Sarshayev Marat, Turdaliyeva Botagoz, Tanbayeva Gulnur, Makhanbetkhan Shayakhmet, Mussabekov Maxat, Davletov Dimash, Maidan Aiman, Berdikhojayev Mynzhylky
"Joint-Stock Company" Central Clinical Hospital, Almaty 050060, Kazakhstan.
Kazakhstan School of Public Health, Kazakhstan's Medical University, Almaty 050060, Kazakhstan.
J Clin Med. 2024 Dec 28;14(1):125. doi: 10.3390/jcm14010125.
Intracranial atherosclerosis (ICAS) is a major cause of ischemic stroke, disproportionately affecting populations with significant vascular risk factors. Although ICAS imposes a considerable health burden, research on this condition in Central Asia remains scarce, especially among the Kazakh population. This study analyzes demographic characteristics, treatment outcomes, and procedural challenges associated with ICAS in 216 patients treated at a single institution. This retrospective study included patients with ≥70% intracranial artery stenosis confirmed by imaging and presenting with ischemic symptoms. All patients underwent angioplasty and stenting with dual antiplatelet therapy (DAPT). Data collected included demographics, comorbidities, stenosis characteristics, procedural details, and outcomes assessed by the modified Rankin Scale (mRS). The median age was 63.5 years (IQR: 57-68.6), and 73.7% were male. Hypertension was the most common comorbidity (98%), followed by ischemic heart disease (58%) and diabetes mellitus (40.9%). Multi-location ICAS was significantly associated with patients over 75 years of age ( = 0.025). Additionally, obesity and stenosis severity greater than 70% showed trends toward significance, with -values of 0.064 and 0.079, respectively. Stenosis predominantly affected the internal carotid artery (54.5%) and vertebrobasilar system (31.6%). The average hospital stay was longer for posterior circulation stenosis (7.1 days) compared to anterior circulation (4.7 days). The periprocedural complication rate was 0.7%, with two deaths attributed to ischemic complications. At follow-up, four patients experienced worsening mRS scores (>2), particularly those with severe stenosis in the basilar artery and M1 segment. ICAS in the Kazakh population is strongly associated with hypertension and aging, with posterior circulation stenosis contributing disproportionately to worse outcomes. The low complication rates highlight the safety of modern endovascular techniques. However, further research is needed to optimize treatment strategies for severe and multi-location ICAS, particularly in Central Asian populations.
颅内动脉粥样硬化（ICAS）是缺血性中风的主要原因，对具有显著血管危险因素的人群影响尤为严重。尽管ICAS带来了相当大的健康负担，但中亚地区对这种疾病的研究仍然很少，尤其是在哈萨克族人群中。本研究分析了在单一机构接受治疗的216例ICAS患者的人口统计学特征、治疗结果和手术挑战。这项回顾性研究纳入了经影像学证实颅内动脉狭窄≥70%且有缺血症状的患者。所有患者均接受了血管成形术和支架置入术，并辅以双重抗血小板治疗（DAPT）。收集的数据包括人口统计学、合并症、狭窄特征、手术细节以及通过改良Rankin量表（mRS）评估的结果。中位年龄为63.5岁（四分位间距：57 - 68.6岁），73.7%为男性。高血压是最常见的合并症（98%），其次是缺血性心脏病（58%）和糖尿病（40.9%）。多部位ICAS与75岁以上患者显著相关（P = 0.025）。此外，肥胖和狭窄严重程度大于70%呈现出显著趋势，P值分别为0.064和0.079。狭窄主要影响颈内动脉（54.5%）和椎基底系统（31.6%）。后循环狭窄患者的平均住院时间（7.1天）比前循环狭窄患者（4.7天）更长。围手术期并发症发生率为0.7%，有两例死亡归因于缺血性并发症。在随访中，四名患者的mRS评分恶化（>2），特别是那些基底动脉和M1段严重狭窄的患者。哈萨克族人群中的ICAS与高血压和老龄化密切相关，后循环狭窄对不良结局的影响尤为突出。低并发症发生率凸显了现代血管内技术的安全性。然而，需要进一步研究以优化针对严重和多部位ICAS的治疗策略，特别是在中亚人群中。
