Intracranial arterial stenosis on diagnosis and treatment

[Abstract] severe intracranial artery stenosis is the main reason for acute ischemic stroke. While less frequent warning signs of intracranial stenosis lesion symptoms, most patients do not appear directly caused by TIA complete stroke, requiring more active and effective diagnosis and treatment. This paper lists the most commonly used primary diagnosis of intracranial arterial stenosis method, and the status of intracranial arterial stenosis were described in detail.

[Keywords:] intracranial arterial stenosis, stroke, diagnosis, intervention

Acute stroke [1] (Stroke has a high incidence, high morbidity, high mortality and high recurrence rate, and ischemic stroke (cerebral thrombosis, cerebral embolism is the main type of ischemic cerebrovascular disease incidence hemorrhagic cerebrovascular disease is far higher than the study found that in 70% of cerebrovascular disease of ischemic cerebrovascular disease, ischemic cerebrovascular disease is mainly caused by cerebral vascular stenosis or occlusion in all ischemic stroke patients, 8% to 10% were due to intracranial arterial stenosis caused by atherosclerosis, because the race difference. the distribution of atherosclerosis, there are big differences. intracranial atherosclerotic stenosis is the stroke patients in Asia important reason [2], accounting for 33% of patients constitutes the cause ~ 51%. explore the effective treatment of intracranial artery stenosis is of clinical cerebrovascular disease, one of the hot area of ​​Research.

A major intracranial artery stenosis diagnosis
1.1 DSA (Digital Subtract Angiography, DSA: DSA can show intracranial blood vessels from the neck to the entire vascular tree, and can be dynamically observed in the vascular contrast agent through the process, and after being through the subtraction lateral skull affected by small blood vessels clearly visible so far the diagnosis of intracranial arterial stenosis DSA is the most reliable means.

1.2 Magnetic resonance angiography (Magnetic Resonance Angiograph, MRA: MRA [3] The imaging is still based on the flow of blood and brain tissue signal difference obtained. MRA is based on the diagnosis of intracranial vascular tree asymmetry to vascular obstruction, but the MRA limited by the resolution, can not observe the small lumen of the exception. application of cerebral venous and sinus MR venography method can be found in vascular obstructive disease. artery plus two-dimensional MRA "pre-saturation" technique that allows intracranial venous system display, easy-to-find AVM draining veins and venous sinus thrombosis.

1.3 transcranial Doppler (Transcranial Doppler, TCD: Doppler ultrasound to detect the end of major intracranial arterial hemodynamics and blood physiological parameters of a non-invasive method of examination of cerebral vascular disease, mainly in the blood flow velocity to assess the level of blood flow, due to cerebral artery in cerebral blood vessels under the same circumstances is almost fixed diameter is relatively constant, according to cerebral blood flow velocity decreased or increased regional cerebral blood flow can be speculated that the corresponding changes. TCD As a non-invasive examination methods, now widely used in various vascular diseases, inspection, to check changes in cerebral blood flow in patients with mental illness Research literature on its main drawback is the operator can not see the intracranial blood vessels The course and blood vessels and the angle between the ultrasound beam, reducing the blood flow velocity accuracy of repeated measurements.

1.4 CT angiography (Computed Tomography Angiography, CTA): The diagnosis refers to intravenous injection of iodine contrast agent. The use of spiral CT or electron beam CT, in subjects with vascular contrast agent filling the peak of the continuous thin volume scan, then after computer for image processing. three-dimensional reconstruction of vascular images. CTA clearly shows that Willis arterial circle. And the brain before, during and after the artery and its major branches. Occlusion type of vascular disease can provide important diagnostic evidence.

2 Current treatment of cerebral artery stenosis
Treatment of intracranial stenosis is the main non-drug treatment and drug treatment.

2.1 Drug therapy: drug therapy has two main aspects. One is to find and remove the risk factors due to intracranial stenosis is the primary cause of atherosclerosis hardening of beech, so look to find the removal of atherosclerotic risk factors including hypertension, diabetes, smoking, excessive drinking, high homocysteine, etc. The second is the use of probucol (probucol, aspirin (aspirin or other anti-platelet and statin (statins. The drawback is that medical anticoagulation, antiplatelet therapy is often not achieve control of the role of stroke attack. Links to free download http://www.hi138.com 2.2 Non-drug treatment: non-drug treatments include surgery and percutaneous transluminal angioplasty (PTA.

2.2.1 Surgery: mainly refers to the extracranial - intracranial arterial anastomosis. The use of the technology can be extracranial external carotid artery or other arterial blood directly to the blood supply to ischemic brain tissue, mainly in the superficial temporal - middle cerebral artery, superficial temporal artery - posterior cerebral artery, middle meningeal artery - middle cerebral artery anastomosis that can increase cerebral blood flow and improve nerve function. Increase in cerebrovascular reserve capacity. Thus increasing the recurrence of cerebral infarction of brain tissue tolerance. The drawback is that brain surgery - vascular anastomosis and extracranial endarterectomy by many factors, higher risk.

2.2.2 intervention: Clinical studies have shown that no matter whether to accept medical treatment of intracranial atherosclerotic stenosis have a higher stroke risk, so require more active intervention. At home and abroad have confirmed the considerable coverage intracranial angioplasty and effective control of security, suggesting that intracranial atherosclerotic stenosis of the recent intervention is effective, although there will be such as thrombosis, vascular dissection, rupture, dissection, restenosis, or death other complications, but as long as strict indications. select the appropriate cases, materials and methods. and adequate preoperative hemodynamic evaluation, it is possible to obtain more satisfactory results.

Cerebral artery stenosis in a large surgical injury, and the deep cerebral artery stenosis is difficult to implement, therefore, endovascular treatment is the best method of treatment [5] on the cerebral artery stenosis of endovascular treatment or methods for more than more mature is the extracranial carotid and vertebral artery stenosis in the hospital conditions, the intracranial cerebral artery stenosis can also be endovascular treatment of cerebral artery stenosis endovascular treatment plant currently is basically the use of stents into the surgery, the use of flexible stents prop open the arteries to narrow.

During cerebral angiography and endovascular treatment, patients need blood routine, blood coagulation, liver and kidney function, and the need for ECG and iodine allergy test, still need to preoperative fasting. Stent implantation in the general proposition 3d at least should be given before the anti-platelet therapy, oral aspirin or clopidogrel. postoperative intensive care unit to be observed in about 24h. stent implantation in patients need to continue antiplatelet therapy.

In the intraoperative and postoperative, patients may have very few complications, including: puncture site infection, hematoma, femoral artery fistula and vascular dissection, carotid sinus response, ischemic stroke, cerebral hemorrhage, vascular restenosis so long as adequate preoperative preparation, strictly indications and contraindications, surgery careful operation, after careful observation and timely treatment can reduce complications.

References
[1] Wang Yilong, Wang Yongjun, Wu enemy, and so on. Chinese Stroke Prevention Research [J]. Chinese Journal of Stroke. 2007,2 (1) :20-37.

[2] Tao Qingling. Sun Zhi. Zhao Hui, et al. Intracranial artery stenosis stenting and medical treatment efficacy [J]. Journal of Neurosurgery, 2006,21 (4) :233-235.

[3] Wang Wu, Zhang Xuezhe. Magnetic resonance angiography, the Sino-Japanese Friendship Hospital ,1999,10:360-361
[4] Liu W, Deng Yuping, Luo Weiliang, intracranial artery stenosis stenting of the value of the Chinese Journal of Practical Medicine, 2009,6 (4) :15-16 Links to free download http://www . hi138.com