Журнал «Медицина неотложных состояний» Том 21, №1, 2025

Механічна тромбектомія (МТ) визнана одним з найефективніших методів лікування гострого ішемічного інсульту, оскільки вона забезпечує швидке відновлення кровопостачання в уражених ділянках мозку. Своєчасне проведення цієї процедури є критично важливим для зменшення неврологічних дефіцитів і поліпшення прогнозу для пацієнтів. В умовах, коли швидкість і точність втручання можуть визначати успішність лікування, роль анестезіолога стає незамінною. Анестезіологічна підтримка під час МТ забезпечує не лише контроль за станом пацієнта, а й активну участь у процесі управління ризиками, які виникають під час і після процедури. Дотримання сучасних анестезіологічних протоколів не тільки підвищує ймовірність успішного результату, але й дозволяє адаптувати лікування до специфічних потреб пацієнтів, особливо тих, хто має менш сприятливі клінічні показники. З огляду на це важливо не лише досліджувати оптимальні підходи до анестезії, але й вивчати фізіологічні фактори, які можуть впливати на анестезіологічний супровід. Також необхідно розробляти ефективні стратегії для управління післяопераційним болем. Підвищення обізнаності про ці аспекти сприятиме покращенню клінічних результатів, зменшенню ризику ускладнень і загальному поліпшенню якості життя пацієнтів після проведення тромбектомії.

Mechanical thrombectomy is acknowledged as one of the most effective treatments for acute ischemic stroke, as it facilitates the rapid restoration of blood flow to the affected brain regions. Timely execution of this procedure is critical for reducing neurological deficits and improving patient prognosis. In situations where the speed and precision of intervention can determine treatment success, the role of the anesthesiologist becomes indispensable. Anesthesiological support during mechanical thrombectomy not only ensures patient monitoring but also involves active participation in risk management throughout and after the procedure. Adherence to modern anesthesiological protocols not only increases the likelihood of successful outcomes but also allows for the adaptation of treatment to the specific needs of patients, particularly those with less favorable clinical indicators. In this context, it is essential not only to explore optimal anesthesia approaches but also to investigate the physiological factors influencing anesthesiological support. Furthermore, developing effective strategies for postoperative pain management is necessary. Raising awareness about these aspects will contribute to improving clinical outcomes, reducing the risk of complications, and enhancing the overall quality of life for patients following thrombectomy.

механічна тромбектомія; гострий ішемічний інсульт; анестезіологічний супровід; перед-операційна підготовка; оцінка ризиків; післяопераційний біль

mechanical thrombectomy; acute ischemic stroke; ­anesthetic support; preoperative preparation; risk assessment; postoperative pain

1. Salaudeen MA, Bello N, Danraka RN, Ammani ML. Understanding the Pathophysiology of Ischemic Stroke: The Basis of Current Therapies and Opportunity for New Ones. Biomolecules. 2024;14(3):305.
2. Barreto AD. Intravenous thrombolytics for ischemic stroke. Neurotherapeutics. 2011;8:388-399.
3. Tsivgoulis G, Kargiotis O, Alexandrov AV. Intravenous thrombolysis for acute ischemic stroke: a bridge between two centuries. Expert Rev Neurother. 2017;17:819-837.
4. Fugate JE, Rabinstein AA. Absolute and Relative Contraindications to IV rt-PA for Acute Ischemic Stroke. Neurohospitalist. 2015;5(3):110-121.
5. Padma S, Majaz M. Intra-arterial versus intra-venous thrombolysis within and after the first 3 hours of stroke onset. Arch Med Sci. 2010;6(3):303-315.
6. Tsivgoulis G, Katsanos AH, Sandset EC, Turc G, Nguyen TN, Bivard A, Fischer U, Khatri P. Thrombolysis for acute ischaemic stroke: Current status and future perspectives. Lancet Neurol. 2023;22:418-429.
7. Macdonald IR, Linehan V, Sneek B, Volders D. Standardized approach to direct first pass aspiration technique for endovascular thrombectomy: Description and initial experience with CANADAPT. Interventional Neuroradiology. 2024;8:15910199241230360.
8. Romano DG, Cioni S, Leonini S, et al. Manual thromboaspiration technique as a first approach for endovascular stroke treatment: A single-center experience. Interventional Neuroradiology. 2016;22(5):529-534.
9. Щеглов Д.В., Конотопчик С.В., Пастушин О.А. Клінічний протокол лікування хворих на ішемічний інсульт. Українська інтервенційна нейрорадіологія та хірургія. 2021;3(37):14-56.
10. Chabanovych N, Mamonova M, Konotopchyk S, et al. Analysis of the experience of anesthetic management during endovascular mechanical thrombectomy in ischemic cerebral stroke. Ukr. Intervent. Neuroradiol. Surg. 2020;34(4):70-81.
11. Коломійченко С.О., Мамонова М.Ю., Конотопчик С.В. Анестезіологічне забезпечення механічної тромбектомії: огляд сучасних тенденцій та підходів. Українська інтервенційна ней-рорадіологія та хірургія. 2024;1(47):46-59.
12. Mokin M, Pendurthi A, Ljubimov V, et al. Aspects, large vessel occlusion, and time of symptom onset: Estimation of eligibility for endovascular therapy. Neurosurgery. 2018;83:122-127.
13. Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870-947.
14. Albers GW, Marks MP, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708-718.
15. Ren Z, Mokin M, Bauer CT, Miao Z, Burgin WS, Wang Y. Indications for mechanical thrombectomy: Too wide or too narrow? World Neurosurgery 2019;127:492-499.
16. Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J. Measurements of acute cerebral infarction: A clinical examination scale. Stroke. 1989;20(7):864-870.
17. Pexman JH, Barber PA, Hill MD, Sevick RJ, Demchuk AM, Hudon ME. Use of the Alberta stroke program early CT score (ASPECTS) for assessing CT scans in patients with acute stroke. Am J Neuroradiology. 2001;22(8):1534-1542.
18. Lapointe-Shaw L, Fang J, Saposnik G, Austin PC. Risk prediction scores for stroke patients and outcome improvement after mechanical thrombectomy: A systematic review and meta-analysis. Journal of Neurology, Neurosurgery & Psychiatry. 2020;91(12):1349:1360.
19. Vagal A, Wintermark M, Nael K, Bivard A, Parsons M, Grossman AW, Khatri P. Automated CT perfusion imaging for acute ischemic stroke. Neurology. 2019;93(20):888-898.
20. Copen WA, Schaefer PW, Wu O. MR perfusion imaging in acute ischemic stroke. Neuroimaging Clinics of North America. 2011;21(2):259-283.
21. Cao C, Martinelli A, Spoelhof B, Llinas RH, Marsh EB. In potential stroke patients on warfarin, the international normalized ratio predicts ischemia. Cerebrovascular Diseases Extra. 2017;7(2):111-119.
22. Suárez V, et al. Chronic hyponatremia and brain structure and function before and after treatment. American Journal of Kidney Diseases. 2024;84(1):38-48.e1.
23. Castro D, Sharma S. Hypokalemia. In StatPearls [Internet]. StatPearls Publishing. 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482465/.
24. Sadiq NM, Anastasopoulou C, Patel G. Hypercalcemia. In StatPearls [Internet]. StatPearls Publishing. 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430714/.
25. Pelouto A, Reimer J, Hoorn EJ, Zandbergen AA, Hertog HM. Hyponatremia is associated with unfavorable outcomes after reperfusion treatment in acute ischemic stroke. European Journal of Neuro–logy. 2023;3:e16156.
26. Jorairahmadi S, Javaherforooshzadeh F, Jannatmakan F, Soltani F, Shidel Zadeh L. Evaluation of the relationship between changes in potassium concentration and arrhythmia during coronary artery bypass grafting surgery. Anesthesiology and Pain Medicine. 2022;12(1):e121809.
27. Fandler-Höfler S, Odler B, Kneihsl M, Wünsch G, Haidegger M, Poltrum B, Beitzke M, Deutschmann H, Enzinger C, Rosenkranz AR, Gattringer T. Acute and chronic kidney dysfunction and outcome after stroke thrombectomy. Translational Stroke Research. 2021;12(5):791-798.
28. Vaja R, Rana M. Drugs and the liver. Anaesthesia and Intensive Care Medicine. 2020;21(10):517-523. https://doi.org/10.1016/j.mpaic.2020.07.001.
29. Amitrano L, Guardascione MA, Brancaccio V, Balzano A. Coagulation disorders in liver disease. Seminars in Liver Disease. 2002;22(1):83-96.
30. Kes VB, Solter VV, Supanc V, Demarin V. Impact of hyperglycemia on ischemic stroke mortality in diabetic and non-diabetic patients. Annals of Saudi Medicine. 2007;27(5):352-355.
31. Li Y, Liu Y, Liu S, et al. Diabetic vascular diseases: Molecular mechanisms and therapeutic strategies. Signal Transduction and Targeted Therapy. 2023;8:152.
32. Laredo C, Renú A, Llull L, Tudela R, López-Rueda A, Urra X, Chamorro Á. Elevated glucose is associated with hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke patients with severe pretreatment hypoperfusion. Sci. Reports. 2020;10(1):10588.
33. Johnston KC, Hall CE, Kissela BM., Bleck TP, Conaway MR; GRASP Investigators. Glucose regulation in acute stroke patients (GRASP) trial: A randomized pilot trial. Stroke. 2009;40(12):3804-3809.
34. Rodriguez-Hernandez A, Babici D, Campbell M, Carranza-Reneteria O, Hammond T. Hypoglycemic hemineglect: A stroke mimic. eNeurologicalSci. 2023;30:100444. https://doi.org/10.1016/j.ensci.2023.100444.
35. Hong JM, Kim DS, Kim M. Hemorrhagic transformation after ischemic stroke: Mechanisms and management. Frontiers in Neurology. 2021;12:703258.
36. Gowda R, Jaffa M, Badjatia N. Thermoregulation in brain injury. In A.I. Ropper, W.R. Freeman (Eds.). Handbook of Clinical Neurology. 2018;157:789-797.
37. Goldberger JJ, Arora R, Buckley U, Shivkumar K. Autonomic nervous system dysfunction: JACC focus seminar. Journal of the American College of Cardiology. 2019;73(10):1189-1206.
38. Garmon EH, Huecker MR. Topical, local, and regional anesthesia and anesthetics. In StatPearls [Internet]. StatPearls Publishing. 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430894/.
39. Fuller BM, Dellinger RP. Lactate as a hemodynamic marker in the critically ill. Current Opinion in Critical Care. 2012;18(3):267-272.
40. Park MAJ, Cave G, Freebairn RC. Metabolic acidosis in anaesthesia and critical care. BJA Education. 2024;24(3):91-99.
41. Chen R, Ovbiagele B, Feng W. Diabetes and stroke: Epidemiology, pathophysiology, pharmaceuticals, and outcomes. The American Journal of the Medical Sciences. 2016;351(4):380-386.
42. Fountouki A, Tegos T, Ztriva E, Kaiafa G, Didangelos T, Theofanidis D, et al. Hyperglycemic patterns in acute stroke patients. Cureus. 2024;16(6):e62039.
43. Fan Y, Wang S, Lv Y, Shi G, Lu Y, Chen L. THRIVE, –ASTRAL, and iScore scales for predicting prognosis of mechanical thrombectomy in patients with acute ischemic stroke. Irish Journal of Medical Science. 2024;5:2509-2514.
44. Levy JH, Key NS, Azran MS. Novel oral anticoagulants: Implications in the perioperative setting. Anesthesiology. 2010;113(3);726-745.
45. Anastasian ZH. Anaesthetic management of the patient with acute ischemic stroke. British Journal of Anaesthesia. 2024;113:ii9-ii16.
46. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
47. Gallo D, Manrique L, Polanco M, González-Mandly A, Torres E, Palacio E, et al. De novo headache in ischemic stroke patients treated with thrombectomy: A prospective study. Journal of Headache and Pain. 2022;23(1):85.
48. Wu CL, Raja SN. Treatment of acute postoperative pain. The Lancet. 2011;377:2215-2225.
49. Macrae WA. Chronic post-surgical pain: 10 years on. British Journal of Anaesthesia. 2008;101:77-86.
50. Gilron I, Orr E, Tu D, O’Neill JP, Zamora JE, Bell AC. A placebo-controlled randomized clinical trial of perioperative administration of gabapentin, rofecoxib, and their combination for spontaneous and movement-evoked pain after abdominal hysterectomy. Pain. 2005;113:191-200.
51. Souter AJ, Fredman B, White PF. Controversies in the perioperative use of nonsteroidal antiinflammatory drugs. Anesthesia & Analgesia. 1994;79:1178-1190.
52. Li L, Sluter MN, Yu Y, Jiang J. Prostaglandin E receptors as targets for ischemic stroke: Novel evidence and molecular mechanisms of efficacy. Pharmacological Research. 2021;163:105238.
53. Khalili G, et al. Effect of preemptive and preventive acetaminophen on postoperative pain score: A randomized, double-blind trial of patients undergoing lower extremity surgery. Journal of Clinical Anesthesia. 2013;25:188-192.
54. Alchina J, Dharb A, Siddiqui K, Christoc PJ. Why paracetamol (acetaminophen) is a suitable first choice for treating mild to moderate acute pain in adults with liver, kidney or cardiovascular disease, gastrointestinal disorders, asthma, or who are older. Current Medical Research and Opinion. 2022;38(5):811-825.
55. Chang CY, Challa CK, Shah J, Jean DE. Gabapentin in acute postoperative pain management. BioMed Research International. 2014. Article ID: 631756.
56. Sinatra RS, de Leon-Casasola OA, Viscusi ER. Acute pain management. Cambridge University Press. 2009:679.
57. Sherman M, Sethi S, Hindle A, Chanza T. Multimodal pain management in the perioperative setting. Open Journal of Anesthesio–logy. 2020;10:47-71.
58. Ellison N. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. Anesthesia & Analgesia. 2002;94:1377.
59. Macintyre PE. Safety and efficacy of patient-controlled analgesia. British Journal of Anaesthesia. 2001;87:36-46.