Analysis Of Prognostic Factors In Patients With Acute Anterior Circulation Occlusive Stroke Treated With Mechanical Stent Thrombectomy

Background:Acute ischemic stroke(AIS)is a group of diseases that cause cerebral ischemia and hypoxic necrosis due to various causes of cerebral vascular blockage and blood not flowing into the brain.It accounts for 69.6% to 70.8% of the total stroke.It has the characteristics of rapid progress,high mortality rate and high disability rate,and its incidence is increasing year by year and younger.Therefore,early diagnosis,opening of occluded blood vessels as soon as possible,restoring normal blood supply to save ischemic brain tissue,avoiding irreversible neurological damage and preventing recurrence have become the key to the treatment of acute ischemic stroke.Venous dissolution Thrombus is the most important method to restore blood flow at present,but there are some shortcomings such as limited time window,strict indication,low opening rate and high occlusion rate after vessel opening.With the development of interventional technology,mechanical thrombectomy has been widely recognized by domestic and foreign scholars and used in clinical treatment of AIS patients.Objective:To investigate the prognostic factors of patients with acute anterior circulation occlusive stroke treated by Solitaire stent thrombectomy.Methods:From March 2016 to January 2019,86 patients with acute anterior circulation occlusive stroke admitted to the second affiliated Hospital of Dalian Medical University were enrolled retrospectively.They were all confirmed by emergency CTA(computed tomographic angiography)or DSA(digital subtraction angiography)and treated with Solitaire stent thrombectomy.According to the score of modified Rankin scale(m RS),the patients were divided into good prognosis group(0 ~ 2 points,46 cases)and poor prognosis group(3 ~ 6 points,40 cases).The risk factors of cardiovascular and cerebrovascular disease,NIHSS(national institute of health stroke scale)score at admission,occlusion site(internal carotid artery or middle cerebral artery),onset to recanalization time,cerebral hemorrhage were analyzed.The parameters of univariate analysis(P < 0.05)were included in multivariate Logistic regression analysis to determine the prognostic factors.Results:(1)The average NIHSS score at admission was 19,and the good prognosis rate was 53.5%(46 cases).There were significant differences in age,NIHSS score and hypertension between the two groups(all P < 0.01).There was no significant difference in sex,diabetes,atrial fibrillation and coronary heart disease between the two groups(all P > 0.05)(2)86%(74 cases)of patients’ blood vessels were successfully recanalized and 15.1%(13 cases)had symptomatic cerebral hemorrhage.The time from onset to successful recanalization,the site of occlusion,the rate of successful opening and the incidence of symptomatic intracerebral hemorrhage were significantly different between the two groups(all P < 0.05).(3)In univariate analysis,the parameters of P < 0.05 were taken as independent variables,and the prognosis as dependent variables,multivariate Logistic regression showed that the increased age,history of hypertension,increased NIHSS score and complications of symptomatic intracerebral hemorrhage were the risk factors of poor prognosis(all P < 0.05).Shortening the time from onset to recanalization and successful recanalization were protective factors for good prognosis(all P < 0.05).Conclusion:Increased age,history of hypertension,increased NIHSS score and symptomatic intracerebral hemorrhage after operation were all risk factors for poor prognosis of patients with acute ischemic stroke treated with Solitaire stent thrombectomy.Shortening the time from onset to recanalization and successful recanalization were the protective factors for the prognosis of patients with acute ischemic stroke treated with Solitaire stent thrombectomy.