Analysis On Characteristics And Risk Factors Of The Cerebral Arteriosclerosis In Ischemic Stroke Patients Aged 90 Years And Older

Background and ObjectiveCerebrovascular disease, malignant tumor and cardiovascular disease are the three leading causes to death of the residents in our country. In recent years, the investigation reports showed cerebrovascular disease has beyond the malignant tumor become the first risk factor of harm to health of residents in China. The incidence of ischemic stroke accounts for about 60%-80% in the incidence rate of cerebrovascular diseases in China. The sixth nationwide census data showed that China has entered the aging society and the aging speed became much quicker than before. China is a country of the high incidence rate of ischemic stroke, the increasing number of elderly population means the increasing number of patients with ischemic stroke. While the ischemic stroke in the elders is with high incidence, poor prognosis, disability, high death rate and high recurrence rate, which the characteristics are the major problems in clinical neurology that requires us to understand further the specific incidence risk factors of cerebral arterial stenosis and ischemic stroke. However, current studies of the cerebral arteriosclerosis and ischemic stroke mainly focus on the general elderly population; studies for the elderly population over 90 years old are still rare. This study focuses on the characteristics of arteriosclerosis and incidence risk factors for the elderly population aged 90 years or older with ischemic stroke, aiming to provide a theoretical basis for the clinical prevention and treatment for the elderly patients over 90 years old with ischemic stroke.Materials and methodsContinuous retrospective study of a total of 92 patients, aged 90 years or older, admitted to Daping hospital from July 2009 to July 2014 were respectively enrolled in this study. All participants underwent CTA to assess the presence and severity of atherosclerotic stenosis with intra cranial and extra cranial cerebral artery. The association between atherosclerotic stenosis and related risk factors were analyzed. The subjects were divide into senility group(≥90 years, n=92) and control group(≤90 years, n=110), which were randomly coded by systematic sampling; According to the head and neck CTA images of intra cranial and extra cranial artery stenosis degree of elderly patients were divided into stenosis group and non-stenosis group. To compare the characteristics and differences between the two groups, the association between cerebral arteriosclerosis and medical history, body mass index(BMI), blood pressure, blood glucose, blood lipid, uric acid and cystatin were analyzed simultaneously.Results1. The frequency of atherosclerotic stenosis in study group was higher than the frequency in control group(P<0.05). The most common positions of cerebral artery atherosclerotic stenosis were: I-ICA(79.9%), MCA(71.2%), E-ICA(60.9%). While in control group the most common positions were: E-ICA(42.7%), I-ICA(35.9%), PCA(16.4%).2. The incidence rate of stenosis in intra cranial artery was higher than in extra cranial artery. The incidence of intracranial arterial stenosis in study group is higher than in control group. All the results above are with statistical significance(P<0.05).3. The incidence rate of artery stenosis were both presenting higher in anterior circulation than in posterior circulation, the difference was statistically significant(P < 0.05).4. The incidence of plaque in study group was significantly higher than the control group(P < 0.05). According to statistics of study group data: ①the predilection site of neck plaque was intracranial segment of internal carotid artery(93.4%), followed by extra cranial segment of internal carotid artery(78.8%); ②the predilection site of calcific plague was intracranial segment of internal carotid artery(86.9%); the significant predilection sites of mixed plaques was extra cranial segment of internal carotid artery(48.3%); fatty plaque and fibrous plaque were multiply in extra cranial carotid artery. ③The calcified plaque detection rate was highest(25.8%), followed by mixed plaque(15.4%), fatty plaque and fibrous plaque was relatively low(4% vs 1.7%).5. Tortuous date statistics showed: ①compared to control group, the incidence of tortuosity in study group is significantly higher(86.8% vs 57.9%), the difference was statistically significant(P < 0.05). ②The predilection site of artery tortuosity is in the left vertebral artery(46.7% vs 35.5%) in both study group and control group. ③The incidence in left vertebral artery(study group vs control group 75% vs 80%) was significantly higher than in right vertebral artery(P < 0.05).6. Compared the mono-factor analysis of Intra cranial or extra cranial arterial stenosis in the study group and the control group: ①history of hypertension and coronary heart disease in the study group was significantly higher than in the control group, and systolic blood pressure and diastolic blood pressure levels were significantly higher than those in control group, there was significant difference between the groups(P<0.05). ②smoking and drinking in the control group was significantly more than the study age group, and BMI, triglyceride and low density lipoprotein levels were higher than those in the study group, there was significant difference between the groups(P<0.05).7. Artery stenosis was defined as stenosis rate greater than 50%, the patients in study group were divided into stenosis group and non-stenosis group for mono-factor analysis. The results showed that age, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose levels in stenosis group were higher than non-stenosis group(P<0.05). Further multi-factor logistics regression analysis of the risk factors showed that overweight was the independent risk factor of the incidence in the patients over 90 years old with extra cranial artery stenosis(95%CI=1.242-11.412, OR=3.765, P<0.05).Conclusion1. The prevalence and severity of cerebral arteriosclerosis are obviously increased in the ischemic stroke patients aged 90 years and older. The predilection site of intra or extra cranial artery stenosis in patients aged 90 years and older are intracranial segment of internal carotid artery and middle cerebral artery; the predilection site of extra cranial artery stenosis is extra cranial segment of internal carotid artery and extra cranial segment of vertebral artery; intracranial artery stenosis rate is significantly higher than that of extra cranial artery; anterior circulation artery stenosis is higher than that of posterior circulation.2. The incidence rate of stenosis, plaque and tortuosity increased significantly; the type of plaque and tortuosity have no significantly difference with the type and proportion of those in ordinary patients; the predilection site of plague are intra cranial segment of internal carotid artery and extra cranial segment of internal carotid artery; the predilection site of tortuosity is left vertebral artery.3. The incidence of intra or extra cranial artery stenosis in patients aged 90 years and older is significantly interrelated with overweight, systolic blood pressure, diastolic blood pressure, fasting blood glucose, in which the overweight is the independent risk factor.4. The history of hypertension, coronary heart disease and elevated cystatin levels are closer to the ischemic stroke patients aged 90 years and older.5. Less smoker, drinkers, and lower body mass index, triglyceride and low density lipoprotein level in patients aged 90 years and older Suggest that healthy lifestyle has a certain relationship with late onset of stroke and longevity in aged 90 years and older.