Analysis Of The Efficacy And Safety Of Emergency Carotid Artery Stent Implantation

Objective:To explore the effectiveness and safety of carotid artery stent implantation(CAS)in the treatment of acute internal carotid artery occlusion stroke.Methods:Clinical data of 121 patients with acute internal carotid artery occlusion who underwent EVT were retrospectively collected from Neurology Department of Linyi People’s Hospital from January 2020 to December 2021.Patients were divided into a stent implantation group(88 cases)and a non stent implantation group(33 cases)based on whether they received carotid artery stent implantation treatment during the same period,and the differences in clinical prognosis between the two groups were compared.According to the modified Rankin scale(mRS)score at 3 months after surgery,patients were divided into a good prognosis group(mRS score ≤ 2 points)and a poor prognosis group(mRS score>2 points).Univariate analysis was performed on the basic data,imaging indicators,surgery-related data,prognostic indicators and other data of the two groups.The relevant factors with clinical significance were analyzed by multivariate Logistic regression.To further explore the independent risk factors affecting the clinical prognosis of acute internal carotid artery occlusive stroke patients after endovascular therapy.Results:Among 121 patients with acute internal carotid artery occlusion who received endovascular treatment,88(72.7%)underwent stent implantation at the same time.Among them,64 patients achieved 90 day functional independence(mRS score ≤ 2points),with a good prognosis rate of 72.7%.33 patients(27.3%)did not undergo carotid artery stent implantation,of which only 15 patients achieved 90 day functional independence,with a good prognosis rate of 45.5%.There was a significant difference in the good prognosis rate between the two groups of patients(p<0.05).In addition,5patients(5.7%)in the stent implantation group died during the 90 day follow-up,while 7patients(21.2%)in the non stent implantation group died,with a significantly higher mortality rate than the stent implantation group(p<0.05).Out of 121 patients,a total of 81(66.9%)had a good functional prognosis after 90 days,while 40(33.1%)had a poor prognosis.Compared with patients with poor prognosis,patients with good prognosis have a shorter time from onset to puncture,a higher proportion of carotid artery stent implantation during the same period,and a higher preoperative ASPECT score,with statistically significant differences(P<0.05).Multivariate logistic regression analysis showed that the time from onset to puncture(OR=0.921,95% CI=0.850-0.997,P=0.042),acute phase stent implantation(OR=2.920,95% CI=1.220-6.991,P=0.016),and preoperative ASPECTS score(OR=1.21295% CI=1.017-1.445,P=0.032)were independent influencing factors on the 90 day prognosis of patients with acute carotid artery occlusion treated with endovascular therapy.Conclusions:1.For patients with acute internal carotid artery occlusion stroke,emergency carotid artery stent implantation is safe and feasible.2.Patients who have a short time from onset to puncture,receive emergency carotid artery stent implantation at the same time,and have a higher preoperative ASPECTS are more likely to have a good prognosis after receiving intravascular treatment..