Analysis Of Factors Related To Clinical Prognosis Of Successful Reperfusion Patients With Mechanical Thrombectomy

Objective:The main purpose of this study is to explore the factors affecting clinical prognosis and whether the effect of onset-to-reperfusion time(ORT)on prognosis is related to the degree of compensation of baseline collateral circulation in patients with successful reperfusion after mechanical thrombectomy of acute anterior circulation large vessel occlusion.Methods: The medical records of AC-LVO patients treated in the Stroke Center of Taizhou people’s Hospital from February 2017 to September 2020 were analyzed retrospectively.Before thrombectomy,all patients underwent CTA examination to determine the location of occlusive vessels,and then MT was performed.First of all,according to the modified Rankin scale(m RS)score 90 days after operation,the patients were divided into two groups: good prognosis and poor prognosis.The general data and clinical data affecting the postoperative clinical outcome were included in multivariate analysis.Furthermore,according to the grade score of collateral circulation on CTA images,all patients were divided into two groups: good collateral circulation group and poor collateral circulation group.Univariate and multivariate analysis were used to explore the correlation between the ORT and clinical prognosis 90 days after successful reperfusion.Results:According to the enrollment and exclusion criteria,201 patients with acute AC-LVO were included in this study.90 days after operation,96 patients(47.8%)in good prognosis group and 105 patients(52.2%)in poor prognosis group were followed up.The comparison of general and clinical data between the two groups showed that there were statistical differences in hyperlipidemia,previous history of stroke and diabetes,Alberta stroke program early CT score(ASPECTS),age,systolic blood pressure,the proportion of patients with symptomatic intracranial hemorrhage after operation,good collateral circulation,baseline National Institute of Health stroke scale(NIHSS)score and ORT(P<0.05).The factors with P<0.1 in baseline data were included in multivariate Logistic regression analysis.It was found that hyperlipidemia(OR=3.417,95%CI:1.453-8.039,P=0.005),previous stroke history(OR =3.336,95%CI:1.293-8.607,P=0.013),higher admission NIHSS score(OR=0.906,95%CI: 0.829-0.989,P=0.028),low ASPECTS(OR=1.395,95%CI:1.170-1.662,P < 0.001)and prolonged ORT(every 30 min delay,OR=0.843,95%CI:0.764-0.929,P=0.001)were independent risk factors for poor prognosis.Good collateral circulation(OR=2.921,95%CI:1.224-6.971,P=0.016)is an independent protective factor with good prognosis.According to the grade of collateral circulation,it was found that there were 130patients(64.7%)with good collateral circulation and 71 patients(35.3%)with poor collateral circulation.The data of the two groups were analyzed by univariate analysis and multivariate Logistic analysis.In the group with good collateral circulation,hyperlipidemia,diabetes,low ASPECTS,prolonged ORT,high NIHSS score on admission,previous stroke and age increase were associated with poor prognosis(P<0.05).Multivariate regression analysis showed that past stroke history,age increase,hyperlipidemia,higher admission NIHSS score and low ASPECTS were independently associated with poor prognosis in patients with good collateral compensation.The prolongation of ORT(every 30 min delay,OR=0.909,95%CI:0.815-1.014,P=0.088)is not an independent predictor of poor prognosis in patients with good collateral compensation.In the group with poor collateral circulation,univariate analysis showed that diabetes mellitus,low ASPECTS and prolonged ORT were associated with poor prognosis.Multivariate regression analysis showed that only the prolongation of ORT(every 30 min delay,OR=0.710,95%CI:0.540-0.934,P=0.014)was an independent risk factor for poor prognosis.Conclusion:(1)Prolonged ORT,hyperlipidemia,previous stroke history,higher admission NIHSS score and low ASPECTS were independent risk factors for poor prognosis in patients with acute AC-LVO successfully reperfused after MT,while good collateral circulation was an independent protective factor for good prognosis in patients with acute AC-LVO successfully reperfused after MT.(2)In the population with poor collateral circulation compensation,the prolongation of ORT is an independent risk factor for poor prognosis in patients with acute AC-LVO who were successfully reperfused after MT,while in the population with good collateral circulation compensation,no obvious correlation was found between the ORT and the prognosis of the patients.(3)The effect of ORT on the prognosis of patients with AV-LVO successfully reperfused after mechanical thrombectomy is related to the degree of collateral circulation compensation.