| Part one Efficacy and safety of mechanical thrombectomy in different ages with acute ischemic stroke: a meta-analysis Objective To systematically evaluate the safety and effectiveness of mechanical thrombectomy for patients with acute ischemic stroke in different ages.Methods PubMed,EMbase,The Cochrane Library,Web of Science,CNKI,and WanFang Data databases were electronically searched to collect intervention trial about the efficacy and safety of mechanical thrombectomy for patients with acute ischemic stroke in different ages from inception to August,2019.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies,then,meta-analysis was performed by using Stata 12.0 software.Results A total of 13 studies involving 2995 patients were included.The results of meta-analysis showed that compared with the control group,80 years old and over patients had no statistically significant difference in reperfusion success rates(OR=0.90,95%CI 0.71 to 1.14,P=0.378),incidence of symptomatic intracranial hemorrhage(OR=1.30,95%CI 0.86 to 1.94,P=0.212),but had higher incidence of any intracranial bleeding events(OR=1.61,95%CI 1.28 to 2.04,P<0.001),3-month mortality(OR=2.14,95%CI 1.73 to 2.64,P<0.001)and lower good functional prognosis rate at 3 months(OR=0.46,95%CI 0.30 to 0.71,P<0.001).Conclusion Current evidence suggests that people aged 80 and above can obtain effective perfusion through mechanical thrombectomy,but the incidence of postoperative adverse outcome events is higher and the prognosis is relatively poor.Due to limited quality and quantity of the included studies,more high-quality studies are needed to verify above conclusion.Part two Establishment and verification of a nomogram for non-cardiac ischemic stroke recurrence risk within 3 yearsObjective To find out independent risk factors for recurrence of non-cardiac ischemic stroke within 3 years,establish and validate a nomogram prediction model.Methods The clinical datas of 182 non-cardiac ischemic stroke inpatients from January 2015 to June 2016 in the Department of Neurology of the Second Hospital of Lanzhou University were retrospectively analyzed.Non-cardiac ischemic stroke was screened using Cox regression analysis.Independent risk factors for relapse within 3 years.Then,a collinear prediction chart model was established for the selected independent risk factors,and the discrimination,accuracy and clinical validity of the model were verified internally.Results Cox regression analysis of basic clinical information,hematology and imaging related datas by the two groups of patients showed that smoking(HR=3.13,95%CI : 1.53 ~ 6.41),diabetes(HR=2.80,95%CI : 1.19 ~ 6.63),hyperhomocysteinemia(HR=2.25,95%CI : 1.10 ~ 4.61),severe leukoaraiosis(HR=3.51,95%CI : 1.23 ~ 10.02)were non-cardiogenic ischemic independent risk factors for relapse within 3 years of stroke(P <0.05).Based on the above mentioned 4 independent risk factors for recurrence,a nomogram model was established to predict the recurrence of non-cardiac ischemic stroke within 3 years.The internal verification results of the nomogram model showed that the C-index was 0.76(95% CI: 0.68 to 0.84),and the area under the ROC curve(AUC)was 0.79,witnessed that the model had a good discrimination ability.In addition,the calibration curve suggested a better consistency between the model's predicted recurrence rate and the patient's actual recurrence rate.Conclusion This study shows that smoking,diabetes,hyperhomocysteinemia,and severe leukoaraiosis are independent risk factors for recurrence in non-cardiac ischemic stroke patients within 3 years.The nomogram prediction model is established based on this has good discrimination and calibration,and can improve the predictive power of non-cardiac ischemic stroke patients within 3 years to a certain extent. |
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