The Comparative Study Of The Preoperative Evaluation And The Mainstream Thrombectomy Model Of Mechanical Thrombectomy In Patients With Acute Ischemic Stroke

Background and purpose: A large number of studies have confirmed that mechanical thrombectomy has brought revolutionary changes to the treatment of acute ischemic cerebrovascular disease,improved the vascular recanalization rate,extended the treatment time window,and quickly became an important treatment method for AIS(acute ischemic stroke).However,the wide development and popularization of this technology project in China is still confronted with many problems,such as unbalanced regional development,non-standard diagnosis and treatment process.This study compared the current commonly used preoperative assessment methods of acute ischemic stroke and the two main methods of thrombectomy,providing a preliminary theoretical basis for the optimization of diagnosis and treatment process and technical improvement of anterior circulation large vessel occlusive stroke.Methods: This paper retrospectively studied the imaging and clinical data of patients with acute anterior circulation great vessel occlusion admitted to our hospital from September2015 to December 2018.The evaluation time of two imaging evaluation methods(head CT with rapid cerebral angiography and head CT with CTA)was compared.To compare and study the two surgical intervention methods(single stent thrombectomy and Navien catheter combined with stent thrombectomy),the open rate,the number of times of thrombectomy,the open time,the incidence of surgical complications,the average hospital stay and the total cost of hospitalization.Results: Comparison of the two preoperative evaluation methods: in terms of the evaluation time,head CT with rapid cerebral angiography(n=87,50.5±16.7 minutes)was significantly shorter than head CT with CTA(n=34,75.9±19.3 minutes).Comparison of two main methods of thrombectomy: Single stent thrombectomy(n = 56),Target vessel opening rate79%,Opening time 127.3±26.4 minutes,The average times of thrombectomy were 2.9±0.8,The rate of distal embolism was 21%(n =12,6 cases of distal branch of middle cerebral artery,6 cases of Anterior cerebral artery,2 cases of both),The average hospitalization time was18.3±7.2days,and the average hospitalization cost was126,000±38,000 yuan.Navien catheter with stent for thrombolysis(SWIM technique)(n=73),Target vessel opening rate89%,Opening time 59.3±25.3 minutes,The average times of thrombectomy were1.9±0.4,Therate of distal embolism was 7%(n =5,All were distal branches of the middle cerebral artery),The average hospitalization time was 15.7±8.9 days,and the average hospitalization cost was117,000 ± 49,000 yuan.Compared with single stent thrombolysis,intermediate catheter combined with stent thrombolysis significantly improved the target vessel opening rate,shortened the opening time,reduced the opening times,and had a lower incidence of complicationsConclusions: For AIS of LargeVessel Occlusion,the application of CT combined with rapid cerebral angiography as a preoperative evaluation method is simple and rapid,which is more suitable for the regional treatment centers limited by objective conditions.From the perspective of surgical technique,the Navien catheter combined with stent for thrombolysis is more efficient and safe,and there was no increase in total hospital costs,so it’s more economical overall.