Thrombectomy for Stroke in Brazil—Late Evidence or Promising Future?

Filho, Pedro Tadao Hamamoto; Módolo, Gabriel Pinheiro; Freitas, Carlos Clayton Macedo de; Zanini, Marco Antônio; Bazan, Rodrigo

doi:10.3389/fsurg.2021.651183

Cited by 1 publication

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“…Therefore, even though our patients were not so different from the RESILIENT's at the baseline (regarding to age and NIHSS at admission) and our recanalization rates were close to the RESILIENT's, we had more patients with complications (symptomatic intracerebral hemorrhage and need for decompressive craniectomy), which may be linked to that difference on time to treatment. This difference points to the need for LMIC to expand the accessibility to MT; it is not enough to have MT available: it is needed to have it largely and promptly available in order to ensure its benefits (41). Limitations of cerebral intervention include the high level of procedural skills required by the operator, technical limitations associated with catheter technology in middle income countries, lengthy duration of the method, and high costs (42,43).…”

Section: Discussionmentioning

confidence: 99%

Clinical and Functional Outcomes of Patients Receiving Cerebral Reperfusion Therapy: A Stroke Databank Study in Brazil

Furlan

Luvizutto²,

Filho³

et al. 2022

Front. Surg.

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ObjectivesCerebral reperfusion therapy is recommended for the treatment of acute ischemic stroke. However, the outcomes of patients receiving this therapy in middle- and low-income countries should be better defined. This study aimed to evaluate the clinical and functional outcomes of cerebral reperfusion therapy in patients with ischemic stroke.Materials and MethodsThis retrospective study included patients with ischemic stroke treated with cerebral reperfusion therapy, including intravenous thrombolysis (IVT), mechanical thrombectomy (MT), and IVT with MT. The primary outcomes were death and disability, assessed using the modified Rankin scale (mRS), and stroke severity, assessed using the National Institutes of Health Stroke Scale (NIHSS), after intervention and 90 days after ictus. The association between the type of treatment and the primary outcome was assessed using binary logistic regression after adjusting for confounding variables. Furthermore, receiver operating characteristic (ROC) curves were generated to identify the cutoff point of the NIHSS score that could best discriminate the mRS score in all types of treatments.ResultsPatients (n = 291) underwent IVT only (n = 241), MT (n = 21), or IVT with MT (n = 29). In the IVT with MT group, the incidence of death within 90 days increased by five times (OR, 5.192; 95% CI, 2.069–13.027; p = 0.000), prevalence of disability increased by three times (OR, 3.530; 95% CI, 1.376–9.055; p = 0.009) and NIHSS score increased after IVT (from 14.4 ± 6.85 to 17.8 ± 6.36; p = 0.045). There was no significant difference between the initial NIHSS score and that after MT (p = 0.989). Patients' NIHSS score that increased or decreased by 2.5 points had a sensitivity of 0.74 and specificity of 0.65, indicating severe disability or death in these patients.ConclusionAltogether, a 2.5-point variation in NIHSS score after reperfusion is an indicator of worse outcomes. In our particular context, patients receiving the combination of IVT and MT had inferior results, which probably reflects challenges to optimize MT in LMIC.

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Section: Discussionmentioning

confidence: 99%