| Objective: By analyzing the relationship between clinical outcome and clinical parameters of patients with acute anterior circulation macrovascular occlusion treated with late time window(≥ 6 hours),to explore the key indicators affecting the clinical efficacy of 3 months,and to accurately screen the conditions of patients undergoing endovascular therapy.The predictive ability of(totaled health risks in vascular events,THRIVE),Pittsburgh Intravascular treatment response(Pittsburgh Response to Endovascular Therapy,PRE)score and Houston Intraarterial Therapy-2(HIAT-2)score were compared.Method: A total of 79 patients with acute anterior circulation macrovascular occlusion treated by endovascular thrombectomy in the Department of Neurology from July 2019 to December 2020 were collected retrospectively,and the time window was more than 6 hours.The baseline data of the patients included age,sex,smoking history,blood pressure,blood glucose,past history(such as atrial fibrillation,hypertension,diabetes,middle wind,etc.),history of antiplatelet drugs,history of anticoagulants,time of onset,(NIHSS)score of the National Institutes of Health Stroke scale before and after treatment,postoperative bleeding conversion,symptomatic bleeding,90-day m RS score,etc.Receiver operating characteristic(ROC)Area under curve(AUC)to compare and analyze the ability of THRIVE score,PRE score and HIAT-2 score to predict functional prognosis of 90-day m RS score.Univariate Logistic regression analysis was used to determine the relationship between clinical parameters and prognosis.Multivariate Logistic regression was used to analyze the factors associated with good outcomes of 90-day m RS score.Results:(1)Among 79 patients treated with endovascular therapy at a late time window(≥ 6 hours)for acute anterior circulation large vessel occlusion,the thrive score showed moderate predictive accuracy for good outcome(m RS 0-2)at 3 months after surgery(AUC = 0.741,95% CI 0.630-0.833,p<0.0001),and the THRIVE score showed moderate predictive accuracy for severe poor outcome(MRS 4-6)at 3 months after surgery(AUC = 0.738,95%CI 0.627-0.831,p<0.0001).HIAT-2 score was highly predictive of severe adverse outcome(m RS 4-6)at 3 months after surgery(AUC =0.750,95% CI 0.640-0.841,p<0.0001).The PRE score had low predictive accuracy for good outcome(m RS 0-2)at 3 months after surgery(AUC = 0.699,95% CI 0.586-0.797,p=0.0007)and good predictive accuracy for severe poor outcome(m RS 4-6)at 3months after surgery(AUC = 0.758,95% CI 0.648-0.847,p<0.0001).There was no significant difference between the three scores in predicting severe adverse outcomes,and the combination of the three scores did not significantly improve the predictive power(2)In the comparison of different collateral circulation,there were differences in age p= 0.043)between the two groups,but there were no significant differences in gender,blood glucose,baseline NIHSS score,thrombolysis,aspects,vascular occlusion site,smoking,hypertension,diabetes,hyperlipidemia and history of atrial fibrillation.(3)In patients with endovascular treatment in the late time window(within 6-36hours),the duration from occlusion to recanalization was not associated with 90-day clinical outcomes(OR=1.00,95%CI(1.00,1.00),P =0.5494),the probability of good90-day outcome MRS 0-2 increased by 21.3 times in patients with grade 2 upper lateral branch of DSA(OR=22.3,95%CI(1.6,305.6),and the time of ischemia was no longer an independent risk factor for stroke medium-term outcome.History of hypertension decreased the probability of good outcome at 90 days in patients with anterior circulation LVO by 92%,and it was an independent risk factor that increased blood glucose on admission reduced the probability of good outcome at 90 days in patients with anterior circulation LVO by 35%,which was an independent risk factor.Conclusion:(1)Within 6-36 hours of acute anterior circulation occlusion,patients with thrive score > 2,hiat2 score > 3 and pre score > 24 can be used to screen patients who are not suitable for endovascular treatment(2)Within 6-36 hours of acute anterior circulation occlusion,ischemic time is no longer an independent risk factor for mid-term stroke outcome(3)Within the late time window(6-36h)of acute anterior circulation occlusion,some patients with moderate or more collateral branches(Astin≥ 2)can benefit from recanalization... |
PDF Full Text Request