ABSTRACT
Objective To investigate the predictors of death after endovascular mechanical thrombectomy (EMT) in patients with acute vertebrobasilar occlusive stroke (VBOS).Methods Patients with acute VBOS treated with EMT in Wuhan No.1 Hospital were enrolled retrospectively.The demographic and clinical data were collected.According to whether the patients died at 90 d after procedure,they were divided into survival group and death group.The demographic and clinical data were compared between the two groups.Multivariate logistic regression analysis was used to determine the independent risk factors for death at 90 d after EMT.Results A total of 47 patients were enrolled.The median age was 62 years,34 were males (72.3％),the median baseline National Institutes of Health Stroke Scale (NIHSS) score was 16,42 patients (89.4％) had recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] 2b/3 grade),and 12 (25.5％) died within 90 d after procedure.Univariate analysis showed that the baseline NIHSS score (26 [21-28]vs.12 [5-23];Z=-3.165,P=0.002),percentage of neutrophil (81.61％ ± 11.82％ vs.72.20％ ± 12.09％;t =-2.137,P =0.033),neutrophil/lymphocyte ratio (10.54 ±7.17 vs.4.98 ±3.57;t =-2.393,P=0.017),and incidence of sICH (25.0％ vs.2.9％;x2 =5.627,P=0.018) in the death group were significantly higher than those in the survival group,while the percentage of lymphocyte (12.00％ ± 9.04％ vs.20.67％ ±10.39％;t =-2.429,P=0.015) was significantly lower than that of the survival group.Multivariate logistic regression analysis showed that high baseline NIHSS score (odds ratio [OR] 1.243,95％ confidence interval [CI] 1.046-1.318;P =0.038),high neutrophil/lymphocyte ratio (OR 1.278,95％ CI 1.002-1.630;P =0.049) and symptomatic intracranial hemorrhage (OR 5.088,95％ CI 1.065-38.718;P =0.046) were the independent predictors for death.Conclusion High baseline NIHSS score,high neutrophil/lymphocyte ratio and symptomatic intracranial hemorrhage are the independent predictors for death within 90 d after EMT in patients with acute VBOS.
ABSTRACT
Objective@#To investigate the predictors of death after endovascular mechanical thrombectomy (EMT) in patients with acute vertebrobasilar occlusive stroke (VBOS).@*Methods@#Patients with acute VBOS treated with EMT in Wuhan No. 1 Hospital were enrolled retrospectively. The demographic and clinical data were collected. According to whether the patients died at 90 d after procedure, they were divided into survival group and death group. The demographic and clinical data were compared between the two groups. Multivariate logistic regression analysis was used to determine the independent risk factors for death at 90 d after EMT.@*Results@#A total of 47 patients were enrolled. The median age was 62 years, 34 were males (72.3%), the median baseline National Institutes of Health Stroke Scale (NIHSS) score was 16, 42 patients (89.4%) had recanalization (modified Thrombolysis in Cerebral Infarction[mTICI] 2b/3 grade), and 12 (25.5%) died within 90 d after procedure. Univariate analysis showed that the baseline NIHSS score (26 [21-28]vs. 12 [5-23]; Z=-3.165, P=0.002), percentage of neutrophil (81.61% ±11.82% vs. 72.20% ±12.09%; t=-2.137, P=0.033), neutrophil/lymphocyte ratio (10.54±7.17 vs. 4.98±3.57; t=-2.393, P=0.017), and incidence of sICH (25.0% vs. 2.9%; χ2=5.627, P=0.018) in the death group were significantly higher than those in the survival group, while the percentage of lymphocyte (12.00%±9.04% vs. 20.67%±10.39%; t=-2.429, P=0.015) was significantly lower than that of the survival group. Multivariate logistic regression analysis showed that high baseline NIHSS score (odds ratio [OR] 1.243, 95% confidence interval [CI] 1.046-1.318; P=0.038), high neutrophil/lymphocyte ratio (OR 1.278, 95% CI 1.002-1.630; P=0.049) and symptomatic intracranial hemorrhage (OR 5.088, 95% CI 1.065-38.718; P=0.046) were the independent predictors for death.@*Conclusion@#High baseline NIHSS score, high neutrophil/lymphocyte ratio and symptomatic intracranial hemorrhage are the independent predictors for death within 90 d after EMT in patients with acute VBOS.
ABSTRACT
Objective To explore the safety and efficacy of Solitaire AB double stents in acute occlusions in bifurcation of cerebral artery (including the ends of internal carotid artery and middle cerebral artery M1 segment).Methods The clinical and imaging data of six cases treated with the double stent retriever technique using the Solitaire AB system in Wuhan No.1 Hospital from January to November 2017 were retrospectively analyzed.And the therapeutic effect and postoperative complications of them were analyzed.Results One patient took the double stents directly,whereas five patients were treated with double stent-retriever thrombectomy after the failure of single stent thrombectomy.All of the six patients achieved recanalization successfully (modified thrombolysis in cerebral infarction (mTICI) 3 in five patients,mTICI 2b in one).All patients had no intracranial hemorrhage immediately after thrombectomy.In the 24 hours,7 days and 2 weeks,the median NIHSS score was 10 (3-17),3 (1-15) and 1 (0-15),respectively.During perioperative period,one patient had asymptomatic cerebral hemorrhage,one died of symptomatic cerebral hemorrhage within 48 hours,and one was complicated with pulmonary infection.Five patients were followed up by outpatient visit,and four patients showed good outcome (modified Rankin Scale score ≤2).Conclusion In the emergency revascularization of acute cerebral artery occlusion at arterial bifurcation,double stent-retriever is better at increasing the efficacy of thrombectomy and is safe compared with single stent mechanical thrombectomy.