| Objectives The study intends to investigate the effects of collateral circulation on the pathogenesis of ischemic stroke and the NIHSS score in the treatment of severe middle cerebral artery stenosis(degree of stenosis ≥70% or occlusion).The results of this study provide guidance on the selection of clinical treatment options,the assessment of neurological impairment,and the judgment of clinical short-term outcomes.Methods The study continuously collects a total of 123 cases of unilateral middle cerebral artery severe stenosis(or occlusion)after cerebral Digital Subtraction Angiography(DSA)in our department,divided into open branch group and unopen branch group according to the presence of the collateral circulation.The brain Magnetic Resonance and Diffusion(MRI+DWI)are used to analyze the characteristics of infarct.At the same time the study records NHISS score of admission and NIHSS score of 7 days after treatment,evaluating the short-term neural function after internal medicine conservative treatment.The study carries out statistical analysis on the result of experimental data,and clarifies the effects of collateral circulation on the pathogenesis classification of cerebral infarction and neurological function.Results1.Among the 123 patients,open groups of the lateral branch are 42 cases(34.1%)and unopened groups 81 cases(65.9%).In open group of the lateral branch,there are 20 cases of hypertension(47.6%),18 cases of hyperhomocysteinemia(47.6%),with the serum cholesterol 3.67 ± 1.04mmol/L.In the unopened group of the lateral branch,there are 55 cases of hypertension(67.9%),51 cases of hyperhomocysteinemia(66.7%),withtotal cholesterol 4.09±0.99mmol/L.The above three kinds of risk factors in the two groups are statistically significant(P <0.05).2.In the pathogenesis of collateral circulation,open group of the collateral circulation,there are 17 cases of artery-to-artery embolism(40.5%),penetrating artery were 13 cases of the perforator artery of carrier arterial occlusion(31.0%),7 cases of hypoperfusion/impaired emboliclearance(16.7%),5 cases of mixed mechanisms(11.9%).In the unopened group of collateral circulation,32 cases of hypoperfusion/impaired emboliclearance(39.5%),20 cases of penetrating artery(24.7%),17 cases of artery-to-artery embolism(21.0%),12 cases of mixed mechanisms(14.8%).The differences in pathologic typing between the two groups were related to the openness of collateral circulation(P <0.05).3.In the open group of collateral circulation,NHISS score was 5.43?3.24 on admission,and after 7 days conservative treatment the score was 1.31±1.46,treatment improvement rate was 0.83±0.16.In the unopened group of collateral circulation,NHISS score was 6.85?3.51 on admission,and after 7 days conservative treatment the score was 1.90?1.24,treatment improvement rate was 0.75?0.14.The scores of NIHSS before and after treatment were significantly different from those of non-collateral compensated group(P <0.05).4、In the primary collateral compensation,there are 2 cases(4.8%).In the secondary collateral compensation,there are 23 cases of the pia mater artery compensation(54.8%),and had 6 cases of ophthalmic artery compensation(13.4%).In the third collateral compensation there are 11 cases(26.2%).The proportion of pia mater artery compensation is the largest.There was no significant difference between NIHSS score(on admission and 7 days after the treatment)and treatment improvement rate(P <0.05).Conclusion1.Blood pressure,homocysteine and serum cholesterol levels can inhibit the establishment of collateral circulation in patients with severe(or occlusion)middle cerebral artery stenosis.Blood pressure,homocysteine and increased serum cholesterol levels may be a risk factor for the establishment of collateral circulation or not in patients with severe middle cerebral artery stenosis(or occlusion).2.In the middle cerebral artery severe(or occlusion)stenosis,openness of collateral circulation or not can affect the pathogenesis of cerebral infarction classification.The most common pathologic mechanism of the open group of collateral circulation is artery-to-artery embolism mechanism.The most common pathological mechanism of the unopened group is the decrease of hypoperfusion/impaired emboliclearance.3.After the effective establishment of collateral circulation,the patients with unilateral middle cerebral artery severe stenosis(or occlusion)have mild clinical symptoms.After 7 days of treatment,patients have higher neurological improvement rate.4.In the middle cerebral artery severe(or occlusion)stenosis,the compensation way is mainly pia mater artery compensation,followed by the capillary network compensation,and the Willis loop and ophthalmic artery compensation are rare.There was no significant correlation between different collateral compensatory methods and neurological function. |
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