Resultados obtenidos en el manejo de enfermedades cerebrales mediante terapia endovascular / Results obtained in the management of brain disorders with endovascular therapy

Antecedentes: La terapia endovascular neurológica ha evolucionado rápidamente en un período de tiempo relativamente corto. Esta técnica ha pasado de sus propósitos iniciales, enfocados a pacientes en los que la cirugía abierta no representaba una buena opción, a convertirse en una corriente de la práctica cotidiana. Objetivo: Exponer los resultados obtenidos en pacientes con diversas patologías cerebrales abordados por terapia endovascular, durante un período de 24 meses, con la finalidad de analizar los beneficios de este método terapéutico. Metodología: Estudio observacional, retrospectivo, analítico, que incluye como población todos los pacientes con patología cerebral intervenidos mediante terapia endovascular, en el Grupo Hospitalario Kennedy, Centro de Intervencionismo Angio Manabí, Hospital Luis Vernaza y Clínica Guayaquil; durante el período comprendido entre junio de 2010 a mayo de 2012. Resultados: Las patologías más diagnosticadas fueron aneurismas cerebrales con 75 por ciento (n = 175) de los casos, seguido por malformaciones arteriovenosas con 14 por ciento (n = 33). Las complicaciones observadas fueron migración de coil y ruptura de un aneurisma durante su embolización. Se observó una mortalidad total de 2,82 por ciento, relacionada con mal estado clínico y alto grado imagenológico de pacientes con aneurismas cerebrales. Posterior a la intervención, 96,23 por ciento (n = 204) de los pacientes permanecen en grado Rankin 1. Conclusiones: La terapia endovascular neurológica ha obtenido resultados altamente satisfactorios en diversas patologías del sistema nervioso, con bajo índice de complicaciones y morbimortalidad; constituyendo así una excelente elección en el manejo de estas patologías.

Background: Endovascular therapy has evolved rapidly over a relatively short period of time. This technique has evolved from its initial purposes, to treat patients for whom no good open surgical option existed, to become a mainstream of everyday practice. Objective: To present obtained results in patients with brain diseases approach by endovascular therapy, for a period of 24 months, in order to analyze the benefits of this therapeutic method. Methodology: Observational, retrospective, analytical study, of all patients with brain diseases treated by endovascular therapy at Grupo Hospitalario Kennedy, Centro de Intervencionismo AngioManabí, Hospital Luis Vernaza and Clínica Guayaquil, from June 2010 to May 2012. Results: Conditions most commonly diagnosed were brain aneurysms with 75 percent (n = 175) of cases, followed by arteriovenous malformations with 14 percent (n = 33). Complications observed were coil migration in two cases, and aneurysms rupture during the embolization. There was a total mortality of 2,82 percent, related to poor clinical condition and high imaging grade in patients with intracranial aneurysms. After intervention, 96,23 percent (n = 204) of the patients are in Rankin grade 1. Conclusions: Endovascular therapy has achieved highly satisfactory results in several diseases of the nervous system, with low rate of complications and morbid-mortality, making it an excellent choice in the management of these pathologies.

Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial.

BACKGROUND: Tranexamic acid can reduce bleeding in patients undergoing elective surgery. We assessed the effects of early administration of a short course of tranexamic acid on death, vascular occlusive events, and the receipt of blood transfusion in trauma patients. METHODS: This randomised controlled trial was undertaken in 274 hospitals in 40 countries. 20 211 adult trauma patients with, or at risk of, significant bleeding were randomly assigned within 8 h of injury to either tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo. Randomisation was balanced by centre, with an allocation sequence based on a block size of eight, generated with a computer random number generator. Both participants and study staff (site investigators and trial coordinating centre staff) were masked to treatment allocation. The primary outcome was death in hospital within 4 weeks of injury, and was described with the following categories: bleeding, vascular occlusion (myocardial infarction, stroke and pulmonary embolism), multiorgan failure, head injury, and other. All analyses were by intention to treat. This study is registered as ISRCTN86750102, Clinicaltrials.govNCT00375258, and South African Clinical Trial RegisterDOH-27-0607-1919. FINDINGS: 10 096 patients were allocated to tranexamic acid and 10 115 to placebo, of whom 10 060 and 10 067, respectively, were analysed. All-cause mortality was significantly reduced with tranexamic acid (1463 [14.5%] tranexamic acid group vs 1613 [16.0%] placebo group; relative risk 0.91, 95% CI 0.85-0.97; p=0.0035). The risk of death due to bleeding was significantly reduced (489 [4.9%] vs 574 [5.7%]; relative risk 0.85, 95% CI 0.76-0.96; p=0.0077). INTERPRETATION: Tranexamic acid safely reduced the risk of death in bleeding trauma patients in this study. On the basis of these results, tranexamic acid should be considered for use in bleeding trauma patients. FUNDING: UK NIHR Health Technology Assessment programme, Pfizer, BUPA Foundation, and J P Moulton Charitable Foundation.