Endovascular therapy is an effective treatment for large vascular stroke. However, the prognosis of stroke is affected by many factors [11]. In our research, the baseline NIHSS score, LKN time to puncture, smoking, time stratification, and PH2 showed an obvious correlation with the outcome in patients with acute ischemic stroke after undergoing EVT. Stroke is prevalent worldwide and has a high morbidity rate. Many scales are used to measure the severity and outcome of stroke. The NIHSS is a quantifiable scale that is used to evaluate stroke severity [12]. The patients who had a low base NIHSS score often had more favorable clinical outcomes than the patients with a high base NIHSS score. The result of a previous study, which analyzed 484 stroke patients, showed that the recanalization of patients with an NIHSS score of 5 (IQR, 4–7) (thrombolysis in cerebral infarction,TICI 2b-3) was achieved in 26 (78.7%) patients [13], and the patients all had favorable clinical outcomes. A low baseline NIHSS score was independently predictive of a favorable outcome in both patients with posterior circulation (Odds Ratio[OR] 1.547, 95% confidence interval [CI], 1.232–1.941) and anterior circulation (OR, 1.279, 95% CI, 1.188–1.376) stroke. The baseline NIHSS score for a favorable functional outcome in anterior circulation stroke was 4 (IQR, 3–7) compared with 3 for posterior circulation (IQR, 1–5) [14].
The time was relative to the clinical outcomes. Previous study showed there is much opportunity to enhance outcomes through reducing door to GP time[15]. Our study suggests that any effort to improve the time of LKN to GP will result in a positive outcome. A study by Sun CH et al. found that when the logistic regression model adjusted for age, NIHSS, hypertension, diabetes mellitus, reperfusion status, and symptomatic hemorrhage, the pre-procedural time frame of LKN to GP was directly associated with 90-day positive outcomes (OR 0.996; 95% CI [0.993 to 0.998]; P<0.001) [16]. Another study also found that the LKN-to-GP time improved the outcome, particularly in those with good ASPECTS (CT stroke score system) presenting within 6 hours. Strategies to decrease reperfusion times should be investigated, particularly early on and with good ASPECTS [17]. Our study is consistent with the previously reported studies.
Smoking is a major risk factor for many diseases, including stroke, especially among young and middle-aged stroke patients. Our study also showed that the percentage of smokers in the patients with poor outcomes was higher than in the patients with favorable outcomes[2]. Previous study found a strong dose–response relationship between cigarettes smoked daily and ischemic stroke among young men. The study is a population-based case–control study of risk factors for ischemic stroke in men ages 15 to 49 years .The odds ratio for the current smoking group compared with never smokers was 1.88. The study found a strong dose–response relationship between the number of cigarettes smoked daily and ischemic stroke among young men. Although complete smoking cessation is the goal, even smoking fewer cigarettes may reduce the risk of ischemic stroke in young men[18]. The relationship between smoking and stroke is controversial. In some research, smoking in stroke patients may be beneficial to stroke patients after EVT. However, these data cannot be misunderstood as a benefit of smoking. Another study found that smoking was not associated with a good functional prognosis (mRS≤2) at 3 months in the AIS patients who were treated with intravenous thrombolysis (IVT) [19]. Due to the controversial effects of cigarette smoking on cardiovascular health, smoking cessation is still recommended for stroke prevention [20].
The sooner a stroke patient is treated, the better the prognosis of the patient. The Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands showed that patients who were treated with an occlusion of the intracerebral internal carotid artery or the middle cerebral artery within a 6-hour window from the LKN time window from the onset of symptoms would benefit from EVT [21]. A previous study showed that endovascular thrombectomy could benefit patients and provided evidence of reversible cerebral ischemia across the 6–24 h time window. Previous study findings suggested that in acute stroke patients, a thrombectomy should be carried out based on the mode of presentation or the time of presentation within the 6–24 h time window [12].
Symptomatic intracerebral hemorrhage( sICH) is the most serious complication after IVT and EVT. Using a combination of the predictors that were available both before and at the end of bridging therapy and direct thrombectomy may provide indications for the early identification of patients who are candidates for a more or less post-procedural intensive management. In those patients who are at a high risk of sICH, the monitoring and treatment of hypertension and hyperglycemia should be intensified. Patients who are at a low risk of sICH should be transferred back to the referring hospital quickly in a sedative state [22]. A previous study found no difference in the rates of sICH between primarily utilized stent retriever devices and non-stent retriever devices and the incidence of symptomatic intracranial hemorrhage in care-dependent stroke patients was similar to care-independent patients [23]. Our data suggested that the incidence of sICH was higher compared to the previously reported data [24] (10% vs 6%) and the type PH2 occurred are more in the poor outcome group than the favorable outcome group.
There are two biases or limitations in the current work.First, Many factors influence the stroke outcomes ,our study didn’t selected all the factors out.Second,the stroke outcome are relative to the early rehabilitation.Our study didn’t include the early rehabilitation factor.