Prognostic Factors And Pathological Study Of Thrombus In Patients With Acute Ischemic Stroke After Mechanical Thrombectomy

Background & Objective: With the popularity of intravascular interventional therapy,mechanical thrombectomy has gradually become the main treatment for acute ischemic stroke.In this context,thrombi from stroke patients can be collected and related analysis of fresh thrombi materials can be performed with the help of stent retrievers to assess risk factors and the impact of thrombi on mechanical recanalization and clinical outcomes.Methods: Data of 53 patients with anterior circulation acute ischemic stroke(AIS)were collected from our hospital from December to 20 months of 2021 to December to 20 months of 2022.All of these patients received interventional thrombus removal within the time window.Prognosis was assessed by using the modified Rankin Scale(m RS)at 7,30,and 90 days postoperatively.Patients were grouped according to modified m RS Scores: good prognosis(m RS≤2 points)and poor prognosis(m RS≥3points).Univariate analysis was used to analyze the relationship between various factors and prognosis of patients,and the significant factors in a single factor were incorporated into the Logistics regression analysis of multiple factors to analyze the independent factors affecting the prognosis of patients with AIS.Results: 1.Univariate analysis showed that the prognosis at day 7 was correlated with blood flow recanalization and NIHSS score at 24 hours after surgery(P<0.05),and the prognosis at day 30 was significantly correlated with thrombus location,fibrinogen,NIHSS score at 24 hours after surgery(P<0.05).The prognosis of patients at 90 days was significantly correlated with diabetes mellitus,thrombus location,and NIHSS score before surgery,24 hours after surgery(P<0.05).2.Multivariate analysis showed that vascular recanalization,NIHSS score 24 hours after surgery were independent influencing factors for 1-week prognosis of patients.The lower the NIHSS score,the better the prognosis at 1 week.Thrombosis location and NIHSS score 24 hours after surgery were independent factors influencing the prognosis of AIS patients at 30 days.Compared with ICA,MCA patients had a better prognosis.In addition,the lower the NIHSS score 24 hours after surgery,the better the patient’s 30-day prognosis.At 90 days after surgery,the location of thrombus and the NIHSS score at 24 hours after surgery were independent factors influencing the prognosis of AIS patients.Compared with ICA,MCA patients had a better prognosis.The lower the NIHSS score 24 hours after surgery,the better the prognosis of patients.Among the 23 cases of cardiogenic thrombus,1 case was in the RBC group,and the other 22 cases were in the FBI group.Among the 29 cases of large atherosclerotic thrombus,19 cases were in the RBC group and 10 cases were in the FBI group.One case of thrombus of unknown origin was attributed to FBI group.Conclusion: The prognosis of patients at 7 days is mainly related to vascular opening and NIHSS score at 24 hours after surgery.Prognosis at day 30 was correlated with thrombus location,fibrinogen,and NIHSS score(24 hours after surgery).A lower NIHSS score(before surgery,24 hours after surgery)has a positive effect on the 90-day prognosis of patients.Patients with MCA occlusion had better prognosis at 90 days than those with ICA occlusion.Patients without diabetes will have a better prognosis at 90 days.The components of cardiogenic thrombus are the same as those of atherosclerotic thrombus.Cardiogenic thrombus mainly consists of fibrin thrombus,while atherosclerotic thrombus mainly consists of erythrocyte.