Analysis of the efficacy of mechanical thrombectomy in acute progressive ischemic stroke with large vessel occlusion in the anterior circulation

Abstract

Objective To investigate the efficacy and safety of mechanical thrombectomy inpatients 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 withlarge vessel occlusion in the anterior cirulation in Hebei General Hospital were included. According to thetime of onset and whether the patients underwent mechanical thrombectomy, the patients were divided intodirect 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 modifiedThrombolysis in Cerebral Infarction (mTICI) were used to evaluate neurological prognosis and vascularrecanalization. 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 prognosisamong the 3 groups (χ2 = 19.572, P = 0.000). The rate of good prognosis in standard medical treatmentgroup was lower than that progressive stroke mechanical thrombectomy group (Z = ⁃ 2.829, P = 0.005) anddirect mechanical thrombectomy group (Z = ⁃ 4.422, P = 0.000), while there was no statistically significantdifference in the rate of good prognosis between direct mechanical thrombectomy group and progressivestroke mechanical thrombectomy group (Z = ⁃ 0.525, P = 0.600). Logistic regression analysis showed thathigh 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 therisk factors for poor prognosis, and direct mechanical thrombectomy was the protective factor for goodprognosis (OR = 0.431, 95%CI: 0.212-0.879; P = 0.021). There was no statistically significant difference inthe vascular recanalization rate between progressive stroke mechanical thrombectomy group and directmechanical thrombectomy group (χ2 = 0.218, P = 0.640). There was a statistically significant difference inthe incidence of symptomatic intracranial hemorrhage after treatment among the 3 groups (χ2 = 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(χ2 = 5.178, P = 0.075). Conclusions Mechanical thrombectomy is feasible in patients with acuteprogressive ischemic stroke with large vessel occlusion in the anterior circulation, and has a good efficacyand safety.

doi：10.3969/j.issn.1672⁃6731.2024.11.006