Avaliação das terapias de reperfusão cerebral no acidente vascular cerebral isquêmico, realizadas no Hospital das Clínicas da Faculdade de Medicina de Botucatu-UNESP
Carregando...
Data
2021-05-24
Autores
Furlan, Natalia Eduarda
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
As doenças cerebrovasculares estão entre as principais causas de morbimortalidade no Brasil, causando um grande impacto sobre a saúde da população. A terapia de reperfusão é indicada para o tratamento da fase aguda do acidente vascular cerebral isquêmico (AVCi). Porém, os resultados e a modalidade da terapia a ser utilizada, ainda são assunto de debate na literatura. Objetivo: Descrever a evolução clínica dos pacientes submetidos à terapêutica de reperfusão cerebral no AVCi e avaliar as associações entre as modalidades da terapia e a evolução clínica dos pacientes. Métodos: Coorte observacional retrospectiva, avaliando através do prontuário eletrônico, o período agudo e 3 meses após o evento, dos pacientes diagnosticados com AVCi e que foram tratados com terapia de reperfusão cerebral endovenosa (IV) ou trombectomia mecânica (IA) e/ou terapia combinada (endovenosa seguida de trombectomia mecânica), internados no Hospital das Clínicas da Faculdade de Medicina de Botucatu (HC-UNESP) no período de junho de 2012 a dezembro de 2020. Foi considerado nível de significância de p<0,05 para todas as análises. Resultados: Os pacientes mais velhos tiveram os desfechos mais desfavoráveis, exceto para taxa de mortalidade, na alta hospitalar. No grupo de pacientes tratados com terapia combinada (endovenosa seguida de trombectomia mecânica) houve um aumento na incidência de morte, bem como aumento na pontuação do NIH Stroke Scale (NIHSS). As curvas ROC mostraram que um aumento ou diminuição de 2,5 pontos no NIHSS foi associado a incapacidade grave ou morte após o tratamento. Conclusão: A reperfusão cerebral foi um tratamento viável para o AVCi em pacientes idosos e muito idosos, pois não aumentou a mortalidade. No entanto, observou-se que os idosos apresentaram piores resultados funcionais na alta hospitalar e 90 dias após o acidente vascular cerebral (AVC). Quanto a terapia utilizada no tratamento, os resultados piores foram altamente sensíveis e especificados com uma variação de pontuação NIHSS de 2,5 pontos após a intervenção. Os critérios clínicos de seleção de pacientes para tratamento com terapia combinada, devem ser melhor estabelecidos.
Cerebrovascular diseases are among the leading causes of morbidity and mortality in Brazil, causing a major impact on the health of the population, the cerebral reperfusion therapy is indicated for the treatment of the acute phase of ischemic stroke (ischemic stroke). However, the results and the modality of this therapy to be used is still a matter of debate in the literature. Objective: To describe the clinical outcome of patients undergoing cerebral reperfusion therapy for ischemic stroke and to evaluate the associations between the modalities of therapy and clinical outcome of patients. Methods: Retrospective observational cohort, evaluating, through electronic medical records, the acute period and 3 months after the event, of patients diagnosed with CVA and who were treated with intravenous (IV) cerebral reperfusion therapy or mechanical thrombectomy (IA) and/or therapy combined (intravenous followed by mechanical thrombectomy), admitted to the Hospital das Clínicas da Faculdade de Medicina de Botucatu (HC-UNESP) in the period from June 2012 to December 2020. A significance level of p<0.05 was considered for all analyses. Results: Older patients had the most unfavorable outcomes, except for mortality rate, at hospital discharge. In the group of patients treated with combination therapy (intravenous followed by mechanical thrombectomy) there was an increased incidence of death as well as increased NIH Stroke Scale Score (NIHSS). ROC curves showed that a 2.5 point increase or decrease in NIHSS was associated with severe disability or death after treatment. Conclusion: Cerebral reperfusion was a feasible treatment for stroke in elderly and very elderly patients, as it did not increase mortality. However, it was observed that the elderly had worse functional outcomes at hospital discharge and 90 days after stroke. As for the therapy used in the treatment, the worse outcomes were highly sensitive and specified with a NIHSS score range of 2.5 points after the intervention. Clinical criteria for selecting patients for treatment with combination therapy should be better established.
Cerebrovascular diseases are among the leading causes of morbidity and mortality in Brazil, causing a major impact on the health of the population, the cerebral reperfusion therapy is indicated for the treatment of the acute phase of ischemic stroke (ischemic stroke). However, the results and the modality of this therapy to be used is still a matter of debate in the literature. Objective: To describe the clinical outcome of patients undergoing cerebral reperfusion therapy for ischemic stroke and to evaluate the associations between the modalities of therapy and clinical outcome of patients. Methods: Retrospective observational cohort, evaluating, through electronic medical records, the acute period and 3 months after the event, of patients diagnosed with CVA and who were treated with intravenous (IV) cerebral reperfusion therapy or mechanical thrombectomy (IA) and/or therapy combined (intravenous followed by mechanical thrombectomy), admitted to the Hospital das Clínicas da Faculdade de Medicina de Botucatu (HC-UNESP) in the period from June 2012 to December 2020. A significance level of p<0.05 was considered for all analyses. Results: Older patients had the most unfavorable outcomes, except for mortality rate, at hospital discharge. In the group of patients treated with combination therapy (intravenous followed by mechanical thrombectomy) there was an increased incidence of death as well as increased NIH Stroke Scale Score (NIHSS). ROC curves showed that a 2.5 point increase or decrease in NIHSS was associated with severe disability or death after treatment. Conclusion: Cerebral reperfusion was a feasible treatment for stroke in elderly and very elderly patients, as it did not increase mortality. However, it was observed that the elderly had worse functional outcomes at hospital discharge and 90 days after stroke. As for the therapy used in the treatment, the worse outcomes were highly sensitive and specified with a NIHSS score range of 2.5 points after the intervention. Clinical criteria for selecting patients for treatment with combination therapy should be better established.
Descrição
Palavras-chave
Acidente vascular cerebral, Ativador de plasminogênio tecidual, Trombectomia, Idoso, Stroke, Tissue plasminogen activator, Thrombectomy, Elderly