Điều trị can thiệp nội mạch ở bệnh nhân đột quỵ thiếu máu não trên 6 giờ từ thời điểm khởi phát: cửa sổ thời gian so với cửa sổ nhu mô=Endovascular treatment for the patients with acute ischemic stroke in the beyond 6

Điều trị can thiệp nội mạch ở bệnh nhân đột quỵ thiếu máu não trên 6 giờ từ thời điểm khởi phát: cửa sổ thời gian so với cửa sổ nhu mô=Endovascular treatment for the patients with acute ischemic stroke in the beyond 6 - hour: time window versus tissue window

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Tác giả: Huy Lương Dương, Huy Thắng Nguyễn, Minh Hùng Nguyễn, Quốc Trung Nguyễn, Bằng Phan, Thị Minh Hằng Trần, Văn Sóng Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Y học cộng đồng, 2024

Mô tả vật lý: tr.281-286

Bộ sưu tập: Metadata

ID: 242047

Thêm vào giỏ

So sánh kết cục của bệnh nhân đột quỵ nhồi máu não từ 18 tuổi trở lên, được điều trị can thiệp nội mạch trong cửa sổ 6-16 giờ so với cửa sổ trên 16 giờ dựa vào sự bất tương xứng hình ảnh học tưới máu và lõi nhồi máu. Đối tượng và phương pháp: Phân tích hồi cứu tiến hành trên dữ liệu được thu thập (tiến cứu) ở những bệnh nhân được điều trị can thiệp nội mạch thuộc tuần hoàn trước, sau 6 giờ từ khi khởi phát. Điểm Rankin cải tiến (mRS) từ 0-2 được xem xét là có kết cục tốt về mặt chức năng tại thời điểm 90 ngày. Bệnh nhân được lựa chọn bằng sự bất tương xứng giữa lâm sàng và hình ảnh học dựa trên tiêu chuẩn của nghiên cứu DEFUSE 3 ở cả 2 nhóm ngoại trừ tiêu chuẩn về thời gian. Kết quả: Trong số 165 bệnh nhân đột quỵ tắc mạch não lớn trong nghiên cứu, 79 bệnh nhân (47,9%) được can thiệp nội mạch trong cửa sổ sau 16 giờ kể từ thời điểm khởi phát
86 bệnh nhân (52,1%) được can thiệp trong cửa sổ 6-16 giờ. Các bệnh nhân trong nhóm cửa sổ 6-16 giờ có thời gian từ khi khởi phát đến khi chọc động mạch đùi ngắn hơn so với những bệnh nhân nhóm sau 16 giờ (trung vị 12,2 giờ so với 20,5 giờ, p <
0,001). Không có sự khác biệt đáng kể về mặt thống kê giữa hai nhóm về thang điểm NIHSS (trung vị 14,5 so với 15,0, p = 0,46). Các đặc điểm hình ảnh học tưới máu (lõi nhồi máu: trung vị 9 ml so với 9 ml, p = 0,67
thể tích vùng tranh tối tranh sáng: trung vị 112 ml so với 103 ml, p = 0,61
tỷ lệ bất tương xứng: trung vị 7,1 so với 7,24, p = 0,88) và thời gian từ khi chụp tưới máu đến khi chọc động mạch đùi (trung vị 73 phút so với 81 phút, p = 0,2). Không có sự khác biệt đáng kể giữa hai nhóm về khả năng độc lập chức năng (48,8% so với 44,3%, p = 0,56), tỷ lệ tử vong sau 90 ngày (9,3% so với 13,9%, p = 0,35), tỷ lệ tái thông mạch não thành công (91,9% so với 82,3%, p = 0,065), xuất huyết não có triệu chứng (2,3% so với 3,8%, p = 0,67). Kết luận: Ở nghiên cứu này, cho dù ở cửa sổ thời gian nào, những bệnh nhân được lựa chọn điều trị can thiệp nội mạch dựa trên sự bất tương xứng giữa hình ảnh học tưới máu và lõi nhồi máu đều có kết cục như nhau.To compare outcomes in patients with ischemic stroke aged 18 years and older who received endovascular intervention within 6-16 hours versus within 16 hours based on perfusion imaging and core infarction discordance. Subject and methods: Retrospective analysis was conducted on data collected (prospectively) in patients treated with endovascular intervention in the anterior circulation, after 6 hours from onset. A modified Rankin score (mRS) of 0-2 is considered good functional outcome at 90 days. Patients were selected based on clinical and imaging discordance based on the criteria of the DEFUSE 3 study in both groups except for time criteria. Results: Among 165 patients with large cerebral embolic stroke in the study, 79 patients (47.9%) received endovascular intervention within a window after 16 hours from the time of onset
86 patients (52.1%) received intervention within a 6-16 hour window. Patients in the 6-16 hour window group had a shorter time from onset to femoral artery puncture than those in the 16 hour window group (median 12.2 hours vs 20.5 hours, p <
0.001). There was no statistically significant difference between the two groups in terms of NIHSS score (median 14.5 vs 15.0, p = 0.46). Perfusion imaging characteristics (infarct core: median 9 ml vs 9 ml, p = 0.67
penumbra volume: median 112 ml vs 103 ml, p = 0.61
discordance ratio: median 7.1 vs 7.24, p = 0.88) and time from perfusion imaging to femoral artery puncture (median position 73 minutes vs 81 minutes, p = 0.2). There was no significant difference between the two groups in functional independence (48.8% vs 44.3%, p = 0.56), 90-day mortality (9.3% vs 13.9%, p = 0.35), successful cerebral revascularization rate (91.9% vs 82.3%, p = 0.065), symptomatic cerebral hemorrhage(2.3% vs 3, 8%, p = 0.67).Conclusion: In this study, regardless of the time window, patients selected for endovascular treatment based on perfusion imaging and core infarction discordance had similar outcomes.

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