RESUMEN
Despite there being a robust amount of literature and numerous randomized clinical trials regarding acute ischemic stroke treatment, the trials have not included some frequent controversial situations for which decision-making strategies are an urgent and unmet need in clinical practice. This article tries to summarize the current evidence about some selected situations (mechanical thrombectomy in low ASPECTS, low NIHSS with proximal occlusion, acute basilar occlusion, distal and medium vessel occlusion, among others), make suggestions on how to approach them in clinical practice and show what to expect in acute stroke research in the near future.
Asunto(s)
Isquemia Encefálica , Procedimientos Endovasculares , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Isquemia Encefálica/terapia , Humanos , Reperfusión , Estudios Retrospectivos , Accidente Cerebrovascular/cirugía , Trombectomía , Resultado del TratamientoRESUMEN
ABSTRACT Despite there being a robust amount of literature and numerous randomized clinical trials regarding acute ischemic stroke treatment, the trials have not included some frequent controversial situations for which decision-making strategies are an urgent and unmet need in clinical practice. This article tries to summarize the current evidence about some selected situations (mechanical thrombectomy in low ASPECTS, low NIHSS with proximal occlusion, acute basilar occlusion, distal and medium vessel occlusion, among others), make suggestions on how to approach them in clinical practice and show what to expect in acute stroke research in the near future.
RESUMO Apesar de possuir um corpo de literatura robusto e inúmeros ensaios clínicos randomizados sobre o tratamento do AVC isquêmico agudo, os trials não incluíram algumas situações frequentes e controversas para as quais as estratégias de tomada de decisão são uma necessidade urgente na prática clínica. Este artigo tenta resumir as evidências atuais sobre algumas situações selecionadas (trombectomia mecânica em ASPECTS baixo, NIHSS baixo com oclusão proximal, oclusão basilar aguda, oclusão de vaso distal e médio, entre outras), propor sugestões de como abordá-las na prática clínica e mostrar o que esperar na pesquisa de AVC agudo no futuro próximo.
RESUMEN
CONTEXT AND OBJECTIVE: Cerebrovascular disease is one of the most important causes of death and disability worldwide. The patient's inability to identify the warning signs of stroke substantially delays the search for emergency services, which is related directly to a worse outcome. Thus, during the 2011 Stroke Campaign in Brazil, a survey was conducted to identify the lay population's knowledge with regard to the recognition, treatment, and prevention of stroke. DESIGN AND SETTING: This retrospective, cross-sectional, multicenter study was held in cities throughout southeastern Brazil. METHODS: The campaign was conducted by students of several medical schools under the guidance of neurologists (assistants and professors). The students traveled to various public areas in Sao Paulo, Campinas, Sorocaba, Taubaté, and Pouso Alegre, where information about stroke was distributed and a specific questionnaire was administered. RESULTS: A total of 1304 people answered the questionnaire: 43.9% claimed to know what a stroke was, 65% knew someone who has had the disease, 35% knew > 3 risk factors for stroke, and 28.8% knew a preventive measure. Further, 17.9% was able to list at least 3 signs or symptoms of a stroke, 33.6% was aware that they should activate the emergency service, and 3.1% would have checked the time at which the signs and symptoms had developed. CONCLUSION: Despite the severity of stroke, the population that we analyzed has a low level of knowledge. Campaigns should increase the lay population's understanding of this disease, thus improving its prevention and treatment and contributing to public health politics.