| Research purpose:To investigate the therapeutic effects of bridging therapy and direct mechanical thrombectomy for acute posterior circulation artery occlusion and the main factors affecting the prognosis of the disease 90 days after operation.Research methods:From January 2017 to October 2019,55 patients with acute posterior circulation artery occlusion confirmed by cerebral arteriography(DSA)and treated with intravascular therapy were retrospectively collected from the National Advanced Stroke Center of our hospital.Among them,2 patients failed to open blood vessels and 53 patients were successfully opened.Fifty-three patients who were successfully opened were divided into groups according to whether intravenous thrombolysis was performed or not,including 22 patients in bridging therapy)22 group and 31 patients in direct mechanical thrombectomy group.Statistical analysis was made on the efficacy of the two therapies.According to the mRS score of 90 days after operation,the patients were divided into two groups: good recovery group(mRS score?2 points)and poor recovery group(mRS score?3 points),and the related factors affecting the clinical prognosis of the two groups were analyzed.The gender,age,past medical history(coronary heart disease,stroke,diabetes,hypertension,atrial fibrillation),smoking history,drinking history,admission blood pressure,serum glycosylated hemoglobin(Hb),homocysteine(Hcy),uric acid(UA),low density lipoprotein(LDL-L),platelet count(PLT),creatinine,fasting blood glucose,preoperative ASPECTS score were collected.NIHSS score before and NIHSS score immediately after operation,collateral circulation opening degree(Batman score),occlusion site(basilar artery,vertebral artery or posterior cerebral artery),anesthesia method,embolectomy times,GPIIb/IIIa receptor antagonist usage,postoperative mTICI classification,symptomatic intracranial hemorrhage(SICH),balloon dilatation or stent implantation,onset time to hospital,time to hospital to femoral artery puncture,Baseline and clinical data of onset to femoral artery puncture(time window),femoralartery puncture to recanalization,hospital to recanalization,onset to recanalization,post-stroke associated pneumonia,post-stroke lower limb venous thrombosis,etc.;Single factor analysis was used to analyze the differences between the above two groups of patients with different classification standards.Logistics regression was used to analyze the main factors affecting the clinical prognosis of patients with acute posterior circulation artery occlusion after endovascular treatment.Research results:1.55 patients with posterior circulation acute posterior circulation artery occlusion,including 10 females and 43 males,with an average age of(59.89 9.43)years,2 patients(3.64%)who were not opened died,and 53 patients(96.36%)were opened.Among the 53 patients who were successfully opened,the shortest time window was 1.5 hours,the longest was 22 hours,and the number of times of embolectomy was 1(1,2).46 cases(86.79%)had successful reperfusion(M TICI ?2B),27 cases(50.94%)had good recovery 90 days after discharge,12 cases(22.64%)had symptomatic intracranial hemorrhage(SICH),of which 8 cases died,11 cases(20.75%)had post-stroke associated pneumonia,7 cases(13.21%)had post-stroke lower limb venous thrombosis,and 19 cases(35.85%)died 90 days after discharge.2.The NIHSS score(14.55 ± 9.68)immediately after operation,successful reperfusion in 20 cases(90.91%),SICH in 4 cases(18.18%),stroke-related pneumonia in 2 cases(9.09%),lower limb venous thrombosis after stroke in 2 cases(9.09%),good recovery in 13 cases(59.09%)at 90 days,and death in 7 cases(31.82%)at 90 days in bridging treatment group.TheNIHSS score(15.67±10.63)immediately after operation in the direct mechanical thrombectomy group,26 cases(83.87%)of successful reperfusion,8 cases(25.81%)of sich,9 cases(29.03%)of stroke-related pneumonia,5 cases(16.13%)of post-stroke lower limb venous thrombosis,14 cases(45.16%)of good recovery after 90 days,and 12 cases(38.70%)of death after 90 days were not statistically different between the above two groups(p > 0.05).However,the number of thrombectomy was significantly different between bridging treatment group 1(1,1)and direct mechanical thrombectomy group 1(1,2)(p =0.001).However,in terms of age,sex,past history(coronary heart disease,stroke,diabetes,hypertension,atrial fibrillation),smoking history,drinking history,blood pressure(systolic and diastolic pressure),LDL,Hcy,Hb,UA,PLT,creatinine,fasting blood glucose,collateral circulation openness(BATMAN score),preoperative ASPECTS score,preoperative NIHSS score,occlusion site,anesthesia mode,GPIIb/ IIIa receptor antagonist,in-situ stenosis,balloon dilatation or stent implantation,time from onset to hospital,time from hospital to femoral artery puncture,time from onset to femoral artery puncture,time from femoral artery puncture to recanalization,time from hospital to recanalization,etc.(P > 0.05).3.Compared with the group with poor recovery,the group with good recovery has statistically significant results: age(57.03±9.65 VS 62.85±8.38)years old p=0.023,preoperative ASPECTS score(8.63±1.64 VS 7.65±1.50)points p=0.028,The collateral circulation,BATMAN score(7.48±1.97 VS 5.07±1.74)p < 0.001,NIHSS score(7.81 5.56 vs 22.89 7.91)immediately after operationp < 0.001,sich(2 cases(7.41%)VS10 cases(38.46%)] p = 0.018,times of embolectomy [1(1,1)vs 1.5(1,2)]p = 0.011.4.multivariate Logistic regression analysis showed that the OR values of NIHSS score immediately after operation,BATMAN score and SICH were 0.791,1.696 and 0.059 respectively,and 95%CI were 0.688 ~ 0.910,1.079 ~ 2.666 and0.004 ~ 0.981 respectively,all p < 0.05.1.Research conclusion:1.Bridging therapy or direct mechanical thrombectomy is safe and effective for acute posterior circulation arterial occlusive stroke,and there is no obvious difference in curative effect between the two methods,but bridging therapy can significantly reduce thrombectomy times.2.The degree of collateral circulation opening(Batman score),NIHSS score 24 hours after operation and presence or absence of SICH are the main factors affecting the prognosis of endovascular treatment for acute posterior circulation arterial occlusion. |
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