| Abstract | Objectives: The aim of our study was to investigate if EVT for acute stroke caused by occlusion of MCA is as efficient in low volume centers as it is in clinical trials. Furthermore, to identify whether any previous comorbidities or treatments have an impact on clinical outcome or thrombectomy outcome within the population of the University Hospital Split, in Croatia.
Materials and methods: A retrospective cohort study was carried out during 2020 of Neurology department in University Hospital Split. All data was acquired from the archives of the Neurology department, all patients treated with EVT for occlusion of MCA were included. A total of 90 patients of varied age, gender, previous health condition and treatments. Data collected was analyzed with IBM SPSS Statistics for Windows 26 (IBM Corp, 2019), for which t-tests and phi coefficient of correlation were used.
Results: The mean age for the patients was 77±9 years, with a span of 43 to 90 years. Selected patients showed an even gender distribution of 54% female and 46% male, of whom 94% had at least one comorbidity. Prior therapies as antiplatelet, anticoagulant or statins were utilized in roughly 20% of our study population. Good thrombectomy outcome (TICI 2b or 3) was achieved in 64% of our patients. There was a statistically significant difference in NIHSS and mRS between admission and discharge (t-test, P<0.01, t=5.883, df=45 and t=36.515, df=55 respectively). The good thrombectomy outcome significantly decreases the mRS at the discharge (-0.220, P<0.01). The NIHSS was also decreased but it did not reach the statistical significance (-0.134, P=0.094). There was a low negative correlation between the use of stent retriever and thrombectomy outcome (-0.220, P=0.05). Patients where thrombolysis was utilized prior to EVT had a better early outcome; TICI 2b or 3 was obtained in 77.3% of participants. No previous comorbidities or treatments, except the use of anticoagulants, had impact on thrombectomy or clinical outcome. Patient on anticoagulants had worse thrombectomy (-0.251, P<0.05) and clinical outcome (mRS discharge 0.217, P<0.05 and NIHSS discharge 0.271, P=0.043).
Conclusion: Even though EVT is slightly less effective than described in clinical trials, using EVT is effective in improving clinical outcome, for patients with MCA occlusion. Previous comorbidities and treatments do not affect the diseased, except for anticoagulants. |
| Abstract (croatian) | Ciljevi: Cilj naše studije bio je istražiti je li endovaskularno liječenje akutnog moždanog udara uzrokovanog okluzijom MCA u svakodnevnoj praksi jednako učinkovito kao i u velikim kliničkim studijama. Također smo željeli istražiti je li ikakvi prethodni komorbiditeti ili terapija imaju utjecaja na ishod trombektomije kod bolesnika liječenih u Kliničkom bolničkom centru Split.
Materijali i metode: Retrospektivno kohortno istraživanje provedeno je u Klinici za neurologiju KBC-a Split. Svi podaci dobiveni su iz arhive Klinike. Uključeni su svi pacijenti koji su tijekom 20202.g. liječeni EVT zbog okluzije MCA. Obrađeni su podaci ukupno 90 bolesnika različite dobi, spola, s različitim komorbiditetima i prethodnim terapijama. Analiza podataka napravljena je programom IBM SPSS statistika za Windows 26 (IBM Corp, 2019), korišteni su t-tests i fi koeficijent korealcije.
Rezultati: Prosječna dob pacijenata je 77±9 godina, raspon od 43 do 90. Pedeset i četiri posto pacijenata su bile žene. Bar jedan komorbiditet imalo je 94% pacijenata. Prethodnu antiagregacijsku, antikoagulantnu ili terapiju statinima imalo je 20% bolesnika. Dobar ishod trombektomije (TICI 2b ili 3) postignut je kod 64% pacijenata. Razlika između NIHSS-a i mRS-a pri prijemu i otpustu bila je značajna (t-test, P<0.01, t=5.883, df=45 and , t=36.515, df=55). Dobar ishod trombektomije značajno snižava mRS pri otpustu (-0.220, P<0.01). Snižava i NIHSS ali bez dosezanja statističke značajnosti (-0.134, P=0.094). Zamijećena je Blaga negativna korelacija između ishoda trombektomije i korištenja stent retrivera (-0.220, P=0.05). Bolesnici kojima je prije EVT ordinirana tromboliza imali su bolji ishod trombektomije; TICI 2b ili 3 postignut je kod 77.3% bolesnika. Nikakvi prethodni komorbiditeti ili terapija, izuzev antikoagulantne, nisu imali utjecaja na ishod trombektomije ili klinički ishod. Bolesnici koji su bili na prethodnoj antikoagulantnoj terapiji imali su lošiji ishod trombektomije (-0.251, P<0.05) i lošiji klinički ishod (mRS pri otpustu 0.217, P<0.05 i NIHSS pri otpustu 0.271, P=0.043).
Zaključak: iako je učinak EVT nešto lošiji nego što je opisano u velikim kliničkim studijama upotreba EVT je učinkovita metoda u liječenju akutnog ishemijskog moždanog udara uzrokovanog okluzijom MCA i značajno poboljšava klinički ishod liječenja ovih bolesnika. Prethodne bolesti i terapija ne utječu na ishod liječenja izuzev prethodne antikoagulantne terapije. |
