Relationship between vascular collateral compensation and blood flow recanalization and prognosis in patients with acute ischemic stroke after mechanical thrombectomy

Objective To investigate the effect of vascular collateral compensation on the prognosis of patients with acute ischemic stroke after mechanical thrombectomy, and analyze the factors that cause ineffective recanalization after thrombectomy. Methods It was a retrospective cohort study. A total of 155 acute ischemic stroke patients who were admitted to the Affiliated Hospital of Xuzhou Medical University from October 2020 to May 2022 and underwent mechanical thrombectomy were enrolled. According to the modified Rankin Scale (MRS) scores three months after operation, they were divided into two groups:a good prognosis group (MRS ≤ 2, n=84) and a poor prognosis group (MRS ≥ 3, n=71). Then, on the basis of vessel recanalization (TICI 2b/3), they were divided into two groups:an effective recanalization group (TICI 2b/3 and MRS ≤ 2, n=76) and an ineffective recanalization group (TICI 2b/3 and MRS ≥ 3, n=46). Their clinical data were collected, including preoperative ASITN/SIR grade, preoperative ASPECTS score, postoperative MRS score, NIHSS score, TICI score, as well as basic demographic information, cerebrovascular disease risk factors, and auxiliary examination data. Then, the t-test, χ²-Test, U-test and Logistic regression analysis were applied to analyze the impact of the above factors on the prognosis of patients with acute ischemic stroke after mechanical thrombectomy. The value of independent risk factors in predicting the prognosis of patients with acute ischemic stroke after mechanical thrombectomy was evalauted by the ROC curve.Results Univariate analysis showed that preoperative NIHSS score, postoperative 1 h NIHSS score, postoperative 24 h NIHSS score, preoperative ASITN/SIR grade, preoperative ASPECTS score, postoperative TICI grade, white blood cell count, low-density lipoprotein cholesterol(LDL), history of diabetes, glycosylated hemoglobin, homocysteine (HCY) and blood glucose were statistically different in both groups (P<0.05). Multivariate logistic regression analysis showed that ASITN/SIR grade (OR=0.342, 95%CI=0.135-0.868, P<0.05), TICI grade (OR=0.436, 95%CI=0.195-0.975, P<0.05) and ASPECTS score (OR=0.412, 95%CI=0.274-0.619, P<0.05) were statistically significant (P<0.05), which were the independent risk factors for poor prognosis. Furthermore, there were statistical differences between the two subgroups in venous thrombolysis, diabetes history, blood sugar, preoperative ASPECTS score, postoperative 1 h NIHSS score, postoperative 24 h NIHSS score, preoperative ASITN/SIR grade, postoperative TICI grade, neutrophils, total cholesterol, glycosylated hemoglobin, LDL, white blood cell count, and HCY (P<0.05). Multivariate logistic regression analysis showed that diabetes (OR=3.278, 95%CI=1.359-7.903, P<0.05) was statistically different, which was an independent risk factor for ineffective recanalization.Conclusions ASITN/SIR grade, TICI grade, ASPECTS score are positively correlated with the prognosis of patients with acute ischemic stroke after mechanical thrombectomy, and low scores and grades can be regarded as the independent risk factors for poor prognosis. Diabetes nistory and low preoperative ASPECTS score are the independent risk factors for ineffective recanalization.