| Backgrounds: In recent years,a number of large multicenter randomized trials on mechanical thrombectomy(MT)in acute Ischemic stroke with large vessel occlusion(AIS-LVO)have observed the phenomenon that successful reperfusion is not parallel to the prognosis of patients.With the development of neurointerventional devices and technologies,the successful reperfusion(m TICI 2b-3)rate of MT treatment is getting higher and higher,but there are still about 45% to 54% of patients got poor prognosis despite of successful reperfusion.Therefore,it is urgent to identify those who may not benefit from early reperfusion.Objective: To analyze the data of AIS-LVO patients undergoing MT treatment to figure out the influencing factors of poor functional prognosis after successful reperfusion,to determine a prediction model of poor prognosis,and to construct the Individual Poor Prognosis Risk Scale(IPPRS)to identify those who may get poor prognosis.Methods: A retrospective study was conducted in AIS-LVO patients who received MT treatment in the Stroke Center of the Second Hospital of Dalian Medical University from April 2016 to September 2022.Patients who achieved successful reperfusion after surgery were screened out and divided into two groups,according to the Modified Rankin Scale(m RS)within 90 days after MT: good prognosis group(m RS ≤ 2)and poor prognosis group(m RS>2).Demographic data,general clinical data,surgery related data and clinical outcomes were collected in patients who meet these requirements.Bivariate analysis,binary logistic regression modeling,and linear discriminant analysis were used to determine a prediction model of poor prognosis.And the Receiver-Operating Characteristic curve(ROC curve)was used to test the fitting of the regression model and to get the cut-off point of those predicting factors.The binary classification of the predictive factors through the cut-off point was carried 5out in order to build IPPRS.Finally a rough way to estimate the possibility of individual poor prognosis was got.Results: Totally,178 patients who met the inclusion and exclusion criteria were included in this study.The successful reperfusion rate of AIS-LVO patients in our hospital after MT treatment was 84%(150/178).Even if successful reperfusion was achieved through surgery,54%(81/150)patients still had poor prognosis.(1)The univariate analysis between the good prognosis group and the poor prognosis group shows: Compared to the poor prognosis group,the good prognosis group had lower age [66(59-77)vs 71(65-81)],lower FBG level [5.96(5.42-7.84)vs 6.92(6.03-9.81)],lower SBP level at admission [144(133-158)vs 151(137-168)],lower neutrophil lymphocyte ratio(NLR)[2.74(1.64-4.55)vs 3.31(2.13-8.00)],lower admission NIHSS score [14(12-17)vs 16(12-21)],and higher ASPECTS [10(9-10)VS 9(7-10)],higher number of patients treated with intravenous butylphthalide [26(40%)vs 16(20%)],shorter onset to admission time [90(60-186)vs 126(71-211)],shorter onset to recanalization time [340(270-420)vs 380(290-510)],less symptomatic intracranial hemorrhage rate [1(2%)vs 20(25%)],and less hemorrhagic transformation rate [11(17%)vs 36(43%)],there were significant differences between two groups(P<0.05).There were no significant differences between the two groups of patients on gender,hypertension,diabetes,hyperlipidemia,atrial fibrillation,smoking,drinking,TC,LDL-C,TG,DBP at admission,stroke site(anterior circulation or posterior circulation),responsible occluded artery,etiological classification,collateral circulation grade,number of pass,intraoperative/postoperative application of tirofiban,rt-PA intravenous thrombolysis treatment,remedial treatment,onset to puncture time,onset to puncture time,onset to recanalization time,onset to start of thrombolysis time,door to start of thrombolysis time,thrombolysis to puncture time and operation time(P>0.05). (2)The binary logistic regression analysis of AIS-LVO patients who achieved reperfusion after MT but had different functional prognosis showed that: elderly(adjusted OR=1.072,95% CI: 1.020-1.126,P=0.006),high NLR(adjusted OR=1.179,95% CI: 1.106-1.367,P=0.030),long time from onset to recanalization(adjusted OR=1.006,95% CI: 1.001-1.011,P=0.027),symptomatic intracranial hemorrhage(adjusted OR=12.237,95% CI: 1.072-139.699,P=0.044)were independent risk factors for poor prognosis.High ASPECTS(adjusted OR=0.620,95% CI:0.426-0.901,P=0.012)was an independent protective factor for poor prognosis.(3)Prediction and analysis of independent risk factors for poor prognosis: The model which was combined with five influencing factors: age,NLR,onset to recanalization time,ASPECTS and symptomatic intracranial hemorrhage has good accuracy and recognition ability for poor prognosis(AUC=83.2%).The optimal threshold of each influencing factor was calculated according to the yoden index for binary prediction analysis.The results were age ≥ 67.5 years old(OR=4.057,95% CI: 1.733-9.501),NLR ≥ 5.48(OR=2.442,95% CI: 0.928-6.423),onset to recanalization time ≥ 460min(OR=4.779,95% CI: 1.763-12.952),ASPECTS≤ 9(OR=2.188,95% CI:0.988-4.849)and symptomatic intracranial hemorrhage(OR=18.498,95% CI:2.234-153.150).Although not every prediction factor is significant in the model,the combined prediction model has good accuracy and identification(AUC=82.5%),sensitivity is 80.2%,specificity is 69.2%,positive predictive value is 76.4%,and negative predictive value is 73.7%.(4)Construction of IPPRS: NLR ≥ 5.48,ASPECTS ≤ 9 get 1 point;age ≥ 67.5 years old and onset to recanalization time ≥ 460 min get 2 points;and symptomatic intracranial hemorrhage get 8 points.When IPPRS ≥ 3,the probability of poor prognosis exceeds 50%.Conclusions: This study showed that age,NLR,onset to reperfusion time,ASPECTS,and symptomatic intracranial hemorrhage are important factors to predict the poor prognosis in AIS-LVO patients after successful reperfusion through MT treatment.Preliminary,IPPRS was constructed,offering the possibility to predict the prognosis of successfully reperfused patients. |
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