Clinical Analysis Of Patients With Mild Stroke Of LAA And PAD According To CISS

BackgroundStroke is an episode of neurological dysfunction caused by focal cerebral,spinal,or retinal cell death on the basis of disturbance of local blood circulation.Broadly stroke includes cerebral infarction,intracerebral hemorrhage and subarachnoid hemorrhage.Stroke is the second leading cause of death following cancer worldwide,with high incidence rate,high recurrence rate,high mortality rate and high disability rate.The latest epidemiological study shows that in the past 30 years,the prevalence of stroke in China is rising.With the increase of age,the incidence,morbidity and mortality of stroke are gradually increased.Several clinical researches shows mild ischemic stroke accounts for a large proportion,despite difference in specific data.Mild stroke has not got enough attention from patients and health care providers because of its mild and nondisabling feature.On the other hand,the etiologic classification of ischemic stroke has significant impact on both basic research and clinical practice.On the basis of SSS-TOAST,Korean TOAST and A-S-C-O,the CISS criteria taking account of risk factors,etiological classification and pathogenesis was proposed.Currently there is a lack of analysis of mild ischemic stroke according to CISS criteria.ObjectiveTo investigate the clinical characteristics of the mild stroke of large artery atherosclerosis(LAA)and penetrating artery disease(PAD)on the basis of CISS criteria.MethodsMild ischemic stroke patients of LAA and PAD admitted to the department of Neurology of Xinxiang Medical University between March 2015 and June 2016 were retrospectively enrolled in the present study.The general data,risk factors,clinical manifestations,imaging feature,outcome and prognosis were analyzed.Results(1)General data: eventually 129 mild ischemic stroke patients were enrolled,including 78 LAA and 51 PAD.Of the mild stroke of LAA,there were 45 men and 33 women.Mean age was 62.50±9.10(range from 45 to 88).Of the mild stroke of PAD,there were 28 men and 23 women.Mean age was 59.75±11.12(range from 34 to 80).(2)Risk factors: the most common risk factors of both LAA and PAD groups were smoking history,hypertension,dyslipidemia,and hyperhomocystinemia.Univariate analysis shows the patients' constituent ratios of coronary atherosclerotic heart disease(?2=4.188,P=0.041)and hypertension(?2=6.294,P=0.012)in LAA group were significantly higher than those in PAD group.(3)Clinical manifestations: the most common symptoms of both LAA and PAD groups were facial paralysis,dizziness,speech disturbance,and paralysis.Univariate analysis shows the patients' constituent ratios of paralysis(?2=10.311,P=0.001)and sensory disturbance(?2=4.030,P=0.045)in PAD group were significantly higher than those in LAA group;the patients' constituent ratio of cognitive impairment(P=0.049)in LAA group was significantly higher than that in PAD group.The baseline NIHSS score(z=-2.434,P=0.015)in PAD group was significantly higher than that in LAA group.(4)Imaging feature: in LAA group,severe large artery stenosis or occlusion was observed in 64 cases(82.05%),multiple infarctions in 69 cases(88.64%),watershed infarction in 26 cases(33.33%).Of all 51 PAD patients,the responsible vessel was single penetrating artery,the leision was single.Univariate analysis shows the patients' constituent ratio of multiple asymptomatic artery stenosis(?2=15.839,P=0.000)in LAA group was significantly higher than that in PAD group.(5)Outcome and prognosis: There was no significant difference in outcome and prognosis,apart from hospital day.However,compared with the mild stroke of PAD,the number of patients with poor outcome and prognosis was obviously higher in the LAA group.Conclusions(1)The general data,risk factors,and clinical manifestations are similar between LAA and PAD group.However,compared with PAD group,the number of patients with poor outcome and prognosis is obviously higher in the LAA group,which means heavier social burden.(2)There is significant difference in imaging feature between LAA and PAD group.(3)Perfect imaging evaluating is necessary to patients with mild stroke,which is of importance for etiological classification and individualized treatment.