| Objectives:To explore the application of electroencephalogram monitoring in evaluation of prognosis of patients with acute anterior circulation infarct after intravascular therapy.Method:The study is prospective study.The patients with acute anterior circulatory macrovascular occlusion,who were attacked by the disease within 24 hours and were evaluated to have the surgery indication by imaging,were selected.All the enrolled patients underwent intravascular intervention therapy under local anaesthesia,and their post-operative immediate m TICI grading results of blood flow in the occluded vessels all reached grade 3.The following parameters of all the patients were recorded: gender,age,time from onset to revascularization,TOAST type,occluded vessel location,pre-operative NIHSS score,lymphocyte-monocyte ratio upon admission,electroencephalograms at 24 hours,3 days and 7 days after surgery,and post-operative 3-month m RS score.For the examination of electroencephalogram,the electrode was placed in accordance with the international standard system 10-20,the electroencephalogram was recorded for 20 minutes at the resting,waking and eye-closed status.Based on Clinical Electroencephalography by Wu Shengling and Huang Yuangui,the electroencephalograms were classified into different types: normal,slightly abnormal,moderately abnormal,and severely abnormal,and analyzed in combination with the m RS scores.Results:1.Analysis of basic information: A total of 40 patients were enrolled,including 23 males and 17 females.In terms of age,there were 28 patients at the age smaller than 70 and 12 ones at the age greater than or equal to 70.In terms of time from onset to revascularization,24 patients had the time shorter than or equal to 8 hours and 16 ones with the time longer than 8 hours.For TOSAT type,there were 13 cases with aorticantherosclerosis type,20 ones with cardiogenic cerebral embolism type and 7 ones with others.In respect of occluded vessel location,15 cases had internal carotid occlusion and 25 ones had middle cerebral artery occlusion.In terms of NIHSS scores,2 cases had scores smaller than 6,28 ones had 6～16 scores and 10 ones had scores greater than 16.For lymphocyte-monocyte ratio upon admission,there were 23 cases with the ratio smaller than or equal to 2.633 and 17 ones with the ratio greater than2.633.In respect to prognosis,22 cases had good prognosis and 18 ones had poor prognosis.The prognosis for intravascular therapy for acute cerebral infarction was associated with pre-operative NIHSS scores and time from onset to revascularization,with statistically significant difference(P<0.05).The prognosis for intravascular therapy for acute cerebral infarction was not associated with gender,age,occluded vessel location,TOAST type and lymphocyte-monocyte ratio upon admission,with no statistically significant difference(P>0.05).2.Analysis of electroencephalogram changes within one week and post-operative 3-month prognosis outcomes: Post-operative 24 hours:There were 2 cases of normal electroencephalograms with both good prognosis,16 cases of slightly abnormal electroencephalograms including12 ones with good prognosis and 4 ones with poor prognosis;9 cases of moderately abnormal electroencephalograms including 7 ones with good prognosis and 2 ones with poor prognosis;13 cases of severely abnormal electroencephalograms including one case with good prognosis and 12 ones with poor prognosis.Post-operative 3 days: There were 10 cases of normal electroencephalograms with all good prognosis;8 cases of slightly abnormal electroencephalograms with all good prognosis;10cases of moderately abnormal electroencephalograms,including 2 ones with good prognosis and 8 ones with poor prognosis;12 cases of severely abnormal electroencephalograms,including 2 ones with good prognosis and 10 ones with poor prognosis.Post-operative 7 days: There were 12 cases of normal electroencephalograms with all good prognosis;8 cases of slightly abnormal electroencephalograms with all good prognosis;12case of moderately abnormal electroencephalograms including 2 ones with good prognosis and 10 ones with poor prognosis;8 cases of severely abnormal electroencephalograms with all poor prognosis.The differences were of statistical significance(P<0.05).3.Time from onset to revascularization and electroencephalogram changes within one week: 24 cases of revascularization within 8 hours after onset: From post-operative 24 hours to post-operative day 3,14 patients showed improvement of the electroencephalogram;and from post-operative day 3 to post-operative day 7 there were 8 patients with improved electroencephalograms.16 cases of revascularization after 8hours after onset: From post-operative 24 hours to post-operative day 3there were 2 patients with improved electroencephalograms,and from post-operative day 3 to post-operative day 7 there were 2 patients with improved electroencephalograms;the time of revascularization had correlation with electroencephalogram improvement rate from post-operative 24 hours to post-operative day 3,with statistically significant difference(P<0.05).4.Pre-operative NIHSS scores and electroencephalogram changes within one week: 2 cases with pre-operative NIHSS scores smaller than 6:There was one patient with improved electroencephalogram from post-operative 24 hours to post-operative day 3;the other one with improved electroencephalogram from post-operative day 3 to post-operative day 7.28 cases with pre-operative NIHSS scores 6 ～ 16:There were 15 patients with improved electroencephalograms from post-operative 24 hours to post-operative day 3;7 ones with improved electroencephalogram from post-operative day 3 to post-operative day 7.10 cases with pre-operative NIHSS scores greater than 16: There was no patient with improved from post-operative 24 hours to post-operative day3;2 patients with improved electroencephalogram from post-operative day 3 to post-operative day 7.The pre-operative NIHSS scores had correlation with electroencephalogram improvement rate from post-operative 24 hours to post-operative day 3,with statistically significant difference(P<0.05).5.Lymphocyte-monocyte ratio upon admission and electroencephalogram changes within one week: 23 cases with lymphocyte-monocyte ratio upon admission smaller than or equal to 2.633: There were 10 patients with improved electroencephalograms from post-operative 24 hours to post-operative day 3;3 ones with improved electroencephalogram from post-operative day 3 to post-operative day7.17 cases with lymphocyte-monocyte ratio upon admission greater than 2.633: There were 6 patients with improved electroencephalograms from post-operative 24 hours to post-operative day 3;7 ones with improved electroencephalogram from post-operative day 3 to post-operative day 7.The lymphocyte-monocyte ratio upon admission showed no correlation with electroencephalogram changes within one week,with no statistically significant difference(P>0.05).Conclusion:1.The patients with acute anterior circulation infarct undergoing intravascular therapy can be evaluated for prognosis accurately by examining post-operative 24-hours electroencephalogram.If normal or slightly and moderately abnormal electroencephalograms,the prognosis will be good;However,if electroencephalogram is still moderately or severely abnormal,the prognosis will be poor.2.The study show that The electroencephalogram changes from post-operative 24 hours to post-operative day 3 and the prognosis from post-operative 3 months of the patients show correlation with their pre-operative NIHSS scores and revascularization time,and may be no correlation with their TOAST types,lymphocyte-monocyte ratios,gender,age,occluded vessel location upon admission. |
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