Analysis of the efficacy of mechanical thrombectomy in acute progressive ischemic stroke with large vessel occlusion in the anterior circulation
Objective To investigate the efficacy and safety of mechanical thrombectomy in patients with acute progressive ischemic stroke with large vessel occlusion in the anterior circulation.Methods From January 2020 to April 2023,414 patients with acute progressive ischemic stroke with large vessel occlusion in the anterior cirulation in Hebei General Hospital were included.According to the time of onset and whether the patients underwent mechanical thrombectomy,the patients were divided into direct mechanical thrombectomy group(n=293),progressive stroke mechanical thrombectomy group(n=45),and standard medical treatment group(n=76).The modified Rankin Scale(mRS)and modified Thrombolysis in Cerebral Infarction(mTICI)were used to evaluate neurological prognosis and vascular recanalization.The incidence of symptomatic intracranial hemorrhage after treatment and 3-month all-cause mortality were recorded.Results There was a statistically significant difference in neurological prognosis among the 3 groups(x2=19.572,P=0.000).The rate of good prognosis in standard medical treatment group was lower than that progressive stroke mechanical thrombectomy group(Z=-2.829,P=0.005)and direct mechanical thrombectomy group(Z=-4.422,P=0.000),while there was no statistically significant difference in the rate of good prognosis between direct mechanical thrombectomy group and progressive stroke mechanical thrombectomy group(Z=-0.525,P=0.600).Logistic regression analysis showed that high National Institutes of Health Stroke Scale(NIHSS)score before treatment(OR=1.298,95％CI:1.216-1.385;P=0.000)and standard medical treatment(OR=7.572,95％CI:3.048-18.809;P=0.000)were the risk factors for poor prognosis,and direct mechanical thrombectomy was the protective factor for good prognosis(OR=0.431,95％CI:0.212-0.879;P=0.021).There was no statistically significant difference in the vascular recanalization rate between progressive stroke mechanical thrombectomy group and direct mechanical thrombectomy group(x2=0.218,P=0.640).There was a statistically significant difference in the incidence of symptomatic intracranial hemorrhage after treatment among the 3 groups(x2=6.575,P=0.037),and direct mechanical thrombectomy group was higher than that of standard medical treatment group(Z=-2.376,P=0.018).There was no statistically significant difference in the 3-month all-cause mortality(x2=5.178,P=0.075).Conclusions Mechanical thrombectomy is feasible in patients with acute progressive ischemic stroke with large vessel occlusion in the anterior circulation,and has a good efficacy and safety.
Ischemic strokeCircle of WillisArterial occlusive diseasesThrombectomyPrognosisRisk factorsLogistic models
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