| Objective:To analyze the risk factors of intracranial hemorrhage transformation after endovascular treatment for acute ischemic stroke.Meanwhile,investigate the efficacy and safety of rescue stenting after failed mechanical thrombectomy.Methods:We collected and retrospectively analyzed the clinical data of 94 patients with acute ischemic stroke,who had underwent endovascular treatment,admitted to the Second Affiliated Hospital of Nanjing Medical University from January 2017 to September 2019.All patients received mechanical thrombectomy,and those failed were given remedial treatment.Divide the patients into two groups according to intracranial hemorrhagic transformation after operation,31 cases in hemorrhagic transformation group(HT group)and 63 cases in non-hemorrhagic transformation group(non-HT group).Independent risk factors for intracranial hemorrhagic transformation after endovascular treatment were analyzed by univariate analysis and multivariate Logistic regression.Then divide 37 patients who had received the rescue treatment into two groups according to whether the stent was finally implanted,21 cases in rescue stenting group(RS group)and 16 cases in the non-rescue stenting group(non-RS group).Compare the baseline data,treatment information and clinical outcomes of these two groups,as well as the data betweeen RS recanalization group(n=19)and MT recanalization group(n=57),to evaluate the effectiveness and safety of rescue stenting.Results:(1)84 patients(89.4%)achieved successful recanalization after treatment,and intracranial hemorrhagic transformation appeared in 31 cases(33.0%).At 90 days follow-up,45 cases(47.9%)had good prognosis,and 15 cases(16.0%)died within 90 days.(2)Univariate analysis and multivariate Logistic regression analysis showed that: diabetes(OR=10.169,95%CI : 2.268 ～ 45.588,P=0.002),use of antithrombotic drugs(OR=4.594,95%CI:1.192～17.704,P=0.027),high baseline NIHSS score(OR=1.433,95%CI:1.188～1.728,P<0.001)and increased number of thrombectomy(OR=4.073,95%CI:1.632～10.169,P=0.003)are independent risk factors for intracranial hemorrhagic transformation after endovascular treatment.(3)RS group showed a significantly higher rate of successful recanalization(90.5% vs.50.0%,P=0.009)and good functional outcome(47.6% vs.12.5%,P=0.035)compared with non-RS group.There was no significant difference in the incidence of hemorrhagic transformation(23.8% vs.43.8%,P=0.291)and symptomatic intracranial hemorrhage(14.3% vs.25.0%,P=0.437),as well as mortality(14.3% vs.31.2%,P=0.254)between the two groups.Additionally,good functional outcome(52.6% vs.57.9%,P=0.689),incidene of hemorrhagic transformation(26.3% vs.33.3%,P=0.569)and symptomatic intracranial hemorrhage(15.8% vs.14.0%,P=1.000),and mortality(10.5% vs.12.3%,P=1.000)in RS recanalization group are comparable to that in MT recanalization group.Conclusion:(1)Diabetes,use of antithrombotic drugs,high baseline NIHSS score,and increased number of thrombectomy are independent risk factors for intracranial hemorrhage transformation after endovascular treatment.(2)Rescue stenting can increase the successful recanalization rate of occluded vessels and improve functional outcomes,without increasing the risk of hemorrhage transformation.The treatment appears to be safe and effective as a remedy after failed mechanical thrombectomy. |
