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Trombólise intra-arterial associada a angioplastia adjunta na fase aguda do acidente vascular cerebral isquêmico / Intra-arterial thrombolysis associated to adjuvant angioplasty in the acute phase of ischemic stroke
Falcão, Carlos Henrique; Falcão, Antônio Eiras; Ulhoa, Alexandre; Rezende, Marco Túlio; Salgado, Constantino González; Malheiros, Waldir Gomes; Silva, José Antônio Corrêa da; Peixoto, Edison Carvalho Sandoval.
  • Falcão, Carlos Henrique; Hospital de Clínicas de Niterói. Niterói. BR
  • Falcão, Antônio Eiras; Universidade Estadual de Campinas (UNICAMP). Campinas. BR
  • Ulhoa, Alexandre; Hospital de Clínicas de Niterói. Niterói. BR
  • Rezende, Marco Túlio; Hospital de Clínicas de Niterói. Niterói. BR
  • Salgado, Constantino González; Hospital de Clínicas de Niterói. Niterói. BR
  • Malheiros, Waldir Gomes; Hospital de Clínicas de Niterói. Niterói. BR
  • Silva, José Antônio Corrêa da; Hospital de Clínicas de Niterói. Niterói. BR
  • Peixoto, Edison Carvalho Sandoval; Faculdade de Medicina - Universidade Federal Fluminense (UFF). Niterói. BR
Rev. bras. cardiol. invasiva ; 18(3): 263-272, set. 2010. tab, ilus, graf
Article in Portuguese | LILACS | ID: lil-566800
RESUMO

INTRODUÇÃO:

A reperfusão precoce da artéria responsável pelo acidente vascular cerebral isquêmico está associada ao salvamento da zona de hipoperfusão adjacente à área central isquêmica. Nosso objetivo foi analisar em uma série retrospectiva de pacientes a eficácia da trombólise intra-arterial em restabelecer o fluxo no vaso tratado na fase aguda do acidente vascular cerebral isquêmico e avaliar o grau de incapacidade por meio da escala de Rankin modificada (ERm) no seguimento mínimo de três meses, identificando variáveis prognósticas.

Método:

Série de 30 pacientes com acidente vascular cerebral isquêmico [tempo entre o início dos sintomas e o início da trombólise (At) < 6 horas no território carotídeo e < 12 horas no território vértebro-basilar) associado a oclusão de uma artéria cerebral, angiograficamente comprovada, e sem hemorragia ou sinais de infarto de grande extensão na tomografia computadorizada, submetidos a trombólise intra-arterial, combinada ou não a angioplastia intracaniana adjunta.

Resultados:

A pontuação admissional na escala do acidente vascular cerebral do National Institute of Health Stroke Scale (NIHSS) foi de 15 + ou - 17. A trombólise intra-arterial, combinada ou não...
ABSTRACT

BACKGROUND:

Early reperfusion of an occluded artery responsible for an acute ischemic stroke is associated to the salvage of the hypoperfused zone adjacent to the central ischemic area. Our objective was to analyze the efficacy of intra-arterial thrombolysis in reestablishing flow in the treated vessel during the acute phase of ischemic stroke in a retrospective series of patients and evaluate the degree of disability using the modified Rankin scale (mRS) in a minimum follow-up period of three months, identifying prognostic variables.

METHODS:

Series of 30 patients with acute ischemic stroke [time from the onset of symptoms and beginning of thrombolysis (Δt) < 6 hours in the carotid territory and < 12 hours in basilar territory] associated to the occlusion of a cerebral artery confirmed by angiography and without hemorrhage or major early infarction signs at computed tomography (CT) scan, undergoing intra-arterial thrombolysis associated to adjuvant intracranial angioplasty.

RESULTS:

The National Institute of Health Stroke Scale (NIHSS) score was 15 ± 17. Complete recanalization was observed in 21 patients (70%) and partial recanalization in 9 patients (30%). Intracranial angioplasty was required in 8 patients. Favorable outcome (mRS < 2) was obtained in 53.3% of the overall sample and in 64% of the patients with middle cerebral artery occlusion. A better outcome was associated to better collateral flow (P = 0.07), involvement of the middle cerebral artery (P = 0.01), involvement of the right cerebral hemisphere (P = 0.07), and intra-arterial thrombolysis < 4.5 hours (P = 0.057). An unfavorable outcome was associated to hyperglycemia (P = 0.003), initial NIHSS > 18 (P = 0.01), advanced age (P = 0.01) and higher doses of recombinant tissue plasminogen activator (rt-PA) (P = 0.08).

CONCLUSIONS:

Intra-arterial thrombolysis in the acute phase of ischemic stroke and associated to adjunct intracranial angioplasty has proven to be an effective method with a high percentage of complete recanalization and favorable outcome in appropriately selected patients.
Subject(s)
Full text: Available Index: LILACS (Americas) Main subject: Reperfusion / Thrombolytic Therapy / Stroke Type of study: Risk factors Limits: Female / Humans / Male Language: Portuguese Journal: Rev. bras. cardiol. invasiva Journal subject: Cardiology / General Surgery Year: 2010 Type: Article Affiliation country: Brazil Institution/Affiliation country: Faculdade de Medicina - Universidade Federal Fluminense (UFF)/BR / Hospital de Clínicas de Niterói/BR / Universidade Estadual de Campinas (UNICAMP)/BR

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Full text: Available Index: LILACS (Americas) Main subject: Reperfusion / Thrombolytic Therapy / Stroke Type of study: Risk factors Limits: Female / Humans / Male Language: Portuguese Journal: Rev. bras. cardiol. invasiva Journal subject: Cardiology / General Surgery Year: 2010 Type: Article Affiliation country: Brazil Institution/Affiliation country: Faculdade de Medicina - Universidade Federal Fluminense (UFF)/BR / Hospital de Clínicas de Niterói/BR / Universidade Estadual de Campinas (UNICAMP)/BR