A Control Study Of Direct Arterial Thrombectomy And Bridging In Patients With Acute Anterior Circulation Large Vessel Occlusive Cerebral Infarction Within 6 Hours

BackgroundStroke is one of the major diseases that seriously threaten the health of our population,and the first cause of illness and death in China.60%～80% of the patients with new stroke are acute ischemic stroke(AIS),of which 28%～46% of the AIS is accounted by large vessel occlusion(LVO),the prognosis is poor,the disability rate and the case fatality rate are high,up to 70%,which brings a heavy burden to the family and the society.Therefore,the level of AIS treatment is closely related to the health of our people.The key to successful treatment is to achieve recanalization of responsible blood vessels within an effective time window.Intravenous thrombolytic therapy in time window is the only effective method for vascular recanalization before 2015,but there are some disadvantages such as lower recanalization rate of AIS with large vessel occlusion,shorter treatment time window and more excluded indexes.In 2015,NEJM published the positive results of five randomized controlled trials for the treatment of acute ischemic stroke.Acute is chemic stroke opened a new era of endovascular treatment of(Endovascular Therapy EVT).The guidelines for acute ischemic stroke were rewritten.For ischemic stroke with acute anterior circulation large vessel occlusion(Anterior Circulation Large vessel Occlusion AC-LVO)within 6 hours of onset,both domestic and foreign guidelines recommended initiating intravascular therapy on the basis of intravenous thrombolytic therapy.In particular,mechanical thrombectomy with thrombectomy stent can significantly improve the recanalization rate of large occluded vessels and improve the prognosis of the patients,without increasing the complications of symptomatic intracranial hemorrhage and the adverse events such as 90-day mortality.As the second proven and recommended safe and effective vascular recanalization method.The efficacy and safety of bridging in the treatment of acute AC-LVO ischemic stroke have been confirmed.However,studies have shown that intravenous thrombolysis may increase the incidence of symptomatic intracranial hemorrhage(s ICH),especially the proportion of s ICH in emergency patients who need oral antiplatelet drugs before operation is signific-antly increased,which may cause complications of systemic hemorrhage,delay the time of arterial thrombectomy,and increase the cost of treatment,etc.Therefore,for AIS patients with acute macrovascular occlusion,many scholars have suggested that direct arterial thro-mbectomy can be performed to shorten the time to start endovascular therapy and to open occluded blood vessels as soon as possible.This is also a controversial treatment of AIS and need to be identified as a hot issue.In response to the above,we designed the study in conjunction with our work in endovascular treatment of acute ischemic stroke in recent years.ObjectiveThe purpose of this study was to investigate and compare the safety and efficacy of direct arterial thrombectomy and bridging in cerebral infarction patients with acute anterior circulation large vessel occlusion within 6 hours.MethodsThis study is a retrospective analysis,From February 2017 to June 2018,we collected the acute anterior circulation macrovascular occlusion in Liaocheng peopleundefineds Hospital and Liaocheng brain Hospital within 6 hours of the onset of acute anterior circulation thrombus removal by bridging and direct arterial thrombus removal from Liaocheng peopleundefineds Hospital and Liaocheng brain Hospital.The patient with cerebral infarction.All the patients were in accordance with the following criteria: within 6hours of onset,m RS score before stroke was 0 ～ 1;ischemic stroke was caused by internal carotid artery or middle cerebral artery M1 segment occlusion or middle cerebral artery M2 segment occlusion;age ≥ 18 years;NHISS score ≥ 6 points.According to the treatment,the patients were divided into two groups: bridging group(r-t PA or urokinase thrombolytic mechanical removal group),direct arterial thrombectomy group.Before treatment,24 hours after treatment and before discharge from hospital,the(NIHSS)score of the stroke scale and the 90 day modified Rankin scale(m RS)score were observed to evaluate the efficacy of the treatment.The conversion rate of symptomatic intracranial hemorrhage and the 90-day mortality were observed to evaluate the safety of the treatment.The risk factors associated with symptomatic intracranial hemorrhage were observed.Results(1)Effectiveness: there was no significant difference in the the recanalization rate of occluded vessels and the good prognosis rate of m RS in 90 days between the direct artery embolization group and the bridging treatment group.(2)Safety: there was no significant difference in the incidence and mortality of s ICH between the direct artery embolization group and the bridging treatment group.(3)The patients with NIHSS score ≥ 21,the cardiogenic cerebral embolism,the ASTIN/SIR< 2,the time from onset to opening and the times of arterial embolization ≥ 3times were the high risk patients of s ICH after endovascular treatment in patients with acute AC-LVO stroke.Conclusion(1)There was no significant difference in the efficacy and safety between direct thrombus removal and bridging treatment in acute AC-LVO stroke patients within 6 hours of onset.Direct thrombus removal may be an alternative to bridging therapy.(2)Before treatment,NIHSS score ≥ 21,cardiogenic cerebral embolism,the ASTIN/SIR<2,the time from onset to opening and the times of arterial embolization ≥ 3were the risk factors of s ICH after intravascular treatment in patients with acute AC-LVO stroke.