Comparison Of The Efficacy Of Endovascular Treatment For Acute LAA And CE Precirculation Large Vessel Occlusion

Background: Acute ischemic stroke(AIS)is one of the leading causes of death and disability worldwide,especially in patients with large occlusive stroke.With the release of several groundbreaking randomized controlled trials(RCTS),endovascular therapy(EVT)has been recommended as the standard for the treatment of acute large vessel occlusion(LVO)in multiple stroke and interventional societies worldwide.However,these guidelines are based on western populations and there is a lack of evidence from The Chinese population.In China,unlike in western countries,major atherosclerotic stroke is more common than cardiogenic embolism.Currently,there are few data on whether the etiology of stroke affects the reperfusion and prognosis of patients with acute ischemic stroke treated intravascular therapy,and there are still differences in the risk factors and functional prognosis of acute ischemic stroke of different etiologies.Purpose: Objective To investigate the difference of functional prognosis and safety in patients with large artery atherosclerosis(LAA)and cardioembolism(CE)after mechanical thrombectomy in two different causes of anterior circulation major artery occlusion.Methods: The clinical data of stroke patients with anterior circulation large vessel occlusion who received endovascular treatment in stroke Green Channel in The Affiliated Hospital of Cardio-Cerebrovascular Diseases,Yan ’an University from January 2019 to January 2021 were retrospectively analyzed.A total of 115 stroke patients with anterior circulation large vessel occlusion who received endovascular therapy were included.According to the modified TOAST classification,the causes of stroke were divided into CE group(49 cases)and LAA group(58 cases).Among them,8 patients with arteriolar occlusion,other causes and unknown causes were excluded.The basic information,degree of vascular recanalization,time from vascular puncture to recanalization,collateral circulation grade,frequency of thrombectomy,and remedial treatment measures after thrombectomy were compared between the two groups.The functional prognosis of the two groups was evaluated by two days postoperative improvement of nerve function and ninety days m RS score.The incidence of postoperative symptomatic intracranial hemorrhage(s ICH),incidence of reocclusion after opening and ninety days mortality were evaluated for the safety of intravascular therapy in two groups.RESULTS:(1)There were no significant differences in the history of hypertension,hyperlipidemia,diabetes and cerebral infarction between the atherosclerotic group and the cardiogenic embolism group(P>0.05).(2)The age,NIHSS score at baseline,incidence of coronary heart disease or rheumatic heart disease and atrial fibrillation in cardiogenic embolism group were significantly higher than those in atherogenic embolism group(P<0.05).The proportion of male and smoking history in LAA group was higher than that in CE group(P<0.05).The time from puncture to recanalization and the rate of good collateral circulation in CE group were lower than that in LAA group(P<0.05).The proportion of remedial measures and times of thrombolysis in atherosclerotic group were higher than those in cardiogenic embolism group,and the difference was statistically significant(P<0.05).(3)There were no significant differences in the overall final recovery rate and the90-day good prognosis rate between the two groups(82.8% vs87.8 %;56.9% vs51.0 %),there were no significant differences in ninety days mortality and the incidence of72-hour s ICH between the two groups(5.2% vs8.2 %;6.9% vs12.2 %)(P>0.05).The rate of re-occlusion in LAA group was higher than that in CE group(20.7% vs 4.1%),and the difference was statistically significant(P<0.05).CONCLUSION: Differences between two groups of patients with clinical data,on the whole blood vessels take rate,two days postoperative neurological function improvement,the good prognosis of 90-day rate,ninety days mortality and incidence of s ICH 72 hours did not see significant difference,CE group of older patients,coronary heart disease,rheumatic or greater incidence of atrial fibrillation,higher baseline NIHSS,prompt ischemia area is larger.