The Relationship Between The Cerebral Infarction And The Opening Of Collateral Circulation In Patients With Their MCA Stenosis

Objective:Ischemic stroke is a common and frequently-occurring disorder harming human health. Its impact on the family and society as well as the cost of the treatment of stroke and the impact of the loss of the labor force is huge. Therefore, the research that taking preventive measure and reducing the damage of nerve function continues to deepen before or after the stroke. The clinical manifestations of patients with ischemic cerebro vascular disease are not completely consistent with the severity of cerebral artery. Some patients with milder intracranial atherosclerotic stenosis will stroke, while some severe ones will not stroke. The incidence rate of the cerebral infarction in patients with the degree of the vascular stenosis is not the same. And even if the incidence, lesion size, neurological impairment is also very different.What is the reason of it? In recent years, many research confirmed that the reason are concerned with the collateral circulation except traditional risk factors of ischemic cerebrovascular disease. What kind of relationship between its risk factors and the opening of collateral circulation? That is the issue this study explores.To explore the relationships between the cerebral infarction and the opening of collateral circulation, and it between the cerebral infarction and degrees of stenosis, and it between the area of the cerebral infarction and the opening of collateral circulation, and it between degrees of stenosis and the opening of collateral circulation, and it between cerebral vascular risk factors and the opening of collateral circulation in patients with their MCA stenosis, expects to contribute to the clinical evaluation of patients with ischemic stroke, prognosis, individual treatment options.Methods:Eighty six patients with MCA stenosis were included in the study from May, 2011 to January,2016, who were in hospital and performed DSA investigation in department of neurology of Kunming medical university fifth affiliated hospital.63 males and 23 females, mean (53.12±9.70)years, who were divided into two groups. There were 46 patients with fresh infarction group, others without infarct 40 people were in non-infarction group. We analysised the relationship between the new cerebral infarction and the opening of collateral circulation, and it between the new cerebral infarction and collateral flow classification, and it between the area of the cerebral infarction and the opening of collateral circulation, and it between the cerebral infarction and degrees of stenosis, and it between degrees of stenosis and the opening of collateral circulation, and it between cerebral vascular risk factors and collateral circulation opening.Results:1. Eighty six patients with MCA stenosis were divided into the fresh infarction group and the non-infarction group. The opening of collateral circulation comparison in two groups:16patients(34.78%)exist formation of collateral circulation in fresh infarction group, while 25 patients(62.5%)exist formation of collateral circulation in non-infarction group.χ2=6.589, P<0.05.There is statistical significance between two groups. Spearman correlation analysis showed. y=-0.277, P<0.05, cerebral infarction and the opening of collateral circulation were negatively correlated.2.41 Collaterals were assessed with the ASITN/SIR Collateral Flow Grading System. Collateral flow classification level 1 and 2 are used as the poor collateral circulation group, and collateral flow classification level 3 and 4 are used as the good collateral circulation group. Collateral flow classification level 1 and 2 accounted for 81.75%, and level 3 and 4 accounted for 18.25% in 16 patients existing formation of collateral circulation in fresh infarction group. Collateral flow classification level 1 and 2 accounted for only 8%, and level 3 and 4 accounted for 92% in 25 patients existing formation of collateral circulation in no cerebral infarction group.χ2=22.563, P<0.05. There is statistical significance between two groups. Spearman correlation analysis showed, γ=-0.742, P<0.05,cerebral infarction and collateral flow classification were negatively correlated.3.The area of the cerebral infarction comparison in 46 patients with fresh infarction according to collateral circulation:16 patients exist formation of collateral circulation and the area of the cerebral infarction mean(1.42±1.24)cm2.30 patients do not exist formation of collateral circulation and the area of the cerebral infarction mean (3.95±5.06)cm2.t=2.596, v=35.04, P<0.05.There is statistical significant correlation between the area of the cerebral infarction and the opening of collateral circulation.4.The opening of collateral circulation comparison in different degrees of 86 MCA stenosis:51 patients are in mild and moderate group and 13 patients(25.5%) exist formation of collateral circulation, while 35 patients are in severe group and 28 patients(80%) exist formation of collateral circulation.χ2=24.722, P<0.05. There is statistical significance between two groups. Spearman correlation analysis showed, γ=0.536, P<0.05, the opening of collateral circulation is positively correlated with degrees of stenosis.5. There is no significant correlation between degrees of MCA stenosis and cerebral infarction in eighty six patients with single MCA stenosis.6.There is no significant correlation between cerebrovascular risk factors as hypertension, diabetes, smoking, high cholesterol, homocysteine and the opening of collateral circulation in eighty six patients with single MCA stenosis.Conclusions:1. This study show that cerebral infarction is negatively correlated with the opening of collateral circulation. The flow classification of collateral circulation plays a very important role. Collateral flow classification is the higher the rating, the less prone to occur cerebral infarction. Collateral circulation has a protective effect on cerebral artery stenosis. This study show that the opening of collateral circulation can reduce the area of the cerebral infarction in patients with single MCA stenosis.2. This study show that the opening of collateral circulation is positively correlated with degrees of stenosis. The more severe of artery of stenosis, the more chance of the opening of collateral circulation.3. This study show no significant correlation between the cerebral infarction and degrees of stenosis in patients with single MCA stenosis.4.This study show no significant correlation between risk factors of cerebrovascular disease as hypertension, diabetes, smoking, high cholesterol, homocysteine and the opening of collateral circulation in patients with single MCA stenosis.