| Objective: Acute great vascular occlusive stroke is one of the diseases with the highest mortality rate.The proportion of patients with poor prognosis is still high after receiving timely vascular recanalization.Therefore,how to improve the prognosis is the focus and hotspot of current clinical research.The objective of this study was to investigate the risk factors for poor prognosis 90 days after recanalization of endovascular therapy in patients with acute large vessel occlusive stroke.Methods: Part Ⅰ: A total of 185 patients with LVOs who received endovascular therapy in Jin Yang Hospital Affiliated to Guizhou Medical University from January 2020 to November 2022 were selected as the research objects,among which 11 cases were lost to followup and 4 cases had no vascularization.A total of 170 patients included in the statistical analysis were followed up.According to the 90-day m RS Score,the patients were divided into good prognosis group(n=77)and poor prognosis group(n=93).Age,sex,smoking history,alcohol history,past history,NIHSS score on admission and postoperative,Glasgow score on admission(GCS),bridging treatment,intervention method,onset--admission time,onset--operation time,admission blood pressure,infarct volume,occlusive system,TOAST classification,and thrombus removal were collected from 170 patients Univariate analysis was performed on the number of times,intraoperative medication,balloon dilatation,stroke-related pneumonia,gastrointestinal bleeding,cerebral hernia formation,hemorrhage transformation and laboratory data.The indexes with p<0.05 in univariate analysis were finally included in multivariate Logistic regression analysis to analyze independent risk factors affecting 90-day poor prognosis.Secondly,the 170 patients were divided into bridging treatment group(n=103)and non-bridging treatment group(n=67)according to whether preoperative intravenous thrombolysis was performed.Univariate analysis of relevant baseline data was performed.Part II: According to whether the 170 patients with successful recalculation had postoperative hemorrhage transformation,they were divided into the hemorrhage transformation group(n=61)and the non-hemorrhage transformation group(n=109).Univariate analysis was performed on relevant baseline data,and the p < 0.05 in the univariate analysis was finally included in the multivariate Logistic regression analysis to analyze the risk factors of postoperative hemorrhage transformation.Results: Part Ⅰ: Among 170 patients with vascular recanalization included in the analysis,77(45.3%)had a good 90-day prognosis(m RS≤2),while 93(54.7%)had a poor 90-day prognosis.In univariate analysis,the incidence of admission NIHSS score,postoperative NIHSS score,carotid plaque proportion,infarct volume,thrombectomy times,triglycerides,random blood glucose,serious cardiac complications,strokerelated pneumonia,cerebral hernia formation,and postoperative hemorrhage transformation in the poor prognosis group were higher than those in the good prognosis group,with statistical significance(p < 0.05).The admission GCS score,smoking proportion and blood calcium value were all lower than those of good prognosis group,with statistical significance(p < 0.05).In multivariate analysis,stroke-related pneumonia(OR: 3.964,95%CI: 1.619-9.702,p=0.003),postoperative hemorrhage conversion(OR: 4.166,95%CI: 1.530-11.344,p=0.005),blood glucose level(OR: 0.793,95%CI: 0.6633-0.948,p=0.011),triglyceride(OR: 0.417,95%CI: 0.248-0.699,p=0.001)were the factors affecting the poor prognosis of patients with acute great vessel occlusion stroke after intravascular therapy.Part II: 61 patients(35.88%)underwent postoperative hemorrhage transformation.In univariate analysis of hemorrhage transformation and non-hemorrhage transformation groups,thromposectomy times,random blood glucose,triglyceride,and posterior circulation occlusion rate in hemorrhage transformation group were higher than those in non-hemorrhage transformation group,with statistical significance(p<0.05).In multivariate analysis,triglyceride(OR: 1.554,95%CI: 1.121-2.153,p=0.008),occlusive system(OR: 2.644,95%CI: 1.074-6.057,p=0.034),number of thrombus removal(OR: 1.387,95%CI: 1.077-1.785,p=0.011)was an independent risk factor for hemorrhage transformation in patients with acute great vessel occlusion after endovascular therapy.Conclusions: There was no significant correlation between the prognosis of patients with endovascular therapy and whether they received intravenous thrombolytic therapy before surgery,while stroke-related pneumonia,postoperative hemorrhage transformation were risk factors affecting the poor prognosis of patients with LVOs after intravascular endovascular therapy.The number of thrombectomy,triglyceride and posterior circulation occlusion were independent risk factors for postoperative bleeding transformation. |
