Analysis of Prognostic Risk Factors in Patients with Complete Revascularization After Thrombectomy for Acute Anterior Circulation Large Vessel Occlusion.

OBJECTIVE

Prognostic risk factors were analyzed for patients with acute anterior circulation large vessel occlusion stroke who achieved modified Treatment in Cerebral Ischemia (mTICI) 3 grade by endovascular treatment.

METHODS

Patients with Acute ischemic stroke with mTICI=3 grade after endovascular treatment from June 2019 to September 2024, at the Eighth Clinical College of Guangzhou University of Traditional Chinese Medicine, were retrospectively analyzed. Data related to patients' baseline data, risk factors, test data, and surgical data were collected, and the primary endpoint was 90-day poor functional outcome, defined as patients' modified Rankin score >2 at 90 days after surgery. The predictive effect was evaluated using receiver operating characteristic curve analysis, and multivariate logistic regression analysis was used to explore the independent correlation between inflammatory markers and prognosis.

RESULTS

A total of 103 eligible patients were included. Multivariate logistic regression analysis showed that the neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR] = 1.10, 95% confidence interval [CI]: 1.01∼1.20, P = 0.021) at 24 hours after surgery, 7-day National Institute of Health stroke scale (NIHSS) score: (OR = 1.15, 95% CI: 1.07∼1.23, P < 0.001), diabetes history: (OR = 9.60, 95% CI: 2.41∼38.26, P = 0.001), was independently associated with poor prognosis in patients with mTICI = grade 3 after endovascular therapy. Receiver operating characteristic curve analysis: NLR (area under the curve [AUC] = 0.687, 95% CI: 0.584∼0.790) at 24 hours after surgery, NIHSS (AUC = 0.826, 95% CI: 0.746∼0.906), and diabetes history (AUC = 0.667, 95% CI: 0.563∼0.771). Three-marker combined predictive indicators (AUC = 0.889, 95%CI: 0.829∼0.949) CONCLUSIONS: In patients with acute anterior large vascular occlusive stroke with mTICI = grade 3 after endovascular therapy, NIHSS score at 7 days after surgery, NLR within 24 hours after surgery, and history of diabetes were independent influencing factors for poor prognosis. Patients with a history of diabetes who had a NLR ≥6.7 within 24 hours and a NIHSS score ≥4.5 at 7 days after surgery were more likely to have a poor prognosis.