Evaluation of The Clinical Results In Stroke Patients Treated With Endovascular Therapy In The Interventional Neurology Department: Experience of A Stroke Center

Year 2020, Volume: 11 Issue: 4, 443 - 449, 31.12.2020

Nihat Şengeze , Vedat Ali Yürekli

Abstract

Objective: Stroke is still one of the most common cause of death and disability in the worldwide. Endovascular treatments have almost revolutionized treatment of stroke. Intra-arterial thrombolytic therapy and mechanical thrombectomy are frequently treatment options for endovascular treatmen. We evaluated the treatment strategies, clinical outcomes and mortality rates in stroke patients treated with endovascular therapy. Material-Method: Of the 42 patients treated by endovascular therapy between June 2019 and March 2020 were included this study. Hemogram, routine biochemical examination, erythrocyte sedimentation rate, coagulation time, aPTT, INR values of all patients were examined. Endovascular treatment strategies, stroke risk factors and etiology, mTICI recanalization scores, functional outcomes and mortality rates were analyzed. Results: Among 42 patients, the mean age was 64.7±12.3 and 16 (38.1%) were women. NIHSS at admission were obtained as 13.5 (8-16), ASPECT score as 10 (9.75-10). Of 42 patients, large vessel occlusion was present in 28 (66.7%), and 31 (73.8%) had received intravenous thrombolytic therapy until the endovascular treatment. Stent retrievers were used in 21 (50%) of the patient. The successful recanalization of mTICI 2b-3 was obtained in 33 (78.6%). There were 30 (71.4%) patients had a favorable functional outcome (mRS 0-2) and 7 (16.7%) patients had mortality at third month. Conclusion: It is also seen in our study that centralized stroke centers have caused significant improvements in stroke treatment with the endovascular procedures and can significantly reduce stroke-related mortality and morbidity.

Keywords

Stroke, Large Vessel Occulusion, Endovascular Therapy, Clinical outcomes of stroke

Girişimsel Vasküler Nöroloji Kliniğinde Endovasküler Yolla Tedavi Edilen İnme Olgularında Sonuçların Değerlendirilmesi: Bir İnme Merkezi Deneyimi

Abstract

Amaç: İnme halen dünya çapında ölümlerin ve engellilik gelişiminin en sık nedenlerinden biridir. Endovasküler tedaviler ise akut inme tedavisinde adeta bir devrim yaratmıştır. İnmenin endovasküler tedavisinde sıklıkla intraarteriyel trombolitik tedavi ve mekanik trombektomi tedavi seçenekleri kullanılmaktadır. Biz bu çalışmada, XXXX Üniversitesine başvuran, inme tanısı ile endovasküler tedaviye aldığımız hastalarda, tedavi stratejileri, klinik sonlanım ve mortalite oranlarını değerlendirdik.
Materyal-Metod: Çalışmaya Haziran 2019-Mart 2020 yılları arasında akut iskemik inme kliniği ile hastaneye başvuran, sonrasında endovasküler yolla tedavi edilen 42 hasta dahil edildi. Çalışmaya alınan bütün olguların hemogram, rutin biyokimyasal inceleme, eritrosit sedimentasyon hızı, pıhtılaşma zamanı, aPTT, INR değerleri retrospektif olarak incelendi. Hastaların endovasküler tedavi stratejileri, inme risk faktörleri, inme etyolojisi, endovasküler tedavi sonrası mTICI skorları ile rekanalizasyon başarısı, üçüncü ay sonundaki fonksiyonel sonlanımı, üçüncü aydaki mortalite oranları incelendi. Bulgular: Çalışmaya dahil edilen 42 hastanın ortalama yaşı 64,7±12,3 ve 16 (%38,1)’sı kadın’dı. Hastaların başvuru sırasındaki NIHSS ortanca ve persentil (25-75) değerleri ise 13,5 (8-16), beyin bilgisayarlı tomografi ASPECT skoru 10 (9,75-10) olarak saptandı. Hastaların 28 (%66,7)’inde büyük damar oklüzyonu mevcuttu, 31 (%73,8)’i başvuru sonrası endovasküler tedaviye alınana kadar intravenöz trombolitik tedavi almıştı. Hastaların 21 (%50)’inde işlem sırasında geri çekilebilir stent kullanılmıştı. Endovasküler işlem sonunda hastaların 33 (%78,6)’ünde mTICI 2b ve üzeri başarılı rekanalizasyon elde edilmişti. Hastaların 30 (%71,4)’u üçüncü ay sonu mRS 0-2 arasında iyi sonlanıma sahipti ve üçüncü ay sonunda 7 (%16,7)’sinde mortalite gerçekleşmişti. Sonuç: Endovasküler işlemlerin inme tedavisinde önemli gelişmelere neden olduğu mortalite ve morbiditeyi belirgin düzeyde azalttığı çalışmamızda da görülmektedir.

Keywords

İnme, Büyük Damar Oklüzyonu, İnme Merkezi, Endovasküler Tedavi, Klinik Sonlanım

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