Effect of endovascular mechanical thrombectomy in young and middle-aged patients with anterior circulation large vessel occlusion-acute ischemic stroke and influencing factors of prognosis
Objective To observe the outcome of endovascular mechanical thrombectomy(MT)in young and middle-aged patients(aged 18 to 50 years)with anterior circulation large vessel occlusion-acute ischemic stroke(LVO-AIS),and to explore the influencing factors of 90-d poor prognosis after MT.Methods Fifty-two young and middle-aged patients with anterior circulation LVO-AIS were performed MT within 24 h after onset in Zhongnan Hospital of Wuhan University from January 2019 to August 2022,and were divided into good prognosis group[modified Rankin score(mRS)≤2]and poor prognosis group(mRS＞2)according to 90-d mRS after MT.The gender,age,comorbidities(hypertension,diabetes,atrial fibrillation,coronary heart disease,hyperlipidemia),smoking habits,vascular occlusion location,vascular occlusion number,TOAST etiology classification,National Institute of Health Stroke Ccale(NIHSS)score on admission,Alberta stroke program early CT score(ASPECTS),neutrophil to lymphocyte ratio(NLR),rate of intravenous thrombolysis,time from onset to puncture,time from onset to recanalization,time from puncture to recanalization,frequency of embolectomy,balloon and/or stent implantation rate,vascular reperfusion success rate and incidence of postoperative complications(intracranial hemorrhage,symptomatic intracranial hemorrhage,pulmonary infection and deep venous thrombosis of lower extremities)were compared between two groups.Multivariate logistic regression analysis was used to analyze the influencing factors of 90-d poor prognosis after MT in young and middle-aged patients with anterior circulation LVO-AIS.ROC curve was plotted to evaluate the predictive efficiencies of hypertension and admission ASPECTS on 90-d poor prognosis after MT.Results(1)The 90-d mRS after MT was ≤2 in 29 patients and＞2 in 23.The admission ASPECTS was higher in good prognosis group[8.00(8.00,9.00)]than that in poor prognosis group[7.00(5.50,8.00)](U=-2.944,P=0.003),the rate of hypertension was lower in good prognosis group(20.69％)than that in poor prognosis group(60.87％)(x2=7.134,P=0.008),and there were no significant differences in the age,TOAST etiology classification,admission NIHSS score,NLR,vascular occlusion location,and proportions of male patients,diabetes,hyperlipidemia,atrial fibrillation,coronary heart disease,smoking habits,and vascular occlusion number ≥2 between two groups(P＞0.05).(2)The postoperative vascular reperfusion success rate was higher in good prognosis group(93.10％)than that in poor prognosis group(56.52％)(x2=7.719,P=0.005).There were no significant differences in the time from onset to operation,time from onset to recanalization,time from puncture to recanalization,frequency of embolectomy,rate of intravenous thrombolysis,balloon and/or stent implantation rate,and incidences of symptomatic intracranial hemorrhage,intracerebral hemorrhage,pulmonary infection,and deep vein thrombosis in lower extremities between two groups(P＞0.05).(3)Admission ASPECTS(OR=0.531,95％CI:0.138-0.887,P=0.016)and hypertension(OR=4.589,95％CI:1.046-20.143,P=0.043)were the influencing factors of 90-d poor prognosis after MT in young and middle-aged patients with anterior circulation LVO-AIS.(4)The AUC of hypertension for predicting 90-d poor prognosis after MT was 0.701(95％CI:0.553-0.848,P=0.014),the sensitivity was 60.9％,and the specificity was 79.3％.When the optimal cut-off value of admission ASPECTS was 7.5,the AUC for predicting 90-d poor prognosis after MT was 0.735(95％CI:0.600-0.870,P=0.004),the sensitivity was 65.2％,and the specificity was 75.9％.The AUC of the them two in combination for predicting 90-d poor prognosis after MT was 0.822(95％CI:0.707-0.936,P＜0.001),the sensitivity was 82.6％,and the specificity was 65.5％.Conclusion The young and middle-aged patients with anterior circulation LVO-AIS are at a high risk of 90-d poor prognosis after MT when they are complicated with hypertension and reduced ASPECTS on admission,and the combination of hypertension and admission ASPECTS has a high prognostic value.
acute ischemic strokeanterior circulation large vessel occlusionmechanical thrombectomyhypertensionAlbert stroke program early CT score
NETL
NSTL
万方数据
维普
