학술논문
Acute Stroke Management in Turkiye: Intravenous Tissue Plasminogen Activator and Thrombectomy NoroTek: Turkiye Neurology Single Day Study/Turkiye'de Akut Inme Yonetimi: IV tPA ve Trombektomi NoroTek: Turkiye Noroloji Tek Gun Calismasi
Original Article / Ozgun Arastirma
Original Article / Ozgun Arastirma
Document Type
Report
Author
Topcuoglu, Mehmet Akif; Ozdemir, Atilla Ozcan; Arsava, Ethem Murat; Gunes, Aygul; Aykac, Ozlem; Gencer, Elif Sarionder; Cabalar, Murat; Yayla, Vildan; Erdogan, Haci Ali; Erdogan, Mucahid; Acar, Zeynep Ozdemir; Giray, Semih; Kablan, Yuksel; Tanriverdi, Zeynep; Tekan, Ulgen Yalaz; Asil, Talip; Akpinar, Cetin Kursad; Yurekli, Vedat Ali; Acar, Bilgehan; Sirin, Hadiye; Guler, Ayse; Baydemir, Recep; Akcakoyunlu, Merve; Ocek, Levent; Cetiner, Mustafa; Nazliel, Bijen; Caglayan, Hale Batur; Ongun, Nedim; Eren, Alper; Arlier, Zulfikar; Cenikli, Utku; Gokce, Mustafa; Bavli, Songul; Yaka, Erdem; Ozkul, Ayca; Degirmenci, Bahar; Aluclu, Ufuk; Isikay, Canan Togay; Aslanbaba, Eda; Sorgun, Mine; Aytac, Emrah; Ay, Halil; Kunt, Refik; Senadim, Songul; Unsal, Yaprak Ozum; Eskut, Neslihan; Alioglu, Zekeriya; Yilmaz, Arda; Genc, Hamit; Yilmaz, Ayse; Milanoglu, Aysel; Gurkas, Erdem; Degirmenci, Eylem; Bektas, Hesna; Ilgezdi, Irem; Bilgic, Adnan Burak; Akyol, enol; Gungor, Levent; Kale, Nilufer; Coban, Eda; Yesilot, Nilufer; Ekizoglu, Esme; Kizek, Ozgu; Kursun, Oguzhan; Yildiz, Ozlem Kayim; Bolayir, Asli; Kisabay, Aysin; Bastan, Birgul; Acar, Zeynep; Niflioglu, Buket; Guven, Bulent; Kaya, Dilaver; Afsar, Nazire; Yazici, Duran; Toplutas, Eren; Ozkan, Esra; Ilik, Faik; Ince, Fatma Birsen; Buyukserbetci, Gulseren; Onder, Halil; Karadeli, Hasan Huseyin; Kozak, Hasan Huseyin; Demirbas, Hayri; Midi, Ipek; Aydin, Isa; Epceliden, M. Tuncay; Atmaca, Murat Mert; Bakar, Mustafa; Sen, Mustafa; Turgut, Nilda; Keskin, Onur; Akdogan, Ozlem; Bilgili, Ozlem; Sirinocak, Pinar Bekdik; Yevgi, Recep; Akkas, Sinem Yazici; Yoldas, Tahir; Duman, Taskin; Ozel, Tugba; Unal, Ali; Dora, Babur; Atasoy, Tugrul; Cinar, Bilge Piri; Demir, Tulin; Demir, Turgay; Can, Ufuk; Aslan, Yildiz; Bas, Demet Funda; Sener, Ufuk; Yilmaz, Zahide; Bozdogan, Zehra; Ozdemir, Gokhan; Krespi, Yakup; Ozturk, Serefnur
Source
Turkish Journal of Neurology. December 2023, Vol. 29 Issue 4, p249, 7 p.
Subject
Language
English
ISSN
1301-062X
Abstract
Introduction In Turkiye, intravenous (IV) tissue plasminogen activator (tPA) was licensed in May 2006, approximately 10 years after licensing in the European Union region (1). In the period that followed, [...]
Objective: To reveal the profile and practice in patients with acute stroke who received intravenous tissue plasminogen activator (IV tPA) and/or neuro-interventional therapy in Turkiye. Materials and Methods: On World Stroke Awareness Day, May 10, 2018, 1,790 patients hospitalized in 87 neurology units spread over 30 health regions were evaluated retrospectively and prospectively. Results: Intravenous tPA was administered to 12% of 859 cases of acute ischemic stroke in 45 units participating in the study. In the same period, 8.3% of the cases received neurointerventional treatment. The rate of good prognosis [modified Rankin score (mRS) 0-2] at discharge was 46% in 83 patients who received only IV tPA [age: 67 [+ or -] 12 years; National Institutes of Health Stroke Scale (NIHSS): 12 [+ or -] 6; hospital stay, 24 [+ or -] 29 days]; 35% in 51 patients who underwent thrombectomy (MT) alone (age: 64 [+ or -] 13 years; NIHSS: 14.1 [+ or -] 6.5; length of hospital stay, 33 [+ or -] 31 days), 19% in those who received combined treatment (age: 66 [+ or -] 14 years; NIHSS: 15.6 [+ or -] 5.4; length of hospital stay, 26 [+ or -] 35 days), and 56% of 695 patients who did not receive treatment for revascularization (age: 70 [+ or -] 13 years; NIHSS: 7.6 [+ or -] 7.2; length of hospital stay, 21 [+ or -] 28 days). The symptom-to-door time was 87 [+ or -] 53 minutes in the IV treatment group and 200 [+ or -] 26 minutes in the neurointerventional group. The average door-to-needle time was 66 [+ or -] 49 minutes in the IV tPA group. In the neurothrombectomy group, the door-to-groin time was 103 [+ or -] 90 minutes, and the TICI 2b-3 rate was 70.3%. In 103 patients who received IV tPA, the discharge mRS 0-2 was 41%, while the rate of mRS 0-1 was 28%. In 71 patients who underwent neurothrombectomy, the mRS 0-2 was 31% and mRS 0-1 was 18%. The door-to-groin time was approximately 30 minutes longer if IV tPA was received (125 [+ or -] 107 and 95 [+ or -] 83 minutes, respectively). Symptomatic bleeding rates were 4.8% in IV recipients, 17.6% among those who received only MT, and 15% in combined therapy. Globally, the hemorrhage rate was 6.8% in patients receiving IV tPA and 16.9% in MT. Conclusion: IV thrombolytic and neurointerventional treatment applications in acute ischemic stroke in Turkiye can provide the anticipated results. Heterogeneity has begun to be reduced in our country with the dissemination of the system indicated by the "Directive on Health Services to be Provided to Patients with Acute Stroke." Keywords: Acute stroke, thrombolytic therapy, thrombectomy, prognosis, treatment window, metric Amac: Turkiye'de intravenoz doku plazminojen aktivatoru (IV tPA) ve/veya noro-girisimsel tedavi uygulanan akut inme hastalarinin profili ve uygulamaya dair pratiklerin ortaya konulmasi. Gerec ve Yontem: 10 Mayis 2018 Dunya Inme Farkindalik Gunu'nde 30 saglik bolgesine yayilmis olan 87 noroloji biriminde yatmakta olan 1.790 hasta retrospektif ve prospektif olarak degerlendirilmistir. Bulgular: Calismaya katilan 45 birimde 859 akut iskemik inme olgusundan %12'sine IV tPA uygulanmistir. Ayni donemde %8,3 olgu norogirisimsel tedavi almistir. Taburculuk esnasinda iyi prognoz [modifiye Rankin skoru (mRS) 0-2] orani sadece IV tPA uygulanan 83 olguda [yas: 67 [+ or -] 12 yil; Ulusal Saglik Inme Olcegi (NIHSS): 12 [+ or -] 6, hastanede yatis suresi 24 [+ or -] 29 gun] %46; sadece trombektomi (MT) uygulanan 51 olguda (yas: 64 [+ or -] 13 yil; NIHSS: 14,1 [+ or -] 6,5; hastanede yatis suresi 33 [+ or -] 31 gun) %35, kombine tedavi alanlarda (yas: 66 [+ or -] 14 yil, NIHSS: 15,6 [+ or -] 5,4, yatis suresi 26 [+ or -] 35 gun) %19 ve revaskularizasyona yonelik tedavi uygulanmayan 695 olguda (yas: 70 [+ or -] 13 yil, NIHSS 7,6 [+ or -] 7,2; ortalama yatis suresi: 21 [+ or -] 28 gun) %56'dir. Semptom kapi zamani IV tedavi alanlarda 87 [+ or -] 53 dakika iken norogirisimsel grupta 200 [+ or -] 26 dakikadir. IV tPA grubunda ortalama kapi igne zamani 66 [+ or -] 49 dakikadir. Norotrombektomi grubunda kapi-kasik zamani 103 [+ or -] 90 dakika ve TICI 2b-3 orani %70,3'dur. IV tPA uygulamasi yapilan 103 olguda taburculuk mRS 0-2 %41 iken mRS 0-1 orani %28 olarak belirlenmistir. Toplam norotrombektomi uygulanan 71 olguda mRS 0-2 %31 ve mRS 0-1 %18 olarak kaydedilmistir. Kapi-kasik girisi zaman IV tPA almis ise yaklasik yarim saat daha uzundur (sirasiyla; 125 [+ or -] 107 dakika ve 95 [+ or -] 83 dakika). Semptomatik kanama oranlari ise sadece IV alanlarda %4,8; sadece MT yapilanlarda %17,6; kombine tedavide %15 olup IV alan hastalarda global olarak %6,8 ve MT'de %16,9'dur. Sonuc: Turkiye'de akut iskemik inmede IV trombolitik ve norogirisimsel tedavi uygulamalari beklenen sonuclari saglayabilmektedir. Ulkemizde "Akut Inmeli Hastalara Verilecek Saglik Hizmetleri Hakkinda Yonerge"nin isaret ettigi sistemin yayginlastirilmasi ile heterojenite azaltilma yoluna girmistir. Anahtar Kelimeler: Akut inme, trombolitik tedavi, trombektomi, prognoz, tedavi penceresi, metrik
Objective: To reveal the profile and practice in patients with acute stroke who received intravenous tissue plasminogen activator (IV tPA) and/or neuro-interventional therapy in Turkiye. Materials and Methods: On World Stroke Awareness Day, May 10, 2018, 1,790 patients hospitalized in 87 neurology units spread over 30 health regions were evaluated retrospectively and prospectively. Results: Intravenous tPA was administered to 12% of 859 cases of acute ischemic stroke in 45 units participating in the study. In the same period, 8.3% of the cases received neurointerventional treatment. The rate of good prognosis [modified Rankin score (mRS) 0-2] at discharge was 46% in 83 patients who received only IV tPA [age: 67 [+ or -] 12 years; National Institutes of Health Stroke Scale (NIHSS): 12 [+ or -] 6; hospital stay, 24 [+ or -] 29 days]; 35% in 51 patients who underwent thrombectomy (MT) alone (age: 64 [+ or -] 13 years; NIHSS: 14.1 [+ or -] 6.5; length of hospital stay, 33 [+ or -] 31 days), 19% in those who received combined treatment (age: 66 [+ or -] 14 years; NIHSS: 15.6 [+ or -] 5.4; length of hospital stay, 26 [+ or -] 35 days), and 56% of 695 patients who did not receive treatment for revascularization (age: 70 [+ or -] 13 years; NIHSS: 7.6 [+ or -] 7.2; length of hospital stay, 21 [+ or -] 28 days). The symptom-to-door time was 87 [+ or -] 53 minutes in the IV treatment group and 200 [+ or -] 26 minutes in the neurointerventional group. The average door-to-needle time was 66 [+ or -] 49 minutes in the IV tPA group. In the neurothrombectomy group, the door-to-groin time was 103 [+ or -] 90 minutes, and the TICI 2b-3 rate was 70.3%. In 103 patients who received IV tPA, the discharge mRS 0-2 was 41%, while the rate of mRS 0-1 was 28%. In 71 patients who underwent neurothrombectomy, the mRS 0-2 was 31% and mRS 0-1 was 18%. The door-to-groin time was approximately 30 minutes longer if IV tPA was received (125 [+ or -] 107 and 95 [+ or -] 83 minutes, respectively). Symptomatic bleeding rates were 4.8% in IV recipients, 17.6% among those who received only MT, and 15% in combined therapy. Globally, the hemorrhage rate was 6.8% in patients receiving IV tPA and 16.9% in MT. Conclusion: IV thrombolytic and neurointerventional treatment applications in acute ischemic stroke in Turkiye can provide the anticipated results. Heterogeneity has begun to be reduced in our country with the dissemination of the system indicated by the "Directive on Health Services to be Provided to Patients with Acute Stroke." Keywords: Acute stroke, thrombolytic therapy, thrombectomy, prognosis, treatment window, metric Amac: Turkiye'de intravenoz doku plazminojen aktivatoru (IV tPA) ve/veya noro-girisimsel tedavi uygulanan akut inme hastalarinin profili ve uygulamaya dair pratiklerin ortaya konulmasi. Gerec ve Yontem: 10 Mayis 2018 Dunya Inme Farkindalik Gunu'nde 30 saglik bolgesine yayilmis olan 87 noroloji biriminde yatmakta olan 1.790 hasta retrospektif ve prospektif olarak degerlendirilmistir. Bulgular: Calismaya katilan 45 birimde 859 akut iskemik inme olgusundan %12'sine IV tPA uygulanmistir. Ayni donemde %8,3 olgu norogirisimsel tedavi almistir. Taburculuk esnasinda iyi prognoz [modifiye Rankin skoru (mRS) 0-2] orani sadece IV tPA uygulanan 83 olguda [yas: 67 [+ or -] 12 yil; Ulusal Saglik Inme Olcegi (NIHSS): 12 [+ or -] 6, hastanede yatis suresi 24 [+ or -] 29 gun] %46; sadece trombektomi (MT) uygulanan 51 olguda (yas: 64 [+ or -] 13 yil; NIHSS: 14,1 [+ or -] 6,5; hastanede yatis suresi 33 [+ or -] 31 gun) %35, kombine tedavi alanlarda (yas: 66 [+ or -] 14 yil, NIHSS: 15,6 [+ or -] 5,4, yatis suresi 26 [+ or -] 35 gun) %19 ve revaskularizasyona yonelik tedavi uygulanmayan 695 olguda (yas: 70 [+ or -] 13 yil, NIHSS 7,6 [+ or -] 7,2; ortalama yatis suresi: 21 [+ or -] 28 gun) %56'dir. Semptom kapi zamani IV tedavi alanlarda 87 [+ or -] 53 dakika iken norogirisimsel grupta 200 [+ or -] 26 dakikadir. IV tPA grubunda ortalama kapi igne zamani 66 [+ or -] 49 dakikadir. Norotrombektomi grubunda kapi-kasik zamani 103 [+ or -] 90 dakika ve TICI 2b-3 orani %70,3'dur. IV tPA uygulamasi yapilan 103 olguda taburculuk mRS 0-2 %41 iken mRS 0-1 orani %28 olarak belirlenmistir. Toplam norotrombektomi uygulanan 71 olguda mRS 0-2 %31 ve mRS 0-1 %18 olarak kaydedilmistir. Kapi-kasik girisi zaman IV tPA almis ise yaklasik yarim saat daha uzundur (sirasiyla; 125 [+ or -] 107 dakika ve 95 [+ or -] 83 dakika). Semptomatik kanama oranlari ise sadece IV alanlarda %4,8; sadece MT yapilanlarda %17,6; kombine tedavide %15 olup IV alan hastalarda global olarak %6,8 ve MT'de %16,9'dur. Sonuc: Turkiye'de akut iskemik inmede IV trombolitik ve norogirisimsel tedavi uygulamalari beklenen sonuclari saglayabilmektedir. Ulkemizde "Akut Inmeli Hastalara Verilecek Saglik Hizmetleri Hakkinda Yonerge"nin isaret ettigi sistemin yayginlastirilmasi ile heterojenite azaltilma yoluna girmistir. Anahtar Kelimeler: Akut inme, trombolitik tedavi, trombektomi, prognoz, tedavi penceresi, metrik