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miércoles, 28 de septiembre de 2016

Endovascular Therapy for Strokes

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ACEPNow - By Will Boggs - September 28, 2016
"Endovascular therapy (EVT) may be effective for acute ischemic stroke caused by occlusion of the middle cerebral artery M2 segment, suggests a multicenter retrospective study...
Dr. Gerhard Schroth from the University of Bern, Switzerland, who has published several studies of EVT for acute stroke, told Reuters Health by email, “M2 is a big artery and its occlusion should be treated by interventional neuroradiology.”
“If the clinical symptoms are severe (e.g., NIHSS more than 5), it should be treated by thrombectomy – what we call endovascular image-guided microsurgical thrombectomy – without any restriction,” he said. “The interventional neuroradiologist has to make a risk-benefit calculation, based on the vascular anatomy, which he investigates by DSA (Digital Subtraction Angiography).”
“The risk to perform an intervention may be too high, e.g., if the patient is agitated and moves the head (indicating intubation and general anesthesia) or if there is a severe arteriosclerotic process, e.g., with ipsilateral high-grade carotid stenosis,” Dr. Schroth said. “However – again – these are no absolute contraindications – our high-volume stroke center (more the 1,500 acute strokes, more than 200 thrombectomies per year) would aspirate or perform stent-retriever thrombectomy if the symptoms are severe.”