Clinical Characteristics and Prognostic Analysis of Patients with Endovascular Treatment for In-Hospital Large Vessel Occlusive Stroke
ZHANG Li, LIU Zhiguang, FU Xinmin, ZHANG Yang, ZONG Hailiang
2024, 19(3):
310-318.
DOI: 10.3969/j.issn.1673-5765.2024.03.009
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Objective To investigate the clinical characteristics, pathogenesis, endovascular treatment and prognosis of patients treated with endovascular treatment for large vessel occlusive stroke occurring in hospital, and to provide reference information for the prevention strategies of large vessel occlusive stroke in hospital.
Methods A retrospective analysis was performed on 45 patients (in-hospital group) who were hospitalized in Xuzhou Central Hospital for non-ischemic stroke from July 2020 to July 2023 and had large vessel occlusive stroke during hospitalization. During the same study period, 100 patients with large vessel occlusive stroke who entered the emergency greenway of our hospital from outside the hospital were used as control cases (out-of-hospital group). Baseline data, laboratory-related indicators, and endovascular treatment-related data were collected to analyze the demographics, risk factors, pathogenesis, and treatment outcomes of the two groups and compared. Multivariate logistic regression was used to analyze the prognostic effects of patients with large vessel occlusive stroke occurring in hospital.
Results Patients with in-hospital large vessel occlusive stroke had a wide variety of first diseases, mainly occurring in brain surgery (10/45, 22.2%), cardiac surgery (9/45, 20.0%), blood nail hernia surgery (9/45, 20.0%), and thoracic surgery (5/45, 11.1%), and 23 cases (51.1%) were associated with surgery. There was no statistically significant difference between the two groups in terms of gender, age, history of smoking and alcohol, hypertension, diabetes mellitus, hyperlipemia, coronary artery heart disease, valvular heart disease, cardiac insufficiency and history of previous stroke. Compared with the out-of-hospital group, more patients in the in-hospital group had a combination of atrial fibrillation (53.3% vs. 19.0%,
P＜0.001), malignant tumor (15.6% vs. 1.0%, P=0.002), other arterial thrombosis (15.6% vs. 1.0%, P=0.002), and perioperative period (51.1% vs. 1.0%, P＜0.001), and the NIHSS score at the onset of the disease was higher [21.0 (14.5-35.0) points vs. 18.0 (13.5-24.5) points, P=0.019]. The levels of white blood cell count (U=1385.000, P＜0.001), D-dimer (U=654.500,
P＜0.001) and IL-6 (U=1376.000, P＜0.001) in the in-hospital group were higher than those in the out-of-hospital group, and the levels of hemoglobin (U=1758.000, P=0.035), systolic blood pressure (t=-2.766, P=0.006) and diastolic blood pressure (U=1317.500, P＜0.001) were lower than those in the out-of-hospital group, and the differences were all statistically significant. The difference between the in-hospital group and the out-of-hospital group in the distribution of anterior and posterior circulation was not statistically significant. There were 7 cases (15.6%), 22 cases (48.9%), and 16 cases (35.6%) of large vessel occlusive stroke with atherosclerosis, cardiogenic type, and other causes in the in-hospital group, and 63 cases (63.0%), 26 cases (26.0%), and 11 cases (11.0%) in the out-of-hospital group, respectively, with a statistically significant difference (χ2=29.432, P<0.001). There were no significant difference in volume ratio of ischemic to infarcted area before endovascular treatment, postoperative TICI blood flow grading, hemorrhagic transformation / contrast leakage, and mortality between the two groups. Compared with the out-of-hospital group, the onset-to-treatment time and recanalization time were shorter in the in-hospital group, and intraoperative use of remedies was less frequent (P<0.05). After adjusting for NIHSS score at onset, atrial fibrillation, valvular heart disease, and volume ratio of ischemic to infarcted area, there was still a negative correlation between in-hospital stroke and good prognosis of patients with large vessel occlusive stroke treated with endovascular treatment (OR 0.213, 95%CI 0.063-0.711, P=0.012).
Conclusions Patients with endovascular treatment for large vessel occlusive stroke in and out of hospitals have different clinical characteristics, pathogenesis and treatment outcomes. In-hospital patients with large vessel occlusive stroke have more severe symptoms of clinical neurological injury, more comorbid underlying diseases, complex etiologic mechanisms, and poor prognosis. Strict control of surgical indications, prevention and control of infection, and active intervention of risk factors may reduce the incidence of large vessel occlusive stroke in clinical practice.
