Účinnost a bezpečnost urgentní mikrochirurgické embolektomie při selhání intravenózní trombolýzy a mechanické trombektomie u pacientů s akutním ischemickým iktem – protokol systematického review

Stiahnuť PDF English version

Autori: M. Klugar ¹; J. Fiedler ^2,3; R. Líčeník ¹; S. Ostrý ^4,5
Pôsobisko autorov: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute, of Biostatistics and Analyses, Faculty, of Medicine, Masaryk University, Brno, Czech Republic ; The Czech National Centre for, Evidence-Based Healthcare and, Knowledge Translation (Cochrane, Czech Republic, Czech Republic, CEBHC ¹; Department of Neurosurgery, České, Budějovice Hospital, Czech Republic ²; Department of Neurosurgery, Faculty, of Medicine in Plzeň, Charles University in Prague, Czech Republic ³; Department of Neurology, České, Budějovice Hospital, Czech Republic ⁴; Department of Neurosurgery and, Neurooncology, First Faculty of Medicine, Charles University in Prague and, Military University Hospital Prague, Czech Republic ⁵
Vyšlo v časopise: Cesk Slov Neurol N 2020; 83/116(4): 416-420
Kategória: Původní práce
doi: https://doi.org/10.14735/amcsnn2020416

Súhrn

Úvod: Intravenózní trombolýza (IVT) podaná v okně 4,5 h od počátku příznaků je léčbou první volby akutní ischemické CMP (iCMP). V případě akutního uzávěru velké mozkové cévy vede IVT k časné kanalizaci střední mozkové tepny (a. cerebri media; ACM) pouze ve 13–33 % případů. Endovaskulární mechanická trombektomie (MT) během 6 h od počátku symptomů signifikantně zvyšuje úspěšnost rekanalizace a zlepšuje výsledný klinický stav pacientů. V indikovaných případech a pokud nejsou kontraindikace, MT následuje IVT. Tato kombinovaná terapie jako léčba druhé volby je nejlepší dostupná léčba akutní iCMP s uzávěrem ACM. Mikrochirurgická embolektomie (ME) je diskutovanou léčbou třetí volby u pacientů s akutní iCMP a okluzí ACM po selhání MT. Cílem tohoto review je zhodnocení účinnosti a bezpečnosti ME u pacientů s akutní iCMP při okluzi ACM a selhání IVT a MT v časovém okně 8, 16 a 24 h od začátku symptomů.

Metodika: Iniciální vyhledávání bude provedeno v databázích MEDLINE a EMBASE. Komprehenzivní systematické vyhledávání bude zahrnovat relevantní databáze jak pro publikované zdroje (MEDLINE, EMBASE, BMC, Cinahl, Scopus, a WoS), tak nepublikované zdroje literatury (Open Grey, MedNar, Cos Conference Papers Index a ProQuest). Na základě metodologie Joanna Briggs Institute, dva autoři systematického review nezávisle na sobě nejprve zanalyzují názvy, souhrny a texty identifikovaných literárních zdrojů a posléze kriticky zhodnotí metodologickou kvalitu relevantních studií a provedou extrakci dat pomocí standardizovaných nástrojů. Extrahovaná data budou syntetizována narativně, vč. specifikace typu intervence, charakteristiky cílové skupiny a typu výstupů. K detekci publikačního zkreslení bude použito funnel plot (trychtýřového grafu).

Klíčová slova:

ischemie mozku – embolektomie – trombektomie – mikrochrurgie – střední mozková tepna – tkáňový aktivátor plazminogenu

Zdroje

1. Jauch EC, Saver JL, Adams HP Jr. et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44 (3): 870–947. doi: 10.1161/STR.0b01 3e318284056a.

2. Powers WJ, Derdeyn CP, Biller J et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015; 46 (10): 3020–3035. doi: 10.1161/STR.0000000000000074.

3. Bhatia R, Hill MD, Shobha N et al. Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke 2010; 41 (10): 2254–2258. doi: 10.1161/STROKEAHA.110.592535.

4. Kimura K, Iguchi Y, Shibazaki K et al. Early recanalization rate of major occluded brain arteries after intravenous tissue plasminogen activator therapy using serial magnetic resonance angiography studies. Eur Neurol 2009; 62 (5): 287–292. doi: 10.1159/000235753.

5. Ciccone A, Valvassori L, Nichelatti M et al. Endovascular treatment for acute ischemic stroke. N Engl J Med 2013; 368 (10): 904–913. doi: 10.1056/NEJMoa1213701.

6. Nogueira RG, Jadhav AP, Haussen DC et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018; 378 (1): 11–21. doi: 10.1056/NEJMoa1706442.

7. Albers GW, Marks MP, Kemp S et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018; 378 (8): 708–718. doi: 10.1056/NEJMoa1713973.

8. Berkhemer OA, Fransen PS, Beumer D et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372 (1): 11–20. doi: 10.1056/NEJMoa1411587.

9. Campbell BC, Mitchell PJ, Kleinig TJ et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372 (11): 1009–1018. doi: 10.1056/NEJMoa1414792.

10. Goyal M, Menon BK, van Zwam WH et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387 (10029): 1723–1731. doi: 10.1016/S0140-6736 (16) 00163-X.

11. Jovin TG, Chamorro A, Cobo E et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372 (24): 2296–2306. doi: 10.1056/NEJMoa1503780.

12. Saver JL, Goyal M, Bonafe A et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372 (24): 2285–2295. doi: 10.1056/NEJMoa1415061.

13. Goyal M, Demchuk AM, Menon BK et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372 (11): 1019–1030. doi: 10.1056/NEJMoa1414905.

14. Leischner H, Flottmann F, Hanning U et al. Reasons for failed endovascular recanalization attempts in stroke patients. J Neurointerv Surg 2019; 11 (5): 439–442. doi: 10.1136/neurintsurg-2018-014060.

15. Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 2007; 38 (3): 967–973. doi: 10.1161/01.STR.0000258112.14918.24.

16. Rajajee V, Kidwell C, Starkman S et al. Early MRI and outcomes of untreated patients with mild or improving ischemic stroke. Neurology 2006; 67 (6): 980–984. doi: 10.1212/01.wnl.0000237520.88777.71.

17. Maingard J, Phan K, Lamanna A et al. Rescue intracranial stenting after failed mechanical thrombectomy for acute ischemic stroke: a systematic review and meta--analysis. World Neurosurg 2019; 132: e235–e245. doi: 10.1016/j.wneu.2019.08.192.

18. Sugiyama T, Kazumata K, Asaoka K et al. Reappraisal of microsurgical revascularization for anterior circulation ischemia in patients with progressive stroke. World Neurosurg 2015; 84 (6): 1579–1588. doi: 10.1016/j.wneu.2015.07.053.

19. Park J, Hwang YH, Kim Y. Extended superciliary approach for middle cerebral artery embolectomy after unsuccessful endovascular recanalization therapy: technical note. Neurosurgery 2009; 65 (6): E1191–E1194. doi: 10.1227/01.NEU.0000351783.00831.BB.

20. Horiuchi T, Nitta J, Ogiwara T et al. Outcome predictors of open embolectomy in middle cerebral artery occlusion. Neurol Res 2009; 31 (9): 892–894. doi: 10.1179/174313209X382494.

21. Kanematsu R, Kimura T, Ichikawa Y et al. Safety of urgent STA-MCA anastomosis after intravenous rt-PA treatment: a report of five cases and literature review. Acta Neurochirurgica 2018; 160 (9): 1721–1727. doi: 10.1007/s00701-018-3576-y.

22. Jacobson JH, Wallman LJ, Schumacher GA et al. Microsurgery as an aid to middle cerebral artery end- arterectomy. J Neurosurg 1962; 19: 108–115. doi: 10.3171/jns.1962.19.2.0108.

23. Hino A, Oka H, Hashimoto Y et al. Direct microsurgical embolectomy for acute occlusion of the internal carotid artery and middle cerebral artery. World Neurosurg 2016; 88: 243–251. doi: 10.1016/j.wneu.2015.12.069.

24. Horiuchi T, Nitta J, Sakai K et al. Emergency embolectomy for treatment of acute middle cerebral artery occlusion. J Neurosurg 2007; 106 (2): 257–262. doi: 10.3171/jns.2007.106.2.257.

25. Inoue T, Tamura A, Tsutsumi K et al. Surgical embolectomy for large vessel occlusion of anterior circulation. Br J Neurosurg 2013; 27 (6): 783–790. doi: 10.3109/02688697.2013.793286.

26. Park J, Hwang YH, Huh S et al. Minimally invasive and rapid surgical embolectomy (MIRSE) as rescue treatment following failed endovascular recanalization for acute ischemic stroke. Acta Neurochir (Wien) 2014; 156 (11): 2041–2049. doi: 10.1007/s00701-014-2179-5.

27. Krajickova D, Krajina A, Herzig R et al. Mechanical recanalization in ischemic anterior circulation stroke within an 8-hour time window: a real-world experience. Diagn Interv Radiol 2017; 23 (6): 465–471. doi: 10.5152/dir.2017.17049.

28. Kim DW, Jang SJ, Kang SD. Emergency microsurgical embolectomy for the treatment of acute intracranial artery occlusion: report of two cases. J Clin Neurol 2011; 7 (3): 159–163. doi: 10.3988/jcn.2011.7.3.159.

29. Katsuno M, Kawasaki K, Izumi N et al. Surgical embolectomy for middle cerebral artery occlusion after thrombolytic therapy: a report of two cases. Surg Neurol Int 2014; 5: 93. doi: 10.4103/2152-7806.134520.

30. Fiedler J, Ostry S, Bombic M et al. Urgent middle cerebral artery embolectomy of calcified embolus after intravenous thrombolysis: 2-dimensional operative video. Oper Neurosurg 2019; 17 (2): E54–E55. doi: 10.1093/ons/opy404.

31. Benes V, Netuka D, Charvat F et al. Recanalization of long-lasting middle cerebral artery occlusion by a combination of surgical and interventional approaches: technical case report. Neurosurgery 2005; 57 (4 Suppl): E401. doi: 10.1227/01.neu.0000176853.98516.4e.

32. Haninec P, Houstava L, Klener J. Shotgun pellet embolus of the middle cerebral artery treated by emergency embolectomy. Br J Neurosurg 1996; 10 (3): 311–314. doi: 10.1080/02688699650040214.

33. Moher D, Shamseer L, Clarke M et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4 (1): 1. doi: 10.1186/2046-4053-4-1.

34. Joanna Briggs Institute Reviewer‘s Manual. The Joanna Briggs Institute 2017.

35. Wahlgren N, Ahmed N, Dávalos A et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke--Monitoring Study (SITS-MOST): an observational study. Lancet 2007; 369 (9558): 275–282. doi: 10.1016/S0140-6736 (07) 60149-4.

36. Hino A, Oka H, Hashimoto Y et al. Ultraearly emergency embolectomy for acute occlusion of the internal carotid artery and middle cerebral artery. Int J Stroke 2014; 9 (Suppl 3): 64.

37. Anonymous. Arteriotomy; Studies from Kyungpook National University describe new findings in arteriotomy. Medical Patent Business Week 2010 01/15/ 2010 Jan 15.

38. Moola S, Munn Z, Tufanaru C et al. Systematic reviews of etiology and risk. In: Aromataris E, Munn Z (eds). Joanna Briggs Institute Reviewer‘s Manual. The Joanna Briggs Institute 2017.

39. Riley DS, Barber MS, Kienle GS et al. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol 2017; 89: 218–235. doi: 10.1016/j.jclinepi.2017.04.026.

40. Munn Z, Porritt K, Aromataris E et al. Summary of findings tables for Joanna Briggs Institute Systematic reviews. [online]. Available from URL: https: //nursing.lsuhsc.edu/JBI/docs/Grade/Summary_of_Findings_Tables_for_Joanna_Briggs_Institute_Systematic_Reviews-V3.pdf.