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Abstract(s)
O acidente vascular cerebral isquémico é uma causa de elevada mortalidade e morbilidade
em Portugal. Caracteriza-se pela súbita perda de fluxo sanguíneo numa determinada área
do cérebro resultando em défice neurológico correspondente. Pode ter várias causas,
nomeadamente embólica ou trombótica. O tratamento preconizado, no caso de estarmos
perante um acidente vascular cerebral isquémico, é a recanalização do vaso afetado, que
pode ser obtida através da trombólise, se esta for possível, até às 4.5 horas, ou através de
trombectomia até às 6 horas após início de sintomas. No entanto, muitos pacientes
chegam ao hospital depois desta janela terapêutica. Se houver a possibilidade de estender
a janela terapêutica, por mais tempo, a o número de pacientes aptos a usufruir de
tratamento aumentaria. Evidências recentes sugerem que é possível estudar a penumbra
ou a evolução da lesão isquémica através de técnicas imagiológicas, e assim, avaliar a
possibilidade de se estender o tempo permitido para ingressar na trombólise.
O objetivo desta monografia é reunir e analisar estudos que mostram a viabilidade da
recorrência a técnicas de imagem para selecionar pacientes candidatos a trombólise
mesmo ultrapassadas as 4.5 horas após última vez vistos bem.
Medscape, PubMed, Direção Geral da Saúde e American Heart Association/American
Stroke Association, são as plataformas que servem de base a este estudo.
Ensaios clínicos que têm vindo a surgir, trazem esperanças para o tratamento trombolítico
tardio. Perante pacientes que acordam com sintomas, ou cuja janela terapêutica foi
ultrapassada, é possível recorrer a imagiologia para averiguar a viabilidade de trombólise.
Stroke is an important cause of morbidity and mortality in Portugal. It is characterized by a sudden loss of blood flow in a particular region of the brain, triggering the corresponding neurologic dysfunction. It may have multiple causes, namely thrombotic or embolic. The usual treatment for an ischemic stroke is recanalization of the affected vessel, which can be done by thrombolysis if this is possible within 4,5h of onset or by thrombectomy up to 6h of onset. However, many patients arrive at the hospital after these time windows. If there is a chance to extend the therapeutic window, the amount of patients able to receive treatment would increase. Recent evidence suggests that it is possible to study the penumbra or the evolution of the ischemic lesion through imaging, therefore, evaluate the possibility to extend the allowed timings for thrombolysis. The goal of this monography is to gather and analyze studies that show the capability of imaging in selecting patients for late window thrombolysis. Medscape, PubMed, Direção Geral da Saúde and American Heart Association/American Stroke Association are the platforms used to write this monography. Recent clinical trials bring hope to late window thrombolysis. When facing patients who wake up exhibiting symptoms, or who's therapeutic window has passed, it's possible to resort to imaging to verify thrombolosys' viability.
Stroke is an important cause of morbidity and mortality in Portugal. It is characterized by a sudden loss of blood flow in a particular region of the brain, triggering the corresponding neurologic dysfunction. It may have multiple causes, namely thrombotic or embolic. The usual treatment for an ischemic stroke is recanalization of the affected vessel, which can be done by thrombolysis if this is possible within 4,5h of onset or by thrombectomy up to 6h of onset. However, many patients arrive at the hospital after these time windows. If there is a chance to extend the therapeutic window, the amount of patients able to receive treatment would increase. Recent evidence suggests that it is possible to study the penumbra or the evolution of the ischemic lesion through imaging, therefore, evaluate the possibility to extend the allowed timings for thrombolysis. The goal of this monography is to gather and analyze studies that show the capability of imaging in selecting patients for late window thrombolysis. Medscape, PubMed, Direção Geral da Saúde and American Heart Association/American Stroke Association are the platforms used to write this monography. Recent clinical trials bring hope to late window thrombolysis. When facing patients who wake up exhibiting symptoms, or who's therapeutic window has passed, it's possible to resort to imaging to verify thrombolosys' viability.
Description
Keywords
5 Horas Imagiologia Rm Tc Com Perfusão Trombólise Após 4 Trombólise Tardia