ROLUL BIOMARKERILOR SERICI ÎN PREDICȚIA RECANALIZĂRII FUTILE ȘI PROGNOSTICULUI FUNCȚIONAL LA PACIENȚII CU AVC ISCHEMIC SUPUȘI TROMBECTOMIEI MECANICE
DOI:
https://doi.org/10.52692/1857-0011.2025.3-83.38Cuvinte cheie:
accident vascular cerebral ischemic, trombectomie mecanică, recanalizare futilă, biomarkeri, CRP, NLR, D-dimer, MMP-9Rezumat
Introducere: În ciuda succesului tehnic al trombectomiei mecanice (TEM) la pacienții cu accident vascular cerebral ischemic prin ocluzie de vas mare, peste 60% dintre pacienți rămân cu prognostic funcțional nefavorabil („recanalizare futilă”). Identificarea precoce a pacienților cu risc ridicat reprezintă o prioritate clinică.
Scop: Analiza narativă a literaturii privind valoarea predictivă a biomarkerilor serici (inflamatori, hemostatici și ai integrității barierei hemato-encefalice) în recanalizarea futilă și evoluția neurologică.
Material și metode: Revizuire narativă a literaturii prin consultarea bazei de date PubMed, utilizând atât cuvinte- cheie libere („ischemic stroke”, „thrombectomy”, „biomarkers”, „prediction”), cât și termeni MeSH corespunzători, perioada 2016-2025. Au fost identificate 2043 de publicații cu includerea în analiza finală a 46 de studii.
Rezultate: Proteina C-reactivă și raportul neutrofile/limfocite sunt predictori independenți ai mortalității și dizabilității la 3 luni post-TEM. D-dimerii și trombocitopenia se asociază cu prognostic nefavorabil, iar MMP-9, S100B și NfL oferă date despre lezarea barierei hemato-encefalice și leziunea neuronală, cu rezultate prognostice variabile. Integrarea lor într-un panel multiparametric poate crește acuratețea stratificării riscului.
Concluzii: Biomarkerii serici pot completa parametrii clinico-imagistici, oferind un instrument valoros pentru identificarea pacienților cu risc crescut de recanalizare futilă și pentru dezvoltarea unor terapii personalizate.
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