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Almeida Xavier S, Rodrigues A, Meira T, Mota Dória H, Figueira C, Amorim J, Pestana R, Nobrega J, Franco J, Carneiro Â. Fly and treat: Endovascular treatment of ruptured aneurysms at an insular tertiary center. J Stroke Cerebrovasc Dis 2023; 32:107390. [PMID: 37866295 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107390] [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: 02/23/2023] [Revised: 09/15/2023] [Accepted: 09/24/2023] [Indexed: 10/24/2023] Open
Abstract
(Objectives) Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition associated with poor outcomes. Early intervention is critical, particularly in low-volume hospitals, which are advised to transfer aSAH patients to high-volume centers. This study examines a novel protocol implemented in 2016 at Região Autónoma da Madeira, a Portuguese island. It involves the mobilization of experienced neurointerventionalists from high-volume hospitals to provide aSAH treatment. (Methods) We conducted a retrospective analysis on 30 aSAH patients who underwent endovascular treatment at the island center between November 2016 and April 2022. Additionally, we included a comparison group of 74 aSAH patients, treated with the endovascular approach at Hospital de Braga (high volume center at Portugal mainland). (Results) There was no statistical difference in patients' clinical severity between both hospitals (median WFNS score of 1). Although 90 % of patients in the novel protocol group received treatment within 3 days, we observed a significant delay compared to Hospital de Braga. Rates of aneurysm occlusion and intra-procedure complications between the two groups were similar. At the 3-months follow-up, there were no statistically significant differences between groups regarding patients that achieved a modified Rankin score of 2 or less. However, the island center exhibited a significantly higher mortality rate. (Conclusions) Overall, our results suggest that making the neurointerventionalist fly to an insular center is feasible and allows most patients to be treated within the first 72 h, as recommended. We highlight some potential recommendations for implementing this model and discuss possible causes that might justify the high mortality rate.
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Affiliation(s)
- Sofia Almeida Xavier
- Neuroradiology department, Hospital de Braga, Portugal, 4710-243 Braga, Portugal.
| | - Alexandra Rodrigues
- Neuroradiology Unit, Hospital Central do Funchal - SESARAM, Funchal, Portugal; Neuroradiology department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.
| | - Torcato Meira
- Neuroradiology department, Hospital de Braga, Portugal, 4710-243 Braga, Portugal; School of Medicine, University of Minho, Braga, Portugal
| | - Hugo Mota Dória
- Neuroradiology Unit, Hospital Central do Funchal - SESARAM, Funchal, Portugal
| | - Carolina Figueira
- Neuroradiology Unit, Hospital Central do Funchal - SESARAM, Funchal, Portugal
| | - José Amorim
- Neuroradiology department, Hospital de Braga, Portugal, 4710-243 Braga, Portugal
| | - Ricardo Pestana
- Neurosurgery department, Hospital Central do Funchal- SESARAM, Funchal, Portugal
| | - Júlio Nobrega
- Intensive care medicine department, Hospital Central do Funchal - SESARAM. Funchal, Portugal
| | - José Franco
- Neuroradiology Unit, Hospital Central do Funchal - SESARAM, Funchal, Portugal
| | - Ângelo Carneiro
- Neuroradiology department, Hospital de Braga, Portugal, 4710-243 Braga, Portugal
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Pero G, Dória HM, Piano M, Macera A, Quilici L, Cervo A. Intracranial Carotid Occlusions : ADAPT versus SAVE and the role of Balloon Guide Catheters. Clin Neuroradiol 2023; 33:825-831. [PMID: 37099134 PMCID: PMC10450001 DOI: 10.1007/s00062-023-01286-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 11/21/2022] [Indexed: 04/27/2023]
Abstract
PURPOSE Specific decisions made by neurointerventionists are often lost behind the data of large-scale trials, and many of these studies have taken place before the development of new techniques and devices. This study compares the stent-retriever assisted vacuum-locked extraction (SAVE) technique with a direct aspiration first pass (ADAPT), as well as the use of a balloon guide catheter (BGC), in intracranial internal carotid artery (IC-ICA) occlusions. METHODS Observational and retrospective study from an Italian hospital, including patients who underwent thrombectomy for IC-ICA occlusion between 1 January 2019 and 31 March 2021. RESULTS Out of 91 IC-ICA occlusions, the ADAPT was the first choice in 20 (22%) and the SAVE in 71 (78%). A BGC was used in 32 (35%) cases, always in conjunction with the SAVE technique. The use of SAVE technique without BGC was associated with the least risk of distal embolization (DE) in the territory occluded (44% vs. 75% when ADAPT technique was used; p = 0.03) and achieved first pass effect (FPE) more frequently (51% vs. 25%, p = 0.09). When the SAVE technique was used, BGC (BGC-SAVE) compared to no BGC (NoBGC-SAVE) was associated with a tendency for less DE (31% vs. 44%, p = 0.3), more FPE (63% vs. 51%, p = 0.5), the same median number of passes (1, p = 0.8) and similar groin-to-recanalization times (36.5 vs. 35.5 min, p = 0.5), none of which reached statistical significance. CONCLUSION Our findings support the use of SAVE technique for IC-ICA occlusions; the added benefit of BGC compared to long sheaths was not remarkable in this sample.
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Affiliation(s)
- Guglielmo Pero
- Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Hugo Mota Dória
- Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
- Department of Neuroradiology, Hospital Central do Funchal, Funchal, Madeira, Portugal
- Universidade da Madeira, Funchal, Madeira, Portugal
| | - Mariangela Piano
- Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Antonio Macera
- Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Luca Quilici
- Department of Neuroradiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Amedeo Cervo
- Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
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Correia M, Silva I, Gabriel D, Simrén J, Carneiro A, Ribeiro S, Dória HM, Varela R, Aires A, Minta K, Antunes R, Felgueiras R, Castro P, Blenow K, Magalhães R, Zetterberg H, Maia LF. Early plasma biomarker dynamic profiles are associated with acute ischemic stroke outcomes. Eur J Neurol 2022; 29:1630-1642. [DOI: 10.1111/ene.15273] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/03/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Manuel Correia
- Department of Neurology Centro Hospitalar Universitário do Porto Porto Portugal
- Instituto de Ciências Biomédicas Abel Salazar University of Porto Porto Portugal
| | - Isabel Silva
- Department of Neurology Centro Hospitalar Universitário do Porto Porto Portugal
- i3S ‐ Instituto de Investigação e Inovação em Saúde University of Porto, Porto, Portugal and IBMC ‐ Instituto de Biologia Molecular e Celular, University of Porto Porto Portugal
| | - Denis Gabriel
- Department of Neurology Centro Hospitalar Universitário do Porto Porto Portugal
| | - Joel Simrén
- Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg 431 41 Mölndal Sweden
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital 431 80 Mölndal Sweden
| | - Angelo Carneiro
- Department of Neuroradiology Centro Hospitalar Universitário do Porto Porto Portugal
| | - Sara Ribeiro
- i3S ‐ Instituto de Investigação e Inovação em Saúde University of Porto, Porto, Portugal and Ipatimup ‐ Institute of Molecular Pathology and Immunology, University of Porto Porto Portugal
| | - Hugo Mota Dória
- Department of Neuroradiology Centro Hospitalar Universitário do Porto Porto Portugal
| | - Ricardo Varela
- Department of Neurology Centro Hospitalar Universitário do Porto Porto Portugal
| | - Ana Aires
- Department of Neurology Centro Hospitalar Universitário de São João Porto Portugal
| | - Karolina Minta
- Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg 431 41 Mölndal Sweden
- Department of Neurodegenerative Disease University College London Institute of Neurology Queen Square London UK
| | - Rui Antunes
- Intensive Care Unit Centro Hospitalar Universitário do Porto Porto Portugal
| | - Rui Felgueiras
- Department of Neurology Centro Hospitalar Universitário do Porto Porto Portugal
| | - Pedro Castro
- Department of Neurology Centro Hospitalar Universitário de São João Porto Portugal
| | - Kaj Blenow
- Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg 431 41 Mölndal Sweden
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital 431 80 Mölndal Sweden
| | - Rui Magalhães
- Population Studies Instituto de Ciências Biomédicas Abel Salazar University of Porto Porto Portugal
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg 431 41 Mölndal Sweden
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital 431 80 Mölndal Sweden
- Department of Neurodegenerative Disease University College London Institute of Neurology Queen Square London UK
- UK Dementia Research Institute at UCL London UK
- Hong Kong Center for Neurodegenerative Diseases Hong Kong China
| | - Luis F Maia
- Department of Neurology Centro Hospitalar Universitário do Porto Porto Portugal
- Instituto de Ciências Biomédicas Abel Salazar University of Porto Porto Portugal
- i3S ‐ Instituto de Investigação e Inovação em Saúde University of Porto, Porto, Portugal and IBMC ‐ Instituto de Biologia Molecular e Celular, University of Porto Porto Portugal
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Dias MC, Dos Reis RS, Santos JV, Nunes AP, Ferreira P, Maia B, Fragata I, Reis J, Lopes JR, Cruz L, Santo G, Machado E, Gabriel D, Felgueiras R, Dória HM, Carneiro A, Correia M, Veloso LM, Barros P, Gregorio T, Carvalho A, Ribeiro M, Teotonio P, Neto L, E Melo TP, Canhao P, Filipe JP, Moreira G, Azevedo E, Silva ML, Costa EC, Oliveira G, Pereira L, Neves L, Rodrigues M, Marto JP, Calado S, Grenho F, Branco G, Baptista T, Rocha J, Ferreira C, Pinho J, Amorim JM, Araujo JM, Neiva RM, Viana J, Lobo M, Freitas A, Cruz VT, Sargento-Freitas J, Lopes JC. Nationwide Access to Endovascular Treatment for Acute Ischemic Stroke in Portugal. ACTA MEDICA PORT 2022; 35:127-134. [PMID: 34499849 DOI: 10.20344/amp.15031] [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: 10/11/2020] [Revised: 01/23/2021] [Accepted: 02/10/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding endovascular treatment in mainland Portugal and its administrative districts. MATERIAL AND METHODS A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between stroke onset, first-door, and puncture. RESULTS A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000 inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged from 212 to 432 minutes, reflecting regional heterogeneity. DISCUSSION Overall endovascular treatment rates and procedural times in Portugal are comparable to other international registries. We found geographic heterogeneity, with lower endovascular treatment rates and longer onset-to-puncture time in southern and inner regions. CONCLUSION The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in high-volume tertiary hospitals.
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Videira G, Pereira D, Mota Dória H, Sousa AP, Coelho T, Martins da Silva A. Myelopathy in hereditary ATTR Val30Met amyloidosis patients. Amyloid 2021; 28:271-272. [PMID: 33988057 DOI: 10.1080/13506129.2021.1927696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Gonçalo Videira
- Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Diogo Pereira
- Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Hugo Mota Dória
- Department of Neurorradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Paula Sousa
- Department of Neurophysiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Teresa Coelho
- Department of Neurophysiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Martins da Silva
- Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Biomedical Investigation Multidisciplinary Unit, Porto, Portugal
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Pero G, Dória HM, Giavarini M, Quilici L, Cervo A, Macera A, Piano M. Impact of the SARS-COV-2 Pandemic on the Endovascular Treatment of Acute Stroke - an Italian Single-Center Experience. J Stroke Cerebrovasc Dis 2021; 30:106028. [PMID: 34392026 PMCID: PMC8324420 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106028] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/12/2021] [Accepted: 07/24/2021] [Indexed: 01/19/2023] Open
Abstract
Objectives The SARS-CoV-2 pandemic greatly influenced the overall quality of healthcare. The purpose of this study was to compare the time variables for acute stroke treatment and evaluate differences in the pre-hospital and in-hospital care before and during the SARS-CoV-2 pandemic, as well as between the first and second waves. Materials and methods Observational and retrospective study from an Italian hospital, including patients who underwent thrombectomy between January 1st 2019 and December 31st 2020. Results Out of a total of 594 patients, 301 were treated in 2019 and 293 in 2020. The majority observed in 2019 came from spoke centers (67,1%), while in 2020 more than half (52%, p < 0.01) were evaluated at the hospital's emergency room directly (ER-NCGH). When compared to 2019, time metrics were globally increased in 2020, particularly in the ER-NCGH groups during the period of the first wave (N = 24 and N = 56, respectively): “Onset-to-door”:50,5 vs 88,5, p < 0,01; “Arrival in Neuroradiology – groin”:13 vs 25, p < 0,01; “Door-to-groin”:118 vs 143,5, p = 0,02; “Onset-to-groin”:180 vs 244,5, p < 0,01; “Groin-to-recanalization”: 41 vs 49,5, p = 0,03. When comparing ER-NCGH groups between the first (N = 56) and second (N = 49) waves, there was an overall improvement in times, namely in the “Door-to-CT” (47,5 vs 37, p < 0,01), “Arrival in Neuroradiology – groin” (25 vs 20, p = 0,03) and “Onset-to-groin” (244,5 vs 227,5, p = 0,02). Conclusions During the SARS-CoV-2 pandemic, treatment for stroke patients was delayed, particularly during the first wave. Reallocation of resources and the shutting down of spoke centers may have played a determinant role.
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Affiliation(s)
- Guglielmo Pero
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda (Niguarda Ca' Granda), Milan, Italy.
| | - Hugo Mota Dória
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda (Niguarda Ca' Granda), Milan, Italy; Department of Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal; Department of Neuroradiology, Hospital Central do Funchal, Rua Nova do Comboio, N. 13, Funchal, Madeira 9050-054, Portugal.
| | - Matteo Giavarini
- Facoltà di Medicina e Chirurgia dell'Università Statale di Milano, Milan, Italy
| | - Luca Quilici
- Department of Neuroradiology, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy.
| | - Amedeo Cervo
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda (Niguarda Ca' Granda), Milan, Italy.
| | - Antonio Macera
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda (Niguarda Ca' Granda), Milan, Italy
| | - Mariangela Piano
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda (Niguarda Ca' Granda), Milan, Italy.
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