Abstract:Aim To investigate the influence of the intracranial collateral circulation on the short-term prognosis of symptomatic carotid artery stenosis after carotid artery stenting(CAS). Methods 111 patients with extracranial carotid artery stenosis were treated with stent in our hospital, the collateral circulation of patient and their rate of events at clinical end point during follow-up period were compared and analyzed. Results The patients in good collateral circulation group was 53, and in poor collateral circulation group was 58; Good collateralization was more frequently associated with serious ipsilateral ICA stenosis (≥90%), and was more obvious with the development of the anterior communicating artery (ACoA), leptomeningeal collaterals(LC)(P＜0.05) and had negative correlation with diabetes (P＝0.036); There were 2 patients with cerebral hemorrhage after CAS, and all of them were in good collateral circulation group; All patients were followed up for 1 year,and 3 cases of recurrent cerebral infarction were in poor collateral circulation group; The scores of NIHSS and mRS in good collateral circulation group were significantly lower than those of poor collateral circulation group before and after 1 year. Conclusion Good collateral circulation can improve the neurological function of symptomatic carotid stenosis patients, and may be a protective factor for ipsilateral stroke during clinical follow-up.

Abstract:Aim To investigate the relationship between fragmented QRS wave (fQRS) of the classification of coronary collateral circulation and the improvement of heart function after percutaneous coronary intervention (PCI) in patients with chronic total occlusion. Methods 245 cases of occlusion patients were included from January 2013 to December 2016 in Shengjing Hospital of China Medical University, to statistically analyse the biochemical indexes, electrocardiogram, interventional data, Rentrop classification of collateral circulation, preoperative and postoperative heart function. Patients were divided into fragmented QRS group (fQRS group, n＝108) and no fragmentation of QRS group (nfQRS group, n＝137) according to the state QRS wave in electrocardiogram, to analyse the difference of fQRS wave, classification of collateral circulation, and the improvement of heart function in 6 month and 1 year after the operation in the two groups. Results The level of collateral circulation in patients of fQRS wave was higher than the nfQRS group, the ventricular ejection fraction and 6 minutes walk test distance were increased after PCI treatment in the two groups of patients, but the left ventricular end diastolic volume index and the brain natriuretic peptide were decreased, the above index change more significantly in fQRS group compared to nfQRS group, the difference was statistically significant, and the collateral circulation classification and the improvement of heart function were positively correlated. Conclusion In coronary chronic total occlusion patients, fQRS was positively related to classification of collateral circulation, percutaneous coronary interventional therapy can improve heart function in patients with chronic total occlusion, and the heart function in patients with fQRS were improved obviously.

Abstract:Aim To research the clinical significance of red blood cell distribution width(RDW) and mean platelet volume(MPV) on the formation of coronary collateral circulation(CCC) in patients with non-ST segment elevation myocardial infarction. Methods 166 patients with non-ST segment elevation myocardial infarction from Department of Cardiology of Nanyang Central Hospital and Henan Provincial Peoples Hospital were divided into impired group(n=98) and CCC good group(n=68) according to retrop classification method for grading CCC. RDW and MPV value were measured by automatic blood cell analyzer. Results RDW values were significantly higher in patients with impaired CCC than that in those with good CCC(18.20%±1.83% vs 13.17%±0.84%, P<0.05),and MPV values were observably lower in patients with impaired CCC than that in those with good CCC(8.16±1.22 fl vs 11.31±1.34 fl, P<0.05). In multivariate logistic regression analysis, high RDW, low MPV, high creatine kinase isoenzyme-MB(CK-MB), absence of preinfarction angina were closely related with impaired CCC. Conclusion In non-ST segment myocardial infarction, high RDW, low MPV, high CK-MB, absence of preinfarction angina were found to be independent predictors of impaired CCC.

Abstract:Aim To investigate the effect of rosuvastatin therapy,including duration of treatment,on coronary collateral growth in patients with advanced coronary artery disease.Methods Study population consisted of 395 （299 men,with the mean age of 65±15 years） consecutive patients who have undergone clinically indicated coronary angiography and had at least one major coronary artery stenosis of ≥95%.Coronary collaterals were graded from 0 to 3 according to the Cohen–Rentrop method and patients with grade 0～1 collateral development were regarded as having poor collateral and patients with grade 2～3 collateral development were regarded as having good collateral.Clinical data including gender,age,clinical manifestation,history of hypertension,diabetes mellitus,myocardial infarction（MI）,coronary artery bypass grafting（CABG）,somking,statin and other medicines,serum lipid level and so on.SPSS 16.0 and multivariate logistic regression were performed to statistic analysis.Results Patients with good collateral score were on rosuvastatin therapy （P<0.01）,and were more likely to have stable angina pectoris as clinical presentation（P<0.01）,and have multivessel disease（P<0.05）.Rosuvastatin therapy for less than 3 months had no effect on collateral development （P0.11） however,patients who were on statin therapy for more than 3 months had significantly better collateral（P0.003）.Diabetes mellitus was the only negative predictor for coronary collateral formation（P<0.05）.Conclusion Rosuvastatin therapy （＞3 months）,stable angina pectoris and having multivessel disease are associated with enhanced coronary collateral development in patients with advanced coronary artery disease.

Abstract:Aim To explore the clinic,neuroimage and cerebrovascular hemodynamics changes in patients with chronic progressive occlusion of middle cerebral artery stem.Methods Seventy five patients with middle cerebral artery stem occlusion were measured by MRI,CT and transcranial Doppler.Results Sixty five patients(86.7%)presented cerebral ischemic symptom and sign.Seventy patients(93.3%) showed different cerebral infarction in MRI or CT.The hypoperfusion watershed infarct and lacunar infarct were most common.The blood flow velocity of occlusion side middle cerebral artery sample depth remarkably reduced in 60 patients(80.0%).Seventy patients(93.3%)showed blood flow velocity compensative acceleration of the occlusion side anterior cerebral artery.Forty five patients(60.0%) showed blood flow velocity compensative acceleration of the occlusion side posterior cerebral artery.Conclusions For patients with chronic progressive occlusion of middle cerebral artery stem,transcranial Doppler and neuroimage might help to evaluate the patient condition and prognosis,they might be important and objective index in understanding the compensative state of collateral circulation and in studying deeply the pathologic mechanism of ischemic cerebrovascular disease.

Abstract:Aim To investigate the coronary artery lesion characteristics and its clinical implications in patients with acute non-ST-segment elevation myocardial infarction(NSTEMI).Methods 83 patients with acute NSTEMI and 109 patients with acute ST-segment elevation myocardial infarction(STEMI)were enrolled in the study with complete clinical and coronary angiographic data.Comparative analysis was done between the two groups,according to the following aspects such as the number of diseased coronary vessels,the coronary artery stenosis degree,the formation of collateral circulation and the part of clinical features.Results Patients of NSTEMI had less single branch lesions than patients of STEMI,there was a significant difference between them(p<0.05);Three branch lesions in NSTEMI group were more than that in STEMI group,significant difference was found(p<0.05);coronary artery lesions were more than that in patients of STEMI when stenosis degree was not less than 90%,but less in NSTEMI group when stenosis degree was less than 90%,they both have significant differences(p<0.05);cases of total coronary occlusion were similar between the two groups(p>0.05);collateral circulations above grade TIMIⅡ were more likely to see in the patients of NSTEMI,significant difference was also found(p<0.05).All the above coronary artery lesion characteristics decided the clinical features of patients with NSTEMI:the case history of previous angina pectoris and old myocardial infarction occurred more commonly(p<0.05);the peak value of CK-MB was obviously lower(p<0.01);serious acute complications such as acute pulmonary edema,cardiogenic shock and fatal arrhythmia were also remarkablely lower(p<0.05).LVEF,the mortality of patients with coronary heart disease being followed up for 3 years and patients among the hospitalization period showed no significant difference between the two groups(p>0.05);but the postinfarction angina pectoris increased obviously in NSTEMI group than that in STEMI group(p<0.05).Conclusions Complex coronary artery lesions,multiple-vessel lesions and severe stenosis,also the existed ischemic preconditioning before attack and collateral circulations were more evident in patients with acute NSTEMI,this is the main reason the non-ST-segment elevation myocardial infarction came into being and that decided the clinical features of patients with acute NSTEMI.

Abstract:Aim There is a growing evidence showing that asymmetric dimethylarginine (ADMA) and intercellular adhesion molecule-1 (ICAM-1) are markers of endothelial dysfunction and the degree of coronary collateral circulation in subjects with severe coronary artery stenosis is attributed to endothelial injury. In the present study, we examined the serum levels of ADMA and ICAM-1 in patients with severe coronary artery stenosis and furthermore to investigate the correlation between the serum levels of ADMA and ICAM-1 with the degree of coronary collateral circulation. Methods 85 patients at least with the stenosis of one vessel >95% among three main vessels of coronary artery were consecutively enrolled in the study according to angiographic estimation in our hospital from June to November in 2005. Development of collaterals was classified by Rentrops method. According to the collateral degree, patients were divided into two groups (poorly developed collateral group: 50 patients with grade 0 and 1; well-developed collateral group:35 patients with grade 2 and 3). The levels of ADMA and ICAM-1 were also determined. Results Compared with patients with poorly developed collateral group, the levels of ADMA of patients with well developed collateral group were significantly decreased (2.23±0.59 μmol/L vs 1.79±0.57 μmol/L, P=0.001). Similarly, the levels of ICAM-1 were also markedly reduced (272.4±68.3 μg/L vs 225.0±61.9 μg/L,P=0.002). Conclusions the present data suggest that poor collateral circulation is related to elevated levels of ADMA and ICAM-1 in patients with severe coronary artery stenosis.

Abstract:Aim To investigate the relationship between serum concentration of basic fibroblast growth factor(bFGF) and coronary collateral circulation(CCC) and the severity of atherosclerosis. Methods 80 patients with severe coronary stenosis were recruited.The CCC were rated by Rentrop rating system: rate 0(n=26),rate 1(n=22),rate 2(n=18),rate 3(n=14).Serum concentrations of bFGF were measured by ELISA,and the severity of coronary artery atherosclerosis was evaluated by Gensinis score system. Results The serum concentrations of bFGF were 20.75±6.89 ng/L,22.04±5.18 ng/L,27.32±6.14 ng/L and 32.27±12.04 ng/L in patients with CCC rate 0,1,2 and 3 group respectively.The serum concentrations of bFGF was increased with CCC rating(p<0.05).Spearman corelation analysis demonstrated that there was a positive correlation between CCC rating and the serum bFGF concentrations(p<0.01). Conclusions In patients with severe coronary artery disease,serum concertrations of bFGF in groups with better CCC formation were significantly higher than those in groups with bad CCC formation.Serum bFGF concentrations showed a positive correlation with the rating of coronary collateral circulation formation.

Abstract:Aim To assess collateral compensative capacity in patients with artery occlusion of internal carotid artery system. Methods In 213 patients with artery occlusion of internal carotid artery system,collateral circulation pathway was measured by transcranial doppler(TCD).Results With extracranial internal carotid artery occlusion,TCD showed ophthalmic artery collateral pathway(OA) in 58%,anterior communicating artery collateral pathway(ACoA) in 93%,and posterior communicating artery collateral pathway(PCoA) in 60% of patients.With distal internal carotid artery occlusion,TCD showed OA in 15%,ACoA in 51%,and PCoA in 61% of patients.In all middle cerebral artery stem occlusion,TCD showed leptomeningeal anastomoses collateral pathway,blood flow velocity compensative acceleration of the lesion side anterior cerebral artery in 91%,blood flow velocity compensative acceleration of the lesion side posterior cerebral artery in 9% of patients.Absent collateral flow was found in 15 patients(7%).The study found 108 patients(55%) with 1 collateral pathway,79 patients(40%) with 2 collateral pathway,and 11 patients(5%) with 3 collateral pathway.Conclusions TCD might further help to know the collateral compensative capacity of patients with artery occlusion of internal carotid artery system.It was suggested that TCD might be an important and objective index in evaluating the treatment effect and the prognosis.

Abstract:Aim To investigate the association between vascular endothelial growth factor (VEGF) and the severity of coronary lesions as well as coronary collateral development in patients with coronary heart disease. Methods The concentration of VEGF was measured by enzyme linked immunoserbent assay (ELISA) in 102 patients with angiographically documented coronary heart disease and 43 normal persons without any angiographically detectable coronary artery disease. The coronary artery score was recorded according to Leaman and the coronary collateral class was made according to Rentrop. The relationships between plasma VEGF and Leaman coronary artery score as well as coronary collateral circulation were assessed. Results The level of coronary artery plasma VEGF was obviously higher in the coronary disease group than in the control group (225±147 ng/L vs 74±52 ng/L ,p<0.01), and the mean VEGF was higher in coronary disease patients with collateral circulation than in patients without collateral circulation (299±152 ng/L vs 202±122 ng/L, p<0.01). The concentration of plasma VEGF was positively related to the Leaman score (r=0.693, p<0.001). Conclusions The plasma VEGF had correlation to both the severity of coronary stenosis and coronary collateral circulation in patients with coronary heart disease. VEGF might enhance collateral circulation development and doubly regulate the development of atherosclersis.