| Objective:To summarize the clinical data of all anterior circulation AIS patients receiving emergency endovascular treatment with a definite time from symptom onset to femoral artery puncture at 4.5 hours to 2 weeks to explore the safety and effectiveness of endovascular treatment and further to discuss the possibility of prolonging the time window of endovascular treatment.Materials and Methods:A retrospective analysis of 54 cases of all anterior circulation AIS patients receiving emergency endovascular treatment with a definite time from symptom onset to femoral artery puncture at 4.5 hours to 2 weeks during the period from January 2016 to November 2017.Vascular recanalization,clinical prognosis and their correlation complications were compared and compared with international studies.Patient's medical history and signs,head CT,TCD or multimodal perfusion CT to support macrovascular disease,and aspects score?6 or infarct volume?1/3 MCA supply area and NIHSS?7 or NIHSS gradually increasing from disease appeared.Recanalization according to m TICI blood flow grading,m TICI 2b or 3 is regarded as vascular recanalization,level 2a is considered part of the recovery of blood flow;clinical prognosis based on the rate of 90 d good functional prognosis(m RS 0-2)patients.Results:The 90 d good functional prognosis rate of patients undergoing endovascular treatment was 50%(27/54).The recanalization rate was 87.04%(47/54).The good prognosis of 90 days after revascularization was 55.32%(26/47),and the good prognosis of 90 days after vascular failed was 14.29%(1/7),the difference between the two groups(P=0.043).The good prognosis of m TICI grade 2b and grade 3 patients after endovascular treatment was 50%(9/18)and 58.62%(17/29)respectively at 90 days,but there was no difference between the two groups(P=0.563).The incidence of 90 d good function prognosis was 48%(24/50)when onset time to femoral artery puncture time was 4.5-24 h,and 4 patients were found with a definite time from symptom onset to femoral artery puncture at 24 hours to 2 weeks.Of them,3 patients had good prognosis of 90 d function and improved clinical symptoms.The complications of this group were mainly in the perioperative period,including 21 cases of pulmonary infection(38.89%),6 cases of s ICH(11.11%),6 cases of open vessel reocclusion(11.11%),2 cases of acute coronary syndrome(3.70%),2 cases of intraoperative arterial dissection and no guide wire perforating blood vessel condition.During the follow-up period of 90 d,1 patient occurred complications,which were TIA attacks(1.85%),and no cerebral apoplexy occurred after stent implantation.The mortality rate was 7.41%(4/54),of which 3 cases died in perioperative period(5.56%),and 1 case of death during 90 d follow-up(1.85%).In the patients with 24h-2w,1 patients had reocclusion of blood vessels and pulmonary infection.All patients had no s ICH or death.The complications of m TICI 2B and grade 3 patients after endovascular treatment were compared,and we found that the incidence of perioperative period complications in the former was 61.11%(11/18),and the incidence of perioperative period complications in the latter was 31.03%(9/29),and there was a difference between the two groups(P=0.043).but the comparison of patients with pneumonia in perioperative complications only after the removal,we found that the incidence of complications in the perioperative period of m TICI 2b was 27.78%(5/18),and the incidence of complications in the perioperative period of m TICI 3 was 27.59%(8/29),and there was no difference between them(p=0.989).Conclusion:The emergency endovascular treatment for AIS patients at 4.5h-2w who are suffered from strict screening can still benefit,and endovascular treatment will be individualized in the future;Endovascular treatment should strive to achieve m TICI 3 blood flow and it can achieve m TICI grade 2b blood flow under special circumstances;Pulmonary infection is the most common complication of endovascular treatment and the key to good outcome is to strengthen nursing. |
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