| Objective We use the transcranial doppler ultrasound to monitor the blood flow velocity of the operative side middle cerebral artery of the acute anterior circulation ischemic stroke patients with successful recanalization after mechanical thrombectomy.To analysis the influence of the middle cerebral artery blood flow velocity on clinical prognosis,postoperative neurological function recovery and postoperative intracranial hemorrhage.Methods From March 2018 to December 2019,45 patients with acute ischemic stroke caused by anterior circulation artery occlusion were diagnosed by neurologists in the Inner Mongolia people's Hospital.1.All patients underwent mechanical thrombectomy at the therapeutic time window,and the postoperative digital subtraction angiography showed revascularization.2.TCD was used to monitor the blood flow velocity of the middle cerebral artery in the operation side after mechanical thrombectomy.According to the peak systolic velocity(PSV)of the middle cerebral artery in the operation side,the patients with middle cerebral artery PSV>140cm/s were divided into high blood flow velocity group,and patients with PSV?140cm/s as normal blood flow velocity group.3.Record the baseline data(gender,age,smoking,alcohol consumption,hypertension,diabetes,coronary disease,atrialfibrillation,hyperlipidemia,stroke or TIA,hyperhomocysteinemia)and the clinical data(blood pressure before and after mechanical thrombectomy,occlusive vessels,onset-to-puncture time,onset-to-reperfusion time,the time from revascularization to TCD examination),the situation of mechanical thrombectomy(m TICI classification,times of thrombectomy,whether the stent was used,thrombolysis,and results of 24 h postoperative CT),and compared the differences between the two groups.4.The neural function of the two groups before and 24 hours after mechanical thrombectomy was evaluated by NIHSS,The recovery of neurological function was evaluated by modified Rankin score(m RS)after mechanical thrombectomy for 3 months,and compared the differences between the two groups.The improvement of neurological function,deterioration of neurological function,good prognosis and death of 90 days after mechanical thrombectomy were recorded,and compared the differences between the two groups.Results A total of 45 cases were collected,all of cases were followed up 90 days after mechanical thrombectomy.1.The good prognosis rate was 53.33%,and the Symptom improvement rate was 64.44%.2.Hyperlipidemia accounted for 50% in the high blood flow velocity group and 17.24% in the normal blood flow velocity group,and the difference between groups was statistically significant,P<0.05.3.Diabetes accounted for 43.75% in the high blood flow velocity group and 13.79% in the normal blood flow velocity group,the difference between groups was statistically significant,P<0.05.4.The systolic blood pressure was 139.00 ± 17.500 mm Hg in the high blood flow velocity group and 125.31± 19.718 mmhg in the normal blood flow velocity group,with statistical significance,P<0.05.5.The postoperative intracranial hemorrhage was 43.75% in the high blood flow velocity group and 13.79% in the normal blood flow velocity group,with statistical significance,P<0.05.6.The score of 24 h NIHSS after mechanical thrombectomy was 15.62 ± 4.801 in the high blood flow velocity group,11.76±4.771 in the normal blood flow velocity group,P<0.05.Difference of NIHSS between preoperative and postoperative 24 hours in high blood flow velocity group was 3.94 ± 5.053,and 7.76 ± 5.132 in normal blood flow velocity group,P<0.05.The m RS score 3.06±1.482 after 90 days in the high blood flow velocity group was statistically significant compared with the m RS score 1.97±1.401 after 90 days in the normal blood flow velocity group,P<0.05.7.The proportion of symptom improvement cases in high blood flow velocity group was43.75%,75.86% in normal blood flow velocity group,with statistical significance,P<0.05.The rate of good prognosis was 31.25% in the high blood flow velocity group and 65.52% in the normal blood flow velocity group,the difference between the two groups was statistically significant,P<0.05.Conclusion1.TCD is an effective bedside method for monitoring cerebral hemodynamics after mechanical thrombectomy.2.Diabetes,hyperlipidemia and high systolic blood pressure after mechanical thrombectomy are possible risk factors for increased blood flow velocity in the middle cerebral artery after mechanical thrombectomy.3.After successful recanalization with mechanical thrombectomy for anterior circulation acute ischemic stroke,higher operative side middle cerebral artery blood flow velocity may indicate an increased risk of poor neurological recovery,intracranial hemorrhage and poor prognosis in 90 days after operation. |
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