Study Of Endovascular Therapy For Acute Anterior Circulation Stroke Patients With Large Vessel Occlusion

Background: Mechanical thrombectomy significantly improved the 90 day outcome in acute ischemic stroke(AIS)patients caused due to large vessel occlusion(LVO)in anterior circulation.At present,the degree of recanalization is defined as achieving Modified Thrombolysis In Cerebral Infarction(m TICI)2b/3 for successful surgery.However,it remains controversial regarding whether there are differences between m TICI2 b and 3 in terms of outcome,complications,etc.Purpose: This study aimed to analyze the factors related to outcome in everyday clinical practice and to compare the therapeutic safety and efficacy of m TICI2 b and 3 recanalizations.Methods: This isa single-center retrospective analysis of 145 AIS patients with anterior circulation LVO who underwent mechanical thrombectomy.Univariate and multivariate analyses were performed to determine the risk factors affecting 90-day outcomes.The primary outcomes included a Modified Rankin Score(m RS)of 0–2 at 90 days.Compare the efficacy and safety of m TICI 2b and 3 reperfusions.Results: 145 patients met the inclusion and exclusion criteria.A total of 42 patients achieved m TICI 2b status,86 achieved m TICI3 status and 17 failed to recanalize(m TICI 0,1,2a).The results of univariate analysis showed that poor outcome after endovascular therapy was associated with age,previous history of coronary heart disease/heart failure,atrial fibrillation,hypertension,preoperative elevation of neutrophil granulocyte,elevated levels of fasting plasma glucose,tandem occlusions,high NIHSS(National Institute of Health stroke scale)score on admission/at discharge,general anesthesia,failed to recanalize(m TICI 0,1,2a),pneumonia,hemorrhagic infarction,subarachnoid hemorrhage,symptomatic intracranial hemorrhage and parenchymatous hematoma.High NIHSS score on admission,advanced-aged,tandem occlusionsandaprevious history ofhypertensionwere independentfactors that affected the therapeutic effect.Thecomparison between m TICI2 b and3 reperfusions showed no differences in short-term outcome,90-daym RS,complications and mortality.Conclusion: High NIHSS score on admission,advanced-aged,tandem occlusions anda previous history of hypertension were independent factors that affected the therapeutic effect.Preoperative evaluation of those patients should be more cautious.Prevention of postoperative complications could improve the prognosis of patients Thesuperiority(efficacy and safety)of m TICI 3 reperfusionwas not significant when compared with m TICI 2b reperfusion.Prolonged efforts to achieve m TICI 3 after achieving m TICI 2b should be considered prudently for those with difficulty achieving 100% reperfusion.