Revascularization in the treatment of acute ischemic stroke

Abstract

Objective ‒ to analyze the experience of providing care to patients with acute stroke in the conditions of the multidisciplinary neurosurgical department of Poltava Regional Clinical Hospital named after M.V. Sklifosovsky.Materials and methods. In the neurosurgical department in 2020 treated 1,148 patients aged 18 to 83, among whom 49 % were patients with acute stroke. Ischemic stroke was observed in 54.7 % of people, and hemorrhagic stroke in 45.3 %. A total of 173 patients with a diagnosis of acute ischemic stroke were hospitalized in 2020, of which 54 patients were delivered within 4.5 hours from the onset of the disease and received thrombolytic therapy and 20 patients within 6 hours who underwent mechanical thrombectomy, with of them, bridging was used in 5 patients. To determine the presence of signs of a stroke and pre-notification, the following scales were used: FAST and «МОЗОК-ЧАС». Neuroimaging was performed as an emergency using native SCT and SCT-angiography or MRT and MRT-angiography in 100 % of cases. To evaluate the results of neuroimaging, the ASPECTS scale was used for stroke in the anterior hemisphere and pc-ASPECTS – in the vertebrobasilar basin. The NIHSS scale was used to determine the severity of the patient; the following scales were used to determine the presence of occlusion of a large vessel: RACE, BRAIN2. A modified Rankin scale was used to assess the patient’s functional status. In the treatment of ischemic stroke, we divided all patients into 2 groups: the first – 41 % patients, who are subject to revascularization treatment, the second – 59 % patients, who are shown only optimal drug therapy. Revascularization had 2 treatment options. The first option provided for thrombolytic therapy in case of detection of small vessel occlusion, the second – mechanical thrombectomy in case of detection of large vessel occlusion. In cases where the patient was admitted within the therapeutic window, bridging therapy was performed, i.e. intravenous administration of plasminogen activator and simultaneous endovascular thrombectomy. In case of simultaneous detection of a stroke and a heart attack in a patient, the Canadian Stroke Best Practice Recommendations for Acute Stroke Management (2018) were used as a basis, according to which the specifics of the management of patients undergoing revascularization treatment are defined. The following EVT techniques were used in our study: ADAPT – in 5 % of patients, Solumbra – in 10 % of patients and SAVE – in 85 % of patients during endovascular thrombectomy.Results. Thrombolytic therapy was carried out – 31 % of the total number of treated patients with ischemic stroke, mechanical thrombectomy – 10 % of the total number of treated patients. Decompressive craniectomies were performed in 6 % of patients with ischemic stroke.Conclusions. Analysis of the results of treatment of patients with ischemic stroke using the above methods indicates a good result at discharge from the medical institution and later, namely on the 90th day after the treatment.