SO SÁNH KẾT QUẢ ĐIỀU TRỊ LẤY HUYẾT KHỐI CƠ HỌC Ở BỆNH NHÂN NHỒI MÁU NÃO CẤP DO TẮC ĐỘNG MẠCH LỚN TRONG CỬA SỔ 6 – 16 VÀ 16 – 24 GIỜ

Abstract

Introduction: Endovascular thrombectomy (EVT) has been proven to be an effective treatment for acute ischemic stroke caused by large vessel occlusion within the extended treatment window of 6–24 hours, according to findings from the DEFUSE-3 (up to 16 hours) and DAWN (up to 24 hours) trials. However, data on EVT within the 16–24 hour treatment window remains limited, with a Class IIA recommendation. Our study evaluates the efficacy and safety of EVT in patients with acute ischemic stroke within the 16–24 hour window, compared to those treated within the 6–16-hour window. Methods: A prospective cohort study was conducted on 200 patients from August 2022 to September 2024 at People’s Hospital 115. Patients diagnosed with acute ischemic stroke due to large vessel occlusion in the anterior circulation within the 6–24 hour window underwent endovascular thrombectomy based on perfusion imaging criteria (Perfusion-RAPID, iSchemaView). Baseline characteristics and clinical outcomes will be compared between the group treated within the 6–16 hour window and the >16–24 hour window. Results: Among 200 patients, 103 were treated within the 6–16 hour window, and 97 within the 16–24 hour window. The median age of the patients was 66 (59–75), the median pre-intervention NIHSS score was 12 (8.5–17.0), and the median infarct core volume was 11 (3–24) ml. Regarding safety and efficacy, the study found no significant differences between the two groups in the following criteria: Successful reperfusion rate (TICI 2b–3: 88.3% vs. 81.4%; p = 0.242), proportion of patients achieving mRS 0–2 at 90 days (44.7% vs. 47.4%; p = 0.915), rate of symptomatic intracranial hemorrhage (1.0% vs. 4.1%; p = 0.330), mortality rate (mRS 6) at 90 days (12.6% vs. 11.3%; p = 0.915). Conclusion: Thrombectomy within the window 16-24 hours remains as effective and safe as interventions within the window 6-16 hours, expanding treatment opportunities for large vessel occlusion stroke patients.