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- 2023-10-03 (2)
- 2023-07-31 (1)
Palabras clave
Trombectomía Mecánica
ASPECTS
Categorías
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Resumen
El ataque cerebrovascular es la segunda causa de morbimortalidad en Chile. La trombectomía mecánica (TM) es una terapia tiempo dependiente, que ha demostrado ser eficaz en disminuir la probabilidad de dependencia funcional, en casos con ACV por oclusión de grandes vasos y volumen de tejido infartado no extenso. Con este enfoque el tratamiento sólo puede ser indicado a alrededor del 9% del total de los ACV isquémicos, por lo que valorar situaciones que no fueron incluidas en los ensayos pivotales, ha sido el énfasis de múltiples estudios publicados recientemente. Se realizó una revisión de la literatura publicada entre enero del 2015 y mayo del 2023, priorizando ensayos clínicos y metaanálisis con datos de pacientes individuales. Se discute la evidencia sobre situaciones que hasta el día de hoy resultan controversiales como la terapia trombolítica endovenosa puente, oclusión de vasos de mediano calibre, “core” o núcleo isquémico extenso, NIHSS bajo, instalación de stent en agudo, utilización de antiagregación en las primeras 24 horas, trombolisis intra-arterial adyuvante y TM en oclusión de arteria basilar. El ampliar la indicación de TM bajo nuevos criterios de selección, prescindir de neuroimágenes avanzadas y el utilizar terapias fibrinolíticas o antiagregantes adyuvantes en casos seleccionados, como también utilizar el acceso radial, parece ser el nuevo cambio de paradigma que va a permitir ampliar el número de pacientes susceptibles de terapia de reperfusión, sin aumentar significativamente las complicaciones asociadas a la intervención.
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Derechos de autor 2023 Andrés Gallardo, Pablo Cox