GIÁ TRỊ CỦA THANG ĐIỂM ASPECTS TIÊN LƯỢNG HỒI PHỤC BỆNH NHÂN NHỒI MÁU NÃO CẤP TUẦN HOÀN TRƯỚC ĐƯỢC LẤY HUYẾT KHỐI CƠ HỌC=Value of Aspects in recover prognosis in patients with acute anterior circulation ischemic stroke undergoing mechanical thrombectomy

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Tác giả: Hoàng Kiên Lê, Quang Anh Nguyễn, Thanh Tâm Nguyễn, Anh Tuấn Trần, TrầN CườNg Trần, Đăng Lưu Vũ

Ngôn ngữ: vie

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Thông tin xuất bản: Tạp chí Điện quang và Y học hạt nhân Việt Nam, 2024

Mô tả vật lý: tr.29-37

Bộ sưu tập: Metadata

ID: 486822

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Mục tiêu: So sánh giá trị tiên lượng hồi phục của thang điểm ASPECTS so với chụp tưới máu trên bệnh nhân nhồi máu não cấp tuần hoàn trước được lấy huyết khối.Phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang hồi cứu kết hợp với tiến cứu 60 trường hợp được chụp CLVT không tiêm thuốc, CTA, CTP, sử dụng phần mềm RAPID tính giá trị core, penumbra và lấy huyết khối cơ học trong 6-24 giờ kể từ thời điểm khởi phát tại trung tâm Điện Quang, bệnh viện Bạch Mai từ tháng 1/2023 đến tháng 1/2024. Hồi phục lâm sàng được đánh giá tại thời điểm sau 3 tháng bởi thang điểm hồi phục chức năng Rankin hiệu chỉnh (mRS). Sử dụng đường cong ROC và giá trị AUC để so sánh giá trị tiên lượng hồi phục lâm sàng tốt và xấu của ASPECTS và các giá trị core, penumbra, mismatch ratio.Kết quả: Từ tháng 1/2023 đến tháng 1/2024, có 60 bệnh nhân được đưa vào nghiên cứu. Tại thời điểm 90 ngày, tỷ lệ kết cục độc lập chức năng mRS tốt là 58%, mRS xấu là 42%. Đường cong ROC đã chỉ ra rằng, trong các chỉ số ASPECTS, core, penumbra và mismatch ratio, chỉ có ASPECTS có khả năng tiên lượng tốt dự hậu đột quỵ (p <
0.05).Kết luận: ASPECTS ≥ 6 có khả năng tiên lượng hồi phục chức năng tốt sau đột quỵ ở những bệnh nhân nhồi máu não cấp tuần hoàn trước được lấy huyết khối tại cửa sổ mở rộng. Từ đó có thể xem xét đến việc sử dụng ASPECTS ≥ 6 để thay thế cho CTP lựa chọn bệnh để lấy huyết khối cơ học tại những cơ sở y tế không có các phương tiện chẩn đoán hình ảnh nâng cao.Purpose: Comparison of the prognostic value of recovery of the ASPECTS score compared with perfusion imaging in patients with acute anterior circulation cerebral infarction undergoing thrombectomy.Methods: Retrospective cross-sectional descriptive study combined with prospective study of 60 cases undergoing CT scan without injection, CTA, CTP, using RAPID software to calculate core and penumbra values and mechanical thrombectomy within 6-24 hours. from the time of onset at Dien Quang center, Bach Mai hospital from January 2023 to January 2024. Good and poor stroke outcomes were assessed at 3 months by the modified Rankin functional recovery score (mRS). Use the ROC curve and AUC value to compare the good and bad stroke prognostic value of ASPECTS and the core, penumbra, mismatch ratio values.Results: From January 2023 to January 2024, 60 patients were included in the study. At 90 days, the independent outcome rate of good mRSfunction was 58%, poor mRS function was 42%. The ROC curve showed that, among the ASPECTS, core, penumbra and mismatch ratio indices, onlyASPECTS had the ability to predict stroke outcome well (p <
0.05).Conclusion: ASPECTS ≥ 6 has the ability to predict good functional recovery after stroke in patients with acute anterior circulation cerebralinfarction undergoing thrombectomy at the extended window. From there, it is possible to consider using ASPECTS ≥ 6 to replace CTP in diseaseselection for mechanical thrombectomy at medical facilities that do nothave advanced imaging diagnostic facilities.

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