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Background After recently published randomized clinical trials, the choice of the best anesthetic procedure for mechanical thrombectomy (MT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) is not definite.

Background The relationship between collateral circulation and prognosis after endovascular treatment in anterior circulation strokes has been reported in many studies.

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Introducción: el tromboembolismo venoso abarca la trombosis venosa profunda y la embolia pulmonar; representa la tercera enfermedad vascular más importante, provocando alta morbimortalidad potencialmente prevenible. El tratamiento se centra en la anticoagulación temprana para prevenir complicaciones, pero que no siempre restaura la permeabilidad venosa. En este escenario, la trombólisis es una opción, especialmente en pacientes con compromiso hemodinámico significativo o con afectación de segmentos anatómicos de alto riesgo; sin embargo, quienes no son candidatos para recibir trombolíticos, suponen un desafío mayor. Objetivo: presentar las características clínicas, diagnósticas y terapéuticas, enfatizando en las opciones endovasculares disponibles, describiendo sus técnicas e indicaciones, destacando sus beneficios y su seguridad para tratar pacientes con tromboembolismo venoso. Métodos: revisión narrativa a partir de la búsqueda bibliográfica en las bases de datos de PubMed y Scielo. Conclusión: Esta revisión destaca las técnicas de manejo endovascular para tromboembolismo venoso frente a la terapia trombolítica clásica sobre todo en pacientes con alto riesgo de sangrado; así como en quienes están contraindicados los trombolíticos sistémicos como los nuevos anticoagulantes orales por el compromiso hemodinámico. Entre las opciones que se tienen de terapia endovascular está la trombólisis dirigida por catéter y la embolectomía cutánea, que presentan menores tasas de recurrencia y complicaciones posteriores a su aplicación, resaltando que la elección debe ser individualizada en cada paciente

Over the last three decades, stroke care has undergone significant transformations mainly driven by the introduction of reperfusion therapy and the organization of systems of care. Patients receiving treatment through a well-structured stroke service have a much higher chance of favorable outcomes, thereby decreasing both disability and mortality. In this article, we reviewed the scientific evidence for stroke reperfusion therapy, including thrombolysis and thrombectomy, and its implementation in the public health system in Brazil.

Introduction: Ischaemic stroke (IS) due to cervical and cerebral artery dissection (CAD) is a rare entity, and few data are available on the use of such reperfusion therapies as intravenous fibrinolysis and mechanical thrombectomy in these patients. We analysed the use of these treatments in patients with IS due to CAD and compared them against patients receiving reperfusion treatment for IS of other aetiologies. Methods: We conducted an observational, retrospective, multicentre study of patients with IS due to CAD recorded in the National Stroke Registry of the Spanish Society of Neurology during the period 2011−2019. Comparative analyses were performed between: a) patients with CAD treated and not treated with reperfusion therapies and b) patients treated with reperfusion for IS due to CAD and patients treated with reperfusion for IS due to other causes. Epidemiological data, stroke variables, and outcomes at discharge and at 3 months were included in the analysis. Results: The study included 21,037 patients with IS: 223 (1%) had IS due to CAD, of whom 68 (30%) received reperfusion treatment. Reperfusion treatments were used less frequently in cases of vertebral artery dissection and more frequently in patients with carotid artery occlusion. Compared to patients with IS due to other causes, patients with CAD were younger, more frequently underwent mechanical thrombectomy, and less frequently received intravenous fibrinolysis. Rates of haemorrhagic complications, mortality, and independence at 3 months were similar in both groups. Conclusions: Reperfusion therapy is frequently used in patients with IS due to CAD. The outcomes of these patients demonstrate the efficacy and safety of reperfusion treatments, and are comparable to the outcomes of patients with IS due to other aetiologies. Resumen: Introducción: El ictus isquémico (II) por disección arterial cervico-cerebral (DAC) es una entidad infrecuente y existen pocos datos sobre el uso de terapias de reperfusión como la fibrinolisis intravenosa y la trombectomía mecánica. Se analizó el uso de dichas terapias en pacientes con II por DAC y se comparó con aquellos pacientes reperfundidos con II por otras causas. Método: Estudio observacional retrospectivo multicéntrico de pacientes con II por DAC basado en el Registro Nacional de Ictus de la Sociedad Española de Neurología durante el periodo 2011−2019. Se realizaron análisis comparativos entre: a) pacientes con DAC tratados y no con terapias de reperfusión y b) pacientes reperfundidos con II por DAC y pacientes reperfundidos con II por otras causas. Se incluyeron variables epidemiológicas, del ictus y resultados al alta y a los 3 meses. Resultados: Un total de 21.037 pacientes con II fueron incluidos. 223 (1%) fueron por DAC y 68 (30%) recibieron tratamiento de reperfusión. El uso de tratamientos de reperfusión fue menor en los casos de DAC de arteria vertebral y mayor en los casos de oclusión carotídea. Los pacientes con II por DAC reperfundidos respecto a aquellos con II reperfundidos por otras causas fueron más jóvenes, la TM se utilizó más y la FIV menos. Las complicaciones hemorrágicas, la mortalidad y la autonomía a los 3 meses fueron similares. Conclusiones: Las terapias de reperfusión se usan con frecuencia en los pacientes con II por DAC. Los resultados demuestran eficacia y seguridad y son equiparables a los pacientes tratados con terapias de reperfusión por II de otras causas.

Resumo A embolia pulmonar (EP) é a terceira maior causa de morte cardiovascular e a principal de morte evitável intra-hospitalar no mundo. O conceito PERT® (do inglês, pulmonary embolism response team) envolve seu diagnóstico e tratamento precoce e multidisciplinar. A trombose venosa profunda (TVP) é a sua causa inicial na maioria dos casos e é responsável por complicações como a recidiva tromboembólica, a síndrome pós-trombótica e a hipertensão pulmonar tromboembólica crônica. Uma abordagem inicial semelhante ao PERT nos casos de TVP ilíaco-femoral grave pode reduzir não apenas o risco imediato de EP e morte, mas também suas sequelas tardias. Novas técnicas percutâneas e aparatos de trombectomia mecânica para o tromboembolismo venoso (TEV) vêm demonstrando resultados clínicos encorajadores. Propomos o desenvolvimento de um conceito ampliado de resposta rápida ao TEV, que envolve não apenas a EP (PERT®) mas também os casos graves de TVP: o time de resposta rápida para o TEV (TRETEV®), ou do inglês Venous Thromboembolism Response Team (VTERT®).

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Background/Objective: There is controversy regarding the need to use advanced imaging to select candidates for thrombectomy in late window acute ischemic stroke (AIS). Hypoattenuation on CT angiography source images (CTA-SI) in arterial phase has been shown to be more sensitive than Alberta Stroke Program Early CT Score (ASPECTS) of brain parenchyma to determine tissue at risk of ischemia. Our hypothesis is that the addition of a second acquisition at 35-50 seconds could complement the assessment of hypoperfused tissue that fails to receive flow through pial vessels. Methods: Patients with large vessel occlusion and 6-24 hours from symptom onset, admitted between August 2019 and July 2023, were evaluated with dual-phase CT angiography (CTA) and CT-Perfusion. A vascular neurologist estimated CTA-SI ASPECTS in both phases at the time of data entry into the RECCA registry. In contrast, the post-processing of CT-Perfusion images was performed in an automated way through RAPID© software. The association between automated CT-perfusion values and dual-phase CTA-SI ASPECTS was assessed through a correlation coefficient. Results: Pearson's coefficient demonstrated a high correlation between ischemic core volume and delayed phase CTA (CTA-DP) ASPECTS with an inverse association of -0.93 and between Tmax > 6 sec volume and arterial phase CTA (CTA-AP) ASPECTS with a value of -0.88. Conclusions: CTA-derived source images (CTA-SI) in two phases may be useful in the selection of patients with AIS presenting beyond the 6-hour window. [ABSTRACT FROM AUTHOR]

We describe the case of a female patient with severe acute pancreatitis of biliary origin who presented with clinical deterioration. A thrombosis of the superior mesenteric artery and hepatic artery was identified as the cause, thus creating a rare vascular complication. She was taken for pharmacological and mechanical thrombectomy, with the subsequent death of the patient. Arterial vascular complications are an entity little recognized in the medical literature; they have a high mortality rate and pose a significant diagnostic and therapeutic challenge. [ABSTRACT FROM AUTHOR]

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Se describe el caso de una paciente femenina con pancreatitis aguda grave de origen biliar quien presentó deterioro clínico, y como causa se identificó una trombosis de arteria mesentérica superior y arteria hepática, de modo que se configuró una complicación vascular poco frecuente. Fue llevada a trombectomía farmacológica y mecánica, con el posterior deceso de la paciente. Las complicaciones vasculares arteriales son una entidad poco reconocida en la literatura médica, tienen una alta tasa de mortalidad y suponen un reto diagnóstico y terapéutico importante.

Resumen Introducción. Usualmente el tratamiento de la enfermedad arterial periférica (EAP) es quirúrgico convencional o endovascular guiado mediante angiografía o ultrasonido. Existen reportes del uso del sistema de aterectomía y trombectomía mecánica Rotarex® y/o del ultrasonido dúplex (UD) como guías para trombectomías de forma separada; sin embargo, la combinación de ambos dispositivos representa una gran ventaja al convertirse en una opción con buena tasa de éxito que podría emplearse en el manejo de diferentes tipos de patologías. Presentación de los casos. Se presentan dos casos de pacientes con antecedente de colocación de stent infrapoplíteo, quienes asistieron al servicio de urgencias de un hospital universitario de Bucaramanga (Colombia) por claudicación intermitente, discromía y dificultad en la marcha (índice tobillo-brazo en examen físico de 0.3 y 0.6). En ambos pacientes se evidenció trombosis del stent mediante dúplex arterial, por lo que se les realizó angioplastia con sistema Rotarex® guiada por UD, logrando resultados clínicos y hemodinámicos satisfactorios en el postoperatorio. Los pacientes fueron dados de alta a los 4 y 6 días después del procedimiento y en ninguno de los dos casos hubo seguimiento posterior al egreso. Conclusiones. La trombectomía con sistema Rotarex® guiada por UD se plantea como una alternativa viable, real y costo-efectiva en pacientes con EAP. Se recomienda implementar este tipo de estrategias con el fin de realizar trabajos con mayor poder estadístico para el análisis de los resultados y que permitan obtener conclusiones reproducibles sobre tasas de éxito, permeabilidad y salvamento de la extremidad.

O Tromboembolismo Arterial (TEA) é uma condição clinicamente desafiadora que afeta a saúde felina, com maior incidência em gatos que apresentam cardiopatias. Este relato de caso apresenta um cenário menos comum, onde um felino de quatro anos, sem histórico de problemas cardíacos, foi diagnosticado com TEA. O animal foi atendido em um hospital veterinário, na cidade de São Paulo, em estado de emergência, com queixa de paraplegia aguda e dor intensa nos membros pélvicos. Antes do evento, o gato estava em bom estado de saúde, com normorexia, normodipsia, normouria e normoquesia. Foi feita analgesia e sedação para controle da dor e uma melhor avaliação, sendo identificada a ausência de dor superficial e profunda nos dois membros pélvicos durante o exame físico. O paciente foi encaminhado para internação para controle da dor, coleta e exames de sangue, imagem e cardiológicos para triagem. Pela tomografia, foi identificada uma massa (trombo/êmbolo) na artéria ilíaca direita. Durante todo o período de internação, o paciente foi submetido a protocolos específicos para o TEA e, após estabilização do quadro, foi indicada a intervenção cirúrgica de trombectomia. O procedimento ocorreu sem intercorrências. O paciente permaneceu internado por mais dois dias para avaliação e evolução do quadro clínico, sendo liberado com alta assistida e recomendações de fisioterapia e retornos semanais para alta definitiva.

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Background Acute ischemic stroke (AIS) is an extremely time-sensitive condition. The field triage of stroke patients should consider a careful balance between the best destination for the timely delivery of intravenous and/or endovascular reperfusion therapies. The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale has been shown to have an accuracy comparable to that of the National Institutes of Health Stroke Scale (NIHSS). However, it has not been tested in the field.

Objective: To analyze the results of endovascular treatment of venous anastomotic stenosis (VAS) in humero-axillary arteriovenous grafts (HAG), comparing outcomes between patent and thrombosed HAG. Material and methods: A retrospective cohort study was made of endovascular treated patients because of a VAS in a HAG between January 2009 and December 2019. Group A: Thrombosed HAG secondary to a VAS. Group B: Patent HAG with a VAS detected during follow-up. Technical success was defined as residual stenosis after treatment

Introduction: This study describes the experience of a reference center using continuous aspiration mechanical thrombectomy for acute high- and intermediate-high-risk pulmonary embolism (PE). Methods: Twenty-nine consecutive patients with acute central PE (48.3% high-risk PE; 82.8% in class >III from the original Pulmonary Embolism Severity Index score; median Charlson Comorbidity Index of 4) were treated with the Indigo® Mechanical Thrombectomy System between March 2018 and March 2020. Technical success was defined as successful placement of the device and initiation of aspiration thrombectomy. Clinical success was defined as any improvement in hemodynamic and/or oxygenation parameters, pulmonary hypertension or right heart strain at 48 hours, and survival to hospital discharge. Safety was defined as freedom from severe adverse events potentially related to the procedure. Three-month follow-up results were collected. Results: Technical success was 96.6%. Miller index and systolic pulmonary arterial pressure were significantly reduced after the procedure (-5.5±3.0, and -10.2±11.5 mmHg, respectively, both pIII do score PESI; mediana 4 do índice de comorbilidades de Charlson) com o sistema de trombectomia mecânica Indigo entre março/2018 e março/2020. Definiu-se sucesso técnico como colocação bem-sucedida do dispositivo e início da trombectomia. Definiu-se sucesso clínico como melhoria hemodinâmica, da oxigenação, hipertensão pulmonar e/ou da sobrecarga cardíaca direita às 48 horas; e sobrevivência hospitalar. Definiu-se segurança como ausência de eventos adversos graves relacionados com o procedimento. Registou-se seguimento clínico a três meses. Resultados: O sucesso técnico foi 96,6%. O índice de Miller e a pressão arterial pulmonar sistólica reduziram-se significativamente (-5,5±3,0 e -10,2±11,5 mmHg, respetivamente, p

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A embolia pulmonar maciça aguda é a forma mais grave de tromboembolismo venoso, que pode causar choque obstrutivo e levar à parada cardíaca e morte. Neste relato de caso, os autores apresentam o caso de uma mulher de 49 anos que se recuperou com sucesso de uma embolia pulmonar maciça com o uso combinado de oxigenação por membrana extracorpórea venoarterial e trombectomia por aspiração pulmonar, sem complicações decorrentes desses procedimentos. Embora a evidência de benefício do suporte mecânico não tenha sido estabelecida em pacientes com embolia pulmonar maciça, a implementação de suporte cardiocirculatório extracorpóreo durante a reanimação pode permitir a melhora da perfusão sistêmica dos órgãos e mais chances de sobrevida. Diretrizes recentes da European Society of Cardiology afirmam que a oxigenação por membrana extracorpórea venoarterial combinada com tratamento por cateter RESUMO pode ser considerada em pacientes que apresentem embolia pulmonar maciça e parada cardíaca refratária. O uso de oxigenação por membrana extracorpórea como técnica autônoma com anticoagulação permanece controverso. Deve-se considerar outras terapias, como trombectomia cirúrgica ou percutânea. Como essa intervenção não é sustentada por estudos de alta qualidade, acreditamos ser importante relatar casos concretos de sucesso. Com este relato de caso, ilustramos o benefício derivado da reanimação assistida por suporte mecânico extracorpóreo e trombectomia por aspiração precoce em pacientes com embolia pulmonar maciça. Além disso, enfatizamos a sinergia que deriva de sistemas multidisciplinares integrados para fornecer intervenções complexas, sendo exemplos notáveis a oxigenação por membrana extracorpórea e a Cardiologia Intervencionista. [ABSTRACT FROM AUTHOR]

Pulmonary embolism (PE) is the leading cause of hospital death and the third most frequent cause of cardiovascular mortality. Traditionally, treatment options have included anticoagulation, thrombolysis, or surgery; however, catheter-directed interventions (CDI), including catheter-directed thrombolysis and aspiration thrombectomy, have been developed for patients with intermediate- or high-risk PE. These techniques can rapidly improve right ventricular function, hemodynamic status, and mortality in some patients, although there is a lack of evidence from randomized controlled trials. This document, prepared by the Interventional Cardiology Association, the Association of Ischemic Heart Disease and Acute Cardiovascular Care, and the Working Group on Pulmonary Hypertension of the Spanish Society of Cardiology (SEC), reviews the current recommendations and available evidence on the management of PE. It emphasizes the importance of rapid response teams, risk stratification, and early patient monitoring in identifying candidates for reperfusion. Based on existing clinical evidence on CDI, the document discusses various clinical scenarios and provides guidance on patient selection, particularly in situations of uncertainty due to insufficient evidence. Lastly, it describes periprocedural support, highlighting the necessary multidisciplinary approach to improve outcomes and reduce morbidity and mortality in patients with PE. Full English text available from: www.revespcardiol.org/en., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

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Resumo A trombectomia mecânica venosa ilíaca geralmente é realizada por acesso em veias localizadas nos membros inferiores, o que impossibilita o tratamento da veia femoral profunda, que, por sua vez, é uma importante via de influxo ao stent venoso ilíaco. Descrevemos um caso clínico em que foi aplicada a técnica inédita de trombectomia percutânea, angioplastia e implante de stent, realizada por sessão e acesso único, obtido na veia jugular interna.

Background: In addition to stent retrievers, direct aspiration has become a reasonable thrombectomy strategy., Objectives: We carried out the thrombectomy by guiding the aspiration catheter fully over the clot and performing immediate manual aspiration; we call this procedure "embed aspiration"., Methods: In this prospective, non-randomised, single-centre study, we included all patients treated at a high volume-of-care stroke centre between 2017 and 2018 for the TRIANA (Thrombectomy in Andalusia using Aspiration) registry. Thrombectomy was carried out by embed aspiration. Patients were classified according to the success (eTICI 2b67-2c-3) or failure (eTICI 0-1-2a-2b50) of the procedure. Baseline clinical data and outcomes were compared, and multivariate analysis was performed., Results: The embed aspiration technique was used in 370 patients. Treatment was successful in 90.3% of patients. Mean puncture-to-recanalisation time was 25 minutes. The overall rate of good outcomes (mRS 0-2) at 3 months was 64%., Conclusions: This study supports real-life evidence that standardised embed aspiration may be an alternative to stent retrievers for thrombectomy., (Copyright © 2021 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)

Homem de 72 anos, fumador, com diabetes tipo 2, hipertensão arterial e enfarte agudo do miocárdio com cirurgia de revascularização, suspendeu medicação há 3 anos por iniciativa própria. Inicia quadro de dor súbita no terço distal da perna esquerda com pé frio e sem pulsos pedioso e tibial posterior. [...]

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Objetivo: evaluar los resultados de la trombectomía más fleboextracción como alternativa en el manejo de la enfermedad hemorroidal externa trombosada. Materiales: estudio observacional, cuantitativo, retrospectivo, transversal y descriptivo de los pacientes que consultaron y se sometieron a la trombectomía más fleboextracción como técnica alternativa en el manejo de la enfermedad hemorroidal externa trombosada en el servicio de coloproctología del Hospital Militar Central desde el primero de enero de 2014 hasta el 31 de diciembre de 2016. Resultados: se encontró que 197 pacientes consultaron por hemorroides externas trombosadas, el 71 % eran hombres y el promedio de edad para el grupo de manejo conservador fue de 48,5 años, frente al promedio del grupo de manejo quirúrgico, que fue de 43,2 años. El seguimiento promedio posterior al inicio del tratamiento médico o quirúrgico fue de 16 meses. En el grupo de manejo quirúrgico, la tasa de recurrencia fue del 7,2 % y el intervalo de recurrencia fue 29,2 meses. Conclusiones: los pacientes a quienes se les practicó la técnica de trombectomía más fleboextracción presentaron una menor tasa de retrombosis hemorroidal, menor tasa de dolor y sangrado posoperatorio. La trombectomía hemorroidal con fleboextracción es una técnica bien tolerada en el consultorio, que se puede realizar sin anestesia, a diferencia del estándar de manejo actual con hemorroidectomía externa en elipse, que requiere anestesia local, regional o general, y una sala de procedimientos quirúrgicos que deja un defecto mayor en la piel por el tejido resecado, un mayor tiempo de cicatrización y de dolor posoperatorio.

Introduction - According to the 2017 Portuguese Program for Cardio-Cerebrovascular Diseases, the OECD reports that cardiovascular diseases are the leading cause of death in member states of the European Union, representing about 36% of deaths in the region in 2010. This figure includes brain vascular diseases. It was intended to evaluate the value of cerebral blood flow (CBF) that best predicts the outcomes from the Via Verde procedure in stroke, with patients undergoing thrombectomy. It was also purpose of this study to increase the reliability of prognosis, optimizing the technique and radiological procedures for determining volumes of 'core' and 'penumbra'. Methods - This was a retrospective study whose clinical cases were collected from the database of Hospital de Beatriz Ângelo (Loures, PT) based on predefined inclusion criteria. After the acquisition of perfusion computed tomography (PCT), a sample of 17 patients, admitted through the Via Verde stroke program, was post-processed using the syngo.via software (NEURO Perfusion application). The data resulting from the perfusion maps were analyzed statistically using the SPSS® [IBM v. 23.0], allowing an analysis that reflected the CBF values related to the volumes of 'core' and 'penumbra'. Results - It was found that there is no statistically significant correlation between age, stroke time extends, and pre-therapeutic ASPECTS with the other variables under study. Relating the post-therapeutic ASPECTS to the core levels 10, 20, and 30 of CBF, it was found that the higher value of ASPECTS corresponds lower volume of the core. A statistically significant reduction (p=0.003) of the ASPECTS values was detected from pre- to post-therapy. The 'core' 10CBF value presents a lower volume of brain tissue infarcted in relation to the 'core' 30CBF, pointing to an inverse trend with the value of 'penumbra' volume. Conclusion - This study proves that it is possible, with a CBF of 10mL / 100g / min, to restore the flow needed to repair the neurological function of affected tissue, and with this CBF the largest volume of brain tissue is obtained for the 'penumbra' and a lower volume of 'core'. The processing and interpretation of the perfusion maps induce variation in the volume of the score of 'core' and 'penumbra'. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the results of thrombectomy combined with vein stripping as an alternative to treat external thrombosed hemorrhoid disease. Materials and methods: This is an observational, quantitative, retrospective, cross-sectional and descriptive study of the patients who underwent thrombectomy combined with vein stripping as an alternative technique to treat thrombosed external hemorrhoid disease at the Coloproctology Service of the Hospital Militar Central from January 1, 2014, to December 31, 2016. Results: It was found that 197 patients consulted due to thrombosed external hemorrhoids. 71% were men. The average age for the conservative treatment group vs. the surgical treatment group was 48.5 vs. 43.2 years, respectively. The average follow-up time after initiation of medical or surgical treatment was 16 months. In the surgical treatment group, the recurrence rate was 7.2% and the recurrence interval was 29.2 months. Conclusions: Patients who underwent thrombectomy combined with vein stripping had a lower recurrence rate of thrombosed hemorrhoids, a lower pain score, and less postoperative bleeding. Hemorrhoid thrombectomy combined with vein stripping is a well-tolerated technique that can be performed at the doctor's office without anesthesia, unlike the current management standard with external elliptical hemorrhoidectomy, which that requires local, regional, or general anesthesia, and a surgical room, leaving a larger skin defect following the resection of the tissue, with longer healing time and greater postoperative pain. [ABSTRACT FROM AUTHOR]

PROPÓSITO: La pandemia mundial por covid-19 ha impuesto nuevos retos para la atención de pacientes con infarto cerebral con oclusión de gran vaso, el tratamiento endovascular con trombectomía mecánica es la elección para estos casos. Las recomendaciones que se presentan buscan mantener la eficacia, la celeridad y la seguridad de la intervención siguiendo las nuevas medidas de bioseguridad. METODOLOGÍA: Revisión no sistemática de la literatura de manejo endovascular para el infarto cerebral en época pre covid-19 y durante la pandemia por covid-19. Los aspectos de la intervención, que a juicio de los autores se modificaron, se presentan en forma de recomendaciones narrativas. RESULTADOS: Se identificaron tres fases en el manejo endovascular del infarto cerebral: preintervención, intervención y postintervención. En la primera se incluyen los temas de selección del candidato, la tamización para covid-19, el consentimiento informado, la notificación-preparación del equipo y la modalidad anestésica. En las otras dos fases se hacen recomendaciones generales. Por último, se identifican puntos importantes para la toma de decisiones en el manejo endovascular del infarto cerebral. CONCLUSIÓN: Las recomendaciones pretenden facilitar la adaptación de los protocolos, evitar retrasos y mantener la seguridad de la intervención endovascular en pacientes con infarto cerebral con oclusión de gran vaso candidatos a trombectomía mecánica en época de covid-19.

El alteplase es el único fibrinolítico actualmente autorizado en Colombia para el tratamiento del ACV isquémico agudo. El tenecteplase constituye una nueva alternativa de tratamiento en esta enfermedad al ofrecer mejor perfil farmacológico, mayor eficacia con mejores desenlaces mayores, porcentajes de recanalización, y con seguridad similar a la del alteplase. La posibilidad de desabastecimiento temporal de alteplase con disponibilidad de tenecteplase en Colombia abre la posibilidad de su uso en ACV isquémico agudo.

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Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Acute stroke is one of the most common causes of morbidity and mortality worldwide. Mechanical thrombectomy is the endovascular procedure that has shown better results in patients with a large vessel involvement. We present here a case of a patient who had a five-hour history of thrombosis of the left mid cerebral artery who developed mixed aphasia and hemiparesis, ASPECTS scale of five, NIHSS score of 14 and a modified Rankin scale (mRS) of 4. A mechanical thrombectomy was performed with stents Solitaire AB and ERIC and manual aspiration of the clot with a 60cc syringe plus instillation of intra-arterial alteplase. Immediate reperfusion was complete (TICI 3). The mRS after the procedure was 2. [ABSTRACT FROM AUTHOR]

Vascular cerebral ischemic disease constitutes a leading cause of morbidity and mortality as well as of disability worldwide. Its incidence has risen in developing countries in which it is estimated that two thirds of all cases occur annually. Risk factors for ischemic stroke are related with obesity and sedentary lifestyle; nonetheless, hypertension is the main factor involved in the occurrence of the disease. The prognosis depends directly on the time since the onset of the symptoms and the establishment of an optimal treatment. In recent years, important advances in the medical and interventionist treatment of ischemic stroke has been made which has resulted in a lower rate of deaths and an improvement in functionality at the short term; however, some of the therapeutic options are not available in most of the hospital centers and many patients are not eligible for endovascular procedures as they attend late or there is a delay in the identification and diagnosis of the disease. Therefore, it is of major importance that physicians and specialists taking care of patients with neurological impairment know diagnostic and therapeutic tools useful in the approach and management of ischemic stroke to improve the prognosis of the affected individuals. In this article we review the clinical approach to patients with vascular cerebral ischemic disease and make an update of the treatment with a focus on the practice of evidence-based medicine. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Colombiana is the property of Acta Medica Colombiana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)