Related Factors Affecting The Clinical Outcome Of Anterior Circulation Acute Ischemic Stroke After Endovascular Treatment

Stroke is one of the major causes of human disability and death,endovascular treatment had been proved to be a safe and effective way to treat large-vessel occlusion acute ischemic stroke(LVO AIS).However,there are still some patients who cannot achieve good clinical outcome after endovascular treatment.Therefore,it is very important to explore the factors affecting the clinical outcome of endovascular treatment.The inflammatory response plays an important role in the process of ischemic stroke.The neutrophil-lymphocyte ratio(NLR)is a biological indicator which can reflect the degree of systemic inflammatory response.On the other hand,collateral circulation is one of the main factors affecting the prognosis,imaging-based collateral scoring system can quantify collateral circulation and provide guidance for interventional physicians.Our study aimed to explore the factors that affecting the clinical outcome of endovascular treatment of acute ischemic stroke in the two direction above.PART 1 Neutrophil-Lymphocyte Ratio Predicts Functional and Safety Outcomes after Endovascular Treatment for Acute Ischemic StrokeBackground and Objective Endovascular treatment(EVT)is proven to be safe and effective for acute large vessel occlusion stroke(LVOS).Neutrophil-lymphocyte ratio(NLR)reflects systemic inflammation which plays an important role in the process of ischemic stroke.This study aims to explore the relationship between NLR and the clinical outcomes of LVOS patients undergoing EVT.Methods Patients were selected from the endovAsCular Treatment for acUte Anterior circuLation ischemic(ACTUAL)stroke registry.The laboratory data before EVT were collected.Poor functional outcome was defined as modified Rankin Scale(mRS)of 3-6 at 3 months.Multivariable logistic regression analyses were performed to explore the relationship of NLR with functional outcome,symptomatic intracranial hemorrhage(sICH)and mortality.Results We eventually included 616 patients.There were 350(56.7%)patients achieving mRS of 3-6 at 3 months,98(15.9%)patients with sICH,and the mortality at 3 months was 24.8%(153/616).Baseline NLR was independently associated with poor functional outcome[odds ratio(OR)1.58;95%confidence interval(CI)1.02-2.45;P = 0.039)and sICH(OR 1.84;95%CI 1.09-3.11;P= 0.023),but showed a trend for predicting 3-month mortality(OR 1.57;95%CI 0.94-2.65;P = 0.088).Conclusions NLR independently predict 3-month functional outcome and sICH but a trend association with mortality after EVT for acute anterior circulation LVOS patients.PART 2:The correlation between capillary index score and clinical outcome of anterior circulation acute ischemic stroke after endovascular treatmentBackground and Objective Capillary index score was used to evaluate the collateral circulation in patients with anterior circulation acute ischemic stroke(AC AIS),and explore the correlation between the CIS and clinical outcome of AC AIS after endovascular treatment(EVT).Methods We retrospectively included LVO AIS patients treated with endovascular treatment in two hospital from March 2014 to March 2017,CIS 0-1 was considered poor CIS(p-CIS)and CIS 2-3 was considered favorable CIS(f-CIS).Univariate comparisons of baseline variables,clinical variables and recanalization outcomes between two groups,statistically significant variables were included in the multivariate logistic regression model and analyzed the predictive value of CIS for symptomatic intracranial hemorrhage(sICH),death and 90-day clinical outcome.Results The study eventually included 157 patients.For the recanalization outcome,patients with f-CIS had higher rates of recanalization(P<0.001),better clinical outcome(P<0.001),lower rates of symptomatic intracranial hemorrhage(P=0.002)and mortality(P<0.001).Multivariate logistic regression analysis showed that CIS was independently associated with 90-day clinical outcome(OR 0.581,95%CI 0.419-0.805;P = 0.001),sICH(OR 0.611,95%CI 0.407-0.919,P = 0.018)but showed no significant association with death(OR 0.783,95%CI 0.492-1.246,P = 0.301)of AC AIS treated with EVT.Conclusion Capillary index score is indepengdently associated with the clinical outcome of AC AIS after EVT which can be used as an available tool for reference to select patients for EVT.