Clinical Prognosis And Risk Factors Analysis:Intravenous Thrombolysis And Endovascular Treatment Of Acute Ischemic Stroke

ObjectivesBased on the result of the intravenous and arterial thrombolysis and mechanical recanalization, we compare the prognosis of patients treated by these three different methods and analyse the risk factors that affect it after the treatment of acute ischemic stroke.Methods32 patients with acute ischemic stroke who were treated by thrombolysis using the original activator recombinant tissue fibrinolytic enzyme (rtPA) and arterial thrombolysis and mechanical recanalization treatment after onset are selected into retrospective analysis (between 2014.04 and 2015.12 in Qilu Hospital of Shandong University). We divided patients into 3 groups:intravenous thrombolysis group, arterial thrombolysis group and mechanical recanalization group. Every patient’s clinical feature and physical examination of nervous system were in accord with acute ischemic stroke. Each patient (NIHSS≥4)eligible for thrombolysis and without any contraindications of thrombolysis was required to adopt brain CT scan to eliminate the possibility of cerebral hemorrhage and other organic diseases. Patients’blood routine, urine routine, CKMB, CTNI, liver and kidney function, blood glucose, fibrinogen (IFB), prothrombin time (PT) and activated partial prothrombin time (APTT) were not abnormal. Patient’s family also had signed up the informed consent form. We collected the baseline data of each patient including medical history, personal history and results of laboratory inspection. NIHSS 0-1 or the reduction^ 10 is regarded as good outcome after hospital discharge.90 days modified Rankin scale (mRS)≤2 is regarded as good long-term outcome. ANOVA and nonparametric test are used to analyze the difference of baseline data among 3 groups. Chi-squared test is used to analyze the outcomes when patients left hospital and after 90 days. Logistic regression is used to analyze the possible risk factors that may influence the prognosis of AIS patients after thrombolysis and mechanical treatment.Results The mean baseline NIHSS is 13.52±6.01. The mean one-hour NIHSS after treatment is 11.29+7.71. The 24-hour NIHSS after treatment is 9.74±8.01. The median NIHSS after hospital discharge is 3 (1,10). The number of patients having good outcomes after hospital discharge is 8 (32.0%). The number of patients having good outcomes in 90 days is 12 (46.2%). Among 32 patients, mortality is 3 (9%); cerebral hemorrhage is 4 cases (10%). The rate of patients with good outcomes after hospital discharge in intra-arterial thrombolysis group, Solitaire thrombectomy group and intravenous thrombolysis group is 40%,42.9% and 23.1% respectively. The rate of patients with good outcomes 90 days in intra-arterial thrombolysis group, Solitaire thrombectomy group and intravenous thrombolysis group is 50%,50% and 40% respectively. The outcomes of intra-arterial thrombolysis and Solitaire thrombectomy are better than that of intravenous treatment. But there is no statistical significance of this difference. Fibrinogen is one of the risk factors of 90-day outcome, but not a independent risk factor that affect acute ischemic stroke.ConclusionsThe outcomes of intra-arterial thrombolysis and Solitaire thrombectomy are better than that of intravenous treatment. But there is no statistical significance of this difference. The reason may be that the sample size is small. In addition, the mortality and number of cases of cerebral hemorrhage is too small. We cannot analyze the difference of rate of mortality and complications in 3 groups. Fibrinogen is one of the risk factors of 90-day outcome (P<0.05), but not an independent risk factor that affect acute ischemic stroke. The related risk factors influencing outcomes of acute ischemic stroke needs to be detected further more through expand sample size.