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Trombectomía Mecánica para el Ictus Isquémico Agudo en Pacientes con Demencia
Hamidreza Saber1, Jason Hinman2, Katherine Mun2
1Department of Radiological Sciences University of California Los Angeles Los Angeles CA.
Stroke (Hoboken, N.J.)
|January 26, 2026
Resumen
Los pacientes con demencia experimentaron ictus más graves pero recibieron menos trombectomía mecánica (TM). La demencia no aumentó de forma independiente la mortalidad después de la TM, pero sí elevó el riesgo de hemorragia intracraneal.
Área de la Ciencia:
- Neurología; Geriatría; Salud Pública
Sus antecedentes:
- La demencia es prevalente en pacientes con ictus isquémico agudo (IA), especialmente en los ancianos.; Los pacientes con demencia a menudo presentan déficits de ictus más graves.
Objetivo del estudio:
- Comparar la gravedad del ictus, la utilización de la trombectomía mecánica (TM) y los resultados en pacientes con IA con y sin demencia.; Investigar el impacto independiente de la demencia en los resultados de la TM, ajustando por la gravedad del ictus.
Principales métodos:
- Análisis retrospectivo de hospitalizaciones en EE. UU. por IA (octubre de 2016 - diciembre de 2017).; Comparación de la gravedad del ictus, el uso de TM y los resultados al alta (mortalidad, disposición funcional, hemorragia intracraneal) entre pacientes con y sin demencia.; Regresión logística multivariable para ajustar por factores de confusión, incluida la gravedad del ictus.
Principales resultados:
- El 10,2 % de las admisiones por ictus isquémico agudo (IA) tenían demencia preexistente, con una mayor prevalencia en pacientes de mayor edad (25 % en los ≥ 80 años).; Los pacientes con demencia tuvieron puntuaciones medianas más altas en la Escala Nacional de Salud de los Institutos de Salud (NIHSS) al momento de la presentación (7 frente a 4) y menores probabilidades de recibir TM (OR, 0,43).; Si bien la mortalidad intrahospitalaria fue mayor en pacientes con demencia después de la TM (21,3 % frente a 11,2 %), esta diferencia no fue significativa después de ajustar por la gravedad del ictus. La demencia se asoció con un mayor riesgo de hemorragia intracraneal después de la TM (OR, 1,57).
Conclusiones:
- La demencia es común en el IA, asociada con una mayor gravedad del ictus.; A pesar de ictus más graves, los pacientes con demencia recibieron TM con menos frecuencia.; La demencia no es un predictor independiente de mortalidad después de la TM, pero aumenta el riesgo de hemorragia intracraneal.
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