| Objective:To observe the efficacy and safety of SWIM technique in the treatment of acute ischemic stroke caused by posterior circulation large vessel occlusion.And to explore the relevant factors affecting the clinical prognosis of patients.Material and Methods:A retrospective analysis of clinical data of 35 patients with acute ischemic stroke caused by posterior circulation occlusion of large blood vessels treated with SWIM technology in the Dalian Central Hospital from February 2017 to November 2018.The patients’ prognosis was evaluated by telephone return visits.According to the 90-day clinical prognosis,patients were divided into good prognosis group(m Rs score ≤ 2 points)and poor prognosis group(m Rs score ≥ 3 points).The data collected included the patient’s gender,age,history of hypertension,diabetes,history of atrial fibrillation,history of coronary atherosclerotic heart disease,previous history of stroke,history of drinking,history of smoking or smoking.NIHSS score,early pc-ASPECTS score,whether to receive intravenous thrombolysis before mechanical thrombus removal,TOAST classification of acute ischemic stroke,time from stroke onset to hospital arrival,time from stroke onset to recanalization,time from hospital arrival to recanalization,vascular recanalization,perioperative intracranial hemorrhage,intracranial artery dissection and other surgical complications,stent placement,intracranial hemorrhage within 24 hours after surgery confirmed by CT and death within 90 days,and related factors that may affect the good clinical prognosis of the patient at 90 d were discussed according to the clinical data of the patients.Results:A total of 35 patients were included,with an average age of 66.1±12.1 years,and 26 males(74.3%)and 9 females(25.7%),the median baseline NIHSS score was 22(IQR15-34).the median baseline pc-ASPECTS score was 9(IQR 7-9),and the median time from onset to hospital was 210(IQR 120 to 390)minutes.The median time from onset to recanalization of all recanalized patients was 344(IQR 245 to 518)minutes,and the averagetime from recanalization to recanalization was 130.9 ± 20.8 minutes for all recanalized patients.In the TOAST stroke etiology classification,68.5%(24/35)of patients with aortic atherosclerosis,28.6%(10/35)of patients with cardiogenic stroke,2.8%(1/35)of other causes,42.9%(15/35)of patients received intravenous thrombolysis before mechanical thrombectomy;the total revascularization rate was 94.3%(33/35),and the stent placement rate was 34.3%(12/35),Among which 28.6%(10/35)of patients with in-situ stenosis could not maintain blood flow,5.7%(2/35)of intracranial artery dissection,and the successful recanalization rate of forward blood flow after stent implantation was 91.7%(11/12);The incidence of thromboembolic events leading to the distal end during the operation was 8.6%(3/35),the incidence of vascular dissection was 2.9%(1/35),and the incidence of intracranial hemorrhage was 2.9%(1/35);The all-cause intracranial hemorrhage rate was 17.1%(6/35)at24 hours postoperatively,the good prognosis rate at 90 days was 45.7%(16/35),and the allcause mortality rate at 90 days postoperative was 37.1%(13/35).Among which the mortality rate during hospital discharge was 31.4%(11/35),and the mortality rate after discharge was5.7%(2/35).In the good prognosis group,the average age was 64.8 ± 12.6 years old,men accounted for 62.5%(10/16),history of hypertension accounted for 50%(8/16),history of diabetes accounted for 31.2%(5/16),history of atrial fibrillation accounted for 25.0%(4/16),history of coronary atherosclerotic heart disease accounted for 18.7%(3/16),history of stroke accounted for 12.5%(2/16),history of smoking accounted for 50%(8/16),history of drinking accounted for 18.7%(3/16),the baseline NIHSS score was 17(11.25-20),and the baseline pcASPECTS score was 9(8.25-9);in the TOAST classification of acute ischemic stroke,aortic atherosclerosis Sclerotic type accounted for 68.8%(11/16),cardiogenic embolism accounted for31.2%(5/16),and other cause type was 0%.The median time from onset to hospital was 195(IQR 150,322)minutes,and the median time to recanalization was 322(IQR 293,458)minutes,and the average time from arrival to recanalization was 129.5 ± 22.4 minutes.Intravenous thrombolysis accounted for 43.8%(7/16),and stent placement accounted for 31.3%(5/16).m TICI ≥ 2b accounts for 100.0%(16/16).In the poor prognosis group,the average age was 67.2±11.6 years old,84.2%(16/19)were male,history of hypertension accounted for 63.2%(12/19),history of diabetes accounted for 47.3%(9/19),history of atrial fibrillation accounted for 36.8%(7/19),history of coronary atherosclerotic heart disease accounted for 31.5%(6/19),history of stroke accounted for 26.3%(5/19),history of smoking accounted for 63.2%(12/19),history of drinking accounted for 52.6%(10/19),the baseline NIHSS score was32(22-35)points,and the baseline pc-ASPECTS score was 8(7-9)points;in the TOAST classification of acute ischemic stroke,aortic atherosclerosis Sclerotic type accounted for 68.4%(13/19),cardiogenic embolism accounted for 26.3%(5/19),other cause type was 5.3%(1/19),and the median time from onset to hospital was 240(IQR 120,420)Minutes,the median time from onset to recanalization was 373(IQR 244,544)minutes,the average time from arrival to recanalization was 132.3 ± 19.0 minutes,intravenous thrombolysis accounted for 42.1%(8/19),and stent placement accounted for 36.8 %(7/19),m TICI ≥ 2b accounted for 89.5%(17/19).Univariate analysis showed that patients with good prognosis had lower baseline NIHSS scores(17 vs.32 P = 0.001)and higher baseline pc-ASPECTS scores(9 vs.8 P =0.016),shorter time from onset to arrival(195 vs.240 P = 0.039),shorter time from onset to recanalization(322 vs.373 P = 0.047),and higher rate of successful recanalization of blood vessels(100% vs.89.5% P = 0.036)and low alcohol consumption(18.7% vs.52.6% P = 0.042)were associated with good prognosis.Conclusions:For patients with acute ischemic stroke due to posterior circulation large vessel occlusion,thrombectomy with SWIM technology is relatively safe and effective;and the patient’s baseline NIHSS score,baseline pc-ASPECTS score,drinking history,and onset to Hospital time,onset to recanalization time,and vascular recanalization were closely related to the 90-day clinical prognosis of patients. |
PDF Full Text Request