| Background: It has become a consensus to receive intravenous thrombolysis for patients with acute stroke within the time window.However,intravenous thrombolysis has strict indications and time window screening.With the development and progress of interventional imaging technology and interventional materials,the treatment methods for patients with acute occlusion of large vessels have become more abundant.Objective: To explore the factors that influence the neurological rehabilitation and prognosis of patients with acute aortic occlusive stroke under two surgical methods,direct intravascular thrombectomy and intravascular thrombolysis followed by mechanical thrombectomy with bridging stents.Methods: A retrospective analysis of patients with acute aortic occlusive cerebral infarction who received simple stent thrombus removal treatment and intravascular thrombolysis followed by bridging stent thrombectomy treatment in the Second Affiliated Hospital of Dalian Medical University from September 2016 to October2020.Based on the modified Rankin 90 days after surgery.The Modified Rankin Scale(m RS)score divides the patients receiving the above treatments into good prognosis group and poor prognosis group(m RS score ≤ 2 points is defined as a good prognosis,3-6 points are defined as a poor prognosis).Collect the general clinical data of the patients receiving the above treatment methods,the NIHSS score at the time of emergency admission,the effective blood vessel recanalization rate,the time from admission to femoral artery puncture,the operation time of thrombectomy,the effective time from admission to the blood vessel recanalization,intracranial hemorrhage at 24 hours after operation,etc.Statistical methods were used to analyze the independent risk factors affecting the prognosis of patients.Results:(1)Patients who received direct thrombectomy therapy had a lower admission NIHSS score in the good prognosis group(11.44±5.33 vs 22.21±8.73,P<0.01),and the time from admission to recanalization was shorter than that in the poor prognosis group(200.69±80.40 vs 265.36±99.42,P<0.05),the operation time was shorter than the poor prognosis group(101.56± 46.72 vs 142.36± 53.33,P < 0.05).(2)The proportion of patients with smoking history in the good prognosis group receiving bridging embolectomy therapy was higher than that in the poor prognosis group(50.0% vs 22.9%,P<0.05),and the low-density lipoprotein content was lower than that in the poor prognosis group(2.00 ± 0.61 vs 2.43 ± 0.72),P < 0.05),the admission NIHSS score was lower than the poor prognosis group [12.50(9.00-17.00)vs 16.00(12.00-25.00),P < 0.05],the ASPECT score was higher than the poor prognosis group [10.00(9.00-10.00)vs 9.00(8.00-10.00),P<0.05],the difference in univariate analysis of gender between the two groups was statistically significant(P=0.013).(3)Multivariate logistic regression analysis showed that the admission NIHSS score in the direct thrombectomy group was an independent predictor of the patient’s prognosis;the low-density lipoprotein content,the admission NIHSS score,and ASPECT score in the bridging thrombectomy group were independent predictors of the patient ’ s prognosis.Among them,the higher admission NIHSS score and low-density lipoprotein content are independent risk factors that affect the patient’s poor prognosis,and the higher ASPECT score is a protective factor that affects the patient’s good prognosis.(4)Compared with direct thrombectomy,bridging thrombectomy has a higher vascular recanalization rate(85.4% vs 68.2%).In terms of patient prognosis and the proportion of complications,the difference between the two treatment methods is not significant.Conclusion: Higher admission NIHSS score is a risk factor for poor prognosis in patients receiving direct thrombectomy;higher admission NIHSS score,higher low-density lipoprotein content,and lower ASPECT score are poor prognosis for patients receiving bridging thrombectomy.Blood vessel recanalization of bridging thrombectomy is higher,and there is no significant difference between the two treatment methods in terms of patient prognosis and complication rate. |
PDF Full Text Request