Correlation between the distribution of cerebral artery stenosis and geographic variation in hospitalized patients with ischemic stroke: A multicenter registry study in China / 中国脑血管病杂志

ABSTRACT

Objective To investigate the geographic variation in the distribution and risk factors of cerebral artery diseases in Chinese patients with ischemic stroke. Methods All 9 346 continuously hospitalized patients with ischemic stroke in 20 hospitals from June 2015 to May 2016 were enrolled in j this multicenter study, using carotid ultrasonography and transcranial color-coded sonography/transcranial 1 doppler to evaluate the degree of extra- and intra- cranial arteries stenosis and verifying by CT angiography or magnetic resonance angiography. All patients were divided into the southern group and the northern group by the definition of the Huai River-Qinling Mountains line to compare the differences of the distribution and risk factors of cerebrovascular diseases. Meanwhile, all patients were divided into the lesion group (defined as the degree of stenosis more than 50% ) and the non-lesion group according to the degree of stenosis to compare the differences of baseline data and geographic distribution of cerebrovascular diseases. i Results The 2 561 northern patients and 6 785 northern patients were enrolled in the study. The proportion of patients with more than 50% degree of extra- and intra-cranial arteries stenosis was significantly higher in northern China than that in southern China (33. 1% [2 243/6 785 ] vs. 25. 0% [639/2 561 ], χ2= 57. 295, P <0.01). The proportions of northern patients with more than 50% degree of stenosis located in the extracranial segment of internal carotid artery, vertebral artery, subclavian artery, middle cerebral artery, the terminal segment of internal carotid artery, intracranial segment of the vertebral artery, and basilar artery were higher than those of southern patients (all P <0. 05). The proportion of patients with intracranial artery stenosis was higher than that with extracranial arteries stenosis in both southern and northern patients (χ2=2.790,P =0. 248). The distribution of arterial lesions in the anterior and posterior circulations was significantly different in southern and northern patients (χ2= 13. 433, P = 0. 001). The proportion of anterior circulation arteries stenosis was higher in southern patients than that in northern patients (58.5% [374/639] vs. 50.3% [1 129/2 243]). While the posterior circulation artery stenosis (27.2% [609/2 243]rs. 23.0% [147/639]) and combined anterior with posterior circulation artery stenosis (22.5%[505/2 243 ]vs. 18.5% [118/639]) were more common in northern patients compared to southern patients. Multivariate logistic regression analysis showed that age, male gender, hypertension, diabetes mellitus, family history of stroke, smoking, and obesity were independent risk factors of cerebral artery stenosis ( OR values were 1.006, 1.670, 1.202, 1.176, 1.546, 1.414 and 1. 230, allP<0.05). While living in northern China was an independent risk factor for cerebral arterial stenosis after modifying the aforementioned parameters ( OR = 1. 385, 95% CI 1. 237 -1. 550, P < 0. 01). Conclusion The distribution and risk factors of cerebrovascular stenosis in patients with ischemic stroke were significantly different in the north and south of China.