| Objective:Mechanical thrombectomy(MT)has become the standard treatment for acute ischemic stroke(AIS)caused by large vessel occlusion(LVO).Under different imaging evaluation modes,the prognosis of MT patients in different time windows has different results,Imaging markers such as infarct core,collateral circulation and infarct growth rate may be helpful to predict the correlation between different time windows and prognosis.This study compares the effects of different imaging markers in the early(≤6h)and late(>6h)time windows on the prognosis of patients with thrombectomy,and further analyzes the factors affecting the prognosis of MT patients to provide references for clinical practice.Methods:A retrospective analysis was performed on 194 patients with acute anterior circulation AIS-LVO who underwent emergency MT admitted to the Second Affiliated Hospital of Soochow University and Zhang Jiagang Hospital of Soochow University from January 2019 to May 2021.General data were collected,including demographic data,risk factors,NIHSS score at admission,onset or last normal time,CT perfusion time,puncture and reperfusion time nodes,etc.And the imaging parameters included Infarct core volume,Hypoperfusion intensity ratio(HIR),Early infarct growth rate(EIGR),etc.The modified Rankin scale(mRS score)was used to assess the clinical outcome 90 days after surgery.The primary outcome was good prognosis at 90 days(mRS 0-2),and the secondary outcome was the incidence of early neurological deterioration,symptomatic intracranial hemorrhage and death.The clinical and imaging data of patients with early and late time window thrombectomy and their correlation with prognosis were compared,and the relationship between infarct core,HIR,EIGR and prognosis under different time windows was analyzed.Results:1.Comparison between early and late time window thrombectomy:There were no significant differences in good prognosis at 90 days(mRS 0-2),early neurological deterioration and symptomatic intracranial hemorrhage between the two groups.Patients in the late time window group had a higher risk of death than patients in the early time window group(OR=7.17,95%CI:1.84-28.00,P=0.005).2.According to different time Windows,the correlation between core infarction volume,HIR,EIGR and prognosis was further analyzed,and the results showed that(1)Patients with high HIR had a reduced rate of good outcome(OR=0.19,95%CI:0.04-0.85,P=0.029)and an increased risk of death(OR=8.17,95%CI:1.22-54.49,P=0.03)in the late time window group compared with patients with early time window group with low HIR.(2)Patients with large(OR=338.19,95%CI:17.59-6502.2,P<0.001)and small(OR=5.28,95%CI:1.10-25.29,P=0.037)core infarction in the late time window group had an increased risk of death compared with patients with small core infarction in the early time window group.Among patients treated in the early time window,patients with large core infarction had an increased risk of death compared with patients with small core infarction(OR=16.49,95%CI:1.16233.95,P=0.038).(3)Patients with high EIGR in the late time window group had an increased risk of death compared with patients with low EIGR in the early time window group(OR=19.36,95%CI:1.15-326.66,P=0.04).3.Comparison between the good prognosis group and the poor prognosis group showed that:Age,female,high NIHSS score on admission were independent risk factors,whereas HIR<0.4 and postoperative mTICI(2b-3)was an independent protective factor.The Area Under Curve(AUC)of age,sex,admission NIHSS score,reperfusion mTICI(2b-3),HIR<0.4 predicting good prognosis(mRS 0-2)at 90 days was 0.837(95%CI:0.781-0.893).Conclusion:1.After multimode imaging screening,there was no significant difference in good prognosis at 90 days of patients with thrombectomy in the early time window and the late time window.However,for thrombectomy patients with large core infarction(≥50ml),high HIR(≥0.4)and high EIGR(≥10ml/h),the time window is still closely related to the clinical outcome.2.Age,female,and admission high NIHSS score were independent risk factors for the prognosis of thrombectomy,while HIR<0.4 and postoperative mTICI(2b-3)were independent protective factors for the prognosis of thrombectomy. |
