Endovasküler Akut İskemik İnme Tedavisi: İlk 100 Vakanın Analizi

Amaç: İnme, Türkiye’de tüm ölümlerin %15 nedenidir. Akut iskemik inmede(Aİİ) tıkanın damarın açılmadığı her dakikada nöron harabiyeti devam etmektedir ve bugün için Aİİ’nin erken dönem en önemli tedavisi tıkalı damarın hızlı ve etkili şekilde açılmasıdır. Biz bu çalışmada merkezimizdeki inme hastalarına uygulanan endovasküler tedavi deneyimlerimizi paylaşmayı amaçladık. Materyal ve method: Ocak 2015 ve Kasım 2018 arasında başvuran, Aİİ tanısı konarak endovasküler tedavi alan ardışık ilk 100 hastanın klinik ve demografik özelliklerini ve endovasküler işlem özelliklerini kaydettik. Bulgular: Çalışmaya dahil edilen 100 hastanın 49’u kadın, 51’i erkekti ve yaş ortalamaları 65(55-74) idi. Hastaların %74’ünde hipertansiyon, %25’inde hiperlipidemi, %38’inde diabetes mellitus, %26’sınde atrial fibrilasyon, %36’ünde koroner arter hastalığı ve %39’ünde sigara kullanımı mevcuttu. Hastaların tedavi öncesi National Institutes of Health Stroke Scale (NIHSS) skoru 15,5 (13-19) idi. Üç aylık takipte 31 hasta kaybedildi ve mortalite oranı %31 olarak hesaplandı. Üçüncü ay sonunda %40 hastada iyi sonuç gözlemlendi (modifiye Rankin skalası skoru 0-2). Etkili rekanalizasyon oranımızın [ Thrombolysis in Cerebral Infarction (TICI2b-3)] %75 olduğu görüldü. Sonuç: Büyük arter tıkanıklığı düşünülen hastaların en erken dönemde endovasküler tedavi imkanlarının olduğu merkezlere sevki sağlanmalıdır. Merkezlerde endovasküler tedavi deneyimi artıkça daha iyi sonuçlar elde edilebilir.

Anahtar Kelimeler:

Akut iskemik inme, Endovasküler tedavi, Mortalite

Endovascular Acute Ischemic Stroke Treatment: Analysis of the First 100 Cases

Background: Stroke account for 15% of all deaths in Turkey. In acute ischemic stroke (AIS), neuronal damage continues every minute until the occluded vessel is not opened. Currently, the most important treatment of AIS is the rapid and effective opening of the occluded vessel. In this study, we aimed to share our experience of endovascular treatment of AIS patients in our center.Materials and Methods: Between January 2015 - November 2018, the first 100 consecutive patients who presented with the diagnosis of AIS and received endovascular treatment were included in this study. We recorded the clinical and demographic characteristics and endovascular procedure characteristics of all patients.Results: Of the 100 patients included in the study, 49 were female and 51 were male, and the median age was 65 (55-74). Hypertension was present in 74%, hyperlipidemia in 25%, diabetes mellitus in 38%, atrial fibrillation in 26%, coronary artery disease in 36%, and smoking in 39% patients. The Median NIHSS score was 15.5 (13-19) prior to treatment. At the 3-month follow-up, 31 patients died and the mortality rate was calculated as 31%. At the end of the 3-month, good outcome was observed in 40% of patients (modified Rankin scale score 0-2). Our effective recanalization rate (Thrombolysis in Cerebral Infarction [TICI2b-3]) was found to be 75%.Conclusions: AIS patients with suspected large artery occlusion should be transferred to centers where endovascular treatment is available, as soon as possible. Better results can be achieved as experience of endovascular treatment in centers increases.

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