Ảnh hưởng của sự tái thông lòng mạch sớm tới tiến triển và tiên lượng ngồi máu não cấp

The impact of early recanalization on the growth and the prognosis of brain acute ischemic stroke

summary

Purpose: to study the impact of early recanalization on the growth and the outcomes of the brain acute ischemia. Method: Cerebral MRI was performed in 53 stroke ischemia patients (from 1/2010 to 6/2013) with our stroke protocols (T2*, FLAIR, Diffusion, perfusion and MR angiography) before 6h from onset, using 1.5tesla Siemens system. We ruled out the patients who had no arterial occlusion on TOF sequence. These patients were treated at Bach mai Hospital with IV thrombolysis, IA thrombectomy (solitaire stent) or without specific treatment. A second MRI was performed at 24h after onset. The patients were divided in to 2 groups: recanalization and non-recanalization. We compared the mean infarcted volume before and after treatment of the 2 groups and between the initial and the second MRI of the each group. We compared also the rate of hemorrhage transformation and the clinical outcomes (modified Rankin Scale) at 3 months of the two groups to assess the impact of early racanalization on ischemic stroke

Results: 53 patients (31 recanilized, 22 non- racanilized). No difference about the age, time from onset, NIHSS, initial volume infracted between 2 groups. The final volume of infaction was 54cm3 versus 141cm3 for the recanalized and non- recanalized patients (p=0.029). An increased volume of the infarction for nonrecanalized patient group (54 versus 141cm3) with significant difference (p=0.0009). There was no difference of symptomatic hemorrhage rate (9% versus 9.6%, p=0.99) between the nonrecanalized and recanalized group. Good clinical outcomes (mRs ≤ 2) was 64.5% versus 22% for the recanalized and non- recanalazed group, p=0.13. Among the patient without recanalization, there were 4 patients died (18%) and 3 patients with mRs 5 at 3 months.

Conclusion: Early recanalazation reduces the growth of ischemic lesion and it is strongly associated with improved functional outcomes.