Analysis Of Prognostic Factors Of Mechanical Thrombectomy For Acute Ischemic Stroke With Large Vessel Occlusion

Background:Stroke is characterized by high morbidity,high mortality rate,high disability rate,high recurrence rate and high treatment cost.It is a major social health problem in the world at present and has caused serious medical burden.Among them,acute ischemic stroke accounted for the vast majority,accounting for about 69.6%～70.8%of stroke.Acute ischemic stroke(AIS)is a group of disease that cause cerebral ischemia and hypoxic necrosis due to various causes of cerebral vascular occlusion.The most common cause of AIS was large vessel occlusive stroke,which represented more than 30%of AIS patients with Large vessel occlusive stroke(LVOS).At present,there are many methods to treat AIS,but opening occluded blood vessels as soon as possible and rebuilding blood supply of brain tissue is still the fastest and most efficient treatment means.Mechanical thrombectomy(MT)therapy has attracted attention and been widely used in the treatment of clinical AIS patients because of its advantages of rapid opening of occluded blood vessels.However,the prognosis of patients treated by endovascular mechanical thrombectomy is different,so it is very important to study the influencing factors for the prognosis of mechanical thrombectomy for acute ischemic stroke.Objective:The purpose of this study was to investigate the prognostic factors of mechanical thrombectomy in the treatment of acute large vascular occlusion stroke.Method:From January 2018 to November 2020,96 patients with acute ischemic stroke admitted to Nanchong Central Hospital and Affiliated Hospital of North Sichuan Medical College from were enrolled retrospectively.Based on the specific inclusion and exclusion criteria.After emergency CTA(computed tomographic angiography)or DSA(digital subtraction angiography)assessment,it was confirmed to be a large vessel occlusion,and received endovascular mechanical thrombectomy within 24 hours.According to the 90 days after modified Rankin scale(mRS)score divided the patients into good prognosis groups(0 to 2 points,34 cases)and poor prognosis group(3-6 points,62 cases),compared two groups of general information,laboratory examination and vascular opening and prognosis follow-up of statistical difference,and the single factor analysis was statistically significant parameters in multiariable Logistic regression analysis,to verify the prognostic factors of mechanical thrombotomy in the treatment of acute large vessel occlusion stroke.Results:1.According to the inclusion and exclusion criteria set in this study,96 patients were finally included,and were divided into good prognosis group(n=34 cases)and poor prognosis group(n=62 cases)based on the 90-day mRS of the patients.Two groups of patients with general information expect for age,with atrial fibrillation,the admission NIHSS score,collateral circulation,preoperative ASPECTS score,TOAST classification difference was statistically significant(P<0.05),and there was no statistical significance in gender,smoking history,drinking history,hypertension,diabetes,coronary heart disease,the previous history of ischemic cerebral apoplexy,the admission blood pressure(P>0.05).2.Two groups of patients with laboratory index of red blood cell count,erythrocyte hematocrit(HCT),plasma prothrombin time(PT),calcitonin(PCT)difference was statistically significant(P<0.05),blood sugar,white blood cell count,neutrophils admission/lymphocyte ratio(NLR),total cholesterol,triglycerides,blood homocysteine difference has no statistical significance(P>0.05).3.Comparison of indicators of vascular opening evaluation and prognosis follow-up between the two groups:the time from admission to vascular recanalization,vascular recanalization grade,mortality within 90 days of treatment,and symptomatic intracranial hemorrhage within 24 hours of treatment had statistical significance(P<0.05),while there was no statistical significance in intravenous thrombolysis(P>0.05).4.The 90-day mRS score was taken as the outcome event,the parameter P<0.05 in univariate analysis was taken as the independent variable,and the 90-day mRS score was taken as the dependent variable for multivariate Logistic regression analysis.The results showed that:Atrial fibrillation[OR=4.26,95%CI(1.03-17.62)],the admission NIHSS score increased[OR=1.23,95%CI(1.06-1.42)],and symptomatic intracerebral hemorrhage occurred within 24 hours of treatment[OR=15.12,95%CI(2.69-84.84)]were risk factors affecting the prognosis of mechanical thrombolysis for acute ischemic stroke with large vessel occlusion.Successful recanalization[OR=0.04,95%CI(0.01-0.48)]is a protective factor for the good prognosis of mechanical thrombotomy for acute ischemic stroke with large vessel occlusion.Conclusion:Atrial fibrillation,the admission NIHSS score increased,and symptomatic intracerebral hemorrhage occurred within 24 hours of treatment are risk factors for the prognosis of mechanical thrombectomy for acute large vascular occlusion stroke.Successful vascular recanalization is a protective factor for the good prognosis of mechanical thrombectomy for acute large vascular occlusion stroke.