Study Of Distributing Of Cerebrovascular Stenosis And Its Risk Factors Based On DSA In Patients With Ischemic Cerebrovascular Disease

Background:Ischemic cerebrovascular disease is common and frequently encountered in ourcountry, with high mortality, morbidity and recurrence, and brings great economic burdento family and our society. It includes cerebral infarction, TIA, vertebral basilar artery bloodsupply deficiency, etc., which accounts for85%of the cerebrovascular disease. The mostcommon and important cause of ischemic cerebrovascular disease is Cerebrovascularstenosis. DSA is thought as the gold standard method for diagnosis cerebrovascular disease,such as cerebrovascular stenosis, occlusion[1]. In previous research，the distribution ofcerebrovascular stenosis has racial differences. However，we do not have large sampleclinical DSA analysis of cerebrovascular stenosis lesions in domestic due to the status quoof technology and equipment and other reasons. In previous studies, there are manysimilarly noninvasive examination, such as colour doppler ultrasound used of carotid artery,TCD, CTA and MRA. But the specificity and sensitivity are not quite significant. Secondly,the distribution of cerebrovascular stenosis may be associated with different risk factors，but the relationships need further research. Finally, we have observed that many ischemicstroke patients loss clear vascular stenosis or occlusion lesion, but there is onlycerebrovascular circuity, which maybe mainly induce ischemic stroke through cerebralhemodynamic effects. In order to clarify the correlation between vascular circuity andischemic stroke, the distribution of cerebrovascular stenosis in3613DSA cases have beenobserved in our study. And we explore the relationship between cerebrovascular stenosisdistribution and common risk factors, the relationship between cerebrovascular circuity andstroke, in order to obtain clinical data of vascular lesionsfor prevention and treatment of stroke.Purpose：1. To definite the distribution of vascular lesions in the3613DSA cases ofcerebrovascular disease2. To clarify the distribution of cerebral vascular in2810cases with ischemiccerebrovascular disease and the relationship between the cerebral stenosis and risk factor byDSA.3. To explore the correlation and risk factors between vascular circuity and ischemicstroke.Method:1. We have observed3613cerebrovascular disease patients in our department during2003to2012, with corresponding DSA examinations. The main diagnose includenon-cardic ischemic stroke, IA, Vertebrobasilar insufficiency, cerebral hemorrhage, andepilepsy. The cerebrovascular disease including stenosis and occlusion of vascular, vasculartortuosity, arteriovenous malformations, moyamoya disease, vascular dissection, and so on.2.2810cases with Ischemic Cerebrovascular Disease, including ischemic stroke，TIA，Vertebrobasilar artery insufficiency, were detected by DSA， through its intracranialvascular pre-circle and post-circle, and the cerebral stenosis and the risk factors of Ischemiccerebrovascular disease in the same way.3. The cases of cerebral vascular tortuosity (Experimental group) was704,Non-cerebral vascular tortuosity group (Control group) was565. The two groups aredivided into ischemic stroke group and non-stroke group according to the occurrence ofischemic stroke, and compared the correlation and risk factors between vascular circuityand ischemic stroke.Results：1. Cerebrovascular stenosis and tortuosity are most commonly found in3613caseswith cerebrovascular disease based on DSA, followed by aneurysm and vascular dissection;2. In2810Ischemic Cerebrovascular Disease patients, vascular stenos is51.17%.Accounting for30.90%of intracranial vascular stenosis, extracranial artery stenosis in69.10%，cerebrovascular stenosis are most commonly found in E-ICA; Anterior circulationlesions accounted for81.19%, accounting for18.81%of posterior circulation disease, both of the degree of stenosis have no significant difference (P=0.885). In the middle-elderlygroup,(46.98%,57.31%) of cerebral vascular stenosis rate was significantly higher thanthat in the young group (38.97%). The distribution of cerebral artery stenosis in differentage groups was significantly different (P <0.05). The young group (48.03%) was lower thanthat of extracranial vascular stenosis in the elder group,(73.64%,81.02%), and intracranialvascular stenosis was higher than that in the elder age group,(45.97%,45.55%);3.222cases with TIA，vascular stenosis for50.00%，among them, the young andmiddle aged patients accounted for13.51%,28.83,57.66%. The distribution of cerebralartery stenosis in different age groups has no significant difference (P=0.246); Accountingfor32.75%of intracranial vascular stenosis, extracranial artery stenosis in67.25%;Anterior circulation lesions accounted for86.67%, accounting for13.33%of posteriorcirculation disease, both of the degree of stenosis have significantly difference (P=0.038),The young group of intracranial artery stenosis rate (73.33%) was higher than that in oldage group,(43.75%,35.94%), and extracranial artery stenosis was lower in elder (68.75%,79.69%) age group;4.601cases with Vertebrobasilar artery insufficiency，vascular stenosis for31.45%，among them, the young, middle aged patients accounted for4.76%,32.28%,62.96%. Thedistribution of cerebral artery stenosis in different age groups has no significant difference(P=0.447); Accounting for14.47%of intracranial vascular stenosis, extracranial arterystenosis in85.53%; Anterior circulation lesions accounted for65.91%, accounting for34.09%of posterior circulation disease, both of the degrees of stenosis have significantdifference (P=0.000);5. Advanced age, male gender, smoking, alcohol consumption, hypertension, diabetesand hyperlipidemia in patients with a high incidence of cerebral vascular stenosissignificantly higher than those without stenosis group (P <0.05), advanced age, smokingpatients was significantly higher than extracranial stenosis of intracranial vessels (P <0.05);6. Compare of tortuosity group (experimental group) and non-tortuous group (controlgroup), ischemic stroke rate in tortuosity group was significantly higher than that ofnon-tortuous group, with significant statistical difference (P=0.000); In tortuosity group,advanced age, female, hypertension as well as hyperlipidemia is significantly higher thannon-tortuous group, the difference is statistically significant ((P <0.05)); Conclusion:1. Cerebrovascular stenosis is the most common causes of ischemic cerebrovasculardisease; The incidence of intracranial stenosis is less than extracranial stenosis in Patientswith ischemic cerebrovascular disease. So the cerebrovascular stenosis maybe play animportang role in ischemic cerebrovascular disease; The cerebrovascular stenosis is themost common causes in the elderly; advanced age, male gender, smoking, alcoholconsumption, hypertension, diabetes, and high cholesterol is the risk factor for cerebralvascular stenosis, and the risk factors of extracranial vessels stenosis are age and smoking.However, hypertension is the most common risk factor for atherosclerosis stenosis resultingischemic cerebrovascular disease.2. Cerebral vascular tortuosity is closely associated with the ischemic stroke. Theelderly, women, hypertension and high cholesterol are risk factors for cerebral vasculartortuosity.