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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

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.

References

  • 1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Executive summary: heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation. 2013;127(1):143-52.
  • 2. Akpınar ÇK. Anterior Sirkülasyon Akut İskemik İnmelerinde Endovasküler Tedavi Stratejileri. Müngen B, Özdemir AÖ, editörler. Akut İskemik İnmede Endovasküler Revaskülarizasyon. 1. Baskı. Ankara: Türkiye Klinikleri; 2019. p.26- 34.
  • 3. Lambrinos A, Schaink AK, Dhalla I, Krings T, Casaubon LK, Sikich N, et al. Mechanical Thrombectomy in Acute Ischemic Stroke: A Systematic Review. Can J Neurol Sci. 2016;43(4):455‐60.
  • 4. Desai SM, Haussen DC, Aghaebrahim A, Al-Bayati AR, Santos R, Nogueira RG, et al. Thrombectomy 24 hours after stroke: beyond DAWN. J Neurointerv Surg. 2018;10(11):1039-42.
  • 5. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285-95.
  • 6. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019-30.
  • 7. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11-20.
  • 8. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018;49(3):e46-e110.
  • 9. Jovin TG, Chamorro A, Cobo E, Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296‐306.
  • 10. Jovin TG, Saver JL, Ribo M, Pereira V, Furlan A, Bonafe A, et al. Diffusion-weighted imaging or computerized tomography perfusion assessment with clinical mismatch in the triage of wake up and late presenting strokes undergoing neurointervention with Trevo (DAWN) trial methods. Int J Stroke. 2017;12(6):641‐52.
  • 11. Albers GW, Lansberg MG, Kemp S, Tsai JP, Lavori P, Christensen S, et al. A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3). Int J Stroke. 2017;12(8):896‐905.
  • 12. Campbell BCV, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009‐18.
  • 13. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischemic stroke: a meta-analysis of individual patient data from five randomized trials. Lancet. 2016;387(10029):1723-31.
  • 14. Sweid A, Hammoud B, Ramesh S, Wong D, Alexander TD , Weinberg JH, et al. Acute ischaemic stroke interventions: large vessel occlusion and beyond. Stroke Vasc Neurol. 2019;5(1):80‐85.
  • 15. Aykaç Ö, Özdemir AÖ. Kılavuzlarda net olmayan vakalarda akut iskemik inme endovasküler tedavisi (Diseksiyon, M2 oklüzyonları, düşük NIHSS, düşük ASPECT). Müngen B, Özdemir AÖ, editörler. Akut İskemik İnmede Endovasküler Revaskülarizasyon. 1. Baskı. Ankara: Türkiye Klinikleri; 2019. p.19-25.
  • 16. Ragoschke-Schumm A, Walter S. DAWN and DEFUSE-3 trials: is time still important? Radiologe. 2018;58(Suppl 1):20-3.
  • 17. Mistry EA, Mistry AM, Nakawah MO, Chitale RV, James RF, Volpi JJ, et al. Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis inStroke Patients: A Meta-Analysis. Stroke. 2017;48(9):2450-6.
  • 18. Coutinho JM, Liebeskind DS, Slater LA, Nogueira RG, Clark W, Dávalos A, et al. Combined intravenous thrombolysis and thrombectomy vs thrombectomy alone for acute ischemic stroke: a pooled analysis of the SWIFT and STAR studies. JAMA Neurol. 2017;74:268-74.
  • 19. Hassan AE, Kotta H, Garza L, Preston L, Tekle W, Sarraj A, et al. Pre-thrombectomy intravenous thrombolytics are associated with increased hospital bills without improved outcomes compared with mechanical thrombectomy alone. J Neurointerv Surg. 2019;11(12):1187‐90.
  • 20. Özkul A. Mekanik trombektomi öncesi intravenöz tromboliz. Müngen B, Özdemir AÖ, editörler. Akut İskemik İnmede Endovasküler Revaskülarizasyon. 1. Baskı. Ankara: Türkiye Klinikleri; 2019. p.40-6.
  • 21. Rahme R, Yeatts SD, Abruzzo TA, Jimenez L, Fan L, Tomsick TA, et al. Early reperfusion and clinical outcomes in patients with M2 occlusion: pooled analysis of the PROACT II, IMS, and IMS II studies. J Neurosurgery. 2014;121(6):1354-8.
  • 22. Dorn F, Lockau H, Stetefeld H, Kabbasch C, Kraus B, Dohmen, et al. Mechanical thrombectomy of M2-occlusion. J Stroke Cerebrovasc Dis. 2015;24(7):1465-70.
  • 23. Salahuddin H, Ramaiah G, Slawski DE, Shawver J, Buehler M, Zaidi SF, et al. Mechanical thrombectomy of M1 and M2 middle cerebral artery occlusions. J Neurointerv Surg. 2018;10(4):330‐334.

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

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

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.

References

  • 1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Executive summary: heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation. 2013;127(1):143-52.
  • 2. Akpınar ÇK. Anterior Sirkülasyon Akut İskemik İnmelerinde Endovasküler Tedavi Stratejileri. Müngen B, Özdemir AÖ, editörler. Akut İskemik İnmede Endovasküler Revaskülarizasyon. 1. Baskı. Ankara: Türkiye Klinikleri; 2019. p.26- 34.
  • 3. Lambrinos A, Schaink AK, Dhalla I, Krings T, Casaubon LK, Sikich N, et al. Mechanical Thrombectomy in Acute Ischemic Stroke: A Systematic Review. Can J Neurol Sci. 2016;43(4):455‐60.
  • 4. Desai SM, Haussen DC, Aghaebrahim A, Al-Bayati AR, Santos R, Nogueira RG, et al. Thrombectomy 24 hours after stroke: beyond DAWN. J Neurointerv Surg. 2018;10(11):1039-42.
  • 5. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285-95.
  • 6. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019-30.
  • 7. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11-20.
  • 8. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018;49(3):e46-e110.
  • 9. Jovin TG, Chamorro A, Cobo E, Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296‐306.
  • 10. Jovin TG, Saver JL, Ribo M, Pereira V, Furlan A, Bonafe A, et al. Diffusion-weighted imaging or computerized tomography perfusion assessment with clinical mismatch in the triage of wake up and late presenting strokes undergoing neurointervention with Trevo (DAWN) trial methods. Int J Stroke. 2017;12(6):641‐52.
  • 11. Albers GW, Lansberg MG, Kemp S, Tsai JP, Lavori P, Christensen S, et al. A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3). Int J Stroke. 2017;12(8):896‐905.
  • 12. Campbell BCV, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009‐18.
  • 13. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischemic stroke: a meta-analysis of individual patient data from five randomized trials. Lancet. 2016;387(10029):1723-31.
  • 14. Sweid A, Hammoud B, Ramesh S, Wong D, Alexander TD , Weinberg JH, et al. Acute ischaemic stroke interventions: large vessel occlusion and beyond. Stroke Vasc Neurol. 2019;5(1):80‐85.
  • 15. Aykaç Ö, Özdemir AÖ. Kılavuzlarda net olmayan vakalarda akut iskemik inme endovasküler tedavisi (Diseksiyon, M2 oklüzyonları, düşük NIHSS, düşük ASPECT). Müngen B, Özdemir AÖ, editörler. Akut İskemik İnmede Endovasküler Revaskülarizasyon. 1. Baskı. Ankara: Türkiye Klinikleri; 2019. p.19-25.
  • 16. Ragoschke-Schumm A, Walter S. DAWN and DEFUSE-3 trials: is time still important? Radiologe. 2018;58(Suppl 1):20-3.
  • 17. Mistry EA, Mistry AM, Nakawah MO, Chitale RV, James RF, Volpi JJ, et al. Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis inStroke Patients: A Meta-Analysis. Stroke. 2017;48(9):2450-6.
  • 18. Coutinho JM, Liebeskind DS, Slater LA, Nogueira RG, Clark W, Dávalos A, et al. Combined intravenous thrombolysis and thrombectomy vs thrombectomy alone for acute ischemic stroke: a pooled analysis of the SWIFT and STAR studies. JAMA Neurol. 2017;74:268-74.
  • 19. Hassan AE, Kotta H, Garza L, Preston L, Tekle W, Sarraj A, et al. Pre-thrombectomy intravenous thrombolytics are associated with increased hospital bills without improved outcomes compared with mechanical thrombectomy alone. J Neurointerv Surg. 2019;11(12):1187‐90.
  • 20. Özkul A. Mekanik trombektomi öncesi intravenöz tromboliz. Müngen B, Özdemir AÖ, editörler. Akut İskemik İnmede Endovasküler Revaskülarizasyon. 1. Baskı. Ankara: Türkiye Klinikleri; 2019. p.40-6.
  • 21. Rahme R, Yeatts SD, Abruzzo TA, Jimenez L, Fan L, Tomsick TA, et al. Early reperfusion and clinical outcomes in patients with M2 occlusion: pooled analysis of the PROACT II, IMS, and IMS II studies. J Neurosurgery. 2014;121(6):1354-8.
  • 22. Dorn F, Lockau H, Stetefeld H, Kabbasch C, Kraus B, Dohmen, et al. Mechanical thrombectomy of M2-occlusion. J Stroke Cerebrovasc Dis. 2015;24(7):1465-70.
  • 23. Salahuddin H, Ramaiah G, Slawski DE, Shawver J, Buehler M, Zaidi SF, et al. Mechanical thrombectomy of M1 and M2 middle cerebral artery occlusions. J Neurointerv Surg. 2018;10(4):330‐334.
There are 23 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original Article
Authors

Nihat Şengeze 0000-0002-2821-3708

Vedat Ali Yürekli 0000-0001-7680-6156

Publication Date December 31, 2020
Submission Date August 27, 2020
Published in Issue Year 2020 Volume: 11 Issue: 4

Cite

Vancouver Şengeze N, Yürekli VA. Girişimsel Vasküler Nöroloji Kliniğinde Endovasküler Yolla Tedavi Edilen İnme Olgularında Sonuçların Değerlendirilmesi: Bir İnme Merkezi Deneyimi. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi. 2020;11(4):443-9.

SDÜ Sağlık Bilimleri Dergisi, makalenin gönderilmesi ve yayınlanması dahil olmak üzere hiçbir aşamada herhangi bir ücret talep etmemektedir. Dergimiz, bilimsel araştırmaları okuyucuya ücretsiz sunmanın bilginin küresel paylaşımını artıracağı ilkesini benimseyerek, içeriğine anında açık erişim sağlamaktadır.