Nakiri Guilherme S, Castro-Afonso Luis H, Monsignore Lucas M, Dias Francisco A, Alessio-Alves Frederico F, Fabio Soraia Ramos C, Camilo Millene R, Cougo-Pinto Pedro T, Leite João Pereira, Pontes-Neto Octavio M, Abud Daniel G
Interventional Radiology Division, Department of Internal Medicine, Hospital das Clínicas-Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
Interventional Radiology Division, Department of Internal Medicine, Hospital das Clínicas-Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
J Stroke Cerebrovasc Dis. 2017 Mar;26(3):532-537. doi: 10.1016/j.jstrokecerebrovasdis.2016.11.128. Epub 2017 Jan 5.
Brazil is a developing country struggling to reduce its extreme social inequality, which is reflected on shortage of health-care infrastructure, mainly to the low-income class, which depends exclusively on the public health system. In Brazil, less than 1% of stroke patients have access to intravenous thrombolysis in a stroke unit, and constraints to the development of mechanical thrombectomy in the public health system increase the social burden of stroke.
Report the feasibility of mechanical thrombectomy as part of routine stroke care in a Brazilian public university hospital.
Prospective data were collected from all patients treated for acute ischemic stroke with mechanical thrombectomy from June 2011 to March 2016. Combined thrombectomy was performed in eligible patients for intravenous thrombolysis if they presented occlusion of large artery. For those patients ineligible for intravenous thrombolysis, primary thrombectomy was performed as long as there was no evidence of significant ischemia for anterior circulation stroke (Alberta Stroke Program Early CT score >6) within a 6-hour time window, and also for those patients with wake-up stroke or posterior circulation stroke, regardless of the time of symptoms onset.
A total of 161 patients were evaluated, resulting in an overall successful recanalization rate of 76% and symptomatic intracranial hemorrhage rate of 6.8%. At 3 months, 36% of the patients had modified Rankin Scale score less than or equal to 2. The overall mortality rate was 23%.
Our study, the first ever large series of mechanical thrombectomy in Brazil, demonstrates acceptable efficacy and safety results, even under restricted conditions outside the ideal scenario of trial studies.
巴西是一个发展中国家，正在努力减少其极端的社会不平等现象，这反映在医疗保健基础设施短缺上，主要是针对完全依赖公共卫生系统的低收入阶层。在巴西，不到1%的中风患者能够在中风单元接受静脉溶栓治疗，公共卫生系统中机械取栓术发展的限制增加了中风的社会负担。
报告在巴西一所公立大学医院将机械取栓术作为常规中风治疗一部分的可行性。
收集2011年6月至2016年3月期间所有接受急性缺血性中风机械取栓术治疗患者的前瞻性数据。对于符合静脉溶栓条件且出现大动脉闭塞的患者，进行联合取栓术。对于那些不符合静脉溶栓条件的患者，只要在6小时时间窗内没有证据表明前循环中风存在明显缺血（阿尔伯塔中风项目早期CT评分>6），对于那些醒后中风或后循环中风患者，无论症状发作时间如何，均进行初次取栓术。
共评估了161例患者，总体再通成功率为76%，有症状颅内出血率为6.8%。在3个月时，36%的患者改良Rankin量表评分为小于或等于2。总死亡率为23%。
我们的研究是巴西首个关于机械取栓术的大型系列研究，即使在试验研究理想场景之外的受限条件下，也显示出了可接受的疗效和安全性结果。
