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Apoplejía

Nina A Hilkens1, Barbara Casolla2, Thomas W Leung3

  • 1Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.

Lancet (London, England)
|May 17, 2024
PubMed
Resumen
Este resumen es generado por máquina.

El accidente cerebrovascular es una de las principales causas de muerte en todo el mundo, caracterizada por déficits neurológicos repentinos. Los avances recientes incluyen nuevos tratamientos para el accidente cerebrovascular isquémico y una mejor atención para el accidente cerebrovascular hemorrágico, mejorando los resultados de los pacientes.

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Área de la Ciencia:

  • Neurología
  • Medicina vascular
  • Salud pública

Sus antecedentes:

  • El ictus es un problema de salud mundial importante, siendo la segunda causa de muerte en todo el mundo.
  • Se presenta clínicamente con déficits neurológicos repentinos, a menudo derivados de causas vasculares.
  • La prevalencia varía significativamente, afectando a una parte sustancial de la población tanto en los países de altos como en los de bajos ingresos.

Objetivo del estudio:

  • Revisar la comprensión y el manejo actuales del accidente cerebrovascular, que abarca el diagnóstico, el tratamiento agudo y la prevención secundaria.
  • Para resaltar los recientes avances terapéuticos tanto en el ictus isquémico como en el hemorrágico.
  • Hacer hincapié en la importancia de las estrategias de prevención secundaria guiadas por mecanismos.

Principales métodos:

  • Revisión de las técnicas de diagnóstico por neuroimagen (TC, RM) para la caracterización del accidente cerebrovascular.
  • Análisis de los tratamientos actuales y emergentes para el ictus isquémico agudo, incluida la trombólisis y la trombectomía endovascular.
  • Examen de los protocolos de tratamiento de la hemorragia intracerebral, centrados en el tratamiento combinado y el control de la presión arterial.
  • Resumen de las estrategias de prevención secundaria basadas en los mecanismos subyacentes del ictus.

Principales resultados:

  • La TC/IRM multimodal identifica eficazmente la patología del accidente cerebrovascular y ayuda en las decisiones de tratamiento.
  • La tenecteplasa es una alternativa segura y eficaz para la trombólisis intravenosa en el accidente cerebrovascular isquémico agudo.
  • Las indicaciones de trombectomía endovascular se han ampliado para los accidentes cerebrovasculares de oclusión de vasos grandes, con ventanas de tiempo extendidas.
  • Los protocolos de cuidados combinados mejoran los resultados de la hemorragia intracerebral.
  • Las estrategias de prevención secundaria se adaptan a los mecanismos del accidente cerebrovascular, incluidas las intervenciones farmacológicas, vasculares y de estilo de vida.

Conclusiones:

  • Se han logrado avances significativos en el tratamiento agudo de los accidentes cerebrovasculares isquémicos y hemorrágicos.
  • Las ventanas de tratamiento ampliadas y las nuevas opciones terapéuticas mejoran los resultados de los pacientes.
  • La prevención secundaria basada en el mecanismo es crucial para reducir la recurrencia del accidente cerebrovascular y la discapacidad a largo plazo.