| Objective: Through retrospective analysis of the perioperative clinical data of patients with acute ischemic stroke,we studied the factors of cerebral hyperperfusion(CH)after intravascular reperfusion,so as to achieve early detection and intervention,and provide a theoretical basis for improving the neurological function prognosis of patients as soon as possible.Method: A total of 86 patients with acute ischemic stroke who received Endovascular Thrombectomy(EVT)at the Department of Neurology,940 Hospital of the Joint Logistic Support Force from June 2018 to June 2022 were included.General clinical data,previous medical history,preoperative apoplexy-related score,responsible vessels,surgical method,anesthesia method,recanalization time,number of thrombectomy,postoperative imaging findings,hemodynamics and other data of patients were collected from the electronic medical record system,and statistical methods such as t test,Chi-square test and Fisher exact test were used.The influencing factors of CH occurrence in patients with acute intravascular recanalization within 1 month after operation were analyzed.Results:1.A total of 86 patients with acute ischemic stroke who received acute endovascular recanalization,with a median age of 70.5 years old,were included in this study,including 50males(58.1%),76 patients with anterior circulation occlusive stroke(88.4%),and 70 patients(81.4%)who only received mechanical thrombation.74 patients(86%)achieved successful recanalization(TICI grade 2b-3),the NIHSS score on admission was 16.13±6.8,the median m RS Score was 5,and CH occurred in 58 patients(67.4%).A total of 21 patients(24.4%)had good neurological function prognosis at 3 months.2.The admission ASPECTS of CH patients were lower than those of non-cerebral hyperperfusion(N-CH)patients(p=0.000),and the number of thrombectomy was higher(p=0.046).The proportion of high density imaging(p=0.000)and anterior circulation large vessel occlusion(p=0.012)in CT immediately after surgery was higher.The levels of Ddimer(p=0.014),fibrinogen degradation products(FDP)(p=0.008)and neuron-specific enolase(NSE)(p=0.021)were higher.3.Binary Logistic regression analysis of the influencing factors of CH suggested that higher ASPECTS before surgery,cerebral infarction was the protective factor for CH after acute intravascular recanalization,anterior circulation occlusive stroke and immediate postoperative CT manifestations of high density were the risk factors for postoperative CH.4.There was no significant difference in postoperative blood pressure and hemodynamics between patients with CH and those with N-CH within 1 month after surgery.The m RS Score at 3 months was positively correlated with the NIHSS score and m RS Score at discharge.The levels of NSE and C-reactive protein(CRP)were lower in CH patients after m RS 0-2 at 3months(p < 0.05).The 3-month m RS Score of N-CH patients was positively correlated with operation time,anesthesia time and anesthesia time.Conclusion:1.Anterior circulation great vessel occlusion and immediate postoperative CT manifestations of high density imaging are risk factors for the occurrence of CH within 1 month after surgery;Higher hospital admission scores and previous history of ischemic stroke were protective factors for CH.2.There was no significant difference in hemodynamics between cerebral hyperperfusion and non-cerebral hyperperfusion patients under stable postoperative blood pressure control.3.High NIHSS Scores and m RS Scores on admission are associated with poor prognosis in patients with acute ischemic stroke and intravascular recanalization;High neutrophil counts,NSE and CRP levels immediately after surgery were associated with poor prognosis. |
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