| Purpose:To study the effect of multimodal endovascular interventions,mainly mechanical embolization,on young patients with acute ischemic stroke(AIS)induced by intracranial large vessel occlusion,and to statistically analyze the risk factors associated with clinical prognosis.Methods: The case data of 64 young AIS patients admitted and treated endovascularly at the Affiliated Hospital of Yan’an University from September 2015 to September 2021 were retrospectively analyzed;all patients had confirmed intracranial large vessel occlusion upon admission,and some patients had undergone intravenous thrombolytic therapy prior to endovascular treatment according to their condition.The prognosis of neurological function was assessed based on the modified rankin scale(m RS)90 days after surgery,and patients were divided into good prognosis group(m RS,0-2 points)and poor prognosis group(m RS,3-6 points).Basic information was also collected,such as patient’s age,gender,history of hypertension,previous history of diabetes mellitus,history of heart disease,history of tobacco and alcohol addiction,history of taking related drugs,as well as the stroke scale score(NIHSS score)on admission,time from symptom onset to admission,initial Alberta Stroke Scale score(ASPECTS score),lateral branch compensation in the infarct area,time of surgical opening,postoperative Immediate NIHSS score,postoperative revascularization m TICI classification,symptomatic intracranial hemorrhage(s ICH)and other clinical data were analyzed univariately using ttest,chi-square test and other correlation methods,and the multivariate parameters were further logistic regression analysis to determine independent predictors of 90-day clinical prognosis.Results:(1).A total of 64 young patients with AIS were included in the study,of which good prognosis group: poor prognosis group = 44;20(68.75% vs 31.25%).The results of univariate analysis showed significant differences between the two groups in terms of baseline data,prevalence of hypertension,NIHSS score at admission,high-density lipoprotein(HDL),and ASPECTS score levels(p < 0.05).(2).Postoperative revascularization occurred in 55 patients(85.94%),and symptomatic cerebral hemorrhage occurred in 6 patients(9.38%).The clinical data of both groups showed a higher rate of successful recanalization in the good prognosis group than in the poor prognosis group [95.45%(42/44)vs 65%(13/20)];the time from puncture to opening,lateral branch compensation,and symptomatic intracranial hemorrhage were statistically significant between the two groups(P < 0.05).(3).Further multivariate logistic regression analysis showed that increased NIHSS score at admission [OR=1.250,95% CI(1.086-1.438)],prolonged puncture to recanalization time [OR=1.053,95% CI(1.034-1.256)] were risk factors for poor prognosis(p<0.05);HDL [OR= 0.154,95% CI(0.039-0.832)],good collateral circulation[OR=0.828,95% CI(0.347-0.846)],and good vascular opening [OR=0.117,95% CI(0.017-0.809)] were protective factors for good patient prognosis.Immediate postoperative NIHSS score [OR=4.846,95% CI(1.031-2.771)] was associated with the occurrence of s ICH postoperatively;good collateral circulation [OR=1.432,95% CI(1.132-2.767)]reduced the occurrence of s ICH postoperatively in patients.Conclusion:(1).Increased NIHSS scores on admission as a risk factor for poor prognosis of endovascular treatment of ischemic stroke in young people.(2).HDL,good collateral circulation as a protective factor for good prognosis in young patients with acute ischemic stroke.(3).Vascular opening status and time to opening are independent influences on the prognosis of ischemic stroke in young people.(4).Immediate postoperative NIHSS score on admission was associated with symptomatic intracranial hemorrhage,while those with good collateral circulation were protective factors for symptomatic intracranial hemorrhage. |
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