Prognostic Analysis Large Vessel Occlusion Stroke Patients After Endovascular Treatment And Cerebral Autoregulation

Part1: Prognostic analysis large vessel occlusion stroke patientsafter endovascular treatmentBackground and objective: Endovascular treatment(EVT)significantly improved the 90 day outcome in acute ischemic stroke(AIS)patients due to large vessel occlusion(LVO)in anterior circulation.However,there were still some patients with poor outcome in despite recanalization after EVT.Recanalization does not always lead to favorable outcome.Risk factors for poor clinical prognosis are getting growing attention.Method: A retrospective study of 112 patients who received EVT was performed in our department of neurology from 2015.09 to 2020.08.The baseline data(age,baseline NIHSS score,anesthesia,etc.),and follow-up data(recanalization status,intracranial hemorrhage,NIHSS score,etc.)was also collected.Univariate and multivariate analyses were performed to determine the risk factors affecting 90-day outcome in terms of m RS score.Results: 295 patients met the inclusion criteria.A total of 248 patients achieved successful recanalization.123 achieved reperfusion status of m TICI 2b,125 achieved m TICI 3 while 47 failed to get recanalized(m TICI 0,1,2a).The results of univariate analysis showed that poor outcome after endovascular treatment was associated with higher age,history of diabetes mellitus,elevated baseline glucose,tandem occlusions,higher baseline NIHSS,general anesthesia.In prognostic multivariate analysis,diabetes mellitus,tandem occlusions,baseline NIHSS,general anesthesia,are independent factors related to poor outcome.The smoking patients might achieve better outcome.Conclusions: Diabetes mellitus,tandem occlusions,higher baseline NIHSS,general anesthesia,are independent factors related to poor outcome.While patients with a history of smoking might achieve better outcome.Part2: Cerebral autoregulation of large vessel occlusion strokepatients after endovascular treatment and its effect on prognosisBackground and objective: Cerebral autoregulation(CA)is the internal mechanism of maintaining the cerebral hemodynamic stability which might be significantly impaired in acute ischemic stroke patients.Previous studies showed that impaired CA function was a negative indicator of favorable outcome,but its relationship with prognosis in acute ischemic stroke(AIS)patients due to large vessel occlusion(LVO)in anterior circulation after EVT is unknown.We conducted this part of study to preliminarily explore this subject.Methods: A total of 140 patients were enrolled in this study,including 70 patients who underwent EVT and 70 healthy controls with age and gender matched.Non-invasive continuous cerebral blood flow velocity and arterial blood pressure were recorded simultaneously for each patient using transcranial Doppler and servo-controlled plethysmograph,respectively.Data was collected three times at 1-3days,3-5 days and 7-9 days after EVT.Transfer function was applied to derive autoregulatory parameters including phase difference(main evaluation index of CA),gain,autoregulation index,rate of recovery and coherence function in bilateral middle cerebral artery.Results: In this part of the study,all the data meet the inclusion criteria for the coherent function ahalysis.Dynamic CA function was impaired bilaterally 1-3 days,3-5days and 7-9days after EVT,and the ipsilateral side was more significantly affected than the contralateral side.The higher value of phase both sides 1-3days after EVT and ipsilateral side 3-5days after EVT is relate to good outcomes.And the values of phase difference in disease side ≥30.77 1-2days after EVT and ≥23.61 3-5days after EVT are independent factors related to good outcome.Conclusions: CA function is significantly impaired in acute stroke patients after EVT and it is related to outcomes.The higher value of phase both sides 1-3days after EVT and ipsilateral side 3-5days after EVT is relate to good outcomes.The values of phase difference in disease side ≥30.77 1-2days after EVT and ≥23.61 3-5days after EVT are independent factors related to good outcome.Part3: The mechanism and influence factors of impaired cerebralautoregulation in large vessel occlusion stroke patients afterendovascular treatmentBackground and objective: Our previous work has shown that impaired cerebral autoregulation could negatively affect the prognosis after EVT in acute stroke patients.We furtherly elucidate the mechanism and its influencing factors in this part.Methods: Additional clinical characteristics of the patient cohort in Part 2,data including low-density lipoprotein cholesterol(LDL)(mmol/L),triglyceride(mmol/L),total cholesterol(mmol/L),vitamin B12(pmol/L)and folic acid(ng/ml)was documented24 hours after EVT,heart rate variability(HRV)were recorded 48 hours after EVT and data analysis.Results: Heart rate variability index(n HF)of AIS patients after EVT(52.18 vs.39.38,P=0.008)and LF/HF(1.24 vs.0.63,p=0.013)was significantly higher than healthy controls,while n HF(47.82 vs.60.62,p=0.013)was significantly lower than healthy controls,The difference was statistically significant,and n HF is positively correlated to phase of ipsilateral side,while smoking history and LF/HF was negatively correlated to phase of ipsilateral side.Conclusions: The LVO-AIS patients after EVT may present disbalance of autonomic nerve system and the impaired function of autonomic nerve system may be the mechanism of impaired cerebral autoregulation in LVO-AIS patients after EVT.