Thrombolysis and thrombectomy as an effective treatment for ischemic cerebral circulation disorders
Research Topic: Vietnamese Medical Research
The number of stroke cases has more than doubled worldwide over the past four decades, including in low- and middle-income countries. Therefore, understanding the present situation of acute ischemic stroke in Vietnam is an urgent theme. The number of stroke cases in Vietnam is correlated with and reflected in the number of thrombolysis and thrombectomies performed. To increase the effectiveness of stroke treatment, use of thrombolysis and thromboembolism alone are insufficient. New organizational models for emergency care and methodologies for identifying the first signs of stroke need to be developed. We conducted a retrospective study of reports from 29 clinics that used these two types of treatment in 2009-2017. In the 50 stroke units, departments, and stroke centers in Vietnam, about 640 beds are designed to potentially receive and treat a population of 93 million people. Among the 1145 patients who were treated with recombinant tissue plasminogen activator, they had a National Institutes of Health Stroke Score (NIHSS) medium score when admitted to the hospital: 14.1; modified Rankin Scale (mRS) post three months: mRS (0-1) was 52.2%, mRS (6 score) was 6.12%. Intracranial hemorrhage rate was 4.1%. Of the 269 patients treated with thrombectomy, the mean age was 62.14 ± 13.3; NIHSS medium score entreat admission to the hospital: 16.2 ± 7.85; complete recanalization after treatment (TICI score 2b-3) was 60.3%. The rate of functional independence (90 day mRS score of 0 - 2) was 34.6%; the death rate was 17.9%; intracranial hemorrhage and symptomatic hemorrhage rate was 22.5% and 10.1%, respectively. Thrombolysis and thrombectomy are important treatments that can reduce disability (not mortality) in some patients after acute ischemic stroke; however, it is necessary to introduce higher quality and safe services. For this purpose, a better integrated approach to stroke care in Vietnam needs to be developed.