| Objectives 1 To preliminarily explore the impact of thrombectomy techniques on the prognosis of patients with acute ischemic stroke;2 The relationship between the expression of plasma ET-1 and NO and the prognosis before and after various endovascular treatments;3 To analyze whether embolus composition of patients with acute ischemic stroke affects their prognosis.Methods Patients with cerebrovascular disease who were treated with EVT in the North China University of Science and Technology Affiliated Hospital and Tangshan Fengrun People’s Hospital from November 2019 to November 2020 were recruited.They were categorized to stent thrombectomy group and aspiration thrombectomy group based on the performed procedures.Cubital venous blood of each patient was collected before surgery,right after surgery and 6 h and 24 h postoperatively for measuring relative levels of ET-1and NO.Thrombus collected during surgery was sent for histological analysis of the compositions and their quantitative measurement.According to the blood cell ratio in the thrombus,patients were further categorized to red blood cell thrombus group and fibrin/platelet thrombus group.Neurological functions at 7 days postoperatively in stent thrombectomy group and aspiration thrombectomy group,as well as red blood cell thrombus group and fibrin/platelet thrombus group were assessed using the National Institutes of Health Stroke Scale(NIHSS).The long-term prognosis at 90 days of followup was assessed using the Modified Rankin Scale(m RS).Results Plasma1 Compared with the preoperative plasma ET-1 levels between the stent thrombectomy group and the catheter aspiration group(500.32 ± 22.81 pg/m L vs 497.76 ±20.94 pg/m L),and the difference was not statistically significant(P>0.05);The plasma ET-1 levels of both groups indicated an initial increase and followed by a decrease tendency postoperatively,which was higher in the stent thrombectomy group than the catheter aspiration group at each observation time point.The differences of pairwise comparison were statistically significant(P<0.05).However,the plasma ET-1 levels remained higher postoperatively than those 24 h before surgery.2 Compared with the preoperative plasma NO levels between the stent thrombectomy group and the catheter aspiration group(30.86 ± 4.06 pg/m L vs 29.32 ± 2.94 pg/m L),the difference was not statistically significant(P<0.05);The NO levels revealed a tendency from decrease to increase postoperatively in both groups.At each observation time point,the NO levels were lower in the stent thrombectomy group than in the catheter aspiration group.The differences of pairwise comparison were statistically significant(P<0.05).Plasma NO levels basically returned to the preoperative levels 24 h postoperatively.3 The NIHSS scores decreased by 4 points and above in the stent thrombectomy group at 7 days postoperatively compared with those in the catheter aspiration group(38.4% vs 32.0%),and the difference was not statistically significant(P>0.05);The m RS scores decreased by0-2 points in both groups at 90 days postoperatively by comparison(32.9% vs 36.0%)and the difference was not statistically significant(P>0.05);Compared with the patients who had undergone hemorrhage conversion between the stent thrombectomy group and the catheter aspiration group(4.1% vs 8.0%),the difference was not statistically significant(P>0.05);4 Compared between fibrin/platelet thrombus and erythrombosis from the onset to the beginning of arterial puncture of both groups(334.63 ± 17.75)min vs(339.67 ±14.23)min,and the difference was not statistically significant(P>0.05);The difference was a statistically significant in the number of receiving thrombectomy between the two types of thrombus patients(1.77 ± 0.68)vs(1.44 ± 0.58)(P=0.028);The intraoperative duration of vessel opening between the two types of thrombus was compared(139.39 ±19.05)min vs(130.65 ± 16.25)min,and the difference was statistically significant(P=0.040).5 The fibrin/platelet thrombosis and erythrothrombosis with intraoperative m TICI grade 2b～3(90.1% vs 81.5%)was compared,and the difference was not statistically significant(P>0.05);The fibrin/platelet thrombosis and erythrothrombosis reduced.4 points in NIHSS scoring at 7 days(28.2% vs 59.3%),and the difference was statistically significant(P=0.004);The m RS scores at 0-2 points for both types of thrombus patients at 90 days postoperatively were compared(27.5% vs 51.9%)and the difference was statistically significant(P=0.024).Conclusions 1 Vasoconstrictor plasma ET-1 levels increased whereas vasodilator NO levels decreased after patients with acute ischemic stroke following endovascular treatment.2 Plasma ET-1 levels after stent thrombectomy were higher than those with catheter aspiration,and NO levels were lower than those of the catheter aspiration;3 Compared with the catheter aspiration,the stent thrombectomy produced a relatively greater damage to the vascular endothelium,whereas it had no apparent impact on the prognosis of patients;4 In patients with acute ischemic stroke received endovascular treatment,a higher proportion of erythrombosis in the thrombus component had a better prognosis than those with a higher proportion of fibrin/platelet thrombus.thrombus.Figure 1;Table 6;Reference 104... |
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