| Objective Mechanical thrombectomy(MT)is an innovative micro-interventional procedure for recanalization of vascular occlusion.With the innovation of the thrombectomy device and the improvement of technology,MT has become an effective recanalization method for acute ischemic stroke(AIS)caused by large vessel occlusion.However,there are few studies on the influence of MT treatment on the prognosis of patients with AIS at home and abroad.Therefore,this paper aims to analyze the related factors of prognosis of patients in AIS with MT,and provide theoretical basis for clinical treatment.Methods 91 patients with AIS(also known as acute cerebral infarction,ACI)treated by MT were collected from the First Affiliated Hospital of Jinan University(July 2013 to April 2018).A standardized questionnaire was used to record the admission of patients,including basic information,current medical history,past history,personal history and auxiliary examination data.According to the modified Rankin Scale(mRs)scoring criteria,the patients were divided into a good prognosis group and a poor prognosis group;according to the survival of the hospital,it is divided into the death in-hospital group and the survival group.The clinical data of the two groups were compared respectively and univariate and multivariate logistic regression analysis was performed.To evaluate the impact of the National Institute of Health Stroke Scale(NIHSS)score on the prognosis of patients in ACI with MT using the receiver operating curve(ROC).Using the Kaplan-Merier method,it was concluded that there were differences in the in-hospital survival rate of different levels of NIHSS score at admission in patients with MT.Results(1)The good prognosis had 29 cases,accounting for 31.9%,and the poor prognosis had 62 cases,accounting for 62.1%.There were 16 cases of deaths,accounting for 17.6%,88 cases of revascularization(mTICI 2b~3),accounting for 96.7%,32 cases of hemorrhagic transformation,accounting for 35.2%,and 10 cases of symptomatic intracerebral hemorrhage,accounting for11.0%.Cardiac embolism was the main etiology,accounting for 46.2%.The anterior circulation was the main occlusion site,accounting for 70.3%.(2)The good prognosis group was compared with the poor prognosis group,univariate analysis showed age,diabetes,hypertension,hemorrhagic transformation,white blood cell,neutrophil count,and neutrophil to lymphocyte ratio(NLR)between the two groups was statistically significant(P<0.05).Multivariate logistic regression analysis showed history of diabetes(P=0.014),NIHSS score at admission(P=0.007)and hemorrhagic transformation(P=0.028)is an independent risk factor for poor prognosis of patients in ACI with MT.(3)Compared with the survival group,the univariate analysis showed that age,etiology type,hemorrhagic transformation,recanalization,NIHSS score at admission,triglyceride and uric acid were significantly different(P<0.05).Multivariate logistic regression analysis showed that NIHSS score at admission(P=0.003)and hemorrhagic transformation(P=0.029)were independent risk factors for predicting death in patients in ACI with MT.(4)The optimal cut-off value of NIHSS score for predicting the prognosis of patients in ACI with MT was 15.18,the area under the ROC curve was 0.766(95%CI 0.665~0.866),with a specificity of 82.8%,and a sensitivity of 61.3.%.The optimal cut-off value of NIHSS score for predicting the death of patients in ACI with MT was 18.37,the area under the ROC curve was0.833(95%CI 0.722~0.944),with a specificity of 82.7%,and a sensitivity of75.0%.Kaplan-Merier method results suggest that there was a difference in the cumulative survival rate of patients with NIHSS scores at admission > 18.37 and ? 18.37(Log Rank=0.000).Conclusion(1)Diabetes were independent risk factors for poor prognosis in patients in ACI with MT.NIHSS score at admission and hemorrhagic transformation were independent risk factors for death in patients in ACI with MT.(2)At the time of NIHSS score at admission >15.18,patients with MT were more likely to have a poor prognosis;patients with MT had a higher risk of death when it was>18.37. |
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