Tần suất và các yếu tố tiên lượng suy giảm thần kinh sớm sau can thiệp nội mạch lấy huyết khối ở bệnh nhân nhồi máu não cấp với lõi trung bình - lớn: Một nghiên cứu đoàn hệ tiến cứu đa trung tâm=Frequency and predictors of early neurological deterioration following thrombectomy in acute ischemic stroke patients with medium to large core: A prospective multicenter cohort study

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Tác giả: Trí Dũng Bạch, Quang Hải Dương, Thị Thảo Dương, Tấn Đức Hà, Quang Thiện Lê, Vũ Sơn Trà Lê, Chí Lành Nguyễn, Quốc Trung Nguyễn, Thanh Nhi Nguyễn, Thành Trung Nguyễn, Thị Bích Hường Nguyễn, Vĩnh Khang Nguyễn, Thanh Vũ Trần, Thị Minh Hằng Trần, Văn Sóng Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.108-118

Bộ sưu tập: Metadata

ID: 242217

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Sự xuất hiện của suy giảm thần kinh sớm (SGTKS) sau điều trị can thiệp nội mạch (CTNM) là một thách thức lớn, đặc biệt ở những bệnh nhân bị nhồi máu não cấp với lõi nhồi máu lớn được can thiệp nội mạch lấy huyết khối. Nghiên cứu này nhằm xác định tần suất, các yếu tố tiên lượng và kết cục ngắn hạn ở những bệnh nhân có SGTKS. Đối tượng và phương pháp: Chúng tôi tiến hành một nghiên cứu đoàn hệ tiến cứu, đa trung tâm tại Việt Nam với sự tham gia của bốn trung tâm đột quỵ, sàng lọc tất cả các bệnh nhân được điều trị CTNM từ tháng 8/2023 – 3/2024. Lõi nhồi máu lớn được xác định bằng ASPECTS từ 3-5 hoặc lõi nhồi máu từ 50-100 ml, được đánh giá bởi hai bác sĩ thần kinh có chứng nhận ASPECTS, với những bất đồng được đánh giả bởi một chuyên gia đột quỵ. Chúng tôi định nghĩa SGTKS là sự gia tăng ≥4 điểm trong thang điểm NIHSS trong vòng 24 giờ sau khi can thiệp lấy huyết khối. Các yếu tố nguy cơ được phân tích bằng mô hình hồi quy logistic đa biến. Kết cục lâm sàng được đánh giá bằng thang điểm mRS, với kết cục xấu là mRS từ 4-6. Kết quả: Trong số 1332 bệnh nhân được sàng lọc, chúng tôi thu nhận 313 bệnh nhân (23.5%). Trong số này, 43 bệnh nhân (13.7%) có SGTKS, gia tăng có ý nghĩa thống kê tỷ lệ kết cục lâm sàng xấu mRS 4-6 sau 30 ngày (SGTKS: 40 (93.02%) so với Không-SGTKS: 148 (55.6%), OR=10.63, KTC 95%: 3.21-35.22, p=0.0001). Trong phân tích hồi quy đa biến, các yếu tố không thể thay đổi được bao gồm tiền sử rung nhĩ (aOR=2.93, KTC 95%: 1.23-6.83, p=0.013), điểm NIHSS (aOR=0.91, KTC 95%: 0.84-0.97, p=0.006), điểm ASPECTS (aOR=0.7, KTC 95%: 0.49-0.99, p=0.047), tổn thương vùng chi phối động mạch não trước (aOR=5.45, KTC 95%: 2.0-14.6, p=0.0007) và nồng độ glucose máu (mmol/dL) (aOR=1.33, KTC 95%: 1.01-1.7, p=0.023). Tái thông mạch máu thành công (aOR=0.24, KTC 95%: 0.077-0.79, p=0.013), và nhập viện trực tiếp đến trung tâm đột quỵ (aOR=0.39, KTC 95%: 0.17-0.83, p=0.017) là các yếu tố bảo vệ có thể điều chỉnh được. Kết luận: Khoảng một trong bảy bệnh nhân nhồi máu não cấp với lõi lớn được can thiệp lấy huyết khối có thể gặp phải suy giảm thần kinh sớm trong vòng 24 giờ sau can thiệp. Nhiều yếu tố có thể tiên đoán suy giảm thần kinh sớm và hỗ trợ đưa ra quyết định điều trị để tối ưu hóa hiệu quả của điều trị can thiệp nội mạch. Cần thực hiện các nghiên cứu lớn hơn để xác nhận lại những kết quả này.The occurrence of early neurological deterioration (END) following endovascular treatment (EVT) presents significant challenge, particularly in patients with acute large ischemic core thrombectomy. We aimed to determine frequency, predictive factors, and short-term outcomes of END. Subject and methods: We conducted a prospective, multicenter study in Vietnam involving four stroke centers, which screened all consecutive patients who underwent EVT (August 2023 – March 2024). Medium-large cores were defined by ASPECTS 3-5 or ischemic cores 50-100 ml, which were assessed by two ASPECTS-certified neurologists, with disagreements resolved by a senior reader. We defined END as an increase of ≥4 points in NIHSS score within 24 hours after thrombectomy. Risk factors were analyzed using multivariate logistic regression models. The prognosis was evaluated using the modified Rankin Scale (mRS), with poor prognosis defined as mRS 4–6. Results: Of the 1332 patients screened, 313 (23.5%) were included. Of these, 43 patients (13.7%) had END, which was associated with higher mRS of 4-6 at 30 days (END: 40 (93.02%) vs. Non-END: 148 (55.6%), OR=10.63, 95%CI: 3.21-35.22, p=0.0001). In multivariate analysis, non-modifiable factors included history of atrial fibrillation (aOR=2.93, 95%CI: 1.23-6.83, p=0.013), NIHSS (aOR=0.91, 95%CI: 0.84-0.97, p=0.006), ASPECTS (aOR=0.7, 95%CI: 0.49-0.99, p=0.047), anterior cerebral artery lesion (aOR=5.45, 95%CI: 2.0- 14.6, p=0.0007) and glucose (mmol/dL) (aOR=1.33, 95%CI: 1.01-1.7, p=0.023). Successful reperfusion (aOR=0.24, 95%CI: 0.077-0.79, p=0.013), and direct admission (aOR=0.39, 95%CI: 0.17-0.83, p=0.017) were modifiable predictors for END. Conclusions: One in seven medium-large core thrombectomy patients may experience END within 24h. Several factors can predict END and support decision-making to optimize the efficacy of EVT. Larger studies are needed to confirm these findings.

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