Clinical Comparative Study Of Mechanical Thrombectomy And Bridging Therapy For Acute Cerebral Infarction With The Antenor Arteries Occlusion

Objective:This study comparatively analyzed the safety and efficacy of mechanical thrombectomy and bridging therapy in the treatment of acute cerebral infarction with the anterior arteries occlusion,and explored the prognostic factors of postoperative hemorrhagic transformation,symptomatic intracranial hemorrhage and the mortality at 90 days after surgery.Methods:From October 2015 to March 2018,A total of 116 patients with acute cerebral infarction were analyzed retrospectively,70 patients in Shanghai Pudong New area people’s Hospital and 46 patients in the second affiliated Hospital of Suzhou University.63 patients were treated with mechanical thrombectomy(MT)and 53 cases with bridging therapy(bridging treatment group).we evaluate the degree of thrombolysis in cerebral infarction(TICI)in cerebral infarction,and compare the incidence of hemorrhage transformation and symptomatic intracranial hemorrhage between the two groups,preoperative ASPECT score,GCS score,NIHISS score before operation and 2 weeks after operation,the modified Rankin scale score(mRS)at 90 days after operation and the mortality at 90 days after operation.Univariate and multivariate unconditioned Logistic regression models were used to analyze the prognostic factors of postoperative hemorrhage transformation,symptomatic intracranial hemorrhage and mortality at 90 days.Results:There was no significant difference in gender,age,previous history(hypertension,diabetes,atrial fibrillation),TOAST classification,glycosylated hemoglobin,blood glucose,triglyceride,total cholesterol,low density lipoprotein,homocysteine,fibrinogen,preoperative NIHSS score,time from visit to the puncture,time from onset to recanalization of patients between mechanical thrombectomy group and bridging treatment group(P>0.05).The preoperative ASPECT score and GCS score of the mechanical thrombectomy group were significantly lower than those of the bridge treatment group(P<0.05),and the time from onset to visit was significantly longer than that of the bridge treatment group(P<0.05).The incidence of postoperative hemorrhage transformation in the direct mechanical thrombectomy group was significantly higher than that in the bridging treatment group(34.9%vs 17.0%),There was significant difference between the two groups(P<0.05),but there was no significant difference in the effective recanalization rate(69.8%79.3%),intracranial symptomatic hemorrhage rate(15.9 vs 7.6%),favorable outcome rate(28.6%vs 35.9%)and mortality at 90 days(22.2%vs 17.0%)in both groups(P>0.05).Conclusions:The clinical efficacy and safety of direct mechanical thrombectomy and bridging therapy for the acute cerebral infarction with anterior arteries occlusion were similar,which needs further randomized controlled clinical trials of the two treatments to verify.Preoperative ASPECT score(<7)was an independent risk factor for symptomatic intracranial hemorrhage after operation.Preoperative ASPECT score(≤7)and symptomatic intracranial hemorrhage were independent risk factors of mortality at 90 days after operation.