Trombólise em Acidente Vascular Isquêmico Cardioembólico
DOI:
https://doi.org/10.34024/rnc.2006.v14.8745Palavras-chave:
Acidente cerebrovascular, Terapia TrombolíticaResumo
Acidentes vasculares cerebrais isquêmicos (AVCi) cardioembólicos são responsáveis por aproximadamente15% de todos os AVCi. Algumas características são sugestivas de cardiembolia como mecanismo do AVCi, dentre elas: déficit máximo no início dos sintomas, múltiplos territórios vasculares acometidos, uma maior tendência à transformação hemorrágica, maior risco de crises epilépticas ou síncope no início dos sintomas e menor chance de ataques isquêmicos transitórios (AIT) premonitórios. Desde a aprovação do ativador do plasminogênio tecidual recombinante (rt-PA) para o tratamento do AVCi quando administrado até três horas do início dos sintomas, essa terapêutica tem sido utilizada como a única capaz de prevenir incapacidade nessa doença por vezes devastadora. Esse artigo faz uma revisão das peculiaridades do tratamento trombolítico no AVCi cardioembólico.
Referências
Versalius A. De Humani Corpis Frabica. Basilae, J Oporini, 1543.
Virchow R. Uber die akut entzundung der arterien. Virchows Arch Pathol Anat 1846; 1:272-378 DOI: https://doi.org/10.1007/BF01975873
Osler W. The principles of practice of Medicine.5th ed. New York: D. Appleton and Co., 1903:1008-1009.
Fisher CM. Occlusion of the internal carotid artery. Arch Neurol 1951; 65:346-377. DOI: https://doi.org/10.1001/archneurpsyc.1951.02320030083009
Liebeskind A, Chinichian A, Schechter M. The moving embolus seen during cerebral angiography. Stroke 1971; 2:440-443. DOI: https://doi.org/10.1161/01.STR.2.5.440
Fisher CM, Adams RD. Observations on brain embolism with special reference to the mechanism of hemorrhagic infarction. J Neuropathol Exp Neurol 1951;10: 92-94.
Okada Y, Yamaguchi T, Minematsu K, Miyashita T, Sawada T, Sadoshima S, et al. Hemorrhagic transformation in cerebral embolism. Stroke 1989; 20:598-603. DOI: https://doi.org/10.1161/01.STR.20.5.598
de Freitas GR, Carruzzo A, Tsiskaridze A, Lobrinus JA, Bogousslavsky J. Massive haemorrhagic transformation in cardioembolic stroke: the role of arterial wall trauma and dissection. J Neurol Neurosurg Psychiatry 2001; 70(5): 672-674. DOI: https://doi.org/10.1136/jnnp.70.5.672
Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP, et al. The Havard Cooperative Stroke Registry: a prospective registry. Neurology 1978; 28:754-762. DOI: https://doi.org/10.1212/WNL.28.8.754
Timsit SG, Sacco RL, Mohr JP, Foulkes MA, Tatemichi TK, Wolf PA, et al. Brain infarction severity differs according to cardiac or arterial embolic source. Neurology 1993; 43:728-733. DOI: https://doi.org/10.1212/WNL.43.4.728
Helgason C. Cardioembolic stroke topography and pathogenesis. Cerebrovasc Brain Metab Rev 1992; 4:28-58.
Caplan LR, Hier DB, D‘Cruz I. Cerebral embolism in the Michael Reese Stroke Registry. Stroke 1983; 14:530 536. DOI: https://doi.org/10.1161/01.STR.14.4.530
Cerebral Embolism Study Group. Cardiogenic brain embolism: The second report of the Cerebral Embolism Task Force. Arch Neurol 1989; 46: 727743. DOI: https://doi.org/10.1001/archneur.1989.00520430021013
Bogousslavsky J, Cachin C, Regli F, Despland PA, Van Melle G, Kappenberger L. Cardiac sources of embolism and cerebral infarction. Clinical consequences and vascular concomitants. Neurology 1991; 41:855-859. DOI: https://doi.org/10.1212/WNL.41.6.855
Caplan LR. Posterior Circulation Disease. Clinical Findings, Diagnosis and Management. Boston, Blackwell Science, 1996.
Grau AJ, Weimar C, Buggle F, Heinrich A, Goertler M, Neumaier S, et al. Risk factors, outcome, and treatment in subtypes of ischemic stroke: The German Stroke Data Bank. Stroke 2001; 32: 25592566. DOI: https://doi.org/10.1161/hs1101.098524
Carod-Artal FJ, Vargas AP, Melo M, Horan TA. American trypanosomiasis (Chagas‘ disease): an unrecognized cause of stroke. J Neurol Neurosurg Psychiatry 2003; 74:516-518. DOI: https://doi.org/10.1136/jnnp.74.4.516
Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org10172 in Acute Stroke Treatment. Stroke 1993; 24:35-41.
Wilterdink JL, Furie KL, Easton JD. Cardiac evaluation of stroke patients. Neurology 1998; suppl 3:S23S26. DOI: https://doi.org/10.1212/WNL.51.3_Suppl_3.S23
Chimowitz MI, Weiss DG, Cohen SL, Starling MR, Hobson RW 2nd. Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease. Stroke 1994; 25:759765. DOI: https://doi.org/10.1161/01.STR.25.4.759
Loh E, Sutton MSJ, Wun CC. Ventricular dysfunction and the risk of stroke after myocardial infarction. N Engl J Med 1997; 336:251257. DOI: https://doi.org/10.1056/NEJM199701233360403
The National Institutes of Neurological Disorders, and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995; 333: 15811587. DOI: https://doi.org/10.1056/NEJM199512143332401
Primeiro Consenso Brasileiro do Tratamento da Fase Aguda do Acidente Vascular Cerebral. Arq. Neuro-Psiquiatr 2001; 59 (4):675-680. DOI: https://doi.org/10.1590/S0004-282X2001000600026
Hsia AW, Sachdev HS, Tomlinson J, Hamilton SA, Tong DC. Efficacy of IV tissue plasminogen activator in acute stroke: Does stroke subtype really matter? Neurology 2003. 61(1): 71-75. DOI: https://doi.org/10.1212/01.WNL.0000071228.56362.36
Molina CA, Montaner J, Abilleira S, Ibarra B, Romero F, Arenillas JF, et al. Timing of spontaneous recanalization and risk of hemorrhagic transformation in acute cardioembolic stroke. Stroke. 2001; 32: 10791084. DOI: https://doi.org/10.1161/01.STR.32.5.1079
Overgaard K, Sereghy T, Boysen G, Pedersen H, Diemer NH. Reduction of infarct volume and mortality by thrombolysis in a rat embolic stroke model. Stroke. 1992; 23: 11671173. DOI: https://doi.org/10.1161/01.STR.23.8.1167
Zhang RL, Chopp M, Zhang ZG, Divine G. Early (1h) administration of tissue plasminogen activator reduces infarct volume without increasing hemorrhagic transformation after focal cerebral embolization in rats. J Neurol Sci. 1998; 160: 18. DOI: https://doi.org/10.1016/S0022-510X(98)00155-5
Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischemic stroke (ECASS II) Lancet. 1998; 352: 12451251. DOI: https://doi.org/10.1016/S0140-6736(98)08020-9
Clark WM, Wissman S, Albers GW, Jhamandas JH, Madden KP, Hamilton S. Recombinant tissue-type plasminogen activator (alteplase) for ischemic stroke 3 to 5 hours after symptom onset: the ATLANTIS study: a randomized controlled trial: Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA. 1999; 282: 20192026. DOI: https://doi.org/10.1001/jama.282.21.2019
Fagan SC, Garcia JH. Hemorrhagic transformation in focal cerebral ischemia: influence of time to artery reopening and tissue plasminogen activator. Pharmacotherapy. 1999; 19: 139142. DOI: https://doi.org/10.1592/phco.19.3.139.30932
Caplan LR, Mohr JP, Kistler JP, Koroshetz W. Should thrombolytic therapy be the first-line treatment for acute stroke? Thrombolysis: not a panacea for ischemic stroke. N Engl J Med. 1997; 337: 13091310. DOI: https://doi.org/10.1056/NEJM199710303371812
Christou I, Alexandrov AV, Burgin WS, Wojner AW, Felberg RA, Malkoff M, et al. Timing of recanalization after tissue plasminogen activator therapy determined by transcranial Doppler correlates with clinical recovery from ischemic stroke. Stroke. 2000; 31: 18121816. DOI: https://doi.org/10.1161/01.STR.31.8.1812
Molina CA, Montaner J, Abilleira S, Arenillas JF, Ribo M, Huertas R, et al. Time course of tissue plasminogen activatorinduced recanalization in acute cardioembolic stroke: a case-control study. Stroke. 2001; 32: 28212827. DOI: https://doi.org/10.1161/hs1201.99821
Molina CA, Montaner J, Arenillas JF, Ribo M, Rubiera M, Alvarez-Sabin J. Differential Pattern of Tissue Plasminogen ActivatorInduced Proximal Middle Cerebral Artery Recanalization Among Stroke Subtypes. Stroke 2004; 35(2): 486-490. DOI: https://doi.org/10.1161/01.STR.0000110219.67054.BF
Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, et al. Intraarterial prourokinase for acute ischemic stroke. The PROACT II study: A randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 1999;282:20032011. DOI: https://doi.org/10.1001/jama.282.21.2003
Zaidat OO, Slivka AP, Mohammad Y, Graffagnino C, Smith TP, Enterline DS, et al. Intra-Arterial Thrombolytic Therapy in Peri-Coronary Angiography Ischemic Stroke. Stroke 2005; 36:1089-1090. DOI: https://doi.org/10.1161/01.STR.0000162392.44326.ec
