| Background and purpose:Stroke is one of the main diseases causing disability and death in the worldwide.In China,stroke is also the most important cause of disability and death,among which ischemic stroke accounts for 70%-80%.How to effectively treat the acute phase of ischemic stroke has become the focus of global attention.Intracranial and extracranial vascular occlusion is the main cause of ischemic stroke.It is the most direct and effective method to early recanalize occlusive vessels as soon as possible to restore blood flow perfusion.A number of clinical studies have confirmed that endovascular treatment,represented by mechanical thrombectomy,can benefit patients with acute anterior circulation large vessel occlusion.The recanalization rate is 59%-88%,but the good neurological prognosis is about 46%.The difference between vascular recanalization rate and clinical prognosis can be attributed to factors such as ischemic reperfusion injury,age,moderate to severe stroke,surgical complications,and delayed vascular recanalization.Ischemia reperfusion injury may be one of the most critical factors.Statins have the effects of anti-oxidative stress,protection of endothelial function,inhibition of inflammatory response,anti-thrombosis,etc.Fundamental research has found that statins can reduce cerebral ischemia-reperfusion injury,and clinical studies have also found that early statin therapy can improve clinical prognosis in the the acute phase of ischemic stroke.At present,it is still unclear whether early statin therapy can improve the functional prognosis of patients with endovascular treatment in acute anterior circulation large vessel occlusive stroke.There are only a few single-center,small-sample studies with low levels of evidence and controversial results.Therefore,this multi-center study aims to analyze the safety and efficacy of early statins use for patients with endovascular treatment in acute anterior circulation large vessel occlusive stroke.Methods:Between August 2013 to May 2018,patients with endovascular treatment and acute anterior circulation occlusive stroke were retrospectively analyzed in the Second Affiliated Hospital of the PLA Military Medical University and 7 other comprehensive stroke centers or national advanced stroke centers.According to whether they were received early statin therapy,the patients were divided into statin group(200 cases)and non-statin group(47 cases).After 1∶1 matching in the propensity matching analysis according to the closest matching method,each group enrolled 43 patients.Baseline data of the two groups of patients before and after the propensity score matching were analyzed and compared..The main efficacy indicators was 90 d mRS score,with neurological improvement and neurological deterioration as secondary efficacy indicators,symptomatic intracranial hemorrhage and 90-day mortality as safety indicators,and multivariate logistic regression analysis was used to identify the relevant factors affecting the neurological prognosis of patients with endovascular treatment in acute anterior circulation large vessel occlusive stroke.Results:1.Comparison of baseline data between the two groups before and after propensity matching: Before the propensity matching,the statin group were higher than the non-statin group in the propotion of diabetes(20.0% VS 4.3%;P = 0.010)and low density lipoprotein(2.53 ± 0.88 VS 2.18 ± 0.68;P = 0.017),and OTD(120(60,198)VS 90(33,141);P = 0.025),OTP(263(188,345)VS 208(155,271));P = 0.005)and OTR(360(274,445)VS 309(248,397);P = 0.032)time were longer than the non-statin group,however the rate of intravenous thrombolysis(36.0% VS 57.4%;P = 0.007)and baseline NIHSS score(13(10,16)VS 17(13,21);P <0.001)were lower than the non-statin group.After propensity matching,baseline data between the two groups were not significantly different(P> 0.05).2.Comparison of the efficacy of the two groups after propensity matching: Compared with the non-statin group,the statin group had a higher rate of 90-day mRS score of 0 to 2(58.1% VS 34.9%;P = 0.031)and neurological improvement(72.1% VS 42.9%;P = 0.006),and a lower rate of neurological deterioration(9.3% VS 28.6%;P = 0.023).3.Comparison of safety between the two groups after propensity matching: the incidence of symptomatic intracranial hemorrhage between the statin group and the non-statin group were not significantly different(14.0% VS 20.9%;P = 0.394).However,the 90-day mortality was lower in the statin group than in the non-statin group(7.0% vs 25.6%;P = 0.019).4.Univariate and multivariate analysis of patients with different neurological prognosis: age,baseline NIHSS score,collateral circulation,ASPECTs,and early statin therapy are all factors that affect the neurological prognosis of patients with endovascular treatment in acute anterior circulation large vessel occlusive stroke(Both P <0.05).The propensity score,age,collateral circulation,early statin thearpy,and baseline NIHSS score were included in the multivariate analysis.Collateral circulation(corrected OR: 5.562;P = 0.001),early statin thearpy(corrected OR: 3.350;P = 0.022)are independent predictors of good neurological outcome in patients with endovascular treatment in acute anterior circulation large vessel occlusive stroke.Conclusions:For patients with acute anterior circulation large vessel occlusive stroke undergoing endovascular therapy,statin therapy has a correlation with good neurological prognosis,and has good safety.Multivariate regression analysis showed that early statin therapy is an independent protective factor affecting the neurological prognosis of these patients. |
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