Trombectomy success in relation to the location and characteristics of the blood clot in acute ischemic stroke

Uvod: Možganska kap (MK) je akutno bolezensko stanje centralnega živčnega sistema. Center za nadzor in preprečevanje bolezni (CDC) ocenjuje pojavnost MK na 795 tisoč primerov na leto, od tega se 140 tisoč primerov konča s smrtnim izidom. Intervencijska radiologija danes omogoča znotrajžilno zdravljenje/odstranjevanje krvnega strdka v možganskih arterijah. Pri zdravljenju MK je bistvenega pomena čas, ki mine do ponovnega odprtja možganske arterije, saj vpliva na končno okvaro in posledično rehabilitacijo bolnika. Namen: Namen magistrskega dela je predstaviti radiološko obravnavo in zdravljenje bolnika z MK. Cilj magistrskega dela je preučiti bolnike, ki so doživeli akutno ishemično MK zaradi s strdkom povzročene zapore debla (M1 segmenta) srednje možganske arterije in ugotoviti, ali obstaja statistično značilna povezava med značilnostmi krvnega strdka in številom uporabljenih manevrov med znotrajžilnim odstranjevanjem strdka. Metode dela: Izvedena je bila retrogradna študija primera. Uporabljena je bila deskriptivna metoda dela, narejen je bil pregled literature, v empiričnem delu pa smo izvedli obdelave slik s programsko opremo ImageJ. Vzorec je predstavljalo 14 bolnikov z akutno ishemično MK, pri katerih je bil izveden znotrajžilni poseg s stent-retrieverjem vrste Trevo® (Trevo Retriever, Stryker Neurovascular, Fremont, CA). Zbrane podatke smo obdelali in analizirali s pomočjo programov Microsoft® Excel in SPSS, različica 21.0. Rezultati: Spearmanov test korelacije je pokazal, da med dolžino krvnega strdka in številom manevrov ni statistično značilne povezave (p=0,613). Podobno tudi med premerom krvnega strdka in številom manevrov ni statistično značilne povezave (p=1). S pomočjo Spearmanovega testa korelacije smo ugotovili, da je kot arterije ACM statistično značilno povezan s številom manevrov (p=0,006). Rezultati t-testa so pokazali, da obstajajo statistično značilne razlike v vrednostih HU med meritvami, narejenimi na krvnem strdku in meritvami brez krvnega strdka (p=0,003). Cronbachova alfa, ki znaša 0,814, je pokazala, da so meritve konsistentne. T-test je pokazal, da obstajajo statistično značilne razlike med meritvami, narejenimi z eno slikovno točko in meritvami, narejenimi s tremi slikovnimi točkami (p=0,008). Rezultati Spearmanovega testa povezanosti kažejo, da med številom manevrov in številčno vrednostjo HU strdka ni statistično značilne povezanosti (p=0,613). Zaključek: Kot poteka arterije, kjer se nahaja zapora s krvnim strdkom statistično pomembno vpliva na uspešnost mehanične rekanalizacije (t.j. število manevrov, ki jih potrebujemo za odstranitev strdka iz M1 segmenta ACM). Z meritvijo kota pred posegom lahko napovemo uspešnost trombektomije s stent-retrieverjem tipa Trevo.Introduction: Acute ishemic stroke is an acute disease of the central nervous system. The Center for Disease Control and Prevention estimates the incidence at 795,000 cases per year, of which 140,000 cases end with death.Interventional radiology allows intravascular treatment/removal of a blood clot in the cerebral arteries. Time is of great importance in the treatment of stroke, as it affects the final impairment and consequent rehabilitation of the patient. Purpose: The purpose of the thesis is to present the radiological treatment of stroke. The aim is to examine patients who have experienced acute ischemic stroke due to clot-induced occlusion of the trunk (M1 segment) of the middle cerebral artery and to determine whether there is a statistically significant relationship between blood clot characteristics and the number of maneuvers used during intravascular clot removal. Methods: A retrospective case study was conducted. Used was the descriptive work method, prepared was an overview of literature and in the empirical part we performed image processing with the ImageJ software. The sample consisted of 14 patients after ischemic stroke who underwent intravascular surgery with a Trevo® stent-retriever (Trevo Retriever, Stryker Neurovascular, Fremont, CA). The collected data were processed and analyzed using Microsoft® Excel and SPSS, version 21.0. Results: Spearman’s correlation test showed that there was no statistically significant association between blood clot length and number of maneuvers (p=0.613). Similarly, there is no statistically significant association between blood clot diameter and number of maneuvers (p=1). Using Spearman’s correlation test, we found that the angle of ACM is related to the number of maneuvers (p =0.006). The results of the t-test showed that there are statistically significant differences in HU values between measurements made on a blood clot and measurements without a blood clot (p=0.003). Cronbach’s alpha\u27s value (0.814) showed that the measurements were consistent. The T-test showed that there are statistically significant differences between measurements made with one pixel and measurements made with three pixels (p=0.008). The results of the Spearman correlation test showed that there is no statistically significant correlation between the number of maneuvers and the amount of HU clot value (p=0.613). Conclusion: The angle of the artery where the blood clot is located, has statistically significant effect on the success of mechanical recanalization (i.e., the number of maneuvers required to remove the clot from the M1 segment of the ACM). By measuring the angle before the procedure, the success of thrombectomy with a Trevo stent-retriever can be predicted