Eficacia del tratamiento de fase aguda en accidente cerebrovascular isquémico a través del grado de discapacidad y dependencia

Abstract

Introduction: Ischemic cerebrovascular accident (CVA) is a public health problem and one of the main causes of permanent disability in adulthood. Objective: To analyse the efficacy, the updated ideal first-line treatment of acute-phase ischemic Stroke in relation to maintaining functional independence in the evaluation of the Modified Rankin Scale (mRS). Methods: Literature search strategy, literature review, electronic database searches including PubMed, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from database inception to July 2021. Results: Obtaining an mRS score < 2 is influenced by multiple factors: time from symptom onset to medical intervention, being a candidate for both thrombolysis and endovascular procedures, the vessel affected, size of the necrotic core, availability of technological means. Intravenous thrombolysis alone, Tenecteplase outperforms Alteplase in mRS scores, but the incidence of recovery to independent function did not differ significantly. Thrombectomy alone is not inferior to intravenous thrombolysis or dual therapy. Conclusion: Evidence supports that time factor (< 3h), necrotic core < 70ml, combined treatment with intravenous thrombolysis and mechanical thrombectomy in large vessel compromise results in scores < 2 mRS at 90 days (function independent). The different types of cerebral blood reperfusion treatments do not differ from each other but will depend on the factors or scenarios described.