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Objective:To analyze the predictors of poor outcomes after emergency intracerebral thrombectomy based on the characteristics of cerebral angiography.Methods:A total of 146 patients with acute ischemic stroke (AIS) who received endovascular treatment in Loudi Central Hospital from March 2019 to February 2022 were included in the study, and digital subtraction angiography (DSA) was performed on the patients. The patients were divided into a good prognosis group (95 cases) and a poor prognosis group (51 cases) by the modified Rankin scale 3 months after operation. Gender, age, time from onset to visit, time from onset to puncture, proportion of intravenous thrombolysis, occlusion site, treatment strategy, National Institute of Health Stroke Scale (NIHSS) score, core infarct volume, ischemic hypoperfusion volume, collateral circulation classification, and venous drainage status were compared between the two groups score; Logistic regression was used to analyze the risk factors affecting the poor prognosis of patients; Receive Operating Characteristic (ROC) curve was used to analyze the predictive value of collateral circulation classification and venous drainage status score for poor prognosis of patients, and the differences in general data and imaging data were compared between groups with different collateral circulation grades and venous drainage status.Results:Compared with the good outcome group, the time from onset to visit, NIHSS score, core infarct volume, ischemic hypoperfusion volume, the proportion of thrombectomy alone, and collateral circulation classification in the poor outcome group [2 (2, 3) levels. 2 (1, 2) level] and venous drainage score [5 (4, 6) points vs. 6 (6, 8) points] increased ( P<0.05), and the proportion of recanalization grade 2b/3 decreased ( P<0.05); NIHSS score, collateral circulation grade and venous drainage status were predictors of poor outcome within 3 months after mechanical thrombectomy ( OR = 2.51, 1.93, 2.61, P<0.05); collateral circulation grade and venous drainage score predicted mechanical thrombectomy in patients with AIS, the area under curve (AUC) of poor outcome after thrombectomy were 0.714 and 0.829, respectively; the time from onset to visit between patients with poor collateral circulation, moderate and good AIS [(236.95 ± 21.03) min, (250.41 ± 21.32) min, (255.72 ± 20.98 min)], core infarct volume [52 (17, 80) ml, 25 (15.5, 30) ml, 15 (10, 25) ml] and venous drainage scores [5 (4, 6) points, 5 (5, 8) points, 5 (5, 8) points] were significantly different ( P<0.05); time from onset to visit in patients with poor venous drainage, moderate and good AIS (234.81 ± 21.22 min), (256.83 ± 20.88) min, (258.97 ± 21.35) min], core infarct volume [17(13, 45) ml, 26(25, 29) ml, 20 (11, 29) ml] and collateral circulation classification [2 (1, 2) level, 2 (1, 3) level, 2 (2, 3) level] were significantly different ( P<0.05). Conclusions:Collateral grading and venous drainage scores based on DSA imaging were predictors of poor outcomes within 3 months of mechanical arterial thrombectomy in patients with AIS.
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Posterior reversible encephalopathy syndrome is a clinical and radiological entity,caused by a variety of reasons.We report a case of rhabdomyolysis complicated by posterior reversible encephalopathy and suggest that giving fluids early,use of diuretics and alkalization of urine may be reasonable for patients with rhabdomyolysis.Monitoring blood pressure is noteworthy to prevent target organ damage,and if patient condition steadily deteriorates,hemodialysis should be initiated.
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The curative efficacy of percutaneous transluminal angioplasty and stenting (PTAS) in the treatment of patients with ischemia cerebrovascular disease caused by artery stenosis was explored. The clinical data of 111 patients with ischemia cerebrovascular disease receiving PTAS in Guangdong Province General Hospital from Aug. 2007 to Nov. 2009 were retrospectively analyzed. In total 132 stents were implanted in the 111 patients. The mortality and rate of neural and non-neural complications were assessed perioperatively. Outcomes [including the frequency of transient ischemic attack (TIA), stroke, or death from vascular diseases) were assessed after operation. NIHSS rating was performed in all cases before and at first week, 6th month and 12th month after the operation. The PTAS success rate was 100%. The degree of stenosis was reduced after PTAS. The total complication rate during perioperative period was 15.3% (the rate of neural complications was 3.6%). Sixty-seven patients were followed up. Three patients (4.48%) developed cerebrovascular events within 1 month, containing one case of TIA, one case of ipsilateral mild stroke and one case of contralateral mild stroke. No severe stroke or death was observed. During a follow-up period of 12 months 7 patients had cerebrovascular events (10.44%), including 2 cases of ipsilateral TIA (2.99%), 2 cases of ipsilateral mild stroke and 2 cases of contralateral mild stroke (2.99%), one case of severe stroke (1.49%). In 13 patients receiving DSA re-examination one year after PTAS, 2 patients (15.38%) had in-stent restenosis. NIHSS scores were obviously decreased during a follow-up period as compared with those pre-operation (P<0.05). It was concluded that PTAS could significantly alleviate the neural function deficit of the patients with ischemia cerebrovascular disease. The success rate of PTAS was high, and the rate of complications was lower and the clinical outcomes were satisfactory. PTAS is a safe and effective therapeutic method, though the long-term outcomes need further study.
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Objective To observe the prognostic factors of functional outcome of patients with cerebral infraction treated in stroke unit.Methods The data of patients with cerebral infractions treated in stroke unit in our hospital were prospectively collected from April 2004 to December 2005 continuously.All the patients They were fol lowed up either by their regular visits to our outpatient clinics or by phone interview.The modified Rankin scale(mRS)score was used as the index of primary outcome.The prognostic factors of the functional outcome were analyzed by monovariate and multivariate logistic regression.Results A total of 150 cases were collected,of whom 98 were with good outcome,52 cases with poor outcome.The multivariate logistic regression showed that the poor outcome was associated with aging,previous history of stroke,high NIHSS scores,complications,and time from onset of the disease to admission to stroke unit.Conclusion The results suggested that older age,having stroke history,higher NIHSS total scores,having complications and delayed hospitalized time were influence factors to functional outcome of cerebral infractions in stroke unit.