Effects Of Multiple Thrombus Removal On Symptomatic Intracranial Hemorrhage After Thrombectomy In Acute Large Vessels Occlusive Stroke

Objective : The purpose of this study is to explore the effects of multiple thrombus removal on symptomatic Intracranial Hemorrhage after thrombectomy in acute large vessels occlusive stroke.Methods : From May 2018 to November 2019,the patients were admitted to the Department of Neurology,the Fourth Affiliated Hospital of China Medical University.The patients was diagnosed as acute cerebral infarcion,and large vessels occlusion(LVO)was indicated by Digital Substraction Angiography(DSA),a total of 75 patients were included.According to the presence of SICH,the patients were divided into SICH(symptomatic intracerebral hemorrhage)group of 13 cases and nSICH(non-symptomatic intracerebral hemorrhage)group of 62 cases.Records of two groups of patients with gender,age,history of smoking and drinking,history of previous stroke,history of hypertension,diabetes,atrial fibrillation,onset to admission time,time from onset to groin puncture(OTP),puncture to recanalization(PTR),admission systolic and diastolic blood pressure,preoperative NIHSS score,immediate postoperative NIHSS score(NIHSS score scale see appendix),number of stent retriever passes,site of large vessels occlusion(internal carotid artery,middle cerebral artery,anterior cerebral artery,vertebral artery and basilar artery),tandem occusions,combined venous thrombolysis(rt-PA),application of antiplatelet drugs before admission(single or double),application of anticoagulant drugs before admission(warfarin or new oral anticoagulants),recanalization,etc.As the same time,according to the number of stent retriever passes,the patients were divided into multiple thrombectomy group(more than 3 times)and routine thrombectomy group(less than 3 times),and record the above information.SPSS23.0 software was used for statistical processing to compare the above indicators between the two groups.The quantitative data were analyzed by T test,and the counting data were analyzed by chi-square test.The factors with statistical difference were included in binary logistic regression to further analyze the effect of multiple thrombus removal on symptomatic Intracranial Hemorrhage after thrombectomy in acute large vessels occlusive stroke(P<0.05).Results:1.Compared with SICH group,nSICH group had significantly shorter PTR(112.54±40.296 vs 71.31±29.226,P=0.000),significantly lower immediate postoperative NIHSS score(27.31±7.920 vs 10.90±8.792,P=0.000),significantly lower rate of multiple thrombus removal(61.5% vs 12.9%,P=0.000)and application of antiplatelet drugs before admission(61.5% vs 35.5%,P=0.042).Compared with the multiple thrombectomy group,routine thrombectomy group had significantly shorter PTR(105.63±37.188 vs71.085±30.541,P=0.000).2.Multiple Logistic regression analysis: immediate postoperative NIHSS score(OR =0.836,P = 0.003)and multiple thrombus removal(OR = 8.850,P = 0.037)were risk factors affecting SICH.3.Correlation analysis suggested that PTR had a significant positive correlation with the number of stent retriever passes.Conclusion:1.Higher immediate postoperative NIHSS score and multiple thrombus removal indicated the increased risk of SICH after mechanical thrombotomy.2.The number of stent retriever passes has a significant influence on PTR,the PTR time prolongs correspondingly with the increase of the number of stent retriever passes.