Summary of doctoral thesis in medicine: Research on treatment of proximal arterial occlusion of the anterior cerebral circulation system within the first 6 hours with intravenous thrombolytic combined with mechanical thrombectomy

The thesis has shown good results both in clinical and medical image of the combination treatment of intravenous thrombolytic agent dose of 0.6 mg/kg with endovascular intervention in the first 6 hours in patients with acute ischemic stroke due to proximal arterial occlusion of the anterior cerebral vessels.
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Summary of doctoral thesis in medicine: Research on treatment of proximal arterial occlusion of the anterior cerebral circulation system within the first 6 hours with intravenous thrombolytic combined with mechanical thrombectomy MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH HANOI MEDICAL UNIVERSITY DAO VIET PHUONG RESEARCH ON TREATMENT OF PROXIMAL ARTERIAL OCCLUSION OF THE ANTERIOR CEREBRAL CIRCULATION SYSTEM WITHIN THE FIRST 6 HOURS WITH INTRAVENOUS THROMBOLYTIC COMBINED WITH MECHANICAL THROMBECTOMY Major : Emergency and Clinical Toxicology Code number : 62720122 SUMMARY OF MEDICAL DOCTORAL THESIS HANOI - 2019 THE WORK HAS BEEN COMPLETED AT HANOI MEDICAL UNIVERSITY Academic Supervisor: 1. Assoc. Prof. PhD. NGUYEN VAN CHI 2. Assoc. Prof. PhD VU DANG LUU Opponent 1: Assoc. Prof. PhD. Mai Xuan Hien Opponent 2: Assoc. Prof. PhD. Le Thi Viet Hoa Opponent 3: Assoc. Prof. PhD. Nguyen Van Lieu The thesis has been defended at University-level Thesis Evaluation Council held in Hanoi Medical University At hour , date month year 2019. This thesis may be found at: - National Library - Library of Hanoi Medical University LIST OF ANNOUNCED RESEARCHS OF AUTHOR RELATED TO THE THESIS 1. Dao Viet Phuong, Nguyen Van Chi (2016), “Combine therapy of intravenous thrombolytic with mechanical arterial thrombectomy in acute ischemic stroke”. Vietnam Medicine Journal, 449 (02) 2/2016, p. 81-85. 2. Dao Viet Phuong, Nguyen Van Chi, Vu Dang Luu (2019), “Factors affecting treatment results for acute ischemic stroke due to proximal arterial occlusion”. Vietnam Medicine Journal, 476 (01&02) 3/2019, p. 156-160. 3. Dao Viet Phuong, Nguyen Van Chi, Vu Dang Luu (2019), “Combined therapy low-dose thrombolysis with mechanical thrombectomy in patient with acute ischemic stroke”. Vietnam Medicine Journal, 480 (01&02) 7/2019, p. 199-203. 1 INTRODUCTION Stroke due to proximal arterial occlusion of the anterior cerebral circulation system has a very high mortality and disability rate, possibly up to 60-80% in patients with simple internal carotid artery occlusion or in combination with the middle cerebral artery. Therefore, revascularization treatment in the acute phase is the most important treatment to reduce mortality and sequelae. Revascularization after acute ischemic stroke is associated with improved clinical outcomes as well as reduced mortality. A meta-analysis of 53 studies in more than 2000 patients showed a close association between the rate of cerebral revascularization and the improvement in clinical outcome after three months compared to the non-revascularization group (odds ratio OR 4.43, 95% confidence interval CI 3.32 - 5.91). Currently, most hospitals could perform treatment technique using intravenous thrombolytic agents for stroke patients with anterior cerebral circulation occlusion in the window 4.5 hours after the onset of symptoms, however the effect has not been significant in these patients, for example revascularization with carotid artery occlusion below 10%, occlusion of the middle cerebral artery in the middle of M1 is 30%, occlusion of M2 is 42% ... Therefore, it is necessary to have more treatment methods for cerebral revascularization even though the patients have been used with thrombolytic agents. Therefore, endovascular intervention to take away thrombosis is very important, for patients who have not yet been revascularized. Another problem is that in Western countries, using the standard dose of thrombolytic agents is combined with thrombectomy. In Vietnam, especially in Bach Mai hospital, using low dose of thrombolytic agents 0.6 mg/kg is becoming regular protocol, so how to access this combination? How is the effective of method? That are the questions need to be studied. On the other hand, 2 this combination treatment used to be performed only when treatment using intravenous thrombolytic agent failed, thus delaying the cerebral re-vascular process, so the combination intravenous thrombolytic agent with endovascular intervention will help to revascularize faster and more effectively. Therefore, we conducted the study Research on treatment of proximal arterial occlusion of the anterior cerebral circulation system within the first 6 hours with intravenous thrombolytic combined with mechanical thrombectomy in order to achieve the following two objectives: 1. Evaluate the results and some complications of treatment for acute ischemic stroke due to proximal arterial occlusion of the anterior cerebral circulation in the first 6 hours by intravenous thrombolytic combined with mechanical thrombectomy. 2. Comment on some factors affecting the effectiveness of treatment and the treatment protocol used in the study. Organization of the study: Thesis includes 155 pages with 3 introduction pages, 43 literature review pages, 26 pages of scope of study and study method, 32 result pages, 46 discussion pages, 3 conclusion pages and 1 proposal page, 1 limitation page. Reference: 167 documents. New contributions of the thesis: The thesis has shown good results both in clinical and medical image of the combination treatment of intravenous thrombolytic agent dose of 0.6 mg/kg with endovascular intervention in the first 6 hours in patients with acute ischemic stroke due to proximal arterial occlusion of the anterior cerebral vessels. The thesis also points out some complications, factors effecting outcome and aligns emergency procedure and treatment procedure by above combination methods. ...