Ứng dụng kỹ thuật hút huyết khối trực tiếp bằng ống thông trong điều trị đột quỵ thiếu máu não cấp tại Bệnh viện Chợ Rẫy

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Tác giả: Huỳnh Nhật Tuấn Nguyễn, Văn Khôi Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại: 362.19681 Physical illness

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2022

Mô tả vật lý: 56-59

Bộ sưu tập: Metadata

ID: 498831

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Chủ đề

Đột quỵ là nguyên nhân tử vong thứ hai trên Thế giới, hiện nay có nhiều kỹ thuật can thiệp nội mạch để điều trị đột quỵ thiếu máu não cấp (ĐQTMNC). Kỹ thuật hút huyết khối trực tiếp bằng ống thông (ADAPT) là một phương pháp đơn giản, nhanh chóng để đạt được kết quả tái thông và kết cục lâm sàng tốt bằng cách sử dụng ống thông hút huyết khối lòng rộng để điều trị ĐQTMNC do tắc động mạch não lớn (TĐMNL). Mục tiêu: Để đánh giá tính an toàn và hiệu quả của kỹ thuật ADAPT trong điều trị ĐQTMNC do TĐMNL ở bệnh viện Chợ Rẫy. Đối tượng và phương pháp: Phân tích hồi cứu tất cả các bệnh nhân ĐQTMNC được điều trị bằng kỹ thuật ADAPT tại Bệnh viện Chợ Rẫy từ tháng 01 năm 2017 đến tháng 01 năm 2021. Hiệu quả và độ an toàn được đánh giá bằng các biến số: tỷ lệ tái thông mạch (thang điểm TICI), thời gian tái thông, biến chứng thủ thuật và kết cục lâm sàng (thang điểm Rankin sửa đổi [mRS]) ở thời điểm 90 ngày. Kết quả: Có 140 bệnh nhân ĐQTMNC được điều trị bằng kỹ thuật ADAPT với điểm NIHSS trung bình lúc nhập viện là 19,1 và được cải thiện về 8,9 khi xuất viện. Thời gian trung bình từ lúc chọc động mạch đến tái thông mạch là 34,9 phút. Tỷ lệ tái thông mạch TICI 2b-3 đạt được ở 116/140 (82,9%) bệnh nhân, kết cục lâm sàng tốt (mRS 0-2) đạt được ở 62/140 (44,3%) bệnh nhân, và tỷ lệ tử vong là 24/140 (17,1%) trong thời gian theo dõi. Kết luận: Kỹ thuật ADAPT sử dụng ống thông hút huyết khối lòng rộng là một phương pháp nhanh chóng, đơn giản, an toàn và hiệu quả để điều trị ĐQTMNC tại bệnh viện Chợ Rẫy.Stroke is the second cause of mortality worldwide, there are currently many endovascular treatment techniques for management of acute ischemic stroke (AIS). A direct aspiration first pass technique (ADAPT) has been introduced as a rapid, simple method for achieving good recanalization and clinical outcomes using large bore aspiration catheters in the treatment of AIS due to large vessel occlusion (LVO). Objectives: To assess the safety and efficacy of ADAPT in the treatment of AIS due to LVO at Choray hospital. Materials and Methods: A retrospective analysis of hospital database was conducted on all patients undergoing stroke therapy with the ADAPT technique at Choray hospital from January 2017 to January 2021. Efficacy and safety were evaluated by the variables: revascularization rates (thrombolysis in cerebral infarction [TICI] score), time to revascularization, procedural complications, and clinical outcomes (modified Rankin scale [mRS] score) at the 90‑day follow‑up visit. Results: From the database review, 140 AIS patients treated with ADAPT were identified. The mean NIHSS score on admission was 19.1 and improved to 8.9 at discharged. The average time from arterial puncture to revascularization was 34.9 minutes. TICI 2b-3 revascularization was achieved in 116/140 (82.9%) patients, good clinical outcomes were achieved (mRS 0-2) in 62/140 (44.3%) patients, and mortality rate was 24/140 (17.1%) during follow‑up. Conclusion: ADAPT utilizing large bore aspiration catheters appears to be a fast, simple, safe, and effective method for the management of AIS at Choray hospital.

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