ผลลัพธ์ทางคลินิกของการสวนหลอดเลือดสมองเพื่อดูดลากลิ่มเลือดในผู้ป่วยโรคหลอดเลือด สมองขาดเลือดเฉียบพลัน: โรงพยาบาลเชียงรายประชานุเคราะห์

Abstract

ABSTRACT

Background:

Mechanical thrombectomy has become the standard of care for patients with acute ischemic stroke due to large vessel occlusion. However, real-world outcomes may vary across healthcare systems, particularly in developing regions. This study represents the first report of such outcomes from Chiangrai Prachanukroh Hospital and Chiang Rai Province.

Methods:

This retrospective cohort study included consecutive patients with acute ischemic stroke who underwent mechanical thrombectomy at Chiangrai Prachanukroh Hospital between October 2022 and October 2024. The study aimed to evaluate 90-day functional outcomes using the modified Rankin Scale (mRS) and to identify factors associated with these outcomes. Univariate and multivariable logistic regression analyses were performed to determine independent predictors of outcomes.

Results:

A total of 135 patients were included, of whom 85 (63.0%) achieved functional independence at 90 days. Successful recanalization was achieved in 90.4% of cases, and symptomatic intracranial hemorrhage occurred in 7.4%. Patients with good outcomes were younger, had lower baseline glucose levels, and higher ASPECTS scores than those with poor outcomes. In multivariable analysis, ASPECTS ≥7 (adjusted odds ratio [aOR] 10.28, 95% confidence interval [CI] 3.17–33.34, p < 0.001) and successful recanalization (aOR 8.91, 95% CI 1.93–41.08, p = 0.005) were independently associated with favorable outcomes, whereas baseline glucose ≥155 mg/dL (aOR 0.31, 95% CI 0.12–0.83, p = 0.019) and symptomatic intracerebral hemorrhage (aOR 0.08; 95% CI 0.01–0.60; p = 0.015) were associated with poorer outcomes. A shorter onset-to-groin puncture time showed a trend toward improved functional outcomes but did not reach statistical significance.

Conclusions:

In this single-center retrospective cohort study, mechanical thrombectomy was associated with high rates of successful recanalization and favorable functional outcomes. Baseline imaging characteristics, procedural success, metabolic status, and the absence of symptomatic intracerebral hemorrhage were identified as independent predictors of outcome. These findings support the effectiveness of thrombectomy in regional healthcare settings and highlight key targets for optimizing stroke care pathways and improving clinical outcomes.