| Abstract | Uvod: Zahvaljujući mehaničkoj trombektomiji, unazad desetak godina došlo je do napretka u liječenja akutnog ishemijskog moždanog udara. Od velike je važnosti u što kraćem vremenskom periodu napraviti neurološku i neuroradiološku procjenu, te odredit je li pacijent kandidat za mehaničku trombektomiju. Ishod se određuje postignutom rekanalizacijom (TICI), NIHSS ljestvicom i mRS ljestvicom.
Svrha rada: Svrha ovog diplomskog rada je prikazati ishode mehaničke trombektomije u liječenju akutnog ishemijskog moždanog udara u Kliničkom bolničkom centru Rijeka, te dobivene rezultate usporediti sa dostupnom literaturom.
Ispitanici i metode: U ovoj retrospektivnom istraživanju uključeno je 265 pacijenata koji su od 10. lipnja 2019. do 31. prosinca 2022. bili liječeni od akutnog ishemijskog moždanog udara sa mehaničkom trombektomijom na Klinici za neurologiju, na Kliničkom zavodu za radiologiju i na Klinici za anesteziju, intenzivnu medicinu i liječenje boli u Kliničkom bolničkom centru Rijeka.
Rezultati: Rezultati istraživanja na 265 pacijenata pokazuju da je prosječna dob u trenutku zahvata iznosila 69 godina i 1 mjeseca i podjednako su bolesnici raspoređeni po spolu. Klinička slika i očekivani ishod mjereni NIHSS ljestvicom po dolasku su prosječno iznosili 13,46, a premorbidni mRS (invaliditet) 0,13. U 71% pacijenata koji zadovoljavaju indikacije za MT okludirana je ACM. U 22,86% pacijenata MT je bila neuspješna, a u 46,12% pacijenata je postignut stupanj rekanalizacije (TICI 2b, 2c i 3) sa očekivanim dobrim kliničkim ishodom. Do komplikacija je došlo nakon MT u 3% pacijenata, a tijekom hospitalizacije preminulo je 16,23% pacijenata. Po otpustu prosječni NIHSS iznosi 7,62, dok prosječni mRS 2,55. Nakon tri mjeseca od MT prosječni NIHSS je 3,51, a mRS je je 1,09.
Zaključak: Povoljni ishod po otpustu iz bolnice (mRS 0-2) imalo 31,42% pacijenata, a usmjereni ishod (mRS 0-3) 36,02% pacijenata, dok je nakon tri mjeseca od MT, povoljan ishod (mRS 0-2) imalo 60% pacijenata, a umjereni ishod (0-3) 67,14% pacijenata. Ishodi MT u Kliničkom bolničkom centru Rijeka u skladu su sa najvećim centrima za mehaničku trombektomiju u Europi. |
| Abstract (english) | Introduction: Thanks to mechanical thrombectomy, progress has been made in the treatment of acute ischemic stroke in the past ten years. It is of great importance to perform a neurological and neuroradiological assessment as soon as possible, and to determine whether the patient is a candidate for mechanical thrombectomy. The outcome is determined by achieved recanalization (TICI), NIH stroke scale and modified Rankin scale (mRS).
Purpose: The purpose of this thesis is to present the results of mechanical thrombectomy in the treatment of acute ischemic stroke at the Clinical Hospital Center Rijeka and to compare the obtained results with the available literature.
Subjects and methods: This retrospective study included 265 patients who were treated for acute ischemic stroke with mechanical thrombectomy from June 10, 2019 to December 31, 2022 at the Clinic for Neurology, the Clinical Institute for Radiology, and the Clinic for Anesthesia, Intensive Care Medicine and Treatment of pain in the Clinical Hospital Center Rijeka.
Results: The results of research on 265 patients show that the average age at the time of the procedure was 69 years and 1 months, and the patients were equally distributed by gender. The clinical picture and the expected outcome measured by the NIHSS scale on arrival averaged 13,46, and the premorbid mRS (disability) was 0,13. In 71% of the patients who meet the indications for MT, the ACM is occluded. In 22,86% of patients, MT was unsuccessful and in approximately half of the patients, the degree of recanalization was achieved (TICI 2b, 2c and 3) with an expected good clinical outcome. Complications occurred after MT in 3% of patients and 16,23% of patients died during hospitalization. Upon discharge, the average NIHSS is 7.62, while the average mRS is 2.55. At the three-month follow-up, the average NIHSS was 3.51, and the mRS was 1,09.
Conclusion: Upon discharge from the hospital, 31,42% of the patients had favorable outcome (mRS0-2) and 36,02% of the patients had a moderate outcome (mRS 0-3). At the control after 3 months, 60% of the patiens had a favorable outcome (mRS 0-2) and 67.14% of the patients had a moderate outcome (mRS 0-3). The outcomes of mechanical thrombectomy at the Clinical Hospital Center Rijeka are in the line with the largest centers for mechanical thrombectomy in Europe. |
