Efficacy of intravenous thrombolysis combined with mechanical interventional stent thrombectomy in acute ischemic stroke

Introduction: The aim was to investigate the efficacy and safety of intravenous thrombolysis in combination with mechanical interventional thrombectomy with a stent in the treatment of acute ischemic stroke. Methods: A retrospective analysis of the clinical data of 118 patients with acute ischemic stroke was performed. The included patients were divided into a control group (recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis) and a thrombectomy group (interventional thrombectomy with a mechanical stent based on rt-PA intravenous thrombolysis). The rate of vascular recanalization and clinical efficacy after treatment were compared between the two groups. The National Institutes of Health Stroke Scale (NIHSS) was used to identify the degree of neurological impairment in all patients before and after treatment, and the Bartel index was used to assess their activity in everyday life. In addition, changes in the level of T-lymphocyte subpopulations in peripheral blood and immunoinflammatory factors before and after treatment were compared, and patient prognosis and incidence of adverse reactions were recorded. Results: The response rate of the intrathrombectomy group (93.2%) was significantly better than that of the control group (76.3%). NIHSS pain scores and modified Rankin scale (mRS) after treatment were significantly lower than before treatment, while Barthel index after treatment was significantly higher than before treatment. The NIHSS score and mRS score in the thrombectomy group obviously decreased compared with those in the control group 1 month after treatment. The Barthel index in the thrombectomy group was obviously higher than that in the control group at 1 month and 2 months after treatment. The levels of cluster of differentiation 3 (CD3)+, CD3+CD4+, CD4+/CD8+ natural killer (NK) cells in the peripheral blood 6 months after treatment were obviously increased compared to those before treatment, while the level of CD3+CD8+ was obviously decreased compared to team before treatment. In the thrombectomy group, the levels of CD3+, CD3+CD4+, CD4+/CD8+ and NK cells were significantly higher than those of the control group, while the level of CD3+CD8+ was significantly lower than that of the control group. In addition, in the thrombectomy group, the levels of serum osteopontin (OPN), malondialdehyde (MDA), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were evidently lower than those in the control group 1 month after treatment, while the level of serum superoxide dismutase (SOD) was evidently higher than in the control group. Compared to that of the control group, the rate of acute vascular reocclusion in the thrombectomy group was significantly reduced 3 months after treatment (10.2% vs. 22.0%). Conclusion: Intravenous thrombolysis in combination with mechanical interventional thrombectomy with a stent can effectively promote vascular recanalization, improve neurological function and the activity of daily life of patients, strengthen immune function, inhibit the response to oxidative stress and improve the prognosis of patients.