u.o. neurologia – stroke unit u.o. neuroradiologia – modulo ......– reduces need for...
TRANSCRIPT
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U.O. Neurologia – Stroke UnitU.O. Neuroradiologia – Modulo Dip. Neuroradiologia Interventistica
Dipartimento Neuroscienze - Riabilitazione
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Corsia d’ospedale: anni ‘60
Courtesy of Prof. V. Toso
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StrokeUnit
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…despite an increased incidence of symptomatic intracerebralhemorrhage, treatment with intravenous tPA within three
hours of the onset of ischemic stroke improved clinicaloutcome at three months.
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Unit Unit SettingSetting: : StrokeStroke UnitUnit
• Treatment at a Stroke Unit compared to treatment in a general ward
– reduces mortality (ARR 3%)
– reduces dependency(ARR 5%)
– reduces need forinstitutional care (ARR 2%)
• All types of patients, irrespective of gender, age, stroke subtype and stroke severity, appear to benefit from treatment in stroke units
Stroke Unit Trialists' Collaboration Cochrane Rev (2007)
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Già autorizzato l’uso entro 4,5 ore in Germania e Regno Unito
Imminente l’approvazione AIFA
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…… e oltre le 4,5 ore?e oltre le 4,5 ore?
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Interpretation
“…despite the early hazard, thrombolysiswithin 6 hours improved functional outcome.
Benefit did not seemto be diminished in elderlypatients.”
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Alive and Independent at Day 90Alive and Independent at Day 90Adjusted odds ratio (95% CI) by stroke onsetAdjusted odds ratio (95% CI) by stroke onset
to treatment timeto treatment time
ECASS IIIECASS IIISITSSITS--MOSTMOST
NN
T 9
NN
T 1
4
“Having more time does not mean physicians can take more time”
NN
T 3
IST III
NN
T 3
4
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Trattamenti in acuto Trattamenti in acuto –– StrokeStroke UnitUnit FerraraFerrara
0
10
20
30
40
50
60
2005 2006 2007 2008 2009 2010 2011 2012
IA
EV
53
205
5% di tutti gli 5% di tutti gli ictusictus
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OUTCOME a 3 mesiOUTCOME a 3 mesipz trattati con trombolisi ev
61
55
50
40
28
31
33
46
11
14
17
14
0% 20% 40% 60% 80% 100%
Ferrara
SITS Europa
tPA metanalisi
placebo
mRS 0-2 mRS 3-5 Morti
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Limiti trombolisi ev
• Finestra temporale rigida
• Numerosi criteri di esclusione
• Basso tasso ricanalizzazione in occlusione grosso vaso
• Rischio emorragico sistemico
Basso tasso pztrattabili/tot. ictus
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… oltre la trombolisi evStudio penombra ischemica in acuto e …
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... ... ricanalizzazionericanalizzazioneendovascolareendovascolare
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www.registroendovascolare.it