脑卒中与颅内颅外血管疾病的关系及干预对策黄
Distribution of arterial stenosis in acute stroke and risk factors
Peking University First Hospital
Department of Neurology
Dr. and Prof. Huang Yining
huangyn@outmail.net.cn
Background
There is high incidence of intracranial arterial stenosis in Chinese stroke patients.
It is assocated with poor outcome in those with arterial stenosis comparing with those without stenosis.
Many risk factors are proved, i.e. age, gender, Hypertension, diabetics.
Question and Purpose
China is a huge country. There are great difference in the geography, life styles, economic development from regions to regions.
Whether the cerebral arterial stenosis is depended on regional distribution?
Whether the stenosis is depended on economic development?
Standard management of acute stroke
10th five year National Project
Sponsored by National Scientific Committee
No：2001BA703B11
A multicenter study
Data and methods
Inclusion criteria
First time of acute ischemic
Admitted in SU and department of neurology
Within 7 days after onset
NIHSS ≧ 5
Involvement of anterior or posterior circulation
Content agreement
Grouping for Statistic analysis
With/ without arterial stenosis
Extracranial group/ intracranial group
Anterior / posterior circulation
Anterior circulation: CCA, ICA, TICA, MCA, ACA
Posterior circulation: Sub A, VAe, VA, BA, PCA
Logistic regression: regions, size of hospitals, age, gender , HTN, DM, LIPID
End-point
Modified Rankin Scale in discharge， and follow-up in month 3 and month 6
good outcome: mRS ? 2
poor outcome: mRS > 2
Results and Analysis
Descriptive statistics of data
1273 cases enrolled
1063 83.5% underwent vascular examination
Age : 61.8±11.0 yrs
Male: 833 (65.4%)
Follow up:
1185/ 1273 ( 93.1%) in month 3
1149/1273 (90.3%) in month 6
Ratio of arterial involvement
568 (53.4%) cases with arterial involvement:
Male: 374 ( 65.8%)
Female: 194 (34.2%)
Stenosis and Economic Development
Classify the hospitals as 3 classes:
Class 1, those from richer regions
Class 2, those from moderate regions
Class 3, those from poorer regions
The patients living in the rich regions had higher incidence of arterial involvement
OR=0.856 ( 95% CI, 0.751-0.976,p=0.040 )
Stenosis and Economic Development
patients in the hospitals of class I is older than in class II and III
Class I age= 62.55±11.19 yrs
Class II age= 60.47±12.10 yrs
Class III age= 60.72±10.55 yrs
Between groups (ANOVA): F=4.367 p=0.013
CONCLUSIONS
Living environment is significantly related to the cerebral arterial involvement. The patients living in relatively “rich regions” suffered from higher incidence of arterial stenosis. It is independent on age, gender, HTN, DM, or Lipid profile.