ARWMC评分联合梗死进展速度对急性大血管闭塞性缺血性脑卒中患者术后24 h发生症状性颅内出血的预测价值OA

Objective To investigate the predictive value of age-related white matter change(ARWMC)score combined with infarction progression rate for symptomatic intracranial hemorrhage(sICH)within 24 h after operation in patients with acute ischemic stroke with large vessel occlusion(AIS-LVO).Methods A to-tal of 352 patients with AIS-LVO who underwent mechanical thrombectomy in this hospital from January 2022 to September 2024 were selected as the research objects.According to whether sICH occurred within 24 h after operation,they were divided into sICH group and non-sICH group.Baseline data of AIS-LVO patients were collected.ARWMC score and the rate of infarction progression were calculated.Multivariate Logistic re-gression was used to analyze the influencing factors of sICH in patients with AIS-LVO within 24 h after sur-gery.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of ARWMC score,infarction progression rate alone and combined detection for sICH in patients with AIS-LVO at 24 h af-ter operation.Results Among 352 patients with AIS-LVO,84 cases(23.86%,84/352)had sICH within 24 h after operation and were included in the sICH group,and the remaining 268 cases were included in the non-sICH group.The proportion of cardiogenic embolism and core infarct volume in the sICH group were larger than those in the non-SICH group,the time from onset to CT perfusion imaging and the time from onset to femoral artery puncture were shorter than those in the non-SICH group,the national institutes of health stroke scale(NIHSS)score and ARWMC score were higher than those in the non-SICH group,the alberta stroke program early CT score(ASPECTS score)was lower than that in the non-SICH group,and the infarc-tion progression rate was faster than that in the non-SICH group,the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that cardiogenic embolism,increased NIHSS score,increased core infarct volume,increased ARWMC score,and accelerated infarction progression were in-dependent risk factors for sICH in patients with AIS-LVO at 24 h after operation(P<0.05).Increased AS-PECTS score was an independent protective factor for sICH in patients with AIS-LVO at 24 h after surgery(P<0.05).ROC curve analysis showed that the area under the curve of ARWMC score combined with infarct progression rate for predicting sICH in patients with AIS-LVO at 24 h after operation was 0.936,which was higher than ARWMC score and infarction progression rate alone in predicting sICH in patients with AIS-LVO at 24 h after operation at 0.827 and 0.810.(Z=5.116,4.848,P<0.001).Conclusion The increase of AR-WMC score and the increase of infarction progression rate are related to the occurrence of sICH in patients with AIS-LVO at 24 h after surgery.The combination of ARWMC score and infarction progression rate has a higher predictive value for sICH in patients with AIS-LVO at 24 h after surgery.