RESUMO
Carotid endarterectomy and carotid angioplasty with stenting are 2 common approaches to revascularization. Phase III randomized clinical trials have focused on comparisons of periprocedural outcomes and composite outcomes that combine procedural events and clinical events during follow-up. The comparison of outcomes beyond the perioperative risk period, where the principal concern is durability, defined in clinical, anatomic, and procedural terms, has received less attention. The purpose of this review is to discuss factors that may influence durability and to compare the durability of carotid revascularization techniques beyond the perioperative period using data from randomized clinical trials.
Assuntos
Estenose das Carótidas/terapia , Endarterectomia das Carótidas , Angioplastia/efeitos adversos , Angioplastia/instrumentação , Angioplastia/mortalidade , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/mortalidade , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/mortalidade , Medicina Baseada em Evidências , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Medição de Risco , Fatores de Risco , Stents , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Fatores de Tempo , Resultado do TratamentoRESUMO
Timely administration of proven therapies remains the primary goal in acute stroke care. Following reperfusion therapy with intravenous thrombolysis, medical and neurological complications may develop in the hospitalized patient with acute ischemic stroke. Medical complications may include deep venous thrombosis, pulmonary embolism, aspiration, systemic infections and neuropsychiatric disturbances. Neurologic complications may include symptomatic intracranial hemorrhage, cerebral edema with elevated intracranial pressure, and post-stroke seizures. Early initiation of preventative strategies and proper management of common complications may improve both short-term and long-term outcomes. Here we review evidence-based management strategies for hospitalized acute ischemic stroke patients following intravenous thrombolysis.