Resumen
La aparición en este año de siete estudios que demuestran la superioridad de la terapia endovascular (TEV) sobre el tratamiento convencional de la trombólisis IV con t-PA en las primeras 4,5 horas posteriores al inicio del ataque cerebrovascular (ACV) isquémico agudo en pacientes con una obstrucción arterial proximal, establece un reto terapéutico para los neurólogos colombianos por el costo social que ocasiona la enfermedad y por las falencias que presenta nuestro sistema de salud para la atención óptima al respecto.
Esta revisión crítica de los estudio MR Clean, Escape, Extend IA, Swift Prime, Revascat, Thrace y Therapy, así como de las guías 2015 de la American Heart Association (AHA), analizan la factibilidad e implementación de esta información en Colombia.
La administración rápida de la terapia intravenosa con t-PA en estos estudios fortalece su implementación en el país e invita a generar protocolos que incluyan imágenes diagnósticas no invasivas como la angiografía cerebral por escanografía cerebral (CTA) o por resonancia magnética (MRA) que seleccionen a los pacientes con obstrucción proximal para brindarles lo más rápido posible el recurso de una TEV a través de una red hospitalaria del ACV.
Los principales retos establecidos son los de allanar las diferencias entre el sector público y privado en la atención de pacientes con ACV isquémico agudo, dotar hospitales públicos con la tecnología y el talento humano que la TEV exige, e integrar una red nacional del ACV.
Citas
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