Clinical Study Of Over-time Window Endovascular Treatment In Patients With Progressive Stroke Caused By Intracranial Macrovascular Occlusion

Objective:24 hour endovascular treatment is safe and effective for acute ischemic stroke patients with partial anterior circulation macrovascular occlusion.However,there are occasional case reports on whether intravascular therapy is safe and effective for patients with progressive ischemic stroke and the onset time is more than 24 hours,but no multicenter big data study has reported.The purpose of this study was to compare endovascular therapy with medical drug therapy in patients with progressive stroke who had exceeded the time window for 24 hours,and to analyze the therapeutic effect and safety of the two groups.Methods:Consecutive patients with over-time window progressive stroke who were treated in our pawn center from January 2016 to December 2019.According to whether they were treated with endovascular therapy or simple drug therapy,they were divided into endovascular treatment group and drug group.The patients in the endovascular treatment group were treated with internal medicine combined with endovascular therapy,and the patients in the drug group were treated with internal medicine.The general information,clinical data and imaging data of the two groups were collected.The baseline data,the rate of good 90 day prognosis(m RS≤2),symptomatic intracranial hemorrhage,90 day mortality and the incidence of adverse events were compared between the two groups.Results:This study included 58 patients with progressive stroke,of which 19patients received the endovascular treatment group and 39 patients received the control group.(1)There was no significant difference in baseline data between the two groups of patients such as age,gender,diabetes,hypertension,hyperlipidemia,smoking,admission NIHSS score,symptom-exacerbated NIHSS score,m RS score≤2 on admission,occlusion site,and ischemic core volume(P>0.05).(2)The good prognosis rate(m RS score≤2)of patients in the endovascular treatment group after 90days was significantly higher than that of the drug group(68.4%VS 38.5%,X~2=4.592~a,P=0.032);The 90 day NIHSS score of the endovascular treatment group was lower than the drug group and the difference was statistically significant(3.3%±2.6 VS 5.2±3.0,P=0.023).In addition,at 90 days,the proportion of patients with a Barthel index of 90-100 in the endovascular treatment group was 53.0%,and the drug group was 25.6%,and there was statistical significance between the two groups(P=0.042).The recanalization rate(TICI≥2b)in the endovascular treatment group was 89.5%.(3)No symptomatic intracranial hemorrhage and 90 day death occurred in the two groups of patients;At 90 days of follow-up,the incidence of adverse events in the two groups was 20.8%and 17.9%,respectively.Conclusion:In patients with intracranial macrovascular stenosis or occlusion after 24 hours of stroke onset and progressive symptoms or after active drug treatment,endovascular therapy is more beneficial to the recovery of clinical neurological function in 90 days than medical therapy alone.Vascular recanalization and stent implantation may be a safe and feasible treatment.