Analysis Of Correlative Factors Of Ineffective Recanalization After Mechanical Thrombectomy In Patients With Acute Anterior Circulation Ischemic Stroke

Objective: Currently,the number of ischemic stroke in China is large and the incidence is on the rise.The development of mechanical thronbectomy has brought benefits to the majority of patients.However,there are still some patients with poor prognosis despite successful revascularization.The aim of this study is to investigate the factors associated with the ineffective recanalization of acute ischemic stroke patients after mechanical thrombectomy and to provide a theoretical basis for clinical practice.Methods: Patients with acute anterior circulation ischemic stroke admitted to the Department of Neurology of Xianyang Hospital of Yan’an University from January 2021 to November 2022 for mechanical thrombectomy were observed and analyzed,and baseline data collection and relevant laboratory tests were completed before thrombectomy,and intracranial hemorrhage was excluded by finishing cranial imaging.Patients with a modified thrombolysis grade of 2b or 3 were screened according to digital subtraction angiography,and then divided into effective recanalization group(0-2)and ineffective recanalization group(3-6)according to the 90 d modified Rankin scale(m RS).The related factors of ineffective recanalization were analyzed univariately,and independent predictors of ineffective recanalization in occluded vessels were further analyzed by logistic regression.The receiver operating characteristic curve(ROC)and area under the curve(AUC)were used to assess the performance of each predictor in predicting ineffective recanalization of occluded vessels,and the critical point was calculated by the Yoden index.Results: A total of 169 patients who underwent mechanical thrombectomy were included according to inclusion and exclusion criteria,including 86 patients(50.89%)in the effective recanalization group and 83 patients(49.11%)in the ineffective recanalization group.In the results of univariate analysis,we found that the effective recanalization group and the ineffective recanalization group were different in terms of history of hypertension,age,admission systolic blood pressure,post-wake stroke,admission National Institutes of Health Stroke Scale(NIHSS)score,large atherosclerotic embolism,cardiogenic embolism,collateral circulation,symptomatic intracranial hemorrhage(s ICH),admission at 1 d,3 d,7 d or discharge(P < 0.05).Multiple logistic regression analysis showed that history of hypertension(OR 4.119,95% CI1.315-12.906),1d postoperative NIHSS score(OR 1.148,95% CI 1.039-1.268),and 7d postoperative or discharge NIHSS score(OR 1.393,95% CI 1.210-1.605)were independent predictors of ineffective recanalization.Conclusion: Patients with a history of hypertension are more likely to develop s ICH after thrombectomy,which may be associated with ineffective recanalization;history of hypertension,NIHSS score 1 d after mechanical thrombolysis,and NIHSS score 7 d after mechanical thrombolysis or at discharge were independent predictors of ineffective recanalization,with the latter two having better predictive power for ineffective recanalization.