| Objectives:1.To observe the safety and efficacy of intracranial arterial stenting in patients with symptomatic middle cerebral artery M1 stenosis;2.To analyze the clinical efficacy and prognosis of intracranial arterial stenting and drug therapy in patients with symptomatic middle cerebral artery M1 stenosis.Methods:A total of 120 patients with symptomatic middle cerebral artery stenosis(sICAS)admitted to our hospital from december 2013 to december 2017 were enrolled.All patients were confirmed to have a stenosis rate of 70%to 99%by DSA.The WASID test method calculates the sICAS patients with a responsible stenosis rate).Communicate effectively with patients and their families,make treatment choices after fully understanding the protocol,and voluntarily decide whether to choose intracranial stenting.Among them,57patients underwent M1 segment stent implantation in the middle cerebral artery as the stent group;63 patients underwent conventional medical conservative treatment as the drug group.Both groups were treated with Siemens 3.0T MRI to assess ischemic stroke.The 64-slice spiral CT head and neck CTA examination and the Philips Allura Xper FD large C-arm catheter were used for DSA examination and stent treatment of middle cerebral artery vessels.narrow.All patients who underwent stent placement were placed in the catheterization room of our hospital by the subject team.Outpatients,hospitalizations,telephone follow-up assessment endpoints,and other adverse events were performed at one,three,six,and tweleve months after enrollment.Serum interleukin-6(IL-6)and neuron-specific enolase(NSE)were detected by enzyme-linked immunosorbent assay(ELISA)before and after treatment.Serum hypersensitive C-reactive protein was detected by immunoturbidimetric assay.The cognitive function changes of patients were observed using the Simple Intelligence State Checklist(MMSE).Results:1.There was no significant difference in age,sex,BMI,smoking,drinking,hypertension,diabetes,coronary heart disease and other general clinical data between the two groups(P>0.05).2.The incidence of all adverse vascular events in the internal medicine group and the stent group within one year[(12,19.05%)vs.5.26%),x~2=3.867,P<0.05],and the TIA recurrence rate was[(12.70%vs.3.51%),x~2=5.980,P<0.05],non-ipsilateral stroke recurrence rate was[(6.34%vs.3.51%),x~2=2.650,P<0.05],ipsilateral stroke recurrence rate was[(7.24%vs.5.26).%),x~2=2.783,P<0.05],the difference between the two groups was statistically significant(P<0.05).There was no significant difference in the incidence of bleeding events between the internal medicine group and the stent group during the follow-up period(P>0.05).3.After treatment,The neurological deficit score(NIHSS)and mRS scores of the two groups were significantly improved,and there was a significant difference between the two groups(P<0.05).Among them,the improvement rate of stent group was better than that of internal medicine group(P<0.05).The scores of NIHSS<3 in the internal medicine group and the stent group were[(23,36.51%)vs.(27,47.37%),x~2=3.267,P<0.05],mRS<2[(26,41.27%)vs.(34,59.65%),x~2=2.689],respectively.There were significant differences between the two groups(P<0.05).4.There were no deaths in the two groups of patients in thirty days.The incidence of death in stent group and internal medicine group within one year was[(3,5.26%)vs.(3,4.76%),x~2=0.763],respectively,with no significant difference(P>0.05).The angiographic stenosis rate in the internal medicine group and the stent group was[(86.35±10.42)%vs.(12.96±3.35)%,t=7.789]respectively after one year follow-up.The difference between the two groups was statistically significant(P<0.003).The rate of vascular stenosis before and after treatment in the internal medicine group was[(85.51±11.37)%vs.(86.35±10.42)%,t=0.682],and there was no significant difference between the two groups(P>0.05).The rate of vascular stenosis before and after stenting group was[(82.49±11.93)%vs.(12.96±3.35)%,t=0.682],and there was a significant difference between the two groups(P<0.05).The incidence of stent restenosis within the follow-up period was(5,8.7%).5.Through three,six,twelve months following-up,the incidence of new/progressive ischemic stroke and transient ischemic attack in the internal medicine group was significantly higher than that in the subcortical arteriosclerosis within twelve months,and there was a significant difference compared with the stent group(P<0.05).There was no significant difference in the incidence of hemorrhagic stroke between the two groups(P>0.05).6.The peak systolic velocity and pulsatility index of the affected middle cerebral artery decreased in the two groups after treatment,and there was significant difference between the two groups before and after treatment(P<0.05).7.Compared with before treatment,the serum levels of IL-6 and hs-CRP of the patients in the two groups decreased.After treatment,and there was significant difference between the two groups(P<0.05).After treatment,the levels of serum IL-6 and hs-CRP in stent group were significantly lower than those in internal medicine group(P<0.05).Compared on previous treatment,there was no significant change in serum NSE level and cognitive function score between the two groups after treatment,and there was no significant difference between the two groups before and after treatment(P>0.05).Conclusions:1.Percutaneous transluminal stent angioplasty can effectively prevent the recurrence rate of stroke/TIA within one year in patients with symptomatic middle cerebral artery M1 segment stenosis,and the clinical effect is better than that in patients with only intensive medical treatment group.2.Stent angioplasty for the treatment of symptomatic middle cerebral artery M1 stenosis is safe and reliable on the basis of strict indications and individualized rational selection of stents.Hemorrhagic vascular events were not observed.3.There is no significant improvement in vascular stenosis in the intensive medical treatment group alone,but the intensive medical treatment combined with stenting group could significantly improve the degree of vascular stenosis,reduce the degree of neurological deficit in stroke patients,improve the quality of life of patients,and reduce the incidence of recurrent stroke.4.Endovascular stent angioplasty can significantly increase the blood flow of stenosis segment,reduce serum inflammatory response,reduce the degree of neurological impairment and improve the quality of life of patients,but it has no significant effect on the short-term cognitive function of patients. |
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