Results of the thrombectomy in treatment at acute ischemic stroke patient at Bach Mai hospital

Evaluating the results of thrombectomy in acute ischemic patients (AIS) due to large vessel occlusion (LVO) in Bach Mai hospital. Patients suffering from AIS due to LVO received endovascular thrombectomy during 05/2012 to 05/2018 at the Radiology Center of Bach Mai University Hospital.

JOURNAL OF MEDICAL RESEARCH RESULTS OF THE THROMBECTOMY IN TREATMENT AT ACUTE ISCHEMIC STROKE PATIENT AT BACH MAI HOSPITAL Quang Anh Nguyen1,2, Luu Vu Dang1,2, Thong Pham Minh1,2, Tuan Tran Anh1, Kien Le Hoang¹, Thien Nguyen Tat¹, Trang Nguyen Thi Thu¹, An Nguyen Huu¹, Hanh Nguyen Thi Thuy³ ¹Radiology Center, Bach Mai Hospital ²Radiology Falculty, Hanoi Medical University ³Medical Record Storage, General Planning Department, Bach Mai Hospital Evaluating the results of thrombectomy in acute ischemic patients (AIS) due to large vessel occlusion (LVO) in Bach Mai hospital Patients suffering from AIS due to LVO received endovascular thrombectomy during 05/2012 to 05/2018 at the Radiology Center of Bach Mai University Hospital They were divided into groups of treatment: group was treated by rt-PA + devices while group received thrombectomy alone The treatement results and characteristics were analyzed and compared Mean age was 59.9 ± 14.5, 54% male The NIHSS and ASPECTS basline were 15.8 and 6.2 with the distribution of occlusion sites being 55% ICA, 40% MCA, and 5% BA Good revascularization (TICI 2b-3) and good clinical recovery (mRS ≤ 2) after months achieved in 71.6% and 48.3% of all patients Intracranial symptomatic hemorrhage was seen in 7.2% of patients There was no difference in good revascularation (69.3% vs 73.3%) and favourable outcome after months (45.3% vs 50.5%) between the two groups of treatment (p > 0.05) Thrombectomy for AIS patients due to LVO was very effective with high rate of good revascularization and clinical recovery Using r-tPA prior to endovascular treatment may delay time without higher rate of revascularation and outcome Keywords: Acute ischemic stroke (AIS), Large vessel occlusion (LVO), Thrombectomy I INTRODUCTION Acute ischemic stroke (AIS) is the second leading cause of mortality and third leading cause of disability worldwide, especially due to the large vessel occlusion (LVO) including basilar (BA), internal carotid (ICA) and middle cerebra artery (MCA) [1; 2] Intravenous recombinant tissue-type plasminogen activator (rt-PA) was approved in 2005 and still was the first indication for AIS patient came within 4.5 hour, but the rate of recanalization in those suffering from LVO was very low (15%) [1; 2] In 2015, five randomized controlled trials of endovascular treatment (EVT) for AIS were published pointing out the positive result of thrombectomy due to LVO [3 - 7] In Vietnam, doctors have started to use the stent retriever beginning in 2012 with the first case in Bach Mai Hospital (BMHU) Currently, the number Corresponding author: Nguyen Quang Anh, of AIS cases due to LVO treated by EVT have increased quickly every year In this study, we have summarized the results and effect of thrombectomy with experience from 05/2012 to 05/2018 Radiology Center, Bach Mai Hospital Email: quanganh_rad@hmu.edu.vn Received: 27/11/2018 Accepted: 12/03/2019 96 JMR 118 E4 (2) - 2019 JOURNAL OF MEDICAL RESEARCH II METHODS 2.Methods Selection criteria Design: crosssectional retrospective study, single-center 292 patients, who suffered from AIS during the period between May 2012 and May 2018, and treated by thrombectomy at BMUH, were analyzed For further evaluation, we divided all stroke patients into groups of treatment: (1) treated by rt-PA + devices while (2) received thrombectomy alone They were compared in detail, including clinical characteristics, neuroimaging findings, and functional outcome * Inclusion criteria: The acute stroke protocol has been employed at BMUH since May 2012 and was updated annually according to the recommendation of ASA (American Stroke Association)/ AHA (American Heart Association) guideline and newest randomized controlled trials (RCTs) in the world [8]: • Age ≥18 • Diagnosis of AIS due to LVO, confirmed in image of MSCT/MRI • NIHSS ≤ 25 • ASPECTS ≥ and pc-ASPECTS ≥ • Time window of treatment (from onset symptoms): up to 6th hours for anterior & 12th hours for posterior circulation • The patient and/or their realtives signed in consent form for agreement * Exclusion criteria: • Hemorrhage or no LVO identified in MRI or MSCT • Large ischemic core in non-contrast computed tomography (NCCT) with ASPECTS ≤5 or pc-ASPECTS ≤ • Unknown onset time or over time window of treatment (> hours with anterior and > 12 hours with posterior circulation) JMR 118 E4 (2) - 2019 Data collection: using patients’ charts Descriptive data were expressed as number of patients, percentage, NIHSS, ASPECTS with standard deviation In the univariate analysis, distributions in age, sex, NIHSS, and other parameters between different outcome groups were assessed using a chisquare or independent t-test depending on the characteristics of data Statistical analyses were performed using SPSS software version 23 A p value