Clinical Study Of Rescue Stenting In The Treatment Of Acute Ischemic Stroke With Large Vessel Occlusion

objective: To investigate the safety and efficacy of rescue stenting implantation after the failure of endovascular treatment for acute ischemic stroke with large vessel occlusion(AIS-LVO);meanwhile,analysis the related risk factors;Further analysis the clinical efficacy and safety of bridging treatment and direct endovascular treatment in the rescue stenting surgery.method: We collected cases of AIS-LVO in our department of neurology from 2015.03 to 2018.03 after the failure of revascularization in endovascular treatment.Baseline data(age,past medical history,baseline NIHSS score,etc.),clinically relevant features(anesthesia methods,treatment time node,etc.),surgery and follow-up data(vascular recanalization,intracranial hemorrhage,NIHSS score,prognosis,etc.)were collected to analyze the therapeutic effect and safety.According to the modified Rankin Scale(mRS)score 90 days after surgery,the patients were divided into a good prognosis group and a poor prognosis group.The risk factors were further analyzed by binary logistic regression analysis.Then the patients were divided into the bridging treatment group and the direct treatment group according to whether they were treated with intravenous thrombolysis.To compare the baseline data,clinical treatment-related characteristics,the symptomatic intracranial hemorrhage rate,the 90-day functional success rate,mortality and other indicators to evaluate whether there is any difference in the safety and effectiveness of the two treatments.results: 60 patients met the standards.(1)In 60 patients,55 patients(91.7%)had revascularization(mTICI 2b~3)immediately after rescue stenting,and the difference between NIHSS scores before and 24 h after surgery [17.5(15,24)points vs.12(8.25,19)points] was statistically significant(P<0.05),the prognosis was good(mRS score 0 ~ 2 points)at 90 days postoperatively 29 cases(48.3%),symptomatic intracranial hemorrhage(SICH)9 For example(15.0%),9 patients died(15.0%).(2)Univariate analysis showed that diabetes,admission NIHSS score,onset-vascular recanalization time,number of thrombectomy,and symptomatic intracranial hemorrhage were related factors affecting prognosis(P<0.05),with diabetes,higher admission NIHSS Scoring,prolongation of onset to revascularization,increased number of thrombectomy,and symptomatic intracranial hemorrhage were associated with poor prognosis in patients.Regression analysis showed that the admission of NIHSS scores(OR=1.138,95% CI: 1.026 to 1.263)and diabetes(OR=1.176,95% CI: 1.038 to 1.825)were risk factors for poor prognosis(P<0.05);(3)There were no statistical differences in clinical baseline data of bridging treatment group and direct treatment group in age,gender,hypertension,diabetes,hyperlipidemia,coronary heart disease,smoking history,low-density lipoprotein level,systolic blood pressure level,and admission NIHSS score(P>0.05);There were no statistical differences in clinical treatment related characteristics between the two groups: anesthesia,onset-femoral puncture time,femoral artery puncture-vascular recanalization time,number of thrombectomy,and balloon expansion(P>0.05);Clinical treatment outcomes: the immediate revascularization rate between the groups(92.3% vs.91.2%),24 h NIHSS score [12.00(7.75,18.00)points vs.14.50(10.00,22.00)points ]and 5-7dNIHSS scores [8(3.00,12.5)points vs.10.5(6.75,16.75)points],90 The prognosis rate(57.7% vs.41.2%),symptomatic intracranial hemorrhage(19.2% vs.11.8%)and mortality(11.5% vs.17.7%)were not statistically significant(P>0.05).conclusions:(1)Rescue stenting implantation is safe and effective in patients with AIS-LVO after revascularization failure;(2)Diabetes,baseline NIHSS score,onset to blood flow reconstruction time,the number of thrombectomy and symptomatic intracranial hemorrhage were the prognostic factors.Further analysis showed that baseline NIHSS scores,diabetes are independent risk factors for treatment;(3)There was no significant difference in the clinical efficacy and safety between the two groups of bridging and direct endovascular treatment.