Cerebrovascular Disease Involved In Clinical Study Of Postoperative Safety And The Medium-and Long-term Prognosis

bjective: Comparative analysis of cerebrovascular disease(artery stenosis and aneurysms)interventional therapy combined with theefficacy of drug treatment with medication alone, and combined withpostoperative clinical and radiologic follow-up data, evaluate treatmenteffectiveness security, as well as medium-and long-term prognosis, toexplore whether simple drug treatment is good or supplementedminimally invasive interventional treatment is more effective, moreappropriate treatment options for patients to explore.Methods: A retrospective analysis of2002to2011, outpatient and wardtreatment, and complete follow-up data intracranial arterial stenosis andaneurysm patients of247. All cases were confirmed by cerebralangiography, brain MRI and the neck vascular ultrasound confirmed.Cases of Carotid arterial stenosis stenting group (CAS)42cases, MT52group;cases of intracranial arterial stenosis stenting group (ICASS)31cases, MT42group; unruptured aneurysms interventional embolizationgroup (32cases), the MT48group of patients. Stent artery stenosis underlocal anesthesia artery stenting group, preoperative3d to oral aspirintablet (300mg/d) and clopidogrel tablets (75mg/d) the postoperativeoral clopidogrel tablets (75mg/d)+aspirin enteric-coated tablets (300mg /d)6months,6months after angiography adjustment aspirinenteric-coated tablets100mg/day, to last a lifetime. The drug treatmentgroup, aspirin enteric-coated tablets300mg/day, after taking six monthsto change100mg/day to maintain lifelong and clopidogrel tablets75mg/day, taking30days. The treatment were observed within30days, from1month to1year,1year to5years for ischemic neurological eventsoccurred. The aneurysm embolization are included aneurysm is found notsubjected to SAH patients. By comparing intervention group andconservative group bleeding, discuss whether should unrupturedintracranial aneurysms.Results: Artery stenosis: two sets of baseline data (gender, age, medicalhistory, systolic blood pressure, blood lipids, NIHSS, MRS) differencewas not statistically significant. The extracranial segments: CAS groupand the MT group within30days of the results: total mortality and theincidence of stroke in the MT group is higher than the CAS group, but nosignificant difference (5.8%,2.3%, P>0.05); No difference between thetwo groups of TIA incidence (3.8%,2.3%, P>0.05)；There were nominor occurrence. CAS group and the MT group at1month to1year(interim) results: stent group no deaths occurred, the total stroke occurredin2cases (4.7%). The drugs group1patient died (1.9%), total stroke anddeath in6cases (11.5%). CAS group and the MT group within1year to5years (long-term) results: total mortality and the incidence of stroke in the MT group was significantly higher than the CAS group (19.2%,9.5%, P<0.05) was statistically significant. Stent group (fatal stroke), total strokeand death in4cases9.5%) deaths occurred. Drug group died (fatal strokeand lung infection), total stroke and death in10cases (19.2%).Intracranial segment: intracranial vascular stent (ICASS) and MT groupresults in30days: ICASS group total mortality and the incidence ofstroke is higher than the MT group, but no significant difference (3.2%,2.4%, P>0.05). From January to1-year results of the the ICASS groupand the MT group: MT group total mortality and incidence of stroke ishigher than the ICASS group, but no significant difference (7.2%,6.4%,P>0.05); the ICASS were no deaths occurred. stroke in2cases (6.4%).Drug group and no deaths occurred, stroke in3patients (7.2%).1year to5-year results of the ICASS group and the MT group: total mortality andthe incidence of stroke in the MT group was significantly higher than theICASS group (14.9%,3.2%, P <0.05), there are significant; the ICASSwere no deaths occurred. TIA occurred without major stroke and death,pawns in1case (3.2%). Drug group1cases deaths occurred (2.4%),major stroke in2cases (4.8%), total stroke and death in6cases(14.9%).Aneurysm treatment: Embolization group:4patients had slightdisability. Conservative treatment group:5patients died, two cases ofsevere disability, moderate disability, mild disability eight cases. Imagingfollow-up results: follow-up of80patients with86aneurysms in the imaging follow-up to54patients with56aneurysms. The interventiongroup:7, the conservative treatment group:49. Imaging follow-upintervention group: a majority of embolism, the conservative treatmentgroup: a neck increases, two tumor increased rupture of the five cases.5cases were ruptured aneurysm rupture leading to SAH readmission ofpatients, and the line of imaging studies confirm, after all causedeath.cause death.Conclusion: CAS can get better vascularrecanalization effect, compared with better long-term efficacy ofmedication, can improve long-term clinical outcome of patients, is aneffective method for the prevention of ischemic stroke recurrence. Forsymptomatic intracranial arterial stenosis early intervention andendovascular stent is a safe, feasible and effective method. Of intracranialarterial atherosclerotic lesions high incidence of early indications withinintracranial artery stent implantation surgery, is expected to reduce theincidence of ischemic stroke. Of course, its long-term efficacy is still alarge number of cases and controls study to observe. Endovasculartreatment of intracranial aneurysms security, reliable, good in thelong-term clinical effects; joint intracranial stent technology enables theintracranial wide-necked aneurysms to get better treatment.