Correlative Reseaech On Collateral Circulation In Patients With Symptomatic Severe Intracranial Arterial Stenosis Or Occlusion

Part one Risk factors for collateral circulation in patients with symptomatic severe intracranial arterial stenosis or occlusionObjectiveTo explore the related risk factors of collateral circulation in patients with symptomatic severe intracranial artery stenosis or occlusion.MethodsA total of 163 patients with severe stenosis or occlusion of symptomatic intracranial arteries diagnosed from January 2018 to December 2019 were screened.All patients underwent digital subtraction angiography(DSA)examination within 14 days of admission.DSA collateral compensation classification method,patients were divided into good collateral circulation group(a total of 77 cases)and poor collateral circulation group(a total of 86 cases).The risk factors of cerebrovascular diseases such as hypertension history,diabetes history,smoking history,drinking history,degree of vascular stenosis,blood lipids were collected in the two groups of patients,and the differences between the risk factors related to good collateral compensation and those in the two groups were compared.Multivariate logistic regression analysis was used to explore the risk factors that influence the establishment of collateral circulation,and further explore the relationship between the related factors and collateral circulation and the predictive value.Results1.Multivariate binary classification Logistic regression showed Neutrophil to lymphocyte ratio(NLR)(OR=1.398,P=0.001,95%CI 1.158～1.689)and cholesterol content(OR=1.595,P=0.01,95%CI 1.118～2.276)is an effective predictor of severe collateral arterial stenosis or poor collaterals in patients with occlusion.2.Each increase of NLR indicates that the risk of poor collateral circulation increases by about 1.4 times.Each increase in total cholesterol content indicates that the risk of poor collateral circulation increases by approximately 1.6 times.3.Spearman correlation analysis showed that the size of the collateral score in patients with symptomatic severe intracranial arterial stenosis or occlusion was negatively correlated with NLR(r=-0.509,P<0.001),and with cholesterol content(r=-0.249,P=0.002)was negatively correlated.4.The NLR predicts the AUC of collateral circulation score in patients with symptomatic severe intracranial artery stenosis or occlusion is 0.620,the sensitivity is 66.7%,and the specificity is 61.3%.Part Two Correlation between different collateral circulation states and cognitive function in patients with severe symptomatic intracranial arterial stenosis or occlusionObjectiveTo investigate the relationship between collateral circulation and cognitive function in patients with symptomatic severe intracranial arterial stenosis or occlusion.MethodsFrom the first part,all 59 patients with non-acute stroke and chronic intracranial arterial severe stenosis or occlusion were selected and evaluated by Mini-Mental State Examination(MMSE)and Montreal cognitive function assessment.The scale(Montreal Cognitive Assessment,MoCA)was used to assess the cognitive function of patients,to explore the differences between cognitive function and collateral scores in patients with occlusion and stenosis,and the correlation between the opening of primary collateral circulation and cognitive function.Results1.There were no significant differences in MMSE,MoCA,and collateral scores between the stenosis group and the occlusion group(P>0.05),but there was a significant difference in the concentration of attention in the MoCA score(P<0.05).2.The AComA open group has higher MMSE and MoCA scores than the AComA non-open group.The total MoCA score and abstract thinking score of the two groups are statistically different(P<0.05).3.There were no significant differences in the MMSE,MoCA scores,and cognitive domain scores of each part of MoCA between the PComA open group and the PComA open group(P>0.05).Conclusion1.NLR and total cholesterol levels are effective predictors of poor collaterals in patients with symptomatic severe intracranial artery stenosis or occlusion.2.NLR may have a certain predictive effect on the collateral circulation of patients with symptomatic severe intracranial artery stenosis or occlusion.3.This study found no differences in the cognitive function and collateral status of patients in the severe stenosis group and the occlusion group.4.The opening of the anterior communicating artery in patients with symptomatic severe intracranial artery stenosis or occlusion may have a certain protective effect on cognitive impairment.