| Objectives 1 We aimed to observe the distribution characteristics of symptomatic large artery atherosclerotic stenoses in patients with acute ischemic stroke, and explore the risk factors of stenotic distribution. 2 We expected to understand the short-term prognosis of patients with symptomatic intracranial artery atherosclerotic stenoses and investigate the factors affecting the prognosis.Methods 1 We consecutively registered 231 in-patients with acute ischemic stroke in Tangshan Worker Hospital, Hebei Medical University from December 2012 to February 2014. Among them, 128 patients with symptomatic large artery atherosclerotic stenoses, which were confirmed by magnetic resonance imaging(MRI) and computed tomography angiography(CTA), were enrolled in this study.According to stenotic location, the patients were divided into three groups: the intracranial artery stenoses group(ICAS), the extracranial artery stenoses group(ECAS) and the extra-intracranial artery stenoses group(E-ICAS). 2 After 6 months follow-up, we recorded the modified Rankin Scale(m RS), and used Logistic regression to analyze the related factors of stenotic distribution and short-term prognosis.Results 1 Among the 231 patients who underwent CTA, there were 95 patients with ICAS(41.1%), 20 patients with ECAS(8.6%), and 13 patients with E-ICAS(5.6%). Furthermore, symptomatic stenotic arteries were list below: middle cerebral artery(n=66, 28.6%), basilar artery(n=12, 5.2%), intracranial segment of internal carotid artery(n=10, 4.3%), posterior cerebral artery(n=8, 3.5%), intracranial segment of vertebral artery(n=8, 3.5%), anterior cerebral artery(n=4, 1.7%), extracranial segment of internal carotid artery(n=24, 10.4%), extracranial segment of vertebral artery(n=6, 2.6%), common carotid artery.(n=3, 1.3%). 2 Multivariate Logistic regression analyses showed that female(odds ratio [OR] 3.568, P=0.025) and hypertriglyceridemia(OR 1.794, P=0.030) were associated with ICAS, hyperhomocysteinemia(OR 3.024, P=0.029) and smoking(OR 3.937, P=0.026) was related to ECAS and E-ICAS, respectively.3 Univariate analyses showed that the National Institutes of Health Stroke Scale(NIHSS) scores at admission(OR 0.872, 95%confidence interval [CI] 0.775~0.980,P =0.022), hyperhomocysteinemia(OR 0.354, 95%CI 0.132~0.984, P=0.039) and anticoagulation therapy(OR 2.597,95%CI 1.123~6.004, P=0.026) were associated with the favorable outcomes of s ICAS patients at 6 months.4Multivariate Logistic regression analyses demonstrated that the patients with severe arterial stenoses(OR 0.182, 95% CI 0.035~0.943, P=0.042) and occlusions(OR 0.156,95%CI 0.029~0.833, P=0.030) had more poor outcomes than those with mild arterial stenoses,and the patients with high baseline NIHSS scores( OR 0.768, 95% CI 0.661~0.892, P=0.001) and hyperhomocysteinemia(OR 0.177,95%CI 0.051~0.608,P=0.006) had worse prognoses, however,the patients receiving anticoagulative drug treatment(OR 7.714,95%CI 2.440~24.389, P=0.001)had better outcomes at 6 months.Conclusions 1 The prevalence of symptomatic ICAS is higher than ECAS in hospitalized patients with acute ischemic stroke.2 Female patients with hypertriglyceridemia are prone to ICAS, however, patients with hyperhomocysteinemia and smoking are likely to have ECAS and E-ICAS, respectively.3 High NIHSS score at admission,arterial severe stenosis/occlusions,hyperhomocysteinemia are the predictors of unfavorable outcomes.4 Whereas anticoagulation therapy is associated with favorable outcomes. |
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