Imagen en el ictus isquémico agudoneurodonostia.com/wp-content/uploads/2017/03/4... · Objetivos...
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Imagen en el ictus isquémico agudo Gorka Arenaza
Transcript of Imagen en el ictus isquémico agudoneurodonostia.com/wp-content/uploads/2017/03/4... · Objetivos...
Imagen en el ictus isquémico agudo
Gorka Arenaza
?
Objetivos de la imagen 1.-Descartar simuladores e ictus hemorrágicos
2.-Oclusión vascular 3.-Core y Penumbra
Emergency imaging before any treatment
Nonenhanced CT will provide necessary information
(Class I; Level of Evidence A)
TAC RM
If endovascular therapy is contemplated, a noninvasive intracranial vascular study is strongly recommended
(Class I; Level of Evidence A)
Patients should receive endovascular therapy with ICA or M1 occlusion
(Class I; Level of Evidence A)
Endovascular therapy may be reasonable M2-M3, ACA and posterior circulation
(Class IIb; Level of Evidence C)
Objetivos de la imagen 1.-Descartar simuladores e ictus hemorrágicos
2.-Oclusión vascular 3.-Core y Penumbra
William T. C. Yuh, AJR 2017 208:1, 32-41
ASPECTS
100-35 35-35
Pat
ien
ts s
ho
uld
re
ceiv
e e
nd
ova
scu
lar
the
rap
y w
ith
ASP
ECTS
≥6
(Cla
ss I;
Lev
el o
f Ev
iden
ce A
)
ASP
ECTS
co
mo
cri
teri
o d
e
incl
usi
ón
MR
CLEA
N
----
ESCA
PE
≥6
EXTE
ND
IA
----
SWIF
T PR
IME
≥6
REVA
SCAT
≥7
Alt
ho
ugh
its
be
nef
its
are
un
cert
ain
, e
nd
ova
scu
lar
the
rap
y m
ay b
e
reas
on
able
) w
ith
in 6
ho
urs
of
sym
pto
m o
nse
t an
d A
SPEC
TS <
6
(C
lass
IIb
; Lev
el o
f Ev
iden
ce B
)
Imágenes fuente
Int J Stroke 2008;3(4):230–6
Colaterales
Bijoy K. Menon et al; Radiology 2015, 275, 510-520.
www.aspectsinstroke.com
Christopher D. d’Esterre et al. International Stroke Conference 2017
The benefits of collateral measurement for selecting patients for endovascular therapy are unknown
(Class IIb; Level of Evidence C)
*Further trials may be helpful to determine if collateral status is beneficial for
ASPECTS <6 or beyond 6 hours
Colaterales como criterio
de inclusión
MR CLEAN ----
ESCAPE mCTA
EXTEND IA ----
SWIFT PRIME ----
REVASCAT ----
TC Perfusión
Christopher D. d’Esterre et al. Stroke. 2015;46:3390-3397
MTT CBVol
Tmax Tmax
Perfusión
MR CLEAN ----
ESCAPE ----
EXTEND IA Ratio 1.2 Core<70
SWIFT PRIME Ratio 1.8 Core<50
REVASCAT CBV>6
The benefits of perfusion for selecting patients for endovascular therapy are unknown
(Class IIb; Level of Evidence C)
Further trials may be helpful to determine if perfusion is
beneficial for ASPECTS <6 or beyond 6 hours
Hospital Ntra. Señora de Aránzazu, 1993 Dr Massó
N.Takakura RSNA 2014
Conclusiones • CT basal y AngioTC obligatorio • Core / Penumbra pendiente de estandariación,
validación • Herramientas prometedoras para aumentar
ventana terapeútica y disminuir recanalización fútil
“Tiempo es cerebro” Penumbra
