Analysis Of Influencing Factors Of Adverse Prognosis After Recanalization Of Intravascular Therapy In Acute Anterior Circulation Ischemic Stroke

Objective:To investigate the influencing factors of adverse prognosis after recanalization in patients with acute anterior circulation large artery occlusion treated with endovascular therapy.Methods:The clinical data of 332 patients with acute anterior circulation large artery occlusive stroke treated by intravascular therapy in the stroke center of Linyi People’s Hospital from January 2020 to December 2021 were collected continuously.Among them,315(94.9%)patients achieved recanalization of occluded vessels,and the modified thrombolysis in cerebral infarction(m TICI)reached 2b-3.The occluded vessels were not unblocked in 17patients(5.1%),and the postoperative m TICI was< 2b.According to the modified Rankin Scale score 90 days after operation,315 patients with occluded vascular recanalization were divided into good prognosis group(MRS≤2)and poor prognosis group(MRS>2).Univariate analysis of the baseline data,neurological injury status,risk factors,CT perfusion imaging and angiographic imaging parameters of the two groups.Multivariate logistic regression was used to explore the independent risk factors affecting the adverse prognosis of intravascular recanalization in patients with acute anterior circulation large artery occlusive stroke.Results:Among the 315 AC-LAO patients who achieved vascular recanalization,173 patients had m RS≤2 90 days after operation,and the good prognosis rate was 54.92%.Among the 17 patients who did not achieve recanalization,only 2 patients achieved 90 day independent function,and the good prognosis rate was 11.76%.There was significant difference between the two groups(P< 0.05).Among 315 patients who achieved recanalization,142(45.08%)had a poor functional prognosis in 90 days(MRS>2).Compared with the good prognosis group,the admission NIHSS score in the poor prognosis group was significantly higher,the early CT(Aspect)score of Alberta stroke project was significantly lower,the volume of infarct core area was significantly higher,and the proportion of patients with collateral circulation grade 2-4 was significantly lower(P < 0.05).The proportion of patients receiving intravenous thrombolysis bridging intravascular therapy was similar between the two groups,and there was no significant correlation between intravenous thrombolysis and prognosis(P >0.05).Admission NIHSS score(OR: 0.953,95% CI: 0.912 ～ 0.996,P= 0.033),Aspect score(OR: 1.184,95% CI:1.016 ～ 1.379,P= 0.030),infarct core volume(OR: 0.988,95% CI: 0.976 ～ 0.999,P=0.033)and collateral circulation grade(OR: 2.148,95% CI: 1.329 ～ 3.471,P= 0.002)were independent factors affecting the adverse prognosis of AC-LAO patients after recanalization.Conclusions:1 、 Endovascular treatment in patients with AC-LAO can improve the vascular recanalization rate.Compared with patients with non vascular recanalization,the higher vascular recanalization rate significantly improves the prognosis of patients.2、There was no significant correlation between the prognosis of patients with vascular recanalization and whether they received intravenous thrombolytic bridging therapy.Patients with high admission NIHSS score,low aspect score,high infarct core volume and low collateral circulation grade are more likely to have a poor prognosis after endovascular treatment.