Účinnost a bezpečnost urgentní mikrochirurgie u pacientů s akutním ischemickýmiktem po selhání intravenózní trombolýzy a mechanické trombektomie – systematické review
Authors:
M. Grubhoffer 1,2; J. Fiedler 1,3; S. Slezáková 4,5; M. Bombic 1; M. Klugar 4,5
Published in:
Cesk Slov Neurol N 2025; 88(2): 83-88
Category:
Review Article
doi:
https://doi.org/10.48095/cccsnn202583
Overview
Cíl: Cílem tohoto systematického přehledu bylo ověřit úlohu urgentní mikrochirurgické embolektomie a extrakraniálního-intrakraniálního bypassu jako třetí linie léčby v případech uzávěru velké mozkové cévy po selhání standardní léčby. Soubor a metodika: Provedli jsme rozsáhlou rešerši osmi zdrojů publikované i nepublikované literatury. Dva recenzenti nezávisle na sobě provedli analýzu názvů, abstraktů, plných textů a poté provedli kritické hodnocení a extrakci dat z vybraných studií pomocí standardizovaných nástrojů. Výsledky zahrnutých studií jsme narativně syntetizovali. Výsledky: Vyhledávání identifikovalo osm relevantních článků, zahrnujících 12 pacientů s urgentním uzávěrem velké cévy (terminální krkavice nebo střední mozková tepna) a selháním standardní léčby, kteří podstoupili mikrochirurgický zákrok do 24 hodin od vzniku příznaků. Mikrochirurgická embolektomie byla provedena ve čtyřech případech (33 %), extrakraniální-intrakraniální bypass v pěti případech (42 %), jejich kombinace ve dvou případech (16 %) a manipulační intraoperační rekanalizace v jednom případě (8 %). Skóre na škále National Institutes of Health Stroke Scale se předoperačně pohybovalo v rozmezí 7–25 bodů a pooperačně (1–7 dní po operaci) v rozmezí 1–18 bodů. Funkční nezávislosti (modifikované Rankinovo skóre 0–2) bylo dosaženo u devíti pacientů (75 %) po 3–12 měsících po operaci. Závěr: Urgentní mikrochirurgická embolektomie, extrakraniální-intrakraniální bypass nebo kombinace těchto metod se jeví jako bezpečná a potenciálně účinná třetí linie léčby u pacientů s urgentním uzávěrem velké cévy v přední mozkové cirkulaci.
Klíčová slova:
cévní mozková příhoda – trombolýza – trombektomie – mikrochirurgie
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Paediatric neurology Neurosurgery NeurologyArticle was published in
Czech and Slovak Neurology and Neurosurgery
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