The Effect Of Leukoaraiosis And Collateral Circulation On The Prognosis Of Patients With Mechanical Thrombectomy In Emergent Large Vessel Occlusion

Objective: To evaluate the severity of leukoaraiosis(LA),collateral circulation quality,and prognosis of patients with emergent large vessel occlusion(ELVO)and to explore the effect of leukoaraiosis and collateral circulation on the prognosis of patients with mechanical thrombectomy(MT).Methods: From January 2017 to October 2019,112 patients who were hospitalized in the Department of Neurology of Subei people's Hospital and confirmed the existence of ELVO by brain CTA were included in the retrospective study.All the selected subjects were examined by brain MRI.To the subjects: 1.To record the general baseline and clinical data of these patients,including demographic information,cerebrovascular disease risk factors,routine blood biochemical examination,according to the m RS score of 90 days follow-up(m RS 0-2 score for good prognosis,m RS 3-6 score for poor prognosis),the patients were divided into the group with good prognosis and the group with poor prognosis,and to analyze the difference of baseline data between the two groups;2.To assess the brain by Fazekas scoring standard the degree of leukoaraiosis and its effect on acute ischemic stroke(AIS)the influence of mechanical thrombectomy;3.The American society of interventional radiology / society of interventional radiology(ASTIN/ SIR)was used to grade the collateral circulation of patients with mechanical thrombectomy,to analyze whether there was collateral circulation and the influence of collateral circulation grading on the prognosis of patients with AIS mechanical thrombectomy;4.To analyze the leukoaraiosis and collateral circulation synergy on the prognosis of patients with mechanical thrombectomy;5.To explore the influence of leukoaraiosis and collateral circulation interaction on prognosis in patients with mechanical thrombectomy with anterior and posterior circulation;6.To explore the influence of leukoaraiosis and collateral circulation on hemorrhagic transformation in mechanical thrombectomy;7.To analyze other influencing factors on the prognosis of mechanical thrombectomy.Results: 1.There were 112 patients in the group,53 in the group with good prognosis,59 in the group with poor prognosis,82 in the group with large vessels occluded in the anterior circulation,30 in the group with great vessels occluded in the posterior circulation,38 cases of anterior circulation and 15 cases of posterior circulation in the group with good prognosis,44 cases of anterior circulation and 15 cases of posterior circulation in the group with poor prognosis.Compared with the good prognosis group,the poor prognosis group included age,gender,discharge NIHSS score,stroke associated pneumonia,leukoaraiosis,no collateral circulation,times of thrombectomy,admission systolic blood pressure,red blood cell count,and D-dimer were statistically significant differences(P < 0.05);the smoking history of patients with good prognosis was higher than that with poor prognosis,the difference was statistically significant(P<0.05).2.Leukoaraiosis was an independent risk factor(OR = 7.46,P = 0.011)for poor prognosis in patients with mechanical thrombectomy.After adjusting for sex,age,smoking history,discharge NIHSS score,stroke associated pneumonia,admission systolic blood pressure,red blood cell count,D-dimer,times of thrombectomy,and presence or absence of collateral circulation,compared with those without leukoaraiosis,leukoaraiosis with mild or moderate to severe degree was associated moderate or severe leukoaraiosis was an independent risk factor for poor prognosis in patients with mechanical thrombectomy(P = 0.032).3.No collateral circulation was an independent risk factor for poor prognosis in patients with mechanical thrombectomy(OR= 3.57,P = 0.021).Compared with those with good collateral circulation,the risk of poor prognosis in patients with bad collateral circulation and no collateral circulation increased gradually;After adjusting for the confounding factors such as gender,age,smoking history,discharge NIHSS score,stroke associated pneumonia,admission systolic blood pressure,red blood cell count,D-dimer,times of thrombectomy and leukoaraiosis,no collateral circulation was still an independent prognostic factor(OR = 5.24,P = 0.035),and compared with those with good collateral circulation,the risk of poor prognosis in patients with bad collateral circulation or no collateral circulation was gradually increased;4.According to the analysis of the interaction between leukoaraiosis and collateral circulation,the patients with leukoaraiosis and without collateral circulation were the independent risk factors for poor prognosis after mechanical thrombectomy(OR= 6.20,P = 0.006).After adjusting for gender,age,smoking history,discharge NIHSS score,stroke associated pneumonia,admission systolic blood pressure,red blood cells,D-D,thrombectomy times and leukoaraiosis,the risk of poor prognosis in patients with leukoaraiosis and without collateral circulation is significantly higher than that in patients with no leukoaraiosis with collateral circulation,leukoaraiosis with collateral circulation,simple leukoaraiosis and simple non collateral circulation(P<0.05);5.There was no significant difference in the effect of interaction between leukoaraiosis and collateral circulation on the prognosis of mechanical thrombectomy patients with anterior and posterior circulation infarction(P > 0.05);6.According to the analysis of the interaction between leukoaraiosis and collateral circulation,there was no collateral circulation with leukoaraiosis in patients,with leukoaraiosis and collateral circulation,without leukoaraiosis and collateral circulation,which were not the independent risk factors of hemorrhagic transformation in patients with mechanical thrombectomy(P > 0.05);7.In addition to leukoaraiosis and collateral circulation,age,discharge NIHSS score,admission systolic blood pressure and D-dimer were the independent risk factors(P < 0.05).Conclusion: 1.For patients with acute large vessel occlusion,moderate to severe leukoaraiosis is an independent risk factor for poor prognosis.Compared with patients without leukoaraiosis and mild leukoaraiosis,moderate to severe leukoaraiosis patients with mechanical thrombectomy have the highest risk of poor prognosis;2.No collateral circulation is an independent risk factor for poor prognosis in patients with mechanical thrombectomy.The risk of poor prognosis in patients without collateral circulation is higher than that in patients with poor or good collateral circulation;3.Through the analysis of the interaction between leukoaraiosis and collateral circulation,the risk of poor prognosis in patients with leukoaraiosis and without collateral circulation is significantly higher than that in patients with simple leukoaraiosis and without collateral circulation;4.The effects of leukoaraiosis and collateral circulation interaction on the prognosis of patients with mechanical thrombectomy in the anterior and posterior circulation were similar;5.In this study,leukoaraiosis and the interaction of collateral circulation did not affect the risk of hemorrhage and transformation in patients with mechanical thrombectomy.6.In addition to the factors of leukoaraiosis and collateral circulation,age,discharge NIHSS score,systolic blood pressure and D-dimer were the independent risk factors for the poor prognosis of mechanical thrombectomy patients.