Cognitive Function Of Multimodal Neuroimage-Guided Thrombectomy On Mild To Moderate Anterior Circulation Infarction With Broadened Therapeutic Window And The Effect Of The High Risk Factors Influencing The Prognosis Of Cognitive Function Analysis

Acute cerebral infarction is a disease with high morbidity and mortality,which poses a serious threat to the health of our people.Thrombectomy is an important method in the treatment of acute ischemic stroke(AIS).The best treatment time for patients with acute cerebral infarction is within 6 hours,and many stroke patients are often unable to treat within the optimal treatment time due to various reasons.The key to a good prognosis after thrombolysis is the presence of ischemic penumbra in the brain of patients.Multimodality imaging enables the screening of the location,size,and metabolic activity of lesions.Therefore,multimodality-guided ultrasound in patients with cerebral infarction Time window arterial embolization prognosis effect has become a hot topic of academic research.The recovery of cognitive function after treatment in patients with cerebral infarction is now receiving more and more attention,and has become another important prognostic indicator in addition to the effect of neurological recovery.However,the prognostic effect of neurological function and cognitive function of supratemporal artery thrombectomy is not the same.Therefore,we performed the prognostic effect(neurological and cognitive function)of super-temporal Thrombectomyin patients with mild to moderate anterior cerebral infarction.Further exploration and analysis of the risk factors for the prognosis of acute cerebral infarction will improve the effectiveness and safety of the super-temporal thrombectomy in patients with mild-to-moderate anterior cerebral infarction and improve theoretical guidance for better improvement of acute The theoretical basis for the prognostic level of cognitive function in patients with cerebral infarction.The main research content is as follows: Part I The Effect of Multimode Imaging Guided Thrombectomy in the Treatment of Mild to Moderate Anterior Cerebral Infarction with Acute Cerebral Infarction and Its Influence on Cognitive FunctionObjective:To compare the prognosis of neurological function and the prognosis of cognitive function and function in the Thrombectomy group and the conservative department of internal medicine under multimodality imaging guidance.Methods: A total of 145 acute cerebral infarction patients with light-tomoderate anterior circulation over time window received 6-10 hours of onset in our hospital from September 2015 to March 2018 were randomized into three groups(CT group,The MRI group and conventional treatment group),CT group and MRI group screened patients with corresponding multimodality images,and eventually 90 patients remained.Thirty-three patients underwent arterial thrombectomy under CT guidance.34 patients underwent arterial thrombectomy under MRI guidance.The remaining 23 patients were treated routinely.Before the treatment,6 hours,24 hours,7 days,and 90 days after the treatment,neurological impairment score NIHSS was used to evaluate the neurological function of 90 patients with acute cerebral infarction.The Mini Mental State Scale(MMSE)was used.The scores of cognitive function in patients with acute cerebral infarction were scored by the Montreal Cognitive Assessment Scale(MoCA)and the Hachinski Ischemia Scale(Hachinski Ischemic Scale).Results:1.Patients who received mechanical thrombectomy had significantly better neurological functions at 6 h(P<0.001),24 h(P<0.001),7 days(P<0.001),and 90 days(P<0.001).2.As well as cognitive functions evaluated by MoCA(26.23 ± 3.85 vs.24.62 ± 2.25,P=0.022,n=85)and MMSE(26.65 ± 2.77 vs.25.10 ± 2.36,P = 0.023,n = 85)compared to the standard therapy group.Conclusion: Patients who received mechanical thrombectomy had significantly better neurological functions at 6 h(P<0.001),24 h(P<0.001),7 days(P<0.001),and 90 days(P<0.001)as well as cognitive functions evaluated by MoCA(26.23 ± 3.85 vs.24.62 ± 2.25,P=0.022,n=85)and MMSE(26.65 ± 2.77 vs.25.10 ± 2.36,P = 0.023,n = 85)compared to the standard therapy group.Part II CT and MRI in the Guidance of Mild to Moderate Anterior Circulation of Acute Cerebral Infarction Thrombectomy GroupDifferences AnalysisObjective:Comparing the CT and MRI two groups of multimodal images in the guidance of mild to moderate pre-circulatory acute cerebral infarction over time window artery thrombectomy surgery differences.Methods: A total of 145 acute cerebral infarction patients with light-tomoderate anterior circulation over time window received 6-10 hours of onset in our hospital from September 2015 to March 2018.A total of 145 patients were treated with CT-guided arterial thrombectomy.Thirty-four patients underwent arterial thrombectomy under MRI guidance.Before the treatment,after 6 hours,24 hours,7 days and 90 days after the treatment,neurological deficit score NIHSS was used to score the neurological function of the CT group and the MRI group.The Mini Mental State Scale(MMSE)was used.The scores of cognitive function in patients with acute cerebral infarction were scored by the Montreal Cognitive Assessment Scale(MoCA)and the Hachinski Ischemia Scale(Hachinski Ischemic Scale).Results:1.Comparison of neurological outcomes between the CT and MRI groups.Patients with light-to-moderate anterior circulation of acute cerebral infarction who underwent ultra-time window arterial embolization under CT guided multimodality imaging in the CT and MR groups were 6 hours after treatment(P<0.001),24 hours(P<0.001),and 7 days(P<0.001),90 days(P<0.001)No statistically significant difference in neurological outcomes.2.The prognosis of cognitive function in CT group and MRI group.There was no significant difference in the prognosis of cognitive function between patients with mild to moderate anterior cerebral infarction with ultratime window arterial embolization guided by CT and MR images.Conclusion: There was no significant difference in the prognosis of neurological function or cognitive function between patients with light-tomoderate anterior circulation with acute cerebral infarction who underwent ultra-temporal aortic thrombectomy under multimodality imaging in the CT and MR groups.Part III Study on The Risk Factors of Prognosis of Vascular Cognitive ImpairmentObjective:Explore the relationship between the risk factors of cognitive function and the prognosis of cognitive function.Methods: To collect data on 550 patients with cognitive impairment from September 2015 to March 2018 in the People’s Hospital of Hebei Province.The MoCA scale was used to analyze the cognitive function of the patients.The single factor method was used.Explore risk factors associated with cognitive impairment in patients.Results:1.Single factor analysis of cognitive dysfunction and age in patients with vascular cognitive impairmentThere was a significant negative correlation between cognitive impairment and age in patients with vascular cognitive impairment(r=0.891,χ2=5.66,P<0.05,mean age of cognitive impairment group(67.51±15.21).2.Univariate analysis of cognitive dysfunction and gender in patients with vascular cognitive impairmentThe proportion of male patients in the cognitive impairment group was significantly higher than that in the cognitive normal group,and there was a significant negative correlation between cognitive dysfunction and male ratio in patients with vascular cognitive impairment.3.Univariate analysis of cognitive impairment and drinking in patients with vascular cognitive impairmentThere was no significant difference between the proportion of alcoholic patients in the cognitive impairment group and the proportion of drinkers in the normal cognitive group.There was no significant correlation between cognitive dysfunction and alcohol consumption in patients with vascular cognitive impairment(r=0.131,χ2=6.26).P>0.05).5.Single factor analysis of cognitive dysfunction and education in patients with vascular cognitive impairmentThe proportion of low-education patients in the cognitive impairment group was significantly higher than that of the low-education level in the cognitive normal group.The proportion of cognitive dysfunction and low education levels in vascular cognitive dysfunction patients was significantly negative.Correlation.5.Univariate analysis of cognitive dysfunction and hypertension in patients with vascular cognitive impairmentThe proportion of patients with a history of hypertension in the cognitive impairment group was significantly higher than that in the cognitive normal group,and there was a significant positive correlation between cognitive dysfunction and history of hypertension in patients with vascular cognitive impairment.6.Univariate analysis of cognitive dysfunction and hyperlipidemia in patients with vascular cognitive impairmentThere was no significant difference in the percentage of patients with high blood lipids between the cognitive impairment group and the cognitively normal group who had a history of hyperlipidemia,and there was no significant correlation between cognitive dysfunction and high blood lipid history in patients with vascular cognitive impairment.Conclusion: Older age,male gender,low education level,and high blood pressure are high risk factors for cognitive impairment in patients with acute cerebral infarction.There is no significant correlation between cognitive dysfunction and high blood lipid history and drinking historyPart IV Transcranial Doppler to Determine the Relationship between Cerebral Stenosis and Cognitive DysfunctionObjective:Univariate analysis was used to investigate the correlation between the extent of intracranial vascular stenosis and cognitive dysfunction detected by transcranial Doppler ultrasound.Methods: To collect data of 55 patients with vascular cognitive impairment who were treated at the Hebei Provincial People’s Hospital between September 2015 and March 2018 and underwent TCD,and to use the MoCA scale to recognize patients with vascular cognitive impairment.Functional analysis was performed.According to the MoCA score,patients were divided into cognitive dysfunction group and normal cognitive function group.Patients with vascular cognitive impairment with a MoCA score below 26(n=43)were cognitively impaired,and patients with vascular cognitive impairment with a MoCA score of 26 or above had a normal cognitive function(n=14).Transcranial Doppler ultrasound was used to investigate the degree of intracranial vascular stenosis in the two groups of patients.Univariate analysis was used to analyze the relationship between the degree of cranial stenosis and cognitive dysfunction in patients with vascular cognitive impairment.Results:1.Correlation analysis of intracranial vascular stenosis and cognitive dysfunction detected by transcranial Doppler ultrasoundThe proportion of patients with intracranial vascular stenosis in the cognitive impairment group was significantly higher than those with intracranial vascular stenosis in the cognitive normal group.Cognitive dysfunction and transcranial Doppler ultrasonography in patients with vascular cognitive impairment The intracranial vascular stenosis showed a significant positive correlation(r=0.931,χ2=16.22,P<0.05).2.Correlation analysis of intracranial vascular stenosis detected by transcranial Doppler ultrasound on the left middle cerebral artery or right side and cognitive impairmentIn the cognitive impairment group,the proportion of patients with intracranial vascular stenosis in the left middle cerebral artery was significantly higher than that of the cognitive normal group in patients with intracranial vascular stenosis in the left middle cerebral artery.Vascular cognitive function There was a significant positive correlation between cognitive impairment in patients with cerebral infarction and intracranial vascular stenosis detected by transcranial Doppler ultrasound in the left middle cerebral artery(r=0.832,χ2=8.23,P<0.05).3.Correlation analysis of intracranial vascular stenosis detected by transcranial Doppler ultrasound in the anterior cerebral circulation and cognitive dysfunctionIn the cognitive impairment group,the proportion of patients with intracranial vascular stenosis in the anterior cerebral circulation was significantly higher than those in the cognitive normal group with intracranial vascular stenosis in the anterior cerebral circulation.Patients with vascular cognitive impairment Cognitive dysfunction and intracranial vascular stenosis detected by transcranial Doppler ultrasound showed a significant positive correlation in the anterior circulation of the brain.Conclusion: Cognitive dysfunction in patients with vascular cognitive impairment and intracranial vascular stenosis detected by transcranial Doppler ultrasound,intracranial vascular stenosis at the anterior circulation site and left middle cerebral artery show a significant positive correlation.Conclusions:1.Compared to conventional medical treatment methods,under the guidance of multi-mode images of light-to-moderate anterior circulation cerebral infarction.It is a safe and effective treatment method for patients with thrombectomy to have superior neurological outcomes and cognitive outcomes.2.There are no significant differences between the CT and MRI in the multi-modality imaging in guiding the thrombectomy.3.Old age,male gender,low education,and high blood pressure are high risk factors for vascular cognitive impairment.It provides theoretical guidance for improving the cognitive function of patients with vascular cognitive impairment.4.Transcranial Doppler ultrasound is noninvasive,repeatable,reliable,and economical.It is used to diagnose intracranial and extracranial blood.