Analysis of predictive factors and short-term efficacy of complications after intracranial-extracranial revascularization for symptomatic atherosclerotic internal carotid artery or middle cerebral artery occlusion
Objective To investigate the early warning factors and short-term efficacy of complications after intracranial-extracranial revascularization in patients with symptomatic atherosclerotic internal carotid artery(ICA)or middle cerebral artery(MCA)occlusion.Methods The clinical data of patients with symptomatic atherosclerotic ICA or MCA occlusion who underwent intracranial-extracranial revascularization at the Neurosurgery Center of Beijing Tiantan Hospital,Capital Medical University from January 2019 to March 2023 were retrospectively analyzed.A total of 120 cases(120 sides,all first surgery)were included.According to whether complications occurred within 14 days after surgery,the patients were divided into a complication group and a non-complication group.The differences in clinical data between the two groups were analyzed,and the indicators with statistically significant differences were included in the multivariate logistic regression model to screen the related factors affecting postoperative complications.The 1∶2 propensity score matching method was used to screen the complication group and the non-complication group.We then compared the differences in modified Rankin Scale score(mRS)and CT perfusion-weighted imaging(CTP)staging between the two groups 3 to 6 months after surgery.Results A total of 19 cases(15.83％)of 120 patients had postoperative complications,including 5 cases(4.17％)of cerebral infarction,2 cases(1.67％)of cerebral hemorrhage,and 12 cases(10.00％)of transient neurological dysfunction.Compared with the non-complication group,patients in the complication group had a higher proportion of surgery on the left side,higher preoperative systolic blood pressure and hematocrit,higher white blood cell count and neutrophil-to-lymphocyte ratio(NLR)on the first postoperative day,higher systemic immune inflammation index,and the differences were statistically significant(all P＜0.05).Multivariate logistic regression analysis showed that high preoperative systolic blood pressure(OR=1.06,95％CI:1.01-1.11,P=0.022)and high NLR on the first day after surgery(OR=1.14,95％CI:1.04-1.24,P=0.006),and the surgical side being the left side(OR=12.87,95％CI:2.68-61.70,P=0.001)were early warning factors for postoperative complications in patients.Comparing the complication group(15 cases)and the non-complication group(25 cases)using 1:2 propensity score matching,there was no statistically significant difference in mRS or CTP staging 3 to 6 months after surgery(both P＞0.05).Conclusions High preoperative systolic blood pressure,high NLR on the first postoperative day,and left-sided surgery are early warning factors for complications after intracranial-extracranial revascularization in patients with symptomatic atherosclerotic ICA or MCA occlusion.Newly-developed postoperative complications have no significant impact on the patient's short-term outcomes.
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