Establishment Of A Predictive Model For The Prognosis Of Acute Cerebral Infarction In The Middle Cerebral Artery Territory Treated With Intravenous Thrombolysis

Objective:In this study,magnetic resonance angiography(MRA)was used to evaluate the LMA collateral circulation of patients suffered with acute cerebral infarction who treated with intravenous thrombolysis.The main responsible causes were the stenosis or occlusion in M1-segment of middle cerebral artery.The aim of this study is to explore the correlation between collateral circulation and the prognosis of intravenous thrombolysis,and to establish a predictive model for the prognosis of intravenous thrombolysis.Our results provide a new insight into the treatment guidance for intravenous thrombolysis of acute cerebral infarction in the MCA territory.Methods:We retrospectively reviewed sixty-three patients suffered with acute ischemic stroke who were hospitalized in the department in the fourth affiliated hospital of China Medical University from January 2015 to September 2018.They all had stenosis or occlusion in the M1-segment MCA,and had been treated with intravenous recombinant tissue plasminogen activator(rt-PA)from at department of neurology,fourth affiliated Hospital,China Medical University.The sixty-three patients were divided into two groups: favorable prognosis group and poor prognosis group,according to their mRS scores 3 months after treatment.Baseline data of patients,including age,sex,National Institute of Health stroke scale(NIHSS)at admission,onset to needle time(ONT),risk factors of atherosclerosis and imaging data were collected.The extent of MRA signal that increased in ipsilateral anterior cerebral artery(ACA)and posterior cerebral artery(PCA)was the sign of ACA laterality(ACAL)and PCA laterality(PCAL),and often encountered in patients with MCA stenosis or occlusion.MRA was used to assess the prominent laterality of ACA and PCA,and the sum of ACAL and PCAL scores represented LMA collateral circulation status.Univariate analysis was used to screen the factors related to the prognosis of intravenous thrombolysis,and ROC curve analysis was used to determine the cut-off point of each factor.Finally,the variables with statistical significance in univariate analysis were incorporated into the logistic regression to carry out multivariate analysis.An optimal model for predicting the prognosis of intravenous thrombolysis was established,and the diagnostic value of the model was evaluated.Result:1.In the univariate analysis,the prognostic factors with significantly difference between the two groups were LMA(P<0.001),ACAL(P=0.002),PCAL(P=0.001),NIHSS at admission(P=0.001)and diastolic pressure(P=0.039).The cut-off points for predicting poor prognosis were LMA≤2,ACAL≤1,PCAL≤1,NIHSS>4,DP > 88 mmHg,respectively.However,there was no significant difference in sex,age,systolic blood pressure,mean arterial pressure,onset to needle time(ONT),DWI-ASPECTS,blood glucose,glycosylated hemoglobin,low-density lipoprotein,homocysteine,fibrinogen,uric acid,MCA stenosis grade,history of cerebrovascular disease,history of hypertension,the history of diabetes,coronary heart disease,atrial fibrillation and smoking between the two groups(P > 0.05).2.The optimal logistic regression prediction model was APNcDc.The prognosis could be predicted according to whether P was greater than 0.4663,the prognosis is good.According to the model,the independent factors of the prognosis of intravenous thrombolysis were NIHSS at admission,ACAL and PCAL.NIHSS at admission(OR,28.516;95%CI,3.993 to 203.636;P=0.001)was the independent risk factor,while ACAL(OR,0.084;95%CI,0.017 to 0.410;P=0.002)and PCAL(OR,0.143;95%CI,0.039 to 0.528;P=0.004)were the independent protection factors for the prognosis of intravenous thrombolysis.3.The area under the ROC curve of the optimal prediction model was 0.931(95%CI:0.838-0.980),Youden index was 0.772,sensitivity was 87.50% and specificity was 89.74% and Kappa statistic was 0.766.Conclusions:1.ACAL PCAL and NIHSS at admission were the independent influence factors for the prognosis of acute cerebral infarction in the MCA territory treated with intravenous thrombolysis.2.The optimal logistic regression prediction model for the prognosis of acute cerebral infarction in the MCA territory with intravenous thrombolysis was APNcDc,which had good sensitivity and specificity in predicting the prognosis of intravenous thrombolysis.Our study provided a rational suggestion for the selection of clinical treatment and provide a scientific criterion for the screening of patients with new therapies in the future.