Preliminary Clinical Research Of Poor Outcome After Endovascular Treatment For Terminal Segment Occlusion Of Acute Internal Carotid Artery

Objective Acute ischemic stroke(AIS)-anterior circulation large vessel occlusion was still focused on its higher mortality and worse clinical outcomes.Tough rate of its revascularization was enlarged by the technique of endovascular therapy,few of patients with total recanalization remained bad outcomes.Goal of the current study was to investigate the influencing factors of emerging malignant events after total revascularization in AIS-terminal internal carotid artery(TICA)patients.In order to make better clinical selection strategies for patients carried out endovascular treatment,Factors were evaluated for predictive value of malignant events followed by univariate analysis.Methods The records of forty-one patients hospitalized senior stroke center of People’s Hospital of Linyi from March 2016 to December 2018 with AIS-TICA as confirmed by digital subtraction angiography(DSA)and subjected to complete recanalization of mechanical thrombectomy were reviewed.Thrombus of T-and L-type was included and I-type with sufficient collateral blood flow was excluded.Collateral circulation of leptomeningeal was evaluated with use of the American Society of Interventional and Therapeutic Neuroradiology/American Society of Interventional Radiology grading system(ASITN/SIR).The European Cooperative Acute Stroke(ECASS)II standard was used to categorize intracranial hemorrhagic transformation(ICH).Additionally,class of the modified Thrombolysis in Cerebral Infarction(mTICI)was used as the ruler of revascularized extent and the modified Rankin Scale(mRS)for outcomes evaluation.The41 cases that satisfied these criteria were then analyzed with use of a retrospective,univariate analysis of influencing factors for malignant events.A number of analyses were performed including correlations between influential factors and malignant events.Malignant events were defined as a malignant middle cerebral artery infarction(mMCAI)or parenchymal hemorrhage(PH)2-ICH.Results Of the 41 subjects with 34 T-type and 7 L-type thrombi,13(31.71%)had postoperative malignant events.Mean age was(62.49±12.25)years old.The mean number of thrombectomy was(2.29±1.81).7(17.07%)were yong stroke defined as less than 50 years old.Only 16 patients(39.2%)showed good outcomes with mRS≤2 at 3months.However,4 patients(9.8%)experienced severe disability(mRS score 4 or 5)and there were 9(21.95%)deaths occurred in the hospital.Besides,patients in the malignant group had significantly higher scores at the baseline National Institute of Health stroke scale(NIHSS)on admission(P=0.032),lower anterior circulation leptomeningeal compensation grade(P<0.001),higher rate of ICH(P=0.012),worse outcomes(P=0.034)and higher mortality(P<0.001).Furthermore,bivariate correlation analysis showed that the probability of malignant events was positively correlated with the scores of baseline NIHSS(r_s=0.340,P=0.030),negatively correlated with anterior circulation leptomeningeal compensatory grade(r_s=-0.534,P<0.001)and none correlated with posterior circulation leptomeningeal compensatory grade(r_s=-0.257,P=0.105).Conclusions The scores of baseline NIHSS on admission and the leptomeningeal compensation of anterior circulation can be predicted whether a malignant event will occur after complete recanalization of endovascular treatment in AIS-TICA patients.Higher rate of emerging malignant events accompanied by higher scores on baseline NIHSS and lower anterior circulation leptomeningeal compensation grade.The probability of malignant events is significantly increased if the anterior circulation leptomeningeal collateral compensation score is 0-1.