| Objective 1.By analyzing the clinical data of patients with acute ischemic stroke in multiple centers,this study compared the prognosis and safety of endovascular treatment in patients with ischemic stroke with two different etiologies,cardio embolism(CE)and large artery atherosclerosis(LAA),and explored the clinical prognosis 90 days after surgery and the predictors of postoperative intracranial hemorrhage transformation.2.After propensity score matching(PSM),further analyze whether there is a difference in the prognosis and safety of endovascular treatment in patients with CE and LAA ischemic stroke.Methods 1.Prospective collection of clinical data of patients with acute ischemic stroke(AIS)receiving endovascular treatment from January 2017 to October 2021 in the three comprehensive stroke centers of Shanghai Tenth People’s Hospital affiliated to Tongji University,Sixth People’s Hospital affiliated to Shanghai Jiao Tong University and Zhongnan Hospital of Wuhan University.According to the etiological classification of TOAST,425 cases were cardioembolic type and 376 cases were atherosclerotic type.Modified cerebral infarction thrombolytic grading(m TICI)was used to assess vascular recanalization.The clinical prognosis of patients was assessed using a postoperative90 dm RS score(90dm RS),where a 90 dm RS score of 0-1 was defined as an excellent prognosis group and a postoperative 90 dm RS score of 0-2 was defined as a good prognosis group.The incidence of postoperative symptomatic intracranial hemorrhage(s ICH),the incidence of intracranial Hemorrhage transformation(HT),and mortality within 90 days were used to assess patient safety.Univariate analysis compared baseline data and endovascular treatment-related data,90 dm RS0-1 score,90 dm RS0-2 score,postoperative s ICH,and HT between CE and LAA groups,and included multivariate logistic regression in the variables with statistically significant differences in univariate analysis results,and determined independent predictors of clinical prognosis and intracranial hemorrhage transformation at 90 days postoperatively.2.The prognosis and safety of patients in the CE group and LAA group were further analyzed by using the propensity matching method.Results 1.Compared with the LAA group,patients in the CE group had a higher median age(76 vs 67),more women(53.6% vs 29.8%),more atrial fibrillation(87.3%vs 6.4%),higher NIHSS scores on admission [17(14,20)vs 16(12,19)],a higher proportion of anterior circulation stroke(92.7% vs 80.1%),more thrombectomy(2 vs1)(P < 0.001),compared with men(46.4% vs 70.2%),hypertension(65.9% vs 77.7%),diabetes mellitus(21.4% vs 32.2%),baseline systolic blood pressure(142 vs 147),smoking(7.3% vs 17.3%),alcohol consumption(3.3% vs 9.3%),angioplasty(5.9% vs31.6%)were less common(P <mean 0.05).2.The CE group had a lower 90-day prognosis rate(90dm RS 0-1 points)than the LAA group(21.9% vs 27.9%,P=0.048),and the conversion rate of intracranial hemorrhage in the CE group was significantly higher than that in the LAA group(45.2%vs 33.8%,P=0.001).There were no significant differences in the successful vascular recanalization rate of m TICI2b/3(87.3% vs 85.4%),the incidence of postoperative symptomatic intracranial hemorrhage(8.7% vs 6.4%),the good prognosis rate of 90 days after surgery(90dm RS 0-2 points: 32.2% vs 36.2%),and the mortality rate within90 days(19.3% vs 16.5%)(P > 0.05).3.Multifactorial logistic regression analysis of clinical prognosis 90 days after surgery showed that CE etiological classification(OR=1.918,95% CI: 1.103～3.334,P=0.021)and high NIHSS score(OR=1.778,95% CI: 1.569～2.015,P<0.001)were independent risk factors for poor prognosis of 90 days.Logistic regression of postoperative intracranial hemorrhage showed that the site of stroke(OR=2.505,95%CI: 1.010～6.214,P=0.048)was an independent risk factor for CE HT.Higher admission to NIHSS is an independent risk factor for CE and LAA HT.A high ASPECT/PCASPECT score is an independent protective factor for HT in patients with CE and LAA.4.After the propensity score matching,the successful vascular recanalization rate(m TICI2b/3 grade: 89.9% vs 86.2%,P=0.237),postoperative 90 dm RS 0-1(27.2% vs.27.6%,P=0.914),90 dm RS 0-2(38.2% vs 36.4%,P=0.691),postoperative symptomatic intracranial hemorrhage(7.4% vs 4.1%,P=0.149),There were no differences in the mortality rate within 90 days(16.1% vs 16.6%,P=0.897),the incidence of symptomatic intracranial hemorrhage(7.4% vs 4.1%,P=0.149),the incidence of postoperative intracranial hemorrhage(44.2% vs 37.8%,P=0.172),and the mortality rate within 90days(16.1% vs 16.6%,P=0.897)(P > 0.05).Conclusions 1.There were significant differences between CE and LAA patients with ischemic stroke in baseline and EVT-related data.2.There were no significant differences between the CE group and LAA group in terms of vascular successful recanalization rate m TICI2b/3,incidence of postoperative symptomatic intracranial hemorrhage,postoperative 90 dm RS 0-2 score,and mortality within 90 days after surgery.However,patients in the CE group had an excellent postoperative score of90 dm RS 0-1,and the proportion of prognosis was lower,and the conversion rate of postoperative intracranial hemorrhage was higher.3.CE etiologic classification is an independent risk factor for poor prognosis of 90 days(90dm RS 2-6 points).A higher7 d NIHSS score after EVT was independently associated with a poor prognosis of 90 days.The site of stroke is an independent risk factor for CE HT.High admission NIHSS scores are independent risk factors for CE and LAA HT.Higher ASPECTS/PCASPECT scores was independently associated with lower HT risk.4.After PSM,the prognosis and safety benefit of endovascular therapy in patients with ischemic stroke in the CE group and LAA group were consistent.Figure [5] Table [15] Reference [91]... |
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