Title Analysis of mechanical thrombectomy outcomes at University Hospital Split in a two-year period
Title (croatian) Analiza ishoda mehaničke trombektomije u Kliničkom bolničkom centru Split u dvogodišnjem razdoblju
Author Christian Benedict Joseph Levesque
Mentor Ivica Bilić (mentor)
Committee member Krešimir Čaljkušić (predsjednik povjerenstva)
Committee member Vana Košta (član povjerenstva)
Committee member Sanda Pavelin (član povjerenstva)
Granter University of Split School of Medicine Split
Defense date and country 2024, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Neurology
Abstract Background: Stroke is a leading cause of disability and death globally. Ischemic stroke, the most common type, arises from blocked cerebral vessels. Mechanical thrombectomy is a groundbreaking treatment for certain strokes, significantly improving outcomes when administered swiftly to eligible patients. Methods: This retrospective cohort study investigated the outcomes of mechanical thrombectomy in stroke patients at the University Hospital of Split during 2021 and 2022. The study included 160 patients (70 in 2021, 90 in 2022) who underwent MT following European Stroke Organization guidelines. Patients with suspected acute ischemic stroke (NIHSS >4) underwent NCCT and CTA to identify large vessel occlusion. The MT procedure, guided by interventional radiologists, utilized a NeuronMax device for clot retrieval. Researchers analyzed clinical data, including NIHSS scores, COVID-19 status, and other baseline variables, to assess patient outcomes. Recovery was evaluated using the modified Rankin Scale post-treatment. Results: No significant differences in baseline demographics or clinical variables were found between 2021 and 2022. The most common pre-existing conditions were atrial fibrillation and hypertension, with a notable minority of patients testing positive for COVID-19 upon admission. The most frequent site of large vessel occlusion was the middle cerebral artery M1 segment. Older age and higher blood glucose levels were associated with poorer functional outcomes (higher mRS scores). Achieving successful reperfusion (higher TICI score) was associated with better outcomes in 2021. While no statistical difference was found in overall TICI or mRS scores between the two years, TICI 3 was the most common reperfusion outcome, while mRS 6 (death) was the most frequent functional outcome. Conclusion: This study identified age, gender, and blood glucose as significant predictors of posttreatment outcomes in acute ischemic stroke patients treated with mechanical thrombectomy. While hypertension and atrial fibrillation were highly prevalent, they did not significantly impact outcomes. This discrepancy highlights the influence of methodological variations on study findings. Despite high rates of successful recanalization, overall functional outcomes (mRS) were poor, emphasizing the need for continued refinement of MT techniques, identification of novel prognostic biomarkers, and a strong emphasis on primary stroke prevention.
Abstract (croatian) Cilj istraživanja: Moždani udar je vodeći uzrok invaliditeta i smrti u svijetu. Ishemijski moždani udar, najčešći tip, nastaje zbog blokade moždanih krvnih žila. Mehanička trombektomija je revolucionarna terapija za određene moždane udare, koja značajno poboljšava ishode kada se brzo primijeni kod odgovarajućih pacijenata. Ispitanici i metode: Ova retrospektivna kohortna studija istraživala je ishode MT u bolesnika s moždanim udarom u KBC-u Split tijekom 2021. i 2022. godine. Studija je obuhvatila 160 bolesnika (70 u 2021., 90 u 2022.) podvrgnutih MT-u prema smjernicama Europske organizacije za moždani udar. Bolesnici sa sumnjom na akutni ishemijski moždani udar (NIHSS> 4) podvrgnuti su NCCT-u i CTA-i radi identifikacije okluzije velikih krvnih žila. MT postupak, vođen intervencijskim radiolozima, koristio je NeuronMax uređaj za uklanjanje ugruška. Analizirani su klinički podaci, uključujući NIHSS skorove, COVID-19 status i druge početne varijable, kako bi se procijenili ishodi bolesnika. Oporavak je procijenjen pomoću modificirane Rankinove skale (mRS) nakon liječenja. Rezultati: Nisu pronađene značajne razlike u početnim demografskim ili kliničkim varijablama između 2021. i 2022. godine. Najčešća prethodna stanja bila su fibrilacija atrija i hipertenzija, sa značajnom manjinom pacijenata pozitivnih na COVID-19 prilikom prijema. Najčešće mjesto okluzije velikih krvnih žila bio je M1 segment srednje moždane arterije. Starija dob i viša razina glukoze u krvi bili su povezani s lošijim funkcionalnim ishodima (viši mRS). Postizanje uspješne reperfzije (viši TICI skor) bilo je povezano s boljim ishodima u 2021. godini. Iako nije pronađena statistička razlika u ukupnim TICI ili mRS rezultatima između dvije godine, TICI 3 bio je najčešći ishod reperfuzije, dok je mRS 6 (smrt) bio najčešći funkcionalni ishod. Zaključi: Ova studija identificirala je dob, spol i glukozu u krvi kao značajne prediktore ishoda nakon liječenja u bolesnika s akutnim ishemijskim moždanim udarom liječenih MT-om. Iako su hipertenzija i fibrilacija atrija bili vrlo česti, nisu značajno utjecali na ishode. Ova neusklađenost naglašava utjecaj metodoloških varijacija na nalaze studije. Unatoč visokim stopama uspješne rekanalikacije, ukupni funkcionalni ishodi (mRS) bili su loši, što naglašava potrebu za kontinuiranim usavršavanjem MT tehnika, identifikacijom novih prognostičkih biomarkera i snažnim naglaskom na primarnoj prevenciji moždanog udara.
Keywords
Ischemic Stroke
Mechanical Thrombolysis
Treatment Outcome
Keywords (croatian)
ishemijski moždani udar
mehanička tromboliza
ishod liječenja
Language english
URN:NBN urn:nbn:hr:171:839160
Study programme Title: Medical Studies in English Study programme type: university Study level: integrated undergraduate and graduate Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
Type of resource Text
File origin Born digital
Access conditions Open access Embargo expiration date: 2024-09-09
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Created on 2024-09-06 12:39:17