Ces radiol. 2020, 74(2):139-146 | DOI: 10.55095/CesRadiol2020/024

Factors influencing clinical outcome of patients with acute ischaemic strokeOriginal article

Petr Polidar
Komplexní cerebrovaskulární centrum, Neurologická klinika LF UP a FN Olomouc

Ischemic strokes are frequent neurological diseases. Annual incidence in Europe varies from 100 to 350/100.000 inhabitants per year. Strokes are leading cause of long-term invalidity and 3rd cause of death worldwide. Reperfusion therapy represents therapeutic keystone. In the year 2015, positive results of five randomized studies showed the superiority and efficacy of mechanical thrombectomy compared to standard treatment in acute ischemic stroke due to large vessel occlusion. Positive results of DAWN and DEFUSE-3 trials published in 2017/2018 showed benefit for endovascular therapy beyond standard therapeutic time window in strictly selected patients based on imaging of ischemic penumbra using CT perfusion or MRI. Thus, "tissue" window is becoming a limiting factor for mechanical thrombectomy now instead of previous "time" window. Use of aspiration thrombectomy and choice of suitable anesthesia caused increase of procedural efectivity of intervention. There are 3 possible positive outcome predictors which can be influenced in acute care. Blood pressure seems to be the key variable in acute phase. Lowering the values is associated with better outcome up to systolic blood pressure under 100 torr where growth of complications is observed. Oxygen stress protective effect of normoglycaemia appears to be more important in case of mechanical thrombectomy. Body temperature seems to be good predictor of outcome in relation to other characteristics of the patient. Its' sole decrease via therapeutic hypothermia is in the cases of acute ischaemic stroke associated with significantly higher incidence of severe complications.

Keywords: ischemic stroke, reperfusion therapy, mechanical thrombectomy, hypertension, hyperglycaemia, hypertermia

Accepted: April 27, 2020; Published: June 1, 2020  Show citation

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Polidar P. Factors influencing clinical outcome of patients with acute ischaemic stroke. Ces radiol. 2020;74(2):139-146. doi: 10.55095/CesRadiol2020/024.
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