RESUMO
BACKGROUND: Mechanical thrombectomy (MT) in association with intravenous thrombolysis is recommended for treatment of acute ischemic stroke (AIS), with large vessel occlusion (LVO) in the anterior circulation. Because MT is only available in comprehensive stroke centers (CSC), the challenge of stroke organization is to ensure equitable access to the fastest endovascular suite. Our aim was to evaluate the feasibility, efficacy, and safety of MT in patients initially managed in 1 CSC (mothership), compared with patients first managed in primary stroke center (PSC), and then transferred to the CSC for MT (drip-and-ship). METHODS: We retrospectively analyzed 179 consecutive patients (93 in the mothership group and 86 in the drip-and-ship group), with AIS secondary to LVO in the anterior cerebral circulation and a clinical-radiological mismatch (NIHSS ≥ 8 and DWI-ASPECT score ≥5), up to 6 hours after symptoms onset. We evaluated 3-month functional modified Rankin scale (mRS), periprocedural time management, mortality, and symptomatic intracranial haemorrhage (sICH). RESULTS: Despite significant longer process time in the drip-and-ship group, mRS ≤ 2 at 3 months (39.8% versus 44.1%, Pâ¯=â¯.562), Thrombolysis in cerebral infarction 2b-3 (85% versus 78%, Pâ¯=â¯.256), and sICH (7.0% versus 9.7%, Pâ¯=â¯.515) were similar in both group regardless of baseline clinical or radiological characteristics. After multivariate logistic regression, the predictive factors for favorable outcome were age (odds ratio [OR] -5years= 1.32, P < .001), initial NIHSS (OR -5pointsâ¯=â¯1.59, Pâ¯=â¯.010), absence of diabetes (ORâ¯=â¯3.35, Pâ¯=â¯.075), and the delay magnetic resonance imagining-puncture (OR -30minâ¯=â¯1.16, Pâ¯=â¯.048). CONCLUSIONS: Our study showed encouraging results from a regional protocol of MT comparing patients transferred from PSC or brought directly in CSC.
Assuntos
Infarto Encefálico/cirurgia , Prestação Integrada de Cuidados de Saúde/organização & administração , Fibrinolíticos/administração & dosagem , Trombólise Mecânica , Transferência de Pacientes/organização & administração , Regionalização da Saúde/organização & administração , Trombectomia , Tempo para o Tratamento/organização & administração , Idoso , Infarto Encefálico/diagnóstico , Infarto Encefálico/mortalidade , Infarto Encefálico/fisiopatologia , Avaliação da Deficiência , Estudos de Viabilidade , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intravenosas , Masculino , Trombólise Mecânica/efeitos adversos , Trombólise Mecânica/mortalidade , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Trombectomia/efeitos adversos , Trombectomia/mortalidade , Fatores de Tempo , Resultado do TratamentoAssuntos
Promoção da Saúde , Acidente Vascular Cerebral/prevenção & controle , Idoso , Prestação Integrada de Cuidados de Saúde , Pessoas com Deficiência , Feminino , França , Instalações de Saúde , Humanos , Masculino , Equipe de Assistência ao Paciente , Parcerias Público-Privadas , Fatores de Risco , Tecnologia Assistiva , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular CerebralRESUMO
BACKGROUND: Thalamic lesions are seen in a multitude of disorders including vascular diseases, metabolic disorders, inflammatory diseases, trauma, tumours, and infections. In some diseases, thalamic involvement is typical and sometimes isolated, while in other diseases thalamic lesions are observed only occasionally (often in the presence of other typical extrathalamic lesions). SUMMARY: In this review, we will mainly discuss the MRI characteristics of thalamic lesions. Identification of the origin of the thalamic lesion depends on the exact localisation inside the thalamus, the presence of extrathalamic lesions, the signal changes on different MRI sequences, the evolution of the radiological abnormalities over time, the history and clinical state of the patient, and other radiological and nonradiological examinations.