Akut iskemik uyanma inmesinde mekanik trombektominin etkinliğinin retrospektif olarak değerlendirilmesi
Date
2020
Authors
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Akut iskemik inmede tedavi yanıtını belirleyen en önemli parametrelerden biri semptomların süresidir. Semptom süresi uzadıkça geri dönüşümsüz nöron hasarı ve hastalarda fonksiyon kaybı meydana gelme ihtimali artar. Bu nedenle, akut inmede, mekanik trombektomi kararının verilmesinde semptom süresi oldukça önemlidir. Ancak akut iskemik uyanma inmelerinde semptom süresi bilinmemektedir. Bu durum akut iskemik uyanma inmeli olgularının yönetimini zorlaştırmaktadır. DAWN ve DEFUSE-3 çalışmalarında ileri görüntüleme yöntemleri ile seçilen hastalarda mekanik trombektominin bu hastalarda 16-24 saate kadar etkili olabileceği gösterilmiştir. Bu sayede semptomlarının başlangıç zamanı bilinmeyen olgularda mekanik trombektomi günlük pratikte daha çok uygulanmaya başlanmıştır. Biz bu tez çalışmasında akut iskemik uyanma inmesi ile başvuran ve büyük damar tıkanıklığı saptanan olgularda mekanik trombektominin etkinliğini değerlendirmeyi amaçladık. Çalışmamızda Ocak 2012- Şubat 2020 tarihleri arasında Bursa Uludağ Üniversitesi Tıp Fakültesi hastanesinde mekanik trombektomi ile tedavi edilen 22 akut iskemik uyanma inmesi olgusu retrospektif olarak değerlendirildi. Hastaların demografik verileri, komorbid hastalıkları kaydedildi. Mekanik trombektomi sonrası ilgili damarın rekanalizasyonu Thrombolysis in Cerebral Infarction (TICI) skalası ile değerlendirildi. TICI≥2b rekanalizasyon başarılı olarak kabul edildi. Çalışmamızda TICI≥2b rekanalizasyon %86,36 (19/22) oranında sağlandı. Klinik yanıt ise 90. gün modifiye Rankin Skalası (mRS) ile değerlendirildi. Hedeflenen klinik sonuç fonksiyonel bağımsızlık (mRS≤2) olarak belirlendi. Fonksiyonel bağımsızlık ise %36,36 (8/22) oranında sağlandı. İki olguda (%9,09) semptomatik intrakranial hemoraji gözlendi. Tez çalışmamızda elde ettiğimiz sonuçlar doğru hasta seçimi ile akut iskemik uyanma inme olgularında mekanik trombektomi ile yüksek fonksiyonel bağımsızlık oranlarının sağlanabileceğini göstermektedir. Benzer şekilde düşük iv komplikasyon oranları mekanik trombektominin bu hasta grubununda güvenilirliğini desteklemektedir.
The symptom duration is the one of the most important prognostic factors in acute ischemic stoke. Prolongation of the symptom duration may entail, irreversible neuron damage. Therefore, determining symptom onset time is a very important step in the decision of mechanical thrombectomy. However, the duration of symptoms is not known in ischemic wake-up strokes. That is why, management of these cases is harder compared to patients with known onset strokes. In the DAWN and DEFUSE-3 studies, mechanical thrombectomy has been proven to be effective for up to 16-24 hours in patients selected with advanced imaging methods. In this way, mechanical thrombectomy was started to be performed more frequently in patients with unknown sypmtom onset. In this thesis, we aimed to evaluate the feasibility of mechanical thrombectomy in patients with acute ischemic wake-up strokes. Twenty-two acute ischemic wake-up stroke cases treated with mechanical thrombectomy in Bursa Uludağ University Medical Faculty Hospital between January 2012 and February 2020 were evaluated retrospectively. Demographic data and comorbid diseases of the patients were recorded. After mechanical thrombectomy, recanalization of the occluded vessel was evaluated with Thrombolysis in Cerebral Infarction (TICI) scale. TICI≥2b recanalization was considered successful. In our study, TICI≥2b recanalization was achieved at the rate of 86.36% (19/22). The functional outcome was evaluated on the 90th day with the modified Rankin Scale (mRS). The targeted clinical outcome was determined as functional independence (mRS≤2). Functional independence was achieved at v the rate of 36.36% (8/22). Symptomatic intracranial hemorrhage was observed in 2 (9.09%) cases. The results we obtained in our thesis study suggest that high functional independence rates can be achieved with mechanical thrombectomy in wake-up strokes. Similarly, our low complication rates support the safety of mechanical thrombectomy in this patient group.
The symptom duration is the one of the most important prognostic factors in acute ischemic stoke. Prolongation of the symptom duration may entail, irreversible neuron damage. Therefore, determining symptom onset time is a very important step in the decision of mechanical thrombectomy. However, the duration of symptoms is not known in ischemic wake-up strokes. That is why, management of these cases is harder compared to patients with known onset strokes. In the DAWN and DEFUSE-3 studies, mechanical thrombectomy has been proven to be effective for up to 16-24 hours in patients selected with advanced imaging methods. In this way, mechanical thrombectomy was started to be performed more frequently in patients with unknown sypmtom onset. In this thesis, we aimed to evaluate the feasibility of mechanical thrombectomy in patients with acute ischemic wake-up strokes. Twenty-two acute ischemic wake-up stroke cases treated with mechanical thrombectomy in Bursa Uludağ University Medical Faculty Hospital between January 2012 and February 2020 were evaluated retrospectively. Demographic data and comorbid diseases of the patients were recorded. After mechanical thrombectomy, recanalization of the occluded vessel was evaluated with Thrombolysis in Cerebral Infarction (TICI) scale. TICI≥2b recanalization was considered successful. In our study, TICI≥2b recanalization was achieved at the rate of 86.36% (19/22). The functional outcome was evaluated on the 90th day with the modified Rankin Scale (mRS). The targeted clinical outcome was determined as functional independence (mRS≤2). Functional independence was achieved at v the rate of 36.36% (8/22). Symptomatic intracranial hemorrhage was observed in 2 (9.09%) cases. The results we obtained in our thesis study suggest that high functional independence rates can be achieved with mechanical thrombectomy in wake-up strokes. Similarly, our low complication rates support the safety of mechanical thrombectomy in this patient group.
Description
Keywords
Akut iskemik inme, Uyanma inmesi, Mekanik trombektomi, Acute ischemic stroke, Mechanical thrombectomy, Wake-up stroke
Citation
Bilgin, C. (2020). Akut iskemik uyanma inmesinde mekanik trombektominin etkinliğinin retrospektif olarak değerlendirilmesi. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.