Kết quả điều trị can thiệp tái thông cửa sổ muộn sau 6 giờ ở bệnh nhân nhồi máu não cấp do tắc hệ động mạch đốt sống thân nền=Treatment outcomes for vertebrobasilar artery occlusion after endovascular therapy of patients beyond 6 hours of symptom onset

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Tác giả: Thị Hải Hà Đinh, Hải Linh Nguyễn, Trọng Tuyển Nguyễn, Văn Tuyến Nguyễn

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.213-219

Bộ sưu tập: Metadata

ID: 477878

Thêm vào giỏ

Lợi ích của can thiệp nội mạch cửa sổ muộn ở những bệnh nhân (BN) bị tắc mạch máu lớn hệ tuần hoàn trước đã được xác định. Với hệ động mạch đốt sống thân nền (ĐMĐSTN), kết quả ra sao? Nghiên cứu này nhằm đánh giá kết quả điều trị các BN được can thiệp tái thông ở cửa sổ muộn sau 6 giờ với tắc hệ tuàn hoàn sau. Đối tượng và phương pháp: Nghiên cứu hồi cứu dữ liệu lâm sàng và hình ảnh học của các BN được điều trị can thiệp nội mạch do tắc hệ ĐMĐSTN tại khoa Đột quỵ não, bệnh viện TWQĐ 108 từ tháng 12/2023-7/2024. Kết quả tốt khi điểm mRS ≤3 trong vòng 1 tháng. Kết quả: Gồm 32 BN, có 11 (34,4%) có kết quả thuận lợi. Phân tích hồi quy logistic cho thấy mối liên hệ của các thông số sau với kết quả tốt: điểm NIHSS ban đầu, thang điểm Glasgow (GCS) ban đầu và không có hẹp mạch trước can thiệp tái thông. Trong đó chỉ có NIHSS ban đầu thấp là có mối liên quan đáng kể với kết quả thuận lợi (OR=1,14, 1,01-1,28, p<
0,05). Kết luận: Can thiệp tái thông bằng dụng cụ cơ học ở những BN nhồi máu não cửa sổ muộn sau 6 giờ do tắc hệ ĐMĐSTN vẫn cho thấy hiệu quả hồi phục về chức năng thần kinh theo thang (mRS 0-3) là 34,4%. Các yếu tố điểm NIHSS thấp hơn, điểm Glasgow cao hơn ở thời điểm nhập viện, không có hẹp mạch tiến triển có liên quan đến tiên lượng kết quả thuận lợi.Recent studies have demonstrated the benefits of late-window endovascular intervention in patients with large anterior circulation vessel occlusions. For the vertebrobasilar artery system, we conducted a study on the clinical characteristics, imaging findings, and treatment outcomes of patients who underwent recanalization intervention during the late window (after 6 hours). Methods: This is a retrospective study of clinical and imaging data from patients who received endovascular intervention due to vertebrobasilar artery occlusion at the Stroke department, 108 Military Central hospital from December 2023 to July 2024. A good outcome is defined as a modified Rankin Scale score of ≤3 within 1 month. Results: A total of 32 patients were included in the study, of which 11 (34.4%) had favorable outcomes. Logistic regression analysis showed an association between the following parameters and good outcomes: initial NIHSS score, initial Glasgow Coma Scale (GCS) score, and the absence of preinterventi-on intracranial artery stenosis. Of these, only a lower initial NIHSS score was associated with a favorable outcome (OR=1.14, 1.01-1.28, p<
0.05). Conclusion: Mechanical recanalization intervention in patients with late-window (after 6 hours) acute ischemic stroke due to vertebrobasilar artery occlusion still demonstrates effectiveness in neurlogi- cal functional recovery, with 34.4% achieving a functional recovery defined by an mRS score of 0-3. Factors such as a lower NIHSS score, a higher GCS score at admission, and the absence of progressive arterial stenosis are associated with favorable outcomes.

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