The Study Of Distribution And Risk Factors Of Intracranial And Extracranial Atherosclerotic Stenosis In Patients With Ischemic Stroke

Objectives:To investigate the distribution characteristics and related risk factors of intracranial and extracranial atherosclerotic stenosis in patients with ischemic stroke.Methods:We collected the clinical data of 2434 patients with ischemic stroke in our hospital during the period from January 2015 to May 2018.Among these patients,1798 patients –recived computed tomographic angiography(CTA)of the head and neck arteries,and 636 patients reciveddigital subtraction angiography(DSA).The patients were divided into four groups according to the stenosis site: non-stenosis group,simple intracranial stenosis group,simple extracranial stenosis group,and both intracranial and extracranial stenosis group.At the same time,the patients with intracranial and extracranial arteries stenosis were divided into four groups: anterior circulation stenosis group,posterior circulation stenosis group,both anterior and posterior circulation stenosis group and no stenosis group.Intracranial arteries include: anterior cerebral artery(ACA),middle cerebral artery(MCA),posterior cerebral artery(PCA),internal carotid artery(ICA)c3-c7 segment,basilar artery(BA)and vertebral artery(VA)V4 segment;extracranial arteries include common carotid artery,carotid sinus,internal carotid c1-c2 segments and vertebral artery v1-v3 segments.The anterior circulation arteries includes anterior cerebral artery(ACA),middle cerebral artery(MCA)and internal carotid artery(ICA).Posterior circulation arteries includes posterior cerebral artery(PCA),vertebral artery(VA)and basilar artery(BA).According to the degree of cerebral vascular stenosis,the patients were divided into four groups: non-stenosis group,mild stenosis group,moderate stenosis group,severe stenosis group and occlusion group.The distribution and severity of atherosclerotic stenosis in the intracranial and extracranial arteries of all patients with ischemic stroke were analyzed;The risk factors of cerebral atherosclerotic stenosis,such as age,gender,smoking history,drinking history,hypertension,diabetes,hyperlipidemia,hyperhomocysteinemia and coronary heart disease were analyzed.Multi-factor logistics regression analysis was applied to analyse the risk factors of intracranial and extracranial vascular stenosis in patients with ischemic stroke.Results:Of the 2434 patients enrolled in the study,1958(80.4%)patients were found to have intracranial and extracranial atherosclerotic stenoses,814(33.4%)patients had simple intracranial stenosis,297(12.2%)patients had simple extracranial stenosis,and 847(34.8%)had both intracranial and extracranial stenoses.Therefore,intracranial atherosclerotic stenosis was more common than extracranial stenosis,while the prevalenceof both intracranial and extracranial stenoses was the highest(P < 0.05).In these patients,there was a total of 5,352 arterial stenosis lesions,3,656(68.3%)stenosis foci were located at the anterior circulation arteries(ACA),1,696(31.7%)located at the posterior circulation arteries(PCA),and 952(17.8%)located at the middle cerebral artery(MCA).The result of multivariate chi-square test found that the male,age,smoking,drinking,hypertension,diabetes,hyperhomocysteinemia,and coronary heart disease were the risk factors of intracranial and/or extracranial atherosclerotic stenosis.When compared to the non-stenosis group,the result of multivariate logistic regression analysis found that hypertension and diabetes were the independent risk factors for intracranial stenosis;male,hypertension,diabetes and old age were the independent risk factors for extracranial stenosis;and male,hypertension,diabetes,coronary heart disease,middle-aged and elderly were the independent risk factors for both intracranial and extracranial stenosis.Diabetes and coronary heart disease were independent risk factors for anterior circulation artery stenosis.Hypertension and diabetes were independent risk factors for posterior circulation stenosis.male,hypertension,diabetes,middle-aged,and elderly were the independent risk factors for anterior and posterior circulation stenosis.Diabetes was an independent risk factor for all stenosis groups.Conclusions:Intracranial atherosclerotic stenosis is more common than extracranial stenosis in patients with ischemic stroke,anterior circulation stenosis is more than posterior circulation stenosis.The middle cerebral artery is the most common involved vessel.Hypertension is the most common risk factor for intracranial and extracranial atherosclerotic stenosis.The independent risk factors for each stenosis subgroup are different,and diabetes is the independent risk factor of all the stenosis subgroups.