Endovascular Intervention for Acute Ischemic Stroke in Can Tho University of Medicine and Pharmacy Hospital

Authors

  • Vu Dang Nguyen Can Tho University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
  • Tran Chi Cuong University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
  • Huu Tai Nguyen Can Tho University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
  • Duy Linh Nguyen Can Tho University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
  • Thi Nhu Truc Nguyen
  • Tri Thuc Dinh Can Tho University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
  • Van Minh Le Can Tho University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
  • Tri Nghia Phu Can Tho University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
  • Hoang Thuan Nguyen Can Tho University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
  • Dung Tien Doan Can Tho University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
  • Ahmad Sobri Muda Department of Radiology, Hospital Pengajar Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Sedang, Selangor, Malaysia
  • Van Truyen Ngo Can Tho University of Medicine and Pharmacy, Ho Chi Minh, Vietnam

Keywords:

Acute Ischemic Stroke, IV rTPA, Intra-arterial Thrombolysis, Catheter-based Thrombectomy, Intra and Extracranial Angoplasty and Stenting

Abstract

Introduction:

            Acute cerebral ischemic stroke is a life-threatening emergency with high incidence of mortality and morbidity. Endovascular revascularization has been increasingly adopted as one of the treatment options. In this article, outcomes of endovascular intervention for the treatment of ischemic stroke are reported with highlights on  selected technical experiences.

 Method and subjects:

                A cross sectional descriptive study was conducted on all cerebral ischemic stroke patients who arrived to Can Tho Medical University Hospital within 8 hours from the onset of the first symptom. The National Institute of Health Stroke Scale (NIHSS) was used for stroke grading. Diagnoses were confirmed by plain computed tomography (CT) of the brain, cerebral computed tomography angiography (CTA) or magnetic resonance imaging (MRI) of the brain. Routine biochemical pre-operative investigations were conducted and the patients were screened for comorbidities. Cerebral angiography was indicated when the CT angiography showed occlusions of the carotid arteries, the M1 portion of the middle cerebral arteries (MCA) and the basilar arteries. Vascularization procedure was performed with the thrombus aspiration systems or stent retrievers. In cases that needed angioplasty and stenting, Gateway balloons were used for stenosis dilation. Wingspan and carotid wallstent were used for intra- and extracranial stenoses, respectively.

Results:

            A total of 53 patients were recruited from the 1st of January 2019 to 30th December 2020 (24 months). Male to female ratio was 1.54:1 while their ages ranged from 38 to 90 (mean 64). NIHSS scores ranged from 12 to 25. Approximately 98% of patients had comorbidities with hypertension, diabetes, atrial fibrillation, mitral valve stenosis, valvular insufficiency and atrioventricular block. A total of 44 patients experienced thrombectomy with catheter-based distal aspiration (35), stent retrievers (03), and aspiration plus stent retriever combination (06). There were four patients with stenting after thrombectomy at the MCA. Moreover, four patients had internal carotid artery (ICA) origin stenoses and tandem thrombus embolism at the MCA. These were revascularized with thrombectomy at the MCA and stenting at the ICA stenoses. Another three patients had basilar artery occlusion, and among whom one had stenting after thrombectomy. The total technical success rate for all procedures were 47/53 (88.6%) with thrombolysis in cerebral infarction (TICI) and perfusion scale rates of grade 2B (14%) to grade 3 (86%). The unsuccessful procedure (TICI from 2a to below) were due to the inability to aspirate or retrieve the thrombi. The total death rate was 15/53 (28.3%), due to the combined comorbidities i.e. pneumonia, progressive cerebral edema, cerebral hemorrhage, hypertension, diabetes mellitus, renal failure. There were 31/53 patients (58.4%), which had significant recovery in muscle movement, language and cognition after 2 weeks.

 Conclusion:

            Endovascular intervention is a good option for the management of acute ischemic stroke. The treatment had a high revascularization rate (88.6%) and saved up to 58.4% of patients out of their disability. The successful revascularization is a crucial first step to salvage the patients and obtain a better prognosis.

 Key words: acute ischemic stroke, IV rTPA, intra-arterial thrombolysis, catheter-based thrombectomy, intra and extracranial angioplasty and stenting.

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Published

2022-06-30

How to Cite

Nguyen, V. D., Cuong, T. C., Nguyen, H. T., Nguyen, D. L., Nguyen, T. N. T., Dinh, T. T., Le, V. M., Phu, T. N., Nguyen, H. T., Doan, D. T., Muda, A. S., & Ngo, V. T. (2022). Endovascular Intervention for Acute Ischemic Stroke in Can Tho University of Medicine and Pharmacy Hospital. Journal Of Cardiovascular, Neurovascular &Amp; Stroke, 4(2), 28–39. Retrieved from https://mycvns.com/index.php/journal/article/view/88