Differences In Efficacy In Patients With Acute Anterior Circulation Intracranial Atherosclerotic Large Vessel Occlusion Under The Dominance Of Different Opening Methods

Objective:To explore the safety and efficacy of endovascular therapy dominated by balloon dilation angioplasty.Methods:A retrospective review was included and analyzed 79 patients with acute anterior circulation ICAS-LVO admitted to our center from January 2021 to July 2022.Occlusive segments mainly include bilateral internal carotid artery segments C4-C7 or bilateral middle cerebral artery M1 segments.According to different dominant opening methods,it was divided into balloon dilation group(34 cases)and stent thrombectomy group(45cases).The baseline data of patients were collected including age,sex,smoking,hypertension,hyperlipidemia,diabetes,and clinical data including time from onset to admission,intravenous thrombolysis,NIHSS score at admission,preoperative ASPECT score,femoral artery puncture to vascular recanalization time,vascular opening surgery and immediate postoperative m TICI grade.The primary outcome assessed effectiveness was the proportion of functional independence at 90 days postoperatively,the secondary outcome was the NIHSS score at two weeks after recanalization,the primary outcome assessed safety was the proportion of symptomatic intracranial hemorrhage(s ICH),and the secondary outcome was 90 days all-cause mortality.MTICI grade 2b-3 is defined as successful vascular recanalization;A postoperative 90 dm RS score of 0 to 2 is defined as functional independence.Results:(1)The overall vascular recanalization rate was 88.6%(70/79),and there was no significant difference in the proportion of recanalization between the groups(P>0.05);The NIHSS score was lower than that in the stent embolectomy group(P>0.05)after 2weeks of recanalization in the bulbous expansion group.There were no significant differences in the proportion of 90-d functional independence,s ICH rate and 90-day mortality rate between the two groups(all P>0.05).The occlusion ratio of M1 segment in the stent dominant group was higher than that in the spherical expansion dominant group,and the difference between the groups was statistically significant(P>0.05).The proportion of balloon dilation in the stent dominant group was 51.1%(23/45);(2)There were no significant differences in gender,smoking history,hypertension,hyperlipidemia,diabetes,preoperative intravenous thrombolysis,and stenting between the two groups(all P>0.05).There were no significant differences in age,time from onset to admission,admission NIHSS score,admission aspects,and puncture-to-recanalization time between the two groups(all P>0.05).Conclusion:For patients with acute anterior circulation intracranial atherosclerotic large vessel occlusion,balloon dilation-led endovascular therapy is safe and effective.