A Single-center Retrospective Study Of Prognostic Factors In Patients With Simple Mechanical Thrombectomy And Remedial Stent Implantation

Objective: To investigate whether there is a difference in prognosis between patients with acute cerebral infarction after remedial stent and simple thrombectomy;factors affecting the prognosis of AIS patients after remedial stenting and mechanical thrombectomy.Methods: The data of patients with acute ischemic stroke in our center during period January 2019 to December 2022 were collected.All patients received mechanical thrombectomy.Patients with m TICI score< 2b after thrombectomy were treated with remedial stent.Clinical data such as demographic characteristics,personal history,past medical history,blood routine,blood lipids,liver and kidney function,MPR and THR at admission,SII at admission,SII difference at 24 hours after operation,OPT,NIHSS score at admission,and m RS score at 90 days after operation were collected.According to whether to accept remedial stent treatment,the patients were divided into simple mechanical thrombectomy group(MT group)and remedial stent implantation group(RS group).The demographic characteristics,personal history,past medical history,NIHSS score at admission,MPR at admission,THR at admission,OPT,SII at admission,SII difference at 24 hours after operation,fasting blood glucose at 24 hours after operation,albumin level,fibrinogen level,LDH level,number of thrombectomy,obstruction site,hemorrhagic transformation and m RS score were compared between MT group and RS group.R × C chi-square test was used to compare the prognosis of AIS patients undergoing mechanical thrombectomy and remedial stent treatment.Multivariate binary Logistic regression analysis was used to analyze the independent risk factors affecting the prognosis of patients with remedial stent implantation and patients with simple thrombectomy.ROC curve was used to evaluate the prognostic value of each independent risk factor in AIS patients.Results:(1)Data collection: A total of 709 AIS patients were retrospectively collected in this study.Among them,27 patients were excluded due to incomplete data or loss of follow-up.Finally,682 patients were included in the study,including 451 in the MT group and 231 in the RS group.(2)There was no significant difference in the data collected between MT group and RS group(P> 0.05).(3)There was no difference in prognosis between mechanical thrombectomy and remedial stent implantation in AIS patients(P>0.05).(4)Binary Logistic regression showed that NIHSS score,OPT,number of thrombectomy,LDH,MPR at admission and SII difference at 24 hours after operation were independent risk factors affecting the prognosis of AIS patients in MT group(OR>1,P<0.05);RS group: NIHSS score at admission,OPT,number of thrombectomy,LDH,SII difference at 24 hours after operation,and THR at admission were independent risk factors affecting the prognosis of AIS patients(OR>1,P<0.05).(5)The ROC curve indicated that in MT group,the AUC value of OPT in predicting a bad outcome prognosis was 0.969(P <0.001),and the sensitivity was 0.968.The AUC value of LDH in predicting poor prognosis was 0.890(P <0.001),and the sensitivity was 0.789.The AUC value of admission NIHSS in predicting poor prognosis was 0.860(P < 0.001),and the sensitivity was 0.886.The AUC value of the number of thrombectomy to predict a bad outcome prognosis was 0.934(P < 0.001),and the sensitivity was 0.903.The AUC value of MPR in predicting poor prognosis at admission was 0.715(P < 0.001),and the sensitivity was 0.605.The AUC value of SII difference in predicting poor prognosis was 0.864(P < 0.001),and the sensitivity was0.773.In RS group,the AUC value of SII difference in predicting poor prognosis was 0.799(P < 0.001),and the sensitivity was 0.769.The AUC value of OPT in predicting poor prognosis was 0.937(P < 0.001),and the sensitivity was 0.791.The AUC value of LDH in predicting poor prognosis was 0.899(P < 0.001),and the sensitivity was 0.802.The AUC value of admission NIHSS in predicting poor prognosis was 0.886(P < 0.001),and the sensitivity was 0.802.The AUC value of the number of thrombectomy to predict poor prognosis was 0.933(P < 0.001),and the sensitivity was 0.857.The AUC value of THR at admission to predict poor prognosis was 0.834(P < 0.001),and the sensitivity was 0.780.(6)Using Delong test by Med Calc 20.0 software,it was found that the accuracy of NIHSS combined with MPR,THR and SII in predicting poor prognosis of AIS patients was better than that of NIHSS alone(P < 0.05).Conclusions:(1)Rescue stent does not increase the incidence of poor prognosis in AIS patients compared with thrombectomy alone;(2)The SII difference at 24 hours after operation and THR at admission were independently correlated with the prognosis of salvage stent implantation in AIS patients.(3)MPR at admission and SII difference at 24 hours after operation were independently related to the prognosis of AIS patients after mechanical thrombectomy.(4)MPR,SII and THR levels have certain predictive value for the prognosis of AIS patients.