ABSTRACT
Objective To investigate the influencing factors of the formation of intracranial collateral circulation in patients with anterior circulation chronic occlusion. Methods From January 2015 to December 2017,181 consecutive patients with unilateral internal carotid artery or middle cerebral artery chronic occlusion diagnosed by DSA and admitted to the Department of Neurology,Chinese People′s Liberation Army General Hospital were enrolled retrospectively. According to the American society for interventional and therapeutic neuroradiology/society of interventional radiology ( ASITN/SIR ) collateral circulation grading system, 68 patients were divided into poor collateral circulation group (grade 0-2) and 113 were divided into good collateral circulation group (grade 3-4). After admission,the patients completed the relevant examinations, including blood routine,blood uric acid,blood lipids,and DSA examination. The age,gender,basic diseases (hypertension,diabetes,hyperlipidemia, coronary heart disease, history of previous ischemic stroke) and history of smoking/alcohol of the patients were recorded. The formation of collateral circulation was used as the dependent variable. The factor of P<0. 05 in the univariate analysis was included in the multivariate logistic regression analysis. Results (1) The patients of the poor collateral circulation group were older than those of the good collateral circulation group (61 ± 9 years vs. 56 ± 12 years),and the proportion of hyperlipidemia was higher than that of the good collateral circulation group (26. 5%[18/68] vs. 13. 3%[15/113]). The differences were statistically significant between the groups (all P<0. 05). There were no significant differences in the proportions of gender,hypertension,diabetes,coronary heart disease,ischemic stroke,tobacco and alcohol history between the two groups ( all P>0. 05) . (2) Compared with the good collateral circulation group,the level of high density lipoprotein ( HDL) in the poor collateral circulation group was lower. The differences were statistically significant between the groups (1. 0 ± 0. 2 mmol/L vs. 1. 1 ±0. 3 mmol/L,P<0. 05). There were no significant differences in blood uric acid,triglyceride,cholesterol, low-density lipoprotein,and platelet count levels between the two groups (all P>0. 05). (3) After variable selection,age (from young to old) and HDL (from low to high) as independent variables and the formation of collateral circulation as dependent variables, they were included in multivariate logistic regression analysis. The results showed that increasing age increases the risk of poor collateral circulation (OR,1. 053, 95%CI 1.021-1.085,P <0.05);the elevated HDL level was a protective factor of the formation of collateral circulation (OR,0. 265,95% CI 0. 085-0. 825,P<0. 05). Conclusion With the increase of age,the risk of intracranial poor collateral circulation increases,and the increased HDL level is beneficial to the formation of collateral circulation.
ABSTRACT
Objective To investigate the risk assessment,guiding role,and clinical value of Vaso CT image features for recanalization of vertebrobasilar junction occlusion. Methods From January 2016 to May 2017,14 patients with vertebrobasilar junction occlusion admitted to the Department of Neurology, Chinese PLA General Hospital were analyzed retrospectively. Preoperative cerebral angiography confirmed vertebrobasilar junction occlusion. Vaso CT was used to measure the length of the occluded vessels and vascular direction at both ends. According to these results, the operative risks were evaluated and the recanalization of vertebrobasilar junction occlusion were guided. Results The length of vertebrobasilar junction occlusion was 2. 56-19. 09 mm (mean 4. 5 ± 2. 1 mm) in 14 patients,and 13 of them were treated with the recanalization of vertebrobasilar artery occlusion,the blood vessels of 12 cases were successfully recanalized and stent placement was performed after the recanalization,among them,8 Solitaire stents and 4 Wingspan stents were implanted;One patient did not perform recanalization because of longer length of occlusion (19. 09 mm). All patients operated did not have any perioperative complications, and the neurological symptoms were significantly improved after procedure. Conclusion Vaso CT can accurately determine the surgical risk of the recanalization of vertebrobasilar junction occlusion,and can guide the surgical pathways,reduce the incidence of perioperative complications,and improve the success rate of the operation.
ABSTRACT
Objective To investigate the risk assessment,guiding role,and clinical value of Vaso CT image features for recanalization of vertebrobasilar junction occlusion. Methods From January 2016 to May 2017,14 patients with vertebrobasilar junction occlusion admitted to the Department of Neurology, Chinese PLA General Hospital were analyzed retrospectively. Preoperative cerebral angiography confirmed vertebrobasilar junction occlusion. Vaso CT was used to measure the length of the occluded vessels and vascular direction at both ends. According to these results, the operative risks were evaluated and the recanalization of vertebrobasilar junction occlusion were guided. Results The length of vertebrobasilar junction occlusion was 2. 56-19. 09 mm (mean 4. 5 ± 2. 1 mm) in 14 patients,and 13 of them were treated with the recanalization of vertebrobasilar artery occlusion,the blood vessels of 12 cases were successfully recanalized and stent placement was performed after the recanalization,among them,8 Solitaire stents and 4 Wingspan stents were implanted;One patient did not perform recanalization because of longer length of occlusion (19. 09 mm). All patients operated did not have any perioperative complications, and the neurological symptoms were significantly improved after procedure. Conclusion Vaso CT can accurately determine the surgical risk of the recanalization of vertebrobasilar junction occlusion,and can guide the surgical pathways,reduce the incidence of perioperative complications,and improve the success rate of the operation.