| Objective:Stratification based on factors such as different ages,gender and basic diseases,objective to investigate the application value of cerebral CTP in the prognosis evaluation of patients with AIS after mechanical thrombectomy ultra-6-h time window.Methods:The patients with AIS who underwent mechanical thrombectomy in Hunan Provincial People’s Hospital from January 1,2018 to June 30,2020 and had a 6 hour time window were retrospectively analyzed,According to whether the CT P was performed before operation,the patients were divided into CTP group and non CTP group,including17 CTP group and 31 non CTP group.The clinical data of the two groups were collected,including age,gender,CT perfusion imaging,hypertension,diabetes,coronary heart disease or atrial fibrillation,NIHSS score before and 1 week after operation,Mrs score before and 90 days after operation.The improvement rate of neurological symptoms was evaluated according to whether the NIHSS score decreased more than 4points one week after operation.According to whether the Mrs score was less than or equal to 2 on the 90 th day after operation,the outcome rate was evaluated.The outcome rate and symptom improvement rate of the two groups were compared,and the statistical analysis(Chi square test,Fisher exact test)was carried out based on different age,gender and underlying diseases to explore the application value of cerebral CT perfusion imaging in mechanical thrombectomy of acute cerebral infarction with ultra-6-h time window.Results:1.According to the inclusion criteria,a total of 48 cases with mechanical thrombectomy within 6-24 hours were collected,Among them,there were 33 males and 15 females;there were 14 patients over 70 years old and 34 patients under 70 years old;A total of 35 patients had a history of underlying disease,including 30 with hypertension,10 with type 2diabetes,23 with coronary heart disease,and 13 with atrial fibrillation.2.There was no significant difference in the symptom improvement rate in CTP group in the first week after operation than that in non CTP group(P > 0.05),and the 90 days after operation in CTP group was significantly better than that of non CTP group(P < 0.01).In CTP group and non CTP group,there was no significant correlation between the gender of patients and the improvement rate of symptoms at 1 week after operation and the good prognosis rate at 90 days after operation(P > 0.05).3.In CTP group and non CTP group,there was no significant correlation between the gender of patients and the improvement rate of symptoms at 1 week after operation and the good prognosis rate at 90 days after operation(P > 0.05).In patients with hypertension and AF,the symptom improvement rate in the CTP group was better than that in the non CTP group,with significant differences(P < 0.05);In patients with diabetes mellitus and coronary heart disease,there was no significant difference in the symptom improvement rate in the CTP group compared with the non CTP group(P > 0.05);Patients with underlying diseases,including hypertension,diabetes mellitus,coronary heart disease,and atrial fibrillation,the long-term outcomes of patients in the CTP group were all significantly better than those in the non CTP group(P <0.05).4.In patients aged ≥ 70 years,the symptom improvement rate at 1week after surgery and the good prognosis rate at 90 days after surgery were not significantly different in the CTP group compared with the non CTP group(P > 0.05),in patients aged < 70 years,the symptom improvement rate at 1 week after surgery was not significantly different in the CTP group compared with the non CTP group(P > 0.05),but the good prognosis rate at 90 days after surgery was significantly better in the CTP group compared with the non CTP group(P <0.05).5.In patients with AF,the CTP group had a better symptom improvement rate than the non CTP group(P < 0.05),patients with hypertension,diabetes mellitus,coronary heart disease had a worse symptom improvement rate than the non CTP group(P > 0.05),patients with diabetes mellitus,coronary heart disease,atrial fibrillation had a better long-term outcome than the non CTP group Significant(P < 0.05),Patients with hypertension,the long-term prognosis of patients in the CTP group was not better than that in the non CTP group,and the difference was not significant(P > 0.05).Conclusion:1.The role of preoperative assessment by brain CT perfusion imaging in mechanical thrombus removal in AIS with an ultra-6-h time window is age dependent: in patients aged < 70 years,those who were screened by preoperative perfusion imaging with brain CT and then underwent reoperation had a more favorable outcome.2.Preoperative evaluation with brain CT perfusion imaging to screen more suitable surgical patients is more clinically valuable in patients with AIS who have mechanical thrombus removal in an ultra-6-h time window complicated by diabetes mellitus,coronary heart disease,and atrial fibrillation and other stroke related underlying diseases. |
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