Thrombolysis and mechanical thrombectomy in ischemic stroke of large vessels. Review article.

Abstract

Introduction: Ischemic stroke is a medical emergency, with a high impact on the quality of life of patients suffering from it. Globally, only 5% of stroke patients receive thrombolysis or thrombectomy, despite being the second leading cause of disability and death worldwide. Objectives: to review the literature on thrombolysis and mechanical thrombectomy in acute stroke. Materials and methods: a bibliographic review of 36 scientific articles, including clinical cases, meta-analysis, guidelines, and observational studies, was carried out in the databases Pubmed, International Stroke Treatment Registry, IntechOpen, Google Scholar, among others. The search was conducted under the following topics: thrombolysis and mechanical thrombectomy in ischemic stroke. Discussion: Mechanical thrombectomy is beneficial until 24 hours after the onset of stroke in proximal occlusions of large vessels. According to the studies reviewed, in patients with stroke with basilar artery occlusion, middle cerebral artery and anterior arterial circulation, treated with thrombectomy and/or thrombolysis at 4.5 hours, 6 hours and 24 hours respectively, After the onset of symptoms, there was no significant difference between the use of thrombectomy alone or combined with thrombolysis. In Ecuador, a study has been reported that includes 96 patients, who underwent mechanical thrombectomy, whose effectiveness was evaluated with the modified Rankin scale, showing that, with the use of mechanical thrombectomy, the results are encouraging, suggesting a reduction in disability due to neurological sequelae. Conclusions: The early use of fibrinolysis during the first 4.5 hours, in patients with ischemic brain event of large vessels, is effective alone or accompanied by thrombectomy, however, after 4.5 hours, the greatest benefit is observed with mechanical thrombectomy regardless of the use of previous thrombolysis.