Comparative Study Of Mechanic Thrombectomy In The Treatment Of Intracranial Large Atherosclerotic And Embolic Acute Ischemic Stroke

Objective: To compare the clinical efficacy of mechanical thrombectomy in the treatment of acute ischemic stroke with Intracranial large atherosclerosis(ICAS)and Embolic,and to evaluate the safety and efficacy of stent angioplasty as rescue treatment.Methods: Retrospective analysis of the clinical data of 118 patients with acute large vessel occlusion who underwent endovascular mechanical embolectomy at the stroke center of Fuyang people hospital fromJanuary 2019 to December 2021,according to the results of patients with intraoperative cerebral angiogram,ICAS group of 27 cases(22.9%),Embolic groups of 91(77.1%).The baseline characteristics,time fromonset to puncture,operation time,intraoperative salvage therapy and the use of mTICI score to evaluate vascular recirculation,the incidence of intracranial hemorrhage conversion within 72 h after surgery,and the 90 d mRs Score to evaluate the prognosis of patients in the two groups were analyzed.According to the 90 d mRS score,the patients were divided into good function group(0-2 points)and poor function group(3-6 points).The clinical characteristics of the two groups were compared,and the influencing factors of functional prognosis were analyzed by multivariate logistic regression.Results: Compared with the Embolic group,the ICAS group had a higher rate of posterior circulation occlusion(37.0% vs 14.3%,P=0.009),High proportion of good collateral circulation(51.9% vs 25.3%,P=0.009),balloon dilatation(66.7% vs 7.7%,P<0.001),and stent placement(59.3% vs 6.6%,P<0.001).Operation time obviously prolonged [110.00(80.00 to 130.00)vs 85.00(55.00 120.00),P = 0.021)],younger(63.67±11.48 vs.68.25±10.13 years of age,P = 0.047).The incidence of coronary heart disease(14.8% vs 41.8%,P=0.010),atrial fibrillation(7.4% vs 52.7%,P<0.001)and postoperative symptomatic bleeding(3.7% vs 23.1%,P=0.023)were significantly reduced.There were no significant differences in the rate of successful vascular recirculation(92.6% vs 91.2%,P=1.000)and the rate of good prognosis 3 months after surgery(40.7% vs 49.5%,P=0.426)between the two groups.Multivariate logistic regression analysis showed that,Good collateral circulation(OR=0.163,95% CI:0.058-0.459;P=0.001)was significantly associated with good function 90 days after operation,while NIHSS score(OR=1.160,95% CI: 1.053-1.277;P=0.003),symptomatic intracranial hemorrhage(OR=14.791,95% CI: 2.513-87.047;P=0.003)were the influencing factors of poor function.Conclusion: 1.Mechanical thrombectomy is safe and effective in the treatment of intracranial atherosclerosis and embolic acute ischemic stroke.Comparing the two groups of patients,there are differences in risk factors,surgical methods and the incidence of postoperative symptomatic bleeding.Compared to the Embolic group,patients in the ICAS group are younger,have better collateral circulation,and have lower rates of coronary heart disease and atrial fibrillation,but the operation time is longer,and they often need combined angioplasty,The proportion of balloon dilation and stent implantation is higher.2.Although the incidence of postoperative symptomatic bleeding is lower in the ICAS group,there is no statistical difference in the prognosis of patients treated with mechanical thrombectomy between the two groups.3.Good collateral circulation is a significant predictor of good prognosis and function at90 days.