An Analysis Of The Clinical Effects Of Direct Mechanical Thrombectomy And Bridging Therapy In Patients With Acute Ischemic Stroke Based On Propensity Score Matching

Objective: To evaluate the safety and efficacy of direct mechanical thrombectomy and bridging therapy in patients with acute ischemic stroke based on Propensity Score Matching(PSM).Methods: This study included 243 patients with acute ischemic stroke(AIS)who were hospitalized in the Second Affiliated Hospital of Dalian Medical University from January 2017 to January 2023 and received mechanical thrombectomy.Firstly,according to whether death or not and whether intracranial hemorrhage or not,the patients were divided into death group and non-death group,intracranial hemorrhage group and nonhemorrhage group.The risk factors of death and intracranial hemorrhage were determined by univariate analysis and Logistic regression analysis.Then according to whether preoperative intravenous thrombolysis therapy(IVT)was performed,the patients were divided into direct mechanical thrombectomy(dMT)group and bridging therapy(BT)group.The differences of parameters between the two groups were compared and the variables of propensity score were selected.The matching tolerance was set as 0.02,and all subjects were matched 1:1 to further analyze the clinical effects of the dMT group and the BT group.The primary outcome was mortality;the secondary outcomes were the incidence of intracranial hemorrhage,the complications during hospitalization and the scale scores at discharge.The complications were evaluated by the infection during hospitalization(pulmonary infection and urinary tract infection),deep venous thrombosis(lower extremity venous thrombosis and pulmonary embolism)and bleeding at other sites(gastrointestinal bleeding,mucosal / subcutaneous bleeding).The scale scores included postoperative successful recanalization(m TICI 2b/3),NIHSS(the National Institutes of Health Stroke Scale)score at discharge,Glasgow Coma Scale(GCS)score at discharge,m RS score at discharge and the change of NIHSS score.Results: 1.Compare of General Dates: A total of 243 patients were included with a median age of 70(64-79)years and 160 males(65.8%).They were divided into death group and non-death group according to whether they died or not.The results of univariate analysis showed that there were differences between groups in NIHSS score,GCS score,SOFA score,APACHE II score,Kubota water swallow test score,oxygenation index,previous coronary heart disease,D-dimer,c Tn I,time from onset to mechanical thrombectomy and location of infarction.Logistic regression showed that high NIHSS score,high APACHE II score,previous coronary heart disease and high D-dimer level were independent risk factors of death for AIS patients undergoing the mechanical thrombectomy.According to whether intracranial hemorrhage or not,the patients were divided into intracranial hemorrhage group and non-hemorrhage group.The results of univariate analysis showed that there were differences between groups in Kubota water swallow test score,previous atrial fibrillation,Cr level,TOAST criteria and location of infarction.Logistic regression showed that high Kubota water swallow test score and anterior circulation stroke were independent risk factors for intracranial hemorrhage,while high oxygenation index was a protective factor for intracranial hemorrhage.2.Calculate the Propensity Scores andMatch Subjects: According to whether preoperative intravenous thrombolysis therapy(IVT)was performed the patients were divided into dMT group [131(53.9%)of 243] and BT group[112(46.1%)of 243].Univariate analysis showed that GCS score,SOFA score,APACHE II score,Kubota water swallow test score,mean arterial pressure(MAP),previous atrial fibrillation,previous ischemic stroke,previously taking antithrombotic drugs,INR,BNP,c Tn I,LDL-C levels and TOAST criteria were different between dMT group and BT group.Therefore,the variables of propensity score were gender,GCS score,SOFA score,APACHE II score,Kubota water swallow test score,MAP,previous coronary heart disease,previous atrial fibrillation,previous ischemic stroke,previously taking antithrombotic drugs,INR,BNP,c Tn I,LDL-C levels and TOAST criteria.The matching tolerance was set as 0.02.All subjects were matched 1:1 and 66 pairs were successfully matched.Univariate analysis showed that there was no significant difference between the two groups after matching,which proved PSM was effective.3.Analyze the Clinical Effects of dMT and BT in AIS undergoing the Mechanical Thrombectomy after Matching: A total of 243 patients were included after PSM with a median age of 73(66-80)years and 90 males(68.2%).(1)The primary outcomes evaluation:There was no significant difference between dMT group and BT group in mortality(P=0.31).(2)The secondary outcomes evaluation: the postoperative successful recanalization rate in the BT group was higher than that in the dMT group(P=0.032)but the infection during hospitalization in the BT group was higher than that in the dMT group(P=0.013).There were no significant differences in the incidence of intracranial hemorrhage(P=0.032),deep venous thrombosis(P=0.182),bleeding at other sites(P=0.426),NIHSS score at discharge(P=0.971),GCS score at discharge(P=0.649),m RS score at discharge(P=0.451)and the change of NIHSS score(P=0.883).Conclusion: 1.For AIS patients receiving mechanical thrombectomy,high NIHSS score,high APACHE II score,previous coronary heart disease and high D-dimer level were independent risk factors for death.The higher Kubota water swallow test score and anterior circulation stroke were independent risk factors for intracranial hemorrhage,while high oxygenation index was a protective factor for intracranial hemorrhage.2.The primary outcomes of dMT group and BT group were similar,and there was no significant difference in mortality.The postoperative successful recanalization rate in the BT group was higher than the dMT group,but the infection during hospitalization in the BT group was higher.There were no significant differences in the incidence of intracranial hemorrhage,deep venous thrombosis,bleeding at other sites.And there were no significant differences in NIHSS score,GCS score,m RS score at discharge and the change of NIHSS score.