Extracranial Intracranial Artery Atherosclerotic Stenosis And Occlusion Characteristics And Risk Factors

Objective:To evaluate the stenosis degree, location and clinical character of multi-slice CT angiography(MSCTA) to diagnosis intracranial and extracranial atherosclerotic stenosis and occlusion to guide clinical treatment.To found the character,position and quantity of plaque formation through MSCTA and doppler ultrasound diagnostic equipment, to approach the risk factors effect with atheromatous plaque and cerebral infarction.Materials and Methods:112 patients underwent MSCTA and doppler ultrasound diagnosis for suspected atherosclerotic stenosis with cerebral ischemia.Part of them have function lose from Oct.2009 to Jun.2010.There are 60 male and 52 female,the everage age is 54.8year. To divide patients to cerebral infarction group(72example) and negative group(40example) according to the MRI. Each divided into intracranial atherosclerotic stenosis group, extracranial atherosclerotic stenosis group, mixed atherosclerotic stenosis group and no stenosis group.All of tnem have MRI and doppler ultrasound examine before 24 hours,also have MSCTA examine before 72 hours. Two docters record the results of aloe use double blind methods to approach the existence of artery stenosis or occlusion,the location of pathological changes and stenosis degree,record the character,position and quantity of plaque formation through MSCTA and doppler ultrasound diagnostic equipment, to approach the plaque condition,to evaluate the risk factors of single and multiple plaques.Results:1.There are 95 patients founded artery stenosis of the total 112 patients,73.7% patients with artery stenosis become cerebral infarction,25.9% patients with artery stenosis have no cerebral infarction.The highest cerebral infarction incidence is 25.0% from the both intracranial and extracranial atherosclerotic stenosis group.2.The most common location of atherosclerotic stenosis is common cartid artery bifurcation(22.5%), internal carotid extracranial parts(21.9),middle cerebral artery(13.8%).There is apparente statistical significance between infarction group and non-infarction group.The distribution is consistent with the plaque.3.The highest iccidence of artery stenosis is the moderate group of 356 branchs(22.7%) from 921 branchs,the cerebral infarction iccident of severe stenosis group is 90.1%(229/254) which is the highest.4.The cerebral infarction group and uninfarction group have statistical significance with stenosis incidence rate in soft and calcification plaque group(p<0.01).The cerebral infarction incidence of soft plaque group is 93.5%.mixed plaque 87.5% and calcification plaque 73.2% become cerebral infarction.5.There has consistency between neck vascular ultrasound and CTA check.The positive rate of soft plaque with neck vascular ultrasound higher than CTA group,the positive rate of calcification plaque higher than neck vascular ultrasound group.6.From CTA examine there is 90 patients with plaque from 112 patients,among them there is 33 patients with single plaque(26.2%), multiple plaque 57 patients(63.8%).The incidence of cerebral infarction have conspicuous statistical significance between single plaque and multiple plaque groups (p<0.05).Two groups have conspicuous statistical significance of hyperlipidemia (p<0.01),diabetes and (more than 75 years old)group (p<0.05).The OR value of the hyperlipidemia, diabetes and (age>75)group is 4.484,3.179and 1.808. The incidence of soft plaque of hyperlipidemia group(50.7%) is higher than the other groups.7.In our group there are 18 example patients have DSA examine,among them 9 patients have intervention braces treatment and 1 patient has pass-by treatment.The stenosis partments were found obviously coincidenc through MSCTA and DSA(100%).The clinical symptoms have improved after threatment.Conclusion:1.Intracranial and extracranial atherosclerotic stenosis or occlusion is an important risk factor.73.7% of them become cerebral infarction.The high highest-level cerebral infarction incidence rate group is both intracranial and extracranial arterial stenosis group(25.0%).2.The most common location of atherosclerotic stenosis is common cartid artery bifurcation(22.5%), internal carotid extracranial parts(21.9),middle cerebral artery(13.8%),carotid arter trunk,(12.1%),Intracranial internal carotid artery(10.2%),intracranial vertebral artery(9.2%),proximal basilar artery (7.2%) and distal basilar artery (3.0%).3.It is easy to occur cerebral infarction of soft and ulcer plaque.The probability of calicific plaque is on the small side. The sensitivity of soft plaque neck vascular ultrasound is higher than CTA,the sensitivity of calcification plaque CTA is higher than the neck vascular ultrasound.4.The cerebral infarction incidence rate of multiple plaque is higher than single plaque.The patient with more than two plaque with other risk factor (hyperlipoidemia, diabetes, more than 75 years old) is most sensitivitive to come to cerebral infarction.The correlation of hyperlipoidemia and multiple plaque is biggest,and easy to become soft plaque.5.We must to roundly take MSCTA,type-B ultrasonic,TCD examines to find out the stenosis or occlusion situlation of the patient.At the same time we have to know the collateral circulation and compensation and exercise due diligence.