Long-term Outcome And Influencing Factors After Mechanical Thrombectomy For Acute Anterior Circulation Large Vessel Occlusion

Objective:To investigate the long-term outcome of endovascular mechanical thrombectomy in patients with ischemic anterior circulation stroke caused by acute extra/intra-cranial large vessel occlusion and the influence factor of prognosis.Methods:From January 2012 to June 2019,all consecutive patients with anterior circulation stroke due to acute large vessel occlusion treated with endovascular mechanical thrombectomy at the Department of Neuro-interventional Radiology,the First Affiliated Hospital of Zhengzhou University were retrospectively reviewed.The short term(90 day follow-up)outcome and mild-long(at least 6 months)term outcome were evaluated by using the m RS scores.The m RS 0-2 score was defined as good outcome and 3-6 scores as poor outcome.The baseline characteristics,clinical and imagining data of patients with good and poor outcome were compared,and the related factors affecting outcome were analyzed by multivariate logistic regression analysis.According to the patient’s neurological symptoms,brain imaging results andauxiliary diagnosis results,patients with large-artery atherosclerosis(large-artery atherosclerosis,LAA)and cardiogenic embolism(Cardioembolism,CE)were selected,and the clinical and imaging data between them were analyzed to assess whether they had different effects on long-term efficacy and prognosis.Results:A total of 234 patients were included in this study.Among them,successful recanalization(m TICI ≥ 2b)was achieved in 199 patients(85%),17 patients(7.3%)developed symptomatic intracranial hemorrhage after procedure,106 patients(45.3%)had good outcome at 90 days,and 128 patients(54.7%)had good outcome at the medium and long term follow-up(median follow-up 11 months,IQR 8-15 months).Diabetes(OR=0.38;95%CI:0.16-0.91,p=0.029),baseline NIHSS(OR=1.29;95%CI : 1.18-1.42,p < 0.001)and procedure time(OR=1.01;95%CI :1.00-1.02,p=0.020)were associated with short term poor outcome,while seccessful reperfusion(OR=0.27;95%CI : 0.09-0.78,p=0.016)was protective factor.Age(OR=1.05,95%CI:1.02-1.08,p=0.003),baseline NIHSS(OR=1.17;95%CI:1.05-1.31,p=0.003),and onset to groin puncture time(OR=1.00,95%CI:1.00-1.01,p=0.008)were independent risk factors for mild-long term poor outcome.Sex,bridging therapy,anesthesia,location occlusion,stroke etiology,and permanent stent placement were unrelated with short term and mild-long term outcome.There was no significant difference between large-artery atherosclerosis(LAA)and cardioembolic(CE)in both short and mild-long term prognosis(p = 0.286,0.345,respectively).Conclusion:AIS patients can achieve favorable long-term outcomes post-ET.Old age,higher baseline NIHSS scores and long time from onset to groin puncture are independently associated with unfavorable outcome.