Evaluation Of The Clinical Effect Of DWI Lesion Volume On Interventional Therapy For Acute Cerebral Infarction

Objective: Diffusion-weighted imaging(DWI)has been widely used as an important imaging test in the hyperacute phase of cerebral infarction.This study aims to analyze the relationship between the DWI lesion volume and the prognosis in patients with acute ischemic stroke(AIS)who treated with endovascular treatment(EVT).To evaluate the role of DWI lesion volume in evaluating the prognosis of patients with AIS.Methods:Retrospectively included 64 patients with AIS who underwent interventional therapy in our hospital from September 2016 to December 2018.All of these patients were treated within 6 hours of onset and preoperative magnetic resonance(MR)confirmed the presence of occlusive large blood vessels of acute anterior circulation.There are 41 cases of direct EVT and 23 cases of bridging treatment(IVT+EVT).Collect 30 patients treated with standard drugs at the same time as a control,These patients were confirmed to have AIS by pre-treatment imaging examination and received aspirin,clopidogrel,and other symptomatic treatments according to the guidelines.differences of clinical prognosis between endovascular treatment and standard drug treatment in patients with AIS were compared.Rapid software measures the volume of DWI infarct volume before treatment.The receiver operator characteristic curve(ROC curve)was used to fit the optimal incision volume of the 90-day clinical outcome of acute cerebral infarction.Patients were divided into two groups with different lesion volumes.The differences in influencing factors and prognosis between patients with different lesion volumes were compared.The relationship between recanalization and clinical prognosis in patients with cerebral infarction with large lesions were studied too.The patient's age,gender,cerebrovascular risk factors,onset to treatment time,baseline and onset 24-hour NIHSS score,3-month m RS score,s ICH,aICH,and deaths were recorded.Quantitative data that conformed to the normal distribution were expressed as mean ± standard deviation(x ±S),and statistical inference was performed using two independent samples t test;if the quantitative data was skewed,the median was used,and the comparison between groups was performed by Mann–Whitney U test.Qualitative data is described by frequency,and statistical inference is based on ?2 or Fisher exact probability method.At P < 0.05,it was statistically significant.Results:Comparison of endovascular treatment with standard drug therapy in patients with AIS showed that the mRS score of EVT patients was better than that of the control group at 90 days(P<0.05).There was no significance difference in statistics in age,gender,cerebrovascular disease risk factors,time from onset to admission,baseline and 24-hour NIHSS.There was no significant difference in s ICH,a ICH and mortality between the two groups(P> 0.05).Sixty-four patients receiving EVT ranged in age from 31 to 77 years,with an average age of 61 years,including 28 women and 36 men.The ROC curve was fitted with a 90-day clinical outcome.The optimal cut-point level of infarct volume was 50.6 ml,the sensitivity was 93.6%,the specificity was 73.7%,and the area under the curve was 0.801.The comparison of the volume of different lesions showed that the difference between the lesion volume <50.6ml group and the ?50.6ml group 90-day mRS score 0-2 points and the admission 24-hour NIHSS score was statistically significant(P<0.05);There were significant differences in the baseline NIHSS scores and vascular occlusion sites between the two groups(P<0.05).There was no significant difference in age,gender,cerebrovascular risk factors,onset to treatment time and recanalization rate(P>0.05).There was no significant difference in the ratio of sICH,aICH and death rate(P>0.05).The proportion of mRS score 0-2 in patients with cerebral infarction who achieved revascularization was not statistically different from that in patients with vascular dysfunction(40% vs.16.7%,P=0.380),but the comparison of the proportion of the two mRS scores of 0-3 points showed that the recanalized patients had a benefit trend compared with the non-vascular recanalization patients(70.0% vs.16.7%,P=0.054).There was a statistically significant difference between the two sICH and mortality(P=0.001).There was no significant difference in the a ICH between the two groups(P>0.05).Conclusion:Patients with AIS after EVT are better than standard medications.Patients with DWI lesion volume <50.6 ml who treated by EVT are more likely to have a good prognosis.Patients with DWI lesion volume ? 50.6 ml should not be excluded from EVT treatment because of their potential benefit.It is feasible to evaluate the clinical efficacy of interventional therapy for acute cerebral infarction by DWI lesion volume,which can provide a reference for us to choose the most suitable patients for interventional therapy.