Analysis Of Risk Factors For Hemorrhagic Transformation After Interventional Thrombectomy For Acute Ischemic Stroke

The treatment of thrombectomy is an effective method for the treatment of acute ischemic stroke.However,the complications caused by postoperative hemorrhage seriously affect the prognosis of patients.How to prevent the hemorrhagic transformation after thrombectomy is the focus of current research.In this study,we analyzed the perioperative data of patients undergoing interventional thrombectomy in patients with acute ischemic stroke,and explored the risk factors for hemorrhagic transformation after interventional thrombectomy.The perioperative data of patients with acute ischemic stroke who underwent thrombectomy in our hospital from August 2017 to January 2019 were retrospectively analyzed.According to the postoperative computed tomography(CT)findings,the patients were divided into the postoperative hemorrhage transformation group(HT group)and the non-hemorrhage transformation group(non-HT group).According to previous studies,suspicious risk factors for postoperative hemorrhagic transformation were included.Independent risk factors for interventional hemorrhage after interventional thrombectomy were analyzed by univariate analysis and multivariate logistic regression.The results showed that 55 cases with acute ischemic stroke with age of 56.8±14.1 years old,including 32 male(58.2%)and 23 female(41.8%).Of the 55 cases,23 cases(41.8%)had a history of hypertension,19 cases(35.8%)had a history of atrial fibrillation,7 cases(12.7%)had a history of diabetes,19 cases(34.5%)had smoking history,15 cases(17.3had a history of drinking,and 13 cases(25.6%)had stroke history.There were 11 cases(20.0%)with pre-hospital antiplatelet drugs usage,6 cases(10.9%)with anticoagulant therapy,7 cases(12.7%)with thrombolytic therapy.Patients with general and local anesthesia were 23(41.8%)and 32(58.2%),respectively.There were 21 cases(38.2%)of internal carotid artery occlusion,22 cases(40%)of middle cerebral artery occlusion,1 case(1.8%)of anterior cerebral artery occlusion,10 cases(18.2%)of basilar artery occlusion,and 2 cases(3.6%)of vertebral artery occlusion.During the surgeries,19 patients(34.5%)received tirofiban,45 patients(81.8%)had blood vessel revascularization,15 patients(27.3%)underwent stent placement,and 34 patients(61.8%)had arteriosclerosis confirmed by digital subtraction angiography(DSA).According to the postoperative CT findings,32 patients(58.2%)had postoperative hemorrhage transformation.Univariate analysis: The differences in the number of thrombectomy,the history of atrial fibrillation,and postoperative systolic blood pressure between the HT group and the non-HT group was statistically significant(P<0.05).Multivariate analysis results: the number of thrombectomy(p=0.027,OR=0.453,95%CI 0.224-0.914),the history of atrial fibrillation(p=0.035,OR=4.670,95%CI 1.115-19.560)and the level of systolic blood pressure after thrombectomy(p=0.042,OR=0.959,95%CI 0.921-0.998)were independent risk factors for hemorrhage transformation after thrombectomy in patients with acute ischemic stroke through the multivariate logistic regression analysis.The conclusion of this study is that the number of thrombectomy,history of atrial fibrillation,and postoperative systolic blood pressure are independent risk factors for hemorrhagic transformation after interventional thrombectomy in patients with acute ischemic stroke.