Research On Optimization Of Treatment Process And Solitaire FR Stent In The Treatment Of Acute Ischemic Stroke

Background:Acute ischemic stroke（AIS）has now become one of the major causes of death in the world.In China,the survey data show that there are 240 million new strokes per year,1million 100 thousand stroke patients related to death,and the surviving patients have the sequelae of stroke.In recent years,cerebral apoplexy has become the main cause of death in our country.So,what is the key to the treatment of stroke?The key is the mastery of the rescue time.Time is life,time is the brain.Therefore,the treatment effect of stroke patients is satisfactory,and it has a great correlation with the time.Because of the narrow time window for the treatment of acute ischemic stroke,the earlier the recovery effect is better.So,what we have to strive for is time?However,due to the large difference of medical conditions and levels in different regions of China,the emergency process is uneven.According to the situation of our hospital,it is imperative to establish an emergency treatment process for acute ischemic stroke.Objective:The guidance of treatment for acute ischemic stroke both at domestic and abroad emphasizes that time is life,time is the brain.Because of the lack of standardization of AIS treatment process in China for a long time,the establishment of green channel is not perfect,which leads to a longer delay in hospital.Through this study,to observe the stroke Easy Access established after the treatment time and the value of treatment of acute ischemic stroke to shorten the hospital,and to investigate the effect and safety of the method of application of Solitaire FR stent thrombectomy in patients with emergency treatment process optimization in the treatment of AIS.Methods:A retrospective analysis was conducted in the Department of Neurosurgery of Ji’nan Central Hospital Affiliated to Shandong University from January 2013 to December 2017,and AIS patients were treated by Solitaire FR stent thrombectomy.Among them,22patients with AIS before the establishment of green passage were selected as the control group,they received the traditional emergency treatment mode.After the establishment of green passage for stroke patients,49 cases of AIS patients were selected as the observation group,and the emergency treatment mode was optimized.The two groups were confirmed by intracranial digital subtraction angiography.The Solitaire FR^TM thrombectomy stent was used for intravascular mechanical thrombectomy,and the recanalization of occlusive vessels was achieved.The standard of vascular recanalization was graded by m TICI.The changes of time consumed in the two groups were compared to the time periods of CT,CT to puncture,puncture to vascular recanalization,and access to vascular recanalization,and so on.The clinical effect and prognosis by the National Institutes of Health Stroke Scale（NIHSS:0～42,the higher the score,the worse neural function defect score）,preoperative NIHSS score and postoperative 24 hours NIHSS score observation,90d modified Rankin score（m RS）to evaluate its efficacy and safety.Operation related complications,intracranial hemorrhage conversion rate,90 day mortality rate were used to evaluate the safety of the treatment.Results:In the observation group,the time from CT to CT,femoral artery puncture time,femoral artery puncture to vascular opening time,admission to vessel opening time and onset to vascular access time in the observation group were significantly shorter than those in the control group,and the difference between the two groups was statistically significant[（14.0+1.7）min to（33.0+5.1）min,（20.7+3.1）min to（34.7.0+9.1）min,（93.3+12.6）min-to（158.4+34.4）min,（128.0+13.2）min-to（226.1+35.1）min,（364.0+61.3）min-to（454.5+65.7）min,P<0.05].There was no significant difference in age,onset and time of admission between the observation group and the control group（P>0.05）.There was no significant difference in the NIHSS scores between the two groups before treatment（t=-0.713,P>0.05）.After treatment,the NIHSS scores of the two groups were significantly lower than those before the treatment,and the difference was statistically significant（P<0.05）.However,the improvement of NIHSS score in the observation group was significantly better than that of the control group,and the difference was statistically significant（P<0.05）.After treatment,the m RS score of 90d observation group was significantly better than the control group,and the difference was statistically significant（P<0.05）.In the observation group,49 cases of AIS were confirmed by cerebral angiography,24 cases occlusion of internal carotid artery,22 cases M1 segment occlusion of middle cerebral artery,and 3 cases vascular occlusion of vertebrobasilar system.The control group of 22 cases of patients with cerebral AIS angiography of internal carotid artery occlusion in 8 cases,M1 segment of middle cerebral artery occlusion in 11 cases,vertebral basilar artery occlusion in 3 cases.Solitaire FR safety observation:in the observation group,1 patients had operation related complications（intracranial vasospasm）,0 cases had intracranial hemorrhage transformation,and 2 patients died.In the control group,0 patients had operation related complications,0 cases had intracranial hemorrhage transformation,and 2 patients died.There was no significant difference between the two groups in the fatality rate（x²=0.839,P>0.05）.Conclusion:Optimization work flow of hospital patients with acute ischemic stroke in the treatment process,reduce effectively the hospital delay time,the time of treatment in patients with significantly reduced,effectively save time,improve clinical curative effect and prognosis of patients,improve the quality of life of patients,reduce the death rate.At the same time,the application of Solitaire FR^TM thrombectomy for the treatment of AIS is safe and effective,but the indications and contraindications should be strictly grasped.