A Retrospective Analysis Of The Safety Of Thrombectomy To The Patients With AIS In The Process Of Anticoagulation

BackgroundRefers to the non convulsion cerebral apoplexy,regional nervous system damage,and successive symptoms exist more than 24 h,according to its different imaging(CT or MRI)performance can be identified for ischemic stroke,parenchymal hemorrhage and subarachnoid hemorrhage.Ischemic stroke is one of the most common subtypes of stroke,accounting for about 60-80%of the total stroke.The epidemiological data(GBD 2010)show that stroke has become the second leading cause of death in the world,leading to the primary cause of disability and the third cause of human life expectancy.It is reported that stroke has been one of the causes leading to the most deaths in urban and rural areas in China.An epidemiological study published in 2007 showed that there were more than seven million patients with a history of stroke and survived.About 70 percent of these patients have physical or speech impairments,and motor loss or decline is the most common manifestation.Limb movement function obstacle seriously limits the patient's life and social,the life quality decreased obviously,for the family and family burden of financial resources and manpower,stroke brings us not only is more contradictions.Ischemic stroke fast onset and progression,effective diagnosis and treatment time window is short,and the clinical characteristics of reversible nerve injury repair timeliness short,therefore,for Acute ischemic stroke(Acute ischemic stroke,AIS)of patients,timely diagnosis and rapid symptomatic treatment is the reliable guarantee for survival or rehabilitation.At present,the treatment of such diseases includes intravascular application of drug dissolving embolus and intravascular stent intervention for minimally invasive surgery.Rt-PA is currently the only approved a gleam of thrombolytic drugs,but its shorter treatment time window,the current recommended thrombolysis for 3-4.5 hours after the onset time,because the reason such as disease found that timely medical attention time delay,the temple of heaven in Beijing hospital professor yong-jun wang has released its responsible to the project as a result,only 1.13%or so in acute ischemic stroke patients can accept the intravenous rtPA guide requirements within the scope of clinical we also will have some more special of acute ischemic stroke patients,and this part of the patients with atrial fibrillation history of coronary artery stenosis or lacunar cerebral infarction,due to reasons such as preventive care even before onset were history of oral anticoagulant drugs such patients are generally exist coagulation dysfunction or coagulant function abnormality indicator has become thrombolysis taboo,and occurs during oral anticoagulant drugs patients with arterial embolism,conventional thrombolysis effect is poor,has the characteristics of the blood vessels,the low rate of easily lead to cerebral hemorrhage.Take the invention of the bolt support for AIS patients provides a new means of diagnosis and treatment,with the help of a guide wire end of the guide bracket to blood clots and stretch into mesh,make embolus and good contact with mesh structure and adhesion after recycling bracket and remove emboli altogether,so as to achieve purpose of recanalization,restore brain tissue ischemia reperfusion.In recent years,more and more extensive research on the safety of the stent should were discussed,the results show that after the stent in treating occluded artery blood flow was significantly better than simple intravenous thrombolysis drug effect,and by taking bolt caused by side effects of thrombolysis therapy did not see a significant increase in relatively.With the development of thrombolysis,more and more patients with acute ischemic stroke benefit from the suppository,and with the increasing maturation of thrombolysis,the indication of thrombolysis is increased.Anticoagulation during onset of ischemic cerebral apoplexy patients is one of the more special kind of pressed,most of the patients coagulopathy is beyond thrombolysis indication range,but not beyond should absolute contraindications,can still be attempted to take bolt for such patients.However,there are few studies on the safety and efficacy of thrombolysis in patients with ischemic stroke in anticoagulation.This study will be sent to you by retrospective analysis strudel stents should treatment of anticoagulant blood vessels of the rate of cerebral apoplexy patients,symptomatic intracranial bleeding,postoperative neurologic injury recovery and prognosis,explore the bolt extraction for in oral anticoagulant drugs security and the feasibility of the application of AIS patients,make guidance to clinical diagnosis and treatment.ObjectiveThrough the retrospective analysis for the treatment of strudel stents should anticoagulant during blood vessels of the symptomatic intracranial bleeding rate of cerebral apoplexy patients Recovery of neural function damage and prognosis,and to explore the bolt extraction for AIS patients of the disease in the process of anticoagulant application of the safety and effectiveness,and provides the treatment basis for the clinical work.MethodThis study reviewed from September 2016 to June 2016 in zibo city center hospital neurosurgery team line strudel support bolt extraction for cerebral apoplexy in 49 cases of patients with acute ischemic stroke,including inside 7 days before the onset of patients with a history of oral anticoagulant drugs of 17 cases,7 cases of male patients,10 cases of female patients,ages 45-79 years old,average age 54.35 ±10.78,the team in all patients before the onset of anticoagulant therapy,and were diagnosed with acute cerebral artery occlusion,including 10 cases,5 cases of middle cerebral artery infarction of internal carotid artery infarction,2 cases of basilar artery infarction.And in the same period were no anticoagulant therapy before the onset of AIS patients as control group,also for stent in treating,a total of 32 cases,14 patients with male and female patients with 18 cases,aged 41 to 80 years old,the average age of 63.24 ± 12.81 years,including 15 cases of middle cerebral artery infarction,8 cases of internal carotid artery infarction,5 cases of basilar artery infarction,4 cases of posterior cerebral artery infarction.Strict calculation and registration of two groups of patients from onset to admission time,first time complete cerebral angiogram,pull pin number,blocking blood recovery,intraoperative hemorrhage,record should record the change of the patient's hospitalization consciousness,main reference index with GCS score and NIHSS score,in order to evaluate the strudel scaffold recent curative effect,after endovascular should record hospitalization in patients with CT check presence of cerebral hemorrhage,used to assess the safety treatment,by telephone return visit,outpatient follow-up methods such as the long-term prognosis of patient evaluation and main reference index for patients survival and mRS score of 90 days.Results1.The time of the study of the time of the disease of the artery sheath was 1.82-10.26 hours,and the mean time was 4.42 ± 1.81 hours.In the control group,the time of the allotment was 1.79-10.44 hours,and the mean time was 4.37 ± 1.92 hours.Group and control group for the first time from onset to arterial sheath placement and the time spent on angiographic there was no significant difference(T = 0.38,P = 0.38>0.05).2.Two groups of patients with apple strudel stents should before and after the treatment of NIHSS score with GCS scoreThe changes in the team for the patient to hospital NIHSS score 12-27 points,the average(19.85 ± 4.27),after treatment of NIHSS score of 0 to 30 points,the average(7.87 ±8.61);Control group for the patient to hospital NIHSS score 9-29 points,the average(18.92 ± 9.16),after treatment(0 to 30)for NIHSS score points,the average(8.27 ± 7.28)between the two groups of patients admitted to hospital with NIHSS score changes after treatment there was no statistically significant difference(T = 2.37,P =2.37>0.05).The group patients on admission GCS score(6-12),average(7.68 ±2.91)points,take bolt postoperative GCS score for(3 to 15),average(12.78 ±3.63);Control group patients on admission GCS score(6-13),average(8.18±3.22),postoperative GCS score should for(3 to 15),average(12.46 ± 4.52)in two groups of patients admitted to hospital with changes in GCS score after treatment there was no statistically significant difference(T = 0.78,P = 0.78>0.05).3.The number of thrombolysis and the revascularization in the operation.Two groups of patients were 1 to 3 times should,should an average team patients(2.42 ± 0.86)times,the control group on average take times as suppository(2.76 ±1.07)times,two groups of patients there was no statistically significant difference in number in treating(T = 0.57,P = 0.57>0.05).Recanalization situation based on cerebral infarction thrombolysis(TICI)classification evaluation,should postoperative whole cerebral angiography(Digital subtraction angiography,DSA),with TICI classification above ? b to restore cerebrovascular recanalization,the team in 14 patients achieved cerebrovascular recanalization,good 82.35%to vessels,27 cases in the control group patients achieved cerebrovascular recanalization,good 84.37%to vessels,group and the control group patients cerebrovascular recanalization has no statistically significant difference(T = 1.68,P = 0.21>0.05).4.Comparison of cerebral hemorrhage and cerebral edema during intraoperative and hospitalization.Group 1 patients significantly in cerebral hemorrhage,unable to continue the operation and stop,as the basal artery infarction patients,1 patients during postoperative hospital to only show the CT scattered punctate bleeding,no obvious hemiplegia,disturbance of consciousness,such as performance,2 cases of patients with apparent reperfusion brain edema;Control group 2 symptoms in patients with cerebral hemorrhage,1 called MCA infarction patients,1,posterior cerebral artery infarction patients,1 case during postoperative hospital to basal artery infarction patients with asymptomatic cerebral hemorrhage,cerebral edema of infusion observed in 4 patients,likely to cause cerebral hemorrhage group than the control group,treatment and hospitalization in cerebral hemorrhage and reperfusion injury risk is the main reference for surgery,two groups of patients the occurrence of complications related to risk has no obvious difference(T = 0.41,P = 0.41>0.05).5.Comparison of survival and survival of patients in 3 months.As of the return visit,the study group had 12 patients alive,with a survival rate of 70.58%and a 3-month mRS score(1.82 ± 1.67).23 cases of control group patients survived,the survival rate was 71.87%,3 months for mRS score(2.03 ± 1.87)points,two groups of patients after discharge survival basic same,3 months prognosis has no statistically significant difference(T = 2.54,P = 0.11>0.05).Conclusion1.The Solitaire stent is still effective for the AIS patients with the disease during anticoagulation,and can restore the blood circulation of the blocked artery as soon as possible.2.Solitaire stent did not significantly increase the risk of bleeding during the operation of oral anticoagulant AIS patients.3.Compared with ordinary patients,the patients with AIS during the treatment of anticoagulation were treated with Solitaire stent,whose long-term complications were not significantly increased,and the long-term survival rate was not significantly different.