Relationship Between Basal Ganglia Blush Sign And Postoperative Outcome In Mechanical Thrombectomy For Acute Cerebral Infarction

Background:Acute ischemic stroke caused by occlusion of great blood vessels is extremely disabling and deadly,which seriously endangers people’s health.With the improvement of thrombectomy technology,the vascular recirculation rate has gradually increased,which has become the first choice of treatment for more and more patients.However,the good prognosis rate of patients has not been significantly improved.There are still some patients with successful recirculation of blood vessels due to postoperative complications such as symptomatic intracranial hemorrhage and ineffective recirculation,resulting in poor clinical prognosis or even death.Currently,studies have been conducted to screen patients with preoperative images in order to improve the success rate of surgery and save economic load.This study further determined the relationship between postoperative outcome and Basal ganglia blush sign(BGB)in mechanical thrombectomy for acute ischemic stroke.Methods:In this study,patients with acute cerebral infarction caused by large circulating vessel occlusion before January 2019 to December 2022 who received mechanical thrombectomy and successfully achieved vascular recanalization in China-Japan Friendship Hospital of Jilin University were enrolled.Hemorrhagic transformation includes any intracranial hemorrhage(ICH),hemorrhagic infarction(HI),parenchymal hematoma(PH),symptomatic intracranial hemorrhage(sICH).The independent variable was the basal ganglia brush sign found by intraoperative angiography.The main outcomes were HI,PH,sICH,ICH and 90-day mRS after thrombectomy.Descriptive statistics were used to report and compare baseline patient characteristics.Continuous variables conforming to normal distribution are represented by mean(standard deviation)and median of T-test.Continuous variables conforming to non-normal distributions are expressed as median(quartile range)values using MannWhitney U test.Categorical variables are calculated as numerical(percentage)values,using either the chi-square test or Fisher’s exact test.Multivariate binomial logistic regression analysis was used to evaluate the predictive value of basal segmental brush sign on HI,PH,sICH,ICH and 90-day mRS.AIC was used to determine the model,and variables with P<0.1 in the difference analysis were included in the model for adjustment.IBM SPSS Statistics 26.0 software was used for statistical analysis of the data in this study,and a statistical difference of P<0.05(bilateral)was considered significant.Results:Of the 139 patients included,74(53.2%)had ICH,28(20.1%)HI,46(33.1%)PH and 21(15.1%)sICH.BGB was observed in 67 patients(48.2%).After adjusting for confouncers,patients with BGB were more likely to have HI(OR=10.143,95%CI 3.103-33.149,P<0.001),PH(OR=6.111,95%CI 2.614-14.287,P<0.001),BGB was an independent predictor of sCH(OR=30.213,95%CI 3.921-232.797,P<0.001)and was independently correlated with ICH(OR=39.612,95%CI 13.632-115.105,P<0.001),BGB was more common in patients with poor prognosis(90-day mRS>2)(P=0.009).In addition,baseline NIHSS were correlated with HI(OR=1.154,95%CI 1.040-1.279,P=0.007 and ICH(OR=1.137,95%CI 1.038-1.244,P=0.005).ASPECTS scores were also correlated with PH occurrence(OR=4.643,95%CI 1.196-18.022,P=0.027).TICI scores were also correlated with PH(OR=2.780,95%CI 1.030-7.503,P=0.043)and ICH(OR=6.428,95%CI 1.574-26.256,P=0.010).Conclusions:In ischemic stroke patients with acute anterior circulation great vessel occlusion,the appearance of basal ganglia brush sign on angiography is associated with bleeding transformation and poor prognosis after mechanical thrombectomy and recanalization.