Study On Prognostic Factors Related To Endovascular Therapy In Acute Ischemic Stroke

Objective To analyze retrospectively the risk factors of endovascular therapy affecting prognosis of acute ischemic stroke in our hospital.Methods From June 2018 to December 2022,patients admitted to the Advanced stroke Center of the People’s Hospital of Inner Mongolia Autonomous Region were diagnosed as Large vessel occlusion(LVO)from Acute ischemic stroke,AIS(70 patients).All patients received Endovascular thrombectomy(EVT)within 24 h,and percerebrovascular angiography showed recanalization.The modified Rankin score(m RS)was used to evaluate the neurological recovery 90 days after EVT in both groups.According to m RS Scores,the patients were divided into good prognosis group(m RS≤2 points)and poor prognosis group(m RS≥3 points).Demographic characteristics(gender,age),past medical history(hypertension,diabetes,atrial fibrillation,stroke or TIA,smoking history),clinical data(baseline blood pressure,baseline NIHSS score,TOAST etiological classification,preoperative intravenous thrombolysis of rt-PA)were recorded.Laboratory data(baseline serum uric acid,baseline blood glucose,homocysteine,low density lipoprotein),surgical data(onset to puncture time [OTP],puncture to recirculation time [PTR],m TICI grade),postoperative data(24h postoperative head CT,24-36 h postoperative symptomatic intracranial hemorrhage [sICH]).The difference between the two groups was compared,the data between the two groups were analyzed by binary Logistic regression to obtain the risk correlation,and the operating curve(ROC)was made to guide and evaluate the prognosis of patients after EVT(P < 0.05).Results A total of 81 cases were collected,of which 70 cases were successfully opened and eventually included in this study,with an opening rate of 86.41%.Among the 70 enrolled patients,43 were males and 27 were females;The minimum age was 23 years old,the maximum was 82 years old,the mean age was 63.99±12.11 years old.There were 41 cases(58.57%)in the good prognosis group and 29 cases(41.43%)in the poor prognosis group.Age,sex,history of diabetes mellitus,hypertension,atrial fibrillation,stroke or TIA,smoking history,homocysteine,serum uric acid,low density lipoprotein,baseline blood pressure,preoperative intravenous thrombolysis of rt-PA and TOAST classification were compared between the two groups,P > 0.05.There were significant differences in baseline blood glucose,baseline NIHSS score,OTP,PTR and postoperative sICH transformation between the two groups(P < 0.05).1.Baseline NIHSS score: good prognosis group 15.54±3.8,lower than poor prognosis group 18±5.76,P < 0.05;Logistic regression analysis showed that OR=1.121,95%CI 1.003 ～1.252,P < 0.05,suggesting that higher baseline NIHSS score may increase the risk of poor prognosis after intravascular therapy.2.Blood glucose level: the good prognosis group was 6.77±1.85mmol/L,lower than the poor prognosis group 8.92±3.48 mmol /L,P < 0.05;Logistic regression analysis showed that OR=1.657,95%CI 1.101-2.495,P < 0.05,indicating that elevated blood glucose level was an independent risk factor for poor prognosis after intravascular therapy.When the optimal threshold for predicting poor prognosis was 6.71mmol/L,the sensitivity was 72.4% and the specificity was 61%.3.Time from onset to puncture(OTP): 321.1±102.48 min in the good prognosis group was shorter than 456.48±135.23 min in the poor prognosis group,P < 0.001;Logistic regression analysis showed that OR=1.008,95%CI 1.000-1.016,P < 0.05,indicating that prolonged OTP is an independent risk factor for poor prognosis.When OTP predicted the optimal critical value of poor prognosis was 379 min,the sensitivity was 69%,and the specificity was 78%.4.Puncture to rectomy time(PTR): 86.17±24.05 min in the good prognosis group was shorter than 102.45±27.16 min in the poor prognosis group,P < 0.05;Logistic regression analysis showed that OR=1.054,95%CI 1.010-1.099,P < 0.05,indicating that prolonged PTR was an independent risk factor for poor prognosis.When PTR predicted the optimal critical value of poor prognosis was 96.5min,the sensitivity was 72.4% and the specificity was68.3%.5.Symptomatic intracranial hemorrhage: 1 case in the good prognosis group,17 cases in the poor prognosis group,Logistic regression analysis showed that OR=142.469,95%CI7.161-2834.522,P < 0.05,is an independent risk factor for poor prognosis.sICH predicted a poor prognosis with a maximum entry index of 0.562,a sensitivity of 97.6%,and a specificity of 58.6%.6.The maximum entry index of blood glucose,OTP,PTR and postoperative sICH combined to predict poor prognosis was 0.746,sensitivity was 96.6% and specificity was78%.Conclusions1.Baseline NIHSS score affects the prognosis of EVT patients.2.Preoperative elevated blood glucose,prolonged OTP and PTR,and postoperative sICH are independent risk factors affecting EVT prognosis in AIS patients.3.Combined indexes of blood glucose,OTP,PTR and postoperative sICH can predict the clinical prognosis better than single indexes.