Nhồi máu não cấp sau can thiệp động mạch vành cấp cứu-Reference-Cited by-同舟云学术

Nhồi máu não cấp sau can thiệp động mạch vành cấp cứu

Published:2023-05-02 Issue:88 Volume: Page:
ISSN:1859-3895
Container-title:Journal of Clinical Medicine- Hue Central Hospital
language:en
Short-container-title:jcmhch

Author:

Hoàng Tiến

Abstract

TÓM TẮT Đột quỵ thiếu máu não xảy ra sau can thiệp động mạch vành qua da (PCI) tiên phát thường là hiếm nhưng để lại hậu quả nặng nề. Tỷ lệ bệnh nặng và tử vong nội viện ở nhóm bệnh nhân này cao hơn so với nhóm bệnh nhân bị các biến chứng khác liên quan đến thủ thuật. Chúng tôi báo cáo một trường hợp nhồi máu não cấp sau can thiệp động mạch vành cấp cứu. Chẩn đoán bệnh nhân bị đột quỵ ngay lúc bệnh nhân còn nằm trên bàn thủ thuật rất quan trọng. Người làm thủ thuật nên kiểm tra tình trạng của bệnh nhân sau những bước chính của qui trình can thiệp như hút huyết khối. Nếu nghi ngờ đột quỵ thiếu máu não khi ống thông động mạch đùi vẫn còn trong lòng mạch, tiến hành chụp mạch não ngay là một giải pháp khả dĩ được thực hiện bởi bác sỹ can thiệp để xác định chẩn đoán và xác định hình thái của huyết khối, mức độ thuyên tắc. Lấy huyết khối cơ học và thuốc tiêu sợi huyết như alteplase có thể là giải pháp điều trị chọn lựa trong tình huống này. Nên tránh hút huyết khối thường qui và thực hiện cẩn trọng có thể giúp chúng ta ngăn ngừa biến chứng đột quỵ nhồi máu não cấp. Nhận diện sớm các triệu chứng nghi ngờ nhồi máu não cấp ngay sau khi hoàn tất thủ thuật cũng như trong quá trình theo dõi để đánh giá chính xác thời gian cửa sổ điều trị và phối hợp nhiều nhóm chuyên khoa. ABSTRACT ACUTE ISCHEMIC STROKE AFTER PRIMARY PERCUTANEOUS CORONARY ARTERY INTERVENTION Ischemic stroke occurring after primary percutaneous coronary intervention (PCI) is rare but has severe consequences. The rate of serious illness and in - hospital mortality was higher in this group of patients than in patients with other procedure - related complications. We report a case study with an acute ischemic stroke complication after primary percutaneous coronary intervention. Diagnosing a patient with a stroke while the patient is still on the operating table is very important. The practitioner should check the patient’s condition after key steps of the interventional procedure such as thrombectomy. Suppose an ischemic stroke is suspected while the femoral artery catheter is still in the lumen. In that case, immediate cerebral angiography is a possible solution by the interventional physician to confirm the diagnosis and the morphology of thrombosis, degree of embolism. In this situation, mechanical thrombectomy and arterial thrombolytic agents such as alteplase may be the treatment of choice. Routine thrombectomy should be avoided and done with care to help prevent acute ischemic stroke complications. Early identification of suspected symptoms right after completing the procedure as well as during follow-up to accurately assess the treatment window time and coordinate multiple specialist groups.

Publisher

Hue Central Hospital

Subject

General Medicine

Reference20 articles.

1. 1. Korn ‐ Lubetzki I, Farkash R, Pachino RM, Almagor Y, Tzivoni D, Meerkin D. Incidence and risk factors of cerebrovascular events following cardiac catheterization. Journal of the American Heart Association. 2013;2(6):e000413.

2. 2. Werner N, Zahn R, Zeymer U. Stroke in patients undergoing coronary angiography and percutaneous coronary intervention: incidence, predictors, outcome and therapeutic options. Expert review of cardiovascular therapy. 2012;10(10):1297-1305.

3. 3. Werner N, Bauer T, Hochadel M, Zahn R, Weidinger F, Marco J, et al. Incidence and clinical impact of stroke complicating percutaneous coronary intervention: results of the Euro heart survey percutaneous coronary interventions registry. Circulation: Cardiovascular Interventions. 2013; 6(4):362-369.

4. 4. Dawson LP, Cole JA, Lancefield TF, Ajani AE, Andrianopoulos N, Thrift AG, et al. Incidence and risk factors for stroke following percutaneous coronary intervention. International Journal of Stroke. 2020;15(8):909-922.

5. 5. Nam BYtV, Hướng dẫn chẩn đoán và xử trí hội chứng mạch vành cấp. 2019.