The Prognostic Value Of Clinical-ASPECTS Mismatch In The Treatment Of Acute Middle Cerebral Artery Occlusion With Mechanical Thrombectomy

Objective: The purpose of this study is to explore the prognostic value of Clinical-ASPECTS Mismatch in the treatment of acute middle cerebral artery occlusion with mechanical thrombolysis.Methods: There were 46 patients with acute occlusion of the first segment of middle cerebral artery from January 2015 to November 2018,who received the treatment with Solitaire stent thrombolysis in the department of neurology of the Fourth Affiliated Hospital of China Medical University.NIHSS score on admission of all the patients was no less than 8.Clinical data of the patients were collected,including age,gender,smoking history,drinking history,history of hypertension,history of diabetes,history of coronary heart disease,history of atrial fibrillation,history of cerebrovascular disease,and low density lipoprotein(LDL),glycosylated hemoglobin,homocysteine,time of onset,NIHSS score on admission,systolic blood pressure on admission,diastolic blood pressure on admission,DWI-ASPECTS,time from admission to puncture,recanalization,number of thrombolysis,combined venous thrombolysis,occlusion site stenosis,proximal occlusion site stenosis,recanalization situation,symptomatic intracranial hemorrhage,m RS score at 3 months after surgery,etc.In this study,Clinical-ASPECTS Mismatch was defined as NIHSS score on admission ≥ 8 and DWI-ASPECTS ≥8.According to m RS score after 90 days of thrombolysis,patients were divided into good outcome group(m RS 0~2,27 cases)and bad outcome group(m RS 3~6,19 cases).T test or non-parametric test was applied to measurement data,while chi-square test was applied to count data,and binary logistic regression analysis was performed to further analyze the influence of Clinical-ASPECTS Mismatch on clinical prognosis.P<0.05 indicates that the data is statistically significant.Results:1.The history of hypertension(P=0.002),NIHSS score on admission(P=0.031)and Clinical-ASPECTS Mismatch(P=0.001)in the two groups showed statistical difference.2.NIHSS score on admission,history of hypertension and Clinical-ASPECTS Mismatch were tested with binary Logistic regression analysis.The results showed that history of hypertension(OR=0.077,95%CI:0.012 ~ 0.480,P=0.006)and Clinical-ASPECTS Mismatch(OR=10.181,95%CI:1.762 ~ 58.817,P=0.010)were independent predictive factors of prognosis.Conclusion:1.The history of hypertension and the Clinical-ASPECTS Mismatch are independent predictors of good outcome(m RS 0-2)3 months after thrombolysis.2.The Clinical-ASPECTS Mismatch can guide the treatment of acute middle cerebral artery occlusion with mechanical thrombectomy is safe and effective.Patients with acute middle cerebral artery occlusion with Clincial-ASPECTS Mismatch who were treated with mechanical thrombectomy may have better clinical outcomes.