Experiencia en el tratamiento endovascular del accidente cerebrovascular isquémico agudo en un centro chileno
| Autor: | Walter Feuerhake, Daniel Andreu, Juan A. Pasten, Lautaro Badilla O., Paula Silva, Rodrigo Guerrero, Pablo Reyes S., Gabriel Andrés Rodríguez Vargas, Gabriel Sordo, Gonzalo Bustamante, Rodrigo Rivera, Valentina Besa |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment 030218 nuclear medicine & medical imaging law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law medicine.artery Occlusion medicine Thrombolytic Therapy cardiovascular diseases Intracerebral hemorrhage business.industry Cerebral infarction Stroke scale General Medicine Thrombolysis medicine.disease Surgery Stroke medicine.anatomical_structure Reperfusion Middle cerebral artery business 030217 neurology & neurosurgery Artery |
| Zdroj: | Revista médica de Chile v.146 n.6 2018 SciELO Chile CONICYT Chile instacron:CONICYT |
| ISSN: | 0034-9887 |
| DOI: | 10.4067/s0034-98872018000600708 |
| Popis: | Background: Recently, five randomized controlled trials confirmed the efficacy and safety of endovascular treatment with or without intravenous thrombolysis in acute ischemic stroke with large-vessel occlusion. Aim: To report patients with ischemic stroke treated with endovascular methods. Material and Methods: Retrospective analysis of 104 patients aged 61 ± 15 years (54% males) with ischemic stroke who received endovascular treatment at a single medical center between 2009 and 2017. Results: Sixty one percent were treated with intravenous thrombolysis plus endovascular procedures and 39% with endovascular procedures alone. The median door-to needle time was 61 minutes and door-to femoral puncture was 135 minutes. The median National Institute of Health Stroke Scale (NIHSS) scores on admission, 24 hours later and at discharge were 12,4 and 1 points, respectively. Middle cerebral artery was occluded in 60% of cases. Other frequent localizations where distal carotid artery in 17% and vertebro-basilar artery in 14%. Thrombolysis in cerebral infarction (TICI) scale flow score after the procedure was 3 or 2b in 58% of cases and significantly correlated with NIHSS scores at 24 hours and discharge. Fifty percent of patients had a mRankin score < = 1 and ten patients died (9.6%). Eight percent had a symptomatic intracerebral hemorrhage. Conclusions: The clinical improvement of these patients 24 hours after the procedure and at discharge demonstrate the effectiveness of endovascular treatment in ischemic stroke. The presence neurologists able to interpret multimodal images at the emergency room, the use of local guidelines, the availability of an experienced neuro-interventional team engaged with the workflow and the use of stent retrievers are strongly associated with good outcomes. |
| Databáze: | OpenAIRE |
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