Prognosis Of Patients With Acute Middle Cerebral Artery Occlusion Treated With Endovascular Intervention Analysis Of Influencing Factors

Objective:Exploring the factors influencing the prognosis of patients with acute middle cerebral artery occlusion treated with endovascular intervention.Methods:In this study,58 patients with acute middle cerebral artery occlusion who underwent endovascular intervention admitted to the Department of Neurology of Huaihe Hospital of Henan University from September 1,2019 to August 31,2021.90 days after the invention,using the modified Rankin Scale(m RS)the patients were divided into good prognosis(m RS≤2)group and poor prognosis(m RS>2).Among the 58 patients,38 patients were in the good prognosis group and 20 patients in the poor prognosis group.Baseline data were collected from both groups: sex,age,hypertension,diabetes,atrial fibrillation,previous stroke,smoking history,and clinical data: National Institute of Health Stroke Scale(NIHSS)score,fasting glucose,absolute peripheral blood neutrophil/lymphocyte ratio(NLR)at admission and 24 h postoperative neutrophils-lymphocytes ratio(NLR),treatment status: stroke TOAST etiology typing,preoperative intravenous thrombolysis,time from onset to recanalization(OTR),time from femoral artery puncture to recanalization(PTR),angioplasty(stent implantation or balloon dilatation),and postoperative modified Thrombolysis in Cerebral Infarction score(mTICI).And the relevant indexes were analyzed univariately between the two groups.The variables with statistically significant differences in the univariate analysis were subjected to multifactorial logistic regression analysis to derive factors influencing patient prognosis.Patients with acute middle cerebral artery occlusion treated with endovascular interventions were divided into cardiogenic embolism(Cardioembolism,CE)and large-artery atherosclerosis(LAA)groups according to stroke TOAST etiology typing.The clinical characteristics and the differences in responsiveness to endovascular treatment were compared between the two groups.Results:1.Successful revascularization(mTICI 2b～3)was achieved in 55 cases(94.8%),good prognosis in 38 cases(65.5%),poor prognosis in 20 cases(34.5%),CE in 24 cases(41.4%),LAA in 33 cases(56.9%)and other cause type in 1 case(1.7%).2.Univariate analysis of the good prognosis group compared with the poor prognosis group showed statistically significant differences between the two groups in admission baseline NIHSS score,24 h postoperative NLR,OTR,history of diabetes mellitus,and postoperative recanalisation classification between the two groups(P<0.05).There were no statistically significant differences between the two groups in gender,age at presentation,history of hypertension,history of atrial fibrillation,history of previous stroke,history of smoking,fasting glucose,admission NLR,There were no statistically significant differences between the two groups in terms of TOAST etiology typing,preoperative intravenous thrombolysis,PTR,and balloon dilation levels(P>0.05).Multi-factor logistic regression analysis showed statistically significant differences between groups in admission baseline NIHSS score,postoperative recanalisation classification(mTICI),and time from onset to recanalisation(OTR)(P<0.05).3.The patients were divided into CE group(24 cases)and LAA group(33 cases)according to TOAST classification,and 1 case of other cause type was excluded.there were statistically significant differences between LAA and CE groups in terms of gender,NIHSS score,history of atrial fibrillation,and angioplasty(P<0.05).There were no statistically significant differences between the two groups in terms of age at onset,diabetes mellitus,hypertension,smoking history,time from onset to recanalization,first successful recanalization,intravenous thrombolysis,type of anesthesia,treatment plan,and 90-d prognosis(P>0.05).Conclusion:1.Compared to the good prognosis group,the poor prognosis group had a greater proportion of diabetes mellitus and a higher 24 h postoperative NLR.2.Admission NIHSS score,OTR,and postoperative revascularization mTICI classification are independent influences on the prognosis of endovascular interventions in patients with middle cerebral artery occlusion.3.Compared with the cardiogenic embolization group,the atherosclerosis group had a lower age of onset,a lower baseline NIHSS score,a lower proportion of atrial fibrillation,and a higher proportion of combined angioplasty.