r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2024-29-3-41-48r-n-j-576Research ArticleИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL RESEARCHES AND CASE REPORTSТромболитическая терапия ишемического инсульта, вызванного окклюзией проксимального сегмента средней мозговой артерииThrombolytic therapy of cerebral infarction caused by an occlusion in the proximal segment of the middle cerebral arteryhttps://orcid.org/0000-0003-3942-7442СехвейлСалах М.М.SehweilS. M.M.

Салах М.М. Сехвейл

Ростов-на-Дону

Rostov-on-Don

salahsehweil@yandex.ruhttps://orcid.org/0000-0001-7093-9548ГончароваЗ. А.GoncharovaZ. A.

Ростов-на-Дону

Rostov-on-Don

centrms@mail.ruРостовский государственный медицинский университетРоссияRostov State Medical UniversityRussian Federation2024240720242934148Copyright © Сехвейл С.М., Гончарова З.А., 20242024Сехвейл С.М., Гончарова З.А.Sehweil S.M., Goncharova Z.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/576   Введение

   Введение. Системный тромболизис является общепризнанным высокоэффективным способом лечения ишемического инсульта. Злокачественный ишемический инсульт (ЗИИ), характеризующийся поражением 50 % и более бассейна кровоснабжения средней мозговой артерии, является противопоказанием к выполнению системной тромболитической терапии. В то же время при поступлении в стационар в период терапевтического окна, до идентификации очага инфаркта в бассейне кровоснабжения средней мозговой артерии (СМА), часть пациентов со ЗИИ являются кандидатами для выполнения системного тромболизиса.

   Цель исследования

   Цель исследования: определить эффективность внутривенной тромболитической терапии у пациентов с окклюзией проксимального сегмента средней мозговой артерии.

   Материал и методы

   Материал и методы. В исследование включены 75 пациентов со ЗИИ, 9 из них была выполнена внутривенная тромболитическая терапия (ТЛТ), одному — в сочетании с эндоваскулярной механической тромбоэкстракцией. Один пациент после неэффективной внутривенной ТЛТ был прооперирован (выполнена декомпрессивная гемикраниэктомия).

   Результаты

   Результаты. Выполнение внутривенной ТЛТ и/или эндоваскулярной механической тромбэкстрации у пациентов с окклюзией М1 сегмента СМА не предотвращало закономерного развития обширного ишемического поражения и отека полушария головного мозга у пациентов с окклюзией проксимального сегмента СМА. У 20 % пациентов имело место развитие внутримозгового кровоизлияния. Летальный исход после выполнения ТЛТ имел место у 30 % пациентов, его причиной явились нарастающий отек полушария головного мозга и развитие дислокационного синдрома.

   Заключение

   Заключение. Выполнение внутривенной ТЛТ и/или эндоваскулярной механической тромбэкстрации у пациентов с окклюзией проксимального сегмента СМА не предотвращает закономерное развитие обширного ишемического поражения полушария головного мозга.

   Introduction

   Introduction. Systemic thrombolysis is a generally recognized highly eff ective treatment for ischemic stroke. Malignant cerebral infarction (MCI) in the territory supplied by the middle cerebral artery is characterized by a lesion affecting 50 % or more of the vascular territory therefore acting as a contraindication to systemic thrombolytic therapy. At the same time, when admitted to the hospital during the therapeutic time window, some patients with MCI remain candidates for systemic thrombolysis until an infarcted focus is identifi ed in the area supplied by the middle cerebral artery (MCA).

   Purpose of the study

   Purpose of the study: to assess the eff ectiveness of intravenous thrombolytic therapy in patients with occlusion at the proximal segment of the middle cerebral artery.

   Material and methods

   Material and methods: the study was conducted among 75 MCI patients, 9 of them received intravenous thrombolytic therapy (IVTT), in one case it was combined with endovascular mechanical thrombectomy. One patient underwent surgery (decompressive hemicraniectomy) after ineff ective intravenous IVTT. Results: intravenous thrombolytic therapy and/or endovascular mechanical thrombectomy performed for patients with occlusion of the M1 segment of the MCA did not prevent the natural development of extensive ischemic damage and edema of the cerebral hemisphere in patients with occlusion of the proximal MCA segment. In 20 % of the patients, intracerebral hemorrhage developed. A fatal outcome following IVTT occurred in 30 % of patients; it was caused by increasing swelling of the cerebral hemisphere and the development of dislocation syndrome.

   Conclusion

   Conclusion: intravenous thrombolytic therapy and/or endovascular mechanical thrombectomy performed in patients with occlusion at the proximal segment of the MCA does not prevent the natural development of extensive ischemic damage in the cerebral hemisphere (MCI).

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The authors declare that there are no conflicts of interest present.