Trial of Thrombectomy for Stroke with a Large Infarct of Unrestricted Size.

BACKGROUND: The use of thrombectomy in patients with acute stroke and a large infarct of unrestricted size has not been well studied. METHODS: We assigned, in a 1:1 ratio, patients with proximal cerebral vessel occlusion in the anterior circulation and a large infarct (as defined by an Alberta Stroke Program Early Computed Tomographic Score of ≤5; values range from 0 to 10) detected on magnetic resonance imaging or computed tomography within 6.5 hours after symptom onset to undergo endovascular thrombectomy and receive medical care (thrombectomy group) or to receive medical care alone (control group). The primary outcome was the score on the modified Rankin scale at 90 days (scores range from 0 to 6, with higher scores indicating greater disability). The primary safety outcome was death from any cause at 90 days, and an ancillary safety outcome was symptomatic intracerebral hemorrhage. RESULTS: A total of 333 patients were assigned to either the thrombectomy group (166 patients) or the control group (167 patients); 9 were excluded from the analysis because of consent withdrawal or legal reasons. The trial was stopped early because results of similar trials favored thrombectomy. Approximately 35% of the patients received thrombolysis therapy. The median modified Rankin scale score at 90 days was 4 in the thrombectomy group and 6 in the control group (generalized odds ratio, 1.63; 95% confidence interval [CI], 1.29 to 2.06; P<0.001). Death from any cause at 90 days occurred in 36.1% of the patients in the thrombectomy group and in 55.5% of those in the control group (adjusted relative risk, 0.65; 95% CI, 0.50 to 0.84), and the percentage of patients with symptomatic intracerebral hemorrhage was 9.6% and 5.7%, respectively (adjusted relative risk, 1.73; 95% CI, 0.78 to 4.68). Eleven procedure-related complications occurred in the thrombectomy group. CONCLUSIONS: In patients with acute stroke and a large infarct of unrestricted size, thrombectomy plus medical care resulted in better functional outcomes and lower mortality than medical care alone but led to a higher incidence of symptomatic intracerebral hemorrhage. (Funded by Montpellier University Hospital; LASTE ClinicalTrials.gov number, NCT03811769.).

Aneurisma fusiforme de la carótida intracraneal / Giant fusiform aneurysm in the intracranial crotid artery

Objetivo. Los aneurismas fusiformes son lesiones que se incluyeron en la categoría de los aneurismas gigantes, siendo mucho menos comunes que las lesiones saculares. Los aneurismas fusiformes se localizan por lo general en la circulación posterior. Presentación clínica. Presentamos un caso de un paciente masculino de 56 años de edad, cuyo cuadro de presentación clínica fue como EITR (episodios Isquemicos Transitorios Reversibles-TIA). Posterior a habérsele realizado una tomografía computada y contrastada de cráneo(TC), se le realizó un ECHO-Doppler de ejes carotídeos, completándose el estudio con una panangiografía cerebral. El manejo quirúrgico del enfermo consistió en un puente arterial (arteria temporal superficial/arteria cerebral media), con reconstrucción microvascular del vaso afectado. Conclusión. Los aneurismas fusiformes de la circulación anterior son raros, teniendo una presentación clínica diferente a la de las lesiones saculares. Este tipo de lesiones son un reto de manejo para el cirujano neurovascular. Tal y como se ejemplifica en el presente reporte, los pacientes se benefician de la intervención quirúrgica, requiriéndose abordajes combinados y teniendo simpre en mente, que cada caso deberá de ser individualizado