| This study consists of the following four parts: Part I: Comparative study of solumbra thrombectomy and simple stent thrombectomy Objective:To investigate the differences of operation time,degree of pull-bolt and good clinical prognosis(MRS≤2)on patients with acute anterior circulation macrovascular occlusion treated by solumbra embolectomy and stent-graft alone.Methods:Selected thirty-eight patients with acute anterior circulation macrovascular occlusion,including intracranial segment of internal carotid artery,M1/M2 segment of middle cerebral artery and anterior cerebral artery A1 segment,were successfully treated by endovascular mechanical thrombectomy in our center from January 2017 to October 2017.The 8F balloon guide tube(baloon catheter guiding BCG)was used in the proximal of all the cases.Among them,12 patients were treated with solumbra technique and 21 patients with simple stent-graft technique,the remaining 5 cases were excluded because of other revascularization methods.The basic data of two groups of patients Including age,sex,hypertension,diabetes mellitus,dyslipidemia,smoking,atrial fibrillation,baseline NIHSS score,thrombus load,venous thrombolysis,operation time,number of thrombus and MRS≤2 at 3 months.Results:The risk factors for stroke were similar between the two groups,with no significant difference in the rate of thrombolysis(P> 0.05).There was no significant difference in thrombus burden between Solumbra group and simple stent thrombectomy group(4.22 ± 2.95 vs 4.46 ± 2.52 P = 0.820),and the result of baseline NIHSS score was the same as above(16.56 ± 4.25vs15.96 ± 3.25 P = 0.668).Solumbra group successfully opened the blood vessels with fewer pull operations,indicating that its opening efficiency was higher(1.00(1.00,1.05)vs2.00(2.00,3.00)P = 0.001);Solumbra group used shorter operation time,opened the blood vessels more quickly(62.89 ± 14.96 vs 122.21 ± 44.91 P <0.001).Overall,19 patients(57.6%)achieved good prognosis,10 of the 12 patients(83.33%)in solumbra group,while in the suppository group had only 9 of the 21 patients(42.86%).there was a significant difference between the two groups(P = 0.033).Conclusion:For acute anterior circulation macrovascular occlusion,the use of solumbra technology could shorter operative time,reduce number of times of mechanical embolectomy,and achieve 3 months good clinical prognosis more.Part II: Correlation between DSA-based Clot burden score(CBS)and endovascular treatment prognosis Objective:To investigate the effect of thrombus load on the number of pull bolts,operation time and good clinical prognosis in patients with acute anterior circulation macrovascular occlusion.Methods:Selected thirty-eight patients with acute anterior circulation macrovascular occlusion,including intracranial segment of internal carotid artery,M1/M2 segment of middle cerebral artery and anterior cerebral artery A1 segment,were successfully treated by endovascular mechanical thrombectomy in our center from January 2017 to October 2017.The 8F balloon guide tube(baloon catheter guiding BCG)was used in the proximal of all the cases.According to the CBS score and preoperative angiographic assessment,the patients were divided into CBS≥6 points group and CBS≤5 points group,the basic data of two groups were collected,including age,gender,hypertension,Diabetes mellitus,dyslipidemia,smoking,atrial fibrillation,baseline NIHSS score,number of draws,operation time and 3-month MRS score.The differences between the two groups in the number of pull bolts,operation time and good clinical prognosis were observed.Results:CBS≤5 points in 23 cases,CBS≥6 points in 15 cases.there was no significant difference in basic data and risk factors of CBS≥6 group and CBS≤5 group,(P> 0.05).The baseline NIHSS score was 17.00 ± 3.57 vs 16.09 ± 3.34,with no significant difference(P = 0.428).There was no significant difference in the number of draws,1.96(1.00,2.00)vs 2.00(1.00,3.25)(P = 0.914).The operation times were 107.00±37.03vs108.87±59.29,(P = 0.914).To 3 month MRS score,there were 13 cases(86.67%)in CBS≥6 points group,and 11 cases(47.83%)in CBS≤5 points group,Statistical differences were significant(P = 0.02).CONCLUSIONS: For acute anterior circulation macrovascular occlusion,the preoperative angiography for thrombosis load score(CBS),the patients with CBS ≥ 6 points compared with the patients with CBS ≤ 5 points,3 months good clinical prognosis more.Part III: the correlation between collateral circulation status based on ACG grading on DSA and prognosis of endovascular treatment.Objective:Acute anterior circulation macrovascular occlusion patients underwent angiography ACG collateral circulation assessment,ACG2 grade patients were selected to observe the differences of the time from onset to recanalization(OTR)in different collateral circulation,thrombus load,high-density exudation immediately after operation,hematoma transformation and good clinical prognosis(MRS ≦ 2).Methods:A total of 38 patients with acute anterior circulation macrovascular occlusion,including intracranial segment of internal carotid artery,M1/M2 segment of middle cerebral artery and anterior cerebral artery A1 segment,and ACG grading 2 and above who underwent acute angioplasty in our department from January 2017 to October 2017 were enrolled in this study.Among them,10 patients with collateral circulation blood supply area < 50% of occlusion vessel blood supply area(2a),28 patients with collateral circulation blood supply area> 50% occluded blood supply area(> 2a),then collected the basic data of 2 groups of patients,including age,sex,hypertension,diabetes,dyslipidemia,smoking,Fibrillation,baseline NIHSS score,onset to recanalization(OTR)time,high-density exudation of CT immediately after operation,and follow-up CT with hemorrhagic transformation and MRS score at 3 months.Results:There was no significant difference in risk factors between two groups with different collateral circulation status(P> 0.05).The baseline NIHSS score of >2a group was slightly lower than that of 2a group(16.11 ± 3.36 vs 17.40 ± 3.57),but the difference was not statistically significant(P = 0.311).The OTR time in >2a group was shorter than that in 2a group and 319.15 ± 101.02 vs363.40 ± 153.20,but the difference was insignificant(P = 0.313).The embolic load in >2a group was significantly higher than that in 2a group and 4.96 ± 2.08vs2.60 ± 3.17,significant difference(P = 0.011).In the immediate CT high-density exudation changes and the final hematoma transformation,>2a group were slightly lower than 2a group,respectively 57.14% vs70% and 28.57% vs30 %,but the difference between the groups was not statistically significant;the rate of good clinical prognosis at 3 months in the >2a group was higher that in 2a group,75% vs 30%,the difference was significant(P = 0.021).Conclusion:For acute anterior circulation macrovascular occlusion,after preoperative angiographic assessment,the patients with collateral circulation> 50% of ACG2-grade ischemic areas compared with the patients with collateral circulation <50% of ACG2-grade ischemic areas,the former showed less OTR time,immediate postoperative high density hematoma exudation and hemorrhagic transformation,but the difference was not significant.The group with better collateral circulation had less obvious thrombus load and better clinical prognosis for 3 months.Part IV: Comparison of relative parameters and prognosis of CT high-density exudation and immediate CT without high-density exudation and endovascular treatment after mechanical thrombectomy Objective:In patients with acute anterior circulation macrovascular occlusion,immediate head CT or SIEMENS zeego Dyna CT angiography examination was performed after endovascular treatment to observe the effect of high density exudation changes on occlusive vascular exudation on early(within 72 hours)hemorrhagic transformation,good clinical prognosis and mortality in the area dominated by occlusive vessels.Methods:Selected thirty-eight patients with acute anterior circulation macrovascular occlusion,including intracranial segment of internal carotid artery,M1/M2 segment of middle cerebral artery and anterior cerebral artery A1 segment,were successfully treated by endovascular mechanical thrombectomy in our center from January 2017 to October 2017.The 8F balloon guide tube(baloon catheter guiding BCG)was used in the proximal of all the cases.The CT scan or SIEMENS zeego Dyna CT angiography examination was divided them into immediate CT high-density exudation group and immediate CT non-high-density exudation group.At the end of the study,basic data of two groups were collected,including age,gender,hypertension,diabetes,dyslipidemia,smoking,atrial fibrillation,baseline NIHSS score,thrombus burden,thrombolytic rate,3 months good clinical prognosis,death rate.Head CT was performed at 24 hours and/or 72 hours after surgery.For immediate CT high-density exudation cases,if it was unable to determine contrast agent exudative or bleeding after 24 hours CT,then the head CT was reexamined at 72 hours.The hemorrhagic transformation was performed at 24 hours postoperatively and/or at 72 hours postoperatively.Head CT was observed continuously with high density,and the CT value was <90 HU.Results:Twenty-three cases of CT high-density exudation immediately after operation,15 cases of immediate CT non-high-density exudation,immediate CT high-density exudation group and immediate CT non-high-density exudation group in the basic population data,the difference of high risk factors was not obvious.The thrombus burden was 4.17 ± 2.73 vs 4.60 ± 2.32 in both groups,with no significant difference(P = 0.621).The rates of intravenous thrombolysis in both groups were 73.91% vs80%,respectively,with no significant difference between the two groups(P = 0.49).Immediate hemorrhagic transformation(82.61%)occurred in 19 of 23 patients with immediate high-density CT changes,and 1 of 15 patients(6.67%)immediately after CT with non-high-density change showed that difference was statistically significant(P <0.001).11 of 23 patients who had an immediate CT high density change had a good prognosis(47.82%),whereas 13 patients(86.67%)did not have a high density exudation change.The difference was statistically significant.Mortality was 21.74% vs20%,with no statistical significance.Conclusion:In patients with acute anterior circulation macrovascular occlusion underwent mechanical thrombectomy,performed immediate CT or Dyna CT,the patients with high density exudation compared with the patients without high-density exudation,the former had more early(within 72 hours)hemorrhagic transformations and less 3 months good clinical prognosis.There was no significant difference in mortality. |
