Prognostic Factors Associated With Endovascular Treatment Of Acute Ischemic Stroke In Posterior Circulation

Objectives: To investigate the influence of related factors on the prognosis of posterior circulation acute ischemic stroke patients with endovascular treatment.It provides reference for endovascular treatment of acute ischemic stroke in posterior circulation.Methods: Selected from January 2015 to September 2020 in Jining city of the first people’s hospital neurology 62 acute posterior circulation ischemic stroke patients,the onset time(onset time limit within 6 hours in principle,some advanced compound cases after intervention group of experts to evaluate the ease to within 24 hours),after the standards included in the endovascular treatment technology as the research object,carries on the clinical observation.The patients’ basic information including onset form,previous medical history,blood biochemical indexes,preoperative,postoperative,NIHSS score at discharge,preoperative MRS score,gender and age were collected.Intravascular therapy(including arterial thrombolysis,balloon dilation,stent thrombectomy,and catheter thrombectomy)was performed in 62 patients.The operative time,90-day MRS(≤ 2)ratio,90-day mortality,24-hour symptomatic bleeding rate,and other complications were observed.SPSS 23.0statistical software was used for analysis,t test and chi-square test were used to compare the data,and logistic regression model was used for analysis after controlling the relevant confounding factors.Results:1.Postoperatively,43 cases(69.4%)of m TICI-2B or 3 were recanalized.19 cases(30.6%)were not opened;There were 7 cases of basilar artery lesions,9 cases of basilar+vertebral artery lesions,2 cases of bilateral intracranial vertebral artery lesions,and 1 case of posterior cerebral artery lesions.The treatment was continued in the neurological intensive care unit after surgery,and the treatment principles were as follows:regulating lipid metabolism,anti-platelet,improving brain metabolism,symptomatic support and rehabilitation treatment.Through outpatient reexamination or telephone inquiry,28 patients(45%)had good prognosis after 90 days.2.In this study,there were 17 cases of 90-day mortality(27.4%),8 cases of 24-hour bleeding transformation(12.9%),including 2 cases of symptomatic bleeding.The types of hemorrhage were as follows: 3 cases of subarachnoid hemorrhage,1 case of extravasation contrast agent,4 cases of cerebral lobe hemorrhage.There were 43 cases of pulmonary infection(69.4%),including 21 cases of nosocomial infection(33.8%),39 cases of cerebral edema(62.9%),4cases of cerebral hernia(6.4%),and 2 cases of decompression by bone flap(3.2%).No arterial dissection,pseudoaneurysm,hematoma at the puncture site or other adverse events were observed.Conclusion: Technical feasibility is determined by the proportion of good recanalization achieved in this study for endovascular treatment in the acute phase of posterior circulation ischemic stroke.The results indicated a good90-day prognosis and a low complication rate and mortality rate.The efficacy and safety were explained to a certain extent.According to 90 DMRS score,≤2 was the group with good prognosis,and >2 was the group with poorprognosis.In terms of prognostic factors,t test was used to calculate relevant factors,including OPT,NIHSS scores before,after and after discharge,vascular recanalization(MTICI≥2b)and PC-aspects,which had statistical significance.In patients with posterior circulation acute ischemic stroke receiving endovascular therapy,higher OPT and preoperative NIHSS scores were associated with a relatively poor prognosis,while recanalization and high PC-aspect predicted a relatively good prognosis.