14 Cases Of Clinical Analysis Of Mechanical Thrombectomy In Acute Ischemic Stroke

Objective:To evaluate the clinical efficacy and safety of mechanical thrombectomy in the treatment of acute ischemic stroke caused by intracranial arterial occlusion.Methods:14 patients with acute ischemic stroke treated by mechanical thrombectomy in the Hunan People's Hospital from June 2016 to February 2018 was retrospectively analyzed.With the exclusion of cerebral hemorrhage by CT scanning and confirmation of intracranial large artery occlusion by digital-subtraction angiography(DSA),all the patients went intravenous thrombolytic therapy in the time window of venous thrombolysis.The modified arterial thrombolysis Infarction(mTICI)was used to evaluate the vascular recanalization.The mTICI grade 2b/3 was considered as a successful standard for the treatment of acute ischemic stroke.The prognosis was evaluated by recording the modified Rankin Scale(mRS)score on the 90th day after the operation,and the mRS score of 0-2 was defined as a good prognosis.Record the site of vascular occlusion,the number of thrombectomy and whether angioplasty was performed.Symptomatic intracerebral hemorrhage was recorded at 24 hours after operation(intracranial hemorrhage confirmed by any imaging examination,resulting in aggravation of nerve function defects,with the NIHSS score increased more than 4 points).The preoperative NIHSS score,NIHSS score at 24 hours after operation,and NIHSS score at discharge time were used to evaluate the effect of mechanical thrombectomy.Results:14 patients with acute ischemic stroke treated by mechanical thrombectomy was included.There were 8 males and 6 females;aged 50-84 years(mean age,69.07±10.19years);3 patients were treated with intravenous alteplase before mechanical thrombectomy(in a dose of 0.9 mg per kilogram of body weight,10 percent of which was given as a bolus followed by delivery of the remaining 90 percent as a constant infusion over a period of 60 minutes.);1 patient was treated with intravenous urokinase before mechanical thrombectomy(1.5 million IU was added to 0.9%saline 100 ml,and infusion over a period of 30 minutes);the median time to onset of thrombectomy was 6(5.13,6)hours;the median preoperative National Institute of Health stroke scale(NIHSS)score was 18.5(14.75,20)points,the median NIHSS score at 24 hours after operation was 17(13,20),the median NIHSS score at discharge time was 7.5(6.25,14.5);the median preoperative Glascow Score Scale(GCS)score was 8(6,12.75).The sites of vessel occlusion were intracranial internal carotid artery in 2 patients,middle cerebral artery in 9,basilar artery in 2,vertebral artery in 1.The median number of thrombectomy was2(1.5,2.5).Successful revascularization was achieved in 9 patients[64.3%(TICI ? 2b)];At 90 days,7(50%)patients achieved favorable outcome(mRS score 0-2 points);One(7.1%)patients had symptomatic hemorrhagic transformation.The mortality within 3months was 26.8%.ANOVA showed preoperative NIHSS score(p=0.015).preoperative GCS score(p=0.031)are realated with prognosis.Hypertension(p=0.552),atrial fibrillation(p=1.000),smoking(p=0.611),and diabetes(0.611)have no significantly associated with prognosis.Conclusion:1.Mechanical thrombectomy can enhance the vascular recanalization rate and improve the prognosis of patients.2.Performing Mechanical thrombectomy within 8 hours after onset is effectiveness.3.The mechanical mechanical thrombectomy is safety.