| Objective: Atherosclerotic intracranial arterial occlusion is an important cause of recurrent stroke in Asian population,which seriously endangers the life safety and quality of life of patients.Previous scientific studies have confirmed that the treatment of acute atherosclerotic intracranial arterial occlusion within 24 hours of onset is safe and effective However,there are still controversies about the safety and effectiveness of interventional recanalization therapy for non-acute intracranial large atherosclerotic occlusion with onset time of more than 24 hours.This study aims to compare the safety and effectiveness of interventional recanalization therapy with conventional drug therapy,and to preliminarily explore the factors related to the safety of interventional recanalization therapy.Methods: Affiliated hospital of Qingdao university medical cross the cloud system between January 2018 and May 2021 of acute intracranial artery atherosclerotic occlusion cases were retrospectively analyzed,the clinical data collected through standardized forms a complete single sex of patients with acute intracranial artery atherosclerotic occlusion baseline demographic characteristics(age and gender)risk factors(hypertension,diabetes Hyperlipidemia coronary atherosclerotic heart disease history of smoking and alcohol consumption)test data(fasting glucose low density lipoprotein triglyceride white blood cell count neutrophil count neutrophil percentage)from onset of symptoms to onset of treatment(time of occlusion)Symptoms(chief complaint)Occlusion is located in the anterior circulation(intracranial internal carotid artery)Middle cerebral artery)or posterior circulation(intracranial vertebral artery basilar artery)Modified Rankin scale(m RS)score at admission was divided into interventional recanalization treatment group(42 cases)and conventional medicine group(69 cases)according to treatment method.The occlusive length of the interventional group was collected and subdivided into the occlusive length according to the latest angiographic classification of non-acute intracranial atherosclerotic occlusive length 10 mm group and block length>10 mm group;Occlusion time and subgroup(divided into 30 days occlusion time group and occlusion time group≤30 days)involvement in open surgical procedure Perfusion situation before and after surgery(on the basis of cerebral infarction thrombolysis test(TICI)marking and grading)technical success rate and complications,follow-up treatment for ischemic stroke recurrence rate after composite incidence of vascular events All-cause mortality and m RS scores compared retrospective cohort study ischemic stroke recurrence rates between the two groups Whether there was a difference in m RS scores in the follow-up of all-cause mortality in the incidence of composite vascular events;The influence of length of occlusive lesions and timing of operation on the safety of interventional therapy was also analyzed.Results: A total of 111 patients with non-acute intracranial large atherosclerotic occlusion were included in this study,including 42 in the intervention group and 27(64.3%)males,with a median age of 61 years(range :46-75 years)and a median follow-up of 30(1-44)months.The 1-year stroke recurrence rate was 7.1%,and the 1-year incidence of complex vascular events was 26.2%(30 days)The incidence of internal complex vascular events was 16.7%,the incidence of complex vascular events over 30 days was 9.5%),the 1-year mortality was 4.8%,the follow-up m RS score was 2 points81.0%.The incidence of perioperative complications was 14.3%.After grouping according to the length of occlusion,the positive rate of complications in the group with longer occlusion length was 33.3%,and that in the group with shorter occlusion length was 3.7%.After grouping according to the time of onset,the positive rate of complications in the group with longer onset time was 25%,and that in the group with shorter onset time was 7.7% There were 69 cases in the drug group,including 44 males(63.8%),with a median age of 64 years(range :41-85 years)and a median follow-up of27(1-47)months.The 1-year recurrence rate of stroke was 15.9%,and the 1-year incidence of complex vascular events was 17.4%.More complex vascular events occurred after 1 year(the incidence of complex vascular events within 30 days was 1 The 1-year mortality rate was 7.2%.Follow-up m RS score was 2,78.3%.The 1-year recurrence rate of responsible vascular-related ischemic stroke in the intervention group was lower than that in the drug group(P<0.05)there was no significant difference in the 1-year incidence of complex vascular events between the two groups(P>0.05),the incidence of complex vascular events within 30 days in the drug group was lower than that in the interventional group(P<0.05),there was no significant difference in the incidence of complex vascular events after 30 days between the drug group and the intervention group(P>0.05)There was no significant difference in m RS score of all cause mortality between the intervention group and the drug group(P> 0.05)The incidence of perioperative complications in the shorter occlusion length subgroup was lower than that in the longer occlusion length subgroup(P< 0.05);There was no significant difference in perioperative complication rates between the two subgroups in the interventional group based on time of occlusion(P>0.05)Gender age hypertension diabetes hyperlipidemia coronary heart disease smoking and drinking history fasting blood glucose low density lipoprotein triglyceride white blood cell count neutrophil count neutrophil percentage m RS score on admission was not significantly different between the two groups(P<0.05)Conclusions: For non-acute intracranial large atherosclerotic occlusion,interventional opening treatment has no better overall efficacy than drug treatment within 1 year,but after 1 year,the efficacy of the former tends to be better than that of the latter.Long-term overall efficacy requires longer follow-up,and interventional opening treatment can reduce the incidence of ischemic stroke compared with drug treatment,and has a certain efficacy Safety within 30 days,interventional opening therapy is lower than drug therapy,and selecting cases with shorter occlusion length may reduce complications and benefit patients more. |
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