Outcomes and influencing factors of endovascular treatment in acute ischemic stroke with large vessels occlusion of cerebral anterior circulation
10.3760/cma.j.issn.1671-8925.2018.08.005
- VernacularTitle:急性前循环大血管闭塞血管内治疗效果及影响因素分析
- Author:
Ronghua CHEN
1
;
Jie CAO
;
Jingang XUAN
;
Xucheng ZHU
;
Huaming SHAO
;
Ya PENG
Author Information
1. 213003,常州市第一人民医院(苏州大学附属第三医院)神经外科
- Keywords:
Acute ischemic stroke;
Intracranial large vessel occlusion;
Endovascular treatment
- From:
Chinese Journal of Neuromedicine
2018;17(8):784-789
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the effectiveness and feasibility of endovascular treatment (EVT) in acute large vessel occlusion (LVO) of anterior circulation,and explore its influencing factors.Methods The clinical data of 302 patients with acute LVO of anterior circulation treated with EVT in our hospital from October 2010 to December 2016 were analyzed retrospectively.Collateral blood flow classification (American Society of Interventional and Therapeutic Radiology/Society of Interventional Radiology collateral circulating grading),interventionaI treatment methods,thrombolysisin cerebral infarction (TICI) grading,and National Institutes of Health Stroke Scale (NIHSS) scores before and after treatment were recorded.Incidence and mortality rate of intraoperative and postoperative symptomatic intracranial hemorrhage (sICH) were recorded.The recovery of neurological outcomes was classified by modified Rankin scale (mRS) 90 d after treatment:patients with mRS scores≤2 were divided into a good prognosis group,and those with 3 ≤mRS scores ≤ 6 were divided into a poor prognosis group.Single factor analysis was performed on all clinical parameters that might influence the surgical outcomes;in addition,the influencing factors of prognosis were further analyzed by multivariate Logistic regression analysis.Results (1)After the operation,ASITN/SIR grading 0-2 was noted in 201 patients,ASITN/SIR grading 3-4 was noted in 101 patients.Two hundred sixty-nine patients (89.0％) had good re-canalization (TICI grading 2b-3) after EVT:66.2％ patients were TICI grading 3,22.8％ patients were TICI grading 2b,5.6％ patients were TICI grading 2a,and 5.4％ patients were TICI grading 1-0.The NIHSS scores on discharge (8.4±3.9) were lower than those on admission (16.8+4.7);sICH rate was 10.9％.(2) On 90 d of follow-up,149 patients (49.3％) enjoyed good prognosis,and 153 patients (50.7％) had poor prognosis;and the mortality was 8.3％.(3) Single factor analysis showed that the differences in age,associated atrial fibrillation,NIHSS scores on admission,times of thrombectomy,and collateral circulating grading between good prognosis group and poor prognosis group were statistically significant (P＜0.05);multivariate Logistic regression analysis showed that NIHSS scores on admission and time from symptom onset to vessel recanalization were prognostic risk factors (OR=1.162,95％CI:1.018-1.329,P=0.016;OR=1.008,95％CI:1.003-1.019,P=0.007).Conclusion EVT is an effective and safe approach for acute LVO of anterior circulation.
