3. Một số yếu tố ảnh hưởng tới kết cục lâm sàng bệnh nhân đột quỵ thiếu máu não do hẹp động mạch nội sọ

Vuong Xuan Trung, Mai Duy Ton

Main Article Content

Abstract

Intracranial atherosclerotic stenosis is a major cause of ischemic stroke, especially in Asia; however there is limited data on this group of patients in VietNam. Therefore, we conducted a cross-sectional retrospective study, enrolling patients with ischemic stroke due to intracranial atherosclerotic stenosis at the Stroke Center - Bach Mai Hospital from April to December, 2022. We assessed the clinical outcome at 90 days and factors influencing the outcome. The results showed that unfavorable 90-day outcome (mRS ≥ 3) was 27.8%. The results from univariate and multivariate regression logistics showed that the mechanism of thrombotic occlusion or artery-to-artery embolism (OR = 1.186; 95% CI: 1.013 - 1.388; p = 0.034) and dual antiplatelet therapy (OR = 0.732; 95% CI: 0.617 - 0.866; p < 0.001) were factors affecting patient’s functional outcomes.

Article Details

References

1. Kim YD, Choi HY, Cho HJ, et al. Increasing Frequency and Burden of Cerebral Artery Atherosclerosis in Korean Stroke Patients. Yonsei Medical Journal. 2010;51(3):318-325. doi:10.3349/ymj.2010.51.3.318
2. Yongjun Wang, Xingquan Zhao, Liping Liu, et al. Prevalence and Outcomes of Symptomatic Intracranial Large Artery Stenoses and Occlusions in China. Stroke. 2014; 45(3):663-669. Accessed April 19, 2023.
3. Cao Phi Phong, Phan Đăng Lộc. Tần suất và tiên lượng hẹp động mạch nội sọ ở bệnh nhân thiếu máu não cấp. Tạp chí Y học TP Hồ Chí Minh. 2002;16.
4. Gutierrez J, Turan TN, Hoh BL, et al. Intracranial atherosclerotic stenosis: risk factors, diagnosis, and treatment. Lancet Neurol. 2022;21(4):355-368. doi:10.1016/S1474-4422(21)00376-8
5. Marios Psychogios, Alex Brehm, Elena López-Cancio, et al. European Stroke Organisation guidelines on treatment of patients with intracranial atherosclerotic disease. European Stroke Journal. 2022;7(3):XLII-LXXX. doi:10.1177/23969873221099715
6. Duy Ton Mai, Xuan Co Dao, Ngoc Khue Luong, et al. Current State of Stroke Care in Vietnam. Stroke: Vascular and Interventional Neurology. 2022;2:e000331. https://doi.org/10.1161/SVIN.121.000331
7. Samuels OB, Joseph GJ, Lynn MJ, et al. A Standardized Method for Measuring Intracranial Arterial Stenosis. American Journal of Neuroradiology. 2000;21(4):643-646.
8. Banks JL, Marotta CA. Outcomes Validity and Reliability of the Modified Rankin Scale: Implications for Stroke Clinical Trials. Stroke. 2007;38(3):1091-1096. doi:10.1161/01.STR.0000258355.23810.c6
9. Gong C, Huang J, Kong W, et al. Five-Year Outcomes After Endovascular Treatment for Large Vessel Occlusion Stroke. Frontiers in Neuroscience. 2022;16. Accessed April 19, 2023. https://www.frontiersin.org/articles/10.3389/fnins.2022.920731
10. Balami JS, Sutherland BA, Edmunds LD, et al. A systematic review and meta-analysis of randomized controlled trials of endovascular thrombectomy compared with best medical treatment for acute ischemic stroke. Int J Stroke. 2015;10(8):1168-1178. doi:10.1111/ijs.12618
11. Gardener H, Romano LA, Smith EE, et al. Functional status at 30 and 90 days after mild ischaemic stroke. Stroke Vasc Neurol. 2022;7(5):375-380. doi:10.1136/svn-2021-001333
12. Liu H, Pu Y, Wang Y, et al. Intracranial Atherosclerosis Coexisting With White Matter Hyperintensities May Predict Unfavorable Functional Outcome in Patients With Acute Cerebral Ischemia. Frontiers in Neurology. 2020;11. Accessed April 19, 2023. https://www.frontiersin.org/articles/10.3389/fneur.2020.609607
13. López-Cancio E, Matheus MG, Romano JG, et al. Infarct patterns, collaterals and likely causative mechanisms of stroke in symptomatic intracranial atherosclerosis. Cerebrovasc Dis. 2014;37(6):417-422. doi:10.1159/000362922
14. Ashley M Wabnitz, Colin P Derdeyn, David J Fiorella, et al. Hemodynamic Markers in the Anterior Circulation as Predictors of Recurrent Stroke in Patients With Intracranial Stenosis. Stroke. 2019;50:143-147 Accessed April 19, 2023. https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.020840
15. Marc I Chimowitz, Michael J Lynn, Colin P Derdeyn, et al. Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis. N Engl J Med. 2011;365(11):993-1003. doi: 10.1056/NEJMoa1105335
16. Marc I Chimowitz, Michael J Lynn, Harriet Howlett-Smith, et al. Comparison of Warfarin and Aspirin for Symptomatic Intracranial Arterial Stenosis. N Engl J Med. 2005;352(13):1305-16. Accessed April 19, 2023. https://www.nejm.org/doi/full/10.1056/nejmoa043033
17. Liu L, Wong KSL, Leng X, et al. Dual antiplatelet therapy in stroke and ICAS. Neurology. 2015;85(13):1154-1162. doi:10.1212/WNL.0000000000001972