Analysis of relevant factors affecting the prognosis of mechanical thrombectomy in patients with acute posterior circulation large vessel occlusion cerebral infarction

Abstract

Objective: To explore the factors affecting the prognosis of patients with acute posterior circulation large vessel occlusion cerebral infarction (PCO) after mechanical thrombectomy.

Method: A retrospective study was conducted on a total of 58 patients who received thrombectomy and presented within 24 h of onset with PCO from 31 September 2020 to 31 December 2022. They were divided into two groups based on a 90-day mRS score(The mRS score of 0-3 was defined as a good prognosis, and 4-6 was defined as a poor prognosis).A univariate analysis was conducted on baseline data such as age and patient past medical history, as well as extended cerebral infarction thrombolysis grade (eTICI grade) and incidence of symptomatic intracranial hemorrhage (sICH) after surgery, for the groups with good prognosis and poor prognosis. Factors affecting the 90-day prognosis of patients were also analyzed in subgroups.

Results: The preoperative National Institutes of Health Stroke Scale (NIHSS score)[21(12-35) vs 35(35-35)], postoperative 24-h NIHSS score[13(8-22) vs 35(35-35)], computed tomography (CT)[9(9-10) vs 6.5(6-7.75)] and computed tomography (CTP) brain blood volume (CBV)[9(8-10) vs 4(2-7.75)], cerebral blood flow (CBF)[7(4.5-9) vs 2(1-4)], time to peak (Tmax) [1(0.5-4) vs 0(0-1.75)] imaging of the posterior circulation Alberta stroke project early CT score (pc-ASPECTS score), Different locations of vascular occlusion, time from femoral artery puncture to vascular recanalization(64.96 ± 33.47 vs 92.68 ± 53.17). The differences in the conversion rate of postoperative intracranial hemorrhage(0 vs 16.1%) and the incidence of sICH(0 vs 12.9%) were statistically significant (P < 0.05). The subgroup analysis showed that vascular occlusion site, preoperative CBV pc-ASPECTS scores, and postoperative sICH occurrence were related to the 90-day prognosis of patients, and the differences were statistically significant (P < 0.05).

Conclusions: Some factors that can affect the prognosis of mechanical thrombectomy in patients with acute posterior circulation large vessel occlusion cerebral infarction. Preoperative clinical symptoms and imaging evaluation have certain evaluation values for prognosis.

Keywords: 90-day prognosis; Mechanical thrombectomy; Posterior circulation large vessel occlusion cerebral infarction.