Analysis Of Influencing Factors Of Futile Recanalization After Mechanical Thrombectomy In Acute Severe Cerebral Infarction

Objective: To analyse the clinical characteristics of patients with acute severe cerebral infarction with large vessel occlusion who received mechanical thrombectomy,and to explore the influencing factors of futile recanalization after mechanical thrombectomy in acute severe cerebral infarction,so as to provide reference for precise treatment of cerebral infarction.Methods: This study collected the clinical data of patients with acute anterior and posterior circulatory large vessel occlusive cerebral infarction treated by mechanical thrombectomy within 24 hours of onset time from January 1st,2015 to September 30 th,2020 in the Department of Neurology of Baotou Central Hospital.The patients were divided into mild-to-moderate cerebral infarction group(baseline NIHSS score<16)and severe cerebral infarction group(baseline NIHSS score≥16)according to the baseline National Institutes of Health Stroke Scale(NIHSS)score.The differences of futile recanalization,symptomatic intracranial hemorrhage within 24 hours after operation,hospital mortality and other factors between the two groups were compared,so as to analyse the clinical characteristics of patients with acute severe cerebral infarction treated by mechanical thrombectomy.According to the m RS score at the end of 3 months after operation,patients with acute severe cerebral infarction who achieved successful recanalization(m TICI≥2b)after mechanical thrombectomy were divided into effective recanalization group(m RS≤2,good clinical outcome)and futile recanalization group(m RS > 2,poor clinical outcome),and multivariate logistic regression model was used to analyse the influencing factors of futile recanalization in patients with acute severe cerebral infarction after mechanical thrombectomy.Results: A total of 295 patients with acute large vessel occlusive cerebral infarction treated by mechanical thrombectomy were included.There were 106 patients in the severe cerebral infarction group and 189 patients in the mild-to-moderate cerebral infarction group.The difference analysis between the two groups showed that in the severe cerebral infarction group,the proportion of hyperglycemia(>10mmol/L)at admission(24.5% vs.12.2%,P=0.006),the proportion of admission low baseline GCS score(<9)(28.3% vs.4.8%,P<0.001),the proportion of lesions located in the posterior circulation(34.9% vs.16.9%,P<0.001),the proportion of symptomatic intracranial hemorrhage(23.6% vs.14.3%,P=0.044),the proportion of high NIHSS scores(≥16)at 7 days after operation(50.0% vs.16.4%,P<0.001),the proportion of low GCS scores(<9)at 7 days after operation(34.0% vs.14.8%,P<0.001),the proportion of in-hospital mortality(28.3% vs.12.7%,P=0.001),the proportion of poor functional outcome(m RS>2)at 3 months after operation(69.8% vs.47.1%,P<0.001),the proportion of mortality at 3 months after operation(31.1% vs.15.9%,P=0.002)and the proportion of futile recanalization(61.3% vs.43.9%,P=0.004)were higher than those in the mild-to-moderate cerebral infarction group.The difference between two groups was statistically significant(P<0.05).97 patients with acute severe cerebral infarction whose blood vessels were successfully recanalized(m TICI≥2b)were divided into two groups,including 32 patients in the effective recanalization group and 65 patients in the futile recanalization group.Univariate analysis showed that there were significant in advanced age(>70 years old),atrial fibrillation,low baseline GCS score(<9),poor collateral circulation(ASITN/SIR grade 0-2),high NIHSS score(≥16)at 7 days after operation,low GCS score(< 9)at 7 days after operation,and improvement of early postoperative neurological function(the NIHSS score decreased by more than 4 points compared with baseline NIHSS score at 7 days after operation)between two groups(P<0.05).However,there was no significant difference between the two groups in whether intravenous thrombolysis or not before mechanical thrombectomy(P>0.05).Multiple logistic regression analysis showed that atrial fibrillation(OR 6.833,95% CI 1.700~27.454)and poor collateral circulation(ASITN/SIR grade 0-2)(OR 15.022,95% CI 3.631~62.153)were the independent risk factors of futile recanalization after mechanical thrombectomy in patients with acute severe cerebral infarction,and the improvement of early postoperative neurological function(OR 0.121,95% CI 0.036~0.407)was an independent protective factor of futile recanalization after mechanical thrombectomy in patients with acute severe cerebral infarction.Conclusion:1.The clinical characteristics of patients with acute severe cerebral infarction treated by mechanical thrombectomy include admission hyperglycemia,low GCS score at baseline and 7 days after operation,high NIHSS score at 7 days after operation,high proportion of posterior circulation lesions and the high proportion of symptomatic intracranial hemorrhage within 24 hours after operation,in-hospital mortality,poor functional outcome(m RS>2)and mortality at 3 months after operation and futile recanalization.2.Atrial fibrillation and poor collateral circulation(ASITN/SIR grade 0-2)are the independent risk factors of futile recanalization after mechanical thrombectomy in acute severe cerebral infarction,and the improvement of early postoperative neurological function(the NIHSS score decreased by more than 4 points compared with baseline NIHSS score at 7 days after operation)is an independent protective factor after futile recanalization of mechanical thrombectomy in acute severe cerebral infarction.3.Intravenous thrombolysis before mechanical thrombectomy is not the influencing factor of futile recanalization after mechanical thrombectomy in patients with acute severe cerebral infarction.