Reperfusion therapy for acute ischemic stroke: where are we in 2023? / Terapia de reperfusão para o acidente vascular isquêmico agudo: onde estamos em 2023?

Abstract Over the last three decades, stroke care has undergone significant transformations mainly driven by the introduction of reperfusion therapy and the organization of systems of care. Patients receiving treatment through a well-structured stroke service have a much higher chance of favorable outcomes, thereby decreasing both disability and mortality. In this article, we reviewed the scientific evidence for stroke reperfusion therapy, including thrombolysis and thrombectomy, and its implementation in the public health system in Brazil.

Resumo Nas últimas três décadas, o tratamento do AVC sofreu transformações significativas, impulsionadas principalmente pela introdução das terapias de reperfusão e pela organização dos serviços de AVC. Os pacientes que recebem tratamento em um serviço de AVC bem estruturado têm uma probabilidade muito maior de resultados favoráveis, diminuindo assim a incapacidade funcional e a mortalidade. Neste artigo, revisamos as evidências científicas para as terapias de reperfusão do AVC, incluindo trombólise e trombectomia e sua implementação no sistema público de saúde no Brasil.

Cochlear radiation dose and hearing loss in patients with vestibular schwannoma undergoing radiosurgery: systematic review

Abstract Objectives: To determine the cut-off point of the cochlear radiation dose as a risk factor for hearing loss in patients with vestibular schwannoma treated with radiosurgery. Methods: A systematic review of the literature was performed without language or publication year restrictions in the MEDLINE/PubMed, EMBASE, Web of Science, LILACS/VHL and Cochrane Library databases. Studies that met the following criteria were included: 1) population: adults of both sexes who underwent radiosurgery for vestibular schwannoma treatment; 2) exposure: cochlear radiation; 3) outcome: hearing loss; 4) type of study: cohort. Two independent reviewers conducted the entire review process. The registration number in PROSPERO was CRD42020206128. Results: From the 333 articles identified in the searches, seven were included after applying the eligibility criteria. There was no standardization as to how to measure exposure or outcome in the included studies, and most studies did not present sufficient data to enable meta-analysis. Conclusion: It was not possible to determine a cut-off point for high cochlear dose that could be considered a risk factor for hearing loss.

Fluência de leitura, reconhecimento de palavras e compreensão leitora em alunos do 4º ao 9º ano do ensino fundamental: revisão sistemática / Fluidez lectora, reconocimiento de palabras y comprensión lectora en estudiantes de 4° a 9° año de educación primaria: revisión sistemática / Reading Fluency, Word Recognition and Reading Comprehension of Students From the 4th to the 9th Grade of Elementary School: Systematic Review

O processamento da leitura é resultado da interação de distintos processos cognitivos, como reconhecimento de palavras, compreensão oral e fluência. Há evidências sobre a importância da fluência para predizer a com-preensão de leitura, mas ainda não é claro seu papel ao longo do desenvolvimento. Essa revisão sistemática analisou estudos nacionais e internacionais sobre a re-lação das habilidades de reconhecimento de palavras e fluência de leitura com a compreensão de leitura em alunos do 4º ao 9º ano. A revisão foi conduzida de acordo com a metodologia prisma e utilizou a base de dados PubMed, de 2000 a setembro de 2019. Foram incluídos artigos que respondiam à pergunta norteadora e atendiam à temática estabelecida pelos descritores e palavras-chave. Foram encontrados 992 artigos, dos quais 904 foram excluídos pelo título e resumo e 56 pela leitura do texto completo. Isto possibilitou a análise de 32 artigos. Os resultados sugerem que, diferentemente do reconhecimento de palavras, a habilidade de fluência de leitura tende a manter relação significativa com a compreensão de leitura no decorrer do segundo ciclo do Ensino Fundamental.

El procesamiento de la lectura es el resultado de la interacción de diferentes procesos cognitivos, como el reconocimiento de palabras, la comprensión oral y la fluidez. Existe evidencia sobre la importancia de la fluidez en la predicción de la comprensión lectora, pero a lo largo del desarrollo su papel no está claro. Esta revisión sistemática analizó estudios nacionales e internacionales sobre la relación entre las habilidades de reconocimiento de palabras y fluidez lectora con la comprensión lectora en estudiantes de 4° a 9° grado. La revisión se realizó de acuerdo con la metodología prisma y utilizó la base de datos PubMed, desde el 2000 hasta septiembre de 2019. Fueron incluidos artículos que respondieron a la pregunta guía y cumplieron con la temática establecida por los descriptores y palabras clave. Se encontraron 992 artículos, de los cuales 904 fueron excluidos por título y resumen, y 56 por lectura de texto completo. Esto permitió el análisis de 32 artículos. Los resultados sugieren que, a diferencia del reconocimiento de palabras, la habilidad de fluidez lectora tiende a mantener una relación significativa con la comprensión lectora durante el segundo ciclo de la escuela primaria.

Text processing results from the interaction of different cognitive processes, such as word recognition, listening comprehension, and fluency. There is evi-dence relating to the importance of fluency in pre-dicting reading comprehension, but its role during the course of development is still uncertain. The present systematic review has analyzed national and inter-national research on the relationship between word recognition skills and reading fluency with reading comprehension in students from the 4th to 9th grade. The review was conducted according to theprismamethodology and employed the PubMed database from 2000 to September 2019. The chosen papers answered the orienting question and corresponded to the topic established by the descriptors and keywords. We found 992 articles, of which 904 were excluded by reading the titles and abstracts and 56 by reading the full texts. It was possible to analyze 32 papers. The results suggest that, unlike word recognition, the ability to read fluently tends to uphold a significant relationship with reading comprehension during the second cycle of Elementary School.

Brain Gene Expression-DNA Methylation Correlation in Suicide Completers: Preliminary Results

Abstract Background: Gene expression alterations have been implicated in suicide pathology. However, the study of the regulatory effect of DNA methylation on gene expression in the suicidal brain has been restricted to candidate genes. Objective: The objective of the study was to identify genes whose expression levels are correlated with DNA methylation in the prefrontal cortex of suicides. Methods: Postmortem prefrontal cortex samples from 21 suicides and six non-suicides were collected. Transcriptomic and DNA methylation profiles were evaluated with microarrays; cis correlations between gene expression and CpG methylation were screened. We then analyzed the presence of transcription factor (TF) binding sites (TFBS) at CpG sites correlated with gene expression. Gene expression of TFs involved in neurodevelopmental binding to predicted TFBS was determined in the BrainSpan database. Results: We identified 22 CpG sites whose methylation levels correlated with gene expression in the prefrontal cortex of suicides. Genes annotated to identified CpG sites were involved in neurodevelopment (BBS4, NKX6-2, AXL, CTNND1, and MBP) and polyamine metabolism (polyamine oxidase [PAOX]). Such correlations were not detected in the non-suicide group. Nine TFs (USF1, TBP, SF1, NRF1, RFX1, SP3, PKNOX1, MAZ, and POU3F2) showed differential expression in pre- and post-natal developmental periods, according to BrainSpan database. Conclusions: The integration of different omic technologies provided novel candidates for the investigation of genes whose expression is altered in the suicidal brain and their potential regulatory mechanisms. (REV INVEST CLIN. 2020;72(5):283-92)

Neurobiology of bipolar disorders: a review of genetic components, signaling pathways, biochemical changes, and neuroimaging findings

Bipolar disorder (BD) is a chronic mental illness characterized by changes in mood that alternate between mania and hypomania or between depression and mixed states, often associated with functional impairment. Although effective pharmacological and non-pharmacological treatments are available, several patients with BD remain symptomatic. The advance in the understanding of the neurobiology underlying BD could help in the identification of new therapeutic targets as well as biomarkers for early detection, prognosis, and response to treatment in BD. In this review, we discuss genetic, epigenetic, molecular, physiological and neuroimaging findings associated with the neurobiology of BD. Despite the advances in the pathophysiological knowledge of BD, the diagnosis and management of the disease are still essentially clinical. Given the complexity of the brain and the close relationship between environmental exposure and brain function, initiatives that incorporate genetic, epigenetic, molecular, physiological, clinical, environmental data, and brain imaging are necessary to produce information that can be translated into prevention and better outcomes for patients with BD.

Neurological implications of SARS-CoV-2 infection: review of literature / Implicações neurológicas da infecção por SARS-CoV-2: revisão da literatura

The infection caused by the new coronavirus had its first case described in December 2019, in Wuhan, China, and reached a pandemic status in March 2020. Since then, knowledge about the different aspects of this infection has evolved, as well as increased reports concerning related neurological manifestations. Thus, the neurologist assumes a fundamental role in the care of these patients, who may have a clinical phenotype that goes beyond respiratory aspects. In the present study, we highlight the data available in the literature so far regarding the main neurological implications related to COVID-19 infection, in addition to calling attention for some aspects related to patients with previous neurological diseases who contract this infection.

A infecção causada pelo novo Coronavírus teve seu primeiro caso descrito em dezembro de 2019, em Wuhan, China e alcançou o status de pandemia em março de 2020. Desde então, o conhecimento sobre os diferentes aspectos da referida infecção evolui assim como aumentam relatos de manifestações neurológicas relacionadas. Assim, o neurologista assume papel fundamental na assistência desses pacientes, que podem ter um fenótipo clínico que ultrapassa os aspectos respiratórios. No presente estudo, destacamos os dados disponíveis na literatura até o presente momento no tocante às principais implicações neurológicas relacionadas à infecção pelo COVID-19, além de destacar alguns aspectos relativos aos pacientes com doenças neurológicas prévias que contraem a referida infecção.

Towards universal quality health care through an independent accreditation agency: A review

Background@#Guaranteeing quality of health care services is part of the objectives of Republic Act No. 11223 or the Universal Health Care (UHC) Act of 2019. In assuring that quality services are delivered by health care providers, they must be accredited to participate in the National Health Insurance Program. The UHC Act mandates the Philippine Health Insurance Corporation (PhilHealth) to recognize third party mechanisms as basis of granting incentives for health facilities that deliver services of higher quality. This review aimed to identify lessons and experiences from literature that can be adopted and contextualized in the Philippine setting, for strategic policies on strengthening the national health facility accreditation system. @*Methods@#A systematic review of literature was conducted to generate evidence-based recommendations from discussions on cross country experiences and local government initiatives towards improved accreditation system. @*Results@#By virtue of the UHC Act, a form of strategic purchasing is further institutionalized through a rating system that incentivizes health facilities that provide better services in terms of quality, efficiency, and equity. It is imperative to consider the country’s previous and current gaps and challenges in accreditation and adopt the best practices of other countries, as appropriate to Philippine's local settings. A tool is proposed in creating a national hospital accreditation system using the domains of leadership and governance, financing and sustainability, standards development, program management, and continuing quality improvement. @*Conclusion and Recommendations@#With the legitimacy of third party accreditation body mandated by the UHC Act, operationalization of the prescribed mechanisms and organizational structure must enjoin all pertinent stakeholders and be supported by sustainable funds and technical assistance by the government.

Addressing primary care inequities in underserved areas of the Philippines: A review

@#Background. Inequities in health care exist in the Philippines due to various modifiable and non-modifiable determinants. Through the years, different interventions were undertaken by the government and various stakeholders to address these inequities in primary care. However, inequities still continue to persist. The enactment of the Universal Health Care (UHC) Act aims to ensure that every Filipino will have equitable access to comprehensive and quality health care services by strengthening primary care. As a step towards UHC, the government endeavors to guarantee equity by prioritizing assistance and support to underserved areas in the country. This paper aims to review different interventions to promote equity in the underserved areas that could aid in needs assessment. @*Methods@#A search through PUBMED and Google Scholar was conducted using the keywords, “inequity,” “primary care” and “Philippines.” The search yielded more than 10,000 articles which were further filtered to publication date, relevance to the topic, and credibility of source. A total of 58 full-text records were included in the review. @*Results and Discussion@#In the Philippines, inequities in primary care exist in the context of health programs, facilities, human health resources, finances, and training. These were recognized by various stakeholders, from government and private sector, and nongovernment organizations, taking actions to address inequities, applying different strategies and approaches but with a shared goal of improving primary care. On another end, social accountability must also be instilled among Filipinos to address identified social and behavioral barriers in seeking primary care. With political commitment, improvement in primary care towards health equity can be achieved.@*Conclusion and Recommendation@#To address inequities in primary care, there is a need to ensure adequate human resources for health, facilities, supplies such as medications, vaccination, clean water, and sources of funds. Moreover, regular conduct of training on healthcare services and delivery are needed. These will capacitate health workers and government leaders with continuous advancement in knowledge and skills, to be effective providers of primary care. Institutionalizing advocacy in equity through policies in healthcare provision would help realize the aims of the Universal Health Care Act.

Moving towards evidence-informed policy development on third party accreditation of healthcare facilities in Light of the Universal Health Care Act: Policy analysis

Background@#The Universal Health Care (UHC) Act seeks to delineate the roles of key agencies and stakeholders towards equity in access to quality and affordable health care. Under the pillar of health regulation, the Philippine Health Insurance Corporation is mandated to recognize third party accreditation mechanisms as a basis for granting incentives to health facilities that provide better service quality, efficiency, and equity. @*Methods@#A systematic review of literature was conducted to generate a policy brief that outlined the strengths and weaknesses of the current accreditation system, and how to address arising fragmentation issues in implementation based on international and local evidence. To generate recommendations from a multi-stakeholder approach, a roundtable discussion enjoined by all major stakeholders of the policy issue was conducted by the University of the Philippines Manila Health Policy Development Hub in collaboration with the Department of Health. Thematic analysis of the RTD and the literature review were utilized in crafting the position statement with the general aim of producing consensus policy recommendations, as inputs in the Implementing Rules and Regulations of the Act. @*Results@#Policy analysis using results of literature review and policy discussion was crafted, with thematically arranged recommendations in the domains of leadership and governance, financing and sustainability, standards development, program development, and continuing quality improvement that could help the national health system in determining third party accreditation mechanisms set forth by the UHC Act. Significant issues raised was the composition and requirements of the third party accreditor and the risks in transition. @*Conclusion and Recommendation@#With the PhilHealth Benchbook setting the standards and with the expressed commitment of stakeholders for third party accreditation, it is an opportune time for the UHC Act to institutionalize the accreditation mechanisms that will address existing challenges of PhilHealth accreditation. The literature review and discussion bring forth the proposed tool for the criteria in selecting third party accreditors.

Multivariate statistical analysis of morpho-anatomical data of nine sect. Caulopterae species (Baccharis - Asteraceae) used in folk medicine

Abstract Baccharis species belonging to sect. Caulopterae are difficult to identify. Most countries are controlling the quality of herbal medicines destined for the internal market or export. "Carquejas" are used arbitrarily for the same medicinal purposes and only three species of sect. Caulopterae are official herbal medicines. In the present study, a morpho-anatomical and statistical analysis was performed with nine species of sect. Caulopterae: Baccharis articulata, B. crispa, B. gaudichaudiana, B. microcephala, B. penningtonii, B. phyteumoides, B. sagittalis, B. triangularis and B. trimera, emphasizing the importance of anatomy as a taxonomic tool. A total of 114 populations of these nine species were examined. The first three principal components of morphoanatomical data provided relevant information to classify the species (75.04% of the total variability). The most discriminatory variable in this issue was the stomatal index (1.0530). We determined the qualitative and quantitative variables in order to differentiate the species by using principal components analysis and ANOVA tests. Stomata type, uniseriate trichome type and presence/absence of collenchyma in the wing margin are the qualitative variables that should be analyzed. Regarding quantitative variables, the epidermal ones in superficial view are more important and discriminatory than those of alate stem cross section and they must be considered for proper quality control of the species of this work.

Ultrassonografia no auxílio do diagnóstico de vesiculite seminal em touros de corte / Ultrasonography in the diagnosis of seminal vesiculites in beef bulls

A vesiculite é um processo inflamatório das glândulas vesiculares, podendo ser unilateral ou bilateral, que acomete reprodutores. O objetivo do presente trabalho foi avaliar a utilização da ultrassonografia como meio de diagnóstico precoce das alterações das vesículas seminais em touros. O presente trabalho foi realizado no município de Videira, Santa Catarina. Analisou-se um total 42 reprodutores, com média de idade de 15 meses, das raças Aberdeen Angus e Polled Hereford em semi-confinamento. Foi realizado exame clinico do estado geral dos animais e exame andrológico dos reprodutores. As amostras de sêmen para a realização do exame das características físicas do ejaculado foram obtidas por eletroejaculação. Através da palpação retal, realizou-se a avaliação das glândulas vesiculares por ultrassonografia. A análise estatística dos dados foi realizada por meio de análise de variância (ANOVA) para comparação entre médias com nível de significância de 5%. A presença de vesiculite foi observada em 31 animais (73,8%) dos 42 analisados. Dos 31 animais portadores 11 animais (35,5%) apresentaram vesiculite bilateral e 20 apresentaram vesiculite unilateral (64,5%; P<0,05). Animais com perímetro escrotal maior tendem a desenvolver vesiculite unilateral, tal fato pode ser explicado pela precocidade sexual agravado pela sodomia entre os animais. O uso do ultrassom auxilia de forma preventiva a detecção de animais portadores de vesiculite em reprodutores.(AU)

The vesiculite is an inflammatory process of the vesicular glands, unilateral or bilateral, that affects bulls. The purpose of this study was to evaluate the use of ultrasound as a complementary method for early detection of changes in seminal vesicles in bulls. This study was conducted in the municipality of Videira, Santa Catarina. We evaluated 42 bulls, with an average age of 15 months, Aberdeen Angus and Polled Hereford breeds and in semi-confinement. Clinical animal examination and andrological exam were performed in all animals. Semen samples were obtained by electroejaculation and physical characteristics of the ejaculate were performed. Rectal palpation was performed by ultrasonography to evaluate vesicular glands changes. Statistical analysis of the data was performed using analysis of variance (ANOVA) for comparison between means with significance level of 5%. The presence of vesiculitis was observed in 31 (73.8%) from the 42 analyzed bulls. Of the 31 animals, 11 animals (35.5%) presented bilateral vesiculitis and 20 showed unilateral vesiculitis (64.5%; P<0.05). Animals with a larger scrotal perimeter tend to develop unilateral vesiculitis, which can be explained by the sexual precocity observed by sodomy among animals. In this way, the use of ultrasound helps preventively to detect animals with vesiculitis in breeding animals.(AU)

A Bibliometric Analysis of Scientific Production on Second-Generation Anti- Psychotic Drugs in Malaysia

Objective: We carried out a bibliometric study on the scientific papers related to second generation anti-psychotic drugs (SGAs) in Malaysia. Methods: With the SCOPUS database, we selected those documents made in Malaysia whose title included descriptors related to SGAs. We applied bibliometric indicators of production and dispersion, as Price’s law and Bradford’s law, respectively. We also calculated the participation index of the different countries. The bibliometric data were also been correlated with some social and health data from Malaysia (total per capita expenditure on health and gross domestic expenditure on R&D). Results: We found 105 original documents published between 2004 and 2016. Our results fulfilled Price’s law, with scientific production on SGAs showing exponential growth (r = 0.401, vs. r = 0.260 after linear adjustment). The drugs most studied are olanzapine (9 documents), clozapine (7), and risperidone (7). Division into Bradford zones yields a nucleus occupied by the Medical Journal of Malaysia, Singapore Medical Journal, Australian and New Zealand Journal of Psychiatry, and Pharmacogenomics. Totally, 63 different journals were used, but only one in the top four journals had an impact factor being greater than 3. Conclusion: The publications on SGAs in Malaysia have undergone exponential growth, without evidence a saturation point.

Dermatofibrosarcoma Protuberans on the leg: Pearls in diagnosis and surgical management

Introduction@#Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing soft tissue tumor accounting for less than 0.1% of all malignant neoplasms and approximately 1% of all soft tissue sarcomas1 .@*Case Summary@#We report a case of a 27-year-old female who presented with a 1-year history of a gradually enlarging firm, erythematous to violaceous nodule on the right anterolateral leg. Shave excision biopsy was done, and revealed spindle-shaped fibroblasts arranged in a storiform pattern around an indistinct vasculature. Histopathologic diagnosis revealed dermatofibrosarcoma protuberans. There was prominent, diffuse, positivity for CD34 by immunohistochemistry. The cytogenetic analysis revealed a t(17;22) translocation, confirming our working impression.The patient underwent wide excision with frozen section. All surgical margins of resection were negative for tumor. The patient was referred to plastic surgery for post-excision coverage defect. Split-thickness skin graft was applied over the defect. Patient tolerated the procedure well, and has not experienced recurrence of the tumor.@*Conclusion@#A protuberant, well-circumscribed tumor that seems benign may incidentally be a sarcoma. Skin biopsy, immunohistochemistry and cytogenetic studies using Fluorescence In-Situ Hybridization (FISH) are the most essential laboratory investigations to validate a diagnosis of DFSP. Proper surgical excision with adequate margins will prevent recurrence of the tumor.

Peritaje psicológico y daño psíquico / Psychological assessment and psychic damage

El peritaje psicológico, encuentra su antecedente más cercano en el siglo XVII en la peritación psiquiátrica. Ambas disciplinas, han abogado por el desarrollo de una clasificación nosográfica internacional. En nuestro país a partir de los años 90 se realizaron numerosas investigaciones sobre el concepto de daño psíquico y su relación con situaciones de hostigamiento vivenciadas en el ámbito laboral. Sin embargo, a la luz de estas se colige que el acento está puesto en los procesos que se presentan en el ámbito del trabajo que propician la generación de un daño psíquico. Habiendo quedado el daño psíquico como resultado de un evento único dañoso delegado a disquisiciones jurisprudenciales guiadas por principios, preceptos y normas jurídicas. El estudio psicológico pericial del daño psíquico como concepto utilizado en el fuero civil, se contempla en el fuero del trabajo, por cuanto la Ley de Riesgos del Trabajo (24.557) preceptúa tanto el accidente como la enfermedad laboral. Ello ha motivado la investigación que se desarrolla en el marco de la Programación UBACYT 2016 denominada "El daño psíquico como consecuencia de un accidente o enfermedad laboral".

The psychological examination, finds its antecedent more near in century XVII in the psychiatric examination. Both disciplines have advocated the development of an international nosographic classification. In our country since the 1990s, numerous investigations were carried out on the concept of psychological damage and its relation to situations of harassment experienced in the workplace. However, in the light of the same it is gathered that the accent is placed in the processes that occur in the field of work that lead to the generation of psychic damage. The psychic damage being left as a result of a single harmful event delegated to jurisprudential disquisitions guided by principles, precepts and legal norms. The psychological study of psychic damage as a concept used in civil law is contemplated in the labor courts, since the Labor Risk Law (24,557) provides for both the accident and the occupational disease. This has motivated the investigation that takes place in the framework of the UBACYT Programming 2016 called "Psychic damage as a result of an accident or occupational disease".

Diterpenes and a new benzaldehyde from the mangrove plant Rhizophora mangle

ABSTRACT This work describes the isolation, by high-speed counter-current chromatography, of the diterpenes manool, jhanol and steviol and the benzaldehyde p-oxy-2-ethylhexyl benzaldehyde from the stilt roots hexane extract of the mangrove plant Rhizophora mangle L., Rhizophoraceae. For this, a non-aqueous biphasic solvent system composed of hexane–acetonitrile–methanol 1:1:0.5 (v/v/v) was applied. As far as we know, only steviol was previously isolated in Rhizophoraceae and this is the first time that p-oxy-2-ethylhexyl benzaldehyde is reported.

Brazilian guidelines for endovascular treatment of patients with acute ischemic stroke / Diretrizes brasileiras para o tratamento endovascular de pacientes com acidente vascular cerebral isquêmico agudo

ABSTRACT These guidelines are the result of a joint effort from writing groups of the Brazilian Stroke Society, the Scientific Department of Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Stroke Network and the Brazilian Society of Diagnostic and Therapeutic Neuroradiology. Members from these groups participated in web-based discussion forums with predefined themes, followed by videoconference meetings in which controversies and position statements were discussed, leading to a consensus. This guidelines focuses on the implications of the recent clinical trials on endovascular therapy for acute ischemic stroke due to proximal arterial occlusions, and the final text aims to guide health care providers, health care managers and public health authorities in managing patients with this condition in Brazil.

RESUMO Estas diretrizes são o resultado de um esforço conjunto de membros da Sociedade Brasileira de Doenças Cerebrovasculares (SBDCV), Departamento científico de Doenças Cerebrovasculares da Academia Brasileira de Neurologia (ABN), Rede Brasil AVC (RBAVC) e da Sociedade Brasileira de Neurorradiologia Diagnóstica e Terapêutica (SBNR). Membros destas 4 entidades participaram de fórum de discussões por internet de temas pré-definidos, seguidos de encontros de videoconferência para discussão de pontos controversos e das recomendações, em busca de um consenso final. Estas diretrizes tem seu foco sobre as implicações dos recentes ensaios clínicos de tratamento endovascular do acidente vascular cerebral (AVC) isquêmico agudo relacionado a oclusão de artérias proximais. O texto final foi elaborado para servir de orientação no manejo destes pacientes AVC isquêmico pelos diferentes profissionais de saúde, gestores de saúde pública e de saúde complementar no Brasil.