Effect Of Recanalization Sequence Of Anterior Circulatory Tandem Lesions On Short-term Prognosis Of Acute Ischemic Stroke

Objective: To investigate the effect of recanalization sequence of anterior circulation on short-term prognosis of acute ischemic stroke Methods: 40 patients with acute ischemic stroke due to anterior circulatory tandem lesions diagnosed in the department of neurology of the fourth affiliated hospital of China medical university from January 2018 to June 2019 were selected and treated with intravascular intervention.Collect the patient’s general information,past medical history and operation data,including age,sex,smoking history,drinking history,always have high blood pressure,diabetes,coronary heart disease,atrial fibrillation,heart disease history,previous history of stroke,such as low density lipoprotein cholesterol(ldl-c),glycosylated hemoglobin,homocysteine,to puncture time,patients with baseline NIHSS score.From the onset to puncture time,puncture to target vessel recanalization time,vascular recanalization condition,combined venous thrombolysis,occlusive site,symptomatic intracranial hemorrhage,m RS score 3 months after surgery,etc.The patients were divided into two groups according to the different order of recanalization: group A: patients with extracranial neck restenosis after thrombectomy and stent implantation after thrombectomy,namely balloon dilatation-thrombectomy and carotid artery stent group,A total of 26 patients.Group B: carotid artery stents were required to maintain good access for thrombectomy after ball enlargement,i.e.,balloon dilatation-carotid artery stent-thrombectomy group,with a total of 14 cases.The difference of recanalization sequence between the two groups was compared,and P < 0.05 indicated that the data were statistically significant.Regression analysis was used to further analyze the influence of other factors on prognosis.Results: Balloon expansion-support-hua group of 26 cases,the baseline data,the history of high blood pressure,diabetes,smoking,drinking and other risk factors,respectively,in 14 cases(53.8%),6(23.1%),15(57.7%)cases,10(38.5%)cases,24 cases(92.3%)of men,age mean standard deviation was 67.46 + /-10.88 mm,in coronary heart disease,atrial fibrillation,cerebrovascular disease,and medical history aspects,respectively,4(15.4%)cases,2 cases(7.7%),9(34.6%)cases,The biochemical indexes of low density lipoprotein(U/L),glycosylated hemoglobin(%),homocysteine(umol/L)were 2.8 ± 0.7,5.85(5.47-7.20),14.40(12.10-18.80),onset time(min),admission NIHSS score,and onset to puncture time(min)were 300(210-420),1408±5.50,and 370.35±152.05,respectively.Operation information,including 6 cases for the bridge joint venous thrombolysis treatment,including M1 period of middle cerebral artery occlusion for 11 cases(42.3%),the internal carotid artery occlusion is 15(57.7%)cases,of which 24 cases(92.3%)achieved the recanalization of m TICI2b-3 standard,should the median and interquartile range is 2 times(1-2),targeted to recanalization time was 43.7(43.75-)59 points,postoperative complications,symptomatic intracranial bleeding is 6(23%),good short-term prognosis of 15 cases(57.7%).Balloon expansion-should-group of 14 cases of stent,the baseline data,the history of high blood pressure,diabetes,smoking,drinking and other risk factors respectively,5 cases(35.7%),4(28.6%)cases,10 cases(71.4%),6(42.9%)cases,including male 12(85.7%)cases,age mean standard deviation was 70.14 + /-8.44 mm,in coronary heart disease,atrial fibrillation,cerebrovascular disease,and medical history aspects,respectively,3 case s(21.4%),4(28.6%)cases,4(28.6%)cases,The biochemical indexes of low density lipoprotein(U/L),glycosylated hemoglobin(%),homocysteine(umol/L)were 2.4±0.6,5.75(5.47-6.50),14.95(11.60-16.92),onset time(min),admission NIHSS score,and onset to puncture time(min)were 275(240-435),13.71 ± 8.19,and 373.79 ± 185.46,respectively.Operation data,of which 3 cases for the bridge joint venous thrombolysis treatment,including M1 period of middle cerebral artery occlusion in 10(71.4%)cases,start of internal carotid artery occlusion in 4(28.6%)cases,all reached the recanalization of m TICI2b-3 standard,should the median and interquartile range is 2 times(1-2),targeted to recanalization time was 66.5(68.25)38 points,postoperative complications,symptomatic intracranial hemorrhage in 3(21.4%)cases,good short-term prognosis for 9(64.3%)cases.After statistical analysis,there was no significant statistical difference between the two groups in terms of clinical baseline data and surgical-related indicators.After binary Logistic regression analysis,it was suggested that admission NIHSS score(OR=0.175,95%CI: 1.012-1.364,P=0.035)and cerebral hemorrhage(OR=0.481,95%CI: 4.685-258.177,P=0.001)were independent predictors of good prognosis at 3 months.Conclusion: There was no significant difference in the effect of the two recanalization sequences on short-term prognosis in patients with precirculatory tandem lesions.There was no significant difference between the two strategies in the inci dence of symptomatic intracranial hemorrhage and the success rate of vascular recanalization.The strategy based on balloon dilatation-thrombectomy and carotid stents may reduce the recanalization time from puncture to target vessel.The shorter the time from puncture to target vessel recanalization,the better the prognosis.Symptomatic intracranial hemorrhage and admission NIHSS score were negatively correlated with a good prognosis.The lower the postoperative asymptomatic intracranial hemorrhage and admission NIHSS score,the better the prognosis.