| Objective:We aim to use non-contrast CT to explore the influences of different types of HMCAS on the prognosis of acute ischemic stroke.Meanwhile,we predict of benefit of intravenous thrombolysis on different patients,to guide the choice of clinical treatment.Methods:Data of 257 AIS patients treated with rt-PA,in a standardized protocol,from July 2016 to July 2017 were included in our study at our stroke care center,the first Hospital of Jilin university.Records of patients general information were obtained,including age,sex,side,blood glucose on admission,history of atrial fibrillation,time-to-CT,time-to-thrombolysis,National Institutes of Health Stroke Scale(NIHSS)scores on admission,NIHSS scores at 24 hours and Modified Rankin scale(mRS)scores at 3 months.HMCAS were identified and measured by more than 2 attending physicians.Early efficacy and long-term prognosis of intravenous thrombolysis were evaluated by NIHSS scores and mRS scores.The vascular recanalization degree was assessed by the TICI standard.SPSS 21.0 was used for statistical analysis.Data conformed to the law of normal distribution was expressed by means and standard deviation,and the comparison between the two groups was conducted by t test of two independent samples.Dichotomous variables were compared with the?~2 test.Ordered categorical data was compared by Mann-Whitney U test.Logistic regression analysis was used to explore the risk factors influencing both short-term and long-term prognosis outcomes.The diagnostic value of ROC curve for short-term prognosis and long-term prognosis was analyzed.P<0.05 was considered statistically significant.Results:(1)When compared to those without HMCAS,patients with HMCAS(61.11%)have poor mRS scores.The difference was statistically significant(Chi-square=13.186,p<0.001).(2)Comparing outcome of patients with or without HMCAS,the results showed that patients with HMCAS had more hemorrhagic transformation(29.63%),significant higher than those without HMCAS(7.24%).(3)In comparison with patients'short-term prognosis,the thrombus length in poor outcome group was(11.91+5.01),longer than those with good prognosis(8.72+2.92mm).Patients who had a history of atrial fibrillation had good short-term prognosis(77.2%).Patients with continuous thrombus had poor short-term prognosis(74.3%).Thrombus located in MCA M1accounted for the majority(74.3%)of recent poor prognosis.History of atrial fibrillation is the protective prognosis factor of the short-term,but the location is a risk factor for short-term prognosis,corresponding area under the curve were 0.690,0.706(P<0.05).The area under the ROC curve from big to small in proper order are:location,history of atrial fibrillation.(4)Patients with higher NIHSS scores(13.56+3.78)at admission have poor long-term prognosis.The long thrombus length group(12.70+4.78)had poor long-term prognosis.Emergency NIHSS score,length,location are risk factors for long-term prognosis,corresponding area under the curve were 0.708,0.792,0.731(P<0.05).The area under the ROC curve from big to small in proper order are:length,location and emergency NIHSS scores.The diagnostic threshold of emergency NIHSS score for long-term prognosis was 11.The diagnostic threshold of length for long term diagnosis was 10.27.Conclusion:1.HMCAS can help to evaluate the prognosis of patients and guide clinical treatment.2.Although arterial high-density sign increases the risk of hemorrhage transformation,it does not affect the incidence of s ICH and death,which is the key to the effectiveness of intravenous thrombolysis in patients with arterial high-density sign.3.When the length of HMCAS>is 10.27mm,and it is located in the MCA M1 segment or the NHISS score>11,it indicates poor long-term prognosis. |
PDF Full Text Request