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Liu Y, Hong Z, Li Y, Li S, Liu Q, Xie S, Wang J, Wang J, Zheng M. Effect of intravenous thrombolysis combined with mechanical thrombectomy on neurological function and short-term prognosis of patients with acute cerebral infarction. Am J Transl Res 2022; 14:2376-2382. [PMID: 35559387 PMCID: PMC9091080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/09/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study was to assess the effect of intravenous thrombolysis combined with mechanical thrombectomy on neurological function and the short-term prognosis of patients with acute cerebral infarction (ACI). METHODS A total of 120 patients with ACI admitted to our hospital from January 2019 to January 2020 were selected as research objects, and randomized into Group A (n=60) or Group B (n=60). Patients in both groups were treated with intravenous thrombolysis. Group B received ACI conventional treatment and intravenous thrombolysis, while Group A was additionally given mechanical thrombectomy. Then the neurological function scores, serum factor levels, vascular recanalization rate, incidence of adverse reactions, Thrombolysis in Myocardial Infarction (TIMI) grade flow, and effective rate of treatment were compared between the two groups. The clinical trial is available at https://clinicaltrials.gov/, ClinicalTrials.gov Identifier: NCT03502411. RESULTS The neurological function scores of Group A were apparently lower than those of Group B one month after treatment (P<0.001). After treatment, Group A yielded a superior serum factor level compared to Group B (P<0.001), and also showed a higher recanalization rate of blood vessels and a notably lower adverse reaction rate (all P<0.05). CONCLUSION Intravenous thrombolysis combined with mechanical thrombectomy can accelerate the recovery of neurological function in patients with ACI, and yield a more promising outcome in terms of the patient's vascular recanalization rate compared with the monotherapy. It can also reduce the adverse reaction rate of patients to ensure a better short-term prognosis.
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Affiliation(s)
- Yongchang Liu
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
| | - Zhen Hong
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
| | - Yan Li
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
| | - Shaoquan Li
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
| | - Qingran Liu
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
| | - Songwang Xie
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
| | - Junyong Wang
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
| | - Jian Wang
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
| | - Mingming Zheng
- Department of Neurovascular Intervention, Cangzhou Central Hospital Cangzhou, China
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Pan H, Lin C, Chen L, Qiao Y, Huang P, Liu B, Zhu Y, Su J, Liu J. Multiple-Factor Analyses of Futile Recanalization in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy. Front Neurol 2021; 12:704088. [PMID: 34489851 PMCID: PMC8416752 DOI: 10.3389/fneur.2021.704088] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/28/2021] [Indexed: 12/30/2022] Open
Abstract
Background and Purpose: Acute ischemic stroke (AIS) is a serious threat to the life and health of middle-aged and elderly people. Mechanical thrombectomy offers the advantages of rapid recanalization, but the response of patients to this treatment varies greatly. This study investigated the risk factors for futile recanalization in AIS patients after thrombectomy through multivariate analyses. Methods: A retrospective study was conducted in AIS patients with anterior circulation occlusion from a derivation cohort and a validation cohort who underwent thrombectomy and reperfusion defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b/3. Using the modified Rankin Scale (mRS) at 90 days after the operation, the patients were divided into two groups, the meaningful recanalization group (mRS ≤ 2), and the futile recanalization group (mRS > 2). Multivariate logistic regression analyses were performed, and the receiver operating characteristic (ROC) curve was used to construct a risk prediction model for futile recanalization. The performance of prediction model was evaluated on the validation cohort. Results: A total of 140 patients in the derivation cohort were enrolled, 46 patients in the meaningful recanalization group and 94 patients in the futile recanalization group. The two groups were significantly different in age, preoperative National Institute of Health Stroke Scale (NIHSS) score, and collateral circulation ASITN/SIR grade (P < 0.05). In multivariate regression analyses, patients' age ≥ 71, NIHSS ≥ 12, and ASITN/SIR ≤ 3 were risk factors for futile recanalization. Hence, an ANA (Age-NIHSS-ASITN/SIR) score scale consisting of age, NIHSS score, and ASITN/SIR grade factors can effectively predict the risk for futile recanalization (area under curve 0.75, 95% CI 0.67-0.83, specificity 67.4%, and sensitivity 73.4%). The proportion of patients with futile recanalization in ANA groups 0, 1, 2, and 3 were 21.05, 56.76, 79.03, and 90.91%, respectively. Furthermore, ANA score scale had also a good performance for predicting futile recanalization on the validation cohort. Conclusions: Old age, high baseline NIHSS, and poor collateral circulation are risk factors for futile recanalization in AIS patients treated with thrombectomy. An ANA score that considers age, NIHSS, and collateral ASITN/SIR can effectively predict the risk for futile recanalization. Further studies with a larger sample size are needed to validate the prognostic value of this combined score for futile recanalization.
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Affiliation(s)
- Hui Pan
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Changchun Lin
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lina Chen
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Qiao
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peisheng Huang
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Liu
- Department of Neurology, Shanghai Minhang Hospital, Fudan University, Shanghai, China
| | - Yueqi Zhu
- Department of Interventional Radiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingjing Su
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianren Liu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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