Mechanical Thrombectomy In The Anterior Circulation Research On Application Effect In Occlusion

Background:As early as in the five major trials published in the New England Journal in 2015,Background: As early as in 2015,the five major trials published by the New England Journal confirmed that mechanical thrombectomy(MT)for intracranial acute large vessel occlusion is safe and effective and is an A / I grade evidence-based treatment for ELVO patients in the anterior circulation.This efficient and rapid reperfusion therapy has greatly improved the functional prognosis of patients with AIS.The test analysis showed that among every 6 ELVO patients receiving MT treatment,more than 3 patients were relieved about 24 hours after the onset of symptoms,and more than 1 patient achieved functional independence at 3 months.In addition,MT has nothing to do with the increase of sICH or the 3-month mortality rate.These observations highlight the safety of mechanical thrombectomy for acute macrovascular ischemic stroke.In a real event,the surgeon 's experience,the progress of materials science,the improvement of imaging,the acceptance of family members,and the improvement of the120 system can all have an impact on their results.Whether its rigorous RCT experiment can reflect the effect of thrombectomy in real events remains to be studied.Purpose: To evaluate the influence of various factors on the prognosis of patients according to the actual situation in the study of real events analyze the difference between regional research and five major experiments in Yan'an.Methods: This article mainly adopted the method of retrospective study,selecting74 patients with acute anterior circulation occlusion in the cardiovascular and cerebrovascular wards of the Affiliated Hospital of Yan'an University from March 2017 to September 20,2017.All patients who come to our hospital will use head CT to distinguish the skull Internal hemorrhage,and at the same time,the patient was given NIHSS score when he came to the hospital.If the patient was at T <6h,ASPECT score ?6 points,NIHSS score ? 6 points,high suspicion of intracranial vascular occlusion,and then CT and give the patient clear CTA Blood vessel,reduce the time from the onset to the recanalization of the blood vessel,immediately open the green channel to the catheter room after the examination,and perform DSA + mechanical thrombectomy.Record the patient's basic conditions,such as age,gender,history of hypertension,diabetes,cardiomyopathy,atrial fibrillation,etc.,and use mTICI grade to record the recanalization of patients after taking DSA and taking DSA;record the patient's immediate postoperative After 7 days,NIHSS score was used to evaluate the effect of thrombectomy.The clinical data of the patients were recorded,including the time from the onset of the patient to the recanalization of the blood vessel,the time from the admission to the recanalization of the blood vessel,the number of thrombectomy,and whether the patients had severe bone edema after the operation.And at 3 months after surgery,follow-up call or outpatient visit,give the patient a mRS score,evaluate the postoperative prognosis of the patient,mRS score of 0-2 points for the patient is defined as a good prognosis,and mRS for the patient is defined as a prognosis of 3-6 points.Bad;analyze the factors that affect the prognosis of the patient;then use multiple factors to gradually analyze the baseline data and clinical data of the patient,with p <0.05 as statistically significant.Results:1.Comparison of clinical data: male patients accounted for 51.35% of the total number(38 cases),females accounted for 48.65% of the total number(36 cases),aged 33-85 years(average 61.15 years old),31 patients with smoking,and alcohol patients 25 cases,30 cases with hypertension,9 cases with diabetes,20 cases with atrial fibrillation,5 cases with dilated heart disease,all patients had a good prognosis rate of47.30%,and a mortality rate of 12.16%;Vascular recanalization time(3.61 ± 1.53 VS4.67 ± 2.38,P = 0.021),reentry to vascular recanalization time(1.17 ± 0.42 VS 1.37 ±0.84,P = 0.229),number of thrombectomy(1.37 ± 0.49 VS 2.03 ± 0.71,P = 0.000),routine surgery for boneless flap: 4(11.43)vs 4(10.26),P = 0.229).2.Comparison of the effects of thrombectomy: the comparison between the good prognosis group and the poor prognosis group before the operation of the NIHSS score(18.97 ± 4.35VS21.15 ± 4.93,P= 0.047),the comparison of the NIHSS score immediately after the operation(9.97 ± 4.03 VS 14.64 ± 6.46 P = 0.000),postoperative 7NIHSS score comparison(4.83 ± 2.82 VS 13.31 ± 8.05,P = 0.482),vascular recanalization(30(85.71%)VS 31(79.49%),P= 0.482).3.Multivariate stepwise regression analysis showed that the patient's TICI grade and NIHSS score at 7 days after surgery,P <0.05,were statistically significant.Conclusion:1.The prognosis of patients with anterior circulation arterial occlusion and thrombectomy in Yanan area is basically the same as the outcome of the five major experiments.2.Preoperative,immediate postoperative,and 7 days postoperative NIHSS score increased,prolonged time from onset to admission,combined with hypertension are risk factors that affect the prognosis of patients with acute circulation occlusion of large vessels before mechanical thrombectomy;less thrombectomy times,TICI A higher score is a protective factor that affects the prognosis of patients with acute occlusion of large vessels before mechanical thrombectomy.3.Mechanical thrombectomy can effectively improve the patient's good prognosis rate and reduce patient mortality.