| Objective:To analyze the clinical data of patients with acute cardiogenic cerebral vascular embolism caused by atrial fibrillation(AF)and achieve early vascular recanalization by intravascular mechanical thrombectomy(MT),and to explore the influencing factors of poor early prognosis in patients with successful revascularization in acute phase,so as to provide reference for the evaluation and individualized treatment of this type of patients.Methods:Patients with acute anterior circulation large artery embolism associated with atrial fibrillation who were treated with intravenous thrombolysis bridging artery mechanical thrombectomy or simple arterial mechanical thrombectomy were retrospectively included.The improvement of early neurological function was evaluated by combining 24-hour and 7-day relative neurological improvement(RNI).The patients were divided into two groups:poor early prognosis and good early prognosis.at the same time,24-hour RNI>28%and 7-day RNI>42%were considered to have a good early prognosis.Collect the patient’s age,sex,past medical history,old encephalomalacia focus,preoperative ASPECTS score,collateral circulation grade,baseline NIHSS score,time from onset to arterial puncture(OTP),operation time and so on.The diameter of left atrium(LAD),left ventricular ejection fraction(LVEF),hypersensitive troponin,N-terminal segment brain natriuretic peptide(NT-pro-BNP),preoperative blood glucose,lactate dehydrogenase,homocysteine,lymphocyte/monocyte ratio(LMR),peripheral blood neutrophil/lymphocyte ratio(NLR),systemic inflammatory response index(SIRI)and so on.The independent sample t test,Mann-Whitney U test andX~2test were used to compare the results between groups.The statistically significant clinical data between the two groups were analyzed by multivariate Logistic regression analysis.Results:A total of 84 patients with acute atrial fibrillation(AF)related ischemic stroke who underwent recanalization after mechanical thrombectomy were enrolled,including44 patients in the poor early prognosis group and 40 patients in the good early prognosis group.Between the two groups,the proportion of female patients was(47.72%vs.22.5%,P=0.016),age(74.57±8.673 vs.69.65±10.555,P=0.022),long diameter≥20mm encephalomalacia(27.27%vs.7.5%,P=0.018),preoperative ASPECTS score(8(7,10)vs.10(9,10),P=0.000),baseline NIHSS score(20.50(16.00,24.00)vs.17.00(13.25,22.00),P=0.012),left ventricular systolic dysfunction(LVSD)(19(43.2)vs.5(12.5),P=0.002),preoperative blood glucose(7.77(6.61,10.19)vs.6.82(6.21,8.05),P=0.012),urea nitrogen(8.06(5.88,9.97)vs.7.34(5.22,7.83),P=0.039),lymphocyte to monocyte ratio(LMR)(1.78(1.02,2.34)vs.2.54(1.89,3.55),P=0.001),peripheral blood neutrophil/lymphocyte ratio(NLR)(10.08(7.07,13.64)vs.5.91(3.61,7.89),P=0.000),systemic inflammatory response index(SIRI)(5.48(3.00,11.49)vs.2.74(1.65,4.46),P=0.000),high-sensitivity troponin(0.018(0.011,0.029)vs.0.012(0.007,0.019),P=0.014),NT-pro-BNP(1800(1100,3450 vs.830(505,2300),P=0.023)and lactate dehydrogenase(232.00(197.75,289.25)vs.201.00(182.75,245.50),P=0.014)were statistically significant.Multivariate Logistic regression analysis showed that female(OR 15.830,95%CI 1.511-165.821,P=0.021),LVSD(OR 12.164,95%CI 1.680-88.073,P=0.013),female(OR 15.830,95%CI 1.511-165.821,P=0.021)and SIRI(OR 1.448,95%CI 1.044-2.008,P=0.027)were risk factors for early prognosis.ASPECTS score(OR 0.328,95%CI 0.158-0.681,P=0.003)was a protective factor for early prognosis.Conclusion:1.Female,lower preoperative ASPECTS score,LVSD and higher SIRI were independent risk factors for poor early prognosis after mechanical thrombectomy in patients with AF-related acute cardiogenic cerebral vascular embolism.2.In the group of patients with early poor prognosis after mechanical thrombectomy for AF-related acute cardiogenic cerebral vascular embolism,the proportion of patients with larger encephalomalacia before operation is significantly higher,which may provide new ideas for future research. |
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