| Objectives: Atherosclerotic stenosis of intracranial and extracranial arteries is an important cause of ischemic stroke,and the distribution and severity of stenosis are closely related to the prognosis of the disease.Different risk factors have different effects on the progression of atherosclerosis.The characteristics of intracranial and extracranial atherosclerotic stenosis are different from those in the plain area due to the residents living in the special ecological environment of low oxygen and low pressure for a long time.The purpose of this study is to evaluate the distribution characteristics of intracranial and extracranial atherosclerotic stenosis in middle and high altitude areas by whole-brain digital subtraction angiography,and to further study the related risk factors.Methods: A total of 290 patients with intracranial and extracranial atherosclerotic stenosis(n=226)or no intracranial stenosis(n=64)confirmed by whole brain digital subtraction angiography(DSA)were retrospectively collected in Department of Neurology,Qinghai Provincial People’s Hospital from May 2017 to February 2021.The specific distribution of intracranial and extracranial atherosclerosis stenosis was sorted out to obtain the distribution characteristics;2.The non-stenosis group was used as the control group,and the clinical basic data of the selected subjects were collected and statistically analyzed to find out the risk factors affecting the occurrence of cerebral artery stenosis in middle and high altitude areas;3.The relevant factors of different intracranial and extracranial artery stenosis sites were compared,and the influencing factors of stenosis sites were further studied.Results: 1.Distribution characteristics: Through the analysis of 226 patients with intracranial and extracranial atherosclerotic stenosis in middle and high altitude areas included in this study,the following conclusions were obtained:(1)There were 71cases(31.4%)in the simple intracranial artery stenosis group,113 cases(50.0%)in the simple extracranial artery stenosis group,and 42 cases(18.6%)in the combined intracranial artery stenosis group.(2)In the intracranial artery stenosis group,there were 110 anterior circulation(65.1%)and 54 posterior circulation(31.9%).In the extracranial artery stenosis group,there were 193 anterior circulation(78.1%)and 54 posterior circulation(21.9%).(3)The most common sites of intracranial artery stenosis were MCA,I-ICA,I-VA,BA,PCA,ACA;The most common sites of extracranial artery stenosis were E-ICA,E-VA,CCA and ECA.(4)There were 48 cases of mild stenosis(28.4%),44 cases of moderate stenosis(26.0%),and 77 cases of severe or occlusive intracranial artery stenosis(45.6%).There were mild stenosis in92(37.2%),moderate stenosis in 41(16.6%),severe or occlusion in 114(46.2%).2.Whether the narrow risk factors:(1)single factor analysis results: compared with no stenosis group(n = 64),a narrow group(n = 226)of white blood cells,neutrophils and monocytes,hemoglobin,glycosylated hemoglobin,CRP,uric acid and apolipoprotein B levels and male,smoking,drinking,hypertension,diabetes,high proportion of Hcy levels were significantly higher,HDL-C,lymphocyte were significantly lower than no stenosis group,the differences were statistically significant(P<0.05,P<0.001);(2)Multivariate Logistic regression analysis showed that the levels of Tibetan,elderly and monocytes,uric acid,HDL-C and apolipoprotein B could significantly affect the atherosclerotic stenosis(P<0.05,P<0.001),and HDL-C was a protective factor for atherosclerotic stenosis(OR=0.009).The higher the HDL-C level was,the probability of stenosis was significantly lower than that without stenosis.3.Influential factors of stenosis site:Multivariate logistics regression analysis showed that monocytes significantly affected the probability of intracranial,extracranial and intracranial artery stenosis;Aging and HDL-C significantly affect the probability of extracranial artery stenosis and intracranial combined extracranial artery stenosis.The probability of stenosis increased with the increase of monocytes and age,but the higher HDL-C,the higher the probability of stenosis was significantly lower than that of no stenosis(P<0.05,P<0.001).Conclusions: 1.Distribution characteristics: the stenosis rate of extracranial vessels in middle and high altitude areas is significantly higher than that of intracranial vessels;The incidence of stenosis in anterior circulation arteries is higher than that in posterior circulation arteries.MCA is the most common site of intracranial artery stenosis.E-ICA is most common in extracranial artery stenosis.2.Risk factors for stenosis: Tibetans are more prone to intracranial and extracranial artery stenosis than Han.With the increase of age,monocytes,uric acid,apolipoprotein B levels and the decrease of HDL-C levels,the prevalence of stenosis gradually increased.3.Factors affecting the site of stenosis: With the increase of mononuclear cell level,the probability of intracranial,extracranial and intracranial artery stenosis also increases;Increased risk of extracranial and extracranial artery stenosis is associated with increasing age and decreased HDL-C levels. |
