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|Type:||Artigo de periódico|
|Title:||Intra-arterial Thrombolysis Associated To Adjuvant Angioplasty In The Acute Phase Of Ischemic Stroke [trombólise Intra-arterial Associada A Angioplastia Adjunta Na Fase Aguda Do Acidente Vascular Cerebral Isquêmico]|
Da Silva J.A.C.
|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. Method: 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). Conclusion: 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.|
|Appears in Collections:||Unicamp - Artigos e Outros Documentos|
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