แนวทางการรักษาโรค หลอดเลือด สมอง 2563

Keywords:

Abstract

Endovascular treatment has shown benefit in patients with acute ischemic stroke in reducing morbidity and mortality, especially in those with acute major artery occlusion. In 2018, The American Heart Association/ American Stroke Association issues the up-to-date recommendation of the early management of patients with acute ischemic stroke regarding endovascular treatment. The Thai Stroke Society in cooperation with The Royal College of Radiologists of Thailand, The Royal College of Neurological Surgeons of Thailand, The Association of Thai Interventional Neuroradiology and Thai Association of Neurovascular Surgeons issue this updated version of Thai guidelines of endovascular treatment in patients with acute ischemic stroke. Endovascular treatment is one of the treatment options that should be performed in only hospitals with experienced, certified and potential stroke centers. Eligible criteria are (1) adult patients (≥18 years old) (2) prestroke MRS score 0-1, (3) receiving intravenous rtPA within 4.5 hours of stroke onset, (4) causative occlusion of internal carotid artery or MCA segment 1 (M1), (5) NIHSS ≥ 6, (6) ASPECTS score from CT brain ≥ 6, (7) treatment can be initiated (groin puncture) within 6 hours of symptom onset. Outcomes on all patients should be tracked.

References

1. Hanchaiphiboolkul S, Poungvarin N, Nidhinandana S, Suwanwela NC, Puthkhao P, Towanabut S, et al. Prevalence of stroke and stroke risk factors in Thailand: Thai Epidemiologic Stroke (TES) Study. Journal of the Medical Association of Thailand = Chotmaihet thangphaet. 2011;94(4):427-36.

2. Nilanont Y, Nidhinandana S, Suwanwela NC, Hanchaiphiboolkul S, Pimpak T, Tatsanavivat P, et al. Quality of acute ischemic stroke care in Thailand: a prospective multicenter countrywide cohort study. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2014;23(2):213-9.

3. Dharmasaroja PA, Muengtaweepongsa S, Pattaraarchachai J. Clinical course, prognostic factors, and long-term outcomes of malignant middle cerebral artery infarction patients in the modern era. Neurology India. 2016;64(3):436-41.

4. Uransilp N, Dharmasaroja PA, Watcharakorn A, Muengtaweepongsa S. Implementation of multiphase computed tomography angiography in management of patients with acute ischemic stroke in clinical practice. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2019;62:100-4.

5. Dharmasaroja PA, Watcharakorn A, Chaumrattanakul U. Pathophysiology of acute middle cerebral artery infarct by multimodal computed tomography: A pilot study in Thai patients. Journal of neurosciences in rural practice. 2015;6(1):59-64.

6. Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke. 2007;38(3):967-73.

7. Churojana A, Aurboonyawat T, Mongkolratnan A, Songsaeng D, Chankaew E, Withayasuk P, et al. Results of Endovascular Mechanical Thrombectomy for Acute Ischemic Stroke in Siriraj Hospital. J Med Assoc Thai. 2017; 100 (5):588-97.

8. Dharmasaroja PA. Endovascular Treatment in Patients with Acute Ischemic Stroke. Journal of Thai Stroke Society. 2015;14(3):124-34.

9. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. The New England journal of medicine. 2015;372(1):11-20.

10. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. The New England journal of medicine. 2015;372(11):1019-30.

11. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. The New England journal of medicine. 2015;372(11):1009-18.

12. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 hours after symptom onset in ischemic
stroke. The New England journal of medicine. 2015;372(24):2296-306.

13. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. The New England journal of medicine. 2015;372(24):2285-95.

14. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. The New England journal of medicine. 2018;378(1):11-21.

15. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. The New England journal of medicine. 2018;378(8):708-18.

16. Investigators PPST. The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke. 2009;40(8):2761-8.

17. Smith WS, Sung G, Saver J, Budzik R, Duckwiler G, Liebeskind DS, et al. Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke. 2008;39(4):1205-12.

18. Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. Jama. 1999;282(21):2003-11.

19. Alexandrov AV, Wojner AW, Grotta JC, Investigators C. CLOTBUST: design of a randomized trial of ultrasound-enhanced thrombolysis for acute ischemic stroke. Journal of neuroimaging : official journal of the American Society of Neuroimaging. 2004;14(2):108-12.

20. Turk AS, Frei D, Fiorella D, Mocco J, Baxter B, Siddiqui A, et al. ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy. Journal of neurointerventional surgery. 2014;6(4):260-4.

21. Turk AS, Turner R, Spiotta A, Vargas J, Holmstedt C, Ozark S, et al. Comparison of endovascular treatment approaches for acute ischemic stroke: cost effectiveness, technical success, and clinical outcomes. Journal of neurointerventional surgery. 2015;7(9):666-70.

22. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Is- chemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020-35.

23. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 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. 2018;49(3):e46-e110.

Published

2019-08-18

How to Cite

1.

ธรรมสโรช พ, รัตนากร ด, นิธินันทน์ ส, สิงหรา ณ อยุธยา ศ, สุวัชรังกูร ส, เขียนดวงจันทร์ เ, ชุติเนตร อ, อุดมมงคล เ, นิละนนท์ ย, หาญไชยพิบูลย์กุล ส, ตันติวัตนะ จ, เรียบร้อย ก, กอบกิจสุขสกุล ช, โกมลจันทร์ ส, วรกิจธำรงค์ชัย ธ, ฉันธนาภัค เ, ตันทองทิพย์ ด. 2019 Thai Guidelines of Endovascular Treatment in Patients with Acute Ischemic Stroke. J Thai Stroke Soc [Internet]. 2019 Aug. 18 [cited 2022 Dec. 6];18(2):52-75. Available from: https://he01.tci-thaijo.org/index.php/jtss/article/view/209691

More Citation Formats

• ACM
• ACS
• APA
• ABNT
• Chicago
• Harvard
• IEEE
• MLA
• Turabian
• Vancouver

Download Citation

• Endnote/Zotero/Mendeley (RIS)
• BibTeX

Issue

Vol. 18 No. 2 (2019): May - August

Section

Clinical Practice Guidelines