| Stroke is a main origin of morbidity and mortality in China. Survivors of a stroke ortransient ischemic attack (TIA)represent a population at increased risk of subsequent stroke.The exact prevalence of TIA is hard to investigate because a great proportion ofpatients who have a TIA missing to report it to a healthcare provider. Approximately2million strokes that happen every year are new ischemic events. In accordance with theresults of clinical trials and the epidemiological data defining the determinants of recurrentstroke, it is probable to originate evidence-based recommendations to decrease stroke risk.Remarkablely, a lot of the subsistent data stem from studies with restrained numbers ofwomen, diverse ethnic, and older adults groups, and another research is needed todemonstrate the generalizability of the published findings.Cerebral arterial stenosis is a significant pathological mechanism leading to ischemiccerebrovascular disease. Intracranial atherosclerotic stenosis (IAS) is a major origin ofoccurrence and recurrence of ischemic stroke and TIA。Patients with atheroscleroticstenoses of cerebral artery have significant morbidity and mortality rates. The incidence of stroke is different in ethnic and country,and it is much lower inEuropeans and Americans than in asians. The Warfarin and Aspirin for SymptomaticIntracranial Atherosclerotic Disease (WASID) trial showed that patients with symptomaticintracranial arterial stenosis (ICAS)>70%are at significantly high risk of recurrent strokeat the time of being on medical therapy[1]. Even though with optimal medical management,the recurrent incidence still reachs up to10%to24%[1].The rate of recurrent incidence isabout10%to50%[1].With recent advancement of endovascular technology, Stenting is a technique whichhas been applied in cerebrovascular diseases treatment, particularly for ischemiccerebrovascular diseases. However,there were limited data on long-term outcome after thisaggressive therapy. According to the pathogenesis of ischemic stroke and TIA, intracranialstent-assisted angioplasty may merely remove stenosis improve cerebral blood flow withthe management of decompensated ischemia. It is likely to decrease the incidence of strokeor transient ischemic attack. Endovascular stenting has been comfirmed to be an effectivetreatment approach for intracranial arterial stenosis (6-8), assessment of the effectiveness ofstenting are often based on long-term stroke and preoperative event incidence rates. CTbrain perfusion（CTP） is greatly sensitive to the improvement effect of brain perfusionafter stenting. The curative effect of stenting on intracranial atherosclerotic stenosis may beestimated visually using the CTP technique. Brain perfusion data plays an important role inthe preoperative assessment of patients with intracranial atherosclerotic stenosis and in thecurative scheme. Currently，the examination of brain hemodynamics has become ansignificant part in preoperative assessment.However, comparing with medical treatment,the effect clinical of stenting forintracranial atherosclerotic lesions remains controversial. The study pay close attention tolong-term therapeutic effects of stenting and preoperative evaluation.Objective: To analyse the changes of CT brain perfusion imaging parameters beforeand after stenosis stent-assisted angioplasty in severe symptomatic intracranialatherosclerotic stenosis patients, to investigate the preoperative evaluation value of thepreoperative computed tomography perfusion（CTP）imaging. Methods:58cases of severe symptomatic intracranial atherosclerotic stenosisconfirmed by digital subtraction angiography (the degree of stenosis>70%) patients weredivided into low perfusion group and normal perfusion group through preoperative CTPimaging.3months after intracranial stent-assisted angioplasty, the patients were performedwith CTP again to evaluate the cerebral hemodynamic changes. The relative perfusionparameters including regional cerebral blood flow (rCBF)， regional cerebral bloodvolume(rCBV)，regional mean transit time(rMTT)，and regional time to peak(rTTP) in bothgroups were compared.The curative effects of both groups were compared.Results: Comparing with pretreatment,rCBF,rMTT,rTTP were improved significantly(P <0.05) and rCBV was no significant difference (P>0.05) in the low perfusion group aftertreatment, and rCBV, rCBF, rMTT, rTPP were no changed significantly in the normalperfusion group after treatment (P>0.05). The posttreatment follow-up indicated that theincidence of recurrent ischemic stroke and transient ischemic attack in the low perfusiongroup were significantly lower than the normal perfusion group (P <0.05). The patientnumber of mRS≤2increased and had significant better function improvement in the lowperfusion group than the normal perfusion group(P <0.05).Conclusion: Intracranial stent assisted angioplasty could improve the perfusion in thelow perfusion group, but not significant improvement in the normal perfusion group. Theposttreatment follow-up indicated that the low perfusion group had significant betterfunctional improvement,and lower ischemical events than the normal perfusion group afterstent-assisted angioplasty. CTP imaging can accurately reflect the hemodynamic changes ofpatients before and after severe symptomatic intracranial atherosclerotic stenosisstent-assisted angioplasty. Therefore, According to pretreatment CTP parameters incombination with the clinic, it plays the important guiding role for the preoperativeassessment in severe symptomatic intracranial atherosclerotic stenosis treatment. |
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