Reyes S Pablo, Badilla O Lautaro, Andreu Daniel, Besa Valentina, Rivera Rodrigo, Sordo Gabriel, Bustamante Gonzalo, Pasten Juan A, Vargas Gabriel, Silva Paula, Guerrero Rodrigo, Feuerhake Walter
Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
Servicio de Neurología, Neurocirugía y Neurorradiología Intervencional, Clínica Santa María, Santiago, Chile.
Rev Med Chil. 2018 Jun;146(6):708-716. doi: 10.4067/s0034-98872018000600708.
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.
To report patients with ischemic stroke treated with endovascular 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.
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.
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.
最近，五项随机对照试验证实了血管内治疗联合或不联合静脉溶栓治疗急性大血管闭塞性缺血性卒中的有效性和安全性。
报告采用血管内方法治疗的缺血性卒中患者情况。
回顾性分析2009年至2017年间在单一医疗中心接受血管内治疗的104例年龄为61±15岁（54%为男性）的缺血性卒中患者。
61%的患者接受了静脉溶栓联合血管内治疗，39%的患者仅接受了血管内治疗。从入院到穿刺静脉的中位时间为61分钟，从入院到股动脉穿刺的中位时间为135分钟。入院时、24小时后及出院时美国国立卫生研究院卒中量表（NIHSS）评分的中位数分别为12分、4分和1分。60%的病例大脑中动脉闭塞。其他常见部位包括17%的颈内动脉远端和14%的椎基底动脉。术后脑梗死溶栓（TICI）量表血流分级为3级或2b级的病例占58%，且与24小时及出院时的NIHSS评分显著相关。50%的患者改良Rankin量表评分≤1分，10例患者死亡（9.6%）。8%的患者发生有症状性脑出血。
这些患者术后24小时及出院时的临床改善情况证明了血管内治疗缺血性卒中的有效性。急诊室有能够解读多模态影像的神经科医生、采用当地指南、有经验丰富的神经介入团队参与工作流程以及使用取栓支架与良好预后密切相关。
