EVOLUCIÓN DEL MANEJO ENDOVASCULAR EN MALFORMACIONES ARTERIOVENOSAS CEREBRALES
DOI:
https://doi.org/10.51437/nj.v28i1.183Keywords:
Malformación arteriovenosa, embolización, endovascular, neurointervencionismo, líquidos embolizantes.Abstract
Las malformaciones arteriovenosas (MAV’s) del sistema nervioso central (SNC) son un tipo de cortocircuito arteriovenoso que afecta a 1 de cada 100.000 habitantes y debuta principalmente antes de los 40 años. Diferentes presentaciones clínicas pueden retrasar el diagnóstico acertado: crisis convulsivas focales o generalizadas, deterioro súbito por hemorragia intra cerebral, cefalea y déficit neurológico progresivo secundario a fenómenos de robo vascular, son las principales manifestaciones clínicas con diferentes grados de deterioro funcional. Constituye un verdadero reto diagnóstico y terapéutico para el personal sanitario. Se requiere de un abordaje diagnóstico protocolizado, incluyendo: estado clínico basal, evaluación neuropsicológica, estudios de imágenes avanzadas de resonancia nuclear magnética (RNM), angiografía por sustracción digital (DSA, por su sigla en inglés), microcateterismos supraselectivos y pruebas evocativas, de ser necesario. Una vez establecido el diagnóstico, clasificado el grado en al menos tres escalas, y determinados los factores de riesgo de sangrado o resangrado, es posible considerar y ejecutar la mejor estrategia terapéutica para cada caso. El neurointervencionismo ha evolucionado a pasos agigantados en los últimos decenios, pasando de un rol meramente diagnóstico a ser una opción de tratamiento curativo por sí misma. En esta revisión se exponen aspectos básicos de la epidemiología, historia natural de la enfermedad, angioarquitectura, clasificaciones, toma de decisiones terapéuticas y manejo endovascular desde los inicios hasta la actualidad.
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2021-04-29
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Lozano-Tangua, C. F., Zenteno Castellanos, M., Lee, A., Casasco, A. ., Balderrama Bañares, J. L., Rosero Rosero, J. C., Patiño Rodriguez, H. M. ., Montenegro Rosales, H. A. ., Acosta Fernández, R. C., & Ramirez Ocampo, M. . (2021). EVOLUCIÓN DEL MANEJO ENDOVASCULAR EN MALFORMACIONES ARTERIOVENOSAS CEREBRALES. Español, 28(1), 76–114. https://doi.org/10.51437/nj.v28i1.183
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