Kết quả điều trị can thiệp lấy huyết khối ở bệnh nhân nhồi máu não cấp với lõi lớn trong vòng 24 giờ sau khởi phát triệu chứng: Nghiên cứu đoàn hệ tiến cứu=Outcome of acute large ischemic core thrombectomy within 24 hours from symptoms onset: Prospective cohort study

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Tác giả: Văn Hiếu Cao, Quang Hải Dương, Thanh Vũ Huỳnh, Quang Thiện Lê, Văn Nam Lê, Quốc Trung Nguyễn, Thành Trung Nguyễn, Văn Đặng Sơn Nguyễn, Như Thông Phạm, Phước Tuấn Phạm, Đạt Trần, Văn Tảo 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.205-212

Bộ sưu tập: Metadata

ID: 477877

Thêm vào giỏ

Đánh giá tính hiệu quả và an toàn của điều trị NMN cấp với lõi lớn trong 24 giờ bằng sử dụng quy trình hình ảnh học đơn giản: cắt lớp vi tính (CT) sọ não không cản quang và CT mạch máu não (CTA). Phương pháp nghiên cứu: Nghiên cứu quan sát, đoàn hệ tiến cứu tại Bệnh viện Đà Nẵng từ 5/2023 đến 5/2024, lựa chọn những BN NMN cấp do tắc động mạch lớn ở tuần hoàn trước có điểm ASPECTS trước điều trị <
6 trên CT sọ não không cản quang, điểm NIHSS lúc nhập viện ≥ 6, được can thiệp lấy huyết khối trong ≤ 24 giờ đầu. Kết cục đi lại độc lập (điểm mRS là 0-3) vào ngày 90. Kết cục an toàn được xác định bằng chảy máu não (CMN) có triệu chứng theo tiêu chuẩn SITS-MOST. So sánh kết cục điều trị giữa 2 nhóm can thiệp tái thông thành công TICI ≥ 2b và không thành công với TICI từ 0-2a. Kết quả: Trên 157 BN điều trị can thiệp nội mạch lấy huyết khối tại bệnh viện Đà Nẵng từ tháng 5/2023 đến tháng 5/2024 , có 45 bệnh nhân (28.7%) với ASPECTS <
6. Độ tuổi trung vị: 63, nam giới: 57,8%. Điểm ASPECTS nền: 4 (IQR:3-4), NIHSS: 16.3 (±4), tỷ lệ tái thông thành công: 35/45 (77.8%). Vào ngày thứ 90, 23/45 (51,1%) có kết cục đi lại độc lập. Tỷ lệ CMN có triệu chứng: 11.1%, tử vong: 26.7%. So với tái thông không thành công (22.2%), những BN tái thông thành công có tỷ lệ kết cục tốt cao hơn: 22/35 (62.9%) với 1/10 (10%), p=0.004), tỷ lệ tử vong thấp hơn: 7/35 (20%) với 5/10 (50%), p=0.007), tỷ lệ CMN có triệu chứng tương tự giữa 2 nhóm: 4/35 (11.4% với 1/10 (10%), p=0.99). Kết luận: Điều trị can thiệp nội mạch cho kết quả đầy hứa hẹn ở những BN NMN cấp với lõi lớn trong vòng 24 giờ chỉ bằng quy trình hình ảnh học đơn giản: chụp CT sọ não không cản quang và chụp CT mạch máu não, đặc biệt ở những trường hợp tái thông thành công. Kết quả này gợi ý có thể mở rộng chỉ định can thiệp lấy huyết khối rộng hơn nữa trong thực hành lâm sàng.We conducted a prospective, single-center, observational cohort study at Da Nang Hospital between May 2023 and May 2024, enrolling patients who had acute large-vessel occlusion in the anterior circulation, an ASPECT score <
6 points on pre-treatment NCCT, an NIHSS score ≥ 6 at admission, and who received EVT within 24 hours of onset. An ambulatory outcome was defined as an mRS score of 0 to 3 at 90 days. Safety outcomes were defined by symptomatic intracranial hemorrhage(sICH) according to SITS-MOST criteria. We compared outcomes between successful (TICI ≥2b) and unsuccessful (TICI 0-2a) recanalization groups after EVT. Results: We screened 157 patients who received EVT, 45 of whom (28.7%) had ASPECTS <
6. The median age was 63, and 57,8% of the patients were men. Baseline ASPECTS was 4 (IQR: 3-4), and NIHSS was 16.3 (±4), and the rate of successful recanalization (TICI ≥2b) was 35/45 (77.8%). At 90 days, 23/45 (51.1%) achieved an ambulatory outcome. The sICH rate was 11.1%, and mortality was 26.7%. Compared with unsuccessful recanalization 10/45 (22.2%), patients with successful reperfusion had a significantly higher rate of a good ambulatory outcome 22/35 (62.9% vs 1/10 (10%), (p= 0.004), with a numerically lower 90-day mortality 7/35 (20%) vs. 5/10 (50%), p=0.07), sICH were similar between the two groups 4/35 (11.4%) vs. 1/10 (10%), p=0.99). Conclusions: EVT showed promising outcomes in patients with large core strokes within 24 hours selected by simplifying the NCCT-CTA protocol, particularly in successfully recanalized cases, suggesting it can expand the indicated criteria for EVT in daily clinical practice.

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