Endovaskularno liječenje akutnog moždanog udara

master's thesis

• Title (english): Endovascular treatment of acute ischemic stroke
• Author: Josip Glavić
• Mentor: David Ozretić (mentor)
• Committee member: Marko Radoš (predsjednik povjerenstva)
• Committee member: Milan Radoš (član povjerenstva)
• Committee member: David Ozretić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Radiology); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Radiology

Abstract

Brza i djelotvorna revaskularizacija glavni je cilj liječenja akutnog ishemijskog moždanog udara jer pacijenti gube približno 2 milijuna neurona po minuti u ishemičnom području. Do nedavno, intravenska primjena rekombinantnog tkivnog aktivatora plazminogena (rtPA) bila je jedina odobrena terapijska opcija. Nedavno objavljena istraživanja konačno su dokazala korist endovaskularnog pristupa, mijenjajući u potpunosti liječenje akutnog ishemijskog moždanog udara. Mehanička trombektomija stent retrieverom preporučuje se kao standard liječenja akutnih ishemijskih moždanika s okluzijom unutarnje karotidne arterije, srednje cerebralne arterije, prednje cerebralne arterije, bazilarne arterije i vertebralne arterije. Okluzija velike krvne žile uzrokuje 35-40% svih akutnih ishemijskih udara, a taj tip okluzije posebno slabo reagira na IV rtPA. Ovaj minimalno invazivni zahvat koristi mali uređaj nazvan stent retriever kako bi uklonio ugrušak i rekanalizirao žilu. Pacijenti koji su podvrgnuti mehaničkoj trombektomiji mogu se tretirati s IV rtPA prije postupka, ali to nije uvijet za terapijsku postupak. Bolji rezultati prikazani su kombiniranom terapijom IV rtPA i endovaskularnom terapijom.

Abstract (english)

Rapid and effective revascularization is the mainstay of acute ischemic stroke treatment because patients lose approximately 2 million neurons per minute in the affected brain territory. Until recently, intravenous recombinant tissue-type plasminogen activator (rtPA) was the only established therapeutic option. Recently published trials have finally proven the benefit of endovascular approach, changing completely the evaluation and treatment of patients. Mechanical thrombectomy with stent retrievers is now recommended as the standard of care for acute ischemic strokes with occlusions of internal carotid artery, middle cerebral artery, anterior cerebral artery, basilar artery and vertebral artery. Large vessel occlusion is the cause of 35-40% of all acute ischemic strokes and this type of occlusion in particular responds poorly to IV rtPA. This minimally invasive procedure uses a tiny device called a stent retriever to remove blood clots in the brain, restoring blood flow. Patients who undergo mechanical thrombectomy can be treated with IV rtPA before the procedure, but do not have to be. Better results are shown with combined IV rtPA and endovascular treatment therapy.

• Keywords: akutni moždani udar; ishemija; endovaskularno liječenje; minimalno invazivni postupci; brzi oporavak
• Keywords (english): acute ishemic stroke; endovascular treatment; minimally invasive procedure; fast recovery
• Language: croatian
• URN:NBN: urn:nbn:hr:105:111009
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-01-03 09:38:58