RESUMEN
BACKGROUND AND PURPOSE: We present our single-center experience using catheter-based therapy for acute ischemic stroke patients who were not candidates for intravenous thrombolytic therapy. METHODS: Neurologic outcomes were assessed in patients with acute ischemic stroke, ineligible for intravenous thrombolysis, treated with an emergent catheter-based therapy. RESULTS: Nonparametric analysis of neurological outcomes demonstrated a benefit in National Institutes of Health Stroke Scale (NIHSS) at long-term follow-up (P=0.036). Independence in daily activities and improvement in NIHSS of > or =4 points were achieved in 38% and 56% of patients, respectively. Four patients (25%) died, including 2 patients (12.5%) who died from intracranial hemorrhage. CONCLUSIONS: Catheter-based treatment offers a promising treatment strategy in patients with acute ischemic stroke ineligible for intravenous thrombolysis.
Asunto(s)
Angioplastia de Balón/métodos , Isquemia Encefálica/tratamiento farmacológico , Isquemia Encefálica/terapia , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/terapia , Terapia Trombolítica/métodos , Anciano , Isquemia Encefálica/diagnóstico , Femenino , Heparina/administración & dosificación , Heparina/uso terapéutico , Humanos , Infarto de la Arteria Cerebral Media/prevención & control , Infusiones Intraarteriales , Hemorragias Intracraneales/prevención & control , Masculino , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Stents , Accidente Cerebrovascular/diagnóstico , Activador de Tejido Plasminógeno/uso terapéutico , Resultado del Tratamiento , Activador de Plasminógeno de Tipo Uroquinasa/uso terapéuticoRESUMEN
Angioplasty and stent placement have become accepted alternatives to surgery in many vascular territories. The most recent application of percutaneous intervention has been to explore its clinical utility and safety for stroke prevention in carotid arteries. Over the past 8 years, from January 1994 until Nov 2002, we performed 449 elective carotid stent procedures in 426 patients and in 481 vessels. Informed consent was obtained from each patient. Success was achieved in 97.3% of the patients treated. After one month of follow-up, 12 (2.8%) patients experienced stroke or death. After an average of 2.8 ± 1.7 years (range 1 month to 8.8 years) of follow-up, restenosis was found in 11 (2.6%) patients and was treated with balloon angioplasty. Our results, in a predominantly high-risk surgery group of patients, suggest that carotid stent placement is a viable treatment alternative to conventional surgery. It is likely that as the technology continues to evolve, the procedural risks of stroke and death will be minimized by embolic protection devices, making carotid stenting an option for low-risk surgical patients.