Artigo Recomendado do Mês
Comentário a «Revascularização mecânica no acidente vascular cerebral isquémico»
Lino Patrício
Membro do Corpo Redactorial da Revista Portuguesa de Cardiologia
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array:23 [ "pii" => "S2174204913001645" "issn" => "21742049" "doi" => "10.1016/j.repce.2013.10.008" "estado" => "S300" "fechaPublicacion" => "2013-07-01" "aid" => "299" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2013" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "prv" "cita" => "Rev Port Cardiol. 2013;32:645-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2244 "formatos" => array:3 [ "EPUB" => 127 "HTML" => 1528 "PDF" => 589 ] ] "itemAnterior" => array:18 [ "pii" => "S2174204913001566" "issn" => "21742049" "doi" => "10.1016/j.repce.2013.10.002" "estado" => "S300" "fechaPublicacion" => "2013-07-01" "aid" => "330" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2013;32:643-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3088 "formatos" => array:3 [ "EPUB" => 143 "HTML" => 2185 "PDF" => 760 ] ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Guidelines</span>" "titulo" => "Third universal definition of myocardial infarction" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "643" "paginaFinal" => "644" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Kristian Thygesen, Joseph S. Alpert, Harvey D. White" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Kristian" "apellidos" => "Thygesen" ] 1 => array:2 [ "nombre" => "Joseph S." "apellidos" => "Alpert" ] 2 => array:2 [ "nombre" => "Harvey D." "apellidos" => "White" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204913001566?idApp=UINPBA00004E" "url" => "/21742049/0000003200000078/v1_201310270023/S2174204913001566/v1_201310270023/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artigo Recomendado do Mês</span>" "titulo" => "Comentário a «Revascularização mecânica no acidente vascular cerebral isquémico»" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "645" "paginaFinal" => "646" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Lino Patrício" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Lino" "apellidos" => "Patrício" "email" => array:1 [ 0 => "linopatricio@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Membro do Corpo Redactorial da Revista Portuguesa de Cardiologia" "identificador" => "aff0005" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Abstract</span><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Objectives:</span> This study sought to assess the feasibility and safety of a recently described technique of mechanical recanalization with the help of a stent-like device.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Background:</span> In the special group of acute stroke patients with an intracranial large vessel occlusion, intravenous tissue-type plasminogen activator on its own leads to a good clinical outcome (mRS ≤2) in only 15% to 25% of cases. The aforementioned technique of mechanical recanalization showed very promising clinical results.</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Methods:</span> Forty patients presenting within 6<span class="elsevierStyleHsp" style=""></span>h from stroke symptom onset were enrolled. Mechanical recanalization was performed using a Solitaire FR revascularization device. The primary endpoint of the study was the clinical outcome rated with the help of the modified Rankin Scale (mRS) after 90 days. Results Twenty-four patients (60%) showed a good clinical outcome (mRS ≤2) at 90 days. One symptomatic hemorrhage was detected on follow-up computed tomography. The death rate was 12.5% (5 patients). Successful recanalization (Thrombolysis In Cerebral Infarction score ≤2b) of the target vessel was achieved in 95% of the patients with a mean of 1.8 runs with the device.</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Conclusions:</span> The ReFlow (Mechanical Recanalization With Flow Restoration in Acute Ischemic Stroke) study shows that mechanical recanalization with flow restoration is highly effective in stroke patients with a large intracranial vessel occlusion presenting within 4.5<span class="elsevierStyleHsp" style=""></span>h after symptom onset. (Mechanical Recanalization with Flow Restoration in Acute Ischemic Stroke [ReFlow];© 2013 by the American College of Cardiology Foundation.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comentário</span><p id="par0040" class="elsevierStylePara elsevierViewall">O artigo publicado este mês no JACC por Roth é o primeiro artigo, com um <span class="elsevierStyleItalic">device stent like</span>, sobre revascularização aguda do acidente vascular cerebral (AVC) com percentagens de revascularização de 95%.</p><p id="par0045" class="elsevierStylePara elsevierViewall">O problema do AVC isquémico em Portugal, é seguramente ainda mais grave do que o do enfarte agudo do miocárdio com supra de ST (EAMCSST) quanto à mortalidade, mas principalmente quanto à morbilidade. A história recente da cardiologia no tratamento do EAMCSST, mostrou o longo caminho que foi preciso percorrer até à posição atual das sociedades científicas, quanto à indicação para angioplastia primária. Longe vão os tempos de alguns defenderem a trombólise como a terapêutica correta no EAM. Sabe-se hoje que os países que mantiveram esta estratégia são os que têm uma percentagem mais baixa de <span class="elsevierStyleItalic">reperfusão</span>. Hoje, quer as autoridades quer as sociedades científicas aceitam e promovem o acesso para todos à reperfusão no EAMCSST, com a criação de prevenções 24-7-365. O AVC isquémico tem sido tratado como o EAM o foi há 20 anos, pelas particularidades do leito vascular cerebral, mas principalmente pela atitude expectante dos neurologistas, com uma atitude em tudo semelhante aos cardiologistas clínicos de há uns anos.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Estes são os primeiros dados dum dispositivo <span class="elsevierStyleItalic">stent like</span>, que seguramente será de mais fácil utilização aos prévios dispositivos de trombectomia, difíceis de manipular em anatomias tortuosas, em vasos frágeis e com grande potencial de dissecção. É de notar que, pela primeira vez, Roth et al. tiveram excelentes tempos <span class="elsevierStyleItalic">door-device</span> (95<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>33<span class="elsevierStyleHsp" style=""></span>mm) com dois terços dos doentes com tempos inferiores a 100 minutos e tal como no EAMCSST tempos de <span class="elsevierStyleItalic">door-device</span> < 100 minutos tiveram melhor prognóstico. Quase dois terços dos doentes tiveram excelente prognóstico (Rankin score ≤ 2) com um baixo risco de hemorragia intracraniana (2,5%) e uma aceitável mortalidade (12,5%).</p><p id="par0055" class="elsevierStylePara elsevierViewall">As equipas de prevenção ao EAM estão criadas e respondem atualmente em todo o país 24-7-365. Penso que no futuro há que aproveitar estas estruturas para ajudar os neurorradiologistas a cumprir a sua obrigação em responder à intervenção de fase aguda no AVC isquémico. Estou convencido que o futuro da intervenção aguda no AVC isquémico seguirá os passos dados pela reperfusão no EAMCSST. Aproveitemos o que a história nos ensinou e o que as estruturas criadas podem permitir. Repetir a história, criar novas unidades para o AVC seria redundante e ineficaz. Saibamos todos estar unidos para o tratamento do AVC isquémico.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Comentário" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-03-28" "fechaAceptado" => "2013-04-28" "multimedia" => array:1 [ 0 => array:5 [ "identificador" => "tb0005" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Mechanical Recanalization With Flow Restoration in Acute Ischemic Stroke The ReFlow (Mechanical Recanalization With Flow Restoration in Acute Ischemic Stroke) Study</span></p><p id="par0015" class="elsevierStylePara elsevierViewall">Christian Roth, MD,*† Wolfgang Reith, MD,* Silke Walter, MD,‡ Stefanie Behnke, MD,‡, Michael Kettner, MD,* Julio Viera, MD,* Umut Yilmaz, MD,* Maria Alexandrou, MD,*, Maria Politi, MD,* Panagiotis Kostopoulos, MD,† Heiko Körner, MD,* Christoph Krick, MD,* Anton Haass, MD,‡ Klaus Fassbender, MD,‡Panagiotis Papanagiotou, MD*†, Homburg and Bremen, Germany in J Am Coll Cardiol Intv 2013;6:386–91</p></span>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003200000078/v1_201310270023/S2174204913001645/v1_201310270023/en/main.assets" "Apartado" => array:4 [ "identificador" => "9913" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Recommended article of the month" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003200000078/v1_201310270023/S2174204913001645/v1_201310270023/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204913001645?idApp=UINPBA00004E" ]
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