An interview with Professor Rao DXY experience of collateral circulation in the treatment of ischemic stroke

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Ding Xiangyuan: Professor Rao, Hello, thank you for your interview with Ding Xiangyuan! Stroke is also known as stroke, cerebral blood circu


Ding Xiangyuan: Professor Rao, Hello, thank you for your interview with Ding Xiangyuan! Stroke is also known as stroke, cerebral blood circulation disorders is a sudden onset of the disease. Acute ischemic stroke is the most common type of stroke, the total stroke from 60% to 80%, with high incidence, high mortality and high disability rate of "three high" characteristics, has become the first killer of serious harm to human health. Would you please give us a brief introduction of the epidemiology of stroke in China?

Professor Rao Mingli: Recently we did not do this survey, epidemiological investigation on stroke is about ten years ago, from the survey situation, the incidence rate of stroke is relatively high, probably more than 2 million people each year, the prevalence rate is relatively high, at present there are at least 7 million people or more, every year the mortality rate is at least 1 million 500 thousand, so the stroke is caused by the national Ministry of health very seriously, as a key national disease prevention and control. The country set up prevention and screening group of cerebrovascular disease, head of Chen Zhu, currently in the country have been carried out in this work, we tried to get the stroke as the focus of disease prevention, so as to reduce its incidence rate, disability rate and mortality, more countries reduce medical costs.

Ding Xiangyuan: what are the high risk factors for the disease?

Professor Rao Mingli: now more and more risk factors, according to the present investigation, the risk has more than 300 kinds, risk factors in common or hypertension, diabetes, high cholesterol, heart disease, smoking, obesity and so on, these are the most important and preventable risk factors. Age, sex, and genes are not preventable. We should have a good control over the risk factors that can be prevented.

Ding Xiangyuan: at present, stroke especially acute ischemic stroke has become the medical and public health issue is serious, how to be more effective in the treatment of acute ischemic stroke has plagued many clinicians. What is the clinical treatment of ischemic stroke?

Professor Rao Mingli: ischemic stroke is divided into two parts, one in the acute phase and the other in the chronic phase. Treatment of chronic phase is two level of prevention of disease, acute stroke should be treated actively, the current treatment is to reconstruct the blood circulation, improve brain blood supply, reduce the risk factors, antithrombotic, dehydration, reducing the intracranial pressure, cerebral stroke especially serious to do surgery. Patients with acute phase should be treated with thrombolytic therapy if they are within the time window of thrombolysis (usually 3-4.5 hours, and can be relaxed within 6 hours in China). But the patients thrombolysis is not many, because the patient to the hospital late, Miss thrombolytic time window, on the other hand, the medical staff do not pay enough attention, so some patients have failed to thrombolytic therapy, these patients can be other treatment, including reducing intracranial pressure, improve collateral circulation, protect brain cells, anti thrombus and so on among them, more important is to promote the blood circulation of the brain.

Ding Xiangyuan: at present, the clinical treatment of ischemic stroke in the difficulty?

Professor Rao Mingli: it's time for thrombolytic therapy, which should be better publicized and educated. Thrombolytic therapy in China is relatively small, but the emphasis on the work of the hospital to do more patients, the effect is still very good.

Ding Xiangyuan: "guidelines for prevention and treatment of cerebrovascular disease in China" has clearly pointed out that the recovery or improvement of ischemic areas of blood perfusion is the focus of the entire treatment. At last, the stroke is also techpool pharmaceutical sponsored a new therapeutic strategy in the national tour conference, Professor David S.Liebeskind from University of California at Los Angeles in the United States pointed out that for acute ischemic stroke, "collateral" as to improve cerebral perfusion is an important way, has received wide attention of international scholars and clinicians and recognition. Would you please give us a brief introduction of collateral circulation? And how effective collateral circulation is formed?

Professor Rao Mingli: as early as 300 years ago, Wills in anatomy book wills ring, the circle of Willis, this is the earliest in the anatomical description of relatively complete collateral circulation, namely a collateral circulation, it is very important as the intracranial vascular compensatory collateral circulation. Later, we found that the collateral circulation should be divided into three levels, one level of collateral circulation is a wills ring, it is born, everyone is not the same, there are variations, such as variation between the anterior cerebral artery and anterior communicating artery, wills ring may be complete; the posterior communicating artery also makes the anterior circulation and variation. After the cycle of contact is not good; there are very small or absent posterior communicating artery, posterior cerebral artery directly from internal carotid artery via the posterior cerebral artery, called the embryo, so wills artery ring is not complete, if one side of the brain infarction, the other side of the artery is not good for compensation.

The two level is the collateral circulation between many blood vessels and vascular connections between the artery and intracranial vessels including internal carotid artery and external carotid artery, middle meningeal connection of anterior cerebral artery, posterior cerebral artery and peripheral vascular connections etc.. It is found that the two level collateral circulation plays an important role in the pathogenesis and treatment of ischemic cerebrovascular disease, and is closely related to the prognosis of the disease. Many patients with cerebral vascular stenosis is very serious, angiography showed that the blood vessel is almost completely blocked, but there is no paralysis and other clinical symptoms, this is because he has a good collateral circulation, can be completely compensatory. This is the relationship between collateral circulation and stroke. After stroke, treatment can be achieved by promoting collateral circulation, reducing infarct size and helping patients recover. At the same time, the patients with good collateral circulation have a good prognosis.

The three stage is collateral circulation vessels, the growth of new blood vessels from vascular endothelial cells, also can be treated with vascular endothelial growth factor (VEGF) in addition to promote the formation of new blood vessels, called molecular bypass, which can form more collateral circulation. How to increase VEGF to form better collateral circulation is the target of treating stroke.

Grade two and grade three collateral collateral circulation can promote myocardial infarction better recovery, as a therapeutic target for this drug, now also play a role, such as Yuri Franklin, it was listed in 2005, from basic experiment to clinical application has confirmed that it has a certain effect, its main role is to promote the formation of collateral circulation.

Ding Xiangyuan: what is the significance of collateral circulation in the prevention and treatment of ischemic stroke?

Professor Rao Mingli: collateral circulation is closely related to the prevention and treatment of ischemic stroke. In terms of prevention, the promotion of collateral circulation can reduce the incidence of stroke, in terms of treatment, promote collateral circulation can help patients recover early. We should make good use of this mechanism to prevent and treat ischemic cerebrovascular disease. Studies have shown that patients with severe carotid stenosis, the risk of stroke in patients with good collateral circulation is significantly lower than that of patients with poor collateral circulation. From the point of view of treatment, collateral circulation can affect the efficacy of thrombolytic therapy, the patients with good collateral circulation after thrombolytic therapy recanalization and reperfusion of the situation will be better. In addition, collateral circulation can also affect the size of cerebral infarction and reduce the risk of bleeding after thrombolytic therapy.

Ding Xiangyuan: what are the effects of collateral circulation on the prognosis of patients with ischemic stroke?

Professor Rao Mingli: a good prognosis for patients with good collateral circulation. In the prediction of clinical outcomes, patients with ischemic stroke who received thrombolytic therapy were more likely to have an early neurological improvement and 3 months of life care in patients with complete Willis rings. For patients with acute cerebral infarction caused by intracranial or carotid artery stenosis or occlusion. The DSA can accurately evaluate whether or not the establishment of collateral circulation of patients, so as to judge the prognosis, the prognosis of patients with collateral circulation is better than that without collateral circulation in patients.

Ding Xiangyuan: what are the problems of collateral circulation in ischemic stroke?

Professor Rao Mingli: we also need to look at more of the drugs used in the treatment of stroke, especially in the prevention of early oral administration of oral medications to reduce collateral circulation.

Ding Xiangyuan: what is the prospect of collateral circulation in ischemic stroke?

Prof. Rao Mingli: the treatment is very good. With the development of imaging technology change rapidly, understanding of cerebral collateral circulation will be more in-depth, there is hope to find a better method of intervention of collateral, collateral circulation of ischemic stroke will also become a powerful new means of intervention.

Ding Xiangyuan: Well, thank you again for accepting our interview with Ding Xiangyuan!

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