Segabrottnám við brátt blóðþurrðarslag er mesta framför í læknisfræði í áraraðir
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Authors
Albert Páll SigurðssonIssue Date
2018-01-04
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Role of Thrombectomy in Acute Ischemic StrokeCitation
Læknablaðið 2018,104(1):19-26Abstract
Segabrottnám við brátt blóðþurrðarslag er eitt mesta framfaraskref í æðalækningum í áraraðir. Meðferðin er flókin, en farið er yfir ýmis tæknileg atriði sem huga þarf að. Nána samvinnu þarf milli mismunandi sérgreina þar sem val sjúklinga til meðferðar er flókið. Innæðalæknar þurfa að vera í náinni samvinnu við slaglækna. Meðferðin krefst skipulagsbreytinga, sennilega með auknum mannafla og kostnaði. Fjarlækningar auka gjöf segaleysandi meðferðar við brátt blóðþurrðarslag og vegna tækniframfara er auðveldara að veita slíka þjónustu, en hins vegar þarf að ryðja ýmsum hindrunum úr vegi þannig þær geti orðið að veruleika. Ljóst má vera að fjarlækningar gætu einnig gagnast við segabrottnám. Erfitt getur reynst að veita svo flókna meðferð í 343.000 manna dreifðu samfélagi þar sem skortur er á sérhæfðri þekkingu á mörgum stöðum. Mikilvægt er að hafa í huga þá miklu áskorun sem almenn innleiðing kransæðaþræðinga var á sínum tíma, en þeim hindrunum var rutt úr vegi. Getum við dregið lærdóm af því?This article discusses endovascular thrombectomy in acute ischemic stroke. This treatment is vascular medicine's most significant leap in years. This treatment is complicated, and various technical aspects are discussed. Close cooperation is required between different specialties since patient selection for treatment is complex. Interventionists need close collaboration with stroke neurologists. Government needs to be involved as this treatment mandates structural changes which will incur more manpower and financial resources. Telemedicine is also discussed as it has been shown to be advantageous for augmenting thrombolytic administration for acute ischemic stroke. Due to technical advances, it has been easier to provide such service, but hurdles need to be resolved so it can be fully implemented. It is likely that telemedicine will also play a role in thrombectomy. This article proposes how thrombectomy could be delivered in Iceland. It will prove difficult to provide such complex treatment in a scattered population of 343.000 people where expertise is limited to one or two sites. It is important to remember, that coronary intervention was a formidable challenge at one time, but it was accomplished. Can we learn from that experience?
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http://laeknabladid.is/tolublod/2018/01/nr/6593Rights
Archived with thanks to Læknablaðiðae974a485f413a2113503eed53cd6c53
10.17992/lbl.2018.01.169
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