ОПТИМИЗАЦИЯ ЭНДОВАСКУЛЯРНОЙ ТАКТИКИ ПРИ ОСТРОМ ИШЕМИЧЕСКОМ ИНСУЛЬТЕ С УЧЁТОМ АНГИОАРХИТЕКТОНИКИ И КОЛЛАТЕРАЛЬНОГО КРОВОТОКА
Ключевые слова:
ишемический инсульт, механическая тромбэктомия, коллатеральное кровообращение, ангиоархитектоника, эндоваскулярная терапия, реперфузия, mTICI, First Pass Effect, CTA, CTPАннотация
Острый ишемический инсульт остаётся одной из ведущих причин смертности и инвалидизации во всём мире, несмотря на значительный прогресс в области реперфузионной терапии. Современная эндоваскулярная терапия, включая механическую тромбэктомию, продемонстрировала высокую эффективность в восстановлении кровотока при окклюзии крупных церебральных артерий. Однако клинические исходы остаются вариабельными, что обусловлено сложной взаимосвязью факторов, таких как ангиоархитектоника сосудистого русла, характеристики тромба и состояние коллатерального кровообращения.
Цель исследования. Оценка влияния ангиоархитектоники и коллатерального статуса на результаты эндоваскулярного лечения и разработка алгоритма выбора оптимальной тактики тромбэктомии. Исследование выполнено в формате проспективного когортного анализа с включением 148 пациентов с острым ишемическим инсультом. Всем пациентам проводилась комплексная нейровизуализация (КТ, КТА, КТП) с последующей стратификацией по типу вмешательства.
Результаты. Применение алгоритмизированного подхода с учётом коллатерального кровотока и анатомических особенностей достоверно повышает частоту достижения полной реперфузии (mTICI 3), увеличивает вероятность First Pass Effect и улучшает функциональные исходы через 90 дней. Установлено, что хороший коллатеральный статус ассоциирован с меньшим ростом инфаркта и более высокой вероятностью функциональной независимости.
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