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dc.rights.licenseAtribución-NoComercial-SinDerivadas 4.0 Internacional
dc.contributor.advisorLozano Castillo, Alfonso Javier
dc.contributor.authorSalazar Díaz, Luis Carlos
dc.date.accessioned2021-02-04T19:29:25Z
dc.date.available2021-02-04T19:29:25Z
dc.date.issued2020-10-01
dc.identifier.citationSalazar Díaz, L. C. (2020). Tratamiento endovascular versus manejo estándar para el vasoespasmo cerebral en pacientes con hemorragia subaracnoidea aneurismática [Tesis de especialidad, Universidad Nacional de Colombia]. Repositorio Institucional.
dc.identifier.urihttps://repositorio.unal.edu.co/handle/unal/79079
dc.description.abstractReview question: in this review we assessed the effectiveness and safety of endovascular therapy (i.e. intra-arterial vasodilator infusion, balloon angioplasty, stent or combined therapy) compared to standard management for treatment of cerebral vasospasm in adults with aneurysmal subarachnoid hemorrhage. Background: although 30% of patients with cerebral vasospasm develop delayed cerebral ischemia, currently there is no way to know whether a patient would have this complication. There are a wide range of treatment options and the choice is based on the experience of the clinicians, patient preferences and adverse effects. Studies characteristics: we searched the available literature up to 2 May 2020 and included 26 controlled studies with 1783 patients. The studies included both men and women aged over 18 years with clinical and radiological diagnosis of aneurysmal subarachnoid haemorrhage and cerebral vasospasm. Ten studies (799 patients) included people that had been treated with endovascular treatment and compared with medical therapy. In most studies, people received intra-arterial vasodilatory infusion (i.e. papaverine, nimodipine, nicardipine, colforsin). Fifteen studies compared endovascular therapy against each other technique (912 participants). One study (72 patients) included three arms (medical therapy, intra-arterial vasodilator infusion and balloon angioplasty). Key results: long-term functional status and angiographic improvement suggest superiority with intra-arterial vasodilator compared to medical treatment (moderate / serous risk of bias). We found no difference on adverse events rate between endovascular therapy and medical treatment (moderate / serous risk of bias). Quality of evidence: results should be interpreted with caution because the risk of bias, imprecision, inconsistency and heterogeneity.
dc.description.abstractPregunta de investigación: en este trabajo se evaluó la efectividad y la seguridad del tratamiento endovascular (i.e. infusión intraarterial de vasodilatador, angioplastia con balón, stent recuperable o terapia combinada) en comparación con el tratamiento estándar para el manejo del vasoespasmo cerebral en adultos con hemorragia subaracnoidea aneurismática. Antecedentes: aunque el 30% de los pacientes con vasoespasmo cerebral desarrollan isquemia cerebral tardía, actualmente no hay forma de saber que pacientes desarrollarán esta complicación. Existe una amplia gama de opciones terapéuticas y la elección se basa en la experiencia clínica, las preferencias del paciente y los eventos adversos. Características de los estudios: se realizó búsqueda sistemática de estudios controlados hasta el 2 de mayo de 2020. Se incluyó 26 estudios con 1783 pacientes. Los estudios incluyeron hombres y mujeres mayores de 18 años con diagnóstico clínico y radiológico de hemorragia subaracnoidea aneurismática y de vasoespasmo cerebral. Diez estudios (799 pacientes) incluyeron pacientes que recibieron terapia endovascular versus tratamiento médico. La mayoría de los estudios utilizó infusión intraarterial de vasodilatador (i.e. papaverina, nimodipino, nicardipino, colforsina, etc.). Quince estudios (912 pacientes) compararon diferentes modalidades de terapia endovascular entre sí. Un estudio (72 pacientes) incluyó tres brazos de comparación (terapia médica, vasodilatardor intraarterial y angioplastia con balón). Resultados clave: el estado funcional a largo plazo y la mejoría angiográfica sugiere ser superior con vasodilatador intraarterial comparado con tratamiento médico (riesgo de sesgo moderado / serio). No se observó diferencias significativas en los eventos adversos entre la terapia endovascular versus el tratamiento médico (riesgo de sesgo moderado / serio). Calidad de la evidencia: los resultados deben interpretarse con cautela: riesgo de sesgo, imprecisión, inconsistencia y heterogeneidad.
dc.format.extent100
dc.format.mimetypeapplication/pdf
dc.language.isospa
dc.rightsDerechos reservados - Universidad Nacional de Colombia
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subject.ddc610 - Medicina y salud
dc.titleTratamiento endovascular versus manejo estándar para el vasoespasmo cerebral en pacientes con hemorragia subaracnoidea aneurismática
dc.title.alternativeEndovascular treatment versus standard management for cerebral vasospasm in aneurysmal subarachnoid haemorrhage
dc.typeOtro
dc.rights.spaAcceso abierto
dc.description.additionalLínea de investigación: Neuroimágenes.
dc.type.driverinfo:eu-repo/semantics/other
dc.type.versioninfo:eu-repo/semantics/acceptedVersion
dc.publisher.programBogotá - Medicina - Especialidad en Radiología e Imágenes Diagnósticas
dc.contributor.researchgroupGRUPO DE INVESTIGACIÓN EN RADIOLOGÍA E IMÁGENES DIAGNÓSTICAS (GRID)
dc.description.degreelevelEspecialidades Médicas
dc.publisher.branchUniversidad Nacional de Colombia - Sede Bogotá
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dc.rights.accessrightsinfo:eu-repo/semantics/openAccess
dc.subject.proposalProcedimientos endovasculares
dc.subject.proposalSubarachnoid hemorrhage
dc.subject.proposalEndovascular procedures
dc.subject.proposalHemorragia subaracnoidea
dc.subject.proposalVasospasm intracranial
dc.subject.proposalVasoespasmo intracraneal
dc.type.coarhttp://purl.org/coar/resource_type/c_1843
dc.type.coarversionhttp://purl.org/coar/version/c_ab4af688f83e57aa
dc.type.contentText
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Atribución-NoComercial-SinDerivadas 4.0 InternacionalThis work is licensed under a Creative Commons Reconocimiento-NoComercial 4.0.This document has been deposited by the author (s) under the following certificate of deposit