Clinical Analysis Of104Patients With Acute Ischemic Stroke Due To Anterior Circulation After Endovascular Treatment

Objective:To analysis the efficacy and safety of endovascular treatment ofacute stroke caused by anerior circulation large vessel occlusion.Materials and Methods:We retrospectively analyzed104cases of patients with acuteischemic stroke in anterior circulation caused by large vessel occlusion(LVO),70cases with pure intra-arterial thrombolytic therapy, andmechanical recanalization in34cases. We selected sixty patients as acontrol group who were also caused by anterior circulation arteryocclusion and received no endovascular or intravenous thrombolytictherapy during the time period studied. The clinical outcome was themodified Rankin scale score (mRS) at90days; this categorical scalemeasures functional outcome, with scores ranging from0(no symptoms)to6(death), mRS0-2point was defined as good outcome. We used themodified Thrombolysis in Cerebral Infarction score (mTICI) to assess thereperfusion; mTICI score0~1point was defined as no reperfusion,2a~3as reperfusion.Results:Overall, the rate of good outcome at90days was42.3%in theendovascular group and16.7%in the control group, they had significantdifference. There was no significant difference in the mortality ratebetween the two groups (19.2%vs23.3%, p＜0.01).47.1%in themechanical recanalization group achieved good outcome while40%in the group of those received intra-arterial thrombolysis alone, thedifference was not significant. The rate of good outcome in the patientswho achieved partial or complete reperfusion was significant higher thanthose who didn’t (58.3%vs20.5%, p＜0.01). At the end of interventionaloperation,57.7%achieved partial or complete reperfusion,70.6%for thegroup received mechanical recanalization and51.4%for those receivedintra-arterial thrombolysis alone. For the patients with internal carotidartery occlusion, the rate of reperfusion was significant higher in themechanical recanalization group than the intra-arterial thrombolysisgroup (73.3%vs43.8%, p＜0.05); however, the difference between thetwo groups for the patients with middle cerebral artery occlusion was notsignificant (68.4%vs63.9%). The rate of good outcome was45.6%forthe patients received endovascular therapy within6hours and32%beyond6hours, but the difference was not significant. There were8patients (7.7%) developed symptomatic intracerebral hemorrhages,3diedand5remained disability at3months; procedure-related complicationsincluded embolization into the target downstream territory in2patientsand vessel dissections in4patients, but none of them caused seriousclinical symptoms.Conclusion:Endovascular treamtment could improve the reperfusion rate ofocclusion artery, could significantly improve the rate of good outcomewhile not increasing the mortality rate; mechanical recanalization may beused as the rescue therapy in the patients who respond poorly tointra-arterial thrombolysis; the main causes of death in patients arecerebral infarction and clinical complications.