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Impacto da pandemia de COVID-19 na abordagem e tratamento endovascular dos doentes com AVC isquémico sem infeção por SARS-CoV-2
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Resumo(s)
Introdução: A terapêutica de primeira linha no tratamento do Acidente Vascular Cerebral isquémico (AVCi) agudo por oclusão de grande vaso é a trombectomia (TEV) com ou sem fibrinólise, sendo o intervalo de tempo até à reperfusão um dos principais fatores de bom prognóstico. A pandemia COVID-19 foi responsável pela alteração da dinâmica dos cuidados de saúde, incluindo na resposta assistencial da Via Verde AVC. O objetivo do estudo é avaliar o impacto da mesma no tratamento endovascular do AVCi.
Metodologia: Estudo retrospetivo, recorrendo à base de dados do Serviço de Imagiologia Neurológica da ULS Santa Maria, incluindo os doentes com AVCi, submetidos a TEV no 1º mês de cada trimestre dos anos de 2019, 2020 e 2021, sem infeção SARS-CoV-2. Outcome primário: Nível de dependência funcional aos 90 dias após o AVCi (mRS ≤ 3); Outcome secundário: Mortalidade aos 90 dias após o AVCi.
Resultados: Foram incluídos 220 doentes: 72 em 2019, 84 em 2020 e 64 em 2021. Os tempos pré e intra-hospitalares foram superiores em 2020, mas só o porta-TC (p=0,037) e o sintomas-recanalização (p=0,028) tiveram um aumento estatisticamente significativo. Não houve diferença estatisticamente significativa na percentagem de doentes com mRS ≤ 3 (p=0,977) nem na mortalidade aos 90 dias pós-AVC (p=0,227) entre os anos de 2019, 2020 e 2021. Um TICI≥2C mostrou-se preditor independente de um mRS ≤ 3 aos 90 dias (OR=2,643; p=0,025); a TH sintomática foi preditor independente da mortalidade aos 90 dias (OR=30,57; p=0,001). O tempo de recanalização diminuiu ao longo do tempo (B=-0,039) e foi superior se na presença de uma oclusão cervical (B=12,561) (R2= 0,103; F=1,877; p=0,045).
Conclusão: Apesar das dificuldades atravessadas durante a pandemia e do aumento dos tempos pré e intra-hospitalares, os resultados do tratamento endovascular do AVCi na ULS Santa Maria mantiveram-se semelhantes, não tendo havido diferenças significativas nos outcomes primário e secundário, entre os três anos.
Background and Purpose: First-line therapy for Acute Ischemic Stroke (AIS) due to large vessel occlusion is thrombectomy (EVT) with or without fibrinolysis, with the time interval until reperfusion being one of the main factors for a good prognosis. The COVID-19 pandemic was responsible for changing the dynamics of healthcare, including the Stroke Green Way’s care response. The aim of the study is to assess its impact on the endovascular treatment of AIS. Methodology: Retrospective study, using the database of the Neurological Imaging Service of ULS Santa Maria, including patients with AIS who underwent EVT in the first month of each quarter of the years 2019, 2020, and 2021, without SARS-CoV-2 infection. Primary outcome: Level of functional dependence at 90 days after ischemic stroke (mRS ≤ 3); Secondary outcome: Mortality at 90 days after ischemic stroke. Results: 220 patients were included: 72 in 2019, 84 in 2020, and 64 in 2021. Pre- and intra-hospital times were higher in 2020, but only door-to-imaging (p=0.037) and symptom-to-recanalization time (p=0.028) showed a statistically significant increase. There was no statistically significant difference in the percentage of patients with mRS ≤ 3 (p=0.977) or in 90-day post-stroke mortality (p=0.227) between the years 2019, 2020, and 2021. A TICI≥2C was shown to be an independent predictor of mRS ≤ 3 at 90 days (OR=2.643; p=0.025); symptomatic intracranial hemorrhage was an independent predictor of 90-day mortality (OR=30.57; p=0.001). Recanalization time decreased over time (B=-0.039), and it was higher in the presence of cervical occlusion (B=12.561) (R2= 0.103; F=1.877; p=0.045). Conclusion: Despite the challenges faced during the pandemic and the increase in pre- and intra-hospital times, the results of endovascular treatment for ischemic stroke at ULS Santa Maria remained similar, with no significant differences observed in the primary and secondary outcomes among the three years.
Background and Purpose: First-line therapy for Acute Ischemic Stroke (AIS) due to large vessel occlusion is thrombectomy (EVT) with or without fibrinolysis, with the time interval until reperfusion being one of the main factors for a good prognosis. The COVID-19 pandemic was responsible for changing the dynamics of healthcare, including the Stroke Green Way’s care response. The aim of the study is to assess its impact on the endovascular treatment of AIS. Methodology: Retrospective study, using the database of the Neurological Imaging Service of ULS Santa Maria, including patients with AIS who underwent EVT in the first month of each quarter of the years 2019, 2020, and 2021, without SARS-CoV-2 infection. Primary outcome: Level of functional dependence at 90 days after ischemic stroke (mRS ≤ 3); Secondary outcome: Mortality at 90 days after ischemic stroke. Results: 220 patients were included: 72 in 2019, 84 in 2020, and 64 in 2021. Pre- and intra-hospital times were higher in 2020, but only door-to-imaging (p=0.037) and symptom-to-recanalization time (p=0.028) showed a statistically significant increase. There was no statistically significant difference in the percentage of patients with mRS ≤ 3 (p=0.977) or in 90-day post-stroke mortality (p=0.227) between the years 2019, 2020, and 2021. A TICI≥2C was shown to be an independent predictor of mRS ≤ 3 at 90 days (OR=2.643; p=0.025); symptomatic intracranial hemorrhage was an independent predictor of 90-day mortality (OR=30.57; p=0.001). Recanalization time decreased over time (B=-0.039), and it was higher in the presence of cervical occlusion (B=12.561) (R2= 0.103; F=1.877; p=0.045). Conclusion: Despite the challenges faced during the pandemic and the increase in pre- and intra-hospital times, the results of endovascular treatment for ischemic stroke at ULS Santa Maria remained similar, with no significant differences observed in the primary and secondary outcomes among the three years.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
AVC isquémico Trombectomia SARS-CoV-2 COVID-19