Nghiên cứu kết quả điều trị dị dạng động tĩnh mạch não triệt căn bằng can thiệp nội mạch

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Tác giả: Đăng Hoá Dương, Hải Phú Hoàng, Quốc Toản Huỳnh, Nguyễn Ngọc Minh Lê, Vũ Huỳnh Lê, Ngu, Duy Nhật Nguyễn, Nhật Thành Nguyễn, Thành Được Nguyễn, Viết Quý Nguyễn, Văn Phước Phan, Đức Anh Trần, Nguyễn Tuấn Minh Trần, Thanh Tú Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học lâm sàng Bệnh viện Trung ương Huế, 2023

Mô tả vật lý: tr.26-34

Bộ sưu tập: Metadata

ID: 342314

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Đặt vấn đề: Mục tiêu lớn nhất trong điều trị dị dạng động tĩnh mạch não là điều trị triệt căn bao gồm loại bỏ toàn bộ cấu trúc động mạch nuôi, nhân dị dạng và tĩnh mạch dẫn lưu. Ở những BN được điều trị triệt căn thì không phải tất cả đều có kết cục tốt mà bên cạnh đó vẫn tồn tại những tai biến, biến chứng nhất định. Do đó chúng tôi tiến hành nghiên cứu này với hai mục tiêu: Khảo sát đặc điểm lâm sàng, hình ảnh học bệnh nhân dị dạng động tĩnh mạch não trước và sau can thiệp nội mạch điều trị triệt căn. Đánh giá kết cục chức năng của bệnh nhân 3 tháng sau can thiệp. Đối tượng, phương pháp: Nghiên cứu mô tả cắt ngang, có theo dõi dọc trên 50 bệnh nhân trong đó có 31 trường hợp đã xuất huyết nội sọ và 19 trường hợp chưa xuất huyết được điều trị tại Trung tâm đột quỵ, bệnh viện Trung Ương Huế từ tháng 01/2019 đến tháng 06/2022. Kết quả: Can thiệp nội mạch được thực hiện 83 lần để tắc hoàn toàn dị dạng cho 50 bệnh nhân. Độ an toàn là 97.4% cho mỗi lần can thiệp với tỉ lệ biến chứng nặng gặp trong 1 lần can thiệp là 3.6%. Đối với nhóm có dị dạng động tĩnh mạch não chưa vỡ, can thiệp giúp gần hai phần ba số bệnh nhân cải thiện rõ rệt triệu chứng đau đầu, hơn một nửa cải thiện tình trạng co giật trong vòng 3 tháng tuy nhiên tỉ lệ biến chứng dẫn đến di chứng mức độ vừa với mRS 3 là 5.3%. Trên nhóm bệnh nhân có bAVM não đã vỡ gây xuất huyết nội sọ, không có trường hợp nào tái xuất huyết trong vòng 3 tháng theo dõi. Kết luận: Can thiệp nội mạch điều trị triệt căn dị dạng động tĩnh mạch não trên những bệnh nhân có chỉ định có độ an toàn và hiệu quả cao. Từ khóa: Dị dạng động tĩnh mạch não, AVM não, Nút mạch, Can thiệp mạch não. ABSTRACT The study on results of radical brain arteriovenous malformation treatment by endovascular intervention Le Vu Huynh1, Duong Dang Hoa1, Nguyen Thanh Duoc1, Nguyen Viet Quy2, Hoang Hai Phu2, Huynh Quoc Toan2, Tran Duc Anh1, Le Nguyen Ngoc Minh1, Tran Nguyen Tuan Minh2, Tran Thanh Tu1, Nguyen Duy Nhat1, Nguyen Nhat Thanh1, Phan Van Phuoc1, Nguyen Xuan Thuan1, Nguyen Van Lam1, Tran Hoang Phuc1, Nguyen Thi Ngoc Tran1 Background: The ultimate goal in the treatment of a brain arteriovenous malformation (bAVM) is radical treatment that includes eradication of the entire feeding arteries, nidus and draining veins. In patients who are completely treated, not all have good results, there are still serious complications. Therefore, we carry out this study with the following objectives: (1) Investigate clinical and imaging characteristics of patients with bAVM before and after radical endovascular intervention
(2) Evaluate functional outcome after 3 months of treatment. Methods: A cross - sectional prospective study on 50 patients, including 31 cases with intracranial hemorrhage and 19 cases without bleeding, were treated at the Stroke Center, Hue Central Hospital from January 2019 to June 2022. Results: Endovascular intervention procedure was performed 83 times to completely embolize bAVM in 50 patients. Serious complications ratio encountered in 1 interventional procedure was 3.6%. For the group of unruptured bAVM, the radical treatment helped nearly two - thirds of patients significantly improve headache, more than half improve epilepsy within 3 months. The procedural complications leading to moderate sequelae (mRS = 3) was 5.3%. In the group of ruptured bAVM, there was no case of re - bleeding within 3 months of follow - up. Conclusions: Endovascular intervention for radical treatment of brain arteriovenous malformation in patients with indications is safe and effective.

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