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OBJECTIVE: To investigate the distribution of atherosclerotic steno-occlusive lesions in Chinese patients with ischemic cerebrovascular disease and the risk factors for occlusive lesions of intracranial and extracranial arteries. METHODS: 583 consecutive patients with ischemic cerebrovascular disease, 449 males and 134 females, aged 18-86, 415 with cerebral infarction and 168 with transient ischemic attack (TIA), underwent angiography. The angiographic findings and relevant clinical; data were analyzed. RESULTS: Fifty of the 583 patients had normal findings in angiography and 527 had occlusive lesions of different degrees, among which 24.3% had only extracranial artery disease (EAD), 36.8% had only intracranial disease (IAD), and 38.9% had both EAD and IAD. In total the incidence of IAD was 75.6%, higher than that of EAD (63.2%). In the carotid TIA patients the percentage of IAD was significantly higher than that of the EAD (P = 0.005), and in the cerebral infarction patients the percentage of IAD was higher than that of the EAD, but now significantly. In the patients with TIA of vertebrobasilar artery the incidence of IAD was significantly higher than that of the EAD (P < 0.01). The proportion of pure IAD alone was high in patients aged < or =40 was 75.5% with the middle cerebral artery as the most frequently involved site, while the proportion of coexistence of IAD and EAD was high in the middle-aged and old-aged groups (39.4% and 48.0% respectively, P < 0.001) with the origin of internal carotid artery as the commonest site of lesions. Multivariable Logistic regression identified age, diabetes, hyperlipidemia, and coronary artery disease as the independent risk factors for EAD, and hypertension, diabetes, and hyperlipidemia for IAD. The patients with EAD were significantly elder and had an increased frequency of coronary artery disease compared with those with IAD. CONCLUSION: In general, the morbidity of IAD was higher that that of EAD in the Chinese patients with ischemic cerebrovascular disease, and presents symptoms of both extracranial and intracranial arteries; however, pure EAD is not uncommon. The distribution pattern of occlusive disease differs among different groups of patients. The patients with EAD are often elder and have an increased frequency of coronary artery disease.

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OBJECTIVE: To discuss the benefits and complications of percutaneous transluminal stenting for stenosis of internal carotid artery (ICA). METHODS: 355 patients with ICA stenosis were included from 1997 to 2003. All of them took periprocedual anticoagulation treatment, cerebral vascular angiography and cervical Doppler sonography. 72 patients used cerebral protection of filter devices. Among the 283 patients without cerebral protection 202 patients (71.38%) underwent predilation, 66 patients (23.32%) underwent postdilation; and 3 patients underwent neither. RESULTS: The heart rates of 25.0% of all the patients decreased. Dislocation of microemboli happened in 5 patients. 2 of them improved after treatment. 3 of them got dyskinesia of one side. 2 patients (0.56%) died of intracerebral hemorrhage (ICH). 256 patients (84.77%) turned for the better. 260 patients (73.34%) were followed up. Restenosis occurred in 11 patients (4.23%). CONCLUSION: Percutaneous transluminal stenting for stenosis of internal carotid artery is safe if proper periprocedual treatment and operative procedure are taken. However, enough attention should be paid to the occurrence of ICH resulting from over-flow after operation.

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OBJECTIVE: To discuss the safety of intracranial stenting for refractory symptomatic intracranial artery stenosis. METHODS: Forty-eight patients with symptomatic intracranial artery stenosis were treated by transluminal stent-assistant angioplasty. Of them, 40 cases were selected because they had recurrent TIAs or mild stroke despite of antiplatelet or anticoagulation therapy; 8 cases with high-grade stenosis after acute cerebral artery theromblysis. Lesions involved MCA (17/48); Basilar artery (8/48); intracranial vertebral artery (18/18); and distal ICA (5/18). RESULTS: For 46 of 48 cases the flexible coronary stent were successfully deployed. The average stenosis reduced from 83% to 5%, short-term follow-up showed good clinical improvement. Complications include vessel rupture (1/18); acute thrombosis within stent (1/48); perforation of cortical artery (1/18) and perforate vessel occlusion (1/18). CONCLUSION: Stent-assistant angioplasty are effective for treatment of symptomatic intracranial stenosis, the higher rate of complications may be because of the limited experiences of this technique. it need further practise and long term follow-up study.

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OBJECTIVE: To test feasibility, safety and efficacy of combined intraarterial thrombolysis and intra-cerebral stent for acute ischemic stroke. METHODS: From 2001-5 to 2002-8, 19 patients with acute onset of stroke were treated with intraaterial thrombolysis followed by intra-cerebral stent. 9 located in middle cerebral artery (MCA), 10 located in basal artery (BA). For each patient, intraarterial thrombolysis of MCA or BA was applied at first, stent angioplasty was applied at the stenosis left after the thrombolysis by using the stent for coronary artery. RESULTS: All the 19 patients left stenosis after intraaterial thrombolysis, and the average stenosis was 85% in diameter. After the operation of stent, the images showed the vascular is smooth and had no stenosis left. The symptoms were disappeared or improved. Thrombus formation in the stent occurred on 1 patient 24 hours after the operation. TIA never occurred in the left 18 patients then. TCD follow up showed blood flow is normal. CONCLUSIONS: It is feasibility of intraaterial thrombosis followed by intra-cerebral stent. And it is valid for preventing occlusion again of the vessel and decreasing the rate of TIA occurring.

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