Observation And Analysis Of Endovascular Treatment For Acute Ischemic Stroke Caused By Atherosclerosis-induced Large Artery Occlusion In Anterior Circulation

Background:Acute ischemic stroke（AIS）has become the first cause of death and disability in adults in China and the morbidity of AIS still has a growing trend^[1].A number of studies have shown that endovascular treatment（EVT）can effectively improve the recanalization rate and prognosis of patients.However,most of all the studies were conducted in western people.For Chinese patients,the most common type of AIS is large artery atherosclerosis,which means poor vascular basis and a higher risk of intracranial hemorrhage.While,there is few large-scale clinical study of EVT for AIS caused by atherosclerosis-induced large artery occlusion（LVO）in China at present.Objective:（1）To evaluate the efficacy and safety of endovascular treatment for AIS caused by atherosclerosis-induced LVO in anterior circulation;（2）to explore the relationship between the time of endovascular treatment and the prognosis of AIS patients caused by atherosclerosis-induced LVO in anterior circulation.Methods:The clinical data of 164 patients from January 2019 to October 2020 were analyzed.Among them,80 patients had adopted EVT for AIS that caused by acute anterior circulation occlusion.The remaining 66 patients without intravenous thrombolysis and endovascular treatment were selected as the standard medical treatment group.Specifically,（1）the patients in the two groups were followed up in30th day and 90th days after enrollment.The time from onset to admission,recanalization and prognosis of the two groups were analyzed.The NIHSS score（baseline,24 hours after treatment,7th days after treatment and 30th days after treatment）was assessed to evaluate the changes of nerve defect degree in the two groups,and compare the treatment efficacy,the incidence of intracranial hemorrhage,mortality and prognosis of the two groups to explore the effectiveness and safety of intravascular therapy.（2）the NIHSS score,m RS score in 90th day,the efficiency and mortality in two groups was assessed to evaluate in the patients after intravascular therapy in different treatment time windows.The correlation between the time of onset and the beginning of femoral artery puncture and prognosis of patients was analyzed.Results:There was no significant difference in baseline data between EVT group and standard medical treatment group（P>0.05）;there were also no significant differences in vascular occlusion site and laboratory examination results including blood lipid,blood homocysteine between the two groups（P>0.05）;the onset of disease between the two groups was significantly lower than that of the standard medical treatment group（P>0.05）.There were no significant differences in admission time（P>0.05）;NIHSS scores of EVT group at 24 h,7th days and 30th days after treatment were lower than that of baseline,and significantly lower than that in standard medical treatment group（P<0.05）;respectively,the clinical improvement rates of EVT group and standard medical treatment group were 41.25%and 24.24%,which showed significant difference（P<0.05）;after 90th days of treatment,NIHSS score of EVT group was significantly lower than that of standard medical treatment group（P<0.05）.The benefit prognosis rates of EVT group were 55.00%and 37.88%,which showed significant difference（P<0.05）.In the EVT group,the good prognosis rate was 52.73%within 6hours and 48.00%between 6-24 h,respectively,with no significant difference（P>0.05）.The mortality rate in two groups has no significant difference（18.18%vs 20.00%）.The rate of decompressive craniectomy in EVT group was significantly lower than that in standard medical treatment group（8.75%vs 21.21%）,and the incidence of pulmonary infection in EVT group was lower than that in standard medical treatment group（28.75%vs 46.97%）,with significant difference（P<0.05）.Conclusion:（1）EVT can significantly improve the prognosis of patients with AIS caused by atherosclerosis-induced LVO in anterior circulation and has no difference in mortality compared with standard medical treatment.（2）Patients with AIS caused by atherosclerosis-induced LVO in anterior circulation can benefit from endovascular treatment within 24 hours.And the earlier to operate femoral artery puncture,the more benefit can be obtained.