Trombectomía intraarterial mecánica en el ictus agudoexperiencia en la Región de Murcia

Abstract

ABSTRACT Background and Purpose: The ischemic stroke is a problem of health highly prevalent being a frequent cause of death and disability. At the moment, the therapeutic focus is directed toward getting recanalization of the occluded vessel. To achieve this objective we use the mechanical thrombectomy, that is the procedure by which the extraction of the thrombus is done using mechanical devices. The initial implantation of this treatment realized with devices of 2nd generation as the stent retrievers was subject to the lack of clinical trials conclusive that were not come until 2015. In our hospital this therapy was introduced in 2010, after the evaluation for a multidisciplinary team and the creation of a protocol established based on the existing literature. The main target of our study is to verify the effectiveness and safety of the treatment with mechanical thrombectomy in our habitual clinical practice. Methods: An observational study with prospective registry and retrospective review of all the patients with acute ischemic stroke treated with mechanical thrombectomy in Virgen de la Arrixaca Universitary Hospital, center of reference to this treatment in the region of Murcia. There was assessing the influence of epidemiologic, clinical and procedure variables in different result variables: functional prognosis (mRS90), mortality, early good neurological outcome, symptomatic intracranial hemorrhage and futile recanalization (complete recanalization and mRS > 2). As the indication for people over 80 years was not clear, also the results in patients over 80 years were evaluated compared with the least group of this age Results: Two hundred patients were included, getting a complete recanalization of the vessel in 92,5 % of the patients, good functional prognosis (mRS90 ? 2) in 43 % with a mortality of 27,9 %, early good neurological outcome in 46,9 % and symptomatic intracranial hemorrhage in 8,4 %. The NIHSS pre-procedure and the symptomatic intracranial hemorrhage were significantly associated with poor prognosis at 90 days and with the mortality. Also the DM, the occluded artery and the procedure time also influence in the mortality. The hypertension absence had a tendency to the association with the early good neurological outcome. The procedure time was associated with asymptomatic intracranial hemorrhage. The age and the NIHSS pre-procedure were associated with futile recanalization. The hypertension, smoking habit, atrial fibrillation, the previous anticoagulation, a poor functional prognosis and the mortality were more frequent in the group older than 80 years. Conclusions: Our results are similar to other released works so that we can affirm that mechanical thrombectomy with stent retrievers as treatment of acute ischemic stroke is effective and sure in practice clinic. At the time of realizing a better selection of the patient candidate for this treatment we will have to consider the different variables that can influence in the result of the same one.