Dados do Trabalho

Título

Recanalization therapies in acute ischemic stroke: The experience of a Brazilian University Hospital.

Resumo

BACKGROUND: Stroke is the second leading cause of death and disability in the world. Ischemic stroke (IS) corresponds to 85% of cases and its treatment reduces sequelae and mortality. However, recanalization therapies for stroke are available only to a small portion of the population and there are few data in the brazilian literature on this topic.
OBJECTIVES: To evaluate the clinical characteristics of patients undergoing recanalization therapy treated at a public University Hospital in Ribeirão Preto; to identify the predictors of in-hospital mortality and symptomatic hemorrhagic transformation (HTs) and good functional outcome using the Modified Rankin Scale (mRs) 0-2 at 90 days after therapy was instituted.
METHODOLOGY: A review of the medical records of patients with acute stroke who underwent endovenous thrombolysis and/or endovascular treatment between the years 2001 to 2017 was performed.
RESULTS: There were 869 patients treated, most of them male (57%), mean age of 66.5±13.1 years, median NIHSS 15 and 65.7% with proximal occlusion. The rate of intravenous thrombolysis was 87.5% and endovascular treatment was 28.7%. Mean admission-needle time was 57 minutes [35-70] and ictus-needle time was 204 minutes [150-248]. HTs occurred in 5.9% of patients, in-hospital death in 16.8% and the median mRs after 90 days was 3. The predictors of good functional outcome (0-2) were age and NIHSS; for hospital mortality, in addition to these, diabetes mellitus, proximal occlusion and HTs; for HTs, NIHSS, proximal occlusion and blood glucose.
CONCLUSION: The profile of patients with acute ischemic stroke is predominantly male, in the sixth decade of life, with several comorbidities, admitted within 2.5 hours of symptom onset, high blood pressure and blood glucose levels, in addition to severe and severe symptoms. high rate of proximal occlusion. The HT rate was similar to those reported in international and national studies. The shorter treatment time had an impact on the functional outcome, supported by previous evidence. The present study presents the largest series of patients treated with thrombolysis and/or thrombectomy in Brazil, throughout a historical serie, showing the safety of recanalization therapies and less chance of sequelae, with 40% of patients having a good functional outcome.