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Introduction: Stroke is one of the leading causes of death in Latin America, a region with countless gaps to be addressed to decrease its burden. In 2018, at the first Latin American Stroke Ministerial Meeting, stroke physician and healthcare manager representatives from 13 countries signed the Declaration of Gramado with the priorities to improve the region, with the commitment to implement all evidence-based strategies for stroke care. The second meeting in March 2020 reviewed the achievements in 2 years and discussed new objectives. This paper will review the 2-year advances and future plans of the Latin American alliance for stroke. Method: In March 2020, a survey based on the Declaration of Gramado items was sent to the neurologists participants of the Stroke Ministerial Meetings. The results were confirmed with representatives of the Ministries of Health and leaders from the countries at the second Latin American Stroke Ministerial Meeting. Results: In 2 years, public stroke awareness initiatives increased from 25 to 75% of countries. All countries have started programs to encourage physical activity, and there has been an increase in the number of countries that implement, at least partially, strategies to identify and treat hypertension, diabetes, and lifestyle risk factors. Programs to identify and treat dyslipidemia and atrial fibrillation still remained poor. The number of stroke centers increased from 322 to 448, all of them providing intravenous thrombolysis, with an increase in countries with stroke units. All countries have mechanical thrombectomy, but mostly restricted to a few private hospitals. Pre-hospital organization remains limited. The utilization of telemedicine has increased but is restricted to a few hospitals and is not widely available throughout the country. Patients have late, if any, access to rehabilitation after hospital discharge. Conclusion: The initiative to collaborate, exchange experiences, and unite societies and governments to improve stroke care in Latin America has yielded good results. Important advances have been made in the region in terms of increasing the number of acute stroke care services, implementing reperfusion treatments and creating programs for the detection and treatment of risk factors. We hope that this approach can reduce inequalities in stroke care in Latin America and serves as a model for other under-resourced environments.
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The large and increasing burden of stroke in Latin American countries, and the need to meet the UN and WHO requirements for reducing the burden from non-communicable disorders (including stroke), brought together stroke experts and representatives of the Ministries of Health of 13 Latin American countries for the 1st Latin American Stroke Ministerial meeting in Gramado, Brazil, to discuss the problem and identify ways of cooperating to reduce the burden of stroke in the region. Discussions were focused on the regional and country-specific activities associated with stroke prevention and treatment, including public stroke awareness, prevention strategies, delivery and organisation of care, clinical practice gaps, and unmet needs. The meeting culminated with the adoption of the special Gramado Declaration, signed by all Ministerial officials who attended the meeting. With agreed priorities for stroke prevention, treatment, and research, an opportunity now exists to translate this Declaration into an action plan to reduce the burden of stroke.
Assuntos
Efeitos Psicossociais da Doença , Política de Saúde , Acidente Vascular Cerebral/epidemiologia , Humanos , Incidência , América Latina/epidemiologia , Prevalência , Acidente Vascular Cerebral/mortalidadeAssuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Hemorragia Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Acidente Vascular Cerebral/diagnóstico por imagem , Cérebro/cirurgia , Procedimentos Endovasculares/métodos , Neuroimagem/métodos , Angiografia , Tomografia Computadorizada por Raios X , Acidente Vascular Cerebral/complicações , Dislipidemias/complicações , Trombólise Mecânica , Reabilitação do Acidente Vascular Cerebral/métodos , Hipertensão/complicaçõesRESUMO
Long-awaited positive trial data have shown the efficacy of endovascular treatment in patients with ischemic stroke who arrive at the hospital within the first 6 hours with large-vessel occlusion of the anterior circulation. With the introduction of stent retrievers (SRs) for mechanical thrombectomy, efficient and safe large-artery recanalization treatment can be achieved. However, sometimes there are patients who do not attain complete flow restoration following attempts with traditional maneuvers. The authors present the case of a 57-year-old man with acute ischemic stroke due to an M1 embolus that extended into both M2 trunks. This patient was successfully treated with an innovative technique in which a Solitaire SR (Covidien) and a Catch SR (Balt) were used in a "Y" configuration, for which the authors coined the term "Y-stent retriever."
Assuntos
Isquemia Encefálica/cirurgia , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Stents , Acidente Vascular Cerebral/cirurgia , Isquemia Encefálica/diagnóstico por imagem , Revascularização Cerebral/instrumentação , Revascularização Cerebral/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagemRESUMO
Resumen: Las fístulas carótido- cavernosas (FCC) son derivaciones vasculares que permiten el flujo de sangre desde la arteria carótida al seno cavernoso; pueden producir síntomas en ambos sexos a cualquier edad. Algunas fístulas se caracterizan por una conexión directa entre el segmento cavernoso de la arteria carótida interna y el seno cavernoso. Otras FCCs son durales, y consisten en una comunicación entre el seno cavernoso y una o más ramas meníngeas de la arteria carótidainterna, la arteria carótida externa , o ambas. La terapia endovascular es la modalidad de elección en estos casos.Se presenta el uso de N-butilcianoacrilato (NBCA) en una exitosaembolización transarterial de una FCC dural alimentada por ramas de las arterias carótida interna y principalmente carótida externa (Barrow tipo D) en un niño de 1 año.
Abstract:Carotid-cavernous fistulas (CCFs) are vascular shunts that allow blood to flow from the carotid artery into the cavernous sinus; they can produce symptoms in both sexes at any age. Some fistulas are characterized by a directconnection between the cavernous segment of the internal carotid artery and the cavernous sinus, other CCFs are dural, consisting of a communicationbetween the cavernous sinus and 1 or more meningeal branches of the internal carotid artery, the external carotid artery, or both. Endovascular management is the treatment modality of choice in these cases.We report the use of n-butilcianoacrilate (NBCA) in the successful transarterial embolization of a dural CCF fed by arterial branches of the internal but principally external carotid arteries (Barrow type D)in a 1 year old child.
Resumo: As fístulas carotídeas-cavernosas (FCC) são pistas vasculares que permitem o fluxo sanguíneo da artéria carótida para o seio cavernoso; pode produzirsintomas em ambos os sexos em qualqueridade. Algumas fístulas são caracterizadas por umaconexãodireta entre o segmento cavernoso da artéria carótida interna e o seio cavernoso. OutrosFCCssãodural, consistindo em umacomunicação entre o seio cavernoso e umoumais ramos meníngeos da artéria carótida, a artéria carótida externa ou ambos. A terapia endovascular é o modo de escolhanesses casos. É apresentado o uso de n-butilcianoacrilato (NBCA) em umaembolizaçãotransarterialbem sucedida de uma FCC dural alimentada por ramos das artérias carótidas internas e principalmente artéria carótida externa (tipo Barrow D) em um menino de 1 ano de idade.
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BACKGROUND AND PURPOSE: Endovascular treatment of broad-neck, complex cerebral aneurysms is a challenging issue. Placement of a stent over the aneurysm neck and secondary coil embolization prevents coil migration and allows dense packing of the coils. Another challenge is represented by distal aneurysms situated in small vessels. In these cases, the use of little stents, which we are going call ministents, could be a good decision. These low-profile intracranial ministents can be deployed into arteries with diameters between 1.5 and 3.10 mm and delivered through microcatheters with an internal diameter of 0.0165 inches, which allows easier navigation in small-sized, delicate vessels. We present six cases of wide-neck aneurysms, with small parental arteries less than 2.5 mm using a low-profile ministent system (LEO Baby and LVIS Jr) plus coil embolization. MATERIALS AND METHODS: We retrospectively reviewed patients in whom LEO Baby or LVIS Jr stent was used for the treatment of intracranial aneurysms. Five aneurysms were treated during 2013-2014 in our service using the LEO Baby stent and one aneurysm using LVIS Jr. Stent-assisted coil embolization was performed using the jailing technique in all cases. Clinical and angiographic findings, procedural data, and follow-up are reported. RESULTS: Six consecutive patients were included in this study. Four patients presented with subarachnoid hemorrhage in the subacute-chronic phase and two patients had unruptured aneurysms. Two of the six aneurysms were located at branches of the sylvian artery, one at the basilar artery, two at the anterior communicating artery, and one at the P1-P2 artery. The procedures were successful. Six-month control digital subtraction angiograms were obtained in all cases; they demonstrated complete occlusion of the aneurysms in all instances. All patients had good clinical outcomes on follow-up, as measured with the Glasgow Outcome Scale and Modified Rankin Scale. CONCLUSIONS: The results of this small study show that the LEO Baby and LVIS Jr ministents could be safe and efficient for endovascular treatment of intracranial broad-neck aneurysms situated in small arteries.
Assuntos
Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/terapia , Stents , Adulto , Idoso , Angiografia Digital , Angiografia Cerebral , Feminino , Escala de Coma de Glasgow , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/terapia , Resultado do TratamentoRESUMO
Sinus pericranii es una anomalía vascular poco frecuente que consiste en conexiones anómalas congénitas o adquiridas entresistemas venosos extracraneales e intracraneales. Los lagos venosos extracraneales se conectan a los senos durales intracranealesa través de venas dilatadas diploicas y emisarias.Este trastorno es hallado generalmente en la población pediátrica y la mayoría de las veces involucra el seno sagital superiory ocasionalmente el seno transverso. Son procesos generalmente estables habiéndose publicado inclusive casos de regresiónespontánea.
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Anormalidades Congênitas , Seio PericrânioRESUMO
Muchos estudios demuestran la eficacia del tratamiento de la enfermedad de Moyamoya mediante técnicas de revascularizaciónindirecta, y en nuestro medio la técnica más usada y con mejores resultados es la pialsinangiosis, principalmente para casospediátricos con dicha patología. Si bien no existía evidencia en cuanto al uso de estas técnicas en un adulto con una insuficienciacirculatoria cerebral localizada causada por una enfermedad oclusiva de varias arterias cerebrales IC de origen ateromatoso,juzgamos válido intentar realizar la misma técnica de pialsinangiosis. Como resultado del procedimiento, pudimos observar unamejoría en la revascularización cerebral y una disminución objetiva del área cerebral comprometida, además de que la pacientepermanece asintomática luego de un extenso seguimiento.
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Revascularização Cerebral , Doença de MoyamoyaRESUMO
Introducción: Denominamos fístula carótido-cavernosa (FCC) a cualquier comunicación anómala entre la arteria carótidainterna y el seno cavernoso generando un shunt arteriovenoso patológico. Métodos: Revisión retrospectiva, del servicio deNeurointervencionismo Uruguay CEDIVA, incluyendo 17 pacientes con FCC diagnosticados entre julio de 1998 hasta julio de2013; valorando clínica, tratamiento realizado y resultados. Búsqueda bibliográfica de FCC en los últimos 10 años. Resultados:Edad promedio 48 años; 58% hombres y 42% mujeres. 76,4% tuvieron antecedente traumático, y 23,6% no tuvieron antecedente.Clínica más frecuente fue la ocular (94%). Todos los pacientes se hicieron arteriografía diagnóstica. De los 13 pacientes conantecedente traumático, todos fueron FCC directa. De los 4 pacientes sin antecedente traumático, 3 fueron FCC indirectas, yuna fue FCC directa. El tratamiento en todos fue endovascular. La elección de la técnica a utilizar se basó en característicasde la FCC y el neurointervencionista encargado del procedimiento. A todos los pacientes se les realizó arteriografía de controla los 3 meses. Hubo mejoría clínica en 76,4% de los pacientes. Conclusiones: Es una entidad de gran importancia, siendofundamental que el neurocirujano la conozca correctamente a fin de realizar un diagnóstico y tratamiento precoz para prevenirsecuelas potencialmente graves.