| Part1 safety and efficacy of PTAS therapy for symptomatic severe MCA stenosis patients【Objective】 To investigate the safety and efficacy of patients of symptomatic severe middle cerebral artery(MCA) stenosis underwent percutaneous transluminal angioplasty and stenting(PTAS) therapy.【Materials and methods】 From 2011.12 to 2013.12,48 symptomatic severe MCA stenosis patients were received PTAS therapy in our department in total. As a follow-up to the end of2014.06,we analyze their clinical data and follow-up results,and evaluate the incidence of adverse events in perioperative and follow-up period.【Results】 The mean age of patients was 62.1 ± 2.9 years old. The mean stenosis degree was reduced from 84.3± 6.2% to 19.6± 4.7% after angioplasty. The periprocedural complication rate was 4.17%. The primary endpoint event rate was 10.42% of the total(4 patients had TIA,1 patient had stroke). the mean follow-up time was 16.3 ± 3.1 months. Patients` m RS scores had improved one month after PTAS.【Conclusions】 These results suggest that the PTAS therapy is safe and efficient at short-term follow-up in symptomatic severe MCA stenosis patients. It`s more effective than drug therapy in short-term, but the Long-term effects need to be studied further.Part2 The value of CTP for the assessment of cerebral ischemia in patients with middle cerebral artery stenosis【Objective】 By using of CTP(computed tomography perfusion) to assess preoperative and postoperative cerebral perfusion.To discuss the value of CTP for the scope of cerebral ischemia and extent of improvement in ischemic.【Materials and methods】 32 symptomatic severe MCA stenosis patients were underwent head CTP examination before and after PTAS. By numerical analysis of MTT((Mean Transit Time) and TTP(Time To Peak), the degree of preoperative and postoperative cerebral ischemia improvement was clear. According to the extent of the area of ipsilateral TTP, 32 patients were ASPECTS(Alberta Stroke Program Early CT Score) scored before and after PTAS, and analyze how extent of cerebral ischemic changed.【Results】 The ipsilateral MTT and TTP values of all 32 patients were significantly prolonged compared with the contralateral;patients MTT, TTP were significantly improved after PTAS;preoperative ipsilateral averaged ASPECTS was 3.2 ± 1.4,and an average ASPECTS was 8.9 ± 0.9 postoprative.【Conclusions】 CTP can intuitively and accurately evaluate the scope and extent of cerebral ischemia in symptomatic severe MCA stenosis patients,and it can provide an objective basis for improvement of cerebral ischemic after PTAS.Part3 To investigate causes of in-stent restenosis【Objective】 In-stent restenosis(ISR) is a frequent problem after PTAS. This section focuses on the major risk factors for the occurrence of ISR.【Materials and methods】37 symptomatic severe MCA stenosis patients had reviewed DSA a half year after PTAS, 21 males and 16 females. According the degree of restenosis,all patients were divided into two groups,and were recorded as ISR group and NISR group. Making statistical analysis and comparison for ISR group and ISR group according to the different risk factors,such as,age,sex,hypertension,diabetes,hyperlipidemia,and smoking,Respectively.【Results】 The number of ISR occurs for 6 cases(16.22%),Where 2 males and 4 females in all 37 patients,and the gender composition of ISR group and NISR group have a significant difference. There are 4 cases with diabetes in 6 cases,and the composition of rate of diabetes also have a significant difference between two groups. Otherwise,average inside diameter of blood vessels between two groups are notly different. The rest of the factors were not statistically significant difference between two groups.【Conclusions】 Female,diabetes and small inside diameter of blood vessels perhaps are the major risk factors causing ISR after PTAS,but high blood pressure, smoking and other factors had no significant effect on the ISR. |
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