机械血栓切除术治疗前后循环急性大血管闭塞性缺血性卒中患者的效果及预后的影响因素OACSTPCD

Objective To observe the clinical effect of mechanical thrombectomy(MT)in the treatment of anterior and posterior circulation acute ischemic stroke with large vessel occlusion(AIS-LVO),and analyze the related factors affecting the prognosis.Methods A total of 124 patients with AIS-LVO admitted to Department of Neurology,Cangzhou People's Hospital from April 2019 to April 2023 were selected as the research objects.According to mRS score at 90 days after operation,they were divided into the good prognosis group and the poor prognosis group.The basic clinical characteristics,NIHSS score,occlusion vessel location,blood pressure,ASPECT score,surgical and prognostic indicators of the two groups were analyzed.The statistically significant factors were included in the multivariate Logistic regression model,and the receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of the influencing factors for the prognosis.Results There were 45 patients with good prognosis and 79 patients with poor prognosis.There was significant difference between the two groups in NIHSS score,location of occluded vessel,blood pressure and ASPECT score,time from admission to recanalization,successful recanalization,vascular recanalization grade(TICI),intracranial hemorrhage within 24 hours,mRS score at 90-day after operation,deaths at 90-day after operation between the two groups(P<0.05).Multivariate Logistic regression analysis showed that increased NIHSS score(P=0.014,OR=2.065),increased blood pressure at admission(P=0.044,OR=1.033),increased ASPECT score(P=0.001,OR=1.741),longer time from admission to recanalization(P=0.002,OR=2.912),increased time from admission to reopening(P=0.001,OR=1.025),and intracranial hemorrhage within 24 hours(P=0.034,OR=4.033)increased the probability of poor prognosis.ROC analysis showed that the area under the curve(AUC)of Logistic regression analysis model for predicting the prognosis of mechanical thrombectomy in patients with AIS-LVO was 0.768(95%CI:0.861-0.962,P<0.001).The sensitivity was 74.68%and the specificity was 97.78%.Conclusion NIHSS score at admission,blood pressure,ASPECT score,time from onset to admission,time from admission to recanalization,and intracranial hemorrhage within 24 hours are the risk factors affecting the prognosis.The predictive model established by these factors has good diagnostic efficacy.Multivariate analysis can be used as an important predictor of prognosis in patients with AIS-LVO treated by MT.