Decision-making strategies for reperfusion therapies: navigating through stroke trials gaps

Mateus Paquesse Pellegrino; Felipe Borelli Del Guerra; Iago Navas Perissinotti

doi:10.1590/0004-282X-ANP-2022-S123

Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2022; 80(S 05): 60-71
DOI: 10.1590/0004-282X-ANP-2022-S123

CEREBROVASCULAR DISEASE

Decision-making strategies for reperfusion therapies: navigating through stroke trials gaps

Estratégias de decisão para terapias de reperfusão: navegando nas lacunas dos trials de AVC

Mateus Paquesse Pellegrino

¹Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, São Paulo, SP, Brazil.

,

Felipe Borelli Del Guerra

²Hospital de Base do Distrito Federal, Brasília, DF, Brazil.

,

Iago Navas Perissinotti

³Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil.

⁴Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto Central, Departamento de Neurologia, São Paulo, SP, Brazil.

› Author Affiliations

Abstract

ABSTRACT

Despite there being a robust amount of literature and numerous randomized clinical trials regarding acute ischemic stroke treatment, the trials have not included some frequent controversial situations for which decision-making strategies are an urgent and unmet need in clinical practice. This article tries to summarize the current evidence about some selected situations (mechanical thrombectomy in low ASPECTS, low NIHSS with proximal occlusion, acute basilar occlusion, distal and medium vessel occlusion, among others), make suggestions on how to approach them in clinical practice and show what to expect in acute stroke research in the near future.

RESUMO

Apesar de possuir um corpo de literatura robusto e inúmeros ensaios clínicos randomizados sobre o tratamento do AVC isquêmico agudo, os trials não incluíram algumas situações frequentes e controversas para as quais as estratégias de tomada de decisão são uma necessidade urgente na prática clínica. Este artigo tenta resumir as evidências atuais sobre algumas situações selecionadas (trombectomia mecânica em ASPECTS baixo, NIHSS baixo com oclusão proximal, oclusão basilar aguda, oclusão de vaso distal e médio, entre outras), propor sugestões de como abordá-las na prática clínica e mostrar o que esperar na pesquisa de AVC agudo no futuro próximo.

Keywords:

Stroke - Ischemic Stroke - Thrombectomy - Mechanical Thrombolysis - Thrombolytic Therapy

Palavras-chave:

Acidente Vascular Cerebral - AVC Isquêmico - Trombectomia - Trombólise Mecânica - Terapia Trombolítica

Full Text

References

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