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Gutiérrez-Zúñiga R, Alonso de Leciñana M, Delgado-Mederos R, Gállego-Cullere J, Rodríguez-Yáñez M, Martínez-Zabaleta M, Freijo M, Portilla JC, Gil-Núñez A, Díez Sebastián J, Lisbona A, Díez-Tejedor E, Fuentes B. Beyond hyperglycemia: glycaemic variability as a prognostic factor after acute ischemic stroke. Neurologia 2023; 38:150-158. [PMID: 37059570 DOI: 10.1016/j.nrleng.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/14/2020] [Indexed: 04/16/2023] Open
Abstract
INTRODUCTION Glycaemic variability (GV) refers to variations in blood glucose levels, and may affect stroke outcomes. This study aims to assess the effect of GV on acute ischaemic stroke progression. METHODS We performed an exploratory analysis of the multicentre, prospective, observational GLIAS-II study. Capillary glucose levels were measured every 4 hours during the first 48 hours after stroke, and GV was defined as the standard deviation of the mean glucose values. The primary outcomes were mortality and death or dependency at 3 months. Secondary outcomes were in-hospital complications, stroke recurrence, and the impact of the route of insulin administration on GV. RESULTS A total of 213 patients were included. Higher GV values were observed in patients who died (n = 16; 7.8%; 30.9 mg/dL vs 23.3 mg/dL; p = 0.05). In a logistic regression analysis adjusted for age and comorbidity, both GV (OR = 1.03; 95% CI, 1.003-1.06; p = 0.03) and stroke severity (OR = 1.12; 95% CI, 1.04-1.2; p = 0.004) were independently associated with mortality at 3 months. No association was found between GV and the other outcomes. Patients receiving subcutaneous insulin showed higher GV than those treated with intravenous insulin (38.95 mg/dL vs 21.34 mg/dL; p < 0.001). CONCLUSIONS High GV values during the first 48 hours after ischaemic stroke were independently associated with mortality. Subcutaneous insulin may be associated with higher VG levels than intravenous administration.
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Affiliation(s)
- R Gutiérrez-Zúñiga
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - M Alonso de Leciñana
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - R Delgado-Mederos
- Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J Gállego-Cullere
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, España
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Clínico Universitario, Santiago de Compostela, España
| | - M Martínez-Zabaleta
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, España
| | - M Freijo
- Servicio de Neurología, IIS Biocruces-Bizkaia, Bilbao, España
| | - J C Portilla
- Servicio de Neurología, Hospital San Pedro de Alcántara, Cáceres, España
| | - A Gil-Núñez
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - J Díez Sebastián
- Servicio de Bioestadística, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - A Lisbona
- Servicio de Endocrinología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - E Díez-Tejedor
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España.
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Gómez-Roldós A, González-Sánchez M, Vales-Montero M, Vázquez-Alen P, Fernández-Bullido Y, Iglesias-Mohedano AM, Díaz-Otero F, García-Pastor A, Gil-Núñez A. Fatal intracerebral haemorrhage associated with thrombosis with thrombocytopenia syndrome after ChAdOx1-S vaccine. Rev Neurol 2022; 75:199-202. [PMID: 36169326 DOI: 10.33588/rn.7507.2021323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has had a devastating impact on health, society and economics worldwide. Therefore, vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have recently emerged as an important measure to fight the pandemic. ChAdOx1-S (Oxford-AstraZeneca) is an adenovirus-vectored vaccine that expresses the SARS-CoV-2 spike protein. It shows an acceptable safety profile. Nevertheless, several cases of unusual thrombosis and thrombocytopenia have been reported after initial vaccination with ChAdOx1-S mimicking autoimmune heparin-induced thrombocytopenia. This condition has been called thrombosis with thrombocytopenia syndrome (TTS) and complications such as intracerebral haemorrhage have been described. CASE REPORT We present a case of intracerebral haemorrhage after ChAdOx1-S vaccination. Middle-aged patient with no prior medical history was seen in the emergency room 16 days after the first dose of ChAdOx1-S vaccine with sudden onset left hemiplegia and severe holocranial oppressive headache. She did not receive heparin treatment in the previous 100 days. Blood test showed moderate thrombocytopenia and a right frontal lobar haemorrhage was seen on computed tomography scan, computed tomography venography was negative for thrombosis. The presence of antibodies against platelet factor 4 was confirmed. The patient's neurological condition progressively worsened. She developed a treatment resistant intracranial hypertension syndrome and she died three weeks later. CONCLUSIONS TTS is a rare adverse effect of ChAdOx1-S vaccine, defined by the presence of thrombosis in uncommon locations. In our case we report an spontaneous intracerebral haemorrhage probable due to the thrombocytopenia related to probable TTS. It represents a rare clinical presentation of TTS.
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Affiliation(s)
- A Gómez-Roldós
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - M Vales-Montero
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P Vázquez-Alen
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | | | - F Díaz-Otero
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A García-Pastor
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Gil-Núñez
- Hospital General Universitario Gregorio Marañón, Madrid, España
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Garcia-Pastor A, Gil-Núñez A, Ramirez-Moreno JM, González-Nafría N, Tejada J, Moniche F, Portilla-Cuenca JC, Martínez-Sánchez P, Fuentes B, Gamero-García MA, de Leciñana MA, Masjuan J, Verge DC, Aladro Y, Parkhutik V, Lago A, de Arce-Borda AM, Usero-Ruiz M, Delgado-Mederos R, Pampliega A, Ximenez-Carrillo Á, Bártulos-Iglesias M, Castro-Reyes E. Endarterectomy, Stenting, or Medical Treatment for Symptomatic Carotid Near-Occlusion: Results from CAOS, a Multicenter Registry Study. AJNR Am J Neuroradiol 2022; 43:1304-1310. [PMID: 35981762 PMCID: PMC9451631 DOI: 10.3174/ajnr.a7617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/17/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE The treatment of symptomatic carotid near-occlusion is controversial. Our aim was to analyze the results of carotid endarterectomy and carotid artery stent placement in patients with symptomatic carotid near-occlusion and to identify factors related to technical failure, periprocedural complications, and restenosis. MATERIALS AND METHODS We conducted a multicenter, prospective nonrandomized study. Patients with angiography-confirmed carotid near-occlusion were included. We assessed the revascularization rate and periprocedural stroke or death. Twenty-four-month clinical and carotid imaging follow-up was performed, and rates of carotid restenosis or occlusion, ipsilateral stroke, and mortality were analyzed. Carotid artery stent placement, carotid endarterectomy, and medical treatment were compared. RESULTS One hundred forty-one patients were included. Forty-four carotid artery stent placement and 23 carotid endarterectomy procedures were performed within 6 months after the event. Complete revascularization was achieved in 83.6%, 81.8% in the carotid artery stent placement group and 87% with carotid endarterectomy (P = .360). Periprocedural stroke or death occurred in 6% (carotid artery stent placement = 2.3%; carotid endarterectomy = 13%; P = .077) and was not related to revascularization failure. The carotid restenosis or occlusion rate was 8.3% (5% restenosis, 3.3% occlusion); with carotid artery stent placement it was 10.5%; and with carotid endarterectomy it was 4.5% (P = .419). The 24-month cumulative rate of ipsilateral stroke was 4.8% in the carotid artery stent placement group, 17.4% for carotid endarterectomy, and 13.1% for medical treatment (P = .223). Mortality was 12%, 4.5%, and 5.6%, respectively (P = .422). Revascularization failure and restenosis occurred more frequently in patients with full collapse compared with patients without full collapse (33.3% versus 5.6%, P = .009; 21.4% versus 2.9%, P = .032, respectively). CONCLUSIONS Carotid artery stent placement and carotid endarterectomy are associated with high rates of failure and periprocedural stroke. Carotid near-occlusion with full collapse appears to be associated with an increased risk of technical failure and restenosis. Carotid near-occlusion revascularization does not seem to reduce the risk of stroke at follow-up compared with medical treatment.
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Affiliation(s)
- A Garcia-Pastor
- From the Department of Neurology (A.G.-P., A.G.-N., E.C.-R.), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Gil-Núñez
- From the Department of Neurology (A.G.-P., A.G.-N., E.C.-R.), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J M Ramirez-Moreno
- Department of Neurology (J.M.R.-M.), Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - N González-Nafría
- Department of Neurology (N.G.-N., J.T.), Complejo Asistencial Universitario de León, Neurology, Leon, Spain
| | - J Tejada
- Department of Neurology (N.G.-N., J.T.), Complejo Asistencial Universitario de León, Neurology, Leon, Spain
| | - F Moniche
- Department of Neurology (F.M.), Hospital Universitario Virgen del Rocío, Sevilla, Sevilla, Spain
| | - J C Portilla-Cuenca
- Department of Neurology (J.C.P.-C.), Hospital San Pedro Alcántara, Cáceres, Spain
| | - P Martínez-Sánchez
- Department of Neurology (P.M.-S., B.F.), Hospital Universitario La Paz, Madrid, Spain
| | - B Fuentes
- Department of Neurology (P.M.-S., B.F.), Hospital Universitario La Paz, Madrid, Spain
| | - M A Gamero-García
- Department of Neurology (M.A.G.-G.), Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M A de Leciñana
- Department of Neurology (M.A.d.L., J.M.), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Masjuan
- Department of Neurology (M.A.d.L., J.M.), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - D C Verge
- Department of Neurology (D.C.V.), Corporació Sanitaria Parc Taulí, Sabadell, Spain
| | - Y Aladro
- Department of Neurology (Y.A.), Hospital Universitario de Getafe, Getafe, Spain
| | - V Parkhutik
- Department of Neurology (V.P., A.L.), Hospital Universitari La Fe, Valencia, Spain
| | - A Lago
- Department of Neurology (V.P., A.L.), Hospital Universitari La Fe, Valencia, Spain
| | - A M de Arce-Borda
- Department of Neurology (A.M.d.A.-B), Hospital Universitario de Donostia, Donostia, Spain
| | - M Usero-Ruiz
- Department of Neurology (M.U.-R.), Hospital Universitario de Valladolid, Valladolid, Spain
| | - R Delgado-Mederos
- Department of Neurology (R.D.-M.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Pampliega
- Department of Neurology (A.P.), Hospital General Univeristario de Alicante, Alicante, Spain
| | - Á Ximenez-Carrillo
- Department of Neurology (Á.X.-C.), Hospital Universitario de La Princesa, Madrid, Spain
| | - M Bártulos-Iglesias
- Department of Neurology (M.B.-I.), Hospital Universitario de Burgos, Burgos, Spain
| | - E Castro-Reyes
- From the Department of Neurology (A.G.-P., A.G.-N., E.C.-R.), Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Gil-Núñez A, Masjuan J, Montaner J, Castellanos M, Segura T, Cardona P, Tembl JI, Purroy F, Arenillas J, Palacio E. Proprotein convertase subtilisin/kexin type 9 inhibitors in secondary prevention of vascular events in patients with stroke: Consensus document and practice guidance. Neurologia 2022; 37:136-150. [PMID: 33358061 DOI: 10.1016/j.nrl.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/31/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Patients with history of stroke or transient ischaemic attack present considerable risk of future vascular events. Reducing levels of low-density lipoprotein (LDL) cholesterol decreases the incidence of new vascular events, although in a substantial number of patients, the currently available lipid-lowering therapies fail to achieve the therapeutic goals recommended in clinical guidelines. The aim of this consensus statement is to provide updated information on the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab in the secondary prevention of vascular events in patients with history of ischaemic stroke. METHODS A literature review was performed to identify the main evidence on the use of PCSK9 inhibitors in these patients and the recommended therapeutic targets of LDL cholesterol. The results were discussed in 2 consensus meetings that constituted the basis for the drafting of the document. CONCLUSIONS PCSK9 inhibitors are effective in reducing vascular risk in secondary prevention; evolocumab specifically has achieved this reduction in patients with history of ischaemic stroke. Moreover, both alirocumab and evolocumab present good safety profiles, even in patients achieving LDL cholesterol levels <20 mg/dL, and no signs of cognitive impairment have been observed in patients treated with evolocumab who achieved very low levels of LDL cholesterol. In the light of this evidence, we provide practical recommendations about the use of PCSK9 inhibitors in secondary prevention of vascular events in patients with history of ischaemic stroke and follow-up of these patients.
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Affiliation(s)
- A Gil-Núñez
- Sección Neurología Vascular-Centro de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, España; Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - J Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J Montaner
- Servicio de Neurología, Hospital Virgen Macarena, Sevilla, España
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica A Coruña, La Coruña, España
| | - T Segura
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España
| | - P Cardona
- Servicio de Neurología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | - J I Tembl
- Servicio de Neurología, Hospital La Fe, Valencia, España
| | - F Purroy
- Servicio de Neurología, Hospital Arnau de Vilanova, Lérida, España
| | - J Arenillas
- Servicio de Neurología, Hospital de Valladolid, Valladolid, España
| | - E Palacio
- Servicio de Neurología, Hospital Marqués de Valdecilla, Santander, España
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5
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Gil-Núñez A, Masjuan J, Montaner J, Castellanos M, Segura T, Cardona P, Tembl JI, Purroy F, Arenillas J, Palacio E. Proprotein convertase subtilisin/kexin type 9 inhibitors in secondary prevention of vascular events in patients with stroke: Consensus document and practice guidance. Neurologia (Engl Ed) 2021; 37:136-150. [PMID: 34906541 DOI: 10.1016/j.nrleng.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/05/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Patients with history of stroke or transient ischaemic attack present considerable risk of future vascular events. Reducing levels of low-density lipoprotein (LDL) cholesterol decreases the incidence of new vascular events, although in a substantial number of patients, the currently available lipid-lowering therapies fail to achieve the therapeutic goals recommended in clinical guidelines. The aim of this consensus statement is to provide updated information on the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab in the secondary prevention of vascular events in patients with history of ischaemic stroke. METHODS A literature review was performed to identify the main evidence on the use of PCSK9 inhibitors in these patients and the recommended therapeutic targets of LDL cholesterol. The results were discussed in 2 consensus meetings that constituted the basis for the drafting of the document. CONCLUSIONS PCSK9 inhibitors are effective in reducing vascular risk in secondary prevention; evolocumab specifically has achieved this reduction in patients with history of ischaemic stroke. Moreover, both alirocumab and evolocumab present good safety profiles, even in patients achieving LDL cholesterol levels < 20 mg/dL, and no signs of cognitive impairment have been observed in patients treated with evolocumab who achieved very low levels of LDL cholesterol. In the light of this evidence, we provide practical recommendations about the use of PCSK9 inhibitors in secondary prevention of vascular events in patients with history of ischaemic stroke and follow-up of these patients.
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Affiliation(s)
- A Gil-Núñez
- Sección Neurología Vascular-Centro de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - J Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Montaner
- Servicio de Neurología, Hospital Virgen Macarena, Sevilla, Spain
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica A Coruña, La Coruña, Spain
| | - T Segura
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, Spain
| | - P Cardona
- Servicio de Neurología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - J I Tembl
- Servicio de Neurología, Hospital La Fe, Valencia, Spain
| | - F Purroy
- Servicio de Neurología, Hospital Arnau de Vilanova, Lérida, Spain
| | - J Arenillas
- Servicio de Neurología, Hospital de Valladolid, Valladolid, Spain
| | - E Palacio
- Servicio de Neurología, Hospital Marqués de Valdecilla, Santander, Spain
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Gutiérrez-Zúñiga R, Alonso de Leciñana M, Delgado-Mederos R, Gállego-Cullere J, Rodríguez-Yáñez M, Martínez-Zabaleta M, Freijo M, Portilla JC, Gil-Núñez A, Díez Sebastián J, Lisbona A, Díez-Tejedor E, Fuentes B. Beyond hyperglycemia: glycaemic variability as a prognostic factor after acute ischemic stroke. Neurologia 2020; 38:S0213-4853(20)30272-3. [PMID: 33069448 DOI: 10.1016/j.nrl.2020.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/10/2020] [Accepted: 06/14/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Glycaemic variability (GV) refers to variations in blood glucose levels, and may affect stroke outcomes. This study aims to assess the effect of GV on acute ischaemic stroke progression. METHODS We performed an exploratory analysis of the multicentre, prospective, observational GLIAS-II study. Capillary glucose levels were measured every 4 hours during the first 48 hours after stroke, and GV was defined as the standard deviation of the mean glucose values. The primary outcomes were mortality and death or dependency at 3 months. Secondary outcomes were in-hospital complications, stroke recurrence, and the impact of the route of insulin administration on GV. RESULTS A total of 213 patients were included. Higher GV values were observed in patients who died (n = 16; 7.8%; 30.9 mg/dL vs 23.3 mg/dL; p = 0.05). In a logistic regression analysis adjusted for age and comorbidity, both GV (OR = 1.03; 95% CI, 1.003-1.06; p = 0.03) and stroke severity (OR = 1.12; 95% CI, 1.04-1.2; p = 0.004) were independently associated with mortality at 3 months. No association was found between GV and the other outcomes. Patients receiving subcutaneous insulin showed higher GV than those treated with intravenous insulin (38.95 mg/dL vs 21.34 mg/dL; p < 0.001). CONCLUSIONS High GV values during the first 48 hours after ischaemic stroke were independently associated with mortality. Subcutaneous insulin may be associated with higher VG levels than intravenous administration.
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Affiliation(s)
- R Gutiérrez-Zúñiga
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - M Alonso de Leciñana
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - R Delgado-Mederos
- Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J Gállego-Cullere
- Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, España
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Clínico Universitario, Santiago de Compostela, España
| | - M Martínez-Zabaleta
- Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, España
| | - M Freijo
- Servicio de Neurología, IIS Biocruces-Bizkaia, Bilbao, España
| | - J C Portilla
- Servicio de Neurología, Hospital San Pedro de Alcántara, Cáceres, España
| | - A Gil-Núñez
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - J Díez Sebastián
- Servicio de Bioestadística, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - A Lisbona
- Servicio de Endocrinología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - E Díez-Tejedor
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España
| | - B Fuentes
- Servicio de Neurología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España.
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Palacios-Mendoza MA, García-Pastor A, Gil-Núñez A, Ramírez-Moreno JM, González-Nafría N, Moniche F, Portilla-Cuenca JC, Fuentes B, Gamero-García MA, Alonso de Leciñana M, Masjuan J, Canovas-Verge D, Aladro Y, Lago A, de Arce-Borda AM, Usero-Ruiz M, Delgado-Mederos R, Pampliega A, Ximenez-Carrillo Á, Bártulos-Iglesias M, Castro-Reyes E. Ultrasonographic and hemodynamic characteristics of patients with symptomatic carotid near-occlusion: results from a multicenter registry study. Neuroradiology 2020; 63:705-711. [PMID: 33025041 DOI: 10.1007/s00234-020-02567-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The ultrasonographic and hemodynamic features of patients with carotid near-occlusion (CNO) are still not well known. Our aim was to describe the ultrasonographic and hemodynamic characteristics of a cohort of patients with CNO. METHODS A prospective, observational, nationwide, and multicenter study was conducted from January/2010 to May/2016. Patients with digital subtraction angiography (DSA)-confirmed CNO were included. We collected information on clinical and demographic characteristics, carotid and transcranial ultrasonography and DSA findings, presence of full-collapse, collateral circulation, and cerebrovascular reactivity (CVR). RESULTS One hundred thirty-five patients were analyzed. Ultrasonographic and DSA diagnosis of CNO were concordant in only 44%. This disagreement was related to the presence/absence of full-collapse: 45% of patients with CNO with full-collapse were classified as a complete carotid occlusion, and 40% with a CNO without full-collapse were interpreted as severe stenosis (p < 0.001). Mean velocities (mV) and pulsatility indexes (PIs) were significantly lower in the ipsilateral middle cerebral artery compared with the contralateral (43 cm/s vs 58 cm/s, p < 0.001; 0.80 vs 1.00, p < 0.001). Collateral circulation was identified in 92% of patients, with the anterior communicating artery (73%) being the most frequent. CVR was decreased or exhausted in 66% of cases and was more frequent in patients with a poor or absent collateral network compared with patients with ≥ 2 collateral arteries (82% vs 56%, p = 0.051). CONCLUSION The accuracy of carotid ultrasonography in the diagnosis of CNO seems to be limited, with significant discrepancies with DSA. Decreased ipsilateral mV, PI, and CVR suggest a hemodynamic compromise in patients with CNO.
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Affiliation(s)
| | - A García-Pastor
- Hospital General Universitario Gregorio Marañón, Neurology, C/ Dr Esquerdo 46, 28007, Madrid, Spain
| | - A Gil-Núñez
- Hospital General Universitario Gregorio Marañón, Neurology, C/ Dr Esquerdo 46, 28007, Madrid, Spain
| | | | | | - F Moniche
- Hospital Universitario Virgen del Rocío, Sevilla, Neurology, Sevilla, Spain
| | | | - B Fuentes
- Hospital Universitario La Paz, Neurology, Madrid, Spain
| | | | | | - J Masjuan
- Hospital Universitario Ramón y Cajal, Neurology, Madrid, Spain
| | | | - Y Aladro
- Hospital Universitario de Getafe, Neurology, Getafe, Spain
| | - A Lago
- Hospital Universitari La Fe, Neurology, Valencia, Spain
| | | | - M Usero-Ruiz
- Hospital Universitario de Valladolid, Neurology, Valladolid, Spain
| | | | - A Pampliega
- Hospital General Univeristario de Alicante, Neurology, Alicante, Spain
| | | | | | - E Castro-Reyes
- Hospital General Universitario Gregorio Marañón, Neurology, C/ Dr Esquerdo 46, 28007, Madrid, Spain
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Rodríguez-Pardo J, Secades-García S, Riera-López N, Alonso de Leciñana M, Real-Martínez V, Carneado-Ruiz J, Díaz-Guzmán J, Díez-Tejedor E, Egido-Herrero J, Gil-Núñez A, Matute-Lozano MC, Trillo S, Vera-Lechuga R, Vivancos-Mora J, Ximénez-Carrillo Á, Fuentes B. Contraindications to intravenous thrombolysis in prehospital triage of thrombectomy candidates. Eur J Neurol 2020; 27:2439-2445. [PMID: 32638466 DOI: 10.1111/ene.14429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The existence of contraindications to intravenous thrombolysis (IVT) is considered a criterion for direct transfer of patients with suspected acute stroke to thrombectomy-capable centers in the prehospital setting. Our aim was to assess the utility of this criterion in a setting where routing protocols are defined by the Madrid - Direct Referral to Endovascular Center (M-DIRECT) prehospital scale. METHODS This was a post hoc analysis of the M-DIRECT study. Reported contraindications to IVT were retrospectively collected from emergency medical services reports and categorized into late window, anticoagulant treatment and other contraindications. Final diagnosis and treatment rates were compared between patients with and without reported IVT contraindications and according to anticoagulant treatment or late window categories. RESULTS The M-DIRECT study included 541 patients. Reported IVT contraindications were present in 227 (42.0%) patients. Regarding final diagnosis no significant differences were found between patients with or without reported IVT contraindications: ischaemic stroke (any) 65.6% vs. 62.1%, ischaemic stroke with large vessel occlusion (LVO) 32.2% vs. 28.3%, hemorrhagic stroke 15.4% vs. 15.6%, stroke mimic 18.9% vs. 22.3% respectively. Amongst patients with LVO, endovascular thrombectomy (EVT) was performed less often in the presence of IVT contraindications (56.2% vs. 74.2%). M-DIRECT-positive patients had higher rates of LVO and EVT compared with M-DIRECT-negative patients independent of reported IVT contraindications. CONCLUSIONS Reported IVT contraindications alone do not increase EVT likelihood and should not be considered to determine routing in urban stroke networks.
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Affiliation(s)
- J Rodríguez-Pardo
- Department of Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - S Secades-García
- Department of Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - N Riera-López
- Stroke Code Coordination Center, Servicio de Emergencias Médicas SUMMA-112, Madrid, Spain
| | - M Alonso de Leciñana
- Department of Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - V Real-Martínez
- Stroke Code Coordination Center, Servicio de Emergencias Médicas SUMMA-112, Madrid, Spain
| | - J Carneado-Ruiz
- Department of Neurology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - J Díaz-Guzmán
- Department of Neurology, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - E Díez-Tejedor
- Department of Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - J Egido-Herrero
- Department of Neurology, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - A Gil-Núñez
- Department of Neurology, Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - M C Matute-Lozano
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Spain
| | - S Trillo
- Department of Neurology, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - R Vera-Lechuga
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Spain
| | - J Vivancos-Mora
- Department of Neurology, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Á Ximénez-Carrillo
- Department of Neurology, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - B Fuentes
- Department of Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
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9
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Fuentes B, Alonso de Leciñana M, Calleja-Castaño P, Carneado-Ruiz J, Egido-Herrero J, Gil-Núñez A, Masjuán-Vallejo J, Vivancos-Mora J, Rodríguez-Pardo J, Riera-López N, Ximénez-Carrillo Á, Cruz-Culebras A, Gómez-Escalonilla C, Díez-Tejedor E. Impact of the COVID-19 pandemic on the organisation of stroke care. Madrid Stroke Care Plan. Neurología (English Edition) 2020. [PMCID: PMC7334907 DOI: 10.1016/j.nrleng.2020.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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10
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Fuentes B, Alonso de Leciñana M, Calleja-Castaño P, Carneado-Ruiz J, Egido-Herrero J, Gil-Núñez A, Masjuán-Vallejo J, Vivancos-Mora J, Rodríguez-Pardo J, Riera-López N, Ximénez-Carrillo Á, Cruz-Culebras A, Gómez-Escalonilla C, Díez-Tejedor E. Impact of the COVID-19 pandemic on the organisation of stroke care. Madrid Stroke Care Plan. Neurologia 2020; 35:363-371. [PMID: 32563566 PMCID: PMC7241395 DOI: 10.1016/j.nrl.2020.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 11/21/2022] Open
Abstract
Introducción La sobrecarga asistencial y los cambios organizativos frente a la pandemia de COVID-19 podrían estar repercutiendo en la atención al ictus agudo en la Comunidad de Madrid. Métodos Encuesta estructurada en bloques: características del hospital, cambios en infraestructura y recursos, circuitos de código ictus, pruebas diagnósticas, rehabilitación y atención ambulatoria. Análisis descriptivo según el nivel de complejidad en la atención del ictus (disponibilidad o no de unidad de ictus y de trombectomía mecánica). Resultados De los 26 hospitales del SERMAS que atienden urgencias en adultos, 22 cumplimentaron la encuesta entre el 16 y 27 de abril. El 95% han cedido neurólogos para atender a pacientes afectados por la COVID-19. Se han reducido camas de neurología en el 89,4%, modificado los circuitos en urgencias para ictus en el 81%, con circuitos específicos para sospecha de infección por SARS-CoV2 en el 50%, y en el 42% de los hospitales los pacientes con ictus agudo positivos para SARS-CoV2 no ingresan en camas de neurología. Ha mejorado el acceso al tratamiento, con trombectomía mecánica las 24 h en el propio hospital en 10 hospitales, y se han reducido los traslados interhospitalarios secundarios. Se ha evitado el ingreso de pacientes con ataque isquémico transitorio o ictus leve (45%) y se han incorporado consultas telefónicas para seguimiento en el 100%. Conclusiones Los cambios organizativos de los hospitales de la Comunidad de Madrid frente a la pandemia por SARS-Co2 han modificado la dedicación de recursos humanos e infraestructuras de las unidades de neurología y los circuitos de atención del ictus, realización de pruebas diagnósticas, ingreso de los pacientes y seguimiento.
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Affiliation(s)
- B Fuentes
- Servicio de Neurología y Centro de Ictus, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPAZ, Madrid, España.
| | - M Alonso de Leciñana
- Servicio de Neurología y Centro de Ictus, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPAZ, Madrid, España
| | - P Calleja-Castaño
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - J Carneado-Ruiz
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, España
| | - J Egido-Herrero
- Servicio de Neurología, Hospital Clínico Universitario San Carlos, Universidad Complutense de Madrid, Madrid, España
| | - A Gil-Núñez
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, España
| | - J Masjuán-Vallejo
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá de Henares, ALcalá de Henares (Madrid), España
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - J Rodríguez-Pardo
- Servicio de Neurología y Centro de Ictus, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPAZ, Madrid, España
| | - N Riera-López
- Servicio de Urgencias Médicas de Madrid, SUMMA 112, Madrid, España
| | - Á Ximénez-Carrillo
- Servicio de Neurología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - A Cruz-Culebras
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá de Henares, ALcalá de Henares (Madrid), España
| | - C Gómez-Escalonilla
- Servicio de Neurología, Hospital Clínico Universitario San Carlos, Universidad Complutense de Madrid, Madrid, España
| | - E Díez-Tejedor
- Servicio de Neurología y Centro de Ictus, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPAZ, Madrid, España
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11
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García-Pastor A, Gil-Núñez A, Ramírez-Moreno JM, González-Nafría N, Tejada J, Moniche F, Portilla-Cuenca JC, Martínez-Sánchez P, Fuentes B, Gamero-García MÁ, Alonso de Leciñana M, Masjuán J, Cánovas-Verge D, Aladro Y, Parkhutik V, Lago-Martín A, de Arce-Borda AM, Usero-Ruíz M, Delgado-Mederos R, Pampliega A, Ximenez-Carrillo Á, Bártulos-Iglesias M, Castro-Reyes E. The risk of recurrent stroke at 24 months in patients with symptomatic carotid near-occlusion: results from CAOS, a multicentre registry study. Eur J Neurol 2019; 26:1391-1398. [PMID: 31126001 DOI: 10.1111/ene.14006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The risk of recurrent stroke amongst patients with symptomatic carotid near-occlusion (SCNO) has not been clearly established, and its management remains controversial. The aim was to define the 24-month risk of recurrent stroke and to analyse the effect of the different treatment modalities (medical treatment and revascularization) in a population of patients with SCNO. METHODS A multicentre, nationwide, prospective study from January 2010 to May 2016 was performed. Patients with angiography-confirmed SCNO were included. The primary end-point was ipsilateral ischaemic stroke including periprocedural events within 24 months following the presenting event. Revascularization results and periprocedural complications, ipsilateral transient ischaemic attack, disabling or fatal stroke, and mortality were also noted. RESULTS The study population comprised 141 patients from 17 Spanish centres. Seventy patients (49.6%) were treated by revascularization (carotid stenting in 47, endarterectomy in 23). Complete revascularization was achieved in 58 patients (83%). Periprocedural stroke or death occurred in 5.7%. The 24-month cumulative incidence of the primary end-point was 11.1% (95% confidence interval 5.8-16.4; n = 15), 12% in the medical treatment group and 10.2% in the revascularization group, log-rank P = 0.817. The cumulative rates of ipsilateral ischaemic stroke or transient ischaemic attack, disabling or fatal stroke, and mortality, were 17%, 4.5% and 7.5%, respectively. CONCLUSIONS The rate of ipsilateral ischaemic stroke in patients with SCNO seems to be lower than the known rate associated with severe carotid stenosis without near-occlusion. The potential benefit of revascularization in the prevention of stroke in patients with SCNO may be influenced by the effectiveness and safety of the procedure.
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Affiliation(s)
- A García-Pastor
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Gil-Núñez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - J Tejada
- Complejo Asistencial Universitario de León, León, Spain
| | - F Moniche
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | - B Fuentes
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | - J Masjuán
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Y Aladro
- Hospital Universitario de Getafe, Getafe, Spain
| | - V Parkhutik
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - A Lago-Martín
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - M Usero-Ruíz
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - A Pampliega
- Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | - E Castro-Reyes
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
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12
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Fuentes B, Sanz-Cuesta BE, Gutiérrez-Fernández M, Martínez-Sánchez P, Lisbona A, Madero-Jarabo R, Delgado-Mederos R, Gállego-Cullere J, Rodríguez-Yáñez M, Martínez-Zabaleta M, Freijo M, Alonso de Leciñana M, Portilla JC, Gil-Núñez A, Díez-Tejedor E. Glycemia in Acute Stroke II study: a call to improve post-stroke hyperglycemia management in clinical practice. Eur J Neurol 2017; 24:1091-1098. [PMID: 28707377 DOI: 10.1111/ene.13354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 06/01/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE The aim of the study was to analyze the effect of conventional glucose management, which aimed to maintain glucose levels <155 mg/dL (8.5 mmol/L), on glucose control and the outcomes of patients with acute ischaemic stroke (IS) in a clinical practice setting. METHODS This was a multicenter, prospective cohort study of patients with acute IS. Patients were classified into four groups based on their initial 48-h capillary glucose levels and the administration of and response to corrective treatment: (i) untreated and maximum glucose levels <155 mg/dL (8.5 mmol/L) within the first 48 h; (ii) treated and good responders [glucose levels persistently <155 mg/dL (8.5 mmol/L)]; (iii) treated and non-responders [any glucose values ≥155 mg/dL (8.5 mmol/L) during the 24 h after the start of corrective treatment]; and (iv) untreated with any glucose value ≥155 mg/dL (8.5 mmol/L). The primary outcome was death or dependence at 3 months (blinded rater). RESULTS A total of 213 patients were included. Ninety-seven (45.5%) patients developed glucose levels ≥155 mg/dL (8.5 mmol/L), 69 (71.1%) underwent corrective treatment and 31 patients underwent no corrective treatment at the physician's discretion [28 of whom had isolated values ≥155 mg/dL (8.5 mmol/L)]. Only 11 (16%) patients responded to conventional treatment, whereas 58 (84%) patients were non-responsive. Non-responders showed a twofold higher risk of death or dependence at 3 months (odds ratio, 2.472; 95% confidence interval, 1.096-5.576; P = 0.029). CONCLUSIONS Lack of response to conventional treatment for glucose management in acute IS is frequent and associated with poor outcomes.
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Affiliation(s)
- B Fuentes
- Department of Neurology and Stroke Center, Neuroscience and Cerebrovascular Research Laboratory, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain
| | - B E Sanz-Cuesta
- Department of Neurology and Stroke Center, Neuroscience and Cerebrovascular Research Laboratory, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain
| | - M Gutiérrez-Fernández
- Department of Neurology and Stroke Center, Neuroscience and Cerebrovascular Research Laboratory, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain
| | - P Martínez-Sánchez
- Department of Neurology and Stroke Center, Neuroscience and Cerebrovascular Research Laboratory, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain
| | - A Lisbona
- Department of Endocrinology, La Paz University Hospital, Madrid, Spain
| | - R Madero-Jarabo
- Department of Biostatistics, La Paz University Hospital, Madrid, Spain
| | - R Delgado-Mederos
- Department of Neurology, Santa Creu I Sant Pau Hospital, Barcelona, Spain
| | | | - M Rodríguez-Yáñez
- Department of Neurology, University Hospital Clinic, Santiago de Compostela, Spain
| | | | - M Freijo
- Department of Neurology, Basurto Hospital, Bilbao, Spain
| | - M Alonso de Leciñana
- Department of Neurology and Stroke Center, Neuroscience and Cerebrovascular Research Laboratory, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain.,Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain
| | - J C Portilla
- Department of Neurology, San Pedro de Alcántara Hospital, Cáceres, Spain
| | - A Gil-Núñez
- Department of Neurology, Gregorio Marañón University Hospital, Madrid, Spain
| | - E Díez-Tejedor
- Department of Neurology and Stroke Center, Neuroscience and Cerebrovascular Research Laboratory, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain
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Iglesias-Mohedano A, García-Pastor A, Vázquez-Alen P, Diaz-Otero F, Fernández-Bullido Y, Villanueva-Osorio J, Gil-Núñez A. Factors associated with in-hospital delays in treating acute stroke with intravenous thrombolysis in a tertiary centre. Reply to a letter. Neurología (English Edition) 2017. [DOI: 10.1016/j.nrleng.2015.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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14
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Rodríguez-Pardo J, Fuentes B, Alonso de Leciñana M, Ximénez-Carrillo Á, Zapata-Wainberg G, Álvarez-Fraga J, Barriga FJ, Castillo L, Carneado-Ruiz J, Díaz-Guzman J, Egido-Herrero J, de Felipe A, Fernández-Ferro J, Frade-Pardo L, García-Gallardo Á, García-Pastor A, Gil-Núñez A, Gómez-Escalonilla C, Guillán M, Herrero-Infante Y, Masjuan-Vallejo J, Ortega-Casarrubios MÁ, Vivancos-Mora J, Díez-Tejedor E. The Direct Referral to Endovascular Center criteria: a proposal for pre-hospital evaluation of acute stroke in the Madrid Stroke Network. Eur J Neurol 2017; 24:509-515. [DOI: 10.1111/ene.13233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/24/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - B. Fuentes
- Department of Neurology; La Paz University Hospital; Madrid Spain
| | | | | | | | - J. Álvarez-Fraga
- Department of Neurology; La Paz University Hospital; Madrid Spain
| | - F. J. Barriga
- Department of Neurology; Alcorcon University Hospital Foundation; Madrid Spain
| | - L. Castillo
- Department of Neurology; Alcorcon University Hospital Foundation; Madrid Spain
| | - J. Carneado-Ruiz
- Department of Neurology; Puerta de Hierro-Majadahonda University Hospital; Madrid Spain
| | - J. Díaz-Guzman
- Department of Neurology; 12 de Octubre University Hospital; Madrid Spain
| | - J. Egido-Herrero
- Department of Neurology; San Carlos University Hospital; Madrid Spain
| | - A. de Felipe
- Department of Neurology; Ramón y Cajal University Hospital; Madrid Spain
| | - J. Fernández-Ferro
- Department of Neurology; Rey Juan Carlos University Hospital; Madrid Spain
| | - L. Frade-Pardo
- Department of Neurology; La Paz University Hospital; Madrid Spain
| | | | - A. García-Pastor
- Department of Neurology; Gregorio Marañón University Hospital; Madrid Spain
| | - A. Gil-Núñez
- Department of Neurology; Gregorio Marañón University Hospital; Madrid Spain
| | | | - M. Guillán
- Department of Neurology; Rey Juan Carlos University Hospital; Madrid Spain
| | | | - J. Masjuan-Vallejo
- Department of Neurology; Ramón y Cajal University Hospital; Madrid Spain
| | | | - J. Vivancos-Mora
- Department of Neurology; La Princesa University Hospital; Madrid Spain
| | - E. Díez-Tejedor
- Department of Neurology; La Paz University Hospital; Madrid Spain
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15
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Lozano-Ros A, Luque-Buzo E, García-Pastor A, Castro-Reyes E, Díaz-Otero F, Vázquez-Alen P, Fernández-Bullido Y, Villanueva-Osorio JA, Gil-Núñez A. Endovascular treatment of cerebral venous sinus thrombosis (CVST): Is a complete recanalization required for a good clinical outcome? J Neuroradiol 2015; 43:51-4. [PMID: 26517947 DOI: 10.1016/j.neurad.2015.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/25/2015] [Accepted: 09/14/2015] [Indexed: 11/30/2022]
Abstract
The usual therapy in cerebral venous sinus thrombosis (CVST) is based on anticoagulant treatment with adjusted-dose unfractionated heparin. When medical treatment fails, endovascular techniques, such as mechanical thrombectomy, are available. We report a case of a 21-year-old woman with a diagnosis of left CVST, treated by a neurointerventional approach with mechanical thrombectomy using the Penumbra(®) System. Despite the fact that only incomplete recanalization was achieved, a gradual resolution of the thrombus and a progressive clinical improvement occurred.
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Affiliation(s)
- A Lozano-Ros
- Stroke Unit, Neurology Department, Hospital General Universitario Gregorio-Marañón, Madrid, Spain.
| | - E Luque-Buzo
- Stroke Unit, Neurology Department, Hospital General Universitario Gregorio-Marañón, Madrid, Spain
| | - A García-Pastor
- Stroke Unit, Neurology Department, Hospital General Universitario Gregorio-Marañón, Madrid, Spain
| | - E Castro-Reyes
- Neuroradiology Section, Radiodiagnostic Department, Hospital General Universitario Gregorio-Marañón, Madrid, Spain
| | - F Díaz-Otero
- Stroke Unit, Neurology Department, Hospital General Universitario Gregorio-Marañón, Madrid, Spain
| | - P Vázquez-Alen
- Stroke Unit, Neurology Department, Hospital General Universitario Gregorio-Marañón, Madrid, Spain
| | - Y Fernández-Bullido
- Stroke Unit, Neurology Department, Hospital General Universitario Gregorio-Marañón, Madrid, Spain
| | - J A Villanueva-Osorio
- Stroke Unit, Neurology Department, Hospital General Universitario Gregorio-Marañón, Madrid, Spain
| | - A Gil-Núñez
- Stroke Unit, Neurology Department, Hospital General Universitario Gregorio-Marañón, Madrid, Spain
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16
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Iglesias-Mohedano AM, García-Pastor A, Vázquez-Alen P, Diaz-Otero F, Fernández-Bullido Y, Villanueva-Osorio JA, Gil-Núñez A. Factors associated with in-hospital delays in treating acute stroke with intravenous thrombolysis in a tertiary centre. Reply to a letter. Neurologia 2015; 32:274. [PMID: 26386659 DOI: 10.1016/j.nrl.2015.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 07/20/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- A M Iglesias-Mohedano
- Sección de Neurología Vascular, Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A García-Pastor
- Sección de Neurología Vascular, Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - P Vázquez-Alen
- Sección de Neurología Vascular, Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F Diaz-Otero
- Sección de Neurología Vascular, Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Y Fernández-Bullido
- Sección de Neurología Vascular, Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J A Villanueva-Osorio
- Sección de Neurología Vascular, Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Gil-Núñez
- Sección de Neurología Vascular, Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
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17
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de Andrés-Nogales F, Vivancos Mora J, Barriga Hernández FJ, Díaz Otero F, Izquierdo Esteban L, Ortega-Casarrubios MÁ, Castillo Moreno L, Ximénez-Carrillo Rico Á, Martín Torres MP, Gómez-Escalonilla Escobar CI, Torres González C, de Salas-Cansado M, Casado Gómez MÁ, Soto Álvarez J, Gil-Núñez A. Use of healthcare resources and costs of acute cardioembolic stroke management in the Region of Madrid: The CODICE Study. Neurologia 2014; 30:536-44. [PMID: 25066492 DOI: 10.1016/j.nrl.2014.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 06/21/2014] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Stroke is the main cause of admission to Neurology departments and cardioembolic stroke (CS) is one of the most common subtypes of stroke. METHODS A multicentre prospective observational study was performed in 5 Neurology departments in public hospitals in the Region of Madrid (Spain). The objective was to estimate the use of healthcare resources and costs of acute CS management. Patients with acute CS at<48h from onset were recruited. Patients' socio-demographic, clinical, and healthcare resource use data were collected during hospitalisation and at discharge up to 30 days after admission, including data for rehabilitation treatment after discharge. RESULTS During an 8-month recruitment period, 128 patients were recruited: mean age, 75.3±11.25; 46.9% women; mortality rate, 4.7%. All patients met the CS diagnostic criteria established by GEENCV-SEN, based on medical history or diagnostic tests. Fifty per cent of the patients had a history of atrial fibrillation and 18.8% presented other major cardioembolic sources. Non-valvular atrial fibrillation was the most frequent cause of CS (33.6%). Data for healthcare resource use, given a mean total hospital stay of 10.3±9.3 days, are as follows: rehabilitation therapy during hospital stay (46.9%, mean 4.5 days) and after discharge (56.3%, mean 26.8 days), complications (32%), specific interventions (19.5%), and laboratory and diagnostic tests (100%). Head CT (98.4%), duplex ultrasound of supra-aortic trunks (87.5%), and electrocardiogram (85.9%) were the most frequently performed diagnostic procedures. Average total cost per patient during acute-phase management and rehabilitation was €13,139. Hospital stay (45.0%) and rehabilitation at discharge (29.2%) accounted for the largest part of resources used. CONCLUSIONS Acute CS management in the Region of Madrid resulted consumes large amounts of resources (€13,139), mainly due to hospital stays and rehabilitation.
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Affiliation(s)
- F de Andrés-Nogales
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España.
| | - J Vivancos Mora
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, España
| | | | - F Díaz Otero
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Izquierdo Esteban
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | | | | | - Á Ximénez-Carrillo Rico
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, España
| | | | | | - C Torres González
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
| | - M de Salas-Cansado
- Departamento de Investigación de Resultados en Salud y Farmacoeconomía, Pfizer S. L. U., Alcobendas, Madrid, España
| | - M Á Casado Gómez
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
| | - J Soto Álvarez
- Departamento de Investigación de Resultados en Salud y Farmacoeconomía, Pfizer S. L. U., Alcobendas, Madrid, España
| | - A Gil-Núñez
- Hospital General Universitario Gregorio Marañón, Madrid, España
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Vivancos J, Gilo F, Frutos R, Maestre J, García-Pastor A, Quintana F, Roda J, Ximénez-Carrillo A, Díez Tejedor E, Fuentes B, Alonso de Leciñana M, Álvarez-Sabin J, Arenillas J, Calleja S, Casado I, Castellanos M, Castillo J, Dávalos A, Díaz-Otero F, Egido J, Fernández J, Freijo M, Gállego J, Gil-Núñez A, Irimia P, Lago A, Masjuan J, Martí-Fábregas J, Martínez-Sánchez P, Martínez-Vila E, Molina C, Morales A, Nombela F, Purroy F, Ribó M, Rodríguez-Yañez M, Roquer J, Rubio F, Segura T, Serena J, Simal P, Tejada J. Clinical management guidelines for subarachnoid haemorrhage. Diagnosis and treatment. Neurología (English Edition) 2014. [DOI: 10.1016/j.nrleng.2012.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Alonso de Leciñana M, Egido J, Casado I, Ribó M, Dávalos A, Masjuan J, Caniego J, Martínez Vila E, Díez Tejedor E, Fuentes (Secretaría) B, Álvarez-Sabin J, Arenillas J, Calleja S, Castellanos M, Castillo J, Díaz-Otero F, López-Fernández J, Freijo M, Gállego J, García-Pastor A, Gil-Núñez A, Gilo F, Irimia P, Lago A, Maestre J, Martí-Fábregas J, Martínez-Sánchez P, Molina C, Morales A, Nombela F, Purroy F, Rodríguez-Yañez M, Roquer J, Rubio F, Segura T, Serena J, Simal P, Tejada J, Vivancos J. Guidelines for the treatment of acute ischaemic stroke. Neurología (English Edition) 2014. [DOI: 10.1016/j.nrleng.2011.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Alvarez-Sabín J, Quintana M, Santamarina E, Maisterra O, Gil-Núñez A. Low ankle−brachial index predicts new vascular events and functional outcome after 1 year in patients with non-cardioembolic stroke: our experience and review. Eur J Neurol 2013; 21:100-6. [DOI: 10.1111/ene.12253] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 07/26/2013] [Indexed: 11/28/2022]
Affiliation(s)
- J. Alvarez-Sabín
- Neurovascular Unit; Department of Neurology; Universitat Autònoma de Barcelona; Hospital Vall d'Hebron; Barcelona Spain
| | - M. Quintana
- Neurovascular Unit; Department of Neurology; Universitat Autònoma de Barcelona; Hospital Vall d'Hebron; Barcelona Spain
| | - E. Santamarina
- Neurovascular Unit; Department of Neurology; Universitat Autònoma de Barcelona; Hospital Vall d'Hebron; Barcelona Spain
| | - O. Maisterra
- Neurovascular Unit; Department of Neurology; Universitat Autònoma de Barcelona; Hospital Vall d'Hebron; Barcelona Spain
| | - A. Gil-Núñez
- Stroke Unit; Department of Neurology; Hospital Universitario Gregorio Marañon; Universidad Complutense; Madrid Spain
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Rodríguez-Yáñez M, Castellanos M, Freijo M, López Fernández J, Martí-Fàbregas J, Nombela F, Simal P, Castillo J, Díez-Tejedor E, Fuentes B, Alonso de Leciñana M, Álvarez-Sabin J, Arenillas J, Calleja S, Casado I, Dávalos A, Díaz-Otero F, Egido J, Gállego J, García Pastor A, Gil-Núñez A, Gilo F, Irimia P, Lago A, Maestre J, Masjuan J, Martínez-Sánchez P, Martínez-Vila E, Molina C, Morales A, Purroy F, Ribó M, Roquer J, Rubio F, Segura T, Serena J, Tejada J, Vivancos J. Clinical practice guidelines in intracerebral haemorrhage. Neurología (English Edition) 2013. [DOI: 10.1016/j.nrleng.2011.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Vivancos J, Gilo F, Frutos R, Maestre J, García-Pastor A, Quintana F, Roda JM, Ximénez-Carrillo A, Díez Tejedor E, Fuentes B, Alonso de Leciñana M, Alvarez-Sabin J, Arenillas J, Calleja S, Casado I, Castellanos M, Castillo J, Dávalos A, Díaz-Otero F, Egido JA, Fernández JC, Freijo M, Gállego J, Gil-Núñez A, Irimia P, Lago A, Masjuan J, Martí-Fábregas J, Martínez-Sánchez P, Martínez-Vila E, Molina C, Morales A, Nombela F, Purroy F, Ribó M, Rodríguez-Yañez M, Roquer J, Rubio F, Segura T, Serena J, Simal P, Tejada J. Clinical management guidelines for subarachnoid haemorrhage. Diagnosis and treatment. Neurologia 2012; 29:353-70. [PMID: 23044408 DOI: 10.1016/j.nrl.2012.07.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 07/11/2012] [Accepted: 07/13/2012] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To update the Spanish Society of Neurology's guidelines for subarachnoid haemorrhage diagnosis and treatment. MATERIAL AND METHODS A review and analysis of the existing literature. Recommendations are given based on the level of evidence for each study reviewed. RESULTS The most common cause of spontaneous subarachnoid haemorrhage (SAH) is cerebral aneurysm rupture. Its estimated incidence in Spain is 9/100 000 inhabitants/year with a relative frequency of approximately 5% of all strokes. Hypertension and smoking are the main risk factors. Stroke patients require treatment in a specialised centre. Admission to a stroke unit should be considered for SAH patients whose initial clinical condition is good (Grades I or II on the Hunt and Hess scale). We recommend early exclusion of aneurysms from the circulation. The diagnostic study of choice for SAH is brain CT (computed tomography) without contrast. If the test is negative and SAH is still suspected, a lumbar puncture should then be performed. The diagnostic tests recommended in order to determine the source of the haemorrhage are MRI (magnetic resonance imaging) and angiography. Doppler ultrasonography studies are very useful for diagnosing and monitoring vasospasm. Nimodipine is recommended for preventing delayed cerebral ischaemia. Blood pressure treatment and neurovascular intervention may be considered in treating refractory vasospasm. CONCLUSIONS SAH is a severe and complex disease which must be managed in specialised centres by professionals with ample experience in relevant diagnostic and therapeutic processes.
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Masjuan J, Álvarez-Sabín J, Arenillas J, Calleja S, Castillo J, Dávalos A, Tejedor ED, Freijo M, Gil-Núñez A, Fernández JL, Maestre J, Martínez-Vila E, Morales A, Purroy F, Ramírez J, Segura T, Serena J, Tejada J, Tejero C. Plan de asistencia sanitaria al ICTUS II. 2010. Neurologia 2011; 26:383-96. [DOI: 10.1016/j.nrl.2010.05.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 05/07/2010] [Indexed: 10/18/2022] Open
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Cruz Culebras A, García-Pastor A, Reig G, Fuentes B, Simal P, Méndez-Cendón J, Caniego J, Castro E, Frutos R, Gil A, Vivancos J, Gil-Núñez A, Díez-Tejedor E, Egido J, Alonso de Leciñana M, Masjuan J. Intervencionismo neurovascular en la fase aguda del infarto cerebral. Neurologia 2010. [DOI: 10.1016/j.nrl.2010.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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25
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Cruz Culebras A, García-Pastor A, Reig G, Fuentes B, Simal P, Méndez-Cendón JC, Caniego JL, Castro E, Frutos R, Gil A, Vivancos J, Gil-Núñez A, Díez-Tejedor E, Egido JA, Alonso de Leciñana M, Masjuan J. [Neurovascular intervention in the acute phase of cerebral infarction]. Neurologia 2010; 25:279-286. [PMID: 20643037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND AND PURPOSE Endovascular therapies in acute ischaemic stroke may offer benefits to patients that are not eligible for standard use of intravenous tissue activator plasminogen (iv t-PA) or when this is not effective. Our aim is to present the initial experience in with endovascular techniques in the Community of Madrid. METHODS We present data from our registry of acute ischaemic strokes treated with endovascular re-perfusion therapies in five University Hospitals in Madrid (Spain) during the period 2005-2009. We recorded demographic data, vascular risk factors, risk severity with the NIHSS (National Institute of Health Stroke Scale), endovascular techniques, complications and mortality rates. Functional outcome and neurological disability at 90 days was defined by the modified Rankin scale (mRs). RESULTS A total of 41 patients were treated with endovascular therapies. Mean age was 58.6 ± 19.9, and 56.1% were males. Of those 22 patients had an anterior circulation stroke and 19 had a posterior circulation stroke. Baseline NIHSS score was: median, 17 [range, 2-34]; 7 patients had previously received iv t-PA. The following endovascular techniques were performed: mechanical disruption (26 patients), intra-arterial infusion of t-PA (26 patients), angioplasty and stenting (5 patients), mechanical use of MERCI device (3 patients). Partial or total re-canalization was achieved in 32 patients (78%). Only one patient had a symptomatic cerebral haemorrhage. Three months after stroke, 53.6% of the patients were independent (mRs ≤ 2) and overall mortality rate was 19.5%. CONCLUSIONS Acute ischaemic stroke is a potentially treatable medical emergency within the first hours after the onset of symptoms. Stroke endovascular procedures constitute an alternative for patients with iv t-PA exclusion criteria or when this is not effective.
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Affiliation(s)
- A Cruz Culebras
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
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Cruz Culebras A, García-Pastor A, Reig G, Fuentes B, Simal P, Méndez-Cendón J, Caniego J, Castro E, Frutos R, Gil A, Vivancos J, Gil-Núñez A, Díez-Tejedor E, Egido J, Alonso de Leciñana M, Masjuan J. Neurovascular intervention in the acute phase of cerebral infarction. Neurología (English Edition) 2010. [DOI: 10.1016/s2173-5808(10)70054-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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27
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Simal P, García AM, Alonso de Leciñana M, Fuentes B, Díaz-Otero F, Gil-Núñez A, Díez-Tejedor E, Egido JA. [Thrombolysis in Madrid: is there improvement in the 4 years temporal analysis?]. Neurologia 2009; 24:804-807. [PMID: 20099153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Thrombolysis in acute ischemic stroke (IS) is limited by the short time window. However, this can be improved with adequate coordination of all the professionals and procedures involved in acute stroke treatment. PATIENTS AND METHODS A multicenter, observational, prospective study conducted in IS patients treated with intravenous recombinant tissue plasminogen activator between January 2003 and May 2007 was performed. A descriptive analysis of epidemiologic and clinical variables was conducted. Temporal analysis of safety, efficacy and quality parameters was carried out with the Auto-Regressive Integrated Moving Average (ARIMA) (p, d, q) models. RESULTS From January 2003 to 2007, 324 patients were included (56% males; median age: 65.6). A total of 53.6 % became independent at 3 months (score 0-2 on the Modified Rankin Scale). Mortality rate 3 months after treatment was 15.7% and 3.7% suffered symptomatic intracranial bleeding. The temporal analysis showed a significant increase of thrombolysis, from a mean of 2 procedures per month to 20 (p<0.0001). There was a significant increase in the percentage of 3-month independent patients (0.83% [ARIMA] (1, 0, 1) p<0.0001). CONCLUSIONS Intravenous thrombolysis is a safe and effective procedure for the treatment of IS in the clinical practice. As the experience of all the professionals involved in IS treatment increases, the number of patients who receive iv rtPA increases, with better outcome. Temporal analysis by ARIMA models is useful in planning health policies.
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Affiliation(s)
- P Simal
- Hospital Universitario, Clinico San Carlos, Spain.
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Gil-Núñez A, Alvarez-Sabín J, Quintana M, Barbera G. [Prevalence of the metabolic syndrome in patients with transient ischemic attack or non-cardioembolic stroke]. Neurologia 2009; 24:446-453. [PMID: 19921553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION The presence of metabolic syndrome (MS) in patients with ischemic stroke has been analyzed in few studies and there is evidence that the coexistence of MS and stroke increases the subsequent risk of vascular recurrences, regardless of the classical risk factors (RF). One of the main objectives of the APICA study (prevalence of peripheral arterial disease and metabolic syndrome in acute cerebral ischemia) is to analyze this prevalence in Spain in patients with acute cerebral ischemia and to identify clinical variables with a higher risk of MS. METHODS An epidemiologic, observational, longitudinal, multicenter study including patients over 50 with non-cardioembolic transient ischemic attack (TIA) or ischemic stroke, consecutively recruited. The definition criteria of MS are those of the Adult Treatment Panel III-modified (ATP-IIIm) and of the International Diabetes Federation (IDF) 2005. The statistical analysis was made using the SPSS 15.0 program. A multivariate analysis was performed with the logistic regression models to determine factors associated independently with MS by both criteria. RESULTS In the study, 977 patients were analyzed: 651 (66.7%) were men and mean age was 69.1 years. Approximately two thirds had MS, 66.8% according to the modified ATP-III criteria and 65.1% by the IDF criteria. The factors related with MS by the modified ATP-III were independently associated with gender (OR 5.34 [2.99-9.54], p<0.001). The variables related with MS by IDF were independently associated with female gender (6.39 [3.55-11.5], p<0.001) and a greater concentration of platelets (1.005 [1.002-1.008], p=0.004). CONCLUSIONS An elevated prevalence of MS is found in patients with transient ischemic attack or non-cardioembolic stroke, it being similar in both criteria used (66.8% and 65.1%). Female gender is a clearly significant risk factor and is related independently of the variable that determine MS.
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Affiliation(s)
- A Gil-Núñez
- Servicio de Neurología, Unidad de Ictus, Hospital General Universitario Gregorio Marañón, Madrid.
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Lobos JM, Royo-Bordonada MA, Brotons C, Alvarez-Sala L, Armario P, Maiques A, Mauricio D, Sans S, Villar F, Lizcano A, Gil-Núñez A, de Alvaro F, Conthe P, Luengo E, del Río A, Rico O, de Santiago A, Vargas MA, Martíonez M, Lizarbe V. [European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. Spanish adaptation of the CEIPC 2008]. Neurologia 2009; 24:465-484. [PMID: 19921557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We present the Spanish adaptation made by the CEIPC of the European Guidelines on Cardiovascular Disease Prevention (CVD) in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD through the management of its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care medical doctors in promoting a healthy life style, based on increasing physical activity, change dietary habits, and non smoking. The therapeutic goal is to achieve a Blood Pressure < 140/90 mmHg, but among patients with diabetes, chronic kidney disease, or definite CVD, the objective is <130/80 mmHg. Serum cholesterol should be < 200 mg/dl and cLDL<130 mg/dl, although among patients with CVD or diabetes, the objective is <100 mg/dl (80 mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, to reach body mass index (BMI) guided and waist circumference objectives. In diabetic type 2 patients, the objective is glycated haemoglobin <7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to transfer the recommendations established into the daily clinical practice.
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Affiliation(s)
- J M Lobos
- Sociedad Española de Medicina de Familia y Comunitaria.
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Lobos J, Royo-Bordonada MÁ, Brotons C, Álvarez-Sala L, Armario P, Maiques A, Mauricio D, Sans S, Villar F, Lizcano Á, Gil-Núñez A, de Álvaro F, Conthe P, Luengo E, del Río A, Cortés O, de Santiago A, Vargas M, Martínez M, Lizarbe V. Guía Europea de Prevención Cardiovascular en la Práctica Clínica. Adaptación española del CEIPC 2008. Hipertensión y Riesgo Vascular 2009. [DOI: 10.1016/s1889-1837(09)72176-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Alvarez-Sabín J, Gil-Núñez A, Quintana M, Barbera G. [Prevalence of asymptomatic peripheral artery disease in patients with non-cardioembolic ischemic stroke]. Neurologia 2009; 24:366-372. [PMID: 19798602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION The prevalence of asymptomatic peripheral arterial disease (PAD) detected by the ankle-brachial index (ABI) measurement in stroke patients and its relation with the risk of vascular events recurrence is unknown. A main objective of the APICA study (prevalence of peripheral arterial disease and metabolic syndrome in acute cerebral ischemia) is to analyse the prevalence in our country and to identify clinical variables associated with higher risk of PAD. METHODS Epidemiologic, observational, longitudinal, multicenter study including patients older than 50 with non-cardioembolic transient ischemic attack (TIA) or ischemic stroke, consecutively recruited. PAD was determined if ABI = 0.9. Statistical analysis was performed with SPSS 15.0. A logistic regression analysis was performed to find factors independently associated with asymptomatic PAD. RESULTS 977 patients were included. 651 (66.7 %) were males and mean age was 69.1. 396 (40.5 %) cases had PAD, after excluding patients with previously known PAD, 321 (35.6%) were defined as asymptomatic PAD. The factors independently associated with asymptomatic PAD were: age (OR 1.020 [1.004-1.037], p = 0.017), previous stroke (1.52 [1.05-2.20], p = 0.027), coronary revascularization (1.97 [1.03-3.79], p = 0.041), established stroke (1.86 [1.20-2.88], p = 0.006), atherothrombotic etiology (1.54 [1.13-2.10], p = 0.006), systolic blood pressure (1.009 [1.001-1.017], p = 0.027) and waist perimeter (0.989 [0.978-1.000], p = 0.005). CONCLUSIONS More than a third of the patients with noncardioembolic ischemic stroke have asymptomatic PAD. Asymptomatic PAD is mainly observed in older patients, with hypertension, multiple vascular territories condition and with atherothrombotic etiology of stroke.
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Affiliation(s)
- José Alvarez-Sabín
- Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona.
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Lobos JM, Royo-Bordonada MA, Brotons C, Alvarez-Sala L, Armario P, Maiques A, Mauricio D, Sans S, Villar F, Lizcano A, Gil-Núñez A, de Alvaro F, Conthe P, Luengo E, Del Río A, Cortés O, de Santiago A, Varga MA, Martínez M, Lizarbe V. [European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. CEIPC 2008 Spanish adaptation]. Rev Clin Esp 2009; 209:279-302. [PMID: 19635253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The present CEIPC Spanish adaptation of the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2008. This guide recommends the SCORE model for risk evaluation. The aim is to prevent premature mortality and morbidity due to CVD by means of dealing with its related risk factors in clinical practice. The guide focuses on primary prevention and emphasizes the role of the nurses and primary care doctors in promoting a healthy life style, based on increasing physical activity, changing dietary habits, and not smoking. The therapeutic goal is to achieve a Blood Pressure < 140/90 mmHg, but in patients with diabetes, chronic kidney disease, or definite CVD, the objective is < 130/80 mmHg. Serum cholesterol should be < 200 mg/dl and cLDL < 130 mg/dl, although in patients with CVD or diabetes, the objective is < 100 mg/dl (80 mg/dl if feasible in very high-risk patients). Patients with type 2 diabetes and those with metabolic syndrome must lose weight and increase their physical activity, and drugs must be administered whenever applicable, with the objective guided by body mass index and waist circumference. In diabetic type 2 patients, the objective is glycated haemoglobin < 7%. Allowing people to know the guides and developing implementation programs, identifying barriers and seeking solutions for them, are priorities for the CEIPC in order to put the recommendations into practice.
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Affiliation(s)
- J M Lobos
- Sociedad Española de Medicina de Familia y Comunitaria, España.
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Lobos J, Royo-Bordonada M, Brotons C, Álvarez-Sala L, Armario P, Maiques A, Mauricio D, Sans S, Villar F, Lizcano Á, Gil-Núñez A, de Álvaro F, Conthe P, Luengo E, del Río A, Cortés-Rico O, de Santiago A, Vargas M, Martínez M, Lizarbe V. Guía Europea de Prevención Cardiovascular en la Práctica Clínica. Adaptación española del CEIPC 2008. Semergen 2009. [DOI: 10.1016/s1138-3593(09)70424-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Martí-Fàbregas J, Cocho D, Martí-Vilalta JL, Gich I, Belvís R, Bravo Y, Millán M, Castellanos M, Rodríguez-Campello A, Egido J, Geffner D, Gil-Núñez A, Marta J, Navarro R, Obach V, Palomeras E. Aspirin or Anticoagulants in Stenosis of the Middle Cerebral Artery:A Randomized Trial. Cerebrovasc Dis 2006; 22:162-9. [PMID: 16710082 DOI: 10.1159/000093450] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Accepted: 01/30/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We report the results of an open, randomized, multicenter trial that compared the efficacy of aspirin to oral anticoagulants (OA) for the prevention of vascular events in patients with symptomatic stenosis of the middle cerebral artery (MCA). METHODS Participants were randomly assigned to receive 300 mg/day of aspirin or a dose of OA (target INR 2-3). The MCA stenosis was demonstrated by conventional angiography or by at least two noninvasive examinations. Patients had either transient ischemic attack or cerebral infarct (CI) attributable to the MCA stenosis within 90 days before inclusion. The primary endpoint was: nonfatal CI, nonfatal acute myocardial infarct, vascular death and major hemorrhage. The patients were followed-up for a minimum of 1 year and a maximum of 3 years. RESULTS The study included 28 patients (14 in each treatment group); the average age was 67 +/- 9.9 years. Men constituted 68% of the patients. After a mean follow-up of 23.1 +/- 10.9 months, there were no recurrences of CI in both groups. No endpoint was reported in the aspirin group, but 2 patients in the OA group (14.3%) exhibited vascular events: 1 acute myocardial infarct and 1 intracerebral hemorrhage). However, this difference was not statistically significant (p = 0.48). CONCLUSIONS Our study suggests that aspirin is the treatment of choice for the prevention of vascular events in patients with symptomatic MCA stenosis.
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Affiliation(s)
- J Martí-Fàbregas
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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