MINISTRY OF EDUCATION AND TRANING MINISTRY OF NATIONAL DEFENCE
108 INSTITUTE OF CLINICAL MEDICAL AND
PHARMACEUTICAL SCIENCES
NGUYEN VAN PHUONG
STUDY ON CLINICAL CHARACTERISTICS, COMPUTED
TOMOGRAPHY IMAGING AND EFFICIENCY OF
MECHANICAL THROMBECTOMY IN PATIENTS WITH
ACUTE ISCHEMIC STROKE
SPECIALIZED : ANESTHETICS AND RESUSCITATION
CODE : 62.72.01.22
THE SUMMARY OF MEDICAL PHILOSOPHIC THESIS
Ha Noi - 2019
THIS STUDY HAD BEEN IMPLEMENTED IN THE 108 INSTITUTE
OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCES
The supervisors:
Associate Professor Ph.D TRAN DUY ANH
Associate Professor Ph.D LE VAN TRUONG
Reviewer No.1:
Associate Professor Ph.D Cong Quyet Thang
Reviewer No.2:
Associate Professor Ph.D Nguyen Hoang Ngoc
Reviewer No. 3:
Associate Professor Ph.D Pham Dinh Dai
The thesis was defended in Institute Committee Council at The 108
Institute of Clinical Medical and Pharmaceutical Sciences at …. .m,
……….., 2019.
Can find full text document of this thesis in:
National Library.
108 Institute of Clinical Medical and Pharmaceutical Sciences Library.
1
INTRODUCTION
Stroke is the third leading cause of death and the leading cause
of serious, long-term disability. In which, the ischemic stroke were
accounts for 80% of stroke. Large vessel occlusion stroke had
severe clinical events and causes high disability rates. Mechanical
thrombectomy has been approved by American Heart
Association/American Stroke Association with level IA in 2015 as
standard treatment for acute anterior circulation stroke due to
occlusions of the internal carotid artery (ICA) or the M1 segment of
the middle cerebral artery (MCA) and improvement of functional
independence compared with standard medical care.
However, the selection of patients with acute ischemic stroke
(AIS) are appropriate, whoes are still difficult, especially in many
stroke centers in Viet Nam. So that the study on clinical
characteristics and computerized tomography imaging of AIS
patients due to large cerebral vessels occlusion were necessary and
meaningful in clinical practice. The effectiveness of mechanical
revascularization, which were reported on many international studies,
but there are not many in Vietnam. From that fact, we performed "
Study on clinical characteristics, computed tomography imaging and
efficiency of mechanical thrombectomy in patients with acute
ischemic stroke", the thesis had two main purposes:
1. Clinical characteristics, computed tomography imaging of acute
ischemic stroke due to large vessel of the anterior cerebral artery
system occlusion have been had endovascular mechanical
revascularization.
2. Evaluated the effectiveness and safety of the
endovascular mechanical revascularization method to treated acute
ischemic strokes due to large vessel of the anterior cerebral artery
system occlusion.
THE NEW POINTS OF THESIS
- The research results provide data on clinical characteristics and
computed tomography imaging of acute ischemic stroke due to large
vessel of the anterior cerebral artery system occlusion.
2
- The effectiveness of the endovascular mechanical revascularization
method to treated acute ischemic strokes due to large vessel in
Vietnam.
- Understand the influence factors on good outcome and mortality
after mechanical thrombectomy in patients with acute large vessel
occlusion stroke.
THE STRUCTURE OF THESIS
The thesis consists of 116 pages, including the questions (2
pages), the overview (36 pages), the subjects and methods (19
pages), the research results (25 pages), the discussions (31 pages), the
conclusions (2 pages) and the recommendations (1 page).
There are 31 tables, 16 charts, 2 graph and 13 figures. The
reference has 19 Vietnamese and 131 foreign references.
Five articles related to the subject have been published.
ABBREVIATIONS
AIS: Acute ischemic stroke
CT: computed tomography
ASPECTS: Alberta Stroke Program Early Computed Tomography Score
CTA: computed tomography angiography
ICA: internal carotid artery
LVO: large vessel occlusion
MCA: middle cerebral artery
MT: Mechanical thrombectomy
mRS: modified Rankin scale
n: Number of patients
NIHSS: The National Institutes of Health Stroke Scale
TICI: The thrombolysis in cerebral infarction
CHAPTER 1 – OVERVIEW
1.1. Diagnosis of ischemic stroke
1.1.1. Clinical diagnosis of ischemic stroke
The clinical symptoms of AIS were very diverse, they
depend on the location of the infaction, but there were the following
common clinical symptoms: Paralysis, facial paralysis, language
disorders, visual disturbances, double vision, forced gaze deviation.
In addition, there were also sensory disorders, and unconscious.
3
The National Institutes of Health Stroke Scale (NIHSS) is a
tool used by healthcare providers to objectively quantify the
impairment caused by a stroke. The NIHSS is composed of 11 items,
each of which scores a specific ability between a 0 and 4. For each
item, a score of 0 typically indicates normal function in that specific
ability, while a higher score is indicative of some level of
impairment. The individual scores from each item are summed in
order to calculate a patient's total NIHSS score. The maximum
possible score is 42, with the minimum score being 0.
1.1.2. Clinical diagnosis of the location of acute ischemic stroke
due to large vessel of the anterior cerebral artery system
The cortical signs such as aphasia and neglect are sensitive
indicators for large vessel occlusion (LVO) stroke.
Middle cerebral artery (MCA) occlusion stroke had signs:
aphasia, neglect, motor deficits, loss of sensation in any part of the
body and Conjugate Eye Deviation (CED -prévost's sign).
Internal carotid artery (ICA) occlusion stroke, there are
manifestations of MCA occlusion stroke signs and anterior cerebral
artery (ACA) occlusion stroke signs.
1.1.3. Computerized tomography diagnosis of acute ischemic stroke
Non-contrast computed tomography (NCCT) remains a widely
used imaging technique and plays an important role in the evaluation
of patients with acute ischaemic stroke. NCCT had helped identify
early ischemic changes signs include changes in brain parenchyma
that reflect either decreased attenuation (eg, loss of definition of the
lentiform nucleus) or tissue swelling (eg, hemispheric sulcal
effacement, effacement of the lateral ventricle). Systematic
approaches to recognition of early ischemic changes such as the
Alberta Stroke Program Early CT Score (ASPECTS) system improve
the detection of early ischemic changes.
Computed tomography angiography (CTA) uses an injection
of contrast material into your blood vessels and CT scanning to help
diagnose and evaluate blood vessel disease or related conditions,