Analysising Of Influential Factors Of Prognosis For Acute Basilar Artery Occlusion,Which Were Treated By Mechanical Thrombectomy

BackgroundAs a common clinical disease,stroke has the characteristics of high morbidity,high recurrence rate,high disability and mortality,so it has caused a heavy medical burden on society and families.Among them,acute basilar artery occlusion(ABAO)is a type of ischemic stroke.Its clinical manifestations are characterized by acute onset,severe symptoms,and poor prognosis.In recent years,with the development of interventional techniques and materials,mechanical thrombectomy treatment has achieved revolutionary progress.This method can accurately reach the thrombus position for thrombectomy operation.It has the advantages of rapid recanalization,extended treatment time window,application of large vessel occlusion and high success rate.Therefore,how to judge the prognosis according to the preoperative and postoperative relevant indicators and guide the clinical treatment plan are extremely important,but the current research on the prognostic factors of ABAO receiving mechanical thrombectomy is limited.ObjectiveTo explore the related prognostic factors of mechanical thrombectomy for ABAO patients.MethodsThis study is a retrospective cohort study.It included ABAO patients who had been seen in Nanyang Central Hospital from January 2018 to January 2019 and had an onset time within 4.5-8 hours,and received mechanical thrombectomy treatment.The rankin scale(modified rankin scale,mRS)score divided patients into a good prognosis group(mRS?2)and a poor prognosis group(mRS> 3).Register the medical history data and relevant inspection results of the research object.Compare the baseline data of the two groups of patients with the time from onset to vascular recanalization,collateral circulation,thrombus length,thrombus location,vascular recanalization grade,24 h postoperative NIHSS score,and 24 h postoperative symptomatic intracranial hemorrhage.Factors with statistical differences were included in the multivariate Logistic model to screen for factors affecting the prognosis of mechanical thrombectomy for ABAO.Results1.A total of 53 patients with ABAO who met the inclusion criteria were divided into a good prognosis group(mRS?2,n = 28)and a poor prognosis group(mRS> 3,n = 25)based on the 90-day mRS score of the patients.Except for the admission NHISS score(16VS 20),the difference in baseline data was statistically significant P = 0.000,and there was no statistically significant difference in gender,age,previous history(hypertension,diabetes,coronary heart disease,atrial fibrillation,dyslipidemia,smoking history).Significance,all P> 0.05.2.Comparison of prognosis-related diagnosis and treatment indicators: the difference between the time from onset to revascularization in patients with good prognosis and poor prognosis was statistically significant(559.54 ± 97.45 min VS 682.20± 168.71 min,P = 0.002);the difference in thrombus length was statistically significant(8.90 ± 4.15 mmVS 13.22 ± 5.81 mm,P = 0.021);the differences in collateral circulation were grade 2-4(89.3% VS 12.0%)and grade 0-1(10.7% VS 88.0%)(P = 0.000);proximal thrombus location(42.8% VS 48.0%),mid-range(28.6% VS 32.0%),far-end(28.6% VS 20.0%),the difference was not statistically significant(P = 0.771)?Comparison of prognostic-related treatment effect indexes: the revascularization rate of patients with good prognosis and poor prognosis group was statistically significant(100% VS 40.%)P = 0.013;the difference of NIHSS score 24 h after surgery was statistically significant(14 VS 20,P = 0.000);There was no statistically significant difference in symptomatic intracranial hemorrhage rate after 24 hours(3.6% VS 12.0%,P= 0.065).3.Taking the adverse functional prognosis(mRS score 3-6)at 90 days postoperative follow-up as the outcome event,the factors with differences were statistically significant,including the time from onset to vascular recanalization,NHISS score,vascular recanalization grade,and collateral circulation(ASITN / SIR score)and thrombus length were included in the multivariate Logistic model,and the analysis results showed that the24 h postoperative NIHSS score [OR = 13.16,95% CI(1.22-141.53)],revascularization rate [OR = 0.05,95% CI(0.01-0.21)],collateral circulation [OR = 0.83,95% CI(0.04-0.92)] is an independent risk factor affecting the prognosis of mechanical thrombectomy for ABAO.ConclusionThe NIHSS score,vascular recanalization rate,and collateral circulation at 24 hours after surgery are independent risk factors for predicting the prognosis of mechanical thrombectomy for ABAO.