Traitement endovasculaire de l'accident vasculaire cérébral

Ischemic stroke (IS) is an acute pathology that requires an urgent treatment and a complex organization for the health care systems. IS is the second mortality reason around the world and the third one in industrialized countries based on World Health Organization database. IV thrombolysis started in 1996 as a treatment for IS with the administration of reteplase or Rt-PA up to 4h30 after symptoms beginning with 30 to 40% of efficacy. Mechanical thrombectomy (MT) allows to expand therapeutic window further than IV thrombolysis and higher efficacy. Therapeutic decision is multidisciplinary with senior doctors and appropriate materials: stroke unity composed by interventional neuroradiologists, angio-room, department of Neurosurgery, Intensive Care and imaging equipments to perform neuroradiological examens. MT is considered the gold standard treatment for IS if Aspect Score is > to 5 and symptoms started not more 6 hours before endovascular treatment. Randomized studies showed the superiority of MT + IV thrombolysis over IV thrombolysis only. Endovascular treatment by MT requires financial support from health care systems, but the price is justified by the lower number of disabled patients because morbidity, functional impacts and quality of life at 90 days

Ischemies aigue on traumatiques des membres

Twenty four patients (18 males; 6 females; Mean age 50 years) with acute non traumatic limb ischemia were operated on in our institution. The ischemia has been observed after 24 hours in 15 patients (62;5versus 7 patients (37;5) within 24 hours. The arterial femoral was often (54;1) the site of occlusion. Embolism (29;2) and thrombosis (54;2were the cause of acute limb ischemia. All patients were treated by embolectomy or thrombectomy. The overall mortality was 29;2with a limb salvage rate of 45;8and secondary amputation rate of 29;2. According to our experience; the diagnosis of acute non traumatic limb ischemia is not instituted early and the rate of hospital mortality and morbidity remain high