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Pérez Lázaro C, López-Bravo A, Gómez-Escalonilla Escobar C, Aguirre C, de Felipe A, de la Riva P, Calleja S, Arjona A, Serrano Ponz M, Navarro-Pérez MP, Delgado-Mederos R, Bashir Viturro S, Llul L, Egido J, García Madrona S, Díez González N, Benavente-Fernández L, de la Torre-Colmenero JD, Tejada Meza H, Vesperinas-Castro A, Sánchez-Cirera L, Trillo S. Management of cerebral venous thrombosis in Spain: MOTIVATE descriptive study. Neurologia 2024; 39:226-234. [PMID: 37442428 DOI: 10.1016/j.nrleng.2023.07.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/22/2021] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults. Early, accurate diagnosis can reduce the rate and severity of complications. OBJECTIVE The aim of this study was to analyse the clinical characteristics, management, and treatment of CVT in different centres in Spain. METHODS We conducted a multicentre, retrospective, descriptive study of patients hospitalised due to CVT between 2008 and 2017 at 10 Spanish centres. RESULTS We included 256 patients, with a mean age (SD) of 49.8 (18.7) years; 51% of patients were women. The most frequent symptoms were headache (73%), focal deficits (50%), epileptic seizures (33%), and encephalopathy (21%). The most frequent localisations were the superior sagittal sinus (12.5%), the transverse sinus (10.9%), and 2 or more sinuses or veins (66.4%). Thrombophilia was the most frequent known aetiology (24%), and was most commonly associated with the prothrombin G20210A mutation (19%). Forty-six percent of patients were treated with antithrombotics for 3 to 6 months, 21% for one year, and 22.6% required indefinite anticoagulation. Endovascular therapy was performed in 5% of cases, and 33% required neurosurgery. Regarding outcomes, 75% of patients were independent at 3 months (modified Rankin Scale [mRS] score ≤ 2), with papilloedema (P = .03), focal deficits (P = .001), and encephalopathy (P < .001) showing a statistically significant association with poor prognosis (mRS > 3). The in-hospital mortality rate was 4.3%, with a 3-month mortality rate of 6.3%. CONCLUSION The diverse risk factors and variable presentation of CVT represent a challenge in the diagnosis and treatment of this condition. To improve prognosis and reduce mortality, it is essential to establish management protocols for this entity.
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Affiliation(s)
- C Pérez Lázaro
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, Spain
| | - A López-Bravo
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, Spain.
| | | | | | | | - P de la Riva
- Hospital Universitario Donosti, San Sebastián, Spain
| | - S Calleja
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - A Arjona
- Hospital Universitario Torrecárdenas, Almería, Spain
| | | | - M P Navarro-Pérez
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, Spain
| | | | | | - L Llul
- Hospital Clínic, Barcelona, Spain
| | - J Egido
- Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | | | - H Tejada Meza
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - S Trillo
- Hospital La Princesa, Madrid, Spain
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Tejada Meza H, Saldaña Inda I, Serrano Ponz M, Ara JR, Marta Moreno J. Impact of a series of measures for optimisation hospital code stroke care on door-to-needle times. Neurologia 2023; 38:141-149. [PMID: 37059569 DOI: 10.1016/j.nrleng.2020.07.023] [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: 04/16/2020] [Accepted: 07/07/2020] [Indexed: 04/16/2023] Open
Abstract
INTRODUCTION Time continues to be a fundamental variable in reperfusion treatments for acute ischaemic stroke. Despite the recommendations made in clinical guidelines, only around one-third of these patients receive fibrinolysis within 60minutes. In this study, we describe our experience with the implementation of a specific protocol for patients with acute ischaemic stroke and evaluate its impact on door-to-needle times in our hospital. METHODS Measures were gradually implemented in late 2015 to shorten stroke management times and optimise the care provided to patients with acute ischaemic stroke; these measures included the creation of a specific on-call neurovascular care team. We compare stroke management times before (2013-2015) and after (2017-2019) the introduction of the protocol. RESULTS The study includes 182 patients attended before implementation of the protocol and 249 attended after. Once all measures were in effect, the overall median door-to-needle time was 45minutes (vs 74 minutes before, a 39% reduction; P<.001), with 73.5% of patients treated within 60minutes (a 47% increase; P<.001). Median overall time to treatment (onset-to-needle time) was reduced by 20minutes (P<.001). CONCLUSIONS The measures included in our protocol achieved a significant, sustained reduction in door-to-needle times, although there remains room for improvement. The mechanisms established for monitoring outcomes and for continuous improvement will enable further advances in this regard.
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Affiliation(s)
- H Tejada Meza
- Sección de Neurovascular, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España; Sección de Neurointervencionismo, Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España.
| | - I Saldaña Inda
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - M Serrano Ponz
- Sección de Neurovascular, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España; Departamento de Medicina, Psiquiatría y Dermatología, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, España
| | - J R Ara
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España; Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Marta Moreno
- Sección de Neurovascular, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España
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Tejada García J, Lara Lezama LB, de la Fuente Blanco R, Pérez de Prado A, Benavente Fernández L, Rico Santos M, Fernández Couto MD, Naya Ríos L, Couso Pazó I, Alba PV, Redondo-Robles L, López Mesonero L, Arias-Rivas S, Santamaría Cadavid M, Tejada Meza H, Horna Cañete L, Azkune Calle I, Pinedo Brochado A, García Sánchez JM, Caballero Romero I, Freijo Guerrero MM, Luna Rodríguez A, de Lera-Alfonso M, Arenillas Lara JF, Pérez Lázaro C, Navarro Pérez MP, Martínez Zabaleta M. Selection of patients for percutaneous closure in nonlacunar cryptogenic stroke associated with patent foramen ovale. Data from the NORDICTUS cooperative registry. Neurologia 2022:S2173-5808(22)00145-6. [PMID: 36347422 DOI: 10.1016/j.nrleng.2022.09.008] [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: 05/11/2022] [Accepted: 09/15/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION There is an extending use of percutaneous closure of patent foramen ovale (PFO) as therapy for PFO-associated cryptogenic strokes. The aim of our study was to investigate the clinical practice of percutaneous closure of PFO and to analyse the variables for decision-making on the selection of patients for this procedure. METHOD A prospective observational multicentric survey was conducted using all the cases of cryptogenic stroke/transient ischaemic attack associated with PFO recorded in the NORDICTUS hospital registry during the period 2018-2021. Clinical data, radiological patterns, echocardiogram data and factors related to PFO-associated stroke (thromboembolic disease and paradoxical embolism criteria) were recorded. The indication for closure was analysed according to age (≤/> 60 years) and the characteristics of the PFO. RESULTS In the group ≤ 60 years (n = 488), 143 patients (29.3%) underwent PFO closure. The most influential variables for this therapy were detection of a high-risk PFO (OR 4.11; IC 2.6-6.5, P < .001), criteria for paradoxical embolism (OR 2.61; IC 1.28-5.28; P = .008) and previous use of antithrombotics (OR 2.67; IC 1.38-5.18; P = .009). In the > 60 years group (n = 124), 24 patients had PFO closure (19%). The variables related to this option were history of pulmonary thromboembolism, predisposition to thromboembolic disease, paradoxical embolism criteria, and high-risk PFO. CONCLUSIONS The detection of a high-risk PFO (large shunt, shunt with associated aneurysm) is the main criterion for a percutaneous closure-based therapy. Other conditions to consider in the eligibility of patients are the history of thromboembolic disease, paradoxical embolism criteria or the previous use of antithrombotics.
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Affiliation(s)
- J Tejada García
- Unidad de Ictus, Sección de Neurología, Complejo Asistencial Universitario de León, León, Spain.
| | - L B Lara Lezama
- Unidad de Ictus, Sección de Neurología, Complejo Asistencial Universitario de León, León, Spain
| | - R de la Fuente Blanco
- Unidad de Ictus, Sección de Neurología, Complejo Asistencial Universitario de León, León, Spain
| | - A Pérez de Prado
- Servicio de Cardiología, Complejo Asistencial Universitario de León, León, Spain
| | - L Benavente Fernández
- Unidad de Ictus, Sevicio de Neurología, Hospital Universitario Central de Asturias, Spain
| | - M Rico Santos
- Unidad de Ictus, Sevicio de Neurología, Hospital Universitario Central de Asturias, Spain
| | - M D Fernández Couto
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, Spain
| | - L Naya Ríos
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, Spain
| | - I Couso Pazó
- Unidad de Ictus, Complejo Hospitalario Universitario de Vigo, Spain
| | - P V Alba
- Unidad de Ictus, Complejo Hospitalario Universitario de Vigo, Spain
| | - L Redondo-Robles
- Servicio de Neurología, Complejo Asistencial Universitario de Salamanca, Spain
| | - L López Mesonero
- Servicio de Neurología, Complejo Asistencial Universitario de Salamanca, Spain
| | - S Arias-Rivas
- Servicio de Neurología, Complejo Hospitalario Universitario de Santiago, Spain
| | | | - H Tejada Meza
- Sección de Neurovascular, Servicio de Neurología, Hospital Universitario Miguel Servet, Grupo de Investigación en Neurociencias, Instituto de Investigación Sanitaria (IIS) Aragón, Spain
| | - L Horna Cañete
- Servicio de Neurología, Hospital Galdakao-Usansolo (Bizkaia), Spain
| | - I Azkune Calle
- Servicio de Neurología, Hospital Galdakao-Usansolo (Bizkaia), Spain
| | | | - J M García Sánchez
- Servicio de Neurología, Hospital Universitario de Basurto-OSI Bilbao, Spain
| | - I Caballero Romero
- Servicio de Neurología, Hospital Universitario de Basurto-OSI Bilbao, Spain
| | - M M Freijo Guerrero
- Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Enfermedades Cerebrovasculares (RICORS), Spain
| | - A Luna Rodríguez
- Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Enfermedades Cerebrovasculares (RICORS), Spain
| | - M de Lera-Alfonso
- Unidad de Ictus, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Spain
| | - J F Arenillas Lara
- Unidad de Ictus, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Spain
| | - C Pérez Lázaro
- Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Spain
| | - M P Navarro Pérez
- Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Spain
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Tejada Meza H, Artal Roy J, Pérez Lázaro C, Bestué Cardiel M, Alberti González O, Tejero Juste C, Hernando Quintana N, Jarauta Lahoz L, Giménez Muñoz A, Campello Morer I, Fernández Sanz A, Cruz Velásquez G, Latorre Jiménez A, Vinueza Buitrón P, Crespo Burillo JA, Palacín Larroy M, Millán García JR, Muñoz Farjas E, Oliván Usieto JA, Clavo Pérez LM, Marta Moreno J. Epidemiology and characteristics of ischaemic stroke in young adults in Aragon. Neurologia 2022; 37:434-440. [PMID: 31340903 DOI: 10.1016/j.nrl.2019.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 07/31/2018] [Revised: 04/19/2019] [Accepted: 05/04/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Stroke affects around 15 million people per year, with 10%-15% occurring in individuals under 50 years old (stroke in young adults). The prevalence of different vascular risk factors and healthcare strategies for stroke management vary worldwide, making the epidemiology and specific characteristics of stroke in each region an important area of research. This study aimed to determine the prevalence of different vascular risk factors and the aetiology and characteristics of ischaemic stroke in young adults in the autonomous community of Aragon, Spain. METHODS A cross-sectional, multi-centre study was conducted by the neurology departments of all hospitals in the Aragonese Health Service. We identified all patients aged between 18 and 50 years who were admitted to any of these hospitals with a diagnosis of ischaemic stroke or TIA between January 2005 and December 2015. Data were collected on demographic variables, vascular risk factors, and type of stroke, among other variables. RESULTS During the study period, 786 patients between 18 and 50 years old were admitted with a diagnosis of ischaemic stroke or TIA to any hospital of Aragon, at a mean annual rate of 12.3 per 100 000 population. The median age was 45 years (IQR: 40-48 years). The most prevalent vascular risk factor was tobacco use, in 404 patients (51.4%). The majority of strokes were of undetermined cause (36.2%), followed by other causes (26.5%). The median NIHSS score was 3.5 (IQR: 2.0-7.0). In total, 211 patients (26.8%) presented TIA. Fifty-nine per cent of the patients admitted with a diagnosis of ischaemic stroke (10.3%) were treated with fibrinolysis. CONCLUSIONS Ischaemic stroke in young adults is not uncommon in Aragon, and is of undetermined aetiology in a considerable number of cases; it is therefore necessary to implement measures to improve study of the condition, to reduce its incidence, and to prevent its recurrence.
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Affiliation(s)
- H Tejada Meza
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria (IIS), Aragón, Zaragoza, España.
| | - J Artal Roy
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - C Pérez Lázaro
- Servicio de Neurología, Hospital Clínico Lozano Blesa, Zaragoza, España
| | - M Bestué Cardiel
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | - C Tejero Juste
- Servicio de Neurología, Hospital Clínico Lozano Blesa, Zaragoza, España
| | | | - L Jarauta Lahoz
- Servicio de Neurología, Hospital Obispo Polanco, Teruel, España
| | - A Giménez Muñoz
- Servicio de Neurología, Hospital Royo Villanova, Zaragoza, España
| | - I Campello Morer
- Servicio de Neurología, Hospital Royo Villanova, Zaragoza, España
| | - A Fernández Sanz
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - G Cruz Velásquez
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - A Latorre Jiménez
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - P Vinueza Buitrón
- Servicio de Neurología, Hospital Clínico Lozano Blesa, Zaragoza, España
| | - J A Crespo Burillo
- Servicio de Neurología, Hospital Ernest Lluch, Calatayud, Zaragoza, España
| | - M Palacín Larroy
- Servicio de Neurología, Hospital Ernest Lluch, Calatayud, Zaragoza, España
| | - J R Millán García
- Servicio de Neurología, Hospital de Barbastro, Barbastro, Huesca, España
| | - E Muñoz Farjas
- Servicio de Neurología, Hospital de Alcañiz, Alcañiz, Teruel, España
| | - J A Oliván Usieto
- Servicio de Neurología, Hospital de Alcañiz, Alcañiz, Teruel, España
| | - L M Clavo Pérez
- Servicio de Neurología, Hospital de Barbastro, Barbastro, Huesca, España
| | - J Marta Moreno
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria (IIS), Aragón, Zaragoza, España
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Sancho Saldaña A, Tejada Meza H, Serrano Ponz M, Aladrén Sangrós JÁ, Navasa Melado JM, Seral Moral P, Marta Moreno J. Incidence, outcomes, and associated factors of isolated striatocapsular infarct after mechanical thrombectomy. Neurologia (Engl Ed) 2022; 37:250-256. [PMID: 35595400 DOI: 10.1016/j.nrleng.2019.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 01/09/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe baseline and procedural characteristics and clinical outcomes of isolated striatocapsular infarct (iSCI) after mechanical thrombectomy in patients with large-vessel occlusion of the anterior cerebral circulation and its clinical outcome. METHODS We performed a longitudinal study including all patients treated with mechanical thrombectomy at our centre between 2015 and 2017; patients were divided into 2 groups (iSCI and non-iSCI) according to whether they presented iSCI in a control CT scan at 24 hours. RESULTS Of the 83 patients identified, 22.9% developed an iSCI. There were no statically significant differences in baseline characteristics or in reperfusion times. Patients presenting iSCI showed better collateral circulation and better reperfusion rates in the bivariate analysis. No significant difference was observed for mortality at discharge or at 3 months, or for functional prognosis at 3 months. CONCLUSIONS Even if successful reperfusion is achieved, iSCI is a common sequela, independently of reperfusion time, especially in patients with good collateral circulation.
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Affiliation(s)
- A Sancho Saldaña
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - H Tejada Meza
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - M Serrano Ponz
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - J Á Aladrén Sangrós
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - J M Navasa Melado
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - P Seral Moral
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - J Marta Moreno
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Sancho Saldaña A, Tejada Meza H, Serrano Ponz M, Aladrén Sangrós JŸ, Navasa Melado JM, Seral Moral P, Marta Moreno J. Incidence, outcomes, and associated factors of isolated striatocapsular infarct after mechanical thrombectomy. Neurologia 2022; 37:250-256. [PMID: 31064665 DOI: 10.1016/j.nrl.2019.01.005] [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: 02/22/2018] [Revised: 01/04/2019] [Accepted: 01/09/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To describe baseline and procedural characteristics and clinical outcomes of isolated striatocapsular infarct (iSCI) after mechanical thrombectomy in patients with large-vessel occlusion of the anterior cerebral circulation andits clinical outcome. METHODS We performed a longitudinal study including all patients treated with mechanical thrombectomy at our centre between 2015 and 2017; patients were divided into 2 groups (iSCI and non-iSCI) according to whether they presented iSCI in a control CT scan at 24h. RESULTS Of the 83 patients identified, 22.9% developed an iSCI. There were no statically significant differences in baseline characteristics or in reperfusion times. Patients presenting iSCI showed better collateral circulation and better reperfusion rates in the bivariate analysis. No significant difference was observed for mortality at discharge or at 3 months, or for functional prognosis at 3 months. CONCLUSIONS Even if successful reperfusion is achieved, iSCI is a common sequela, independently of reperfusion time, especially in patients with good collateral circulation.
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Affiliation(s)
- A Sancho Saldaña
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - H Tejada Meza
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - M Serrano Ponz
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Ÿ Aladrén Sangrós
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J M Navasa Melado
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - P Seral Moral
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Marta Moreno
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
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Fernández Sanz A, Ruiz Serrano J, Tejada Meza H, Marta Moreno J. Validation of the Spanish-language version of the simplified modified Rankin Scale telephone questionnaire. Neurologia 2022; 37:271-276. [PMID: 31153685 DOI: 10.1016/j.nrl.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/09/2019] [Accepted: 03/03/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The modified Rankin Scale (mRS) is the main functional assessment tool used after stroke. The simplified mRS questionnaire (smRSq) has recently been validated in English, and represents a simpler, reliable scale with an excellent reproducibility via telephone. The present study aims to validate a Spanish-language version of the telephone smRSq. METHOD We conducted a prospective cohort study, assessing 50 patients 3 months after they presented an ischaemic stroke. We assessed the Spanish-language smRSq by telephone and in person, the mRS with a structured interview, the Spanish-language smRSq, and the Stroke Impact Scale-16. Inter-rater reliability, test-retest reliability, construct validity, and criterion validity were assessed. RESULTS Inter-rater reliability showed strong agreement (k=0.810); test-retest reliability and criterion validity showed moderate agreement (k=0.639 and k=0.759, respectively), and construct validity showed moderate agreement (Spearman correlation coefficient=-0.728). CONCLUSIONS The Spanish-language telephone smRSq is reliable and simple, and saves time in the functional assessment after a stroke.
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Affiliation(s)
- A Fernández Sanz
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - J Ruiz Serrano
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario Miguel Servet, Zaragoza, España
| | - H Tejada Meza
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Marta Moreno
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
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Pérez Lázaro C, López-Bravo A, Gómez-Escalonilla Escobar C, Aguirre C, de Felipe A, de la Riva P, Calleja S, Arjona A, Serrano Ponz M, Navarro-Pérez MP, Delgado-Mederos R, Bashir Viturro S, Llul L, Egido J, García Madrona S, Díez González N, Benavente Fernández L, de la Torre Colmenero JD, Tejada Meza H, Vesperinas Castro A, Sánchez Cirera L, Trillo S. Management of cerebral venous thrombosis in Spain: MOTIVATE descriptive study. Neurologia 2021:S0213-4853(21)00116-X. [PMID: 34511275 DOI: 10.1016/j.nrl.2021.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/29/2021] [Accepted: 05/22/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults. Early, accurate diagnosis can reduce the rate and severity of complications. OBJECTIVE The aim of this study was to analyse the clinical characteristics, management, and treatment of CVT in different centres in Spain. METHODS We conducted a multicentre, retrospective, descriptive study of patients hospitalised due to CVT between 2008 and 2017 at 11 Spanish centres. RESULTS We included 256 patients, with a mean age (SD) of 49.8 (18.7) years; 51% of patients were women. The most frequent symptoms were headache (73%), focal deficits (50%), epileptic seizures (33%), and encephalopathy (21%). The most frequent localisations were the superior sagittal sinus (12.5%), the transverse sinus (10.9%), and 2 or more sinuses or veins (66.4%). Thrombophilia was the most frequent known aetiology (24%), and was most commonly associated with the prothrombin G20210A mutation (19%). Forty-six percent of patients were treated with antithrombotics for 3-6 months, 21% for one year, and 22.6% required indefinite anticoagulation. Endovascular therapy was performed in 5% of cases, and 33% required neurosurgery. Regarding outcomes, 75% of patients were independent at 3 months (modified Rankin Scale [mRS] score ≤ 2), with papilloedema (P=.03), focal deficits (P=.001), and encephalopathy (P <.001) showing a statistically significant association with poor prognosis (mRS> 3). The in-hospital mortality rate was 4.3%, with a 3-month mortality rate of 6.3%. CONCLUSION The diverse risk factors and variable presentation of CVT represent a challenge in the diagnosis and treatment of this condition. To improve prognosis and reduce mortality, it is essential to establish management protocols for this entity.
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Affiliation(s)
- C Pérez Lázaro
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, España
| | - A López-Bravo
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, España.
| | | | - C Aguirre
- Hospital La Princesa, Madrid, España
| | | | - P de la Riva
- Hospital Universitario Donosti, San Sebastián, España
| | - S Calleja
- Hospital Universitario Central de Asturias, Oviedo, España
| | - A Arjona
- Hospital Universitario Torrecárdenas, Almería, España
| | | | - M P Navarro-Pérez
- Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria Aragón (IIS-A), Zaragoza, España
| | | | | | - L Llul
- Hospital Clínic, Barcelona, España
| | - J Egido
- Hospital Clínico San Carlos, Madrid, España
| | | | | | | | | | - H Tejada Meza
- Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | - S Trillo
- Hospital La Princesa, Madrid, España
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Tejada Meza H, Lambea Gil Á, Villar Yus C, Pérez Lázaro C, Navarro Pérez MP, Campello Morer I, Giménez Muñoz Á, Artal Roy J, Alberti González O, Hernando Quintana N, Ruiz Palomino P, Crespo Burillo JA, García Arguedas C, Ballester Marco L, Palacin Larroy M, Seral Moral M, Marta Moreno J. [Three-month functional prognosis of patients hospitalised due to acute ischaemic stroke in Aragon: Rregional analysis of the impact of COVID-19]. Neurologia 2021; 36:531-536. [PMID: 38620471 PMCID: PMC7901365 DOI: 10.1016/j.nrl.2021.02.008] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/21/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction The COVID-19 pandemic has had an impact on ischaemic stroke management, with a reported decrease in hospital admissions, and even disruptions in healthcare and increased in-hospital mortality. However, there is a lack of evidence on the impact of the pandemic on functional prognosis. The aim of this study is to analyse the effect of the COVID-19 pandemic on the 3-month functional outcomes of patients hospitalised due to acute ischaemic stroke in Aragon (Spain). Materil and methods We reviewed the data of all patients admitted due to ischaemic stroke to any hospital in our regional healthcare system between 30 December 2019 and 3 May 2020. We compared modified Rankin Scale scores and mortality at 3 months in patients hospitalised before and after the declaration of a state of emergency due to the COVID-19 pandemic. Results In total, 318 patients with acute ischaemic stroke met our inclusion criteria. No differences were observed between periods in global or specific characteristics, with the exception of a higher proportion of patients older than 80 years during the first period (42.2% vs. 29.0%, P=.028). In the comparative analysis, we found no significant differences in mortality (12.3 vs. 7.9, P=.465) or in the proportion of patients with modified Rankin Scale scores ≤ 2 (57.7% vs. 57.1%, P=.425) at 3 months. Conclusion To our knowledge, this is the first study to analyse the impact of COVID-19 pandemic on the 3-month functional outcomes of patients with ischaemic stroke. In our region, there has been no increase in rates of mortality or disability at 3 months in patients admitted due to ischaemic stroke during the pandemic.
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Affiliation(s)
- H Tejada Meza
- Sección de Neurovascular, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
- Unidad de Neurointervencionismo, Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, España
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España
| | - Á Lambea Gil
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España
- Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - C Villar Yus
- Sección de Neurovascular, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España
| | - C Pérez Lázaro
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España
| | - M P Navarro Pérez
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España
- Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - I Campello Morer
- Servicio de Neurología, Hospital Royo Villanova, Zaragoza, España
| | - Á Giménez Muñoz
- Servicio de Neurología, Hospital Royo Villanova, Zaragoza, España
| | - J Artal Roy
- Servicio de Neurología, Hospital San Jorge, Huesca, España
| | | | | | - P Ruiz Palomino
- Servicio de Neurología, Hospital Obispo Polanco, Teruel, España
| | - J A Crespo Burillo
- Servicio de Neurología, Hospital de Barbastro, Barbastro, Huesca, España
| | - C García Arguedas
- Servicio de Neurología, Hospital de Barbastro, Barbastro, Huesca, España
| | - L Ballester Marco
- Servicio de Neurología, Hospital de Alcañiz, Alcañiz, Teruel, España
| | - M Palacin Larroy
- Servicio de Neurología, Hospital Ernest Lluch, Calatayud, Zaragoza, España
| | - M Seral Moral
- Servicio de Neurología, Hospital Ernest Lluch, Calatayud, Zaragoza, España
| | - J Marta Moreno
- Sección de Neurovascular, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España
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Tejada Meza H, Lambea Gil Á, Villar Yus C, Pérez Lázaro C, Navarro Pérez MP, Campello Morer I, Giménez Muñoz Á, Artal Roy J, Alberti González O, Hernando Quintana N, Ruiz Palomino P, Crespo Burillo JA, García Arguedas C, Ballester Marco L, Palacin Larroy M, Seral Moral M, Marta Moreno J. Three-month functional prognosis of patients hospitalised due to acute ischaemic stroke in Aragon: regional analysis of the impact of COVID-19. Neurologia (Engl Ed) 2021; 36:531-536. [PMID: 34099423 PMCID: PMC8441252 DOI: 10.1016/j.nrleng.2021.02.001] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/21/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction The COVID-19 pandemic has had an impact on ischaemic stroke management, with a reported decrease in hospital admissions, and even disruptions in healthcare and increased in-hospital mortality. However, there is a lack of evidence on the impact of the pandemic on functional prognosis. The aim of this study is to analyse the effect of the COVID-19 pandemic on the 3-month functional outcomes of patients hospitalised due to acute ischaemic stroke in Aragon (Spain). Methods We reviewed the data of all patients admitted due to ischaemic stroke to any hospital in our regional healthcare system between 30 December 2019 and 3 May 2020. We compared modified Rankin Scale scores and mortality at 3 months in patients hospitalised before and after the declaration of a state of emergency due to the COVID-19 pandemic. Results In total, 318 patients with acute ischaemic stroke met our inclusion criteria. No differences were observed between periods in global or specific characteristics, with the exception of a higher proportion of patients older than 80 years during the first period (42.2% vs 29.0%, P = .028). In the comparative analysis, we found no significant differences in mortality (12.3 vs 7.9, P = .465) or in the proportion of patients with modified Rankin Scale scores ≤ 2 (57.7% vs 57.1%, P = .425) at 3 months. Conclusion To our knowledge, this is the first study to analyse the impact of COVID-19 pandemic on the 3-month functional outcomes of patients with ischaemic stroke. In our region, there has been no increase in rates of mortality or disability at 3 months in patients admitted due to ischaemic stroke during the pandemic.
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Affiliation(s)
- H Tejada Meza
- Sección de Neurovascular, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Unidad de Neurointervencionismo, Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Á Lambea Gil
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - C Villar Yus
- Sección de Neurovascular, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - C Pérez Lázaro
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - M P Navarro Pérez
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain; Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - I Campello Morer
- Servicio de Neurología, Hospital Royo Villanova, Zaragoza, Spain
| | - Á Giménez Muñoz
- Servicio de Neurología, Hospital Royo Villanova, Zaragoza, Spain
| | - J Artal Roy
- Servicio de Neurología, Hospital San Jorge, Huesca, Spain
| | | | | | - P Ruiz Palomino
- Servicio de Neurología, Hospital Obispo Polanco, Teruel, Spain
| | | | | | | | | | - M Seral Moral
- Servicio de Neurología, Hospital Ernest Lluch, Zaragoza, Spain
| | - J Marta Moreno
- Sección de Neurovascular, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
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11
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Tejada Meza H, Artal Roy J, Pérez Lázaro C, Bestué Cardiel M, Alberti González O, Tejero Juste C, Hernando Quintana N, Jarauta Lahoz L, Giménez Muñoz A, Campello Morer I, Fernández Sanz A, Cruz Velásquez G, Latorre Jiménez A, Vinueza Buitrón P, Crespo Burillo JA, Palacín Larroy M, Millán García JR, Muñoz Farjas E, Oliván Usieto JA, Clavo Pérez LM, Marta Moreno J. Epidemiology and characteristics of ischaemic stroke in young adults in Aragon. Neurologia (Engl Ed) 2021; 37:434-440. [PMID: 34092536 DOI: 10.1016/j.nrleng.2019.05.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 05/04/2019] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Stroke affects around 15 million people per year, with 10%--15% occurring in individuals under 50 years old (stroke in young adults). The prevalence of different vascular risk factors and healthcare strategies for stroke management vary worldwide, making the epidemiology and specific characteristics of stroke in each region an important area of research. This study aimed to determine the prevalence of different vascular risk factors and the aetiology and characteristics of ischaemic stroke in young adults in the autonomous community of Aragon, Spain. METHODS A cross-sectional, multi-centre study was conducted by the neurology departments of all hospitals in the Aragonese Health Service. We identified all patients aged between 18 and 50 years who were admitted to any of these hospitals with a diagnosis of ischaemic stroke or TIA between January 2005 and December 2015. Data were collected on demographic variables, vascular risk factors, and type of stroke, among other variables. RESULTS During the study period, 786 patients between 18 and 50 years old were admitted with a diagnosis of ischaemic stroke or TIA to any hospital of Aragon, at a mean annual rate of 12.3 per 100 000 population. The median age was 45 years (IQR: 40--48 years). The most prevalent vascular risk factor was tobacco use, in 404 patients (51.4%). The majority of strokes were of undetermined cause (36.2%), followed by other causes (26.5%). The median NIHSS score was 3.5 (IQR: 2.0--7.0). In total, 211 patients (26.8%) presented TIA. Fifty-nine per cent of the patients admitted with a diagnosis of ischaemic stroke (10.3%) were treated with fibrinolysis. CONCLUSIONS Ischaemic stroke in young adults is not uncommon in Aragon, and is of undetermined aetiology in a considerable number of cases; it is therefore necessary to implement measures to improve study of the condition, to reduce its incidence, and to prevent its recurrence.
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Affiliation(s)
- H Tejada Meza
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria (IIS), Aragón, Zaragoza, Spain.
| | - J Artal Roy
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - C Pérez Lázaro
- Servicio de Neurología, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - M Bestué Cardiel
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - C Tejero Juste
- Servicio de Neurología, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | | | - L Jarauta Lahoz
- Servicio de Neurología, Hospital Obispo Polanco, Teruel, Spain
| | - A Giménez Muñoz
- Servicio de Neurología, Hospital Royo Villanova, Zaragoza, Spain
| | - I Campello Morer
- Servicio de Neurología, Hospital Royo Villanova, Zaragoza, Spain
| | - A Fernández Sanz
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - G Cruz Velásquez
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A Latorre Jiménez
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - P Vinueza Buitrón
- Servicio de Neurología, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - J A Crespo Burillo
- Servicio de Neurología, Hospital Ernest Lluch, Calatayud, Zaragoza, Spain
| | - M Palacín Larroy
- Servicio de Neurología, Hospital Ernest Lluch, Calatayud, Zaragoza, Spain
| | - J R Millán García
- Servicio de Neurología, Hospital de Barbastro, Barbastro, Huesca, Spain
| | - E Muñoz Farjas
- Servicio de Neurología, Hospital de Alcañiz, Alcañiz, Teruel, Spain
| | | | - L M Clavo Pérez
- Servicio de Neurología, Hospital de Barbastro, Barbastro, Huesca, Spain
| | - J Marta Moreno
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria (IIS), Aragón, Zaragoza, Spain
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Fernández Sanz A, Ruíz Serrano J, Tejada Meza H, Marta Moreno J. Validation of the Spanish-language version of the simplified modified Rankin Scale telephone questionnaire. Neurología (English Edition) 2021; 37:271-276. [DOI: 10.1016/j.nrleng.2019.03.019] [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: 11/30/2018] [Accepted: 03/03/2019] [Indexed: 10/21/2022] Open
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Tejada Meza H, Saldaña Inda I, Serrano Ponz M, Ara JR, Marta Moreno J. Impact of a series of measures for optimisation hospital code stroke care on door-to-needle times. Neurologia 2020; 38:S0213-4853(20)30273-5. [PMID: 33069450 DOI: 10.1016/j.nrl.2020.07.023] [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: 04/16/2020] [Revised: 06/17/2020] [Accepted: 07/07/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Time continues to be a fundamental variable in reperfusion treatments for acute ischaemic stroke. Despite the recommendations made in clinical guidelines, only around one-third of these patients receive fibrinolysis within 60minutes. In this study, we describe our experience with the implementation of a specific protocol for patients with acute ischaemic stroke and evaluate its impact on door-to-needle times in our hospital. METHODS Measures were gradually implemented in late 2015 to shorten stroke management times and optimise the care provided to patients with acute ischaemic stroke; these measures included the creation of a specific on-call neurovascular care team. We compare stroke management times before (2013-2015) and after (2017-2019) the introduction of the protocol. RESULTS The study includes 182 patients attended before implementation of the protocol and 249 attended after. Once all measures were in effect, the overall median door-to-needle time was 45minutes (vs 74 minutes before, a 39% reduction; P<.001), with 73.5% of patients treated within 60minutes (a 47% increase; P<.001). Median overall time to treatment (onset-to-needle time) was reduced by 20minutes (P<.001). CONCLUSIONS The measures included in our protocol achieved a significant, sustained reduction in door-to-needle times, although there remains room for improvement. The mechanisms established for monitoring outcomes and for continuous improvement will enable further advances in this regard.
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Affiliation(s)
- H Tejada Meza
- Sección de Neurovascular, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España; Sección de Neurointervencionismo, Servicio de Radiología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España.
| | - I Saldaña Inda
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - M Serrano Ponz
- Sección de Neurovascular, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España; Departamento de Medicina, Psiquiatría y Dermatología, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, España
| | - J R Ara
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España; Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Marta Moreno
- Sección de Neurovascular, Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España
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Tejada Meza H, Lambea Gil Á, Sancho Saldaña A, Martínez-Zabaleta M, Garmendia Lopetegui E, López-Cancio Martínez E, Castañón Apilánez M, Herrera Isasi M, Marta Enguita J, Gómez-Vicente B, Arenillas JF, Arenaza Basterrechea N, Timiraos Fernández JJ, Sánchez Herrero J, Maciñeiras Montero JL, Castellanos Rodrigo M, Fernández-Coud D, Casado Menéndez I, Temprano Fernández MT, Freijo M, Luna A, Palacio Portilla EJ, Jiménez López Y, Rodríguez-Castro E, Rodríguez-Yáñez M, Tejada García J, Beltrán Rodríguez I, Julián-Villaverde F, Moreno García MP, Trejo Gabriel-Galán JM, Echavarría Iñiguez A, Pérez Lázaro C, Navarro Pérez MP, Marta Moreno J. Impact of COVID-19 outbreak in reperfusion therapies of acute ischaemic stroke in northwest Spain. Eur J Neurol 2020; 27:2491-2498. [PMID: 32761981 PMCID: PMC7436392 DOI: 10.1111/ene.14467] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 06/24/2020] [Accepted: 08/01/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Spain has been one of the countries more heavily stricken by SARS-CoV-2, which has had huge implications for stroke care. The aim was to analyse the impact of the COVID-19 epidemic outbreak on reperfusion therapies for acute ischaemic stroke in the northwest of Spain. METHODS This was a Spanish multicentre retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. All patients receiving reperfusion therapy for ischaemic stroke between 30 December 2019 and 3 May 2020 were recorded, and their baseline, clinical and radiological characteristics, extra- and intra-hospital times of action, Code Stroke activation pathway, COVID-19 status, reperfusion rate, and short-term outcome before and after the setting of the emergency state were analysed. RESULTS A total of 796 patients received reperfusion therapies for ischaemic stroke. There was a decrease in the number of patients treated per week (46.5 patients per week vs. 39.0 patients per week, P = 0.043) and a delay in out-of-hospital (95.0 vs. 110.0 min, P = 0.001) and door-to-needle times (51.0 vs. 55.0, P = 0.038). Patients receiving endovascular therapy obtained less successful reperfusion rates (92.9% vs. 86.6%, P = 0.016). COVID-19 patients had more in-hospital mortality. CONCLUSION A decrease in the number of patients benefiting from reperfusion therapies was found, with a delay in out-of-hospital and door-to-needle times and worse reperfusion rates in northwest Spain. COVID-19 patients had more in-hospital mortality.
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Affiliation(s)
- H Tejada Meza
- Stroke Unit, Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain.,Interventional Neuroradiology Unit, Department of Radiology, Hospital Universitario Miguel Servet, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IISAragón), Zaragoza, Spain
| | - Á Lambea Gil
- Stroke Unit, Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IISAragón), Zaragoza, Spain
| | - A Sancho Saldaña
- Stroke Unit, Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IISAragón), Zaragoza, Spain
| | | | | | | | - M Castañón Apilánez
- Department of Neurology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - M Herrera Isasi
- Department of Neurology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - J Marta Enguita
- Department of Neurology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - B Gómez-Vicente
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - J F Arenillas
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Neurovascular Research Laboratory, Instituto de Biología y Genética Molecular, Universidad de Valladolid - Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | | | | | - J Sánchez Herrero
- Department of Neurology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | - M Castellanos Rodrigo
- Department of Neurology, Complexo Hospitalario Universitario A Coruña / A Coruña Biomedical Research Insitute, A Coruña, Spain
| | - D Fernández-Coud
- Department of Neurology, Complexo Hospitalario Universitario A Coruña / A Coruña Biomedical Research Insitute, A Coruña, Spain
| | - I Casado Menéndez
- Stroke Unit, Department of Neurology, Hospital Universitario de Cabueñes, Gijón, Spain
| | | | - M Freijo
- Neurovascular Department Biocruces Bizkaia Health Research Institute, Osakidetza, Hospital Universitario Cruces, Barakaldo, Spain
| | - A Luna
- Neurovascular Department Biocruces Bizkaia Health Research Institute, Osakidetza, Hospital Universitario Cruces, Barakaldo, Spain
| | - E J Palacio Portilla
- Department of Neurology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Y Jiménez López
- Department of Neurology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - E Rodríguez-Castro
- Department of Neurology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - M Rodríguez-Yáñez
- Department of Neurology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - J Tejada García
- Department of Neurology, Complejo Asistencial Universitario de León, León, Spain
| | | | | | | | | | - A Echavarría Iñiguez
- Department of Neurology, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - C Pérez Lázaro
- Department of Neurology, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - M P Navarro Pérez
- Department of Neurology, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - J Marta Moreno
- Stroke Unit, Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IISAragón), Zaragoza, Spain
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Tejada Meza H, Lambea Gil Á, Sancho Saldaña A, Villar Yus C, Pardiñas Barón B, Sagarra Mur D, Marta Moreno J. Ischaemic stroke in the time of coronavirus disease 2019. Eur J Neurol 2020; 27:1788-1792. [PMID: 32415888 PMCID: PMC7276912 DOI: 10.1111/ene.14327] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 04/24/2020] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 11/05/2022]
Abstract
Background and purpose Stroke assistance is facing changes and new challenges since COVID‐19 became pandemic. A variation on the patient influx might be one of the greater concerns, due to fewer people coming to emergency departments or coming too late. However, no data quantifying this have been published until now. The aim was to analyse the impact of the COVID‐19 epidemic outbreak on hospital stroke admissions and their characteristics in our region. Methods The data of every patient admitted to any hospital of our healthcare system with a diagnosis of ischaemic stroke between 30 December 2019 and 19 April 2020 were reviewed. Demographic and clinical data were recorded and compared between periods before and after the setting of the state of emergency secondary to the COVID‐19 outbreak. Results In total, 354 patients with ischaemic stroke were admitted in our study period. There was a weekly average of 27.5 cases before the setting of the state of emergency against 12 afterwards (P < 0.001). This drop in stroke cases occurred progressively from week 11, persisting in time despite the decrease in confirmed cases of COVID‐19. No differences in the proportion of intravenous thrombolysis (21.1% vs. 21.5%, P = 0.935) or endovascular therapy (12.4% vs. 15.2%, P = 0.510) were found, nor in other demographic or clinical characteristics except for median onset‐to‐door time (102 vs. 183 min, P = 0.015). Conclusions This observational study offers the perspective of a whole region in one of the countries more heavily stricken by the SARS‐CoV‐2 epidemic and shows that the decrease of stroke events, since the beginning of the COVID‐19 outbreak, happened globally and without any specific patient distribution.
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Affiliation(s)
- H Tejada Meza
- Stroke Unit, Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain.,Interventional Neuroradiology Unit, Department of Radiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Á Lambea Gil
- Stroke Unit, Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A Sancho Saldaña
- Stroke Unit, Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - C Villar Yus
- Stroke Unit, Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - B Pardiñas Barón
- Stroke Unit, Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - D Sagarra Mur
- Stroke Unit, Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - J Marta Moreno
- Stroke Unit, Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Tejada Meza H, Artal Roy J, Serrano Ponz M, Guelbenzu Morte S, Marta Moreno J. Pseudooclusión carotídea: un concepto a tener en cuenta en el ictus agudo. Neurologia 2020; 35:344-345. [DOI: 10.1016/j.nrl.2017.09.010] [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: 03/09/2017] [Revised: 09/13/2017] [Accepted: 09/22/2017] [Indexed: 11/29/2022] Open
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Tejada Meza H, Artal Roy J, Serrano Ponz M, Guelbenzu Morte S, Marta Moreno J. Carotid pseudo-occlusion: a concept to consider in acute stroke. Neurología (English Edition) 2020. [DOI: 10.1016/j.nrleng.2017.09.015] [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: 10/24/2022] Open
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18
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Lambea Gil Á, Tejada Meza H, López Perales C, Artal Roy J, Marta Moreno J. Echocardiographic parameters of atrial cardiopathy and the detection of atrial fibrillation in patients with cryptogenic stroke. Neurología (English Edition) 2020. [DOI: 10.1016/j.nrleng.2017.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Tejada Meza H, Artal Roy J, Martínez García R, Marta Moreno J. Spontaneous recanalisation of a chronic internal carotid artery occlusion. Neurología (English Edition) 2018. [DOI: 10.1016/j.nrleng.2015.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Tejada Meza H, Artal Roy J, Martínez García R, Marta Moreno J. Recanalización espontánea de una oclusión crónica de arteria carótida interna. Neurologia 2018; 33:66-68. [DOI: 10.1016/j.nrl.2015.12.010] [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: 06/17/2015] [Revised: 11/30/2015] [Accepted: 12/21/2015] [Indexed: 11/16/2022] Open
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Tejada Meza H, Modrego Pardo P, Gazulla Abio J. Cervical myelopathy as the initial manifestation of os odontoideum. Neurología (English Edition) 2016. [DOI: 10.1016/j.nrleng.2014.06.004] [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: 12/01/2022] Open
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Tejada Meza H, Modrego Pardo P, Gazulla Abio J. [Cervical myelopathy as the initial manifestation of os odontoideum]. Neurologia 2014; 31:278-9. [PMID: 25150883 DOI: 10.1016/j.nrl.2014.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/23/2014] [Accepted: 06/29/2014] [Indexed: 11/17/2022] Open
Affiliation(s)
- H Tejada Meza
- Departamento de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - P Modrego Pardo
- Departamento de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Gazulla Abio
- Departamento de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
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