Revascularization in the treatment of acute ischemic stroke
Notice bibliographique
Résumé
Objective ‒ to analyze the experience of providing care to patients with acute stroke in the conditions of the multidisciplinary neurosurgical department of Poltava Regional Clinical Hospital named after M.V. Sklifosovsky.Materials and methods. In the neurosurgical department in 2020 treated 1,148 patients aged 18 to 83, among whom 49 % were patients with acute stroke. Ischemic stroke was observed in 54.7 % of people, and hemorrhagic stroke in 45.3 %. A total of 173 patients with a diagnosis of acute ischemic stroke were hospitalized in 2020, of which 54 patients were delivered within 4.5 hours from the onset of the disease and received thrombolytic therapy and 20 patients within 6 hours who underwent mechanical thrombectomy, with of them, bridging was used in 5 patients. To determine the presence of signs of a stroke and pre-notification, the following scales were used: FAST and «МОЗОК-ЧАС». Neuroimaging was performed as an emergency using native SCT and SCT-angiography or MRT and MRT-angiography in 100 % of cases. To evaluate the results of neuroimaging, the ASPECTS scale was used for stroke in the anterior hemisphere and pc-ASPECTS – in the vertebrobasilar basin. The NIHSS scale was used to determine the severity of the patient; the following scales were used to determine the presence of occlusion of a large vessel: RACE, BRAIN2. A modified Rankin scale was used to assess the patient’s functional status. In the treatment of ischemic stroke, we divided all patients into 2 groups: the first – 41 % patients, who are subject to revascularization treatment, the second – 59 % patients, who are shown only optimal drug therapy. Revascularization had 2 treatment options. The first option provided for thrombolytic therapy in case of detection of small vessel occlusion, the second – mechanical thrombectomy in case of detection of large vessel occlusion. In cases where the patient was admitted within the therapeutic window, bridging therapy was performed, i.e. intravenous administration of plasminogen activator and simultaneous endovascular thrombectomy. In case of simultaneous detection of a stroke and a heart attack in a patient, the Canadian Stroke Best Practice Recommendations for Acute Stroke Management (2018) were used as a basis, according to which the specifics of the management of patients undergoing revascularization treatment are defined. The following EVT techniques were used in our study: ADAPT – in 5 % of patients, Solumbra – in 10 % of patients and SAVE – in 85 % of patients during endovascular thrombectomy.Results. Thrombolytic therapy was carried out – 31 % of the total number of treated patients with ischemic stroke, mechanical thrombectomy – 10 % of the total number of treated patients. Decompressive craniectomies were performed in 6 % of patients with ischemic stroke.Conclusions. Analysis of the results of treatment of patients with ischemic stroke using the above methods indicates a good result at discharge from the medical institution and later, namely on the 90th day after the treatment.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».