Clinical Comparative Study Of Heparination And Non-heparination In The Endovascular Treatment Of Acute Cerebral Infarction

Objective: The purpose of this study is to retrospectively evaluate and compare the impact of heparization and non-heparization on hemorrhagic transformation and clinical prognosis in endovascular therapy for acute ischemic stroke.Methods:This study was analyzed retrospectively of acute ischemic stroke patients from January 2015 to November 2021 who undergoing endovascular therapy in the Stroke Center of Chuxiong People’s Hospital.Heparinized and non-heparinized groups were divided according to the use of intraoperative heparin.The primary outcome was symptomatic hemorrhagic transformation,and the secondary outcomes included vascular recanalization,m RS score at discharge,vascular reocclusion.Results: A total of 116 patients were included in the analysis,including 48 patients in the heparinized group and 68 patients in the non-heparinized group.Heparin untreated patients showed a shorter onset to the end of surgery time（500.00 vs 432.50,P=0.049）.However,the other baseline data did not differ between the two groups.The hemorrhagic transformation rate was 15.5% higher than that the non-heparinized group（47.9% vs.32.4%,P=0.09）,however,the difference was not statistically significant.The rates of symptomatic hemorrhagic transformation（33.3% vs 16.2%,P=0.031）were significantly higher and immediate successful reperfusion（m TICI 2b-3）（83.8% vs 58.3,P = 0.002）were significantly lower in the heparinized group.The rate of vascular reocclusion within 24 hours after surgery and the good functional prognosis at discharge（m RS score 0-2）were similar in the two groups.In the multivariate analysis,symptomatic hemorrhagic transformation was independently associated with heparinization（OR 3.362;95%CI 1.232-9.175;P=0.018）and inversely associated with successful reperfusion（OR 2.760;95%CI 0.998-7.634;P=0.05）,onset to the end of surgery time（OR 0.998;95%CI 0.996-1.000;P=0.061）,preoperative International Normalized Ratio（INR values）（OR 0.240;95%CI 0.029-1.971;P=0.184）,and preoperative Platelet Count（PLT values）（OR 1.006;95%CI 0.997-1.014;P=0.178）.Conclusion: This study demonstrates that heparinization during the Endovascular Treatment may be associated with increased risk of s ICH and is an independent risk factor for s ICH.And intraoperative heparinization treatment may not reduce the occurrence of vascular reocclusion.Therefore,the heparinization treatment should be avoided during the endovascular therapy.