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Trombectomía endovascular después de un ictus isquémico de vasos grandes: un metanálisis de los datos de pacientes
Mayank Goyal1, Bijoy K Menon1, Wim H van Zwam2
1Departments of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada.
Lancet (London, England)
|February 23, 2016
Resumen
La trombectomía endovascular reduce significativamente la discapacidad en pacientes con ictus isquémico agudo con oclusión de vasos grandes. Este tratamiento efectivo beneficia a la mayoría de los pacientes, independientemente de la edad o el tiempo de tratamiento, mejorando los resultados a nivel mundial.
Área de la Ciencia:
- Neurología
- Cardiología intervencionista
- Salud pública
Sus antecedentes:
- Cinco ensayos aleatorizados en 2015 demostraron la eficacia de la trombectomía endovascular sobre el tratamiento estándar para el accidente cerebrovascular isquémico agudo.
- Se necesitaron análisis adicionales para confirmar los beneficios en diversas poblaciones de pacientes.
Objetivo del estudio:
- Para agrupar los datos individuales de los pacientes de cinco ensayos clave (MR CLEAN, ESCAPE, REVASCAT, SWIFT PRIME, EXTEND IA).
- Evaluar la eficacia de la trombectomía endovascular en pacientes con ictus isquémico agudo debido a la oclusión de vasos sanguíneos grandes de la circulación anterior proximal.
- Examinar la heterogeneidad del efecto del tratamiento en varios subgrupos de pacientes.
Principales métodos:
- Un metanálisis de los datos individuales de 1287 participantes (634 con trombectomía, 653 con control).
- Se utilizó un modelo de efectos mixtos para analizar el resultado primario (discapacidad reducida en la escala de Rankin modificada a los 90 días).
- El análisis incluyó ajustes por edad, sexo, gravedad del accidente cerebrovascular, sitio de oclusión, uso de alteplasa IV y tiempo hasta el tratamiento.
Principales resultados:
- La trombectomía endovascular redujo significativamente la discapacidad a los 90 días (ratio de probabilidades comunes ajustado [cOR] de 2,49).
- El número necesario para tratar fue de 2,6 para reducir la discapacidad en un nivel en el mRS.
- Los beneficios del tratamiento fueron consistentes en todos los subgrupos, incluidos los pacientes de edad avanzada, los tratados > 300 minutos después del inicio y los no elegibles para alteplasa IV.
Conclusiones:
- La trombectomía endovascular es beneficiosa para la mayoría de los pacientes con ictus isquémico agudo por oclusión de vasos grandes.
- La eficacia del tratamiento es consistente a través de diversas características de los pacientes y ubicaciones geográficas.
- Los hallazgos apoyan la reestructuración global de los sistemas de atención del accidente cerebrovascular para garantizar el acceso oportuno a la trombectomía endovascular.
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