Tesis

Trombektomi Mekanik pada Penatalaksanaan Stroke Iskemik Akut Oklusi Pembuluh Darah Besar di RSUPN Dr. Cipto Mangunkusumo = Mechanical Thrombectomy in Large Vessel Occlusion Management at Dr. Cipto Mangunkusumo.

Latar Belakang: Indonesia sebagai negara berkembang mengalami tantangan dalam aplikasi trombektomi mekanik (TM) seperti tenaga ahli neurointervensi, biaya, dan waktu. Efektivitas TM dibandingkan terapi konservatif dalam memperbaiki luaran fungsional pada stroke iskemik akut di negara berkembang belum ada. Metode Penelitian: Studi kohort retrospektif ini menggunakan data rekam medik di RSUPN Dr. Cipto Mangunkusumo dari Januari 2017 hingga Desember 2021. Stroke iskemik sirkulasi anterior dibuktikan dari gabungan klinis dan pencitraan. Kelompok TM dengan/tanpa trombolisis intravena (TIV) dibandingkan dengan konservatif (TIV saja/ medikamentosa). Luaran utama adalah kemandirian fungsional berdasarkan modified Rankin Scale (mRS) bulan ketiga. Hasil: Dari 111 subjek, terpilih 32 subjek pada TM dan 50 subjek pada konservatif dianalisis lebih lanjut. Kelompok TM memiliki rerata usia lebih muda (p=0,004), proporsi hipertensi lebih rendah (p < 0,001), intubasi lebih tinggi (p=0,014), dan awitan lebih dini (p=0,023). Trombektomi mekanik tunggal lebih dipilih pada waktu awitan lebih panjang dibandingkan terapi kombinasi (180 vs. 120 menit; p=0,411), tetapi tidak ada perbedaan median door to recanalization (395 vs. 370 menit; p=0,153). Proporsi mRS 0-2 bulan ketiga pada kelompok TM lebih tinggi dibandingkan konservatif (28,1% vs. 18,0%; p=0,280). Pada analisis multivariat, ASPECTS (aOR 2,43; IK95% 1,26-4,70; p=0,008) menentukan kemandirian fungsional pada TM. Kesimpulan: Proporsi mRS 0-2 bulan ketiga pada kelompok TM lebih tinggi dibandingkan dengan terapi konservatif pada pasien stroke iskemik akut oklusi pembuluh darah besar di RSUPN Dr. Cipto Mangunkusumo walaupun tidak berbeda secara statistik.
Kata kunci: trombektomi mekanik, terapi endovaskular, stroke iskemik, Indonesia, negara berkembang


Background: Indonesia as a developing nation faces challenges in mechanical thrombectomy (MT) application, including neurointerventionist availability, cost, and time. Mechanical thrombectomy efficacy in improving functional outcome in the setting developing countries has not yet been published. Methods: This was a retrospective cohort reviewing medical records at Dr. Cipto Mangunkusumo Hospital from January 2017 to December 2021. Anterior circulation ischemic stroke diagnosis was based on combination of clinical and imaging characteristics. Mechanical thrombectomy group (with/without intravenous thrombolysis, IVT) was compared to conservative group (IVT only/ best medical treatment). Primary outcome was functional independence on 90 days based on modified Rankin Scale (mRS). Results: From 111 subjects, 32 subjects in MT group and 50 subjects in conservative group were included in analysis. Younger age (p=0.004), lower hypertension (p < 0.001), higher intrubation (p=0.014), and earlier onset were observed in MT group. In intervention group, MT only was chosen in the setting of later onset (180 vs. 120 mins; p=0.411), but there was no difference in door to recanalization time with bridging group (395 vs. 370 mins; p=0.153). Proportion of mRS 0-2 at 90 days in MT group was higher than conservative group (28.1% vs. 18.0%; p=0.280). In multivariate analysis, ASPECTS (aOR 2.43; 95%CI 1.26-4.70; p=0.008) was a good predictor of functional independence in MT group. . Conclusion: Mechanical thrombectomy group had higher proportion of mRS 0-2 at 90 days than conservative group at Dr. Cipto Mangunkusumo Hospital despite statistics indifference.
Keywords: mechanical thrombectomy, endovascular treatment, ischemic stroke, Indonesia, developing countries