Современные аспекты эндоваскулярной тромбэктомии острого ишемического инсульта. Критерии отбора на эндоваскулярную тромбэктомию. Прогнозирование исходов лечения

Эндоваскулярная тромбэктомия (ЭТ) эффективно и безопасно реканализирует окклюзированную артерию и восстанавливает зону ишемии у пациентов с острым ишемическим инсультом (ИИ), улучшая клинический прогноз инсульта в системе передней и задней циркуляции, расширяя временное терапевтическое окно от не более 6 до 24 часов, многократно увеличивая шансы на функциональную независимость и выживаемость. Однако у части пациентов развивается неблагоприятный послеоперационный исход, осложнения и «безрезультативность» реваскуляризации. Результат тромбэктомии зависит не только от критериев отбора пациентов, времени проведения и успеха процедуры, но и многих других факторов. Несмотря на достигнутые успехи в лечении инсульта актуальными остаются вопросы нейровизуализации и отбора пациентов на ЭТ, не до конца ясны патофизиологические механизмы влияния некоторых факторов на результативность процедуры, неясны причины «безрезультативной» реваскуляризации, неблагоприятного исхода и смертности после ЭТ. Анализ мирового опыта по лечению ИИ методом ЭТ показал разнородность используемых критериев отбора пациентов, клинических и нейровизуализационных переменных, факторов прогнозирования и исходов лечения, что затрудняет составление обобщающего вывода и требует дальнейших целенаправленных исследований. В статье рассмотрены вопросы отбора пациентов, патофизиологические механизмы влияния некоторых факторов риска на исход ИИ и причины неблагоприятного исхода и смерти после ЭТ.

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