| ObjectivesThe clinical data of patients with acute ischemic stroke treated by mechanical thrombectomy in our hospital were analyzed retrospectively.The etiology,pathogenesis,surgical procedures and vascular recanalization are preliminarily discussed according to the different vascular lesion sites of the patients.The effects of collateral circulation on vascular recanalization,short-term neurological recovery and long-term clinical prognosis are analyzed.MethodsThe clinical and imaging data of 42 patients with acute ischemic stroke who were treated by mechanical thrombectomy are selected into retrospective analysis(between 2015.08 and 2017.12 in Qilu Hospital of Shandong University.All the patients are in accordance with the following criteria:(1)the age was 18-85 years old;(2)clinical symptoms and neurologic examination of all patients are in line with the clinical features of acute ischemic stroke,and cerebral CT examination excludes cerebral hemorrhage;(3)NIHSS scorepoints>8,mRS?1points before onset;(4)no obvious abnormality was found in blood routine,liver function,kidney function,blood biochemistry and coagulation series;(5)all patients were given arterial thrombectomy and Informed Consent has been signed.(6)The onset time is within 8 hours.The patients are divided into three groups according to different parts of mechanical thrombectomy:extracranial carotid artery group,intracranial internal carotid artery group,middle cerebral artery group and vertebrobasilar artery group.The general clinical data,perfusion grade(mTICI grade),recanalization time,short-term neurological function recovery and long-term prognosis are analyzed.The NIHSS score at discharge is 0-1 points or decreased by 10 points from baseline,the short-term neurological function recovery is regarded as good outcome.After 90 days,telephone follow-up,and the long-term prognosis is evaluated with modified Rankin Scale(mRS score ? 2 points for good long-term prognosis).Symptomatic intracranial hemorrhage is defined as intracranial hemorrhage of any nature and theNIHSS score is increased by?4 points.Intracranial atherosclerotic macrovascular occlusion is defined as mechanical open surgery or after surgery,DSA confirmed that the occlusion with significant stenosis,including significant stenosis refers to:1.combined with in situ stenosis?70%,2.combined with in situ stenosis?50%and distal blood supply is not smooth or still exist after treatment with recyclable stents occlusion tendency.Cardioembolic intracranial macrovascular occlusion is analyzed according to the method of cardioembolic classification in the original toast classification.Twenty of 42 patients evaluated collateral circulation compensation(ASITN/SIR collateral circulation classification system),0?1 grade collateral circulation is poor,2-4 grade collateral circulation is good,preliminary study of 20 patients with collateral circulation compensation on vascular recanalization,short-term neurological function recovery and long-term clinical prognosis.Results1.There are no significant differences in age,hypertension,diabetes,hyperlipidemia,smoking,drinking and other risk factors.Among 42 patients with mechanical embolectomy,including 6 patients in the intracranial segment of internal carotid artery,7 patients in the extracranial segment of internal carotid artery,21 patients in the middle cerebral artery and 8 patients in the vertebrobasilar artery.There are 4 cases(66.7%)of in situ thrombosis caused by atherosclerosis in the extracranial segment of the internal carotid artery,2 cases(28.6%)in the intracranial segment of the internal carotid artery,5 cases(23.8%)in the middle cerebral artery and 4 cases(50%)in the vertebrobasilar artery.There are 3 patients(50%)in the extracranial carotid artery group,4 patients(57.1%)in the intracranial internal carotid artery group,13 patients(61.9%)in the middle cerebral artery group and 0 patients in the vertebrobasilar artery group.2.In the extracranial segment of internal carotid artery group,2 patients(33.3%)developed disturbance of consciousness,2 patients(33.3%)developed disturbance of speech and limb activity on one side,1 patient(16.7%)developed headache and limb activity on one side,and 1 patient(16.7%)developed disturbance of limb activity on the other side.One patient(14.3%)in the intracranial segment of the internal carotid artery developed disturbance of consciousness,two patients(28.6%)developed dysphonia accompanied by weakness of one limb,and four patients(57.1%)developed disturbance of one limb.In middle cerebral artery group,7 patients(33.3%)developed disturbance of consciousness,9 patients(42.8%)developed disturbance of speech and limb activity on one side,and 4 patients developed disturbance of limb activity on the other side,One patient(4.76%)developed symptoms of numbness and weakness on one side of the headache.4 patients in vertebrobasilar artery group were onset of consciousness disturbance,3 patients were onset of consciousness disturbance after dizziness and headache,and 1 patient was onset of consciousness disturbance after inability to speak and limbs movement.The average NIHSS score in the extracranial group of internal carotid artery is 17.83 ±4.83,in the intracranial group of internal carotid artery is 17.29 ±4.54,in the middle cerebral artery group is 15.57±5.41,and in the vertebrobasilar artery group is 25.63±6.61.The baseline NIHSS score in the vertebrobasilar artery group is higher than that in the other three groups.The NIHSS score in the middle cerebral artery group is relatively low.3.The average time from onset to femoral artery puncture is 280.83±121.18min in the extracranial carotid artery group,250± 112.25min in the intracranial internal carotid artery group,261.95±113.97min in the middle cerebral artery group and 282.13±91.55min in the vertebrobasilar artery group.The mean operative time is 129.17±24.58min in the extracranial carotid artery group,94.29±35.98min in the intracranial internal carotid artery group,95.95±24.06min in the middle cerebral artery group and 120±19.27 min in the vertebrobasilar artery group.There are 3 cases(50%)of recanalization in extracranial carotid artery group,4 cases(57.1%)in intracranial internal carotid artery group,17 cases(81%)in middle cerebral artery group and 7 cases(87.5%)in vertebrobasilar artery group.The mean time from onset to recanalization is 403.33 ± 172.74min in the extracranial carotid artery group,318.75 ± 86.45min in the intracranial internal carotid artery group,312.88 ±110.47min in the middle cerebral artery group and 398.57 ± 94.42min in the vertebrobasilar artery group.Intracranial hemorrhage occurred in 1 case(16.7%)in the treatment group,4 cases(57.1%)in the treatment group,5 cases(23.8%)in the middle cerebral artery group and 2 cases(25%)in the vertebrobasilar artery group.Symptomatic intracranial hemorrhage occurred in 1 case(16.7%)in the extracranial segment of internal carotid artery,1 case(14.3%)in the intracranial segment of internal carotid artery,and no symptomatic intracranial hemorrhage occurred in the middle cerebral artery group and vertebrobasilar artery group.4.There were 2 cases(33.3%)in the extracranial segment of internal carotid artery,2 cases(28.6%)in the intracranial segment of internal carotid artery,13 cases(61.9%)in the middle cerebral artery and 3 cases(37.5%)in the vertebrobasilar artery.4.The long-term prognosis is good in 1 case(16.7%),2 cases(28.6%)in the intracranial segment of internal carotid artery,13 cases(61.9%)in the middle cerebral artery and 3 cases(37.5%)in the vertebrobasilar artery.There are 2 deaths(33.3%)in the extracranial segment of the internal carotid artery,3 deaths(42.9%)in the intracranial segment of the internal carotid artery,6 deaths(28.6%)in the middle cerebral artery and 5 deaths(62.5%)in the vertebrobasilar artery.5.There is no statistical difference in sex,age,hypertension,diabetes,hyperlipidemia,smoking and drinking between the patients with good collateral circulation compensation group and the patients with poor collateral compensation group(P>0.05);The revascularization rate(77.3%vs 66.7%,P=0.70)is higher in the group with good collateral circulation compensation,the neurological function recovery is better in the near future(68.2%vs 20%,P=0.007),the long-term prognosis is better(63.6%vs 13.3%,P=0.04),the incidence of intracranial hemorrhage is lower(13.6%vs 40%,P=0.12),and the mortality rate is lower(18.2%vs 53.3%,P=0.36).Conclusions1.The lesion site of different responsible vessels in acute ischemic stroke will affect the operation,curative effect and clinical prognosis of mechanical embolus.And the pathogenesis,clinical characteristics,vascular recanalization rate,bleeding risk and other aspects of different vascular lesions showed different tendencies.The proportion of in-situ thrombosis caused by internal carotid artery extracranial atherosclerosis is high,the recanalization rate is low,the incidence of symptomatic intracranial hemorrhage is high,and the long-term prognosis is poor.The operation time of intracranial segment of internal carotid artery is relatively short.The recanalization rate of thrombi in intracranial segment of internal carotid artery is low and the rate of intracranial hemorrhage is high.The proportion of middle cerebral artery embolism is high,the short-term recovery of nerve function and long-term prognosis are good,and the mortality rate is low.The NIHSS score of baseline is the highest in vertebrobasilar artery AIS.Mechanical embolus revascularization rate is high,mortality rate is high,but because of our sample size is small,in addition to the middle cerebral artery group embolism rate is high and vertebral basilar artery group baseline NIHSS score is high,most of the other differences have no statistical significance,need to expand the sample size for further study.2.Collateral circulation has significant effects on recanalization rate,clinical prognosis and complications of AIS patients with mechanical thrombi,whether in the extracranial carotid artery group,intracranial internal carotid artery group,middle cerebral artery group or vertebrobasilar artery group.The vascular recanalization rate,short-term neurological recovery and long-term prognosis are good,intracranial hemorrhage rate and mortality rate are low in patients with good collateral circulation compensation.Because of the small sample size of this retrospective study,there are no significant difference except for the short-term neurological function recovery and long-term prognosis in the patients with good collateral circulation compensation. |
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