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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We wish to thank the authors for their interest and comments on our paper &#8220;Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy&#8221; &#40;&#8220;<span class="elsevierStyleItalic">Resultados y evoluci&#243;n funcional de pacientes cr&#237;ticos con ictus isqu&#233;mico sometidos a trombectom&#237;a mec&#225;nica</span>&#8221; in Spanish&#41;&#44; and would like to make a few comments too&#58;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We completely share the authors&#8217; view in their letter on the importance of intensive care units &#40;ICU&#41; and intensivists in the good management of neuro-critically ill patients&#46; As intensivists we should always keep a proactive attitude during the hospital admission of patients with strokes&#46; And not only with the most critically ill patients who require the full support ICUs can provide&#44; but also with patients who are not so critical&#44; in whose referring hospitals there are no stroke units&#44; but could achieve better functional outcomes with good management of the neuro-physiological variables&#46; Taking into consideration that cerebrovascular disease is one of the leading causes of mortality and disability&#44; its management should be multidisciplinary &#40;neurology&#44; interventional neuro-radiology and neurosurgery&#41;&#44; which poses an interesting challenge for healthcare today&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">There is no doubt about it&#46; The management of ischemic strokes has evolved during the last few years and so has our team from early IV-only fibrinolysis to intra-arterial fibrinolysis&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> endovascular treatment &#40;EVT&#41; and combined therapies&#46; The comment that the actual indication for EVT is up to 24<span class="elsevierStyleHsp" style=""></span>h after symptom onset is less strict than the indication of our series is right too&#46; We have been expanding the window of opportunity to implement EVT&#44; but we shouldn&#8217;t forget that our study patients date back to 2012&#8211;2014 and were under more restrictive criteria on the implementation of EVT&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">It is also true that the low rate of patients with systemic fibrinolysis of our series is actually lower than that of other studies published&#44; but we should remember that it was a cohort biased towards more clinical severity and&#44; therefore&#44; more proximal arterial occlusions&#46; We have been prescribing alteplase to patients with acute strokes for nearly 20 years and we know that its effects are scarce<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> and that the use of mechanical thrombectomy in these patients has better outcomes&#46; In our hospital&#44; interventional neuro-radiologists on call have a very fast response&#46; That is why in this subgroup of patients we normally omit the previous step of IV fibrinolysis in the light of the immediate availability of this option and how time-consuming it is in patients who won&#8217;t probably have an effective response&#46; On the other hand&#44; the superiority of combined therapies has been put into question by some recent studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We wish to congratulate the authors for their experience and good outcomes&#46; Also&#44; we agree on the need to conduct multicenter studies to know more on the outcomes of endovascular treatment&#46; Our hospital will soon participate in the international multicenter randomized trial SWIFT DIRECT<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> that will be comparing the clinical outcomes between two therapeutic strategies&#58; EVT and EVT plus IV fibrinolysis&#46;</p></span>"
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Letter to the Editor
In reply to “Mechanical thrombectomy in acute ischemic stroke, knowing our results”
En respuesta a «Trombectomía mecánica en el ictus isquémico agudo, conociendo nuestros resultados»
L. Viña Soriaa,d,
Corresponding author
luciavina@yahoo.es

Corresponding author.
, D. Escudero Augustoa,d, S. Calleja Puertab, P. Vega Valdésc, L. López Amora,d, L. Martín Iglesiasa,d
a Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
b Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
c Servicio de Radiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
d Grupo de Investigación de Microbiología Traslacional, Instituto de Investigación del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We wish to thank the authors for their interest and comments on our paper &#8220;Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy&#8221; &#40;&#8220;<span class="elsevierStyleItalic">Resultados y evoluci&#243;n funcional de pacientes cr&#237;ticos con ictus isqu&#233;mico sometidos a trombectom&#237;a mec&#225;nica</span>&#8221; in Spanish&#41;&#44; and would like to make a few comments too&#58;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We completely share the authors&#8217; view in their letter on the importance of intensive care units &#40;ICU&#41; and intensivists in the good management of neuro-critically ill patients&#46; As intensivists we should always keep a proactive attitude during the hospital admission of patients with strokes&#46; And not only with the most critically ill patients who require the full support ICUs can provide&#44; but also with patients who are not so critical&#44; in whose referring hospitals there are no stroke units&#44; but could achieve better functional outcomes with good management of the neuro-physiological variables&#46; Taking into consideration that cerebrovascular disease is one of the leading causes of mortality and disability&#44; its management should be multidisciplinary &#40;neurology&#44; interventional neuro-radiology and neurosurgery&#41;&#44; which poses an interesting challenge for healthcare today&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">There is no doubt about it&#46; The management of ischemic strokes has evolved during the last few years and so has our team from early IV-only fibrinolysis to intra-arterial fibrinolysis&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> endovascular treatment &#40;EVT&#41; and combined therapies&#46; The comment that the actual indication for EVT is up to 24<span class="elsevierStyleHsp" style=""></span>h after symptom onset is less strict than the indication of our series is right too&#46; We have been expanding the window of opportunity to implement EVT&#44; but we shouldn&#8217;t forget that our study patients date back to 2012&#8211;2014 and were under more restrictive criteria on the implementation of EVT&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">It is also true that the low rate of patients with systemic fibrinolysis of our series is actually lower than that of other studies published&#44; but we should remember that it was a cohort biased towards more clinical severity and&#44; therefore&#44; more proximal arterial occlusions&#46; We have been prescribing alteplase to patients with acute strokes for nearly 20 years and we know that its effects are scarce<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> and that the use of mechanical thrombectomy in these patients has better outcomes&#46; In our hospital&#44; interventional neuro-radiologists on call have a very fast response&#46; That is why in this subgroup of patients we normally omit the previous step of IV fibrinolysis in the light of the immediate availability of this option and how time-consuming it is in patients who won&#8217;t probably have an effective response&#46; On the other hand&#44; the superiority of combined therapies has been put into question by some recent studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We wish to congratulate the authors for their experience and good outcomes&#46; Also&#44; we agree on the need to conduct multicenter studies to know more on the outcomes of endovascular treatment&#46; Our hospital will soon participate in the international multicenter randomized trial SWIFT DIRECT<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> that will be comparing the clinical outcomes between two therapeutic strategies&#58; EVT and EVT plus IV fibrinolysis&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Vi&#241;a Soria L&#44; Escudero Augusto D&#44; Calleja Puerta S&#44; Vega Vald&#233;s P&#44; L&#243;pez Amor L&#44; Mart&#237;n Iglesias L&#46; En respuesta a &#171;Trombectom&#237;a mec&#225;nica en el ictus isqu&#233;mico agudo&#44; conociendo nuestros resultados&#187;&#46; Med Intensiva&#46; 2019&#59;43&#58;188&#8211;189&#46;</p>"
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Article information
ISSN: 21735727
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