A new era of endovascular treatment for acute ischemic stroke: what are the implications for stroke care in Brazil?

Abstract

OPINIONA new era of endovascular treatment for acute ischemic stroke: what are the implications for stroke care in Brazil?Uma nova era de tratamento endovascular para o AVC isquêmico: quais são as implicações para o Brasil?In Brazil, stroke has been a neglected disease and the first cause of mortality for decades 1 . After recent advances on stroke policies and practices, stroke has now dropped to the second cause of mortality 1,2,3,4 . A small victory, but we are still far from winning the war against this condition. Less than 1% of stroke patients in Brazil have access to intravenous thrombolysis and admission to a stroke unit

Reperfusion therapy for acute ischemic stroke: where are we in 2023?

“…It is necessary to optimize urgent care through a coordinated stroke pathway for rapid recognition and treatment of patients using evidence-based protocols. 4 According to national and international clinical guidelines, 5 6 7 8 the interventions with a high level of evidence of benefit in acute stroke care are acetylsalicylic acid in the first 24 hours of ischemic stroke for non-thrombolysed patients to avoid stroke recurrence; admission of all patients to stroke units, with a multidisciplinary team trained and engaged in early assessment and rehabilitation protocols; intravenous (IV) thrombolytic treatment in disabling ischemic stroke within 4.5 hours of symptom onset; mechanical thrombectomy (MT) in stroke with large vessel occlusion (LVO) within 24 hours of symptom onset, and decompressive craniectomy of malignant middle cerebral artery (MCA) infarction within 48 hours. The first four out of these five recommendations have already been implemented in the Brazilian SUS.…”