medigraphic.com
ISSN 1729-6935 (Digital)
16 de abril

2022, Número 283

<< Anterior Siguiente >>

16 de abril 2022; 61 (283)


Manejo trombolítico versus endovascular en el accidente cerebrovascular isquémico

Martínez-Zarazúa C, Torres-Rivera MG

Idioma: Español
Referencias bibliográficas: 35
Paginas: 1-8
Archivo PDF: 605.15 Kb.


RESUMEN

Introducción: el accidente cerebrovascular isquémico es una afección endémica; su abordaje ha sido objeto de estudio y se han desarrollado nuevas técnicas y tecnologías para su tratamiento. Actualmente existen dos tipos de terapias, la trombólisis y la trombectomía. Pese a que ambas terapias han sido ampliamente estudiadas, existe controversia sobre cuál de estas tiene mejores tasas de recanalización y resultados funcionales. Objetivo: caracterizar el accidente cerebrovascular isquémico comparando los abordajes terapéuticos para el manejo de la patología. Método: se realizó una revisión bibliográfica para la que se consultaron las bases de datos PubMed, Cochrane y SciELO, empleando los descriptores “Accidente Cerebrovascular”, “Terapia Trombolítica” y “Trombectomía” y los siguientes criterios de selección: revisiones sistémicas, metaanálisis, ensayos clínicos y preclínicos, guías de práctica clínica y revisiones bibliográficas publicadas del 2015 al 2020, con un total de 32 artículos y 4 libros consultados con calidad y validez adecuada. Desarrollo: la trombectomía mecánica ha generado buenos resultados funcionales, con mejores tazas de recanalización y mayor periodo de ventana terapéutico, en comparación con la trombólisis, siendo la aspiración directa costo-efectiva, con mejores resultados que la aplicación del stentriever. Conclusiones: el manejo primario del accidente cerebrovascular isquémico agudo con trombectomía mecánica por aspiración directa, es costo-efectivo, con mejores resultados funcionales que la trombólisis por si sola y es eficaz con o sin la misma.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Goldman L, Schafer A. Goldman-Cecil Medicine. Volume 2. 26th ed.Madrid: Elsevier; 2019.

  2. García C, Martínez A, García V, Ricaurte-Fajardo A, Torres I, Coral J. Actualización endiagnóstico y tratamiento delataque cerebrovascular isquémico agudo. Univ. Med. [Internet].2019 [cited 08/10/2020];60(3):1-13. Available from: https://doi.org/10.11144/Javeriana.umed60-3.actu

  3. De la Garza-Longoria RS,Maldonado-Mancillas JA, Mendoza-Múzquiz PL, Sánchez L.Incidencia de enfermedad cerebrovascularen un servicio de MedicinaInterna. Med Int Méx [Internet].2018 [cited 08/10/2020];34(6):874-80. Available from:https://doi.org/10.24245/mim.v34i6.2062

  4. Guzik A, Bushnell C. Strokeepidemiology and risk factor management.Continuum (MinneapMinn) [Internet]. 2017 [cited08/10/2020]; 23(1):15-39. Availablefrom: https://doi.org/10.1212/CON.0000000000000416

  5. Radu RA, Terecoasa EO,Bajenaru OA, Tiu C. Etiologicclassification of ischemic stroke:where do we stand? Clin NeurolNeurosurg [Internet]. 2017 [cited08/10/2020]; 159:93-106. Availablefrom:https://doi.org/10.1016/j.clineuro.2017.05.019

  6. George P, Steinberg G. Novelstroke therapeutics: unravelingstroke pathophysiology andits impact on clinical treatments.Neuron [Internet]. 2015 Jul [cited08/10/2020]; 87(2):297-309.Available from: https://doi.org/10.1016/j.neuron.2015.05.041

  7. Norris T, Lalchandani, R.Porth's Pathophysiology. 10thed. Philadelphia: Wolters Kluwer;2019.

  8. Splittgerber R. Snell. Neuroanatomíaclínica. 8th ed. Philadelphia:Wolters Kluwer; 2019.

  9. Baynes J, Dominiczak M.Bioquímica médica. 5th ed. Barcelona:Elsevier; 2019.

  10. Koh S, Park H. Neurogenesisin stroke recovery. Transl.Stroke Res [Internet]. 2016 [cited08/10/2020]; 8:3-13. Availablefrom: https://doi.org/10.1007/s12975-016-0460

  11. Yang C, Hawkins KE,Doré S, Candelario-Jalil E. Neuroinflammatorymechanisms ofblood-brain barrier damage in ischemicstroke. Am J Physiol CellPhysiol [Internet]. 2019 [cited10/08/2020]; 316(2):C135-C153.Available from: https://doi.org/10.1152/ajpcell.00136.2018

  12. Kurisu K, YenariMA. Therapeutic hypothermiafor ischemic stroke;pathophysiology and future promise.Neuropharmacology [Internet].2018 [cited 08/10/2020]; 134(PtB):302-9. Available from:https://doi.org/10.1016/j.neuropharm.2017.08.02513. Powers W, Rabinstein A,Ackerson T, Adeoye O, BambakidisN, Becker K, et al. Guidelinesfor the early managementof patients with acute ischemicstroke: 2019 update to the 2018guidelines for the early managementof acute ischemic stroke:a guideline for healthcare professionalsfrom the AmericanHeart Association/AmericanStroke Association. Stroke [Internet].2019 [cited 08/10/2020];50(12):e355-e380. Availablefrom: https://doi.org/10.1161/STR.0000000000000211

  13. Campbell BC. Thrombolysisand thrombectomy foracute ischemic stroke: strengthsand synergies. Semin ThrombHemost [Internet]. 2017 [cited08/10/2020]; 43(2):185-90.Available from: https://doi.org/10.1055/s-0036-1585078

  14. Prabhakaran S, Ruff I,Bernstein RA. Acute stroke intervention:a systematic review.JAMA [Internet]. 2015 [cited08/10/2020]; 313(14):1451-62.Available from: https://doi.org/10.1001/jama.2015.3058

  15. Martins SO, Mont'AlverneF, Rebello LC, Abud DG, Silva GS,Lima FO, et al. Thrombectomy forStroke in the Public Health CareSystem of Brazil. N Engl J Med [Internet].2020 [cited 08/10/2020];382(24):2316-2326. Availablefrom: https://doi.org/10.1056/NEJMoa2000120

  16. Mordasini P, Gralla J. Developmentsin mechanical thrombectomydevices for the treatmentof acute ischemic stroke. ExpertRev Med Devices [Internet]. 2016[cited 08/10/2020]; 13(1):71-81.Available from: https://doi.org/10.1586/17434440.2015.1124019

  17. Pierot L, Gawlitza M, SoizeS. Techniques for endovasculartreatment of acute ischemicstroke. Rev Neurol (Paris) [Internet].2017 [cited 08/10/2020];173(9):594-9. Available from:https://doi.org/10.1016/j.neurol.2017.09.005

  18. Asadi H, Dowling R, Yan B,Wong S, Mitchell P. Advances inendovascular treatment of acuteischaemic stroke. Intern Med J [Internet]. 2015 [cited 08/10/2020];45(8):798-805. Available from: https://doi.org/10.1111/imj.12652

  19. Malhotra A, BoltyenkovA, Wu X, Matouk C, Forman H,Gandhi D, et al. Endovascularcontact aspiration versus stentretriever for revascularizationin patients with acute ischemicstroke and large vessel occlusion:a cost-minimization analysis.World Neurosurg [Internet]. 2020[cited 08/10/2020]; 139:e23-e31.Available from: https://doi.org/10.1016/j.wneu.2020.02.078

  20. Phan K, Maingard J, KokHK, Dmytri A, Goyal S, ChandraR, et al. Contact aspiration versusstent-retriever thrombectomyfor distal middle cerebral arteryocclusions in acute ischemicstroke: meta-analysis. Neurointervention[Internet]. 2018 [cited08/10/2020]; 13(2):100-9. Availablefrom: https://doi.org/10.5469/neuroint.2018.00997

  21. Campbell BC, Mitchell PJ,Churilov L, Yassi N, Kleinig TJ,Dowling RJ, et al. Tenecteplaseversus Alteplase before thrombectomyfor ischemic stroke. NEngl J Med [Internet]. 2018 [cited08/20/2020]; 378(17):1573-1582. Available from: https://doi.org/10.1056/NEJMoa1716405

  22. Primiani CT, Vicente AC,Brannick MT, Turk AS, Mocco J,Levy EI, et al. Direct aspirationversus stent retriever thrombectomyfor acute stroke: a systematicreview and meta-analysis in 9127 patients. J Stroke CerebrovascDis [Internet]. 2019 [cited08/10/2020]; 28(5):1329-37.Available from: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.01.034

  23. Turk III AS, Siddiqui A, FifiJT, De Leacy Ra, Fiorella DJ, GuE, et al. Aspiration thrombectomyversus stent retriever thrombectomyas first-line approach forlarge vessel occlusion (COMPASS):a multicentre, randomised,open label, blinded outcome,non-inferiority trial. Lancet [Internet].2019 [cited 08/10/2020];393(10175):998-1008. Availablefrom: https://doi.org/10.1016/S0140-6736(19)30297-1

  24. Xing PF, Yang PF, Li ZF,Zhang L, Shen HJ, Zhang YX, et al.comparison of aspiration versusstent retriever thrombectomy asthe preferred strategy for patientswith acute terminal internal carotidartery occlusion: a propensityscore matching analysis. AJNRAm J Neuroradiol [Internet]. 2020[cited 08/10/2020]; 41(3):469-476. Available from: https://doi.org/10.3174/ajnr.A6414

  25. Zafar M, Mussa M, MemonRS, Nadeem S, UsmanMS, Siddiqi J, et al. Aspirationthrombectomy versus stent retrieverthrombectomy alone foracute ischemic stroke: a systematicreview and meta-analysis.Cureus [Internet]. 2020 [cited08/10/2020]; 12(5):e8380. Availablefrom: https://doi.org/10.7759/cureus.8380

  26. Bernstock JD, Peruzzotti-Jametti L, Ye D, Gessler FA, MaricD, Vicario N, et al. Neural stemcell transplantation in ischemicstroke: A role for preconditioningand cellular engineering. J CerebBlood Flow Metab [Internet]. 2017[cited 08/10/2020]; 37(7):2314-19. Available from: https://doi.org/10.1177/0271678X17700432

  27. Venkat P, Shen Y, ChoppM, Chen J. Cell-based andpharmacological neurorestorativetherapies for ischemicstroke. Neuropharmacology [Internet].2018 [cited 08/10/2020];134(PtB):310-22. Available from:https://doi.org/10.1016/j.neuropharm.2017.08.036

  28. Thomalla G, SimonsenCZ, Boutitie F, Andersen G,Berthezene Y, Cheng B, et al.MRI-Guided thrombolysis forstroke with unknown time of onset.N Engl J Med [Internet]. 2018[cited 08/20/2020]; 379(7):611-622. Available from: https://doi.org/10.1056/NEJMoa1804355

  29. Marmagkiolis K, HakeemA, Cilingiroglu M, Gundogdu B,Iliescu C, Tsitlakidou D, et al. Safetyand efficacy of stent retrieversfor the management of acute ischemicstroke: comprehensivereview and meta-analysis. JACCCardiovasc Interv [Internet]. 2015[cited 08/20/2020]; 8:1758-1765.Available from: https://doi.org/10.1016/j.jcin.2015.07.021

  30. Bush CK, Kurimella D,Cross LJS, Conner KR, Martin-Schild S, He J, et al. Endovasculartreatment with stent-retrieverdevices for acute ischemic stroke:a meta-analysis of randomizedcontrolled trials. PLoS One [Internet].2016 [cited 08/20/2020];11(1):e0147287. Available from:https://doi.org/10.1371/journal.pone.0147287

  31. Lambrinos A, SchainkAK, Dhalla I, Krings T, CasaubonLK, Sikich N, et al. Mechanicalthrombectomy in acute ischemicstroke: A Systematic Review.Can J Neurol Sci [Internet]. 2016[cited 08/20/2020]; 43(4):455-460. Available from: https://doi.org/10.1017/cjn.2016.30

  32. Health Quality Ontario.Mechanical thrombectomy inpatients with acute ischemicstroke: a health technology assessment.Ont Health TechnolAssess Ser [Internet]. 2016 [cited08/20/2020]; 16(4):179. Availablefrom: https://www.hqontario.ca/Evidence-to-Improve-Care/Health-Technology-Assessment/Journal-Ontario-Health-Technology-Assessment-Series/hta-mechanical-thrombectomy.

  33. Yang P, Zhang Y, ZhangL, Zhang Y, Treurniet KM, ChenW, et al. Endovascular thrombectomywith or without intravenousalteplase in acute stroke. NEngl J Med [Internet]. 2020 [cited08/20/2020]; 382(21):1981-1993.Available from:h t t p s : // d o i . o rg / 1 0 . 1 0 5 6 / N E J -Moa2001123

  34. Achit H, Soudant M,Hosseini K, Bannay A, EpsteinJ, Bracard S, et al. Cost-effectivenessof thrombectomy inpatients with acute ischemicstroke: The THRACE RandomizedControlled Trial. Stroke [Internet].2017 [cited 08/20/2020];48(10):2843-2847. Availablefrom: https://doi.org/10.1161/STROKEAHA.117.017856

  35. Balami JS, Sutherland BA,Edmunds LD, Grunwald IQ, NeuhausAA, Hadley G, et al. A systematicreview and meta-analysisof randomized controlled trialsof endovascular thrombectomycompared with best medical treatmentfor acute ischemic stroke.Int J Stroke [Internet]. 2015 [cited08/20/2020]; 10(8):1168-1178. Available from: https://doi.org/10.1111/ijs.12618




2020     |     www.medigraphic.com