| Part 1 Clinical study on mechanical thrombectomy guided by tissue window for acute ischemic stroke with large vessel occlusion of anterior circulation by atrial fibrillationObjective:To investigate the clinical significance of tissue window in the treatment for acute ischemic stroke with large vessel occlusion of anterior circulation by atrial fibrillation Methods:This was a retrospective review of 55 patients with acute anterior circulatorylarge vessel occlusion by atrial fibrillation treated with mechanical thrombectomy admitted to the intervention department or neurology department,the first affiliated hospital of Soochow University from March 2017 to July 2019.Patients with infarct core volume<70 ml and a total hypoperfused volume:core volume ratio of>1.8,were selected with tissue window tools by CT perfusion(CTP)and MIStar software.The age,sex,risk factors(hypertension,diabetes,history of smoking,hyperlipidemia),baseline National Institutes of Health Stroke Scale(NIHSS)score,Alberta Stroke Program Early CT Score(Aspects),intravenous thrombolysis,passes,time information(onset time,operative time,vascular recanalization time,etc.),vascular recanalization,symptomatic hemorrhage transformation(sHT),3 months mRS score,were recorded.The patients were divided into good prognosis group and poor prognosis group according to the prognosis of 3 months,the baseline data of the two groups was compared.And the factors that could affect the good function prognosis were included in the univariate analysis and multivariate analysis to find out the independent predictor of the good function prognosis.Results:Among all 55 cases in this series,23 men,32 women,the age 68.7±10.1 year,27 patients were treated with mechanical thrombectomy by stent-retriever(SR),21 patients were treated with mechanical thrombectomy by aspiration catheter and stent-retriever(ASR),and 7 patients were treated with aspiration catheter aspiration.After mechanical thrombectomy,successfully recanalization[modified Thrombolysis in Cerebral Infarction(mTICI)score of 2b or 3]was achieved in 87.3%(48/55)of the patients,54 patients achieved successfully recanalization mTICI?2b with rescuing stent placement in 6 patients finally.Good outcome mRS ?2 at 3 months was reported in 58.2%(32/55)of the cases,mortality rate was 16.4%(9/55),symptomatic hemorrhage was reported in 23.6%(13/55).There was a significant difference in the NIHSS score and the ration of symptomatic hemorrhage between the good prognosis group and poor prognosis group.In the multivariate analysis,NIHSS score(OR 0.82,95%CI 0.70?0.96;P=0.012),symptomatic hemorrhage(OR 0.10,95%CI 0.02?0.67;P=0.018),were independent predictors of not good outcome.Conclusion:The prognosis of ischemic stroke with large vessel occlusion of anterior circulation by atrial fibrillation through tissue window was encouraging,NIHSS score and sHT were independent predictors of poor outcome.Part 2 Effect of endovascular stent retriever vs aspiration with stent retriever on revascularization for acute ischemic stroke with large vessel occlusion of anterior circulation by atrial fibrillation.Objective:To investigate the difference of stent-retriever(SR)for thrombectomy versus aspiration catheter and stent-retriever(ASR)for recanalization in acute ischemic stroke by atrial fibrillation.Methods:This was a retrospective review of 48 patients with acute anterior circulatory large vessel occlusion by atrial fibrillation treated with mechanical thrombectomy admitted to the intervention department or neurology department,the first affiliated hospital of Soochow University from March 2017 to July 2019.According to the different thrombectomy methods,the patients were divided into SR group and ASR group.The age,sex,risk factors(hypertension,diabetes,history of smoking,hyperlipidemia),baseline National Institutes of Health Stroke Scale(NIHSS)score,Alberta Stroke Program Early CT Score(Aspects),intravenous thrombolysis,passes,time information(onset to puncture time,onset to vascular recanalization time),efficiency index of vascular recanalization(mTICI,passes,operative time),safety end point(symptomatic hemorrhage transformation,mortality rate),embolic escape,3 months mRS score,were recorded.The efficiency index of vascular recanalization,the ratio of good function prognosis and safety end point were compared between the two groups.Results:Among all 48 cases of in this series,21 men,27 women,the age 69.5±9.6 year.27 patients were assigned to the SR group and 21 patients to the AS group,and there was no significant difference in baseline data between the two groups.After mechanical thrombectomy,successfully recanalization[modified Thrombolysis in Cerebral Infarction(mTICI)score of 2b or 3]was achieved in 85.2%(23/27)of the SR group,4 patients achieved successfully recanalization with rescuing stent placement finally.mTICI score of 2b or 3 was achieved in 90.5%(19/21)of the ASR group,2 patients achieved successfully recanalization with rescuing stent placement finally.The operative time,passes in SR group and ASR groups:81.5±45.3 vs 91,6±49.6?2.0±1.1 vs 1.2±0.8.Good outcome mRS?2 at 3 months was 51.2%(14/27)in SR group?57.1%(12/21)in ASR group.The ratio of sHT was 25.9%(7/27)in SR group,19.0%(4/21)in ASR group.The ratio of mortality was 18.5%(5/27))in SR group,14.3%(3/21)in ASR group.However,there was no significant difference in the efficiency of vascular recanalization,3 months mRS?2 points,and the incidence of safety events between the two groups,P>0.05.The list price of the SR group and the ASR group(ten thousand):7.8±0.6 vs9.8±2.9,P=0.002.And the difference was statistically significant.Conclusion:The results of SR for thrombectomy and ASR for recanalization are similar in acute ischemic stroke by atrial fibrillation,but the first one is more cost-effective... |
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