Analysis Of Early Neurological Deterioration After Bridging Therapy For Acute Ischemic Stroke After Vascular Occlusion And Recanalization

Objective:To explore the risk factors for early neurological deterioration after bridging therapy(BT)in patients with acute ischemic stroke(AIS),and to provide ideas for clinical intervention.Methods:A total of 70 patients with AIS were selected in the neurology ward of XXXX after receiving BT and recanalization,and the general information and previous diseases of the patients were recorded.The NIHSS score of patients with AIS,the time from onset to femoral artery puncture(OPT)were recorded,etc;Alberta Stroke Program early CT Score(ASPECTS)based on head CT status;Vascular recanalization assessment was performed using DSA whole-brain angiography using modified cerebral infarction thrombolytic grading(m TICI)criteria,and collateral circulation flow assessment using the American Society for Interventional and Therapeutic Neuroradiology collateral circulation classification(ASITN/SIR).The degree of neurological deficit at admission and 72 h after BT was measured,and the NIHSS score within 72 h after surgery was ≥4 points compared with the NIHSS score at admission,and the patients with AIS after BT treatment were divided into worsening group and non-deterioration group.The age,sex,white blood cell count(WBC),D-dimer(D-D),low-density lipoprotein(LDL),previous hypertension,atrial fibrillation,diabetes history,smoking history and history of drinking of the two groups were statistically analyzed using SPSS 26.0 software,and P<0.05 was statistically significant for the difference between the END group and the NEND group,and the factors with significant significance in univariate analysis(P<0.05)were statistically significant Logistic regression analysis was included to predict risk factors for developing END after BT.Results:A total of 70 patients with ischemic stroke were screened in combination with inclusion criteria and exclusion criteria,27 patients had END,43 patients had not,the incidence of END reached 38.6%,Atrial fibrillation(χ2=8.826,P=0.003),LDL(t=2.430,P=0.018),OPT≥5h(χ2=5.788,P=0.016),collateral circulation grade ≤ grade 2(χ2=4.191,P=0.041),ASPECTS score(z=-3.178,P= 0.001),and the factors with significant significance in the above univariate analysis(P<0.05)were included in the logistic regression analysis,showing that OPT ≥5 hours(P=0.019),collateral circulation grade ≤ grade 2(P=0.045),and atrial fibrillation(P=0.004)were independent risk factors for the development of END after BT.Conclusion:AIS patients receiving BT revascularization have a higher rate of neurological deterioration,and the most worsened during the 72 hours.Atrial fibrillation,LDL,OPT≥5h,collateral circulation grade ≤ grade 2,ASPECTS score were associated with END after BT in AIS patients,among which OPT≥5h,collateral circulation grade≤ grade 2,and atrial fibrillation may be important risk factors for early neurological deterioration,OPT ≥5h is an independent risk factor for the occurrence of END,indicating that early and timely opening of responsible vessels by thrombolysis or thrombectomy,and restoring reperfusion of ischemic semi-dark band stroke is the key to reducing the mortality and disability rate of patients.Poor collateral circulation,patients are more likely to develop END after bridging therapy,which indirectly indicates that a good collateral state can control the progression of infarct area and avoid the occurrence of END.Atrial fibrillation is also independently correlated with END after BT treatment in AIS patients,for patients with cardioembolism,after sudden embolism,AIS patients may lack early warning of ischemia and adaptability to ischemia,and collateral circulation cannot be established in time,resulting in the occurrence of END.In short,the occurrence of END is the result of a combination of factors and mechanisms.