Účinnost a bezpečnost urgentní mikrochirurgické embolektomie při selhání intravenózní trombolýzy a mechanické trombektomie u pacientů s akutním ischemickým iktem – protokol systematického review

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Authors: M. Klugar ¹; J. Fiedler ^2,3; R. Líčeník ¹; S. Ostrý ^4,5
Authors‘ workplace: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute, of Biostatistics and Analyses, Faculty, of Medicine, Masaryk University, Brno, Czech Republic ; The Czech National Centre for, Evidence-Based Healthcare and, Knowledge Translation (Cochrane, Czech Republic, Czech Republic, CEBHC ¹; Department of Neurosurgery, České, Budějovice Hospital, Czech Republic ²; Department of Neurosurgery, Faculty, of Medicine in Plzeň, Charles University in Prague, Czech Republic ³; Department of Neurology, České, Budějovice Hospital, Czech Republic ⁴; Department of Neurosurgery and, Neurooncology, First Faculty of Medicine, Charles University in Prague and, Military University Hospital Prague, Czech Republic ⁵
Published in: Cesk Slov Neurol N 2020; 83/116(4): 416-420
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2020416

Overview

Úvod: Intravenózní trombolýza (IVT) podaná v okně 4,5 h od počátku příznaků je léčbou první volby akutní ischemické CMP (iCMP). V případě akutního uzávěru velké mozkové cévy vede IVT k časné kanalizaci střední mozkové tepny (a. cerebri media; ACM) pouze ve 13–33 % případů. Endovaskulární mechanická trombektomie (MT) během 6 h od počátku symptomů signifikantně zvyšuje úspěšnost rekanalizace a zlepšuje výsledný klinický stav pacientů. V indikovaných případech a pokud nejsou kontraindikace, MT následuje IVT. Tato kombinovaná terapie jako léčba druhé volby je nejlepší dostupná léčba akutní iCMP s uzávěrem ACM. Mikrochirurgická embolektomie (ME) je diskutovanou léčbou třetí volby u pacientů s akutní iCMP a okluzí ACM po selhání MT. Cílem tohoto review je zhodnocení účinnosti a bezpečnosti ME u pacientů s akutní iCMP při okluzi ACM a selhání IVT a MT v časovém okně 8, 16 a 24 h od začátku symptomů.

Metodika: Iniciální vyhledávání bude provedeno v databázích MEDLINE a EMBASE. Komprehenzivní systematické vyhledávání bude zahrnovat relevantní databáze jak pro publikované zdroje (MEDLINE, EMBASE, BMC, Cinahl, Scopus, a WoS), tak nepublikované zdroje literatury (Open Grey, MedNar, Cos Conference Papers Index a ProQuest). Na základě metodologie Joanna Briggs Institute, dva autoři systematického review nezávisle na sobě nejprve zanalyzují názvy, souhrny a texty identifikovaných literárních zdrojů a posléze kriticky zhodnotí metodologickou kvalitu relevantních studií a provedou extrakci dat pomocí standardizovaných nástrojů. Extrahovaná data budou syntetizována narativně, vč. specifikace typu intervence, charakteristiky cílové skupiny a typu výstupů. K detekci publikačního zkreslení bude použito funnel plot (trychtýřového grafu).

Klíčová slova:

ischemie mozku – embolektomie – trombektomie – mikrochrurgie – střední mozková tepna – tkáňový aktivátor plazminogenu

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