Actualización en guías de manejo endovascular del evento cerebrovascular isquémico agudo

Dr. Álvaro Hernández Guillén, Dr. Francisco Huete Montealegre, Dr. Emmanuel Martínez Martínez, Dr. Pablo Odio Zúñiga, Dr. Miguel Ángel Barboza Elizondo

Resumen


Los eventos cerebrovasculares isquémicos son una entidad clínica frecuente y con un gran impacto en la salud e independencia de los pacientes. Un número importante de estos evolucionan con un pobre resultado funcional al presentar condiciones que les confiere un pobre pronóstico de revascularización mediante la trombólisis intravenosa. Ante esto, la trombectomía mecánica ha venido a ser una opción terapéutica sólida en este tipo de pacientes y aquellos que no resultan candidatos para la administración de alteplasa intravenosa. En los últimos años se ha generado nueva evidencia que respalda este abordaje y demuestra su beneficio en nuevos contextos clínicos para los cuales antes no se tenía ninguna posibilidad de terapia. Por esta razón, las asociaciones internacionales de stroke se han dado a la tarea de actualizar sus guías y recomendaciones con relación a este tema con base en la nueva información que se ha publicado recientemente. En este artículo se pretende establecer los puntos más importantes para definir y abordar un paciente que se considere puede resultar beneficiado de la realización de trombectomía mecánica endovascular.


Palabras clave


evento cerebrovascular isquémico agudo

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Referencias


Smith WS1, Sung G, Starkman S, et al. Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke. 2005; 36:1432–1438

Seners P, Turc G, Maïer B, et al. Incidence and Predictors of Early Recanalization After Intravenous Thrombolysis: A Systematic Review and Meta-Analysis. Stroke. 2016; 47: 2409-2412

Malhotra K, Gornbein J & Saver JL. Ischemic Strokes Due to Large-vessel Occlusions Contribute Disproportionately to Stroke-Related Dependence and Death: A Review. Front. Neurol. 2017. 8:651. doi: 10.3389/fneur.2017.00651

Clark W, Lutsep H, Barnwell S, et al. The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke. 2009; 40:2761–2768

Powers WJ, Rabinstein AA, Ackerson T, et al “2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke” Stroke. 2018;49: DOI: 10.1161/STR.0000000000000158

Turc G, Bhogal P, Fischer U, et al. European Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischaemic Stroke. European Stroke Journal 2019, Vol. 4(1) 6–12

Wintermark M1, Albers GW, Broderick JP, et al. Acute Stroke Imaging Research Roadmap II. Stroke. 2013 ;44(9):2628-39. DOI: 10.1161/STROKEAHA.113.002015

Warach SJ, Luby M, Albers GW, et al. Acute Stroke Imaging Research Roadmap III Imaging Selection and Outcomes in Acute Stroke Reperfusion Clinical Trials Consensus Recommendations and Further Research Priorities. Stroke. 2016; 47:1389-1398. DOI: 10.1161/STROKEAHA.115.012364

Seker F, Potreck A, Möhlenbruch M, et al. Comparison of four different collateral scores in acute ischemic stroke by CT angiography. J NeuroIntervent Surg .2015;0:1–4. DOI:10.1136/neurintsurg-2015-012101

Löwhagen Hendén P, Rentzos A, et al. General anesthesia versus conscious sedation for endovascular treatment of acute ischemic stroke: the AnStroke trial (Anesthesia During Stroke). Stroke. 2017; 48:1601–1607. DOI: 10.1161/STROKEAHA.117.016554

Goyal M, Demchuk AM, Menon BK, et al. Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke. N Engl J Med 2015; 372:1019-1030

Saver JL, Goyal M, Bonafe A, et al SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015; 372:2285–2295. DOI: 10.1056/NEJMoa1415061

Barlinn J, Gerber J, Barlinn K, et al. Acute endovascular treatment delivery to ischemic stroke patients transferred within a telestroke network: a retrospective observational study. Int J Stroke. 2017; 12:502–509. DOI: 10.1177/1747493016681018

Saver JL, Goyal M, van der Lugt A, et al HERMES Collaborators. “Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis”. JAMA. 2016; 316:1279–1288. DOI: 10.1001/jama.2016.13647

Aulicky P, Mikulík R, Goldemund D, et al. Safety of performing CT angiography in stroke patients treated with intravenous thrombolysis. J Neurol Neurosurg Psychiatry. 2010; 81:783–787. DOI: 10.1136/jnnp.2009.184002

Krol AL, Dzialowski I, Roy J, et al. Incidence of radiocontrast nephropathy in patients undergoing acute stroke computed tomography angiography. Stroke. 2007; 38:2364–2366. DOI: 10.1161/STROKEAHA.107.482778

Berkhemer OA, Fransen PS, Beumer D, et al MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015; 372:11–20. DOI: 10.1056/NEJMoa1411587

Bracard S, Ducrocq X, Mas JL et al. THRACE Investigators. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol. 2016; 15:1138–1147. DOI: 10.1016/S1474-4422(16)30177-6

Albers GW, Marks MP, Kemp S, et al. DEFUSE 3 Investigators. Thrombectomy for stroke with perfusion imaging selection at 6–16 hours. N Engl J Med. 2018; 378:708-18

Nogueira RG, Jadhav AP, Haussen DC, et al. TG DAWN Trial Investigators. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct [published online ahead of print November 11, 2017]. N Engl J Med. DOI: 10.1056/NEJMoa1706442

Vilela P & Rowley HA. Brain Ischemia: CT and MRI Techniques in Acute Ischemic Stroke. European Journal of Radiology. 2017: 96: 160-172. DOI: 10.1016/j.ejrad.2017.08.014

Jovin TG, Chamorro A, Cobo E, et al REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015; 372:2296–2306. DOI: 10.1056/NEJMoa1503780

Campbell BC, Mitchell PJ, Kleinig TJ, et al EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015; 372:1009–1018. DOI: 10.1056/NEJMoa1414792


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