| Objective:To investigate the etiology of acute ischemic stroke TOAST type of mechanical thrombectomy with preoperative assessment and anticipation of the effect;observation of dexmedetomidine combined anesthesia sedation from safety and effectiveness of the application of thrombus in patients with AIS AIS;to investigate the mechanical thrombectomy technology safety and postoperative vascular occlusion and bleeding control strategy and transformation;to investigate the effect of mechanical thrombectomy combined with ultra early predictive decompression operation of large vascular occlusive AIS,effective treatment methods of vascular occlusive large area cerebral infarction.Methods:A total of 166 cases of acute ischemic stroke and mechanical thrombectomy were retrospectively analyzed from 2014.12 months to 2018.02 in our department;The entry criteria were determined according to the research purposes,and the corresponding samples were collected and randomly assigned into the test.The following groups are as follows:1.According to the TOAST classification standard,60 cases of large atherosclerosis and 36 cases of cardiogenic embolism were included.The difference of the location of occlusive vessels,collateral circulation,NIHSS score,MRS score,severe complications and mortality of different types of patients were compared.2.According to the random number table method,it was divided into the observation group and the control group,each with 30 cases.The observation group was given intravenous sedation with dexmedetomidine combined with femoral artery puncture and local anesthesia in the control group,and the control group was given local anesthesia alone.To observe and record the hemodynamic changes,risk factors control and therapeutic effect of different anesthetic methods during mechanical thrombectomy in patients with acute ischemic stroke.3.After a total of 21 cases of acute ischemic stroke patients with mTICI score and NIHSS score in the evaluation of vascular recanalization,analysis of the relationship between blood vessel occlusion and causes and the related risk factors;acute ischemic cerebral apoplexy patients complicated with hemorrhagic transformation in a total of 16 cases,the case analysis of clinical characteristics and surgical strategy,analysis of causes of hemorrhagic transformation and the development of effective treatment methods and clinical thinking;the mechanical thrombectomy and confirmed vascular reocclusion in patients with acute ischemic stroke in 53 cases,the intraoperative and postoperative DSA CTA confirmed vascular occlusion,28 cases underwent early predictive decompressive craniotomy,14 cases of salvage simple decompressive craniectomy,11 cases underwent mechanical thrombectomy were performed decompressive craniectomy,were compared after 14 days of treatment of neural function(NIHSS score)and neurological disability score difference.Results:1.large artery atherosclerosis vascular occlusion in internal carotid artery proximal end,especially the two or three level of collateral circulation compensatory collateral circulation to establish a good(P < 0.05),the incidence of NIHSS in patients with relatively low score(P<0.001),thrombectomy and the occlusion complications relative;cardiac vascular occlusion occurred in internal carotid artery end artery and the brain before and in the establishment of collateral circulation is poor,the incidence of NIHSS scores in patients with hemorrhagic transformation is relatively high,more complications,but the long-term effect is relatively good.2.preoperative anesthesia with dexmedetomidine sedation level was higher than that of the control group,the difference was statistically significant(P<0.001);PTR in the observation group was significantly shorter than the control group,the difference was statistically significant(P<0.001);the observation group after 24 h nerve function NIHSS score lower than the control group,the difference was statistically significant(P<0.001);the incidence of complications of observation group was significantly lower than the control group,the difference was statistically significant(P=0.028);observation group of intraoperative blood pressure fluctuations are small,the <30 mm Hg accounted for 83.33%,higher than 43.33% in the control group,the difference was statistically significant(P=0.001);the observation group of heart rate fluctuations are small,< 30 /min accounted for 80%,higher than 40% in the control group,the difference was statistically significant(P=0.001);comparison of oxygen saturation of two groups,the difference was not statistically significant(P=0.157).3.the responsibility of vascular atherosclerosis,the recanalization rate is higher(84.62%)P=0.023;thrombectomy number greater than 3 times,the ratio of vascular occlusion was significantly increased(80%),P < 0.05;clinical outcome(mRS score and postoperative NIHSS)difference(P < 0.05),thrombectomy time window over 6h vessel occlusion increased significantly(P < 0.05 80%);perforator vascular recanalization is in mTIC grade 2B and 3 grade above,the recanalization rate was significantly increased(P < 0.05 83.33%).4.embolectomy group >3,the final clinical outcome(postoperative NIHSS score and mRS)had a poor prognosis(P < 0.01),collateral circulation compensation(P < 0.05),hemorrhagic transformation and bleeding volume(P < 0.01),with statistical significance.5.patients with massive cerebral infarction occurred in 53 cases of acute ischemic stroke,45 cases survived;8 cases died;among them,the simple mechanical thrombectomy group in 11 cases,the average postoperative NIHSS score decreased to 7.73 + 3.52,5 cases died(45%);pure salvage decompression group 14 cases,postoperative the average NIHSS score decreased to 7.14 + 3.44;3 cases died(21%);mechanical thrombectomy and predictability of decompressive craniectomy in 28 cases,the average postoperative NIHSS score decreased to 4.64 + 3.29,23 cases of good recovery,5 cases of residual,no disability or death cases;preoperative NIHSS score were not statistically the difference(P=0.624),postoperative NIHSS score of each group have difference(P=0.016);the 22 LSD statistical method,simple mechanical thrombectomy and decompressive craniectomy group,the treatment effect was not statistically significant(P=0.669);combined treatment group than in the other two groups have good nerve function It can protect the effect,there are statistical differences(P=0.013,P=0.028).Conclusions:1.Preoperative TOAST typing for acute ischemic stroke patients is helpful for pre assessment of collateral circulation,prediction of operative effect and complications,especially for AIS patients with time window.2.Non intubated sedation anesthesia can be safely applied to mechanical thrombectomy for acute stroke,can significantly shorten the operation time,the operation process is stable,reduce the risk of surgery,especially to reduce intraoperative rupture of blood vessels resulting in hemorrhagic transformation,improve neurological function recovery degree.3.To strengthen the control of various risk factors,Solitaire stent thrombectomy,arterial thrombolysis,balloon dilatation,stent implantation,foresight decompressive craniectomy,internal decompression and other surgical procedures can effectively improve vascular recanalization rate.4.preoperative imaging evaluation,attention to the selection of anesthesia methods and improving the skill of thrombectomy are the key factors to prevent the transformation of bleeding after the mechanical thrombectomy.5.active vascular recanalization is the key to the severe ischemic cerebral infarction caused by large vascular occlusion.The embolectomy after vascular occlusion again cases by early assessment of blood vessels and collateral circulation,is expected to appear large area cerebral infarction,ultra early predictive decompressive craniectomy,has positive significance for reducing the mortality and improve the prognosis of neurological function. |
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