| Objective:(1)To evaluate collateral circulation and cerebral perfusion of acute cerebral infarction with one side of middle cerebral artery stenosis by CTA combined with CTP.(2)To analyze the correlation between the state of collateral circulation in patients with middle cerebral artery moderate stenosis above(including moderate and severe stenosis)and ipsilateral perfusion parameters of CBV,CBF,TTP,MTT,NIHSS score at admission and 3 months m RS score after discharge.(3)To analyze the correlation between the state of collateral circulation and age,hypertension,diabetes,LDL-C,TC,HCY.(4)To compare the differences of CBV,CBF,TTP,MTT between the lesion side and the lateral side in patients with mild,moderate and severe stenosis of the middle cerebral artery.Materials and methods: Since February 2016 to November 2016,40 patients with acute cerebral infarction in the First Affiliated Hospital of dalian Medical University were included(distance from onset time> 6 hours,but less than 7 days).Details of the patient's general clinical data are detailed and documented by an experienced physician,NIHSS score was scored at the time of admission.After the time of admission,doctors began to use aspirin and or clopidogrel sulfate antiplatelet,atorvastatin calcium tablets or rosuvastatin calcium tablets lipid-lowering,improve circulation,control blood pressure,blood glucose and treatment of various complications and other related treatment.Forty patients underwent endoscopic MRI + DWI + MRA examination showed a side of MCA stenosis or occlusion and confirmed as a new cerebral infarction.All patients received CTA and CTP examination from 3 to10 days after onset.According to the method of randomized controlled trials published warfarin aspirin in the treatment of symptomatic intracranial arterial stenosis(WASID method)to measure the degree of middle artery stenosis,divided into mild(<50%),moderate(50% ~ 75%)and severe(more than 75%,including 100%).The perfusion parameters of CBV,CBF,TTP and MTT were automatically generated in patients with mild,moderate and severe stenosis by using the software of cerebral perfusion analysis.For 26 cases of MCA moderate stenosis above patients,according to distal level showed by CTA-MIP vascular reconstruction(and contralateral comparison),the collateral circulation state is divided into preferable and undesirable group:preferable group refers to 2~3 points;Undesirable group refers to 0~1 point.Using the same brain perfusion analysis software,adverse side of CBV,CBF,TTP and MTT perfusion parameters in preferable and undesirable collateral circulation were automatic generated.m RS score(modified Rankin score)was performed 3 months after discharge.Using SPSS 20 statistical software to analyze the differerce of ipsilateral CBV,CBF,TTP,MTT,NIHSS scores on admission and 3 months m RS score after discharge between preferable collateral circulation group and undesirable circulation group.The difference of age,elevated blood pressure and diabetes,LDL,TC,HCY between preferable collateral circulation group and undesirable circulation group were compared.And The differences of CBV,CBF,TTP,MTT parameters and the contralateral side were compared in patients with mild,moderate and severe stenosis.Results:(1)Among the 40 patients,there were 31 male patints and 9 female patients,with an average age of 58.83 ±10.67 years old in the study group.Among them,14 patients of mild stenosis were included in the study,of which,2 patients had mild posterior circulation stenosis;There were 13 patienits with moderate stenosis and contralateral mild stenosis of middle cerebral artery in 1 person;13 patients of severe stenosis;More than moderate stenosis patients in 26 cases,CTA-MIP showed 12 patients with preferable collateral circulation,14 ptients with undesirable collateral circulation.(2)More than moderate stenosis patients in 26 cases,preferable collateral circulation group 12 persons,mean age 58.50±13.51 years old,poor collateral circulation group 14 persons,mean age 59.36±11.19 years old.There was no obvious difference between the two groups(P>0.05).Preferable collateral circulation CBV,CBF,TTP,MTT,NIHSS score at admission and 3 months m RS score after discharge were 1.84±0.62,23.78±14.10,20.28±5.30,4.58±1.01,4.50±1.57,1.67±0.89,the undesirable group were0.85±0.62,13.39±7.90,14.66±2.87,3.72±0.75,6± 1.66,3.14 ±0.95.Preferable collateral circulation group CBV,CBF compared with the undesirable collateral circulation was obviously increased(P = 0.000,0.037),TTP and MTT than in undesirable group were significantly prolonged(P = 0.002,0.020),NIHSS scores on admission and 3 months m RS score after discharge than the undesirable collateral circulation group was lower(P = 0.027,0.000).(3)Comparison of age,hypertension,diabetes,LDL,TC,HCY betwen preferable and undesirable collateral circulation group were no significant differences.(4)The CBV and CBF of the patients with mild stenosis were higher than the healthy side(P value was 0.002,0.023);The CBV of the patients with moderate stenosis were decreased than the healthy side,TTP and MTT were extended(P = 0.011,0.003,0.005);The CBV and CBF of the patients with severe stenosis were higher than those in the healthy side(P value was 0.005,0.001).Conculsion:(1)CTA combined with CTP has very important significance for patients with acute ischemic stroke in collateral circulation and cerebral perfusion assessment.(2)The ipsilateral cerebral blood perfusion with preferable collateral circulation was higher than undesirable collateral circulation,3 months of disability after discharge and neurological damage on admission were significantly alleviated.(3)There was no significant correlation between the collateral circulation status and age,hypertension,diabetes,LDL,TC,HCY.(4)The degree of vascular stenosis affects cerebral perfusion.The more serious the degree of vascular stenosis,the more obvious the decrease of CBV and CBF. |
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