Effect Of Intravascular Therapy For Acute Anterior Circulation Ischemic Stroke Of Different Subtypes

Research purpose:Objective to investigate the effect of intravascular therapy in patients with acute anterior circulation stroke and ischemic stroke.Research methods:Seventy-six patients with acute anterior circulation ischemic stroke of different subtypes who were treated with intravascular therapy from February 2017 to January 2019 in the comprehensive stroke center of china-japan union hospital of jilin university were retrospectively included.According to the etiology TOAST typing criteria,it was divided into 55 cases of large artery atherosclerosis stroke(LAA)and 21 cases of cardioembolism(CE).The neurological function recovery of patients at discharge was assessed by the modified Rankin scale(mRS).Patients in the LAA group were divided into 33 patients with good efficacy(mRS score 3)and 22 patients with poor efficacy(mRS score>3)according to mRS score.Respectively to collect demographic data(age,gender)in both groups,past medical history(high blood pressure,diabetes,coronary heart disease,atrial fibrillation,stroke history,smoking history,drinking history),laboratory indexes[glycated hemoglobin(HbA1c),serum homocysteine(Hcy),uric acid(UA),low density lipoprotein(LDL)-L][onset to admission time,clinical data,blood pressure value,preoperative Alberta stroke project early CT scores(ASPECTS),preoperative usnational institutes of health stroke scale(NIHSS)score,intravenous thrombolysis)],surgery related index [anesthesia choice,collateral circulation and occlusion(internal carotid and middle cerebral artery occlusion),the number of bolt,balloon dilatation or stent number,for had spot usage,postoperative blood flow classification(mTICI hierarchical),postoperative NIHSS score],discharge when mRS score,symptomatic intracranial hemorrhage(sICH),hospitalization days,etc.Single factor analysis was used to analyze the differences between the above two groups of patients,and Logistics regression analysis was used to analyze the independent influencing factors of clinical efficacy of endovascular treatment in patients with acute anterior circulation atherosclerotic ischemic stroke.Research results:(1)In 76 patients with anterior circulation ischemic stroke,good vascular recanalization rate reached 93.42% after intravascular treatment;41 patients had good efficacy(53.95%)and 35 patients had poor efficacy(46.05%)after discharge;the incidence of symptomatic cerebral hemorrhage was 9.21% and the mortality was 11.84%.(2)Ualysis showed that patients in the LAA subgroup were more likely to nivariate ansmoke telofaban balloon dilation or stent implantation than those in the CA group(70.91% VS 33.33%,52.73% VS19.05%,34.55% VS 0%),and those in the age group with atrialfibrillation with poor collateral circulation(4/55,7.27%)were less likely to have died of atrial fibrillation than those in the CE group(60.43 11.11 VS 69.61 12.06,10.91% VS 95.24%,20% VS 47.62%,7.27% VS60.43%)23.81%),the differences were statistically significant(P<0.05).(3)LAA subgroup analysis showed that,compared with the less effective group,the proportion of patients with preoperative ASPECTS score(8.54 1.17)and good lateral circulation in the group with better efficacy(90.91%)was higher than that in the group with better efficacy(90.91%).Postoperative mTICI grade(100%)was higher,and the incidence of sICH was lower(0%).The difference between the two groups was statistically significant(P<0.05).(4)Multivariate Logistic regression analysis showed that the degree of collateral circulation opening,postoperative mTICI grading,and the presence or absence of sICH were significantly correlated with the efficacy of endovascular therapy for acute anterior circulation atherosclerotic ischemic stroke.Research conclusion:(1)Intravascular treatment of acute anterior circulation ischemic stroke patients has a high rate of vascular recanalization and good clinical efficacy.(2)Endovascular therapy is also effective and safe for patients with different stroke subtypes of ischemic stroke,but the mortality rate ofCEpatients is higher than that of LAA patients.(3)Collateral circulation and postoperative mTICI grade and sICH are important influencing factors of endovascular treatment in patients with acute atherosclerotic AIS.