| Objective:To explore the risk factors affecting the poor prognosis of interventional therapy for intracranial atherosclerotic stenosis,and to provide evidence-based evidence for the development of interventional therapy.Methods:Patients with ischemic stroke caused by atherosclerotic stenosis in the Affiliated Hospital of Qingdao University who received stents from January 2015 to March 2020 were collected using the hospital Yiduyun database.152 patients were included according to the inclusion and exclusion criteria.Detailed records in patients with baseline data(gender,age,history of diabetes,a history of hypertension,smoking history,total cholesterol,low density lipoprotein cholesterol(ldl-c),high-density lipoprotein cholesterol(hdl-c),to the onset of the lesion blood vessel position,time,stent type,residual stenosis stent placement,anesthesia,etc.),through the postoperative 1 month,3months,6 months,1 year for regular follow-up outpatient and hospitalization,If similar neurological symptoms are present,outpatient or in-patient follow-up is recommended,NIHSS score and MRS score are evaluated,patient prognosis is accurately recorded,and patient end point events are recorded(stroke or infarction in the blood supply area due to re-occlusion of responsible vessels after surgery;Death;The group with end events was defined as the poor prognosis group,and the group without end events was defined as the good prognosis group.SPSS22.0 software was used for statistical analysis to analyze the relationship between risk factors such as underlying disease,lesion vessel location,stent type,residual stenosis and poor prognosis.The continuous variables between the two groups were tested by independent sample t test or rank sum test,and the classified variables were tested by chi-square test or Fisher’s exact test.The accurate P value was calculated and recorded,and P < 0.05 indicated statistical significance.Significant risk factors in univariate analysis were statistically analyzed by logistic regression analysis,and P < 0.05 was considered statistically significant.Results:(1)There were 141 stenosis in the 141 patients,and 140 stents were successfully implanted(60 cases of balloon dilated stents and 80 cases of self-dilated stents),among which 1 case could not be implanted due to bleeding of the guide wire during the operation,resulting in surgical failure,and the success rate of the operation was99.3%.(2)Among the 140 successful patients,23 patients had end point events,with a rate of 16.42%,restenosis in 14(60.87%),infarct in 6(26.08%),perforating stroke in 2(8.69%),perioperative hemorrhage in 1(4.3%);(3)End-point events occurred in 23 patients,including 4 cases of vertebral artery(17.39%),10 cases of basilar artery(43.47%),7 cases of intracranial segment of internal carotid artery(30.43%),and 2 cases of M1 segment of middle cerebral artery(8.69%),P=0.017 < 0.05,the difference was statistically significant.Among the 23 patients with end point event,14 patients(60.8%)were smokers and 9 patients(39.13%)were non-smokers,P=0.008 < 0.05,the difference was statistically significant.Bary Logistic regression analysis showed that OR value was0.274,P=0.006 < 0.05,the difference was statistically significant.(4)In the poor prognosis group,there were 5 patients(21.7%)from onset to implantation of stent less than 14 days,and 18 patients(78.2%)from onset to implantation of stent > 14 days,P=0.04 < 0.05,the difference was statistically significant.Bary Logistic analysis showed that OR value was8.08,P < 0.05,the difference was also statistically significant.(5)The residual stenosis rate of the endpoint event group was 14.1304±9.84565%,and that of the non-endpoint event group was 10.6838±5.48925%,P=0.019 < 0.05,the difference was statistically significant.Binary logistic analysis showed that OR value was 0.933,P=0.035 < 0.05.The difference was statistically significant.(6)Among the 23 patients with poor prognosis,there were 13 cases of balloon expansion stent(56.5%)and 10 cases of self-expansion stent(43.5%),P=0.710> 0.05,the difference was not statistically significant;(7)There were 19 cases(82.6%)under local anesthesia and 4 cases(17.4%)under general anesthesia,P=0.594 > 0.05,and the difference was not statistically significant.(8)Age,history of hypertension,history of diabetes,body mass index,low-density lipoprotein,high-density lipoprotein,stent diameter and stent length were not significantly correlated with prognosis(P = 0.166,0.786,1.00,0.253,0.242,0.467,0.328,0.521,respectively).Conclusion:Stent implantation has high safety and effectiveness in the treatment of patients with intracranial atherosclerotic stenosis.The prognosis of stent implantation was related to the location of the affected vessels,smoking,residual stenosis,the onset of the disease and the timing of stent implantation.The prognosis of stent implantation was not significantly related to stent type,anesthesia,age,history of hypertension,history of diabetes,body mass index,low density lipoprotein,high density lipoprotein,stent diameter and stent length. |
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