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Información de la revista
Vol. 25. Núm. S1.
Catástrofes neurológicas
Páginas 18-23 (Octubre 2010)
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Vol. 25. Núm. S1.
Catástrofes neurológicas
Páginas 18-23 (Octubre 2010)
Catástrofes neurológicas
Acceso a texto completo
Trombosis aguda de la arteria basilar
Acute basilar artery thrombosis
Visitas
...
J.F. Arenillas Lara
Unidad de Ictus, Servicio de Neurología, Hospital Clínico Universitario, Valladolid, España
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Resumen
Bibliografía
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Resumen

La trombosis aguda de la arteria basilar (TAB) ha sido considerada una catástrofe neurológica. Únicamente alrededor de un 20% de los pacientes alcanza un buen pronóstico con tratamiento convencional. Es importante establecer una sospecha diagnóstica precoz para evitar un retraso en el inicio del tratamiento. La evaluación diagnóstica incluye confirmación de la oclusión basilar y estimación de la viabilidad del tejido isquémico, y puede realizarse con resonancia magnética multiparamétrica o con angiotomografía computarizada combinada con sus imágenes fuente. La recanalización arterial precoz determina la posibilidad de alcanzar un buen pronóstico; sin embargo, se desconoce cuál es el mejor tratamiento de la TAB. No se ha demostrado que la trombólisis intraarterial sea superior a la intravenosa, de modo que en ausencia de contraindicaciones debe iniciarse cuanto antes la trombólisis intravenosa, que puede ser el tratamiento principal si no se cuenta con acceso al neurointervencionismo. Recientemente se han notificado tasas excelentes de buen pronóstico (50% de independencia funcional) empleando estrategias escalonadas de combinación de varias modalidades terapéuticas (trombólisis intravenosa ultraprecoz seguida de trombectomía mecánica endovascular de rescate). Estos resultados representan una esperanza para pacientes y neurólogos y suponen un reclamo para continuar innovando e investigando en este campo.

Palabras clave:
Ictus
Pronóstico
Trombosis basilar
Cuidados neurocríticos
Abstract

Acute basilar artery thrombosis (ABT) has been largely considered a neurological catastrophe. With conventional treatment, only around 20% of patients achieve functional independence. An early presumptive diagnosis is essential to avoid treatment delay. Either multiparametric magnetic resonance imaging or computed tomography angiography source images may represent valid non-invasive tools to confirm ABT and evaluate ischemic tissue viability.

The main determinant of ABT outcome is early recanalization but the most effective therapeutic option remains to be clarified. The BASICS prospective registry showed no superiority of intra-arterial over intravenous thrombolysis. Therefore, in the absence of contraindications, intravenous thrombolysis should be started as soon as possible and can be used as the main therapy when interventional procedures are not available. However, recent case series have reported high rates of functional independence (50%) after staged escalation therapy (ultra-early intravenous thrombolysis followed by on-demand endovascular mechanical thrombectomy). These results represent a hope for patients and neurologists and reinforce the need for innovation and research in this field.

Keywords:
Stroke
Outcome
Basilar thrombosis
Neurocritical care
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Copyright © 2010. Sociedad Española de Neurología
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