Experiencia en el tratamiento endovascular del accidente cerebrovascular isquémico agudo en un centro chileno

S., Pablo Reyes; O., Lautaro Badilla; Andreu, D.; Besa, Valentina; Rivera, Rodrigo; Sordo, Gabriel; Bustamante, Gonzalo; Pasten, Juan A.; Vargas, Gabriel; Silva, Paula; T, Rodrigo Guerrero; Feuerhake, Walter

doi:10.4067/s0034-98872018000600708

Cited by 8 publications

(11 citation statements)

References 25 publications

(35 reference statements)

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“…However, there is still a large gap in the availability of MT for the remaining 75% of the population who depend on the public healthcare system. We showed in a recent publication good results in MT for AIS in a single private stroke center in Santiago - Chile, 15 which encouraged us to start a pilot program in 2017 to reduce the breach of stroke care standards between private and public healthcare and to increasingly provide a timely and effective treatment for as many patients as possible.…”

Section: Discussionmentioning

confidence: 94%

Breaking the breach in Latin America: A pilot study of mechanical thrombectomy in the public healthcare system in Chile

et al. 2020

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Background Mechanical Thrombectomy (MT) is the standard of care for treatment of large vessel occlusion stroke. Until the beginning of 2020 MT was not funded nor widely implemented at the public healthcare level in Chile. Objective To describe the results of a pilot program created to provide access to public MT in Santiago - Chile. Methods Analysis from a prospectively collected database of MT cases performed between September 2017 and September 2019 in one center. A stroke network was developed with a single MT capable stroke center and five primary stroke centers. The primary efficacy endpoint was the rate of functional independence (mRS 0-2) at 90 days. Successful reperfusion was defined as 2 b-3 according to the thrombolysis in cerebral infarction scale. Safety outcomes include the rates of symptomatic intracranial hemorrhage and 90-day mortality. Results A total of 100 patients were treated over the study period. Their mean age was 62.8 ± 11.8 years and median baseline National Institute of Health Stroke Scale (NIHSS) measurement was 17. Seventy-seven percent of the patients received intra venous thrombolysis. Successful reperfusion was achieved in 95% of the cases. NIHSS at 24 hours showed a median drop of 7 points from baseline (p < 0.00001) and 50% of the follow-up patients were functionally independent at 90 days. Symptomatic Intracerebral hemorrhage occurred in 5% of the patients and 90-day all case mortality was 11%. Conclusions We demonstrated the feasibility of a publicly funded MT program in Chile, with similar results as other international randomized control trials.

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Section: Discussionmentioning

confidence: 94%

Breaking the breach in Latin America: A pilot study of mechanical thrombectomy in the public healthcare system in Chile

et al. 2020

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“…Varios estudios demuestran que los tratamientos tienen mayor eficacia si se aplican durante la ventana terapéutica; en el caso de la trombólisis endovenosa, la aplicación del fármaco Alteplasa dentro de las 4 -5 horas posteriores al evento, ha evidenciado menor número de complicaciones y rápida recuperación. Mientras que, en la trombectomía mecánica, la ejecución de este procedimiento se lleva a cabo en pacientes en estado crítico, con un cuadro clínico de más de 5 horas de evolución, sin embargo, debido al manejo tardío, los pacientes sometidos a este procedimiento requieren terapias de rehabilitación para recuperar sus funciones motoras (Vamsi et al, 2018;Reyes et al, 2018).…”

Section: Resultados Y Discusiónunclassified

“…Por otro lado, un tratamiento complementario es la trombólisis mecánica, la cual se emplea para eliminar los coágulos resistentes mediante dispositivos mecánicos como los stents autoexpandibles, con el fin de restablecer el flujo sanguíneo del tejido cerebral; dicho procedimiento está indicado en pacientes que poseen un vaso sanguíneo grande ocluido y con un intervalo de 6 -12 horas de evolución desde el inicio de los síntomas (Nogueira et al, 2018). Sin embargo, Reyes et al (2018) menciona que ''este procedimiento está contraindicado en pacientes con evidencia de infarto extenso, antecedentes de coagulopatía, hiperglicemia y alto riesgo de hemorragia sistémica''. En la Tabla 3 se describen las principales actividades que realiza el personal de enfermería, posterior a este procedimiento.…”

Section: Elaborado Por: Autoresunclassified

Actuación de enfermería en el manejo de pacientes con ACV isquémico

Zurita

Guamán

Caba

et al. 2022

SIJIS

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Introducción: el accidente cerebrovascular es considerado una de las principales causas de muerte y discapacidad a nivel mundial, su valoración, diagnóstico y tratamiento adecuado es primordial para evitar secuelas neurológicas. Objetivo: Analizar la actuación de enfermería en el manejo de pacientes con ACV isquémico, mediante una revisión sistemática. Metodología: Se realizó una revisión sistemática de la literatura en buscadores académicos como Google Académico, PubMed, Scielo y Elsevier, acerca del rol de enfermería en el manejo de pacientes con ACV, empleándose un total de 16 artículos originales. Resultados: Se pone de manifiesto que las intervenciones que realiza el personal de enfermería con los pacientes post-ictus son de vital importancia, pues se requiere de un trabajo interdisciplinario. Además de la aplicación de diversas escalas para valorar el estado de los pacientes, se hace hincapié en las actividades que se desarrollan en el tratamiento por trombólisis endovenosa y la trombectomía mecánica, en donde es fundamental considerar el tiempo de evolución para tomar decisiones oportunas; del mismo modo, se encargan de monitorizar el progreso de los pacientes y realizar actividades de rehabilitación con los mismos, para su recuperación. Conclusiones: El manejo de pacientes que han sufrido un ACV es riguroso, por lo cual es necesario que los profesionales de enfermería que se encargan de su cuidado posean amplios conocimientos, ya que intervienen especialmente en el manejo farmacológico y en la monitorización hemodinámica de los pacientes, asimismo debido a que se pueden desencadenar varias secuelas tras el ACV, participan en su rehabilitación.

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“…Many studies have reported the benefit of dual anti platelet therapy such as aspirin and clopidogrel in lowering the risk of stroke risk in patients with intracranial atherosclerosis. Surgical management of critical intracranial atherosclerosis may consist of measures such as extra-cranial to intracranial bye-pass grafting, endovascular treatment such as percutaneous trans-luminal angioplasty and stenting 5 . In patients with any degree of intracranial atherosclerosis the essence of management lies in the early diagnosis, identification of risk factors and their modification and drug therapy in patients diagnosed to be having significant atherosclerosis on the basis of imaging.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors, Vascular Lesion Distribution and Outcome of Strokes Due to Intracranial Atherosclerosis in rural south India

Rajendran¹

2019

jmscr

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Background: Intracranial atherosclerotic stenosis (ICAS) is a common cause of ischemic stroke worldwide and probably in India.. The common risk factors for development of intracranial atherosclerosis include hypertension, diabetes, tobacco use and hyperlipidemia. The morbidity and mortality associated with ischemic stroke makes it essential that individuals with risk factors must be identified and appropriate interventions must be done to prevent stroke. Aim: The aim of this study was to describe the risk factors, distribution of vascular lesions and outcome of stroke due to ICAS. Methodology: All consecutive patients of ischemic stroke due to ICAS were enrolled prospectively on the basis of a predefined inclusion and exclusion criteria. Demographic details and history of systemic illnesses particularly diabetes and hypertension was noted in all the cases. Vascular territory involved was determined on the basis of imaging (computerized tomography, Magnetic resonance imaging and MR angiography. Details about, risk factors, vascular lesions and outcome were noted. Data was examined using SSPE 16.0 software. For statistical purposes p value less than 0.05 was taken as statistically significant. Result: Out of 455 patients there were 328 (72.09%) males and 127 (27.91%) females with a M:F ratio of 1:0.38. The most common age group affected in males and females was 61-70 years (M-29.45%, F-11.42%) followed by 51-60 years (25.93%) in males and more than 70 years (9.89%) in females. The difference in mean age of males and females was found to be statistically 'highly significant'. The most common risk factors associated with stroke was hypertension (54.29%) followed by diabetes mellitus (51.43%).Middle cerebral artery was involved in majority of the cases (n-299, 65.71%). Mean duration of hospital stay was found to be 9.81 +/-7.17 days. Mortality rate was found to be 11.65%. Conclusion: Intracranial atherosclerotic stenosis (ICAS) is a common cause of ischemic strokeIdentification of risk factors and their management remains the best strategy for preventing recurrence.

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Experiencia en el tratamiento endovascular del accidente cerebrovascular isquémico agudo en un centro chileno

Cited by 8 publications

References 25 publications

Breaking the breach in Latin America: A pilot study of mechanical thrombectomy in the public healthcare system in Chile

Breaking the breach in Latin America: A pilot study of mechanical thrombectomy in the public healthcare system in Chile

Actuación de enfermería en el manejo de pacientes con ACV isquémico

Risk Factors, Vascular Lesion Distribution and Outcome of Strokes Due to Intracranial Atherosclerosis in rural south India

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