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Fernandes-Serodio J, Prieto-González S, Espígol-Frigolé G, Ríos-Garcés R, Gómez-Caverzaschi V, Araújo O, Espinosa G, Jordà-Sánchez R, Alba MA, Quintana L, Blasco M, Guillen E, Viñas O, Ruiz-Ortiz E, Pelegrín L, Sainz de la Maza M, Sánchez-Dalmau B, García-Herrera A, Solé M, Castillo P, Aldecoa I, Cano MD, Sellarés J, Hernández-González F, Agustí C, Lucena CM, López-Rueda A, Sánchez M, Benegas M, Capurro S, Sanmartí R, Grau JM, Vilaseca I, Alobid I, Cid MC, Hernández-Rodríguez J. Significance of clinical-immunological patterns and diagnostic yield of biopsies in microscopic polyangiitis and granulomatosis with polyangiitis. J Intern Med 2024; 295:651-667. [PMID: 38462959 DOI: 10.1111/joim.13777] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND Microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) are the two major antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). OBJECTIVES To characterize a homogenous AAV cohort and to assess the impact of clinicopathological profiles and ANCA serotypes on clinical presentation and prognosis. Clinical differences in GPA patients according to ANCA serotype and the diagnostic yield for vasculitis of biopsies in different territories were also investigated. RESULTS This retrospective study (2000-2021) included 152 patients with AAV (77 MPA/75 GPA). MPA patients (96.1% myeloperoxidase [MPO]-ANCA and 2.6% proteinase 3 [PR3]-ANCA) presented more often with weight loss, myalgia, renal involvement, interstitial lung disease (ILD), cutaneous purpura, and peripheral nerve involvement. Patients with GPA (44% PR3-ANCA, 33.3% MPO, and 22.7% negative/atypical ANCA) presented more commonly with ear, nose, and throat and eye/orbital manifestations, more relapses, and higher survival than patients with MPA. GPA was the only independent risk factor for relapse. Poor survival predictors were older age at diagnosis and peripheral nerve involvement. ANCA serotypes differentiated clinical features in a lesser degree than clinical phenotypes. A mean of 1.5 biopsies were performed in 93.4% of patients in different territories. Overall, vasculitis was identified in 80.3% (97.3% in MPA and 61.8% in GPA) of patients. CONCLUSIONS The identification of GPA presentations associated with MPO-ANCA and awareness of risk factors for relapse and mortality are important to guide proper therapeutic strategies in AAV patients. Biopsies of different affected territories should be pursued in difficult-to-diagnose patients based on their significant diagnostic yield.
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Affiliation(s)
- João Fernandes-Serodio
- Department of Autoimmune Diseases, Vasculitis Research Unit, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) in Autoimmune Diseases and Autoinflammatory Diseases, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
- Systemic Immuno-mediated Diseases Unit (UDIMS), Department of Internal Medicine IV, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Sergio Prieto-González
- Department of Autoimmune Diseases, Vasculitis Research Unit, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) in Autoimmune Diseases and Autoinflammatory Diseases, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Georgina Espígol-Frigolé
- Department of Autoimmune Diseases, Vasculitis Research Unit, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) in Autoimmune Diseases and Autoinflammatory Diseases, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Roberto Ríos-Garcés
- Department of Autoimmune Diseases, Vasculitis Research Unit, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) in Autoimmune Diseases and Autoinflammatory Diseases, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Verónica Gómez-Caverzaschi
- Department of Autoimmune Diseases, Vasculitis Research Unit, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) in Autoimmune Diseases and Autoinflammatory Diseases, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Olga Araújo
- Department of Autoimmune Diseases, Vasculitis Research Unit, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) in Autoimmune Diseases and Autoinflammatory Diseases, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Vasculitis Research Unit, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) in Autoimmune Diseases and Autoinflammatory Diseases, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Raül Jordà-Sánchez
- Department of Autoimmune Diseases, Vasculitis Research Unit, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) in Autoimmune Diseases and Autoinflammatory Diseases, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Marco A Alba
- Department of Autoimmune Diseases, Vasculitis Research Unit, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) in Autoimmune Diseases and Autoinflammatory Diseases, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Luis Quintana
- Department of Nephrology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Miquel Blasco
- Department of Nephrology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Elena Guillen
- Department of Nephrology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Odette Viñas
- Department of Immunology, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Estíbaliz Ruiz-Ortiz
- Department of Immunology, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Laura Pelegrín
- Department of Ophthalmology, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Maite Sainz de la Maza
- Department of Ophthalmology, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Bernardo Sánchez-Dalmau
- Department of Ophthalmology, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Adriana García-Herrera
- Department of Anatomic Pathology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Manel Solé
- Department of Anatomic Pathology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Paola Castillo
- Department of Anatomic Pathology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Iban Aldecoa
- Department of Anatomic Pathology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - María D Cano
- Department of Anatomic Pathology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Jacobo Sellarés
- Department of Pulmonary Medicine, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Fernanda Hernández-González
- Department of Pulmonary Medicine, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carlos Agustí
- Department of Pulmonary Medicine, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carmen M Lucena
- Department of Pulmonary Medicine, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antonio López-Rueda
- Interventional Neuroradiology Unit, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marcelo Sánchez
- Department of Radiology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Mariana Benegas
- Department of Radiology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Sebastián Capurro
- Department of Radiology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Raimon Sanmartí
- Department of Rheumatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Josep M Grau
- Department of Internal Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Isabel Vilaseca
- Department of Otorhinolaryngology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Isam Alobid
- Department of Otorhinolaryngology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Maria C Cid
- Department of Autoimmune Diseases, Vasculitis Research Unit, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) in Autoimmune Diseases and Autoinflammatory Diseases, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - José Hernández-Rodríguez
- Department of Autoimmune Diseases, Vasculitis Research Unit, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) in Autoimmune Diseases and Autoinflammatory Diseases, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
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Mosteiro A, Culebras D, Vargas Solano A, Moreno Negrete JL, López-Rueda A, Llull L, Santana D, Pedrosa L, Amaro S, Torné R, Enseñat J. Aneurysmal subarachnoid haemorrhage: Volumetric quantification of the blood distribution pattern to accurately predict the ruptured aneurysm location. Neurocirugia (Astur : Engl Ed) 2024; 35:136-144. [PMID: 38159810 DOI: 10.1016/j.neucie.2023.12.002] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/08/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND In spontaneous subarachnoid haemorrhage (SAH) accurate determination of the bleeding source is paramount to guide treatment. Traditionally, the bleeding pattern has been used to predict the aneurysm location. Here, we have tested a software-based tool, which quantifies the volume of intracranial blood and stratifies it according to the regional distribution, to predict the location of the ruptured aneurysm. METHODS A consecutive series of SAH patients admitted to a single tertiary centre between 2012-2018, within 72 h of onset, harbouring a single intracranial aneurysm. A semi-automatized method of blood quantification, based on the relative density increase, was applied to initial non-contrast CTs. Five regions were used to define the bleeding patterns and to correlate them with aneurysm location: perimesencephalic, interhemispheric, right/left hemisphere and intraventricular. RESULTS 68 patients were included for analysis. There was a strong association between the distribution of blood and the aneurysm location (p < 0.001). In particular: ACom and interhemispheric fissure (p < 0.001), MCA and ipsilateral hemisphere (p < 0.001), ICA and ipsilateral hemisphere and perimesencephalic cisterns (p < 0.001), PCom and hemispheric, perimesencephalic and intraventricular (p = 0.019), and PICA and perimesencephalic and intraventricular (p < 0.001). The internal diagnostic value was high (AUROC ≥ 0.900) for these locations. CONCLUSION Regional automatised volumetry seems a reliable and objective tool to quantify and describe the distribution of blood within the subarachnoid spaces. This tool accurately predicts the location of the ruptured aneurysm; its use may be prospectively considered in the emergency setting when speed and simplicity are attained.
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Affiliation(s)
- Alejandra Mosteiro
- Department of Neurosurgery, Hospital Clínic of Barcelona, University of Barcelona, Spain
| | - Diego Culebras
- Department of Neurosurgery, Hospital Clínic of Barcelona, University of Barcelona, Spain
| | - Alberto Vargas Solano
- Department of Radiology, Hospital Clínic of Barcelona, University of Barcelona, Spain
| | | | - Antonio López-Rueda
- Department of Radiology, Hospital Clínic of Barcelona, University of Barcelona, Spain
| | - Laura Llull
- Comprehensive Stroke Center, Department of Neurology, Hospital Clínic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Daniel Santana
- Comprehensive Stroke Center, Department of Neurology, Hospital Clínic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Leire Pedrosa
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Sergio Amaro
- Comprehensive Stroke Center, Department of Neurology, Hospital Clínic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Ramón Torné
- Department of Neurosurgery, Hospital Clínic of Barcelona, University of Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clínic of Barcelona, University of Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Terceño M, Bashir S, Puig J, I-Estadella JD, Murias E, Jiménez JM, Díaz EG, Monso JF, Bravo-Rey I, Romero V, Werner M, López-Rueda A, Román LS, Anadaluz JB, Doncel-Moriano A, Rosati S, Pérez-García C, Remollo S, Caamaño IR, Aixut S, Chaparro OSC, Garcia JMS, Porto-Álvarez J, Mendez-Cendón JC, Rayon-Aledo JC, Aguilar Y, Parrilla G, Castaño M, Serena J, Silva Y. Impact of Balloon Guide Catheters in Elderly Patients Treated with Mechanical Thrombectomy: Insights from the ROSSETTI Registry. AJNR Am J Neuroradiol 2023; 44:1275-1281. [PMID: 37827717 PMCID: PMC10631533 DOI: 10.3174/ajnr.a8003] [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] [Received: 05/05/2023] [Accepted: 08/17/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND PURPOSE Several nonrandomized studies have demonstrated the effectiveness of balloon guide catheters in treating patients with anterior circulation large-vessel occlusion. However, their impact on the elderly populations has been underreported. We aimed to analyze the effect of balloon guide catheters in a cohort of elderly patients (80 years of age or older) with anterior circulation large-vessel occlusion. MATERIALS AND METHODS Consecutive patients from June 2019 to June 2022 were collected from the ROSSETTI Registry. Demographic and clinical data, angiographic endovascular technique, and clinical outcome were compared between balloon guide catheter and non-balloon guide catheter groups. We studied the association between balloon guide catheters and the rate of complete recanalization after a single first-pass effect modified TICI 2c-3, as well as their association with functional independence at 3 months. RESULTS A total of 808 patients were included during this period, 465 (57.5%) of whom were treated with balloon guide catheters. Patients treated with balloon guide catheters were older, had more neurologic severity at admission and lower baseline ASPECTS, and were less likely to receive IV fibrinolytics. No differences were observed in terms of the modified first-pass effect between groups (45.8 versus 39.9%, P = .096). In the multivariable regression analysis, balloon guide catheter use was not independently associated with a modified first-pass effect or the final modified TICI 2c-3, or with functional independence at 3 months. CONCLUSIONS In our study, balloon guide catheter use during endovascular treatment of anterior circulation large-vessel occlusion in elderly patients did not predict the first-pass effect, near-complete final recanalization, or functional independence at 3 months. Further studies, including randomized clinical trials, are needed to confirm these results.
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Affiliation(s)
- Mikel Terceño
- From the Stroke Unit, Department of Neurology (M.T., S.B., J.S., Y.S.), Hospital Universitari Doctor Josep Trueta de, Girona, Girona Biomedical Research Institute, Girona, Spain
| | - Saima Bashir
- From the Stroke Unit, Department of Neurology (M.T., S.B., J.S., Y.S.), Hospital Universitari Doctor Josep Trueta de, Girona, Girona Biomedical Research Institute, Girona, Spain
| | - Josep Puig
- Department of Radiology (J.P.), Hospital Universitari de Girona Doctor Josep Trueta, Girona, Catalunya, Spain
| | - Josep Daunis- I-Estadella
- Department of Computer Science (J.D.-I.-E.), Applied Mathematics and Statistics, University of Girona, Girona, Catalunya, Spain
| | - Eduardo Murias
- Department of Radiology (E.M., J.M.J.), Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Jose María Jiménez
- Department of Radiology (E.M., J.M.J.), Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Eva González Díaz
- Department of Interventional Neuroradiology (E.G.D., J.F.M.), Department of Radiology, Cruces University Hospital, Barakaldo, PaísVasco, Spain
| | - Jon Fondevila Monso
- Department of Interventional Neuroradiology (E.G.D., J.F.M.), Department of Radiology, Cruces University Hospital, Barakaldo, PaísVasco, Spain
| | - Isabel Bravo-Rey
- Diagnostic and Therapeutical Neuroradiology Unit (I.B.-R., V.R.), Reina Sofia University Hospital, Cordoba, Andalucía, Spain
| | - Veredas Romero
- Diagnostic and Therapeutical Neuroradiology Unit (I.B.-R., V.R.), Reina Sofia University Hospital, Cordoba, Andalucía, Spain
| | - Mariano Werner
- Neurointerventional Department CDI (M.W.), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Antonio López-Rueda
- Department of Interventional Neuroradiology (A.L.-R., L.S.R., J.B.A.), Clinic University Hospital, Barcelona, Barcelona, Spain
| | - Luis San Román
- Department of Interventional Neuroradiology (A.L.-R., L.S.R., J.B.A.), Clinic University Hospital, Barcelona, Barcelona, Spain
| | - Jordi Blasco Anadaluz
- Department of Interventional Neuroradiology (A.L.-R., L.S.R., J.B.A.), Clinic University Hospital, Barcelona, Barcelona, Spain
| | | | - Santiago Rosati
- Department of Interventional Neurorradiology (S.R., C.P.-G.), Department of Radiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Carlos Pérez-García
- Department of Interventional Neurorradiology (S.R., C.P.-G.), Department of Radiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Sebastian Remollo
- Department of Interventional Neuroradiology (S.R., I.R.C.), Hospital universitari Germans Trias i Pujol, Badalona, Spain
| | - Isabel Rodríguez Caamaño
- Department of Interventional Neuroradiology (S.R., I.R.C.), Hospital universitari Germans Trias i Pujol, Badalona, Spain
| | - Sonia Aixut
- Department of Interventional Neuroradiology (S.A., O.S.C.C.), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oscar Sabino Chirife Chaparro
- Department of Interventional Neuroradiology (S.A., O.S.C.C.), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Jacobo Porto-Álvarez
- Department of Neuroradiology (J.P.-A.), Complexo Hospitalario Universitario de Santiago de, Compostela, Galicia, Spain
| | - Jose Carlos Mendez-Cendón
- Interventional Neuroradiology Unit (J.C.M.-C.), Department of Radiology, Hospital Ramón y Cajal, Madrid, Spain
| | - Jose Carlos Rayon-Aledo
- Department of Interventional Neuroradiology (J.C.R.-A.), Hospital General Universitario de Alicante, Alicante, Valenciana, Spain
| | - Yeray Aguilar
- Department of Radiology (Y.A.), Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Guillermo Parrilla
- Department of Interventional Neuroradiology (G.P.), Department of Radiology, Hospital Clínico Universitario Virgen de la, Murcia, Spain
| | - Miguel Castaño
- Department of Interventional Neuroradiology (M.S.), Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Joaquín Serena
- From the Stroke Unit, Department of Neurology (M.T., S.B., J.S., Y.S.), Hospital Universitari Doctor Josep Trueta de, Girona, Girona Biomedical Research Institute, Girona, Spain
| | - Yolanda Silva
- From the Stroke Unit, Department of Neurology (M.T., S.B., J.S., Y.S.), Hospital Universitari Doctor Josep Trueta de, Girona, Girona Biomedical Research Institute, Girona, Spain
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Serrano E, Moreno J, Llull L, Rodríguez A, Zwanzger C, Amaro S, Oleaga L, López-Rueda A. Radiomic-based nonlinear supervised learning classifiers on non-contrast CT to predict functional prognosis in patients with spontaneous intracerebral hematoma. Radiologia (Engl Ed) 2023; 65:519-530. [PMID: 38049251 DOI: 10.1016/j.rxeng.2023.08.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/03/2023] [Indexed: 12/06/2023]
Abstract
PURPOSE To evaluate if nonlinear supervised learning classifiers based on non-contrast CT can predict functional prognosis at discharge in patients with spontaneous intracerebral hematoma. METHODS Retrospective, single-center, observational analysis of patients with a diagnosis of spontaneous intracerebral hematoma confirmed by non-contrast CT between January 2016 and April 2018. Patients with HIE > 18 years and with TCCSC performed within the first 24 h of symptom onset were included. Patients with secondary spontaneous intracerebral hematoma and in whom radiomic variables were not available were excluded. Clinical, demographic and admission variables were collected. Patients were classified according to the Modified Rankin Scale (mRS) at discharge into good (mRS 0-2) and poor prognosis (mRS 3-6). After manual segmentation of each spontaneous intracerebral hematoma, the radiomics variables were obtained. The sample was divided into a training and testing cohort and a validation cohort (70-30% respectively). Different methods of variable selection and dimensionality reduction were used, and different algorithms were used for model construction. Stratified 10-fold cross-validation were performed on the training and testing cohort and the mean area under the curve (AUC) were calculated. Once the models were trained, the sensitivity of each was calculated to predict functional prognosis at discharge in the validation cohort. RESULTS 105 patients with spontaneous intracerebral hematoma were analyzed. 105 radiomic variables were evaluated for each patient. P-SVM, KNN-E and RF-10 algorithms, in combination with the ANOVA variable selection method, were the best performing classifiers in the training and testing cohort (AUC 0.798, 0.752 and 0.742 respectively). The predictions of these models, in the validation cohort, had a sensitivity of 0.897 (0.778-1;95%CI), with a false-negative rate of 0% for predicting poor functional prognosis at discharge. CONCLUSION The use of radiomics-based nonlinear supervised learning classifiers are a promising diagnostic tool for predicting functional outcome at discharge in HIE patients, with a low false negative rate, although larger and balanced samples are still needed to develop and improve their performance.
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Affiliation(s)
- E Serrano
- Departamento Radiología, Hospital Universitario Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - J Moreno
- Clínica Iribas-IRM, Asunción, Paraguay
| | - L Llull
- Departamento de Neurología, Hospital Clínic, Barcelona, Spain
| | - A Rodríguez
- Departamento de Neurología, Hospital Clínic, Barcelona, Spain
| | - C Zwanzger
- Departamento Radiología, Hospital del Mar, Barcelona, Spain
| | - S Amaro
- Departamento de Neurología, Hospital Clínic, Barcelona, Spain
| | - L Oleaga
- Departamento Radiología, Hospital Clínic, Barcelona, Spain
| | - A López-Rueda
- Departamento Radiología, Hospital Clínic, Barcelona, Spain; Servicio de Informática Clínica, Hospital Clínic, Barcelona, Spain.
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Frid S, Bracons Cucó G, Gil Rojas J, López-Rueda A, Pastor Duran X, Martínez-Sáez O, Lozano-Rubí R. Evaluation of OMOP CDM, i2b2 and ICGC ARGO for supporting data harmonization in a breast cancer use case of a multicentric European AI project. J Biomed Inform 2023; 147:104505. [PMID: 37774908 DOI: 10.1016/j.jbi.2023.104505] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE Observational research in cancer poses great challenges regarding adequate data sharing and consolidation based on a homogeneous data semantic base. Common Data Models (CDMs) can help consolidate health data repositories from different institutions minimizing loss of meaning by organizing data into a standard structure. This study aims to evaluate the performance of the Observational Medical Outcomes Partnership (OMOP) CDM, Informatics for Integrating Biology & the Bedside (i2b2) and International Cancer Genome Consortium, Accelerating Research in Genomic Oncology (ICGC ARGO) for representing non-imaging data in a breast cancer use case of EuCanImage. METHODS We used ontologies to represent metamodels of OMOP, i2b2, and ICGC ARGO and variables used in a cancer use case of a European AI project. We selected four evaluation criteria for the CDMs adapted from previous research: content coverage, simplicity, integration, implementability. RESULTS i2b2 and OMOP exhibited higher element completeness (100% each) than ICGC ARGO (58.1%), while the three achieved 100% domain completeness. ICGC ARGO normalizes only one of our variables with a standard terminology, while i2b2 and OMOP use standardized vocabularies for all of them. In terms of simplicity, ICGC ARGO and i2b2 proved to be simpler both in terms of ontological model (276 and 175 elements, respectively) and in the queries (7 and 20 lines of code, respectively), while OMOP required a much more complex ontological model (615 elements) and queries similar to those of i2b2 (20 lines). Regarding implementability, OMOP had the highest number of mentions in articles in PubMed (130) and Google Scholar (1,810), ICGC ARGO had the highest number of updates to the CDM since 2020 (4), and i2b2 is the model with more tools specifically developed for the CDM (26). CONCLUSION ICGC ARGO proved to be rigid and very limited in the representation of oncologic concepts, while i2b2 and OMOP showed a very good performance. i2b2's lack of a common dictionary hinders its scalability, requiring sites that will share data to explicitly define a conceptual framework, and suggesting that OMOP and its Oncology extension could be the more suitable choice. Future research employing these CDMs with actual datasets is needed.
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Affiliation(s)
- Santiago Frid
- Clinical Informatics Service, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain. https://twitter.com/santifrik
| | - Guillem Bracons Cucó
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer, Rosselló 149-153, 08036 Barcelona, Spain
| | - Jessyca Gil Rojas
- Clinical Informatics Service, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Antonio López-Rueda
- Clinical Informatics Service, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; Radiology Service, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Xavier Pastor Duran
- Clinical Informatics Service, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Olga Martínez-Sáez
- Oncology Service, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Raimundo Lozano-Rubí
- Oncology Service, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain
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6
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Remollo S, Werner M, Blasco J, López-Rueda A, San Roman L, Jimenez-Gomez E, Bravo Rey I, Vega P, Murias E, Rosati S, Pérez-García C, González E, Manso X, Aixut S, Chirife Chaparro O, Terceño M, Bashir S, Pumar JM, Ruiz-González E, Méndez JC, Aguilar Tejedor Y, Zamarro J, Castaño M, Daunis-I-Estadella P, Puig J. First-Pass Effect in M1-Occlusion Stroke Patients Treated with Combined Stent-Retriever/Large-Bore Distal Aspiration Catheter Thrombectomy. Clin Neuroradiol 2023; 33:701-708. [PMID: 36856786 DOI: 10.1007/s00062-023-01264-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/17/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Combined stent-retriever/large-bore distal aspiration catheter (LB-DAC) thrombectomy was recently introduced to treat large-vessel occlusion; however, it is unclear whether larger inner diameters improve outcomes. We compared angiographic and clinical outcomes in patients with occlusions of the M1 segment of the middle cerebral artery treated with mechanical thrombectomy using extra-LB-DAC versus LB-DAC in combination with stent-retrievers. METHODS We analyzed consecutive patients with M1 occlusion included in the ROSSETTI registry treated with non-balloon guide catheter combined LB-DAC/stent-retriever thrombectomy between June 2019 and April 2022. We compared demographics, baseline clinical variables, procedural variables, angiographic outcomes, and clinical outcomes [National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) and modified Rankin scale score at 3 months] between patients treated with extra-LB-DAC (Sofia Plus, MIVI Q6, Catalyst7; inner diameter, 0.068″-0.070″) versus LB-DAC (Sofia 5F, MIVI Q5, Catalyst 6; inner diameter, 0.055″-0.064″). Primary outcome was the first-pass effect (FPE) rate, defined as near-complete/complete reperfusion (mTICI 2c-3) after a single pass of the device. RESULTS We included 324 patients (extra-LB-DAC, 185, 57.1% patients). Demographics, clinical data, and clinical outcomes were similar between the two groups; however, there was a trend towards improvement in National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) in the cohort treated with extra-LB-DAC 9 points (IQR 4;16 points) vs. 12 points (IQR 4;18 points, P = 0.083). Patients treated with extra-LB-DAC had higher FPE rate (47% vs. 30.9%; P = 0.003) and higher modified FPE (mTICI ≥ 2b after a single pass) rate (65.9% vs 46.8%; P = 0.001). The use of extra-LB-DAC was an independent factor in predicting FPE (odds ratio 1.982, 95% confidence interval 1.250-3.143, P = 0.004). CONCLUSION Our results suggest that in combined LB-DAC/stent-retriever thrombectomy, a larger aspiration catheter inner diameter is associated with higher rates of FPE and mFPE.
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Affiliation(s)
- S Remollo
- Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - M Werner
- Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - J Blasco
- Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A López-Rueda
- Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - L San Roman
- Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - E Jimenez-Gomez
- Diagnostic and Therapeutical Neuroradiology Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - I Bravo Rey
- Neuroradiology Department, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - P Vega
- Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - E Murias
- Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - S Rosati
- Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - C Pérez-García
- Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - E González
- Interventional Neuroradiology, Radiology Department, Cruces University Hospital, Barakaldo, Spain
| | - X Manso
- Interventional Neuroradiology, Radiology Department, Cruces University Hospital, Barakaldo, Spain
| | - S Aixut
- Neuroradiology Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Llobregat, Spain
| | - O Chirife Chaparro
- Neuroradiology Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Llobregat, Spain
| | - M Terceño
- Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - S Bashir
- Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - J M Pumar
- Neuroradiology Department, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - E Ruiz-González
- Interventional Neuroradiology, Hospital General Universitario de Alicante, Alicante, Spain
| | - J C Méndez
- Interventional Neuroradiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Y Aguilar Tejedor
- Radiology Department, Hospital Universitario Insular de Gran Canaria, Gran Canaria, Spain
| | - J Zamarro
- Interventional Neuroradiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - M Castaño
- Interventional Neuroradiology Unit, Department of Radiology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - P Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - J Puig
- Department of Radiology (IDI) and Institut d'Investigació Biomèdica de Girona, Hospital Universitari Doctor Josep Trueta, Girona, Spain.
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7
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Serrano E, Vila-Trias E, Zarco F, Zamora Martínez C, Moisés J, Gómez FM, López-Rueda A. Difficult withdrawal of an inferior vena cava filter: Technical considerations and associated variables. Radiologia (Engl Ed) 2023; 65:230-238. [PMID: 37268365 DOI: 10.1016/j.rxeng.2022.07.006] [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: 06/06/2022] [Accepted: 07/28/2022] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To analyse the efficacy of the procedure for withdrawing an inferior vena cava (IVC) filter and the clinical and radiological factors associated with difficult withdrawal. MATERIAL AND METHODS This retrospective observational study included patients who underwent IVC filter withdrawal at a single centre between May 2015 and May 2021. We recorded demographic, clinical, procedural, and radiological variables: type of IVC filter, angle with the IVC > 15°, hook against the wall, and legs embedded in the IVC wall > 3 mm. The efficacy variables were fluoroscopy time, success of IVC filter withdrawal, and number of attempts to withdraw the filter. The safety variables were complications, surgical removal, and mortality. The main variable was difficult withdrawal, defined as more than 5 min fluoroscopy or more than 1 attempt at withdrawal. RESULTS A total of 109 patients were included; withdrawal was considered difficult in 54 (49.5%). Three radiological variables were more common in the difficult withdrawal group: hook against the wall (33.3% vs. 9.1%; p = 0.027), embedded legs (20.4% vs. 3.6%; p = 0.008), and >45 days since IVC filter placement (51.9% vs. 25.5%; p = 0.006). These variables remained significant in the subgroup of patients with OptEase IVC filters; however, in the group of patients with Celect IVC filters, only the inclination of the IVC filter >15 ° was significantly associated with difficult withdrawal (25% vs 0%; p = 0.029). CONCLUSION Difficult withdrawal was associated with time from IVC placement, embedded legs, and contact between the hook and the wall. The analysis of the subgroups of patients with different types of IVC filters found that these variables remained significant in those with OptEase filters; however, in those with cone-shaped devices (Celect), the inclination of the IVC filter >15° was significantly associated with difficult withdrawal.
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Affiliation(s)
- E Serrano
- Sección Radiología Vascular e Intervencionista, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - E Vila-Trias
- Servicio Radiología, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - F Zarco
- Sección Radiología Vascular e Intervencionista, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - J Moisés
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Spain
| | - F M Gómez
- Sección Radiología Vascular e Intervencionista, Hospital Clínic de Barcelona, Barcelona, Spain
| | - A López-Rueda
- Sección Radiología Vascular e Intervencionista, Hospital Clínic de Barcelona, Barcelona, Spain
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8
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López-Rueda A, Ibáñez Sanz L, Alonso de Leciñana M, de Araújo Martins-Romeo D, Vicente Bartulos A, Castellanos Rodrigo M, Oleaga Zufiria L. Recommendations on the use of computed tomography in the stroke code: Consensus document SENR, SERAU, GEECV-SEN, SERAM. Radiologia (Engl Ed) 2023; 65:180-191. [PMID: 37059583 DOI: 10.1016/j.rxeng.2022.11.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/18/2022] [Indexed: 03/31/2023]
Abstract
The Spanish Society of Emergency Radiology (SERAU), the Spanish Society of Neuroradiology (SENR), the Spanish Society of Neurology through its Cerebrovascular Diseases Study Group (GEECV-SEN) and the Spanish Society of Medical Radiology (SERAM) have met to draft this consensus document that will review the use of computed tomography in the stroke code patients, focusing on its indications, the technique for its correct acquisition and the possible interpretation mistakes.
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Affiliation(s)
- A López-Rueda
- Sección Radiología Vascular e Intervencionista, Hospital Clínic, Barcelona, Spain.
| | - L Ibáñez Sanz
- Radiología de Urgencias, Hospital 12 de Octubre, Madrid, Spain
| | - M Alonso de Leciñana
- Servicio de Neurología y Centro de Ictus, Instituto para la Investigación biomédica-Hospital Universitario la Paz (IdiPAZ), Universidad Autónoma de Madrid, Madrid, Spain
| | | | - A Vicente Bartulos
- Sección de Radiología de Urgencias, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Castellanos Rodrigo
- Servicio de Neurología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - L Oleaga Zufiria
- Sección Radiología Vascular e Intervencionista, Hospital Clínic, Barcelona, Spain
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9
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López-Rueda A, Ibáñez Sanz L, Alonso de Leciñana M, de Araújo Martins-Romeo D, Vicente Bartulos A, Castellanos Rodrigo M, Oleaga Zufiria L. Recomendaciones sobre el uso de la tomografía computarizada en el código ictus: Documento de consenso SENR, SERAU, GEECV-SEN, SERAM. Radiología 2023. [DOI: 10.1016/j.rx.2022.11.007] [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: 01/29/2023]
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10
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Hernández D, Serrano E, Molins G, Zarco F, Chirife O, Werner M, Lara B, Ramos A, Llull L, Requena M, Cuevas MDDL, Remollo S, Piñana C, López-Rueda A. Comparison of First-Pass Effect in Aspiration vs. Stent-Retriever for Acute Intracranial ICA Occlusion. Front Neurol 2022; 13:925159. [PMID: 35847206 PMCID: PMC9279887 DOI: 10.3389/fneur.2022.925159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study is to evaluate the best endovascular approach (aspiration or stent-retriever) and the impact of stent retriever size and length on clinical and angiographic outcomes in patients with acute intracranial ICA occlusion. We conducted a retrospective analysis of a prospective database of consecutive patients with acute intracranial ICA occlusion undergoing endovascular treatment in four Comprehensive Stroke Center between June-2019 and December-2020. We include 121 patients; Stent-retriever (SR) was used as first technical approach in 107 patients (88.4%) and aspiration was used in 14 patients (11.6%). SR group had higher rate of FPE compared to aspiration group (29 vs. 0%, p = 0.02). In SR subgroup, treatment highlighted higher FPE in the 6 × 50 SR (37.7%), than in the rest of the SR which are 21.2% (4–5 mm size and 20–50 mm length SR) and 19% (6 mm size and 25–40 mm length SR), but it was not found to be statistically significant. There were no other significant differences across the groups regarding primary angiographic or clinical outcomes. In our intracranial ICA occlusion series, stent retrievers were superior to direct aspiration in obtaining FPEs and mFPEs, and longer devices achieved better results with no statistically significant difference. Further studies evaluating the effects of different ICA clot removal approaches are warranted to confirm these results.
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Affiliation(s)
| | | | - Gemma Molins
- Institute for Medical Engineering and Science (IMES), Massachusetts Institute of Technology (MIT), Cambridge, MA, United States
| | | | - Oscar Chirife
- Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Mariano Werner
- Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - Blanca Lara
- Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Ramos
- Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | - Laura Llull
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - Manuel Requena
- Hospital Universitario Valle de Hebrón, Barcelona, Spain
| | | | | | - Carlos Piñana
- Hospital Universitario Valle de Hebrón, Barcelona, Spain
| | - Antonio López-Rueda
- Hospital Clínic de Barcelona, Barcelona, Spain
- *Correspondence: Antonio López-Rueda
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11
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Renú A, Millán M, San Román L, Blasco J, Martí-Fàbregas J, Terceño M, Amaro S, Serena J, Urra X, Laredo C, Barranco R, Camps-Renom P, Zarco F, Oleaga L, Cardona P, Castaño C, Macho J, Cuadrado-Godía E, Vivas E, López-Rueda A, Guimaraens L, Ramos-Pachón A, Roquer J, Muchada M, Tomasello A, Dávalos A, Torres F, Chamorro Á. Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: The CHOICE Randomized Clinical Trial. JAMA 2022; 327:826-835. [PMID: 35143603 PMCID: PMC8832304 DOI: 10.1001/jama.2022.1645] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE It is estimated that only 27% of patients with acute ischemic stroke and large vessel occlusion who undergo successful reperfusion after mechanical thrombectomy are disability free at 90 days. An incomplete microcirculatory reperfusion might contribute to these suboptimal clinical benefits. OBJECTIVE To investigate whether treatment with adjunct intra-arterial alteplase after thrombectomy improves outcomes following reperfusion. DESIGN, SETTING, AND PARTICIPANTS Phase 2b randomized, double-blind, placebo-controlled trial performed from December 2018 through May 2021 in 7 stroke centers in Catalonia, Spain. The study included 121 patients with large vessel occlusion acute ischemic stroke treated with thrombectomy within 24 hours after stroke onset and with an expanded Treatment in Cerebral Ischemia angiographic score of 2b50 to 3. INTERVENTIONS Participants were randomized to receive intra-arterial alteplase (0.225 mg/kg; maximum dose, 22.5 mg) infused over 15 to 30 minutes (n = 61) or placebo (n = 52). MAIN OUTCOMES AND MEASURES The primary outcome was the difference in proportion of patients achieving a score of 0 or 1 on the 90-day modified Rankin Scale (range, 0 [no symptoms] to 6 [death]) in all patients treated as randomized. Safety outcomes included rate of symptomatic intracranial hemorrhage and death. RESULTS The study was terminated early for inability to maintain placebo availability and enrollment rate because of the COVID-19 pandemic. Of 1825 patients with acute ischemic stroke treated with thrombectomy at the 7 study sites, 748 (41%) patients fulfilled the angiographic criteria, 121 (7%) patients were randomized (mean age, 70.6 [SD, 13.7] years; 57 women [47%]), and 113 (6%) were treated as randomized. The proportion of participants with a modified Rankin Scale score of 0 or 1 at 90 days was 59.0% (36/61) with alteplase and 40.4% (21/52) with placebo (adjusted risk difference, 18.4%; 95% CI, 0.3%-36.4%; P = .047). The proportion of patients with symptomatic intracranial hemorrhage within 24 hours was 0% with alteplase and 3.8% with placebo (risk difference, -3.8%; 95% CI, -13.2% to 2.5%). Ninety-day mortality was 8% with alteplase and 15% with placebo (risk difference, -7.2%; 95% CI, -19.2% to 4.8%). CONCLUSIONS AND RELEVANCE Among patients with large vessel occlusion acute ischemic stroke and successful reperfusion following thrombectomy, the use of adjunct intra-arterial alteplase compared with placebo resulted in a greater likelihood of excellent neurological outcome at 90 days. However, because of study limitations, these findings should be interpreted as preliminary and require replication. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03876119; EudraCT Number: 2018-002195-40.
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Affiliation(s)
- Arturo Renú
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mónica Millán
- Stroke Unit, Department of Neuroscience, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Luis San Román
- Neuroradiology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Jordi Blasco
- Neuroradiology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Joan Martí-Fàbregas
- Department of Neurology, Stroke Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Mikel Terceño
- Neuroradiology Service, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Sergio Amaro
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
| | - Joaquín Serena
- Neurology Service, Stroke Unit, Institut d’Investigació Biomèdica de Girona (IDIBGI), Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Xabier Urra
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
| | - Carlos Laredo
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Roger Barranco
- Department of Interventional Neuroradiology, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Pol Camps-Renom
- Department of Neurology, Stroke Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Federico Zarco
- Neuroradiology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Laura Oleaga
- Neuroradiology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Pere Cardona
- Department of Neurology, Bellvitge University Hospital, Barcelona, Spain
| | - Carlos Castaño
- Interventional Neuroradiology Unit, Department of Neuroscience, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Juan Macho
- Neuroradiology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Elisa Cuadrado-Godía
- Department of Neurology, Institut Hospital del Mar d’Investigacions Mèdiques, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elio Vivas
- Department of Neuroradiology, Hospital del Mar, Barcelona, Spain
| | | | | | - Anna Ramos-Pachón
- Stroke Unit, Department of Neuroscience, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jaume Roquer
- Department of Neurology, Institut Hospital del Mar d’Investigacions Mèdiques, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marian Muchada
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Alejandro Tomasello
- Department of Neuroradiology, Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Dávalos
- Stroke Unit, Department of Neuroscience, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Neurology, Stroke Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ferran Torres
- Medical Statistics Core Facility, Clinical Pharmacology Service, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
- Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángel Chamorro
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
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12
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López-Rueda A, Vargas A, Piñana C, Chirife Ó, Werner M, Aja L, Remollo S, Tomasello YA. Angioplasty with a stent retriever to treat vasospasm secondary to subarachnoid hemorrhage due to an aneurysm: a multicenter study of safety and efficacy. Radiología (English Edition) 2022; 64:103-109. [DOI: 10.1016/j.rxeng.2020.04.009] [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] [Received: 01/06/2020] [Accepted: 04/21/2020] [Indexed: 10/18/2022]
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13
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Porta M, Moreno J, Werner M, Chirife Ó, López-Rueda A. Anomalous location of intracranial vessels in adults. Radiologia (Engl Ed) 2022; 64:41-53. [PMID: 35180986 DOI: 10.1016/j.rxeng.2021.11.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
Anomalous intracranial vessels are not uncommon, and this finding is not always associated with arteriovenous malformations. Other conditions such as anomalous connections between arteries or phlebitc patterns can also present as vessels with abnormal intracranial locations. Noninvasive diagnosis is important to determine whether to do more invasive tests such as cerebral digital subtraction angiography or to estimate the risk of bleeding in arteriovenous malformations and therefore to evaluate the need for endovascular/surgical treatment. In this paper, we present an algorithm for the differential diagnosis of anomalous intracranial vessels according to their location (intra/extra-axial) and function (whether the vessels are arterialized). Moreover, we analyze the important points of the angioarchitecture of the principal arteriovenous malformations with risk of intracranial bleeding, such as pial arteriovenous malformations and dural fistulas.
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Affiliation(s)
- M Porta
- Departamento de Radiología, Hospital Clínic de Barcelona, Universidad de Barcelona, Spain
| | - J Moreno
- Departamento de Radiología, Hospital Clínic de Barcelona, Universidad de Barcelona, Spain
| | - M Werner
- Departamento de Radiología, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Ó Chirife
- Departamento de Radiología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A López-Rueda
- Departamento de Radiología, Hospital Clínic de Barcelona, Universidad de Barcelona, Spain.
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14
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Porta M, Moreno J, Werner M, Chirife Ó, López-Rueda A. Vasos intracraneales en localización anómala en adultos. Radiología 2022. [DOI: 10.1016/j.rx.2021.11.002] [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: 11/28/2022]
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15
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Escudero-Martínez I, Mancha F, Vega Á, Zapata M, Ocete RF, Álvarez L, Algaba P, López-Rueda A, Piñero P, Fajardo E, Fernández-Engo JR, Martín-Sánchez EM, Galvao-Carmona A, Zapata-Arriaza E, Lebrato L, Pardo B, Cabezas JA, Ayuso MI, González A, Moniche F, Montaner J. Mediterranean Diet and its Effects on Silent Brain Infarcts in a Cohort of Patients With Atrial Fibrillation. Nutr Metab Insights 2022; 15:11786388221122172. [DOI: 10.1177/11786388221122172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: The benefits of Mediterranean Diet (MeDiet) in prevention of cardiovascular diseases (CVD) in general and ischemic stroke (IS) have been extensively studied and reported. We hypothesize that the consumption of nutrients typical of MeDiet would also reduce the rate of silent brain infarcts (SBI) among AF patients. Methods and Results: Patients with a history of AF who scored 0 to 1 in the CHADS2 score, ⩾50 years and with absence of neurological symptoms were selected from Seville urban area using the Andalusian electronic healthcare database. A 3T brain MRI was performed to all participants. Demographic and clinical data and food-frequency questionnaire (FFQ) were collected. Of the 443 scanned patients, 66 presented SBI. Of them 52 accepted to be scheduled for a clinical visit and were included in the diet sub study and 41 controls were matched per age and sex. There were no statistically significant differences in baseline characteristics. After logistic regression analysis, we found that a higher consumption of fiber from fruit was independently associated with a lower risk of SBI, while a higher consumption of high glycemic load (GL) foods was associated with a higher risk of SBI in a population with AF Conclusion: Our findings support that MeDiet could be suggested as a prevention strategy for SBI in patients with AF.
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Affiliation(s)
- Irene Escudero-Martínez
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Fernando Mancha
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Ángela Vega
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Montserrat Zapata
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Rafael F Ocete
- Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Lucía Álvarez
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Pilar Algaba
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | | | - Pilar Piñero
- Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Elena Fajardo
- Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Eva M Martín-Sánchez
- Information Systems Coordination Service, Support Services of the Andalusian Health, Sevilla, Spain
| | | | - Elena Zapata-Arriaza
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
- Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Lucía Lebrato
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Blanca Pardo
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Juan Antonio Cabezas
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - María Irene Ayuso
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Alejandro González
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
- Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Francisco Moniche
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
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16
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Pérez-García C, Rosati S, Gómez-Escalonilla C, Arrazola J, López-Frías A, González E, Fondevila J, Vega P, Murias E, Jimenez-Gomez E, Bravo Rey I, Macho J, San Roman L, Rodriguez Caamaño I, Paipa AJ, Remollo S, Aguilar Tejedor Y, Bermúdez-Coronel I, Moliner S, Pumar JM, Bashir S, Puig J, López-Rueda A, Blasco J, Nogueira RG, Moreu M. Stent-retriever alone versus combined use of stent-retriever and contact aspiration technique for middle cerebral artery M2 occlusions: a propensity score analysis. J Neurointerv Surg 2021; 14:1062-1067. [PMID: 34750112 DOI: 10.1136/neurintsurg-2021-017987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/02/2021] [Accepted: 10/15/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The optimal endovascular treatment (EVT) technique for middle cerebral artery (MCA) M2 segment occlusions remains unknown. We aim to analyze whether reperfusion rate, procedure times, procedure-related complications, and clinical outcome differed between patients with isolated M2 occlusions who underwent stent-retriever (SR) alone versus combined SR and contact aspiration (CA) as a front-line EVT. METHODS Patients who underwent EVT for isolated MCA-M2 occlusion were recruited from the prospectively ongoing ROSSETTI registry. Patients were divided regarding the EVT approach into SR alone versus SR+CA and propensity score matching was used to achieve baseline balance. Demographic, procedural, safety, and clinical outcomes were compared between groups. Multivariable logistic regression analysis was performed to identify independent predictors of first-pass effect (FPE) and 90-day modified Rankin scale (mRS) 0-2. RESULTS 214 patients underwent EVT for M2 occlusion, 125 treated with SR alone and 89 with SR+CA. Propensity score matchnig analysis selected 134 matched patients. The rates of FPE (42% vs 40%, p=1.000) and 90-day mRS 0-2 (60% vs 51%, p=0.281) were comparable between groups. Patients treated with SR alone had lower need of rescue therapy (p=0.006), faster times to reperfusion (p<0.001), and lower procedure-related complications (p=0.031). Higher initial Alberta Stroke Program Early CT Score was an independent predictor of FPE. Age, baseline National Institutes of Health Stroke Scale score, and procedure duration were significant predictors of good clinical outcome at 3 months. CONCLUSIONS As front-line modality in M2 occlusions, the SR alone approach results in similar rates of reperfusion and good clinical outcomes to combined SR+CA and might be advantageous due to faster reperfusion times and fewer adverse events.
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Affiliation(s)
| | - Santiago Rosati
- Interventional Neuroradiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Juan Arrazola
- Radiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Eva González
- Interventional Neuroradiology, Hospital Universitario de Cruces, Bilbao, Spain
| | - Jon Fondevila
- Interventional Neuroradiology, Hospital Universitario de Cruces, Bilbao, Spain
| | - Pedro Vega
- Interventional Neuroradiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Eduardo Murias
- Interventional Neuroradiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Elvira Jimenez-Gomez
- Interventional Neuroradiology, Hospital Universitario Reina Sofía, Cordoba, Spain
| | - Isabel Bravo Rey
- Interventional Neuroradiology, Hospital Universitario Reina Sofía, Cordoba, Spain
| | - Juan Macho
- Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Luis San Roman
- Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Isabel Rodriguez Caamaño
- Interventional Neuroradiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Andres Julián Paipa
- Neurology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Sebastian Remollo
- Interventional Neuroradiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Yeray Aguilar Tejedor
- Interventional Radiology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | - Sarai Moliner
- Interventional Neuroradiology, Hospital General Universitario de Alicante, Alicante, Spain
| | - José Manuel Pumar
- Interventional Neuroradiology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Saima Bashir
- Neurology, University Hospital Dr Josep Trueta, Girona, Spain
| | - Josep Puig
- Radiology, University Hospital Dr Josep Trueta, Girona, Spain
| | - Antonio López-Rueda
- Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Jordi Blasco
- Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Raul G Nogueira
- Neurology and Interventional Radiology, Grady Memorial Hospital, Chickasha, Oklahoma, USA
| | - Manuel Moreu
- Interventional Neuroradiology, Hospital Clínico San Carlos, Madrid, Spain
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17
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Blasco J, Puig J, López-Rueda A, Daunis-I-Estadella P, Llull L, Zarco F, Macias N, Macho J, González E, Labayen I, Vega P, Murias E, Jimenez-Gomez E, Bravo Rey I, Moreu M, Pérez-García C, Chirife Chaparro O, Aixut S, Terceño M, Werner M, Pumar JM, Aguilar Tejedor Y, Mendez JC, Moliner S, Nogueira RG, San Roman L. Addition of intracranial aspiration to balloon guide catheter does not improve outcomes in large vessel occlusion anterior circulation stent retriever based thrombectomy for acute stroke. J Neurointerv Surg 2021; 14:863-867. [PMID: 34452989 DOI: 10.1136/neurintsurg-2021-017760] [Citation(s) in RCA: 3] [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: 05/07/2021] [Accepted: 08/08/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Balloon guide catheter (BGC) in stent retriever based thrombectomy (BGC+SR) for patients with large vessel occlusion strokes (LVOS) improves outcomes. It is conceivable that the addition of a large bore distal access catheter (DAC) to BGC+SR leads to higher efficacy. We aimed to investigate whether the combined BGC+DAC+SR approach improves angiographic and clinical outcomes compared with BGC+SR alone for thrombectomy in anterior circulation LVOS. METHODS Consecutive patients with anterior circulation LVOS from June 2019 to November 2020 were recruited from the ROSSETTI registry. Demographic, clinical, angiographic, and outcome data were compared between patients treated with BGC+SR alone versus BGC+DAC+SR. The primary outcome was first pass effect (FPE) rate, defined as near complete/complete revascularization (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) after single device pass. RESULTS We included 401 patients (BGC+SR alone, 273 (66.6%) patients). Patients treated with BGC+SR alone were older (median age 79 (IQR 68-85) vs 73.5 (65-82) years; p=0.033) and had shorter procedural times (puncture to revascularization 24 (14-46) vs 37 (24.5-63.5) min, p<0.001) than the BGC+DAC+SR group. Both approaches had a similar FPE rate (52% in BGC+SR alone vs 46.9% in BGC+DAC+SR, p=0.337). Although the BGC+SR alone group showed higher rates for final successful reperfusion (mTICI ≥2b (86.8% vs 74.2%, p=0.002) and excellent reperfusion, mTICI ≥2 c (76.2% vs 55.5%, p<0.001)), there were no significant differences in 24 hour National Institutes of Health Stroke Scale score or rates of good functional outcome (modified Rankin Scale score of 0-2) at 3 months across these techniques. CONCLUSIONS Our data showed that addition of distal intracranial aspiration catheters to BGC+SR based thrombectomy in patients with acute anterior circulation LVO did not provide higher rates of FPE or improved clinical outcomes.
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Affiliation(s)
- Jordi Blasco
- Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Josep Puig
- IDI-Radiology, Doctor Josep Trueta University Hospital of Girona, Girona, Spain
| | - Antonio López-Rueda
- Department of Interventional Neuroradiology, Clinic University Hospital, Barcelona, Barcelona, Spain
| | - Pepus Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Catalunya, Spain
| | - Laura Llull
- Neurology Department, Hospital Clinic de Barcelona, Barcelona, Catalonia, Spain
| | - Federico Zarco
- Comprehensive Stroke Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Napoleon Macias
- Comprehensive Stroke Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Juan Macho
- Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Eva González
- Interventional Neuroradiology, Radiology, Hospital Cruces, Bilbao, Spain
| | - Ion Labayen
- Cruces University Hospital, Barakaldo, País Vasco, Spain
| | - Pedro Vega
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Eduardo Murias
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Elvira Jimenez-Gomez
- Diagnostic and Therapeutical Neuroradiology Unit, Hospital Reina Sofía, Córdoba, Spain
| | - Isabel Bravo Rey
- Neurorradiologia, Hospital universitario Reina Sofia, Córdoba, Spain
| | - Manuel Moreu
- Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Carlos Pérez-García
- Interventional Neuroradiology, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | | | - Sonia Aixut
- Neuroradiology, Hospital Universitari de Bellvitge, Barcelona, Cataluña, Spain
| | - Mikel Terceño
- Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain.,Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mariano Werner
- Department of Radiology, Hospital Clinic I Provincial de Barcelona, University Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - José Manuel Pumar
- Neuroradiology, Hospital Clinico Universitario, Santiago de Compostela, Spain
| | - Yeray Aguilar Tejedor
- Radiology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Canarias, Spain
| | - Jose Carlos Mendez
- Interventional Neuroradiology Unit, Radiology, Hospital Ramón y Cajal, Madrid, Spain
| | - Sarai Moliner
- Interventional Neuroradiology, Hospital General Universitario de Alicante, Alicante, Valenciana, Spain
| | - Raul G Nogueira
- Neurology and Interventional Neuroradiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Luis San Roman
- Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Spain
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18
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Serrano E, Zarco F, Gill AE, Hawkins CM, Macías N, Inarejos Clemente EJ, Torner F, Barber I, Corominas D, González EL, López-Rueda A, Gómez FM. Percutaneous cryoablation of chondroblastoma and osteoblastoma in pediatric patients. Insights Imaging 2021; 12:106. [PMID: 34313884 PMCID: PMC8314258 DOI: 10.1186/s13244-021-01036-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To review the safety and efficacy of percutaneous cryoablation for the treatment of chondroblastoma and osteoblastoma in the pediatric and adolescent population. MATERIALS AND METHODS A retrospective review from 2016 to 2020 was performed to evaluate clinical and imaging response to percutaneous cryoablation in 11 symptomatic patients with diagnosis of chondroblastoma and osteoblastoma treated from two pediatric hospitals with at least 12-month follow-up. Technical success (correct needle placement and potential full coverage of the tumor with the planned ablation zone) and clinical success (relief of the symptoms) were evaluated. The primary objective was to alleviate pain related to the lesion(s). Immediate and late complications were recorded. Patients were followed in clinic and with imaging studies such as MRI or CT for a minimum of 6 months. RESULTS A total of 11 patients were included (mean 14 years, age range 9-17; male n = 8). Diagnoses were osteoblastoma (n = 4) and chondroblastoma (n = 7). Locations were proximal humerus (n = 1), femur condyle (n = 1), and proximal femur (n = 1) tibia (n = 3), acetabulum (n = 3), thoracic vertebra (n = 1) and lumbar vertebra (n = 1). Cryoablation was technically successful in all patients. Clinical success (cessation of pain) was achieved in all patients. No signs of recurrence were observed on imaging follow-up in any of the patients. One of the patients developed periprocedural right L2-L3 transient radiculopathy as major immediate complication. CONCLUSIONS Percutaneous image-guided cryoablation can be considered potentially safe and effective treatment for chondroblastoma and osteoblastoma in children and adolescents.
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Affiliation(s)
- Elena Serrano
- Department of Interventional Radiology, Hospital Clínic Barcelona, Barcelona, Spain.,Department of Interventional Radiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Federico Zarco
- Department of Interventional Radiology, Hospital Clínic Barcelona, Barcelona, Spain.,Department of Interventional Radiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Anne E Gill
- Department of Interventional Radiology, Children's Healthcare of Atlanta, Egleston Hospital, Atlanta, Georgia
| | - C Matthew Hawkins
- Department of Interventional Radiology, Children's Healthcare of Atlanta, Egleston Hospital, Atlanta, Georgia
| | - Napoleón Macías
- Department of Interventional Radiology, Hospital Clínic Barcelona, Barcelona, Spain.,Department of Interventional Radiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | | | - Ferran Torner
- Pediatric Orthopaedics and Traumatology Department, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Ignasi Barber
- Department of Radiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Daniel Corominas
- Department of Interventional Radiology, Hospital Clínic Barcelona, Barcelona, Spain.,Department of Interventional Radiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Enrique Ladera González
- Department of Radiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Antonio López-Rueda
- Department of Interventional Radiology, Hospital Clínic Barcelona, Barcelona, Spain.,Department of Interventional Radiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Fernando M Gómez
- Department of Interventional Radiology, Hospital Clínic Barcelona, Barcelona, Spain. .,Department of Interventional Radiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
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19
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Zarco F, Macías N, Delgado F, Rosati S, González A, Jimenez E, Moreu M, Ortega J, Macho J, López-Rueda A. Multicenter Retrospective Registry of Anterior Communicating Artery Aneurysms with Endovascular Therapy (MACAARET): safety and efficacy study according to morphological considerations and spatial orientations. Clin Radiol 2021; 76:786.e1-786.e8. [PMID: 34274116 DOI: 10.1016/j.crad.2021.06.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/16/2021] [Indexed: 11/25/2022]
Abstract
AIM To analyse the safety and efficacy parameters of endovascular treatment of anterior communicating artery (ACoA) aneurysms, according to their morphological considerations and three-dimensional orientation in a multicentric registry. MATERIALS AND METHODS A retrospective analysis was undertaken of a prospective database of consecutive patients that underwent endovascular embolisation for ACoA aneurysm in four high-volume neuroradiology interventional departments. The study has been registered in ClinicalTrial.gov. Data were collected regarding the clinico-demographic variables of the patients, anatomical variations of the circle of Willis, morphological considerations and spatial orientation of ACoA aneurysms were recorded. Safety and efficacy variables were also recorded. Associations between anatomical variations of the circle of Willis, morphological considerations, and spatial orientation of the ACoA aneurysms and safety and efficacy variables were assessed. RESULTS Data from 122 consecutive patients were collected in the MACAARET study (mean age (±SD) was 55 (±14) and 50.8% (62/122) were male). One hundred and five patients (86.1%) presented with subarachnoid haemorrhage (SAH). ACoA aneurysms with a neck size of >4 mm had less chance of having successful endovascular treatment than those of ≤4 mm (19.8% versus 46.7%; p=0.002) and were also more likely to recanalise during follow-up (61.5% versus 19.5%; p=0.003). Moreover, ACoA aneurysms with an aspect ratio of >1.7 had more chance of having immediate therapeutic success than those with a ratio of ≤1.7 (70.7% versus 44.8%; p=0.012). There were no other associations between the anatomical variables of the ACoA aneurysms and the safety-efficacy variables. CONCLUSION ACoA aneurysms are suitable for both endovascular and microsurgical approaches, but more data are required to determine which is the best approach regarding the morphological and spatial orientation of the aneurysm and the anatomical variations of the circle of Willis.
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Affiliation(s)
- F Zarco
- Department of Radiology, Hospital Clínic, University of Barcelona, Spain
| | - N Macías
- Department of Radiology, Hospital Clínic, University of Barcelona, Spain
| | - F Delgado
- Department of Radiology, Hospital Universitario Reina Sofía de Córdoba, Spain
| | - S Rosati
- Department of Radiology, Hospital Clínico San Carlos, Madrid, Spain
| | - A González
- Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - E Jimenez
- Department of Radiology, Hospital Universitario Reina Sofía de Córdoba, Spain
| | - M Moreu
- Department of Radiology, Hospital Clínico San Carlos, Madrid, Spain
| | - J Ortega
- Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J Macho
- Department of Radiology, Hospital Clínic, University of Barcelona, Spain
| | - A López-Rueda
- Department of Radiology, Hospital Clínic, University of Barcelona, Spain.
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20
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Montejo C, Laredo C, Llull L, Martínez-Heras E, López-Rueda A, Torné R, Garrido C, Bargallo N, Llufriu S, Amaro S. Synthetic MRI in subarachnoid haemorrhage. Clin Radiol 2021; 76:785.e17-785.e23. [PMID: 34193343 DOI: 10.1016/j.crad.2021.05.021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the reliability of synthetic magnetic resonance imaging (SyMRI) for detecting complications associated with subarachnoid haemorrhage (SAH), such as ischaemic lesions, hydrocephalus, or bleeding complications. MATERIALS AND METHODS Twenty patients with SAH, who underwent a conventional brain MRI and a SyMRI on a 3 T MRI machine. Comparable conventional and synthetic T2-weighted fluid attenuated inversion recovery (FLAIR) images were acquired. The presence of ischaemic lesions, hydrocephalus, extra-axial blood collections as well as the volumes of grey matter (GMv), white matter (WMv), and cerebrospinal (CSFv) were compared. The acquisition times of both sequences was also analysed. RESULTS The concordance between the two techniques was excellent for the detection of ischaemic lesions and extra-axial collections (kappa = 0.80 and 0.88 respectively) and good for the detection of hydrocephalus (kappa = 0.69). No significant differences were detected in the number of ischaemic lesions (p=0.31) or in the Evans index (p=0.11). The WMv and CSFv measures were also similar (p=0.18 and p=0.94, respectively), as well as the volume of ischaemic lesions (p=0.79). Compared to conventional MRI, the SyMRI acquisition time was shorter regardless of the number of sections (32% and 6% time reduction for 4 or 3 mm section thickness, respectively). CONCLUSIONS SyMRI allows the detection of potential complications of SAH in a similar way to conventional MRI with a shorter acquisition time.
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Affiliation(s)
- C Montejo
- Center for Neuroimmunology and Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - C Laredo
- Comprehensive Stroke Center, Department of Neurology, Neuroscience Institute, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - L Llull
- Comprehensive Stroke Center, Department of Neurology, Neuroscience Institute, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - E Martínez-Heras
- Center for Neuroimmunology and Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - A López-Rueda
- Radiology Department, Hospital Clinic, Barcelona, Spain
| | - R Torné
- Neurosurgery Department, Neuroscience Institute, Hospital Clinic, Barcelona, Spain
| | - C Garrido
- Radiology Department, Hospital Clinic, Barcelona, Spain; Magnetic Resonance Core Facility August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - N Bargallo
- Radiology Department, Hospital Clinic, Barcelona, Spain; Magnetic Resonance Core Facility August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - S Llufriu
- Center for Neuroimmunology and Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | - S Amaro
- Comprehensive Stroke Center, Department of Neurology, Neuroscience Institute, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
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21
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Serrano E, López-Rueda A, Moreno J, Rodríguez A, Llull L, Zwanzger C, Oleaga L, Amaro S. The new Hematoma Maturity Score is highly associated with poor clinical outcome in spontaneous intracerebral hemorrhage. Eur Radiol 2021; 32:290-299. [PMID: 34148109 DOI: 10.1007/s00330-021-08085-4] [Citation(s) in RCA: 4] [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: 01/10/2021] [Revised: 04/06/2021] [Accepted: 05/20/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The purpose of this study was to analyze the new combined indicators on noncontrast computed tomography (NCCT) to predict functional outcome at discharge, compared to previously individual radiological NCCT signs. METHODS Patients with spontaneous intracerebral hemorrhage (ICH) who underwent baseline CT scan were retrospectively analyzed. Black hole (BH) sign, blend sign (BS), island sign (IS), swirl sign (SwS), Barras classification, any hypodensity, any irregularity, and two combined novel indicators-Combined Barras Total Score (CBTS) and Hematoma Maturity Score-were assessed independently by two radiologists blinded to clinical information. Patients were trichotomized depending on the disability or dependency at discharge according to the Modified Rankin Scale (mRS): no symptoms or no significant/mild disability (mRS 0-2); moderate or severe disability (mRS 3-5); and mortality (mRS 6). RESULTS One hundred fourteen patients with spontaneous ICH confirmed by NCCT were included in the analysis. Multivariable statistical analysis was adjusted for anticoagulation, hematoma volume, ventricular expansion, hypertension, blood glucose level at admission, age, and history of atrial fibrillation and demonstrated that any hypodensity (OR 4.768, p 0.006), any irregularity (OR 4.768, p 0.006), CBTS ≥ 4 (OR 3.205, p 0.025), and the new Hematoma Maturity Score (Immature) (OR 5.872, p 0.006) are independent predictors of functional outcome at discharge. CONCLUSIONS The new concept of the Hematoma Maturity Score was the radiological sign on NCCT with the highest impact on clinical outcome in comparison with the rest of the evaluated radiological signs. KEY POINTS • This is the first manuscript where density and shape characteristics of the ICH had been evaluated together and integrated in a new Hematoma Maturity Score. • The new Hematoma Maturity Score is the radiological sign on NCCT with the highest impact on clinical outcome at discharge.
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Affiliation(s)
- Elena Serrano
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Javier Moreno
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Laura Llull
- Department of Neurology, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Laura Oleaga
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Sergi Amaro
- Department of Neurology, Hospital Clínic Barcelona, Barcelona, Spain
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22
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Blasco J, Puig J, Daunis-I-Estadella P, González E, Fondevila Monso JJ, Manso X, Oteros R, Jimenez-Gomez E, Bravo Rey I, Vega P, Murias E, Jimenez JM, López-Rueda A, Renú A, Aixut S, Chirife Chaparro O, Rosati S, Moreu M, Remollo S, Aguilar Tejedor Y, Terceño M, Mosqueira A, Nogueira RG, San Roman L. Balloon guide catheter improvements in thrombectomy outcomes persist despite advances in intracranial aspiration technology. J Neurointerv Surg 2021; 13:773-778. [PMID: 33632881 DOI: 10.1136/neurintsurg-2020-017027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/27/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND First-pass effect (FPE) has been established as a key metric for technical success and strongly correlates with better clinical outcomes. Most data supporting improved outcomes with the use of a balloon guide catheter (BGC) predate the advent of last-generation large-bore intracranial aspiration catheters. We aim to evaluate the impact of BGC in FPE and clinical outcomes in a large cohort of patients treated with contemporary technology. METHODS Patients were recruited from the prospectively ongoing ROSSETTI registry. This registry includes all consecutive patients with anterior circulation large-vessel occlusion (LVO) from 10 comprehensive stroke centers in Spain. Demographic, clinical, angiographic, and clinical outcome data were compared between BGC and non-BGC groups. FPE was defined as the achievement of mTICI2c-3 after a single device pass. RESULTS 426 patients were included out of which 271 (63.62%) used BCG. BGC-treated patients had higher FPE rate (45.8% vs 27.7%; P<0.001), higher final mTICI ≥2 c recanalization rate (76.8% vs 50.3%, respectively; P<0.001), shorter procedural time [median (IQR), 30 (19-58) vs 43 (33-71) min; P<0.001], higher NIHSS difference from admission to 24 hours [median (IQR), 8 (2-12) vs 3 (0-10); P=0.001], and lower mortality rate (17.6% vs 29.8%, P=0.026) compared with non-BGC patients. BGC use was an independent predictor of FPE (OR 2.197, 95% CI 1.436 to 3.361; P<0.001), and excellent clinical outcome at 3 months (OR 0.34, 95% CI 0.17 to 0.68; P=0.002). CONCLUSIONS Our results support the benefit of BGC use on angiographic and clinical outcomes in anterior circulation LVO ischemic stroke remain significant even when considering recent improvements in intracranial aspiration technology.
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Affiliation(s)
- Jordi Blasco
- Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Josep Puig
- IDI-Radiology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Catalunya, Spain
| | - Pepus Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Catalunya, Spain
| | - Eva González
- Interventional Neuroradiology, Radiology, Cruces University Hospital, Barakaldo, País Vasco, Spain
| | | | - Xabier Manso
- Interventional Neuroradiology, Radiology, Hospital Universitario Cruces, Bilbao, País Vasco, Spain
| | - Rafael Oteros
- Diagnostic and Therapeutical Neuroradiology Unit, Reina Sofia University Hospital, Cordoba, Andalucía, Spain
| | - Elvira Jimenez-Gomez
- Diagnostic and Therapeutical Neuroradiology Unit, Reina Sofia University Hospital, Cordoba, Andalucía, Spain
| | - Isabel Bravo Rey
- Neurorradiologia, Reina Sofia University Hospital, Cordoba, Andalucía, Spain
| | - Pedro Vega
- Radiology, HUCA, Oviedo, Asturias, Spain
| | | | | | - Antonio López-Rueda
- Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Arturo Renú
- Comprehensive Stroke Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Sonia Aixut
- Neuroradiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Oscar Chirife Chaparro
- Interventional Neuroradiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Santiago Rosati
- Department of Radiology, Clinical San Carlos Hospital, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Manuel Moreu
- Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Sebastian Remollo
- Interventional Neuroradiology Unit, University Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Yeray Aguilar Tejedor
- Radiology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Canarias, Spain
| | - Mikel Terceño
- Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain.,Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Antonio Mosqueira
- Neuroradiology Department, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Raul G Nogueira
- Neurology and Interventional Neuroradiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Luis San Roman
- Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
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23
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Rudilosso S, Olivera M, Esteller D, Laredo C, Amaro S, Llull L, Renú A, Obach V, Vera V, Rodríguez A, Blasco J, López-Rueda A, Urra X, Chamorro Á. Susceptibility Vessel Sign in Deep Perforating Arteries in Patients with Recent Small Subcortical Infarcts. J Stroke Cerebrovasc Dis 2020; 30:105415. [PMID: 33142246 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105415] [Citation(s) in RCA: 4] [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: 09/09/2020] [Revised: 10/05/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Recent small subcortical infarcts (RSSI) are considered an acute manifestation of cerebral small vessel disease. Paramagnetic signals in perforating arteries supplying RSSI may be detected on T2*-relaxation derived sequences on MRI and is defined as susceptibility vessel sign (SVS). We aimed to study the prevalence of SVS in patients with RSSI, and explore whether its identification is related to cerebral small vessel disease markers. MATERIALS AND METHODS We selected patients with RSSI identified on MRI during admission from a single-center stroke registry. The main demographic and clinical features, including vascular risk factors, were collected. Radiological features of RSSI and cerebral small vessel disease [white matter hyperintensities in deep and periventricular regions, enlarged perivascular spaces, lacunae, microbleeds, and brain atrophy] were described using validated qualitative scores. The presence of SVS was assessed on T2*gradient-echo or other susceptibility-weighted imaging. We compared the clinical and radiological features of patients with or without SVS in uni- and multivariate models. RESULTS Out of 210 patients with an RSSI on an MRI, 35 (17%) showed SVS. The proportion of SVS+ patients was similar in different susceptibility imaging modalities (p=.64). Risk factor profiles and clinical course were similar in SVS+ and SVS- patients. SVS+ patients had a higher grade of deep white matter hyperintensities and brain atrophy, more lacunae (p=.001, p=.034, p=.022, respectively), and a similar degree of the rest of radiological variables, compared to SVS- patients. In the multivariate analysis, the grade of deep white matter hyperintensities was the only independent factor associated with SVS [OR 3.1 (95% CI, 1.5-6.4)]. CONCLUSIONS SVS in patients with RSSI is uncommon and related to a higher grade of deep white matter hyperintensities. Pathophysiological mechanisms underlying the deposition of hemosiderin in the path of occluded perforating arteries are uncertain and might include endothelial dysfunction or embolic mechanisms.
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Affiliation(s)
- Salvatore Rudilosso
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | - Marta Olivera
- Department of Neurology, Hospital Clínic of Barcelona, Spain
| | - Diana Esteller
- Department of Neurology, Hospital Clínic of Barcelona, Spain
| | - Carlos Laredo
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Sergio Amaro
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Laura Llull
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Arturo Renú
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Víctor Obach
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Víctor Vera
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Alejandro Rodríguez
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Jordi Blasco
- Department of Radiology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Antonio López-Rueda
- Department of Radiology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Xabier Urra
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | - Ángel Chamorro
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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24
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Llull L, Mayà G, Torné R, Mellado-Artigas R, Renú A, López-Rueda A, Laredo C, Culebras D, Ferrando C, Blasco J, Amaro S, Chamorro Á. Stroke units could be a valid alternative to intensive care units for patients with low-grade aneurysmal subarachnoid haemorrhage. Eur J Neurol 2020; 28:500-508. [PMID: 32961609 DOI: 10.1111/ene.14548] [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: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE According to current guidelines, patients with aneurysmal subarachnoid haemorrhage (aSAH) are mostly managed in intensive care units (ICUs) regardless of baseline severity. We aimed to assess the prognostic and economic implications of initial admission of patients with low-grade aSAH into a stroke unit (SU) compared to initial ICU admission. METHODS We reviewed prospectively registered data from consecutive aSAH patients with a World Federation of Neurosurgery Societies grade <3, admitted to our Comprehensive Stroke Centre between April 2013 and September 2018. Clinical and radiological baseline traits, in-hospital complications, length of stay (LOS) and poor outcome at 90 days (modified Rankin Scale score > 2) were compared between the ICU and SU groups in the whole population and in a propensity-score-matched cohort. RESULTS Of 131 patients, 74 (56%) were initially admitted to the ICU and 57 (44%) to the SU. In-hospital complication rates were similar in the ICU and SU groups and included rebleeding (10% vs. 7%; P = 0.757), angiographic vasospasm (61% vs. 60%; P = 0.893), delayed cerebral ischaemia (12% vs. 12%; P = 0.984), pneumonia (6% vs. 4%; P = 0.697) and death (10% vs. 5%; P = 0.512). LOS did not differ between groups (median [interquartile range] 22 [16-30] vs. 19 [14-26] days; P = 0.160). In adjusted multivariate models, the location of initial admission was not associated with long-term poor outcome either in the whole population (odds ratio [OR] 1.16, 95% confidence interval [CI] 0.32-4.19; P = 0.825) or in the matched cohort (OR 0.98, 95% CI 0.24-4.06; P = 0.974). CONCLUSIONS A dedicated SU, with care from a multidisciplinary team, might be an optimal alternative to ICU for initial admission of patients with low-risk aSAH.
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Affiliation(s)
- L Llull
- Comprehensive Stroke Centre, Hospital Clínic Barcelona, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - G Mayà
- Comprehensive Stroke Centre, Hospital Clínic Barcelona, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - R Torné
- Department of Neurosurgery, Hospital Clínic Barcelona, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - R Mellado-Artigas
- Department of Anesthesiology, Hospital Clínic Barcelona, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - A Renú
- Comprehensive Stroke Centre, Hospital Clínic Barcelona, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - A López-Rueda
- Department of Neuroradiology, Hospital Clínic Barcelona, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - C Laredo
- Comprehensive Stroke Centre, Hospital Clínic Barcelona, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - D Culebras
- Department of Neurosurgery, Hospital Clínic Barcelona, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - C Ferrando
- Department of Anesthesiology, Hospital Clínic Barcelona, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - J Blasco
- Department of Neuroradiology, Hospital Clínic Barcelona, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - S Amaro
- Comprehensive Stroke Centre, Hospital Clínic Barcelona, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Á Chamorro
- Comprehensive Stroke Centre, Hospital Clínic Barcelona, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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25
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Renú A, Blasco J, Laredo C, Llull L, Urra X, Obach V, López-Rueda A, Rudilosso S, Zarco F, González E, Guio JD, Amaro S, Chamorro A. Carotid stent occlusion after emergent stenting in acute ischemic stroke: Incidence, predictors and clinical relevance. Atherosclerosis 2020; 313:8-13. [PMID: 33002751 DOI: 10.1016/j.atherosclerosis.2020.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/02/2020] [Accepted: 09/02/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Emergent stent placement may be required during neurothrombectomy. Our aim was to investigate the incidence, predictors and clinical relevance of early extracranial carotid stent occlusion following neurothrombectomy. METHODS We retrospectively analyzed a cohort of 761 consecutive neurothrombectomies performed at our center between May 2010 and August 2018, from whom a total of 106 patients had acute internal carotid artery occlusions. Early stent occlusion was defined as complete vessel occlusion within 24 h of neurothrombectomy. Clinical outcome was evaluated at day 90 with the modified Rankin Score scale (mRS). Pretreatment, procedural and outcome variables were recorded and analyzed using logistic regression. RESULTS Carotid stenting was performed in 99 (13%) patients. Of those, 22 (22%) had early stent occlusion at follow-up. Stent occlusion was associated with a lower use of post-stenting angioplasty [adjusted OR (aOR) = 11.2, 95%CI = 2.49-50.78, p = 0.002)], increased residual intrastent stenosis (aOR = 2.1, 95%CI = 1.38-3.06, p < 0.001) and unsuccesful intracranial recanalization (modified TICI score 0-2a) (aOR = 13.5, 95%CI = 1.97-92.24, p = 0.008). Stent occlusion was associated with poor clinical outcome at day 90 (poorer mRS shift, aOR = 3.9, 95%CI = 1.3-11.3, p = 0.014; mRS>2, aOR = 6.3, 95%CI = 1.8-22.7, p = 0.005), and with an increased rate of symptomatic intracranial hemorrhage at 24 h (14% versus 1%, p = 0.033). CONCLUSIONS Early carotid stent occlusion occurred in one out of five neurothrombectomies and was associated with periprocedural factors that included increased residual intrastent stenosis, a lower use of post-stenting angioplasty and unsuccessful intracranial recanalization. Further investigation is warranted for the evaluation of strategies aimed to prevent carotid stent occlusion.
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Affiliation(s)
- Arturo Renú
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Jordi Blasco
- Radiology Department, Hospital Clinic, Barcelona, Spain
| | - Carlos Laredo
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Laura Llull
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Xabier Urra
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Victor Obach
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Salvatore Rudilosso
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Elisabet González
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - José David Guio
- Radiology Department, Hospital General Universitario, Ciudad Real, Spain
| | - Sergio Amaro
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | - Angel Chamorro
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
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Zwanzger C, López-Rueda A, Campodónico D, Rosati S, Blasco J, San Román L, Macho J. Usefulness of CT angiography for characterizing cerebral arteriovenous malformations presenting as hemorrhage: Comparison with digital subtraction angiography. Radiología (English Edition) 2020. [DOI: 10.1016/j.rxeng.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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López-Rueda A, Vargas A, Piñana C, Chirife Ó, Werner M, Aja L, Remollo S, Tomasello A. Angioplasty with a retrievable stent to treat vasospasm secondary to subarachnoid hemorrhage due to an aneurysm: a multicenter study of safety and efficacy. Radiologia (Engl Ed) 2020; 64:S0033-8338(20)30072-2. [PMID: 32622517 DOI: 10.1016/j.rx.2020.04.011] [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: 01/06/2020] [Revised: 04/02/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the safety and efficacy of angioplasty with a retrievable stent in treating vasospasm secondary to subarachnoid hemorrhage (SAH) due to an aneurysm. METHODS We retrospectively analyzed prospectively collected data from consecutive patients undergoing endovascular angioplasty with a retrievable stent to treat vasospasm related to SAH due to an aneurysm in four neurointerventional radiology departments between January 2018 and July 2019. We included patients aged>18 years with vasospasm>50% of the internal carotid artery (ICA), anterior cerebral artery (ACA), and / or middle cerebral artery (MCA) secondary to SAH due to an aneurysm treated with endovascular angioplasty with a retrievable stent. The variables used to measure safety were complications of the procedure and clinical complications. The variables used to measure radiological efficacy were improvement in the degree of stenosis after endovascular treatment and improvement or normalization of cerebral circulation time CTT). RESULTS We included 16 angioplasty procedures with retrievable stents in 13 patients, in which 33 arterial segments were treated (10 ICA, 15 MCA, and 8 ACA). We observed no complications of the procedure in any patients and no clinical complications in patients who were not intubated. All but one of the patients who had delayed CTT at the beginning of the procedure showed improvements in CTT. The mean improvement in the degree of stenosis was 18%±11.65% in the ICA, 30.67%±18.45% in the MCA, and 28.38%±15.49% in the ACA. No statistically significant associations were observed between endovascular treatment variables and the degree of improvement in stenosis. CONCLUSION Angioplasty with a retrievable stent is a safe and efficacious treatment for vasospasm secondary to SAH due to an aneurysm, improving CTT and stenosis.
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Affiliation(s)
- A López-Rueda
- Departmento de Radiología, Neurorradiología Intervencionista, Hospital Clínic, Barcelona, España.
| | - A Vargas
- Departmento de Radiología, Neurorradiología Intervencionista, Hospital Clínic, Barcelona, España
| | - C Piñana
- Departmento de Radiología, Neurorradiología Intervencionista, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Ó Chirife
- Departmento de Radiología, Neurorradiología Intervencionista, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - M Werner
- Departmento de Radiología, Neurorradiología Intervencionista, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - L Aja
- Departmento de Radiología, Neurorradiología Intervencionista, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - S Remollo
- Departmento de Radiología, Neurorradiología Intervencionista, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - A Tomasello
- Departmento de Radiología, Neurorradiología Intervencionista, Hospital Universitario Vall d'Hebron, Barcelona, España
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Laredo C, Renú A, Llull L, Tudela R, López-Rueda A, Urra X, Macías NG, Rudilosso S, Obach V, Amaro S, Chamorro Á. Elevated glucose is associated with hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke patients with severe pretreatment hypoperfusion. Sci Rep 2020; 10:10588. [PMID: 32601437 PMCID: PMC7324383 DOI: 10.1038/s41598-020-67448-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 05/04/2020] [Indexed: 11/08/2022] Open
Abstract
Several pretreatment variables such as elevated glucose and hypoperfusion severity are related to brain hemorrhage after endovascular treatment of acute stroke. We evaluated whether elevated glucose and severe hypoperfusion have synergistic effects in the promotion of parenchymal hemorrhage (PH) after mechanical thrombectomy (MT). We included 258 patients MT-treated who had a pretreatment computed tomography perfusion (CTP) and a post-treatment follow-up MRI. Severe hypoperfusion was defined as regions with cerebral blood volume (CBV) values < 2.5% of normal brain [very-low CBV (VLCBV)-regions]. Median baseline glucose levels were 119 (IQR = 105-141) mg/dL. Thirty-nine (15%) patients had pretreatment VLCBV-regions, and 42 (16%) developed a PH after MT. In adjusted models, pretreatment glucose levels interacted significantly with VLCBV on the prediction of PH (p-interaction = 0.011). In patients with VLCBV-regions, higher glucose was significantly associated with PH (adjusted-OR = 3.15; 95% CI = 1.08-9.19, p = 0.036), whereas this association was not significant in patients without VLCBV-regions. CBV values measured at pretreatment CTP in coregistered regions that developed PH or infarct at follow-up were not correlated with pretreatment glucose levels, thus suggesting the existence of alternative deleterious mechanisms other than direct glucose-driven hemodynamic impairments. Overall, these results suggest that both severe hypoperfusion and glucose levels should be considered in the evaluation of adjunctive neuroprotective strategies.
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Affiliation(s)
- Carlos Laredo
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Villarroel 170, 08036, Barcelona, Spain
| | - Arturo Renú
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Villarroel 170, 08036, Barcelona, Spain
| | - Laura Llull
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Villarroel 170, 08036, Barcelona, Spain
| | - Raúl Tudela
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Group of Biomedical Imaging of the University of Barcelona, Barcelona, Spain
| | | | - Xabier Urra
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Villarroel 170, 08036, Barcelona, Spain
| | | | - Salvatore Rudilosso
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Villarroel 170, 08036, Barcelona, Spain
| | - Víctor Obach
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Villarroel 170, 08036, Barcelona, Spain
| | - Sergio Amaro
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Villarroel 170, 08036, Barcelona, Spain.
| | - Ángel Chamorro
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Villarroel 170, 08036, Barcelona, Spain.
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Escudero-Martínez I, Ocete RF, Mancha F, Vega Á, Piñero P, López-Rueda A, Fajardo E, Algaba P, Fernández-Engo JR, Martín-Sánchez EM, Galvao-Carmona A, Zapata-Arriaza E, Lebrato L, Pardo-Galiana B, Cabezas JA, Ayuso MI, González A, Moniche F, Montaner J. Prevalence and risk factors of silent brain infarcts in patients with AF detected by 3T-MRI. J Neurol 2020; 267:2675-2682. [PMID: 32410017 DOI: 10.1007/s00415-020-09887-0] [Citation(s) in RCA: 4] [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: 03/16/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Silent brain infarcts (SBI), a finding on neuroimaging, are associated with higher risk of future stroke. Atrial Fibrillation (AF) has been previously identified as a cause of SBI. OBJECTIVES The aim of this study is to determine the prevalence of and risk factors for SBI in patients with AF and low-to-moderate embolic risk according to CHADS2 and CHA2DS2VASc score. METHODS Patients with a history of AF based on medical records who scored 0-1 in the CHADS2 score were selected from the Seville urban area using the Andalusian electronic healthcare database (DIRAYA). Demographic and clinical data were collected and a 3T brain MRI was performed on patients older than 50 years and with absence of neurological symptoms. RESULTS 66 of the initial 443 patients (14.9%) and 41 of the 349 patients with low risk according to CHA2DS2VASc score (11.7%) presented at least 1 SBI. After adjusted multivariable analysis, an older age (OR 3.84, 95% CI 1.07-13.76) and left atrial (LA) enlargement (OR 3.13, 95% CI 1.15-8.55) were associated with SBI in the whole cohort, while only LA enlargement was associated with SBI in the low-risk cohort (OR 3.19, 95% CI 1.33-7.63). CONCLUSIONS LA enlargement on echocardiogram was associated with SBI in patients with AF and low or moderate embolic risk according to CHADS2 and in the low-risk population according to CHA2DS2VASc. Although further studies are needed, a neuroimaging screening might be justified in these patients to guide medical therapies to improve stroke prevention.
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Affiliation(s)
- Irene Escudero-Martínez
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain.,Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | - Rafael F Ocete
- Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain.,Department of Radiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Fernando Mancha
- Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | - Ángela Vega
- Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | - Pilar Piñero
- Department of Radiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Elena Fajardo
- Department of Radiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Pilar Algaba
- Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | | | - Eva M Martín-Sánchez
- Information Systems Coordination Service, Andalusian Healthcare System, Seville, Spain
| | | | - Elena Zapata-Arriaza
- Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain.,Department of Radiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Lucía Lebrato
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain.,Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | - Blanca Pardo-Galiana
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain.,Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | - Juan Antonio Cabezas
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain.,Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | - María Irene Ayuso
- Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | - Alejandro González
- Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain.,Department of Radiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Francisco Moniche
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain.,Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | - Joan Montaner
- Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain. .,Department of Neurology, Hospital Universitario Virgen Macarena, Avenida Doctor Fedriani, No. 3, 41007, Seville, Spain.
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30
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García S, Torné R, Hoyos JA, Rodríguez-Hernández A, Amaro S, Llull L, López-Rueda A, Enseñat J. Quantitative versus qualitative blood amount assessment as a predictor for shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage. J Neurosurg 2020; 131:1743-1750. [PMID: 30579275 DOI: 10.3171/2018.7.jns18816] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 03/28/2018] [Accepted: 07/19/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Reliable tools are lacking to predict shunt-dependent hydrocephalus (SDHC) development after aneurysmal subarachnoid hemorrhage (aSAH). Quantitative volumetric measurement of hemorrhagic blood is a good predictor of SDHC but might be impractical in the clinical setting. Qualitative assessment performed using scales such as the modified Fisher scale (mFisher) and the original Graeb scale (oGraeb) is easier to conduct but provides limited predictive power. In between, the modified Graeb scale (mGraeb) keeps the simplicity of the qualitative scales yet adds assessment of acute hydrocephalus, which might improve SDHC-predicting capabilities. In this study the authors investigated the likely capabilities of the mGraeb and compared them with previously validated methods. This research also aimed to define a tailored mGraeb cutoff point for SDHC prediction. METHODS The authors performed retrospective analysis of patients admitted to their institution with the diagnosis of aSAH between May 2013 and April 2016. Out of 168 patients, 78 were included for analysis after the application of predefined exclusion criteria. Univariate and multivariate analyses were conducted to evaluate the use of all 4 methods (quantitative volumetric assessment and the mFisher, oGraeb, and mGraeb scales) to predict the likelihood of SDHC development based on clinical data and blood amount assessment on initial CT scans. RESULTS The mGraeb scale was demonstrated to be the most robust predictor of SDHC, with an area under the curve (AUC) of 0.848 (95% CI 0.763-0.933). According to the AUC results, the performance of the mGraeb scale was significantly better than that of the oGraeb scale (χ2 = 4.49; p = 0.034) and mFisher scale (χ2 = 7.21; p = 0.007). No statistical difference was found between the AUCs of the mGraeb and the quantitative volumetric measurement models (χ2 = 12.76; p = 0.23), but mGraeb proved to be the simplest model since it showed the lowest Akaike information criterion (66.4), the lowest Bayesian information criterion (71.2), and the highest R2Nagelkerke coefficient (39.7%). The initial mGraeb showed more than 85% specificity for predicting the development of SDHC in patients presenting with a score of 12 or more points. CONCLUSIONS According to the authors' data, the mGraeb scale is the simplest model that correlates well with SDHC development. Due to limited scientific evidence of treatments aimed at SDHC prevention, we propose an mGraeb score higher than 12 to identify patients at risk with high specificity. This mGraeb cutoff point might also serve as a useful prognostic tool since patients with SDHC after aSAH have worse functional outcomes.
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Affiliation(s)
- Sergio García
- 1Department of Neurological Surgery, Hospital Clinic de Barcelona, University of Barcelona
| | - Ramon Torné
- 1Department of Neurological Surgery, Hospital Clinic de Barcelona, University of Barcelona
| | - Jhon Alexander Hoyos
- 1Department of Neurological Surgery, Hospital Clinic de Barcelona, University of Barcelona
| | | | - Sergio Amaro
- 3Comprehensive Stroke Center, Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS); and
| | - Laura Llull
- 3Comprehensive Stroke Center, Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS); and
| | - Antonio López-Rueda
- 4Department of Radiology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Joaquim Enseñat
- 1Department of Neurological Surgery, Hospital Clinic de Barcelona, University of Barcelona
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31
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Renú A, Blasco J, Millán M, Martí-Fàbregas J, Cardona P, Oleaga L, Macho J, Molina C, Roquer J, Amaro S, Dávalos A, Zarco F, Laredo C, Tomasello A, Guimaraens L, Barranco R, Castaño C, Vivas E, Ramos A, López-Rueda A, Urra X, Muchada M, Cuadrado-Godía E, Camps-Renom P, Román LS, Ríos J, Leira EC, Jovin T, Torres F, Chamorro Á. The Chemical Optimization of Cerebral Embolectomy trial: Study protocol. Int J Stroke 2019; 16:110-116. [PMID: 31852410 DOI: 10.1177/1747493019895656] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
RATIONALE The potential value of rescue intraarterial thrombolysis in patients with large vessel occlusion stroke treated with mechanical thrombectomy has not been assessed in randomized trials. AIM The CHemical OptImization of Cerebral Embolectomy trial aims to establish whether rescue intraarterial thrombolysis is more effective than placebo in improving suboptimal reperfusion scores in patients with large vessel occlusion stroke treated with mechanical thrombectomy. SAMPLE SIZE ESTIMATES A sample size of 200 patients allocated 1:1 to intraarterial thrombolysis or intraarterial placebo will have >95% statistical power for achieving the primary outcome (5% in the control versus 60% in the treatment group) for a two-sided (5% alpha, and 5% lost to follow-up). METHODS AND DESIGN We conducted a multicenter, randomized, placebo-controlled, double blind, phase 2b trial. Eligible patients are 18 or older with symptomatic large vessel occlusion treated with mechanical thrombectomy resulting in a modified treatment in cerebral ischemia score 2b at end of the procedure. Patients will receive 20-30 min intraarterial infusion of recombinant tissue plasminogen activator or placebo (0.5 mg/ml, maximum dose limit 22.5 mg). STUDY OUTCOME(S) The primary outcome is the proportion of patients with an improved modified treatment in cerebral ischemia score 10 min after the end of the study treatment. Secondary outcomes include the shift analysis of the modified Rankin Scale, the infarct expansion ratio, the proportion of excellent outcome (modified Rankin Scale 0-1), the proportion of infarct expansion, and the infarction volume. Mortality and symptomatic intracerebral bleeding will be assessed. DISCUSSION The study will provide evidence whether rescue intraarterial thrombolysis improves brain reperfusion in patients with large vessel occlusion stroke and incomplete reperfusion (modified treatment in cerebral ischemia 2b) at the end of mechanical thrombectomy.
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Affiliation(s)
- Arturo Renú
- Comprehensive Stroke Center, Hospital Clínic of Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer (146245IDIBAPS), Barcelona, Spain.,16724University of Barcelona, Spain
| | - Jordi Blasco
- Radiology Department, Hospital Clinic, Barcelona, Spain
| | - Mónica Millán
- Department of Neuroscience, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Joan Martí-Fàbregas
- Department of Neurology, 16689Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain
| | - Pere Cardona
- Department of Neurology, Stroke Unit, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Laura Oleaga
- Radiology Department, Hospital Clinic, Barcelona, Spain
| | - Juan Macho
- Radiology Department, Hospital Clinic, Barcelona, Spain
| | - Carlos Molina
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Jaume Roquer
- Department of Neurology, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Sergio Amaro
- Comprehensive Stroke Center, Hospital Clínic of Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer (146245IDIBAPS), Barcelona, Spain.,16724University of Barcelona, Spain
| | - Antonio Dávalos
- Department of Neuroscience, Hospital Germans Trias i Pujol, Barcelona, Spain
| | | | - Carlos Laredo
- Comprehensive Stroke Center, Hospital Clínic of Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer (146245IDIBAPS), Barcelona, Spain.,16724University of Barcelona, Spain
| | - Alejandro Tomasello
- Department of Neuroradiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Roger Barranco
- Department of Neuroradiology, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Carlos Castaño
- Department of Neuroradiology, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Elío Vivas
- Department of Neuroradiology, Hospital del Mar, Barcelona, Spain
| | - Anna Ramos
- Department of Neuroscience, Hospital Germans Trias i Pujol, Barcelona, Spain
| | | | - Xabier Urra
- Comprehensive Stroke Center, Hospital Clínic of Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer (146245IDIBAPS), Barcelona, Spain.,16724University of Barcelona, Spain
| | - Marián Muchada
- Department of Neurology, Stroke Unit, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Elisa Cuadrado-Godía
- Department of Neurology, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona i DCEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Pol Camps-Renom
- Department of Neurology, 16689Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain
| | - Luis S Román
- Radiology Department, Hospital Clinic, Barcelona, Spain
| | - José Ríos
- Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (146245IDIBAPS), Barcelona, Spain.,Biostatistics Unit, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Enrique C Leira
- Departments of Neurology, Neurosurgery and Epidemiology, University of Iowa, Iowa City, USA
| | - Tudor Jovin
- Cooper Neurological Institute, Cooper Medical School of Rowan University, Camden, USA
| | - Ferran Torres
- Department of Neuroradiology, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Ángel Chamorro
- Comprehensive Stroke Center, Hospital Clínic of Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer (146245IDIBAPS), Barcelona, Spain.,16724University of Barcelona, Spain
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32
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Escudero-Martínez I, Mancha F, Vega-Salvatierra Á, Ayuso MI, Ocete RF, Algaba P, López-Rueda A, Piñero P, Fajardo E, Fernández-Engo JR, Martín-Sánchez EM, Galvao-Carmona A, Zapata-Arriaza E, Lebrato L, Pardo-Galiana B, Cabezas JA, González A, Moniche F, Montaner J. Mediterranean Diet and Physical Activity Protect from Silent Brain Infarcts in a Cohort of Patients with Atrial Fibrillation. J Stroke 2019; 21:353-355. [PMID: 31590481 PMCID: PMC6780023 DOI: 10.5853/jos.2019.01949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/04/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
- Irene Escudero-Martínez
- Department of Neurology, University Hospital Virgen del Rocío, Sevilla, Spain.,Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBIS, Sevilla, Spain
| | - Fernando Mancha
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBIS, Sevilla, Spain
| | | | - María Irene Ayuso
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBIS, Sevilla, Spain
| | - Rafael F Ocete
- Department of Radiology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Pilar Algaba
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBIS, Sevilla, Spain
| | | | - Pilar Piñero
- Department of Radiology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Elena Fajardo
- Department of Radiology, University Hospital Virgen del Rocío, Sevilla, Spain
| | | | - Eva María Martín-Sánchez
- Information Systems Coordination Service, Support Services of the Andalusian Health Service, Seville, Spain
| | | | - Elena Zapata-Arriaza
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBIS, Sevilla, Spain.,Department of Radiology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Lucía Lebrato
- Department of Neurology, University Hospital Virgen del Rocío, Sevilla, Spain
| | | | | | - Alejandro González
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBIS, Sevilla, Spain.,Department of Radiology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Francisco Moniche
- Department of Neurology, University Hospital Virgen del Rocío, Sevilla, Spain.,Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBIS, Sevilla, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBIS, Sevilla, Spain.,Department of Neurology, University Hospital Virgen Macarena, Sevilla, Spain
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Werner M, López-Rueda A, Zarco F, Blasco J, San Román L, Amaro S, Carrero E, Valero R, Oleaga L, Macho J, Bargalló N. Value of Posterior circulation ASPECTS and Pons-Midbrain Index on non-contrast CT and CT Angiography Source Images in patients with basilar artery occlusion recanalized after mechanical thrombectomy. Radiología (English Edition) 2019. [DOI: 10.1016/j.rxeng.2018.06.001] [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: 11/24/2022]
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Riba-Llena I, Jiménez-Balado J, Castañé X, Girona A, López-Rueda A, Mundet X, Jarca CI, Álvarez-Sabin J, Montaner J, Delgado P. Arterial Stiffness Is Associated With Basal Ganglia Enlarged Perivascular Spaces and Cerebral Small Vessel Disease Load. Stroke 2018; 49:1279-1281. [DOI: 10.1161/strokeaha.118.020163] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/07/2018] [Accepted: 03/12/2018] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
We assessed whether the load of cerebral small vessel disease (cSVD) and its individual markers, including lacunes, white matter hyperintensities, microbleeds, and enlarged perivascular spaces (EPVS), are associated with arterial stiffness.
Methods—
We evaluated cSVD markers in a cohort of 782 hypertensive individuals without history of stroke or dementia. The load of the disease was calculated using an ordinal scale ranging from 0 to 4 (1 point was given for each of the 4 markers examined). The arterial stiffness was tested by measuring the carotid–femoral pulse wave velocity with an oscillometric automatic device.
Results—
The mean age of the participants (49.6% women) was 62.7±5.4 years, and the mean systolic/diastolic blood pressure was 142.9/77.3 mm Hg (55.5% of the participants had poor blood pressure control). We found 7.2% cases with lacunes, 6.4% with microbleeds, 6.7% with extensive white matter hyperintensities, 24.5% with extensive basal ganglia EPVS, and 40.1% with extensive EPVS in the centrum semiovale. Regarding the cSVD load, 19.7% of the participants scored 1, 6.5% scored 2, and 1.4% scored ≥3. The median carotid–femoral pulse wave velocity was 10.5 m/s (interquartile range, 9.2–11.9) and was associated with lacunes (odds ratio per carotid–femoral pulse wave velocity SD increase, 1.51; 95% confidence interval, 1.13–2.03), extensive basal ganglia EPVS (odds ratio, 1.39; 95% confidence interval, 1.16–1.67), and cSVD load (common odds ratio, 1.42; 95% confidence interval, 1.19–1.68).
Conclusions—
We found that, in a cohort of hypertensive individuals, the arterial stiffness is associated with the total load of the cSVD, especially with lacunes and basal ganglia EPVS.
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Affiliation(s)
- Iolanda Riba-Llena
- From the Neurovascular Laboratory, Vall Hebron’s Research Institute, Barcelona, Spain (I.R.-L., J.J.-B., X.C., A.L.-R., J.M., P.D.)
- Neurology Service, Vall Hebron’s University Hospital, Barcelona, Spain (I.R.-L., J.Á.-S.)
- Universitat Autónoma de Barcelona, Bellaterra, Spain (I.R.-L., J.J.-B., X.C., A.L.-R., X.M., J.Á.-S., J.M., P.D.)
| | - Joan Jiménez-Balado
- From the Neurovascular Laboratory, Vall Hebron’s Research Institute, Barcelona, Spain (I.R.-L., J.J.-B., X.C., A.L.-R., J.M., P.D.)
- Universitat Autónoma de Barcelona, Bellaterra, Spain (I.R.-L., J.J.-B., X.C., A.L.-R., X.M., J.Á.-S., J.M., P.D.)
| | - Xavier Castañé
- From the Neurovascular Laboratory, Vall Hebron’s Research Institute, Barcelona, Spain (I.R.-L., J.J.-B., X.C., A.L.-R., J.M., P.D.)
- Universitat Autónoma de Barcelona, Bellaterra, Spain (I.R.-L., J.J.-B., X.C., A.L.-R., X.M., J.Á.-S., J.M., P.D.)
| | - Anna Girona
- Emergency Department, SCIAS-Hospital de Barcelona, Spain (A.G.)
| | - Antonio López-Rueda
- From the Neurovascular Laboratory, Vall Hebron’s Research Institute, Barcelona, Spain (I.R.-L., J.J.-B., X.C., A.L.-R., J.M., P.D.)
- Universitat Autónoma de Barcelona, Bellaterra, Spain (I.R.-L., J.J.-B., X.C., A.L.-R., X.M., J.Á.-S., J.M., P.D.)
| | - Xavier Mundet
- Barcelona City Research Support Unit, University Research Institute, IDIAP Jordi Gol, Spain (X.M.)
- Universitat Autónoma de Barcelona, Bellaterra, Spain (I.R.-L., J.J.-B., X.C., A.L.-R., X.M., J.Á.-S., J.M., P.D.)
| | - Carmen I. Jarca
- Primary Care Center Granollers, Institut Català de la Salut, Spain (C.I.J.)
| | - José Álvarez-Sabin
- Neurology Service, Vall Hebron’s University Hospital, Barcelona, Spain (I.R.-L., J.Á.-S.)
- Universitat Autónoma de Barcelona, Bellaterra, Spain (I.R.-L., J.J.-B., X.C., A.L.-R., X.M., J.Á.-S., J.M., P.D.)
| | - Joan Montaner
- From the Neurovascular Laboratory, Vall Hebron’s Research Institute, Barcelona, Spain (I.R.-L., J.J.-B., X.C., A.L.-R., J.M., P.D.)
- Universitat Autónoma de Barcelona, Bellaterra, Spain (I.R.-L., J.J.-B., X.C., A.L.-R., X.M., J.Á.-S., J.M., P.D.)
| | - Pilar Delgado
- From the Neurovascular Laboratory, Vall Hebron’s Research Institute, Barcelona, Spain (I.R.-L., J.J.-B., X.C., A.L.-R., J.M., P.D.)
- Universitat Autónoma de Barcelona, Bellaterra, Spain (I.R.-L., J.J.-B., X.C., A.L.-R., X.M., J.Á.-S., J.M., P.D.)
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Falgàs N, Borrego S, Llull L, Espinosa G, López-Rueda A, Blasco J, Cervera A. Recurrent dural arteriovenous fistulas in a patient with Behçet's disease. Neurología (English Edition) 2017. [DOI: 10.1016/j.nrleng.2015.11.015] [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: 10/18/2022] Open
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Cappucci M, Zarco F, Orgera G, López-Rueda A, Moreno J, Laurino F, Barnes D, Tipaldi MA, Gomez F, Macho Fernandez J, Rossi M. Endovascular treatment of visceral artery aneurysms and pseudoaneurysms with stent-graft: Analysis of immediate and long-term results. Cir Esp 2017; 95:283-292. [PMID: 28583724 DOI: 10.1016/j.ciresp.2017.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 12/20/2016] [Revised: 02/14/2017] [Accepted: 04/28/2017] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The aim of this study is to analyze the safety and efficacy of stent-graft endovascular treatment for visceral artery aneurysms and pseudoaneurysms. METHODS Multicentric retrospective series of patients with visceral aneurysms and pseudoaneurysms treated by means of stent graft. The following variables were analyzed: Age, sex, type of lesion (aneurysms/pseudoaneurysms), localization, rate of success, intraprocedural and long term complication rate (SIR classification). Follow-up was performed under clinical and radiological assessment. RESULTS Twenty-five patients (16 men), with a mean age of 59 (range 27-79), were treated. The indication was aneurysm in 19 patients and pseudoaneurysms in 6. The localizations were: splenic artery (12), hepatic artery (5), renal artery (4), celiac trunk (3) and gastroduodenal artery (1). Successful treatment rate was 96% (24/25 patients). Intraprocedural complication rate was 12% (4% major; 8% minor). Complete occlusion was demonstrated during follow up (mean 33 months, range 6-72) in the 24 patients with technical success. Two stent migrations (2/24; 8%) and 4stent thrombosis (4/24; 16%) were detected. Mortality rate was 0%. CONCLUSION In our study, stent-graft endovascular treatment of visceral aneurysmns and pseudoaneurysms has demonstrated to be safe and is effective in the long-term in both elective and emergent cases, with a high rate of successful treatment and a low complication rate.
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Affiliation(s)
- Matteo Cappucci
- Unidad de Intervencionismo, Servicio de Diagnóstico por Imagen, Policlínico Universitario S. Andrea Sapienza, Roma, Italia
| | - Federico Zarco
- Sección de Intervencionismo Vascular, Centro de Diagnóstico por Imagen, Hospital Universitario Clinic i Provincial de Barcelona, Barcelona, España
| | - Gianluigi Orgera
- Unidad de Intervencionismo, Servicio de Diagnóstico por Imagen, Policlínico Universitario S. Andrea Sapienza, Roma, Italia
| | - Antonio López-Rueda
- Sección de Intervencionismo Vascular, Centro de Diagnóstico por Imagen, Hospital Universitario Clinic i Provincial de Barcelona, Barcelona, España
| | - Javier Moreno
- Sección de Diagnóstico Vascular, Centro de Diagnóstico por Imagen, Hospital Universitario Clinic i Provincial de Barcelona, Barcelona, España
| | - Florindo Laurino
- Unidad de Diagnóstico de Patología Vascular, Servicio de Diagnóstico por Imagen, Policlínico Universitario S. Andrea Sapienza, Roma, Italia
| | - Daniel Barnes
- Sección de Intervencionismo Vascular, Centro de Diagnóstico por Imagen, Hospital Universitario Clinic i Provincial de Barcelona, Barcelona, España
| | - Marcello Andrea Tipaldi
- Unidad de Diagnóstico de Patología Vascular, Servicio de Diagnóstico por Imagen, Policlínico Universitario S. Andrea Sapienza, Roma, Italia
| | - Fernando Gomez
- Sección de Intervencionismo Vascular, Centro de Diagnóstico por Imagen, Hospital Universitario Clinic i Provincial de Barcelona, Barcelona, España.
| | - Juan Macho Fernandez
- Sección de Intervencionismo Vascular, Centro de Diagnóstico por Imagen, Hospital Universitario Clinic i Provincial de Barcelona, Barcelona, España
| | - Michele Rossi
- Unidad de Intervencionismo, Servicio de Diagnóstico por Imagen, Policlínico Universitario S. Andrea Sapienza, Roma, Italia
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Cappucci M, Zarco F, Orgera G, López-Rueda A, Moreno J, Laurino F, Barnes D, Tipaldi MA, Gomez F, Macho Fernandez J, Rossi M. Endovascular Treatment of Visceral Artery Aneurysms and Pseudoaneurysms With Stent-Graft: Analysis of Immediate and Long-Term Results. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.cireng.2017.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abilleira S, Ribera A, Cardona P, Rubiera M, López-Cancio E, Amaro S, Rodríguez-Campello A, Camps-Renom P, Cánovas D, de Miquel MA, Tomasello A, Remollo S, López-Rueda A, Vivas E, Perendreu J, Gallofré M, Martí-Fàbregas J, Delgado-Mederos R, Martínez-Domeño A, Marín R, Roquer J, Ois Á, Jiménez-Conde J, Guimaraens L, Chamorro Á, Obach V, Urra X, Macho J, Blasco J, San Roman L, Martínez-Yélamos A, Quesada H, Lara B, Cayuela N, Aja L, Mora P, Molina C, Ribó M, Pagola J, Rodríguez-Luna D, Muchada M, Coscojuela P, Dávalos A, Millán M, Pérez de la Ossa N, Gomis M, Dorado L, Castaño C, Garcia M, Estela J, Krupinski J, Huertas-Folch S, Nicolás-Herrerias M, Gómez-Choco M, García S, Martínez R, Sanahuja J, Purroy F, Serena J, Castellanos M, Silva Y, Marés R, Pellisé A, Ustrell X, Baiges J, Garcés M, Saura J, Soler-Insa J, Aragonés J, Cocho D, Palomeras E. Outcomes After Direct Thrombectomy or Combined Intravenous and Endovascular Treatment Are Not Different. Stroke 2017; 48:375-378. [DOI: 10.1161/strokeaha.116.015857] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 10/24/2016] [Accepted: 11/15/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Whether intravenous thrombolysis adds a further benefit when given before endovascular thrombectomy (EVT) is unknown. Furthermore, intravenous thrombolysis delays time to groin puncture, mainly among drip and ship patients.
Methods—
Using region-wide registry data, we selected cases that received direct EVT or combined intravenous thrombolysis+EVT for anterior circulation strokes between January 2011 and October 2015. Treatment effect was estimated by stratification on a propensity score. The average odds ratios for the association of treatment with good outcome and death at 3 months and symptomatic bleedings at 24 hours were calculated with the Mantel–Haenszel test statistic.
Results—
We included 599 direct EVT patients and 567 patients with combined treatment. Stratification through propensity score achieved balance of baseline characteristics across treatment groups. There was no association between treatment modality and good outcome (odds ratio, 0.97; 95% confidence interval, 0.74–1.27), death (odds ratio, 1.07; 95% confidence interval, 0.74–1.54), or symptomatic bleedings (odds ratio, 0.56; 95% confidence interval, 0.25–1.27).
Conclusions—
This observational study suggests that outcomes after direct EVT or combined intravenous thrombolysis+EVT are not different. If confirmed by a randomized controlled trial, it may have a significant impact on organization of stroke systems of care.
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Affiliation(s)
- Sònia Abilleira
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Aida Ribera
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Pedro Cardona
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Marta Rubiera
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Elena López-Cancio
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Sergi Amaro
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Ana Rodríguez-Campello
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Pol Camps-Renom
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - David Cánovas
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Maria Angels de Miquel
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Alejandro Tomasello
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Sebastian Remollo
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Antonio López-Rueda
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Elio Vivas
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Joan Perendreu
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Miquel Gallofré
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
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Delgado F, Bravo I, Jiménez E, Murías E, Saiz A, Vega P, López-Rueda A, Blasco J, Macho J, González A. Endovascular treatment in the acute and non-acute phases of carotid dissection: a therapeutic approach. J Neurointerv Surg 2016; 9:11-16. [DOI: 10.1136/neurintsurg-2016-012475] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/17/2016] [Accepted: 06/27/2016] [Indexed: 12/27/2022]
Abstract
BackgroundCarotid dissection (CD) may, in certain cases, lead to significant stenosis, occlusion, or pseudoaneurysm formation, causing embolic stroke or hemodynamic failure, despite medical therapy.ObjectiveTo evaluate the results of endovascular treatment and clinical outcomes of patients with CD.MethodsA four-hospital retrospective study of endovascular treatment of extracranial CD in which medical treatment had failed or patients presented with a National Institute of Health Stroke Scale (NIHSS) score ≥8.ResultsThirty-eight patients (mean age 46.6±13.5 years, 78.9% male, 84.2% spontaneous CD, 44.7% left CD and 26.3% bilateral CD) were analyzed. In 24 patients (63.2%) treatment was undertaken in the acute-phase CD (APCD). IV recombinant tissue plasminogen activator was administered in 7 (29.2%) APCD cases. The patients with APCD exhibited a high rate of successful revascularization (Thrombolysis In Cerebral Infarction ≥2b; 19 patients (79.2%)), a low risk of symptomatic intracranial hemorrhage (n=2 (8.3%)), and good global functional outcomes (modified Rankin Scale (mRS) ≤2; n=17 (70.8%)). Good recanalization correlated (p=0.001) with good clinical evolution (mRS ≤2) in the patients with APCD. Of the 14 patients with non-acute phase CD (NAPCD), seven were treated for pseudoaneurysm with multiple stents (six patients) or covered prostheses, with stenosis being treated in the remaining seven patients.ConclusionsEndovascular treatment of selected cases of patients with CD associated with thromboembolic events and hemodynamic failure after unsuccessful medical therapy is a safe and effective method of restoring vessel lumen integrity, with good short-term clinical evolution.
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Vilar-Bergua A, Riba-Llena I, Ramos N, Mundet X, Espinel E, López-Rueda A, Ostos E, Seron D, Montaner J, Delgado P. Microalbuminuria and the Combination of MRI Markers of Cerebral Small Vessel Disease. Cerebrovasc Dis 2016; 42:66-72. [DOI: 10.1159/000445168] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/01/2016] [Indexed: 11/19/2022] Open
Abstract
Background: Kidney function has been related to the presence of individual markers of cerebral small vessel disease (CSVD), as lacunes, white matter hyperintensities (WMH) or microbleeds. We aimed at studying the relationship of kidney dysfunction with the combination of several markers of CSVD. Methods: Subjects are those included in the ISSYS cohort (Investigating Silent Strokes in hypertensives: a magnetic resonance imaging study). A scale ranging from 0 to 4 points was applied based on the presence (one point each) of lacunes, deep microbleeds, moderate to extensive basal ganglia enlarged perivascular spaces (EPVS), and periventricular or deep WMH. We determined the creatinine-based glomerular filtration rate and the urinary albumin-to-creatinine ratio (UACR) as markers of kidney function and studied their association with the scale of CSVD in univariate and ordinal logistic regression analyses. Results: Among the 975 patients included, 28.2% presented one or more CSVD markers, being the most prevalent marker (either alone or in combination) basal ganglia EPVS. The UACR was elevated at increasing the scores of the CSVD scale and remained as independent predictor of the combination of markers (common OR per natural log unit increase in UACR: 1.23, 1.07-1.41) after controlling per age, gender, cardiovascular risk, antihypertensive treatment and hypertension duration. In contrast, no associations were found between the CSVD scores and the creatinine-based estimated glomerular filtration rate. Conclusions: A significant proportion of stroke-free hypertensives present at least one imaging marker of CSVD. UACR but not creatinine-based glomerular filtration rate is associated with the combination of markers of CSVD.
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Riba-Llena I, Nafría C, Mundet X, López-Rueda A, Fernández-Cortiñas I, Jarca CI, Jiménez-Balado J, Domingo M, Tovar JL, Orfila F, Pujadas F, Álvarez-Sabín J, Maisterra O, Montaner J, Delgado P. Assessment of enlarged perivascular spaces and their relation to target organ damage and mild cognitive impairment in patients with hypertension. Eur J Neurol 2016; 23:1044-50. [PMID: 26968973 DOI: 10.1111/ene.12979] [Citation(s) in RCA: 14] [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: 07/31/2015] [Accepted: 01/18/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Enlarged perivascular spaces (EPVS) have been recently considered a feature of cerebral small vessel disease. They have been related to aging, hypertension and dementia but their relationship with hypertension related variables (i.e. target organ damage, treatment compliance) and mild cognitive impairment (MCI) is not fully elucidated. Our aims were to investigate the relation between basal ganglia (BG) and centrum semiovale (CSO) EPVS with vascular risk factors, hypertension related variables and MCI. METHODS In all, 733 hypertensive individuals free of stroke and dementia from the Investigating Silent Strokes in Hypertensives, a magnetic resonance imaging Study (ISSYS) underwent brain magnetic resonance imaging and cognitive testing to diagnose MCI or normal cognitive aging. RESULTS The numbers of participants presenting high grade (>10) EPVS at the BG and CSO were 23.3% and 40.0%, respectively. After controlling for vascular risk factors, high grade BG EPVS were associated with age (odds ratio 1.68; 95% confidence interval 1.37, 2.06), poor antihypertensive compliance (1.49; 1.03, 2.14) and the presence of microalbuminuria (1.95; 1.16, 3.28), whereas in the CSO only age (1.38; 1.18, 1.63) and male sex were associated with EPVS (1.73; 1. 24, 2.42). MCI was diagnosed in 9.3% of the participants and it was predicted by EPVS in the BG (1.87; 1.03, 3.39) but not in the CSO. This last association was greatly attenuated after correction for lacunes and white matter hyperintensities. CONCLUSIONS Basal ganglia EPVS are associated with the presence of microalbuminuria and poor adherence to antihypertensive drugs. The BG EPVS relation with MCI is not independent of the presence of other cerebral small vessel disease markers.
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Affiliation(s)
- I Riba-Llena
- Neurovascular Research Laboratory, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Nafría
- Neurovascular Research Laboratory, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - X Mundet
- Barcelona City Research Support Unit - IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A López-Rueda
- Neurovascular Research Laboratory, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - I Fernández-Cortiñas
- Neurovascular Research Laboratory, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C I Jarca
- Barcelona City Research Support Unit - IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Jiménez-Balado
- Neurovascular Research Laboratory, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Domingo
- Barcelona City Research Support Unit - IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J L Tovar
- Nephrology Service, Vall Hebron University Hospital, Barcelona, Spain
| | - F Orfila
- Barcelona City Research Support Unit - IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F Pujadas
- Dementia Unit, Neurology Department, Vall Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Álvarez-Sabín
- Stroke Unit, Neurology Department, Vall Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - O Maisterra
- Stroke Unit, Neurology Department, Vall Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Montaner
- Neurovascular Research Laboratory, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Stroke Unit, Neurology Department, Vall Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Delgado
- Neurovascular Research Laboratory, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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Montañola A, de Retana SF, López-Rueda A, Merino-Zamorano C, Penalba A, Fernández-Álvarez P, Rodríguez-Luna D, Malagelada A, Pujadas F, Montaner J, Hernández-Guillamon M. ApoA1, ApoJ and ApoE Plasma Levels and Genotype Frequencies in Cerebral Amyloid Angiopathy. Neuromolecular Med 2015; 18:99-108. [PMID: 26661731 DOI: 10.1007/s12017-015-8381-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 08/14/2015] [Accepted: 11/17/2015] [Indexed: 01/26/2023]
Abstract
The involvement of apolipoproteins, such as the ApoE4 isoform, in Alzheimer's disease (AD) and cerebral amyloid angiopathy (CAA) highlights the fact that certain lipid carriers may participate in soluble β-amyloid (Aβ) transport. Our general aim was to characterize the soluble levels of the apolipoproteins apoE, apoA1 and apoJ/clusterin and their genotype status in patients with CAA. We analyzed the genotypes frequency of APOA1 (rs5069, rs670), CLU (rs11136000, rs1532278, rs7012010, rs9331888) and APOE (rs429358, rs7412) in a cohort of patients with CAA-associated intracerebral hemorrhage (ICH) (n = 59) and compared the results with those from hypertension-associated ICH (n = 42), AD patients (n = 73) and controls (n = 88). In a subgroup of patients, we also determined the plasma concentrations of apoE, apoA1 and apoJ/clusterin. We found increased plasma apoJ/clusterin levels in CAA patients compared to AD patients or controls after adjusting for sex and age (CAA vs. controls, p = 0.033; CAA vs. AD, p = 0.013). ApoA1 levels were not altered between groups, although a strong correlation was observed between plasma Aβ(1-40) and apoA1 among CAA patients (r = 0.583, p = 0.007). Regarding plasma apoE concentration, a robust association between circulating levels and genotype status was confirmed (p < 0.001). Whereas the APOE4 frequency was higher in AD (p < 0.001) and CAA (p = 0.013), the APOA1 and CLU genotypes were not different among groups. In the CAA cohort, the risk-linked CLU variant (C) rs11136000 was associated with white matter hyperintensities (p = 0.045) and the presence of lobar microbleeds (p = 0.023) on MRI. In summary, our findings suggest that apoA1 may act as a physiological transporter of Aβ(1-40) and that apoJ/clusterin appears to be a chaperone related to distinctive lesions in CAA brains.
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Affiliation(s)
- Alex Montañola
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Sofía Fernández de Retana
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Antonio López-Rueda
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Cristina Merino-Zamorano
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Anna Penalba
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | | | - David Rodríguez-Luna
- Neurovascular Unit, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Ana Malagelada
- Dementia Unit, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Francesc Pujadas
- Dementia Unit, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Neurovascular Unit, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Mar Hernández-Guillamon
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
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Sierra-Marcos A, Carreño M, Setoain X, López-Rueda A, Aparicio J, Donaire A, Bargalló N. Accuracy of arterial spin labeling magnetic resonance imaging (MRI) perfusion in detecting the epileptogenic zone in patients with drug-resistant neocortical epilepsy: comparison with electrophysiological data, structural MRI, SISCOM and FDG-PET. Eur J Neurol 2015; 23:160-7. [DOI: 10.1111/ene.12826] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/06/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - M. Carreño
- Institute of Neurosciences; Hospital Clinic; Barcelona Spain
| | - X. Setoain
- Image Diagnosis Center; Hospital Clinic; Barcelona Spain
- Centro de Investigación Biomédica en Red en Bioingeniería; Biomateriales y Nanomedicina (CIBER-BBN); Barcelona Spain
| | - A. López-Rueda
- Image Diagnosis Center; Hospital Clinic; Barcelona Spain
| | - J. Aparicio
- Institute of Neurosciences; Hospital Clinic; Barcelona Spain
| | - A. Donaire
- Institute of Neurosciences; Hospital Clinic; Barcelona Spain
| | - N. Bargalló
- Image Diagnosis Center; Hospital Clinic; Barcelona Spain
- Medical Image Core Facility; August Pi i Sunyer Biomedical Research Institute (IDIBAPS); Barcelona Spain
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Filomena J, Riba-Llena I, Vinyoles E, Tovar JL, Mundet X, Castañé X, Vilar A, López-Rueda A, Jiménez-Baladó J, Cartanyà A, Montaner J, Delgado P. Short-Term Blood Pressure Variability Relates to the Presence of Subclinical Brain Small Vessel Disease in Primary Hypertension. Hypertension 2015; 66:634-40; discussion 445. [DOI: 10.1161/hypertensionaha.115.05440] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 06/03/2015] [Indexed: 12/20/2022]
Abstract
Blood pressure (BP) variability is associated with stroke risk, but less is known about subclinical cerebral small vessel disease (CSVD). We aimed to determine whether CSVD relates to short-term BP variability independently of BP levels and also, whether they improve CSVD discrimination beyond clinical variables and office BP levels. This was a cohort study on asymptomatic hypertensives who underwent brain magnetic resonance imaging and 24-hour ambulatory BP monitoring. Office and average 24-hour, daytime and nighttime BP levels, and several metrics of BP variability (SD, weighted SD, coefficient of variation, and average real variability [ARV]) were calculated. Definition of CSVD was based on the presence of lacunar infarcts and white matter hyperintensity grades. Multivariate analysis and integrated discrimination improvement were performed to assess whether BP variability and levels were independently associated with CSVD and improved its discrimination. Four hundred eighty-seven individuals participated (median age, 64; 47% women). CSVD was identified in 18.9%, related to age, male sex, diabetes mellitus, use of treatment, ambulatory BP monitoring–defined BP levels, and ARV of systolic BP at any period. The highest prevalence (33.7%) was found in subjects with both 24-hour BP levels and ARV elevated. BP levels at any period and ARV (24 hours and nocturnal) emerged as independent predictors of CSVD, and discrimination was incrementally improved although not to a clinically significant extent (integrated discrimination improvement, 5.31%, 5.17% to 5.4%). Ambulatory BP monitoring–defined BP levels and ARV of systolic BP relate to subclinical CSVD in hypertensive individuals.
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Affiliation(s)
- Josefina Filomena
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology,
| | - Iolanda Riba-Llena
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology,
| | - Ernest Vinyoles
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology,
| | - José L. Tovar
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology,
| | - Xavier Mundet
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology,
| | - Xavier Castañé
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology,
| | - Andrea Vilar
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology,
| | - Antonio López-Rueda
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology,
| | - Joan Jiménez-Baladó
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology,
| | - Anna Cartanyà
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology,
| | - Joan Montaner
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology,
| | - Pilar Delgado
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (VHIR) (J.F., I.R.-L., X.C., A.V., A.L.-R., J.J.-B., A.C., J.M., P.D.), Barcelona city Research Support Unit-IDIAP Jordi Gol (X.M., A.C.), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; El Clot Primary Care Center, Institut Català de Salut, Barcelona, Spain (J.F.); La Mina Primary Care Center, University of Barcelona, Barcelona, Spain (E.V.); and Departments of Nephrology (J.L.T) and Neurology,
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Rudilosso S, Urra X, San Román L, Laredo C, López-Rueda A, Amaro S, Oleaga L, Chamorro Á. Perfusion Deficits and Mismatch in Patients with Acute Lacunar Infarcts Studied with Whole-Brain CT Perfusion. AJNR Am J Neuroradiol 2015; 36:1407-12. [PMID: 25882287 DOI: 10.3174/ajnr.a4303] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 11/18/2014] [Accepted: 12/22/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The incidence and significance of perfusion abnormalities on brain imaging in patients with lacunar infarct are controversial. We studied the diagnostic yield of CTP and the type of perfusion abnormalities in patients presenting with a lacunar syndrome and in those with MR imaging-confirmed lacunar infarcts. MATERIALS AND METHODS A cohort of 33 patients with lacunar syndrome underwent whole-brain CTP on admission. Twenty-eight patients had an acute ischemic lesion at follow-up MR imaging; 16 were classified as lacunar infarcts. Two independent readers evaluated NCCT and CTP to compare their diagnostic yield. In patients with DWI-confirmed lacunar infarcts and visible deficits on CTP, the presence of mismatch tissue was measured by using different perfusion thresholds. RESULTS The symptomatic acute lesion was seen on CTP in 50% of patients presenting with a lacunar syndrome compared with only 17% on NCCT, and in 62% on CTP compared with 19% on NCCT, respectively, in patients with DWI-confirmed lacunar infarcts. CTP was more sensitive in supratentorial than in infratentorial lesions. In the nonblinded analysis, a perfusion deficit was observed in 12/16 patients with DWI-confirmed lacunar infarcts. The proportion of mismatch tissue was similar in patients with lacunar infarcts or nonlacunar strokes (32% versus 36%, P = .734). CONCLUSIONS Whole-brain CTP is superior to NCCT in identifying small ischemic lesions, including lacunar infarcts, in patients presenting with a lacunar syndrome. Perfusion deficits and mismatch are frequent in lacunar infarcts, but larger studies are warranted to elucidate the clinical significance of these CTP findings.
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Affiliation(s)
- S Rudilosso
- From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.)
| | - X Urra
- From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Institut d'Investigacions Biomèdiques August Pi i Sunyer (X.U., S.A., Á.C.), Barcelona, Spain
| | - L San Román
- From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Department of Radiology (L.S.R., A.L.-R., L.O.), Hospital Clínic, Barcelona, Spain
| | - C Laredo
- From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.)
| | - A López-Rueda
- From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Department of Radiology (L.S.R., A.L.-R., L.O.), Hospital Clínic, Barcelona, Spain
| | - S Amaro
- From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Institut d'Investigacions Biomèdiques August Pi i Sunyer (X.U., S.A., Á.C.), Barcelona, Spain
| | - L Oleaga
- From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Department of Radiology (L.S.R., A.L.-R., L.O.), Hospital Clínic, Barcelona, Spain
| | - Á Chamorro
- From the Functional Unit of Cerebrovascular Diseases (S.R., X.U., L.S.R., C.L., A.L.-R., S.A., L.O., Á.C.) Institut d'Investigacions Biomèdiques August Pi i Sunyer (X.U., S.A., Á.C.), Barcelona, Spain Department of Medicine (Á.C.), School of Medicine, University of Barcelona, Barcelona. Spain
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Delgado P, Riba-Llena I, Tovar JL, Jarca CI, Mundet X, López-Rueda A, Orfila F, Llussà J, Manresa JM, Alvarez-Sabín J, Nafría C, Fernández JL, Maisterra O, Montaner J. Prevalence and associated factors of silent brain infarcts in a Mediterranean cohort of hypertensives. Hypertension 2014; 64:658-63. [PMID: 24958500 DOI: 10.1161/hypertensionaha.114.03563] [Citation(s) in RCA: 25] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Silent brain infarcts (SBIs) are detected by neuroimaging in approximately 20% of elderly patients in population-based studies. Limited evidence is available for hypertensives at low cardiovascular risk countries. Investigating Silent Strokes in Hypertensives: a Magnetic Resonance Imaging Study (ISSYS) is aimed to assess the prevalence and risk factors of SBIs in a hypertensive Mediterranean population. This is a cohort study in randomly selected hypertensives, aged 50 to 70 years old, and free of clinical stroke and dementia. On baseline, all participants underwent a brain magnetic resonance imaging to assess prevalence and location of silent infarcts, and data on vascular risk factors, comorbidities, and the presence of subclinical cardiorenal damage (left ventricular hypertrophy and microalbuminuria) were collected. Multivariate analyses were performed to determine SBIs associated factors. A total of 976 patients (49.4% men, mean age 64 years) were enrolled, and 163 SBIs were detected in 99 participants (prevalence 10.1%; 95% CI, 8.4%-12.2%), most of them (64.4%) located in the basal ganglia and subcortical white matter. After adjustment, besides age and sex, microalbuminuria and increasing total cardiovascular risk (assessed by the Framingham-calibrated for Spanish population risk function) were independently associated with SBIs. Male sex increased the odds of having SBIs in 2.5 as compared with females. Our results highlight the importance of considering both global risk assessment and sex differences in hypertension and may be useful to design future preventive interventions of stroke and dementia.
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Affiliation(s)
- Pilar Delgado
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.).
| | - Iolanda Riba-Llena
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - José L Tovar
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Carmen I Jarca
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Xavier Mundet
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Antonio López-Rueda
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Francesc Orfila
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Judit Llussà
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Josep M Manresa
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - José Alvarez-Sabín
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Cristina Nafría
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - José L Fernández
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Olga Maisterra
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Joan Montaner
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
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Sarbu N, López-Rueda A, Chirife O, Capurro S. CT-perfusion time-maps likely disclose the earliest imaging signs of posterior reversible encephalopathy syndrome (PRES). J Neuroradiol 2014; 41:147-9. [DOI: 10.1016/j.neurad.2013.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/09/2013] [Accepted: 08/20/2013] [Indexed: 11/27/2022]
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Riba-Llena I, Jarca CI, Mundet X, Tovar JL, Orfila F, López-Rueda A, Nafría C, Fernández JL, Castañé X, Domingo M, Alvarez-Sabín J, Fernández-Cortiñas I, Maisterra O, Montaner J, Delgado P. Investigating silent strokes in hypertensives: a magnetic resonance imaging study (ISSYS): rationale and protocol design. BMC Neurol 2013; 13:130. [PMID: 24083440 PMCID: PMC3852223 DOI: 10.1186/1471-2377-13-130] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 09/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Silent brain infarcts are detected by neuroimaging in up to 20% of asymptomatic patients based on population studies. They are five times more frequent than stroke in general population, and increase significantly both with advancing age and hypertension. Moreover, they are independently associated with the risk of future stroke and cognitive decline.Despite these numbers and the clinical consequences of silent brain infarcts, their prevalence in Mediterranean populations is not well known and their role as predictors of future cerebrovascular and cardiovascular events in hypertensive remains to be determined.ISSYS (Investigating Silent Strokes in Hypertensives: a magnetic resonance imaging study) is an observational cross-sectional and longitudinal study aimed to: 1- determine the prevalence of silent cerebrovascular infarcts in a large cohort of 1000 hypertensives and to study their associated factors and 2-to study their relationship with the risk of future stroke and cognitive decline. METHODS/DESIGN Cohort study in a randomly selected sample of 1000 participants, hypertensive aged 50 to 70 years old, with no history of previous stroke or dementia.On baseline all participants will undergo a brain MRI to determine the presence of brain infarcts and other cerebrovascular lesions (brain microbleeds, white matter changes and enlarged perivascular spaces) and will be also tested to determine other than brain organ damage (heart-left ventricular hypertrophy, kidney-urine albumin to creatinine ratio, vessels-pulse wave velocity, ankle brachial index), in order to establish the contribution of other subclinical conditions to the risk of further vascular events. Several sub-studies assessing the role of 24 hour ambulatory BP monitoring and plasma or genetic biomarkers will be performed.Follow-up will last for at least 3 years, to assess the rate of further stroke/transient ischemic attack, other cardiovascular events and cognitive decline, and their predictors. DISCUSSION Improving the knowledge on the frequency and determinants of these lesions in our setting might help in the future to optimize treatments or establish new preventive strategies to minimize clinical and socioeconomic consequences of stroke and cognitive decline.
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Affiliation(s)
- Iolanda Riba-Llena
- Neurovascular Research Laboratory, Institut de Recerca Vall Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, Barcelona, 08035, Spain.
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González A, López-Rueda A, Gutiérrez I, Moniche F, Cayuela A, Bustamante A, Mayol A, Gonzalez-Marcos JR, Gil-Peralta A. Carotid plaque characterization by virtual histology intravascular ultrasound related to the timing of carotid intervention. J Endovasc Ther 2013; 19:764-73. [PMID: 23210875 DOI: 10.1583/jevt-12-3914mr2.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine the incidence of vulnerable plaques characterized by virtual histology intravascular ultrasound (VH IVUS) in patients with severe internal carotid artery (ICA) stenosis and its relationship to the timing of protected carotid artery stenting (CAS). METHODS The study included 141 patients (119 men; mean age 66.9 ± 9 years) with severe ICA stenosis undergoing CAS with cerebral protection. Patients were classified in 3 groups: 39 symptomatic early CAS (<14 days from clinical symptoms); 58 symptomatic delayed CAS (range 15-180 days), and 44 asymptomatic CAS. Culprit plaque component was evaluated by VH IVUS. A vulnerable plaque was defined by a thin-cap fibroatheroma and/or calcified thin-cap fibroatheroma. RESULTS The composite disabling stroke/mortality was 2.1%. The incidence of vulnerable plaques was significantly higher in the symptomatic early CAS group (25/39, 64.1%) than in the symptomatic delayed CAS group (26/58, 44.8%; p=0.048) or the asymptomatic CAS group (14/44, 31.8%; p=0.003). Symptomatic patients showed a significantly higher incidence of vulnerable plaques (52.6%) than asymptomatic patients (31.8%, p=0.022). There were no significant differences between the symptomatic delayed and asymptomatic groups (p=0.129). By clinical subgroup, a vulnerable plaque was observed in 29 (52.7%) of the patients with 55 transient ischemic attacks, 22 (52.4%) of the 42 minor stroke patients, and 14 (31.8%) of the 44 asymptomatic patients (p=0.152). CONCLUSION The incidence of vulnerable plaques was significantly higher in symptomatic patients, increasing as the intravascular study was performed closer to the index ischemic episode.
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Affiliation(s)
- Alejandro González
- Department of Radiology and Interventional Neuroradiology, Virgen del Rocio University Hospital, Seville, Spain.
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López-Rueda A, González García A, Aguilar Pérez M, Gutiérrez Jarrín I, Mayol Deyá A. Intravascular ultrasound and virtual histology of basilar artery atherosclerotic lesion. A case report. Interv Neuroradiol 2011; 17:472-6. [PMID: 22192552 DOI: 10.1177/159101991101700412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 08/21/2011] [Indexed: 11/16/2022] Open
Abstract
To our knowledge, this paper presents the first intravascular ultrasound and virtual histology (IVUS-VH) study in the basilar artery. IVUS-VH serves to characterize and determine the extension of the plaque and we also to check stent placement.
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Affiliation(s)
- Antonio López-Rueda
- Interventional Neuroradiology, Hospital Clinic i Provincial, Barcelona, Spain.
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