Correlation Between Extracranial And Extracranial Artery Stenosis And Prognosis Of Patients With Acute Ischemic Stroke Undergoing Intravenous Thrombolysis

ObjectiveTo investigate the correlation between extracranial and extracranial arterial stenosis and clinical prognosis in patients with acute ischemic stroke(AIS)after intravenous thrombolysis.MethodsFrom February 2019 to August 2022,185 patients with AIS who received intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rt PA)at the Emergency Green Channel of The First Affiliated Hospital of Kunming Medical University(within 4.5 hours of onset)were continuously collected,and within 24 hours after thrombolysis,head CT was reviewed to assess whether there was bleeding transformation(HT);Complete multimodal magnetic resonance imaging(MRI)examination of the skull within 48 hours to obtain relevant imaging data,and clinical symptoms within 7 days.The general demographic data,cerebrovascular risk factors,laboratory examination results,baseline NIHSS scores,and NIHSS scores 24 hours after thrombolysis were collected and collated.The degree of extracranial and extracranial artery stenosis in each patient was calculated based on a unified formula for the degree of extracranial and extracranial artery stenosis.According to the degree of stenosis,the patients were divided into the group without extracranial and extracranial artery stenosis,and the group with pure intracranial artery stenosis,Simple extracranial artery stenosis group and simultaneous extracranial and extracranial artery stenosis group.The early prognostic indicators of AIS patients receiving thrombolytic therapy were early neurological deterioration(END),HT,and symptomatic intracranial hemorrhage(sICH).The modified Rankin Scale(m RS)was used to evaluate the patients’ late prognosis(m RS score of 0 to 2 indicates a good prognosis,and m RS ≥ 3indicates a poor prognosis),Correlation analysis was used to analyze the correlation between extracranial and extracranial arterial stenosis and the prognosis of intravenous thrombolysis in AIS patients.At the same time,different thrombolytic prognosis outcomes were grouped,and univariate and multivariate regression analysis was used to evaluate the impact of different site stenosis on the prognosis of patients with intravenous thrombolysis.ResultsThis study included 185 patients who were grouped according to the degree of extracranial and extracranial artery stenosis,and defined stenosis>50% as extracranial and extracranial artery stenosis.The results showed that among 185 patients,97 patients(52.4%)had no extracranial and extracranial artery stenosis,54 patients(29.2%)had intracranial artery stenosis alone,9 patients(4.9%)had extracranial artery stenosis alone,and 25 patients(13.5%)had both extracranial and extracranial artery stenosis simultaneously.Comparing the baseline data of the four groups of patients,it was found that there were statistically significant differences in age,gender,history of atrial fibrillation,and baseline NIHSS scores among the four groups.A pairwise comparison of the four groups found that(1)compared with the group without extracranial and extracranial artery stenosis,The age of the group with simple intracranial artery stenosis and the group with simultaneous intracranial and extracranial artery stenosis was significantly higher than that of the group without intracranial and extracranial artery stenosis [(69.31±11.73)years vs(63.91±14.80)years,P=0.005;(70.76±10.06)years vs(63.91±14.80)years,P=0.009],with a statistically significant difference(both P<0.05);(2)Compared with the group with pure intracranial artery stenosis,the proportion of males in the group with pure extracranial artery stenosis was significantly higher(100%vs 51.9%),with a statistically significant difference(P<0.005);(3)Compared with the group without extracranial and extracranial artery stenosis,the proportion of patients with atrial fibrillation in the group with only intracranial artery stenosis was higher and the difference was statistically significant(24.1% vs 7.2%,P<0.005);(4)Compared with the group without extracranial and extracranial artery stenosis,the baseline NIHSS score in the group with only intracranial artery stenosis was significantly higher [8(3,12)points vs 4(3,7)points,P=0.04].The remaining indicators were not statistically significant between the groups.Multivariate logistic regression analysis was used to analyze the indicators that affect the early prognosis of patients with intravenous thrombolysis.The results showed that a high baseline NIHSS score(OR=1.073,95%CI 1.013～1.137,P=0.016)was an independent risk factor for the occurrence of HT and sICH in patients,and the presence or absence of extracranial arterial stenosis did not affect their early prognosis.Multivariate analysis of long-term indicators showed that the baseline NIHSS score(OR=1.243,95%CI 1.135～1.362,P<0.001)was an independent risk factor for poor prognosis and increased the risk of death after intravenous thrombolysis(OR=1.454,95% CI 1.182～1.788,P<0.001).In addition,older age(OR=1.040,95% CI 1.004～1.078,P=0.028)Patients with simultaneous intracranial and extracranial artery stenosis(OR=10.452,95% CI 3.004～36.369,P<0.001)are more likely to have adverse neurological outcomes at 90 days.Conclusions(1)Intravenous thrombolysis does not increase the risk of END,HT,sICH,and90-day death in AIS patients with extracranial and extracranial arterial stenosis.(2)Simultaneous stenosis of intracranial and extracranial arteries and advanced age are independent risk factors for 90 day adverse neurological outcomes in patients undergoing intravenous thrombolysis.(3)High baseline NIHSS score is an independent risk factor for the occurrence of HT,sICH,and late adverse prognosis in AIS patients.