| Objective To compare the effect and clinical effect of endovascular thrombectomy in patients with acute anterior circulation occlusion.Methods A retrospective analysis was performed on 80 patients with acute precirculation large vessel occlusion who received endovascular treatment in Inner Mongolia People’s Hospital from November 2016 to November 2020.There were 42 males with an average age of 66.54±10.81 years.There were 38 females with an average age of 68.18±9.59 years.1.Baseline data: gender,age,smoking history,alcohol consumption,hypertension,diabetes,coronary heart disease,atrial fibrillation,hyperlipidemia,hyperhomocysteine,and previous history of stroke or TIA.2.Patients were stratified according to the "Agitation Sedation Scale"(Attached Table 1),including 20 patients with local anesthesia and 20 patients with non-local anesthesia for grades-3 to 0,20 patients with local anesthesia and 20 patients with non-local anesthesia for grades 1-4.3.Arterial thrombectomy: patients with suspected acute ischemic stroke were immediately treated with head CT to exclude intracranial hemorrhage;Conduct relevant blood tests;CTA or DSA of the head and neck can be used to identify vascular lesions.Patients eligible for intravenous thrombolysis were treated with intravenous thrombolysis bridging therapy,and patients beyond the intravenous thrombolysis time window were treated with arterial mechanical thrombolysis directly.Patients in the local anesthesia group were anesthetized with lidocaine injection only at the puncture site,while patients in the non-local anesthesia group were anesthetized with sedative drugs intravenously.Intra-arterial thrombectomy with Solitaire FR stent;Postoperative head CT examination.4.Observation: Vascular recanalization was evaluated by modified cerebral infarction thrombolysis(m TICI)grading,national Institutes of Health Stroke Scale(NIHSS)score before surgery,NIHSS score 24 hours after surgery,and modified Rankin Scale(m RS)score 90 days after onset.The agitation sedation scale-3 to 0,1to 4 local anesthesia group and non-local anesthesia group were compared.5.Statistical methods: Data were analyzed by SPSS 26.0 software,and P < 0.05 was considered statistically significant.Results1.There were no statistically significant differences between the two groups in age,hypertension,diabetes,history of stroke /TIA,smoking,intravenous thrombolysis,NIHSS score at admission,and ASPECTS score ≥8(P > 0.05).2.MRS score ≤2 after 90 days: agitation sedation scale-3-0 in 2 groups,2 cases in local anesthesia group,4 cases in non-local anesthesia group,P > 0.05;There were3 cases in local anesthesia group and 6 cases in non-local anesthesia group in the two groups of scale 1-4,no difference(P > 0.05).3.In the statistical analysis of m TICI score level 2B-3 for recanalized vessels,there were 17 cases in the local anesthesia group and 18 cases in the non-local anesthesia group in the agitation sedation score scale-3-0 between the two groups,with no difference between the two groups(P > 0.05).There were 11 cases in local anesthesia group and 18 cases in non-local anesthesia group in the two groups of scale1-4,the difference between the two groups was significant(P < 0.05).4.NIHSS score improvement value before and 24 h after mechanical thrombolectomy was as follows: 2±1.29 in the local anesthesia group and 3.85±1.75 in the non-local anesthesia group,P < 0.05;2±1.25 in the local anesthesia group and2.05±1.31 in the non-local anesthesia group,P > 0.05.Conclusion1.Before mechanical thrombectomy for patients with acute ischemic stroke,appropriate anesthesia was selected according to the score of agitation sedation scale to ensure smooth operation,improve vascular recanalization rate and improve prognosis of patients.2.For patients with a score of-3-0 on the Sedation agitation Scale,intravascular thrombectomy performed under non-local anesthesia was associated with improved NHISS scores 24 hours later.3.For patients rated 1-4 on the sedation agitation Scale,intravascular thrombectomy performed without local anesthesia had a higher rate of vascular recanalization.4.There was no statistically significant difference in the prognosis of patients 90 days after surgery between patients rated at-3-0 on the sedation agitation Scale and patients rated at 1-4 on the two anesthesia methods. |
