Objective:To construct a nomogram model for predicting the first pass effect (FPE) in mechanical thrombectomy for acute ischemic stroke with anterior circulation large vessel occlusion(AIS-LVO).Methods:Retrospectively controlled analyzed the clinical data of 146 patients with acute ischemic stroke due to anterior circulation large vessel occlusion who underwent mechanical thrombectomy in the Affiliated Suzhou Hospital of Nanjing Medical University (Suzhou Municipal Hospital) from January 2020 to January 2025. Among the 146 patients, there were 76 males and 70 females, with an age ranged from 39 to 88 years old and a median age of 75 years. According to whether FPE was obtained during the operation, the patients were divided into the FPE group ( n=47)and the non-FPE group ( n=99). The clinical data between the two groups were compared, and those with statistically significant differences ( P<0.05) throngh univariate analysis were included in the multivariate Logistic regression analysis to screen the independent risk factors affecting FPE and establish a nomogram model. The efficiency, goodness of fit and benefit of the established model were tested through internal validation. Results:The results of univariate analysis showed that there were statistically significant differences in the history of essential hypertension, clot burden score (CBS), internal carotid artery tortuosity, hyperdense vessel sign, serum D-dimer value, serum lymphocyte count, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) between the two groups ( P<0.05). Multivariate Logistic regression analysis showed that the history of essential hypertension ( OR=0.25, 95% CI: 0.09-0.67, P=0.006), high clot burden with CBS ≤ 6 points ( OR=0.25, 95% CI: 0.10-0.66, P=0.005), internal carotid artery tortuosity ( OR=0.38, 95% CI: 0.15-0.98, P=0.044), high PLR ( OR=0.98, 95% CI: 0.97-0.99, P=0.005), and high D-dimer ( OR=0.35, 95% CI: 0.15-0.81, P=0.015) were all independent risk factors affecting FPE in mechanical thrombectomy for acute ischemic stroke with anterior circulation large vessel occlusion ( P<0.05). A nomogram prediction model was established based on the above risk factors. The verification results showed that the area under the curve was 0.836, the Hosmer-Lemeshow test showed that χ2=5.105, P=0.746, and the decision curve showed that when the threshold probability was in the range of 0.01 to 0.87, there was a higher net benefit value. Conclusion:The nomogram model established according to the patient′s history of essential hypertension, clot burden score, whether there is internal carotid artery tortuosity, PLR, and D-dimer can predict the probability of obtaining FPE in mechanical thrombectomy for acute ischemic stroke with anterior circulation large vessel occlusion.

Traumatic craniocerebral injury has been paid close attention by neurosurgeons at home and abroad due to its high morbidity and mortality.Cerebral contusion and intracranial hematoma caused by various injury mechanisms are the main causes of increased intracranial pressure in the acute stage of traumatic brain injury.As a classic surgical method,standard decompressive craniotomy,often together with intracranial hematoma evacuation,brain debridement and internal decompression,has become the main surgical treatment in the acute stage of traumatic brain injury,saving the lives of many patients with severe cerebral injury,the importance of this procedure is irreplaceable.In long-term clinical practice,through the unremitting efforts of first-line neurosurgeons and neuroscientists,a large number of studies have been conducted on the relationship between the details,norms and prognosis of craniotomy,so as to better regulate the treatment of traumatic brain injury and reduce the death and disability rate of patients with severe brain injury.This article systematically reviews and analyzes the pathophysiological mechanism of intracranial hypertension and the mechanism,development history,surgical methods,indications and contraindications,prognosis and prospects of the intracranial hypertension.Through this article,the author hope to have some guidance and suggestions for future clinical work.

Objective To clarify the relationship between intracranial pressure monitoring and prognosis of patients with traumatic brain injury after decompressive craniectomy.Methods From December 2015 to December 2017,48 head-injured patients in Affiliated Suzhou Hospital of Nanjing Medical University were enrolled,who were underwent decompressive craniectomy in this retrospective study.The patients were subdivided into 2 groups based on whether postoperative was monitored (n =19) or not (n =29).The prognosis was evaluated by Glasgow Outcome Scale score,with 1 point of prognosis death,2 to 3 points of poor prognosis,and 4 to 5 points of good prognosis.Count data were expressed as a percentage (％).Count data were expressed as percentage (％).The chi-square test was used to compare the difference in the rate of good prognosis and mortality between the two groups.Results The mortality of monitoring group (10.5％) was significantly lower than that of control group (37.9％) (x2 =4.365 5,P =0.036 7) during hospitalization,The rate of good prognosis in the monitoring group (68.4％) and the control group (44.8％) was not statistically significant (x2 =2.573 8,P =0.108 6).Condusion The study showed that continuous monitoring in patients with severe craniocerebral injury could reduce the mortality of patients during hospitalization,but had no significant effect on the improvement of prognosis.