Study Of Factors Influencing Clinical Outcome Of Early Reperfusion Therapy In Acute Ischemic Stroke

Objective:To investigate the clinical outcome of acute ischemic stroke(AIS)patients undergoing intravenous thrombolysis(IVT),endovascular mechanical thrombectomy(EMT)and intravenous thrombolysis bridging to endovascular mechanical thrombectomy and the factors that influence the outcome,to identify factors that may contribute to poor outcome and to optimise the treatment process.Methods:401 patients with large vessel occlusion(LVO)AIS in the anterior circulation who were treated by early reperfusion therapy in the affiliated hospital of Qingdao University from June 2018 to June 2022 were included.Depending on the treatment method,the patients were divided into intravenous thrombolysis group,endovascular mechanical thrombectomy group(direct thrombectomy group)and intravenous thrombolysis-bridged group(bridging therapy group).Baseline data were collected separately and clinical regression at 3 months was assessed using the Modified Rankin Scale(m RS)score: a score of 0-2 was defined as good outcome and a score of 3-6 was defined as poor outcome.The indicators of clinical outcome were determined by univariate and multivariate logistic regression analysis between groups,and the Receiver operating characteristic curve(ROC)was plotted to identify indicators with high predictive value for clinical outcome.Results:Of the 401 patients included,277(69.08%)were in the intravenous thrombolysis group.211(76.2%)patients had a good outcome and 66(23.8%)patients had a poor outcome.Univariate analysis showed that there were statistically significant differences between the good and poor outcome groups in terms of age,history of previous stroke or transient ischaemic attack(TIA),ASPECTS score,baseline National Institutes of Health Stroke Scale(NIHSS)score and NIHSS score at 24 hours post-onset(p<0.05).There was a statistically significant difference(p< 0.05)in the NIHSS scores at 24 hours post-onset.Multi-factor logistic regression analysis showed that NIHSS score 24 hours after onset was an independent factor influencing poor outcome at 3 months of intravenous thrombolysis in patients with AIS [odds ratio(OR)= 1.434,95% confidence interval(CI)1.116-1.842;P = 0.005].The ROC curve showed that the NIHSS score at 24 hours post-onset had a high predictive value for 3-month outcome with intravenous thrombolytic therapy in patients with AIS;There were 74 patients(18.45%)in the direct thrombectomy group.48 patients(64.9%)had a good outcome and 26 patients(35.1%)had a poor outcome.Univariate analysis showed statistically significant differences in age,baseline NIHSS score and NIHSS score at 24 hours post-onset(p< 0.05).Multi-factor logistic regression analysis showed that NIHSS score at 24 hours post-onset was an independent influence on poor outcome at 3months after direct thrombectomy in patients with AIS(OR=1.215,95% CI 1.079-1.367;P=0.001).The results of the ROC curve showed that the NIHSS score at 24 hours post-onset had a high predictive value for the outcome of patients with AIS at 3 months after direct thrombectomy therapy;The bridging therapy group consisted of 50 patients(12.47%).24(48.0%)patients had a good outcome and 26(52.0%)patients had a poor outcome.Univariate analysis showed statistically significant differences in age,NIHSS score at 24 hours post-onset and hemorrhagic transformation(p< 0.05).Multi-factor logistic regression analysis showed that NIHSS score at 24 hours post-onset was an independent influence on poor outcome at 3 months after bridging therapy in patients with AIS(OR=1.209,95% CI 1.074-1.361;P=0.002).The results of the ROC curve showed that the NIHSS score at 24 hours post-onset had a high predictive value for outcome at 3 months after bridging therapy in patients with AIS.The time from stroke to hospital arrival in the intravenous thrombolysis group versus the endovascular therapy group,the time from stroke to puncture and the time from stroke to opening of the occluded vessel in the direct thrombectomy group versus the bridging therapy group were statistically seen,and the differences between the groups were not statistically significant [112(60,158)vs.110.5(60,168.75),P=0.674](228.33±75.87 vs.225.45±61.42,P=0.825)[309(237.5,366.5)vs.319(257.75,401.25),P=0.191].Statistical analysis of the NIHSS score at 24 hours post-onset in the intravenous thrombolysis group,direct thrombectomy group and bridging therapy group showed that the distribution of the NIHSS score at 24 hours post-onset was not identical in all groups and the difference was statistically significant(H = 57.567,P < 0.001).After correction for significance levels using the Bonferroni method revealed statistically significant differences in the NIHSS score at 24 hours post-onset between the intravenous thrombolysis and direct thrombectomy groups(adjusted P < 0.001),the intravenous thrombolysis and bridging therapy groups(adjusted P < 0.001),and no statistically significant differences between the direct thrombectomy and bridging therapy groups(adjusted P = 0.346).Conclusion:1.Age,previous history of stroke or transient ischaemic attack,ASPECTS score,baseline NIHSS score and hemorrhagic transformation were factors influencing clinical outcome at 3 months of early reperfusion therapy for AIS.2.NIHSS score at 24 hours post-onset was an independent influence factor for 3months clinical outcome of early reperfusion therapy for AIS.