Safety And Efficacy Of Endovascular Therapy In Patient With Acute Ischemic Stroke

Background Acute stroke is a major cause of disability and death in humans,which has become the second leading cause of human death.At present,rapid administration of intravenous thrombolysis to appropriate patients remains the mainstay of early treatment of acute ischemic stroke,which is the standard therapy of acute ischemic stroke.However,intravenous thrombolysis has a strict time window limitation and a low rate of recanalization,especially for patients with large vessel occlusion.Endovascular mechanical thrombectomy has the advantages of rapid recanalization of blood vessels,lower bleeding conversion rate,longer treatment time window,etc.,causing widespread concern at home and abroad scholars.Stent retrievers are commonly used for intravascular treatment(such as Solitaire or Trevo stents).The device can capture the clots through the stent and peripheral vascular wall extrusion,restore blood flow,and when we withdraw the stent,the device can remove the embolus simultaneously.Mechanical embolization has the theoretical advantage of rapid recanalization,and there are no risk of long-term complications.Stent thrombectomy has an important therapeutic value and practical significance for patients with acute ischemic stroke caused by large vessel occlusion.Objective To determine the clinical efficacy and safety of endovascular therapy in patients with acute ischemic stroke caused by large vessel occlusion.And to explore the pros and cons of general anesthesia in patients with acute stroke during the perioperative period and investigate the effect of neurological function.Methods A total of 28 patients with acute ischemic stroke in Jinan Central Hospital Affiliated to Shandong University from March 2014 to September 2016 were screened and analyzed retrospectively,who were caused by intracranial proximal arterial occlusion that was confirmed on digital subtraction angiography.Those patients could be treated within 6 hours after symptom onset,using SolitaireTM retrievable stents,and the occluded arteries could be recanalization within 8 hours after symptom onset.All patients underwent general anesthesia with endotracheal intubation.The patients were followed up for 3 months.The modified Rankin scale score(mRS:ranging from 0 to 6,with 0 indicating no symptoms,6 death)and National Institutes of Health Stroke Scale(NIHSS:ranging from 0 to 42,with higher scores indicating more severe neurologic deficits)were recorded both at 30 days and at 90 days,which could be used to evaluate functional outcome.The delayed time due to anesthesia operation,the rate of tracheotomy and the incidence of pneumonia were observed at the same time and compared to the outcome measurements of MR CLEAN.Results(1)The proportion of patients with TICI score of 2b or 3 at final angiogram was 96.4%(27/28).The rate of functional independence(modified Rankin score of 0 to 2)at 30 days and at 90 days were 21.4%(6/28)and 50%(14/28)respectively.The mean value of NIHSS at 90 days after surgery decreased significantly compared with that of preoperative 23.1(t = 9.373,p<0.001).(2)The rate of intracranial hemorrhage was 35.7%(10/28)and the rate of symptomatic intracranial hemorrhage 14.3%(4/28).The rate of death and severe disability at 30 days was 50%(14/28)and at 90 days was 32.1%(9/28).Device-related or procedure-related complications were not observed in our patients.(3)The mean value of delayed time due to anesthesia operation was 19.1 min.The rate of tracheotomy and the incidence of pneumonia were 25%(7/28)and 67.8%(19/28),respectively.Conclusion 1.Among patient with anterior circulation ischemic stroke caused by large vessel occlusion who could be treated within 8 hours after symptom onset,endovascular mechanical thrombectomy using Solitaire retrievable stents was effective and safe.Stent retriever thrombectomy can improved functional independence.2.Despite a longer time from symptom onset to treatment,general anesthesia does not worsen outcome in patients undergoing mechanical thrombectomy compared with historical subgroups.The preliminary study shows that the delayed time due to anesthesia operation is acceptable,but the pros and cons of general anesthesia still need to be further validated by large-scale multicenter randomized clinical trials.