Outcomes Of Endovascular Treatment In Acute Stroke:Cardioembolism Versus Large Artery Atherosclerosis

BackgroundWith the publication of five randomized trials in 2015,the treatment of acute ischemic stroke(AIS)has changed dramatically.Compared with traditional thrombolytic therapy for patients with acute cerebral infarction,Endovascular treatment in the acute phase greatly improves the occlusion rate of occluded vessels and significantly improves the clinical prognosis of patients.Therefore,it is increasingly used in clinical treatment.However,compared with foreign patients,the cause of stroke is mainly cardiogenic embolism.There are more patients with atherosclerotic stenosis in the Chinese population.This different cause may lead to differences in clinical symptoms,imaging characteristics,treatment methods and clinical efficiency in patients with acute stroke.This study retrospectively analyzed the clinical data of patients with AIS caused by large vessel occlusion(LVO)in the anterior circulation of our center,and compared the difference in the efficacy of endovascular treatment.ObjectiveTo investigate the efficacy and safety of endovascular treatment in patients with ischemic stroke due to cardioembolism(CE)and large artery atherosclerosis(LAA).MethodsA retrospective analysis of clinical data of stroke patients with acute anterior circulation aortic occlusion who received endovascular treatment through the stroke green channel of Southern Hospital of Southern Medical University from August 2017 to November 2019.A total of 156 stroke patients were divided into 89 cases in the CE group and 67 cases in the LAA group according to the modified TOAST etiology classification.The basic data,cerebral collateral circulation,vascular recanalization rate,number of thrombectomy,vascular puncture to recanalization time,incidence of symptomatic intracranial hemorrhage(sICH)and 90-day neurological score were compared between the two groups.According to the modified Rankin scale score at 90 days,mRS=0?2 points were defined as the good prognosis group,and mRS=3?6 points were defined as the poor prognosis group.Logistic regression analysis was used to analyze the clinical data of the two groups to determine independent predictors of functional independence at 90 days and sICH in 72 hours.Result(1)The overall good vascular recanalization rate of patients treated with endovascular therapy in the two groups was 82.1%,and the incidence of symptomatic cerebral hemorrhage was 17.9%.At 90 days,66 patients had a good efficacy(42.3%),and 90 patients had a poor efficacy(57.7%),with a mortality rate of 23.1%.(2)The age,atrial fibrillation,and baseline NIHSS scores of the CE group were higher than those of the LAA group,and the differences were statistically significant(P<0.05);the LAA group had a longer vascular puncture to recanalization time than the CE group,and the rate of good collateral circulation was higher(69.7%vs 33.3%P<0.001).the 90-day good prognosis rate in the CE group was significantly lower than that in the LAA group(31.5%vs 56.7%P=0.002),however,There were no significant differences between the two groups in terms of the vascular recanalization rate,sICH incidence in 72h and mortality rate between the two groups(83.1%vs 82.1%;20.2%vs 14.9%;25.8%vs 19.4%).(3)Multivariate Logistic regression analysis of functional independence at 90 days showed that older age and higher baseline NIHSS score were associated with poor prognosis,and good collateral circulation and LAA etiology classification were independently associated with good prognosis;Multivariate regression analysis of sICH in 72h showed that the higher baseline NIHSS score was independently related to the incidence of sICH,while good collateral circulation was an independent protective factor,and there was no significant correlation between age and the occurrence of sICH(P>0.05).ConclusionThe clinical data of patients with ischemic stroke caused by cardiogenic(CE)and atherosclerotic(LAA)were different.There was no significant difference in the overall vascular patency rate,sICH incidence in 72h and mortality between the two groups,but the functional independence at 90 days in the CE group was worse than that in the LAA group,which may be related to the older patients,higher baseline NIHSS score and poor collateral circulation.