Impact And Mechanism Study Of Dominant Lpsilateral Posterior Cerebral Artery On The Prognosis Of Patients With Symptomatic Middle Cerebral Artery Stenosis Or Occlusion

Background: Stenosis or occlusion of the middle cerebral arterial(MCA)is one of the common causes of ischemic cerebrovascular disease.The prognosis is very different.Collateral circulation plays an important role in the prognosis of the disease.After the middle cerebral artery M1 stenosis or occlusion,the meninges collateral circulation becomes the most important collateral circulation pathway.Therefore,it is important to evaluate the effect of collateral circulation of the pia mater on the stenosis or occlusion of the middle cerebral artery in the middle cerebral artery.Magnetic resonance angiography(MRA)has been widely used in the clinical diagnosis and treatment of cerebrovascular disease because of its simple operation,economical and rapid.By observing the Middle Cerebral Artery(MCA)stenosis or occlusion of patients with MRA found that the lesion side of the Posterior Cerebral Arteral(PCA)is relatively coarse,long,known as "Dominant PCA laterality",through the lateral advantage of indirect judgment of the meninges of the collateral circulation,has been applied in clinical practice.PWI is a direct evidence of whether or not ischemic brain tissue is assessed and can directly reflect cerebral hemodynamic changes.Vascular endothelial growth factor(VEGF)and platelet derived growth factor(PDGF-BB)are angiogenesis-related factors,which can promote angiogenesis and protect the brain.Objective: In this study,we investigated the effect of dominant PCA laterality of MCA M1 stenosis or occlusion in patients with acute cerebral infarction by MRA and the mechanism of PCA laterality.Method: Patients with acute cerebral infarction were collected from January 2015 to December 2016 with symptomatic cerebral artery stenosis or occlusion in our hospital.The PCA condition was assessed by MRA,which was divided into dominant PCA laterality group and control group.The clinical data,imaging and blood samples were collected from the two groups.The patients were followed up for 90 days.The follow-up included recurrence,neurological score,cerebral perfusion and laboratory test.Results: 163 cases were met the criteria of the group,31 cases were excluded(2 cases of death,receiving vascular recanalization treatment 3 cases,anterior cerebral artery thickening,lengthening 10 cases,incomplete information in 16 cases),a total of 132 patients were included.Among them,male 75,female 57,male to female ratio of 1.3: 1,the average age of patients 65.45 ± 5.32 years old,Combined risk factors from high to low were: hypertension,internal carotid atherosclerosis,hyperlipidemia,diabetes,smoking,drinking,atrial fibrillation.In these 132 patients,the domimant PCA laterality Group in 80 cases,control group in 52 cases,the two groups of patients had no statistical differences in baseline.At admission,the volume of cerebral infarction was significantly smaller in the dominant PCA laterality group than in the control group,and the two groups were statistically significant(52.30 ± 22 27cm3 vs 75 ± 32.133 To-2.08);The NIHSS score of PCA laterality Group was lower than that of control group,NIHSS score was statistically different between the two groups(10.09 ± 3.43 vs 11.53 ± 4.08).During the follow-up,no death and ischemic stroke occurred in the two groups.At the 90 th day,there were 69 cases with mRS score less than or equal to 2 points in the PCA laterality group,and 36 cases with mRS score less than or equal to 2 points in the control group were significantly different(X2 = 5.61,P = 0.02 <0.05).At admission,rCBF was significantly higher in the PCA laterality group than in the control group(1.32 ± 0.35 vs 1.13 ± 0.38,t = 2.36,P = 0.021 <0.05),the difference was statistically significant.rCBV was higher than that in the control group(1.23 ± 0.23 vs 1.16 ± 0.26,t = 1.27,P = 0.21> 0.05),the difference was not statistically significant;rMTT was lower than that in the control group(0.90 ± 0.22 vs 1.10 ± 0.25,t =-3.71,P = 0.00 <0.01),the difference was statistically significant,rTTP was higher than the control group(1.21 ± 0.08 vs 1.17 ± 0.09,t = 1.40,P = 0.165> 0.05),the difference was not statistically significant;The Brain perfusion in the PCA laterality group was superior to the control group.During the follow-up,the cerebral perfusion of the two groups was significantly improved,and at 90 d,the RCBF of the PCA laterality Group was still higher than that in the control group(1.56 ± 0.36 vs1.39 ± 0 37),the difference was statistically significant.In the two groups,the VEGF in the PCA laterality group was higher than the control group(8.46±2.58 pg/ml vs 7.15±2.67 pg/ml,t=2.20,P=0.031<0.05),the difference was statistically significant.PDGF-BB hospitalization was higher than control group(30.34±3.18 pg/ml vs 28.31±3.78 pg/ml,t=2.56,P=0.013<0.05),the difference was statistically significant.In the follow-up process,both groups of VEGF and PDGF-BB in the 14 d were significantly elevated,then decreased,90 d is still at a high level;In the follow-up process,the VEGF and PDGF-BB were higher in the patients with PCA laterality group than in the control group,and the difference was statistically significant.Conclusion: In patients with acute cerebral infarction in the MCA M1 stenosis or occlusion,the dominant of PCA laterality indicates a smaller infarct volume,a smaller neurological impairment and a good prognosis;the effect of PCA laterality on cerebral infarction is related to the improvement of cerebral perfusion;the effect of PCA laterality on cerebral infarction is related to the improvement the expression of VEGF and PDGF-BB.