Dijagnostičke i terapijske mogućnosti u liječenju stenoze intrakranijskih krvnih žila

master's thesis

• Title (english): Diagnostic and therapeutic options for treatment of intracranial vessel stenosis
• Author: Domagoj Šunde
• Mentor: Zdravka Poljaković-Skurić (mentor)
• Committee member: David Ozretić (predsjednik povjerenstva)
• Committee member: Mario Habek (član povjerenstva)
• Committee member: Zdravka Poljaković-Skurić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Neurology); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology

Abstract

Stenoza intrakranijskih krvnih žila je bolest velikih krvnih žila glave koja može svojom progresijom uzrokovati tranzitornu ishemijsku ataku ili ishemijski moždani udar. Ishemijski moždani udar je 2. po uzroku smrti u Republici Hrvatskoj, s 8,7% svih umrlih godišnje, što ističe važnost ranog prepoznavanja bolesti i brzo reagiranje za pravodobno liječenje. Širok opseg podležećih stanja i bolesti mogu dovesti do razvitka ishemijskog moždanog udara progresijom osnovne bolesti. Stenozu intrakranijskih arterija i druge uzroke moždanog udara razlučujemo modernim tehnikama: anamnezom, kliničkim pregledom, sustavom bodovanja neurološkog statusa (GCS) i težine moždanog udara (NIHSS), nekontrastnim neuroslikovnim metodama (MR i CT) i angiografskim tehnologijama (DSA, MRA i CTA) kojima identificiramo lokaciju sužene ili okludirane arterije i ishemiziranog moždanog tkiva. Uspoređujući međusobno neuroslikovne metode, može se reći da svaka od njih ima svoje prednosti i nedostatke u odnosu na ostale, koji definiraju kada ih je najbolje koristiti, ovisno o etiologiji moždanog udara i vremenu njegovog nastanka. Današnje strategije liječenja intrakranijske arterijske stenoze inkorporiraju medikamentozne, endovaskularne i neurokirurške terapijske opcije čije se učinkovitosti međusobno uspoređuju u velikim studijama. Iako su kliničke studije do sada zagovarale superiornost agresivne medikamentozne terapije DAPT-om za liječenje intrakranijske stenoze nad endovaskularnim intervencijama uz stentiranje, novi dizajnovi stentova su u suvremenim studijama pokazali obećavajuće rezultate zbog kojih stentiranje ima mjesto u standardu za liječenje ICS-a. Ishemijski moždani udar je neurološko hitno stanje koje se zbrinjava u neurološkoj jedinici za intenzivno liječenje uz endarterektomiju ili fibrinolizu, ovisno o vremenskom intervalu između početka simptoma bolesti i aplikaciji terapije. Iako je neurokirurški pristup liječenju intrakranijskoj stenozi i akutnom moždanom udaru do sada pokazao gore rezultate od standarda liječenja, nove strategije ovog tipa liječenja su također pokazale potencijal za buduće češće korištenje.

Abstract (english)

Intracranial blood vessel stenosis is a type of large cranial artery disease which can result in a transitory ischemic attack or an ischemic stroke via its progression. The ischemic stroke is the second most common cause of death in the Republic of Croatia, taking up 8,7% of all annual deaths, emphasizing importance of early disease recognition and swift reaction for the sake of timely treatment. A wide variety of underlying diseases and conditions may lead to the development of an ischemic stroke via primary disease progression. We discern intracranial artery stenosis and other ischemic stroke causes via modern techniques: patient history, examination, scoring systems for approximation of the neurological status (GCS) and severity of a stroke (NIHSS), noncontrast neuroimaging methods (MR and CT) and angiography technologies (DSA, MRA and CTA) with which the location of artery stenosis or occlusion and brain tissue ischemia are identified. Comparing neuroimaging methods with each other, one could say each of them have their advantages and shortcomings which define when it is best to use them, depending on the suspected stroke etiology and time of the onset of the disease. Present intracranial artery stenosis treatment strategies incorporate medical, endovascular and neurosurgical therapy options whose efficacies are being compared to each other in large-scale studies. Although clinical studies have been supporting the superiority of aggressive medical therapy with DAPT for intracranial stenosis treatment over endovascular interventions with stenting, newer stent designs have shown promising results in contemporary studies and have therefore earned stenting a place in standard of care for ICS. The ischemic stroke is a neurological emergency which requires care in a neurointensive care unit, followed along by endarterectomy and fibrinolysis, depending on the time interval between the onset of symptoms of the disease and possible therapy application. Even though neurosurgical approach to intracranial stenosis and acute ischemic stroke treatment has shown worse results than the standard of care so far, newer strategies for this type of treatment have also shown good potential for future use.

• Keywords: intrakranijska stenoza; ishemijski moždani udar; antiagregacijska terapija; stent
• Keywords (english): intracranial stenosis; ischemic stroke; antiplatelet therapy; stent
• Language: croatian
• URN:NBN: urn:nbn:hr:105:305461
• 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: 2023-03-06 09:11:20