Resumen
INTRODUCCIÓN.El ACV menor hace referencia a un evento isquémico que cursa con síntomas leves. Se ha señalado que estos pacientes pueden presentar un desenlace clínico desfavorable.
OBJETIVO:Evaluar el desenlace funcional a 90 días de pacientes con ACV isquémico menor, atendidos en dos hospitales de Bucaramanga, Colombia, entre los años 2015 y 2017.
MÉTODOS.Estudio de cohorte en pacientes con ACV isquémico agudo y un puntaje NIHSS ? 5 puntos. Un desenlace clínico desfavorable a 90 días de seguimiento fue medido como un puntaje Rankin-m ? 3 puntos. Se realizó un análisis bivariado a través de modelos de regresión binomial simple y ajustado por edad y sexo. Un valor p <0,05 fue considerado estadísticamente significativo.
RESULTADOS.Se incluyeron 90 pacientes (edad de 66,6± 13,5 años, 54,4% (n=49) de sexo masculino). El 36,5% (n=23) de los pacientes presentó un puntaje Rankin-m de 3 a 6 puntos. El antecedente de diabetes mellitus (RR: 2,50 IC 95%:1,33-4,70) y un Rankin-m previo de 2 (RR 2,12 IC 95%:1,39-3,24) fueron variables independientemente asociadas a discapacidad significativa.
CONCLUSIÓN.Un estado funcional previamente comprometido, sumado a la disfunción endotelial que genera la diabetes mellitus, contribuye a un desenlace desfavorable en los pacientes con ACV menor.
Citas
Yakhkind A, McTaggart RA, Jayaraman M V, Siket MS, Silver B, Yaghi S. Minor stroke and transient ischemic attack: Research and practice. Front Neurol. 2016;7(86). DOI: 10.3389/fneur.2016.00086
Yaghi S, Willey JZ, Khatri P. Minor ischemic stroke. Triaging, disposition and outcome. Neurol Clin Pract. 2016;6(2):157-63. DOI: 10.1212/CPJ.0000000000000234.
Khatri P, Kleindorfer DO, Yeatts SD, Saver JL, Levine SR, Lyden P, et al. Strokes with minor Symptoms: An exploratory analysis of the NINDS rt-PA trials. Stroke. 2010;41(11):2581-6. DOI: 10.1161/STROKEAHA.110.593632.
Kenmuir CL, Hammer M, Jovin T, Reddy V, Wechsler L, Jadhav A. Predictors of outcome in patients presenting with acute ischemic stroke and mild stroke scale scores. J Stroke Cerebrovasc Dis. 2015;24(7):1685-9. DOI: doi.org/10.1016/j.jstrokecerebrovasdis.2015.03.042
Balucani C, Levine SR. Mild stroke and rapidly improving symptoms: It's not always a happy ending. Stroke. 2011;42(11):3005-7. DOI: doi.org/10.1161/STROKEAHA.111.628701
Laurencin C, Philippeau F, Blanc-Lasserre K, Vallet AE, Cakmak S, Mechtouff L, et al. Thrombolysis for acute minor stroke: Outcome and barriers to management. Cerebrovasc Dis. 2015;40(1-2):3-9. DOI: 10.1159/000381866
Merlino G, Smeralda C, Lorenzut S, Gigli GL, Surcinelli A, Valente M. To treat or not to treat: importance of functional dependence in deciding intravenous thrombolysis of "mild stroke" Patients. J Clin Med. 2020;9(3):768-78. DOI: 10.3390/jcm9030768.
Khatri P, Conaway MR, Johnston KC. Ninety-day outcome rates of a prospective cohort of consecutive patients with mild ischemic stroke. Stroke. 2012;43(2):560-2. DOI: 10.1161/STROKEAHA.110.593897
Deplanque D, Bastide M, Bordet R. Transient ischemic attack and minor stroke: Definitively not so harmless for the brain and cognitive functions. Stroke. 2018; 49:277-9. DOI: 10.1161/STROKEAHA.117.020013.
Ramírez-Moreno JM, Muñoz-Vega P, Alberca SB, Peral-Pacheco D. Health-related quality of life and fatigue after transient ischemic attack and minor stroke. . J Stroke Cere-brovasc Dis. 2019;28(2):276-84. DOI: 10.1016/j.jstrokecere-brovasdis.2018.09.046
Li J, You SJ, Xu YN, Yuan W Shen Y, Huang JY, et al. Cognitive impairment and sleep disturbances after minor ischemic stroke. Sleep Breath. 2019;23(2):455-62. DOI: 10.1007/s11325-018-1709-4.
Yu AY, Hill MD, Coutts SB. Should minor stroke patients be thrombolyzed? A focused review and future directions. Int J Stroke. 2015;10(3):292-7. DOI: 10.1111/ijs.12426. Epub 2014 Dec 25.
Sato S, Uehara T, Ohara T, Suzuki R, Toyoda K, Minematsu K. Factors associated with unfavorable outcome in minor ischemic stroke. Neurology. 2014;83(2):174-81. DOI: 10.1212/WNL.0000000000000572
Coutts SB, Modi J, Patel SK, Aram H, Demchuk AM, Goyal M, et al. What causes disability after transient ischemic attack and minor stroke?: Results from the CT and MRI in the triage of TIA and minor cerebrovascular events to identify high risk patients (CATCH) study. Stroke. 2012;43(11):3018-22. DOI: doi.org/10.1161/STROKEAHA.112.665141
Romano JG, Smith EE, Liang L, Gardener H, Camp S, Shuey L, et al. Outcomes in mild acute ischemic stroke treated with intravenous thrombolysis: A retrospective analysis of the get with the guidelines-stroke registry. JAMA Neurol. 2015;72(4):423-31. DOI: 10.1001/jamaneurol.2014.4354
Lei Z, Ren L, Li S, Feng H, Lai Y, Zhou Y, et al. Prognostic nomogram for patients with minor stroke and transient ischaemic attack. Postgrad Med J. 2021;97:644-49. DOI: 10.1136/postgradmedj-2020-137680
You W Li Y, Ouyang J, Li H, Yang S, Hu Q, et al. Predictors of poor outcome in patients with minor ischemic stroke by using magnetic resonance imaging. J Molec Neurosci. 2019;69(3):478-84. DOI: 10.1007/s12031-019-01379-9
Del Bene A, Palumbo V, Lamassa M, Saia V, Piccardi B, Inzitari D. Progressive lacunar stroke: Review of mechanisms, prognostic features, and putative treatments. Int J Stroke. 2012;7(4):321-9. DOI: doi.org/10.1111/j.1747-4949.2012.00789.x
Pan Y, Meng X, Jing J, Li H, Zhao X, Liu L, et al. Association of multiple infarctions and ICAS with outcomes of minor stroke and TIA. Neurology. 2017;88(11):1081-8. DOI: 10.1212/WNL.0000000000003719
Pan Y, Jing J, Li H, Wang Y. Abnormal glucose regulation increases stroke risk in minor ischemic stroke or TIA. Neurology. 2016;87(15):1551-6. DOI: 10.1212/WNL.0000000000003200
Pan Y, Wang Y, Li H, Gaisano HY, Wang Y, He Y. Association of diabetes and prognosis of minor stroke and its subtypes: A prospective observational study. PLoS ONE. 2016;11(4):e0153178. DOI: 10.1371/journal.pone.0153178
Im K, Ju H, Lee M, Joo BE, Kwon KY, Roh H, et al. Recent glycemic control can predict the progressive motor deficits of acute subcortical infarction with diabetes or prediabetes. Neurol Sci. 2021;42(1):285-91. DOI: 10.1007/s10072-020-04634-9
Martins SCO, Sacks C, Hacke W, Brainin M, Figueiredo FDA, Pontesneto OM, et al. Priorities to reduce the burden of stroke in Latin American countries. Lancet Neurol. 2019;4422(19):30068-7. DOI: 10.1016/S1474-4422(19)30068-7
Meza Bejarano Y, Rodríguez Quintana JH, Amaya González P, Restrepo HF. Causas de no trombolisis en ataque cerebro-vascular. Acta Neurol Colomb. 2013;29:4-19.
Jacova C, Pearce LA, Roldan AM, Arauz A, Tapia J, Costello R, et al. Cognitive performance following lacunar stroke in Spanish- speaking patients: Results from the SPS3 trial. Int J Stroke. 2015;10(4):519-28. DOI: 10.1111/ijs.12511
Smith EE, Fonarow GC, Reeves MJ, Cox M, Olson DM, Hernandez AF, et al. Outcomes in mild or rapidly improving stroke not treated with intravenous recombinant tissue-type findings from Get with the Guidelines-Stroke. Stroke. 2011;42:3110-5. DOI: 10.1161/STROKEAHA.111.613208.
Rota E, Morelli N, ImmovilH P, Cerasti D, Zini A, Guidetti D. "Minor" stroke: not a minor, still open question. J Thromb Thrombolysis. 2020;49(1):132-5. DOI: doi.org/10.1007/s11239-019-02001-w
Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: A meta-analysis of individual patient data from randomised trials. Lancet. 2014;384(9958):1929-35. DOI: 10.1016/S0140-6736(14)60584-5
Urra X, Ariño H, Llull L, Amaro S, Obach V, Cervera Á, et al. The outcome of patients with mild stroke improves after treatment with systemic thrombolysis. PLoS ONE. 2013;8(3):e59420. DOI: 10.1371/journal.pone.0059420
Lindley RI, Wardlaw JM, Whiteley WN, Cohen G, Blackwell L, Murray GD, et al. Alteplase for acute ischemic stroke: Outcomes by clinically important subgroups in the Third International Stroke Trial. Stroke. 2015;46(3):746-56. DOI: 10.1161/STROKEAHA.114.006573
Khatri P, Kleindorfer DO, Devlin T, Sawyer RN, Starr M, Mejilla J, et al. Effect of alteplase vs aspirin on functional outcome for patients with acute ischemic stroke and minor nondisabling neurologic deficits the PRISMS randomized clinical trial. JAMA. 2018;320(2):156-66. DOI: 10.1001/jama.2018.8496
Lan L, Rong X, Li X, Zhang X, Pan J, Wang H, et al. Reper-fusion therapy for minor stroke: A systematic review and meta-analysis. Brain Behav. 2019;9(10):e01398. DOI: 10.1002/brb3.1398
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: A Guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46-e110. DOI: 10.1161/STR.0000000000000158.
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.