Comparison Of Thromboelastography Between Chr7onic Cerebral Ischemia And Cerebral Infarction And Its Correlation With Prognosis Of Large-artery Atherosclerosis Cerebral Infarction

BackgroundChronic cerebral ischemia is a group of clinical syndrome of brain dysfunction caused by chronic cerebral perfusion decline.If not timely intervention,chronic cerebral ischemia can progress to cerebral infarction.Early neurological deterioration and recurrent thromboembolic events will aggravate the condition of patients with cerebral infarction,and the incidence of early neurological deterioration is the highest in patients with large atherosclerotic cerebral infarction.In the prevention and treatment of cerebral infarction,although some patients regularly take antiplatelet drugs,recurrent thromboembolic events still occur.Coagulation plays an important role in chronic cerebral ischemia,early neurological deterioration and recurrent thromboembolism.Thromboelastography can dynamically reflect the whole process of coagulation and fibrinolysis.Objective1.to investigate the difference of thromboelastography(TEG)between chronic cerebral ischemia(CCI)and acute ischemic stroke(AIS);2.to investigate the correlation and predictive value of TEG parameters on early neurological deterioration(END),1-year poor outcome and recurrent thromboembolic events in patients with acute cerebral infarction(AIS)of large artery atherosclerosis(LAA).Methods63 cases of CCI and 93 cases of AIS treated by neurology in the First Affiliated Hospital of Xinxiang Medical University from November 2018 to July 2020 were recruited.The general data and TEG parameters between chronic cerebral ischemia and acute ischemic stroke were compared,TEG parameters include coagulation reaction time(R time),coagulation formation time(K time),αangle(Angle),maximum thrombus amplitude(MA),coagulation index(CI),Fibrinolytic index(LY30).65 cases of LAA cerebral infarction were selected from 93 cases of AIS.Based on whether or not END appeared within 72 hours after cerebral infarction,Whether 1 year functional outcome is good or not,and whether thromboembolic events occurred were divided into 3 research trials.Each trial compares with TEG parameters;Binary logistic regression analysis of TEG parameters was performed on early neurological deterioration,poor functional outcome(m RS≥2),and recurred thromboembolic events;ROC curve assayed TEG parameters predict the effectiveness of them occurrence.Results1.There was no significant difference in general information such as age,gender,smoking and drinking history,and blood pressure between chronic cerebral ischemia and acute ischemic stroke.Group acute ischemic stroke had a significantly lower R time than group chronic cerebral ischemia,while MA and CI were significantly higher than group chronic cerebral ischemia(P<0.05).2.15 out of 65 patients with LAA cerebral infarction had END.55 patients with LAA AIS completed 1-year follow-up,28 patients had poor functional outcomes,and 10 patients had recurrent thromboembolic events.The logistic regression analysis showed that the short R time was an independent risk factor for END(OR=0.347,95% CI: 0.149～0.812,P=0.015);the best cut-off value of R time to predicted END is 2.85 min.The logistic regression analysis showed that the increased MA was an independent risk factor for poor functional outcomes(OR=1.155,95%CI:1.032～1.293,P=0.012);the best cut-off value of MA to predicted poor functional outcomes is 62.6 mm.The TEG parameter MA value of the recurrent thromboembolic event group was significantly higher than that of the non-recurrent thromboembolic event group(P<0.05),but MA was not a risk factor for recurrent thromboembolic event(P=0.056).Conclusions1.cute ischemic stroke is hypercoagulable than chronic cerebral ischemia.2.The decrease of R time and increased MA of TEG parameters separately have a predictive effect on early neurological deterioration and poor functional outcomes after 1year in patients with LAA cerebral infarction.The decrease of R time and increased MA of TEG parameters are respectively related to tearly neurological deterioration and poor functional outcomes after 1 year in patients with LAA cerebral infarction,and can predict its occurrence.3.According to the results of thromboelastography,the application of anticoagulants or antiplatelet aggregation drugs under the detection of coagulation function may prevent the progression of chronic cerebral ischemia to cerebral infarction and early neurological deterioration after LAA type cerebral infarction,and improve the prognosis of patients.