Efficacy And Prognosis Of Direct Thrombectomy And Bridging Therapy For Acute Anterior Circulation Large Vessel Occlusion Stroke Study

Objective:To investigate the clinical efficacy of direct thrombectomy and bridging therapy in acute anterior circulation large vessel occlusive stroke and to analyze the factors that may affect its prognosis,so that clinical experience can be summarized and more patients can benefit from it.Methods:A retrospective collection of 131 patients with acute anterior circulation large vessel occlusive stroke treated endovascularly within the time window at the Department of Neurology,First Hospital of Shanxi Medical University from January 2020 to October2022,including 57 cases of direct embolization and 74 cases of bridging treatment,was conducted to compare the clinical data and clinical prognosis of the two groups.The patients were divided into good prognosis group(m RS score 0-2)and poor prognosis group(m RS score 3-6)according to the modified Rankin Scale(m RS)score at 90 d postoperatively,and the differences in baseline and clinical data between the two groups were compared,and the main factors affecting the prognosis of endovascular treatment in patients with acute anterior circulation large vessel occlusive stroke were analyzed by multifactorial logistic regression.Results:1.A total of 131 patients with acute large vessel occlusive stroke in the anterior circulation were included,of whom 57 were treated with direct thrombectomy and 74 with bridging.The time from onset to hospital admission was significantly longer in the direct embolization group than in the bridging group [256(160-290)min vs 111(70-170)min,P<0.001],while the time from admission to femoral artery puncture was significantly less than in the bridging group [75(62-101)min vs 130(94-159)min,P<0.001].In contrast,there were no significant differences in past medical history,sex,age,admission blood pressure,blood glucose,NIHSS score,ASPECTS score,time from femoral artery puncture to revascularization,site of occlusion,collateral circulation,remedial measures,and TOAST staging(P>0.05).2.In terms of efficacy,the rates of successful revascularization(84.2% vs 87.8%)and good prognosis at 90d(35.1% vs 47.3%)were lower in the direct embolization group than in the bridging group,but the differences were not statistically significant(P>0.05);in terms of safety,the rates of s ICH(10.5% vs 17.6%)and 90 d mortality(14.0% vs18.9%)were lower in the direct embolization group than in the bridging group,but the differences were not statistically significant(P>0.05).3.Among 131 patients with acute anterior circulation great vessel occlusive stroke,55 had good prognosis and 76 had poor prognosis.Compared with the poor-prognosis group,the good-prognosis group was younger [64(56.5-70.5)years vs 69(62-75.5)years,P=0.004],had fewer patients with a history of previous hypertension(47.3% vs 68.4%,P=0.015),and had a shorter time from femoral artery puncture to revascularization[67(46.5,90.5)min vs 95.5(60.5,132.5)min,P=0.001],more patients with good collateral circulation(67.3% vs 26.3%,P<0.001),higher rate of successful revascularization(84.2% vs 87.8%,P=0.019),and lower incidence of s ICH(1.8% vs 23.7%,P<0.001).4.Multifactorial logistic regression analysis showed that advanced age(OR=1.071,95%CI,1.023-1.122,P=0.003),prolonged time from femoral artery puncture to revascularization(OR=1.020,95%CI,1.007-1.033,P=0.002),and s ICH(OR=22.732,95%CI,2.413-214.135,P=0.006)were independent risk factors for poor prognosis in patients treated endovascularly for acute anterior circulation large vessel occlusive stroke,while good collateral circulation(OR=0.168,95%CI,0.065-0.431,P<0.001)was a protective factor.Conclusion:1.Direct thrombectomy has similar efficacy and safety as bridging therapy,and can be considered for patients with acute anterior circulation large vessel occlusive stroke in the time window when intravenous thrombolysis is not appropriate.2.Age,time from femoral artery puncture to revascularization,collateral circulation,and symptomatic intracranial hemorrhage are the main factors affecting the prognosis of endovascular treatment in patients with large vessel occlusive stroke in the acute anterior circulation.