma hs-CRP levels.7,Based the characteristics of plaque, the atherosclerosis plaque group was divided into stable and unstable plaque group. The incidence of hypertension in the unstable plaque group was higher than that in the stable plaque group (P<0.05), the plasma Hcy levels and plasma hs-CRP levels in the unstable plaque group was higher than that in the stable plaque group (P<0.05). 8,According to the results of univariate analysis, put the significant factors into binary logistic regression analysis, the stability of carotid plaque mainly related to plasma hs-CRP level.Conclusion:1,The incidence of carotid artery atherosclerosis plaque was higher in the progressing group, and instable plaque was the main type of plaque in the progressing group. The ischemic stroke patients with moderate to severe carotid stenosis combined unstable plaques were easily worse.2,The levels of plasma hs-CRP and plasma Hcy are in relation with formation and stability of carotid artery atherosclerosis plaque.3,Exacerbation of acute ischemic stroke, one of the mechanisms is ischemic hypoperfusion, decreased ability to remove emboli, and plaque instability caused by cerebral embolism. Hypertension, diabetes mellitus, plasma hs-CRP levels and plasma Hcy levels were risk factors for PIS.
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