Analysis Of Prognostic Factors In Subacute Stent Thrombectomy For Ischemic Stroke

BackgroundIschemic stroke(IS)has a high incidence and disability rate,which aggravates the family and social burden of patients.ntravenous thrombolysis can be used in hyperacute phase,but due to time window limitation and low opening rate of large vessel occlusion,the patients who benefit are limited.Current studies have found that stent embolization can quickly recanalize blood vessels,improve cerebral perfusion,and has a long therapeutic time window.It has attracted wide attention of scholars at home and abroad,and has important value for the treatment and prognosis of patients in subacute stage.PurposeThe purpose of this study was to observe the history and prognosis of IS patients treated with stent thrombectomyin subacute stage,and to compare and analyze the related factors affecting the prognosis of IS patients.MethodsRetrospectively collected40 IS patients who met the inclusion criteria from June 2016 to June 2018 in Department of Neurology,Liaocheng People’s Hospital.In the subacute phase the disease progressed more severely within the time window,the internal and external carotid artery occlusion(internal carotid artery,middle cerebral artery,vertebrobasilar artery)was confirmed by computed tomographic angiography(CTA)and digital subtraction angiography(DSA).Solitaire stent was used for thrombectomy under general anesthesia to effectively open blood vessels and improve cerebral perfusion.By outpatient consultation or telephone 3 months,the baseline data such as clinical manifestations,vascular risk factors,laboratory findings,National Institute of Health Stroke Scale(NIHSS)score and modified Rankin Scale(m RS)score of male and female patients were compared and analyzed.The NIHSS scored 0～1 or reduced ≥10 points indicates that the patient’s discharge prognosis recovered well.After 90-dayof treatment,the m RS≤2 indicates that the patient’s long-term prognosis recovered well.The t-test was used to analyze the differences of baseline characteristics between male and female patients.The prognosis of patients discharged and treated for 90 days was analyzed by t-test.Logistic regression was used to analyze the risk factors of prognosis of patients with IS treated by stent embolization in subacute stage.Results(1)After DSA review,all patients with modified Thrombolysis in Cerebral Infarction Score(m TICI)had good recanalization,70% of patients achieved 2b(suggesting better thrombolytic effect),100% of patients achieved more than 2a(partial improvement of cerebral perfusion),and no complications related to operation occurred.(2)Comparison of baseline data between male and female patients revealed no significant differences between male and female patients.Therefore,in the prognostic analysis,it is no longer necessary to distinguish the factors such as gender,onset and operation time.(3)90-day after operationth the proportion of patients with NIHSS scored 0～1 or reduced ≥10 pointswas 100%(40/40),the proportion of patients with 90-day m RS score≤2 was 95%(38/40),and 3 was 5%(2/40),without severe disability.Conclusions(1)When the clinical manifestations of IS patients in subacute stage are not consistent with the location and size of infarction,good collateral circulation and ischemic penumbra can be detected,timely opening of blood vessels and effectively improving cerebral perfusion,the stent embolization to open the blockage of blood vessels may help improve the prognosis of patients.(2)Fibrinogen(FIB)is a risk factor for the prognosis of IS patients treated with stent thrombectomy in subacute stage,but it is not an independent risk factor.