| Abstract | Cilj istraživanja: Provjeriti postoji li značajna razlika u ranom ishodu liječenja u pacijenata starijih od 80 godina koji su preboljeli akutni ishemijski moždani udar, a liječeni su ili trombektomijom ili općim potpornim mjerama. Također, cilj je bio i odrediti eventualne prediktore lošijeg ili boljeg ishoda u ovih pacijenata.
Ispitanici i metode: U ovo retrospektivni kohortno istraživanje uključen je 51 trombektormirani ispitanik i 51 ispitanika kontrolne skupine. Kontrolni ispitanici nisu bili podvrgnuti MT, već su liječeni općim potpornim mjerama. Kriteriji uključenja ispitanika u obje skupine bili su dob ≥ 80 godina te akutni moždani udar uzrokovan okluzijom ACM M1 segmenta.
Rezultati: U skupini trombektomiranih ispitanika pronađeno je statistički značajno više krvarenja (P<0,01), značajno dulja hospitalizacija (P<0,01), značajno niži mRS zbroj prilikom otpusta (P=0,047) te su trombektomirani ispitanici primali značajno manje antiagregacijske terapije u prehospitalnoj terapiji (P<0,01). Značajno bolji TICI (P=0,022) i niži NIHSS prilikom prijema (P<0,01) te niži NIHSS prilikom otpusta s bolničkog liječenja (P<0,01) kao i veći ΔNIHSS (P<0,01) imali su ispitanici s dobrim ishodom liječenja (mRS≤2) u skupini trombektomiranih ispitanika. Pronađena je značajna negativna korelacija hipertenzije i ΔmRS u skupini trombektomiranih ispitanika (P=0,022). U kontrolnoj skupini je pronađena značajna pozitivna korelacija između ΔmRS i prethodne antiagregacijske terapije (P=0,041), te ΔmRS i upotrebe statina u prehospitalnoj (P=0,037). Pronađena je značajna negativna korelacija između trajanja MT i ishoda trombektomije (TICI) (P=0,044) te pozitivna korelacija MT s aspiracijom i ishoda MT (P=0,027). Hospitalna infekcija je povezana s većim rizikom duže hospitalizacije u obje skupine (OR=1,01, P<0,01). Kraće trajanje trombektomije je značajni prediktor dobrog ishoda trombektomije (TICI 2b, TICI 3) (OR=0,97, P=0,018; CI=0,95-0,99).
Zaključak: U našem istraživanju bolji rani klinički ishod imaju ispitanici podvrgnuti mehaničkoj trombektomiji u usporedbi s bolesnicima koji su liječeni konzervativno. Vrijeme trajanja trombektomije je vrlo važno; kraće trajanje zahvata dovodi do boljeg ishoda liječenja. Hospitalizacija je duljeg trajanja kod ispitanika koji su podvrgnuti mehaničkoj trombektomiji. Prisutnost hospitalne infekcije produljuje trajanje hospitalizacije u obje skupine. Hipertenzija je neovisni negativni prediktor ranog kliničkog ishoda kod trombektomiranih ispitanika. Sistemska tromboliza ne poboljšava ishod trombektomije. |
| Abstract (english) | Aim of the study: The main objective of this study was to examine whether there was a significant difference in early outcome in patients older than 80 years who had experienced acute ischemic stroke, who were treated with either mechanical thrombectomy or general supportive measures. Also, the goal was to determine possible predictors of worse or better outcome in these patients.
Subjects and Methods: 51 subjects underwent the procedure and 51 control subjects were included in this retrospective cohort study. Control group was not subjected to the procedure, but was treated with general supportive measures. Inclusion criteria for both groups were age ≥ 80 years and acute stroke caused by ACM M1 segment occlusion.
Results: In the thrombectomy group, significantly more bleeding (P<0.01) was found, as well as longer hospitalization (P<0.01), lower mRS sum at discharge (P=0.047), also less antiplatelet therapy was received in prehospital therapy (P<0.01). Subjects with a good outcome (mRS≤2) in the thrombectomy group, had significantly better TICI (P=0.022) and lower NIHSS on admission (P<0.01) and lower NIHSS on discharge (P<0.01) as well as higher ΔNIHSS (P<0.01). A significant negative correlation was found between hypertension and ΔmRS in the group of subjects who underwent thrombectomy (P=0.022). In the control group, a significant positive correlation was found between ΔmRS and previous antiplatelet therapy (P=0.041), and ΔmRS with statin use in prehospital therapy (P=0.037). A significant negative correlation was found between the duration of the procedure and the outcome of the procedure (TICI) (P=0.044) and a positive correlation between aspiration thrombectomy and the outcome of the procedure (P=0.027). Nosocomial infection was associated with a higher risk of prolonged hospitalization in the facility (OR=1.01, P<0.01). Shorter duration of thrombectomy is a significant predictor of a good thrombectomy outcome (TICI 2b, TICI 3) (OR=0.97, P=0.018; CI=0.95-0.99).
Conclusion: Subjects who underwent mechanical thrombectomy have a better early clinical outcome compared to patients treated conservatively. The duration of thrombectomy is very important - a shorter duration of the procedure leads to a better treatment outcome. Hospitalization is longer in subjects who have underwent mechanical thrombectomy. The presence of nosocomial infections prolongs the duration of hospitalization in all subjects. Hypertension is an independent negative predictor of early clinical outcome in subjects who underwent thrombectomy. Systemic thrombolysis does not improve the outcome of thrombectomy. |
