The Influential Factors Of Hemorrhage Transformation In Acute Ischemic Stroke Treated With Endovascular Treatment

Background: The stroke is one of the main fatal and disabling disease in humans,and acute ischemic stroke accounts for about 80% of all strokes,which has become a major problem affecting human health.The primary problem to be solved in the treatment of acute ischemic stroke is how to quickly and effectively open the occluded blood vessels and save the ischemic cells.With the advent of the second generation of thrombectomy devices,the endovascular treatment have become more and more important in the treatment of acute ischemic stroke,and have currently been used as the highest recommendation in the clinic.However,the risk of bleeding associated with treatment often leads to worse outcomes for patients,which has attracted widespread attention.However,due to its many influencing factors and the complexity of the mechanism,there is still controversy,conclusion is also inconsistent.Objective:The purpose of this study was to explore the relevant factors influencing the conversion of hemorrhage after the treatment of acute ischemic stroke and to provide references for clinical decision-making.Methods: Choosing 70 patients with acute ischemlc stroke who were treated with intravenous thrombolysis combined with endovascular interventional therapy and endovascular interventional alone in The Second Affiliated Hospital of Dalian Medical Univercity Stroke Center from March 2016 to November 2019.The patients were divided into two groups: hemorrhage transformation group(n=18)and non-hemorrhage transformation group(n=52).The 18 patients with hemorrhagic transformation were divided into symptomatic hemorrhage group: 8 cases;Non-symptomatic hemorrhage group(n=10).Filtrating and recording 27 factors which include age,sex,smoking history,drinking history,history of hyperlipidemia,history of hypertension,history ofatrial fibrillation,baseline blood pressure(Systolic blood pressure and diastolic blood pressure),total cholesterol,low-density lipoprotein,platelet count,WBC count,offending vessel,preoperative emergency blood glucose,APTT,INR,baseline NIHSS score,preoperative aspect score,operation time,number of thrombus removal,whether intravenous thrombolysis was performed before operation,white matter demyelination(blennow classification),treat with tirofiban and the type of thrombus removal device,m TICI scale.These 27 factors were univariate analysis as independent variables.First of all,checking whether the measurement data conforms to the normal distribution.Measurement data that met the normal distribution were used T test,non-parametric tests were used for measurement data that did not meet the normal distribution,and chi-square test/Fisher test was used for count data.For those who were positive in univariate analysis,binary logistlc regression analysis was used to find independent influnential factors.Results:(一)Hemorrhage transformation group and Non-hemorrhage transfomation group1.Umvanate analysis:(1)The average Aspect score of the bleeding group 8.0,compared with the non-bleeding group10.0,P = 0.002,has a statistical difference.(2)The average value of blennow classification of bleeding group is 2.0,non-bleeding group is 1.0,P <0.001,the difference was significant.(3)There was a statistically significant difference in the offending vessel,between the bleeding group and the non-bleeding group.(P=0.036)(4)The other fators such as age,sex,smoking history,drinking history,history of hyperlipidemia,history of hypertension,history of atrial fibrillation,baseline blood pressure(Systolic blood pressure and diastolic blood pressure),total cholesterol,low-density lipoprotein,platelet count,WBC count,preoperative emergency blood glucose,APTT,INR,baseline NIHSS score,operation time,number of thrombus removal,whether intravenous thrombolysis was performedbefore operation,treat with tirofiban and the type of thrombus removal device,m TICI scale in the two groups,P> 0.05.have no statistical significance.2.Binary Logistics Regression Analysis: The three positive factors(with significant differences)in the above univariate analysis were subjected to binary logistic regression analysis.The results showed that both the Aspect score(P=0.030,OR,3.106,95% CI,1.116-8.641)and the blinnow classification(P=0.001,0R,0.124,95%CI,0.037-0.423)were related to intravascular treatment of hemorrhagic transformation after acute ischemic stroke and were independent risk factors.(二)Symptomatic hemorrhage group and Non-Symptomatic hemorrhage group1.Umvanate analysis: The number of diabetic patients in the symptomatic bleeding group was 5.0(62.5%).Compared with the control group(1.0,10%),P = 0.043 was different.2.Binary Logistics Regression Analysis: Binary Logistic regression analysis was performed on the factors with significant differences in the above univariate analysis.The results showed that the histoy of diabet(P=0.035,OR,0.067,95%CI,0.005-0.823)was related to the conversion of symptomatic hemorrhage after endovascular treatment of acute ischemic stroke and were an independent risk factor.Conclusions: Offending vessel,preoperative Aspect score and severity of demyelination of white matter were related to hemorrhagic transformation after endovascular treatment.And preoperative Aspect score and severity of demyelination of white matter can predict hemorrhagic transformation.Diabetes is the independent risk factor of symptomatic intracranial hemorrhage.