Clinical Analysis Of Endovascular Therapy Combined With Decompressive Craniectomy For Acute Anterior Circulation Massive Cerebral Infarction

Purpose:To investigate the clinical efficacy of intravascular interventional recanalization combined with decompressive craniectomy in the treatment of acute massive cerebral infarction,and to find effective and safe treatment methods for patients with acute massive cerebral infarction.Method:Retrospective analysis was performed on patients with acute cerebral infarction with large cerebral hemispheres who received endovascular therapy and decompressive craniectomy or decompressive craniectomy alone at the Second Affiliated Hospital of Nanchang University from January 1,2019 to September 1,2022.According to different surgical methods,they were divided into a combination group(endovascular therapy combined with decompressive craniectomy)and a control group(decompressive craniectomy).According to the clinical data of the two groups before and after the operation,the therapeutic effect of endovascular therapy combined with decompressive craniectomy in patients with massive cerebral infarction was analyzed.Results:A total of 59 patients were included,with 51 survivors and 8 deaths.By comparing the m RS Scores 90 days after treatment between the combined group and the non-combined group,16 cases with good functional outcome(m RS≤3)were treated with endovascular therapy combined with decompressive craniectomy,and the overall effective rate was 53.3%.There were 8 patients with good functional outcome(m RS ≤ 3)after simple decompressive craniectomy,and the overall effective rate was 27.6%,with statistical significance(P < 0.05).The NIHSS scores of the combined and non-combined groups were compared before and after treatment,and there was no significant difference between the two groups before and after treatment(P > 0.05).The NIHSS score of the combined group was lower than that of the non-combined group at the first and second week after surgery,with statistical significance(P< 0.05).Univariate Logistic regression analysis showed that age,surgical method,complicity with heart disease and preoperative NIHSS score were all significant factors associated with good 90-day prognosis.Multivariate Logistic regression analysis showed that combined therapy was an independent protective factor for good functional prognosis of patients,and old age was an independent risk factor for good functional prognosis of patients.Conclusion:Patients with acute large anterior circulation cerebral infarction also benefit from endovascular therapy,and endovascular therapy combined with decompressive craniectomy has better neurological recovery than craniectomy alone.