Influencing Factors Of Clinical Outcome After Mechanical Thrombectomy For Acute Large Vessel Occlusive Cerebral Infarction

Background: Acute ischemic stroke with large artery occlusion(AIS-LVO)is a common emergency in neurology,with high mortality and poor prognosis.From 5multicenter clinical trials published in the New England Journal of Medicine in 2015 to a number of studies so far,it has been shown that for reasonably screened patients with AIS-LVO,endovascular treatment(EVT)based on Mechanical Thrombectomy(MT)can bring significant clinical benefits.However,not all patients after surgery can achieve the ideal clinical outcome,and not all patients lucky enough to survive can achieve a good prognosis,so this issue has been gradually paid attention to.However,due to the large differences in individual patients’ conditions and numerous related influencing factors,the answers to this question are not consistent at present,and some conclusions are still controversial.Objective: To explore the related risk factors of death and poor prognosis after mechanical thrombectomy for acute large vessel occlusive cerebral infarction,so as to provide reference for clinical treatment decision of the disease.Methods: A retrospective collection of 80 AIS-LVO patients who received MT treatment at XXX Stroke Center from 2017.03 to 2020.11.The clinical outcome was divided into the clinical outcome(death or survival)during hospitalization and the prognosis of the surviving patients 90 days after surgery(poor or good).Among the 80 patients,20 were in the death group;60 were in the survival group.The 60 surviving patients were further divided into a poor prognosis group of 29 cases(m RS score>2points);a good prognosis group of 31 cases(m RS score≤2 points).Option 1.General demographic data(age,sex);2.Past medical history(hypertension,diabetes,hyperlipidemia,atrial fibrillation);3.Personal history(smoking history,drinking history);4.Clinical/imaging features [NIHSS score at admission,NIHSS score 24 hours after operation,ASPECT/ PC-ASPECT score,intracranial hemorrhage,symptomatic intracranial hemorrhage,responsible occlusion vessels(internal carotid artery,middle cerebral artery,vertebral artery,basilar artery)];5.Data related to the operation[preoperative combined intravenous thrombolysis,pathogenesis and recanalization time,and femoral artery puncture,femoral artery puncture to patency time,postoperative pumping for class,had to pull pin number,angioplasty(bracket/ball expansion),recanalization after good(grade 2 b/3 m TICI)],such as five categories of 22 factors between the two groups do statistical analysis.Use SPSS 23.0 software for statistical processing.Corresponding test methods were first used to compare the differences in relevant data between the two groups,and then the meaningful results of univariate analysis were incorporated into the multivariate logistic regression analysis to screen out the risk factors for postoperative death and poor prognosis.Results:1.Comparison between the death group and the survival group(1)Univariate analysis The proportion of patients in the death group with diabetes mellitus(P=0.037),the baseline NIHSS score at admission(P<0.001),the 24-hour NIHSS score after surgery(P<0.001),the proportion of symptomatic intracranial hemorrhage(P=0.025),the time from onset to recanalization(P=0.037),the time from onset to femoral artery puncture(P<0.001)was higher than that of the survival group,and the proportion of good postoperative recanalization was lower than that of the survival group(P=0.005).The above factors had statistical differences between the two groups Scientific significance(P<0.05);there was no statistically significant difference between the two groups in terms of gender,age,hypertension,and hyperlipidemia(P>0.05).(2)Multivariate logistic regression analysis The above 7 statistically significant factors were included in the multivariate logistic regression analysis,and the NIHSS score(OR=0.689,95%CI: 0.538-0.882,P=0.003),the time from onset to recanalization(OR =1.012,95%CI: 0.995-1.030,P=0.041),the time from onset to puncture(OR=0.981,95%CI: 0.996-1.048,P=0.035)was statistically significant(P<0.05).2.Comparison between the poor prognosis group and the good prognosis group(1)Univariate analysis The patients in the poor prognosis group were higher than those in the good prognosis group in terms of the baseline NIHSS score at admission(P=0.001),the24-hour NIHSS score(P<0.001),and the time from onset to recanalization(P=0.047).P=0.02)is lower than the good prognosis group,these factors have statistically significant differences between the two groups(P<0.05);the remaining gender,age,hypertension,diabetes,etc.have no statistically significant differences between the two groups(P>0.05).(2)Multivariate logistic regression analysis The above statistically significant results were included in the multivariate logistic regression analysis,showing the 24-hour NIHSS score(OR=3.209,95%CI: 1.427-7.215,0.005),the time from onset to recanalization(OR=0.978,95%CI :1.549-8.918,P=0.048)is statistically significant(P<0.05).Conclusions:Higher NIHSS score at 24 hours,longer time from onset to recanalization and longer time from onset to femoral artery puncture were independent risk factors for death after mechanical thrombectomy in AIS-LVO patients.Increased NIHSS score at24 hours and prolonged time from onset to recanalization were independent risk factors for poor prognosis after mechanical thrombectomy in AIS-LVO patients.