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Rodriguez-Luna D, Pancorbo O, Coscojuela P, Lozano P, Rizzo F, Olivé-Gadea M, Requena M, García-Tornel Á, Rodríguez-Villatoro N, Juega JM, Boned S, Muchada M, Pagola J, Rubiera M, Ribo M, Tomasello A, Molina CA. Derivation and validation of three intracerebral hemorrhage expansion scores using different CT modalities. Eur Radiol 2023; 33:6045-6053. [PMID: 37059906 DOI: 10.1007/s00330-023-09621-0] [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: 11/09/2022] [Revised: 01/26/2023] [Accepted: 02/13/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES To derivate and validate three scores for the prediction of intracerebral hemorrhage (ICH) expansion depending on the use of non-contrast CT (NCCT), single-phase CTA, or multiphase CTA markers of hematoma expansion, and to evaluate the added value of single-phase and multiphase CTA over NCCT. METHODS After prospectively deriving NCCT, single-phase CTA, and multiphase CTA hematoma expansion scores in 156 patients with ICH < 6 h, we validated them in 120 different patients. Discrimination and calibration of the three scores was assessed. Primary outcome was substantial hematoma expansion > 6 mL or > 33% at 24 h. RESULTS The evaluation of single-phase and multiphase CTA markers gave a steadily increase in discrimination for substantial hematoma expansion over NCCT markers. The C-index (95% confidence interval) in derivation and validation cohorts was 0.69 (0.58-0.80) and 0.59 (0.46-0.72) for NCCT score, significantly lower than 0.75 ([0.64-0.87], p = 0.038) and 0.72 ([0.59-0.84], p = 0.016) for single-phase CTA score, and than 0.79 ([0.68-0.89], p = 0.033) and 0.73 ([0.62-0.85], p = 0.031) for multiphase CTA score, respectively. The three scores showed good calibration in both derivation and validation cohorts: NCCT (χ2 statistic 0.389, p = 0.533; and χ2 statistic 0.352, p = 0.553), single-phase CTA (χ2 statistic 2.052, p = 0.359; and χ2 statistic 2.230, p = 0.328), and multiphase CTA (χ2 statistic 0.559, p = 0.455; and χ2 statistic 0.020, p = 0.887) scores, respectively. CONCLUSION This study shows the added prognostic value of more advanced CT modalities in acute ICH evaluation. NCCT, single-phase CTA, and multiphase CTA scores may help to refine the selection of patients at risk of expansion in different decision-making scenarios. KEY POINTS • This study shows the added prognostic value of more advanced CT modalities in acute intracerebral hemorrhage evaluation. • The evaluation of single-phase and multiphase CTA markers provides a steadily increase in discrimination for intracerebral hemorrhage expansion over non-contrast CT markers. • Non-contrast CT, single-phase CTA, and multiphase CTA scores may help clinicians and researchers to refine the selection of patients at risk of intracerebral hemorrhage expansion in different decision-making scenarios.
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Affiliation(s)
- David Rodriguez-Luna
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain.
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain.
- Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain.
| | - Olalla Pancorbo
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Pilar Coscojuela
- Department of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Prudencio Lozano
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Federica Rizzo
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marta Olivé-Gadea
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Manuel Requena
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Álvaro García-Tornel
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Noelia Rodríguez-Villatoro
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jesús M Juega
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Sandra Boned
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marián Muchada
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jorge Pagola
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marta Rubiera
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marc Ribo
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Alejandro Tomasello
- Department of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Carlos A Molina
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
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Sanjuan E, Pancorbo O, Santana K, Miñarro O, Sala V, Muchada M, Boned S, Juega JM, Pagola J, García-Tornel Á, Requena M, Rodríguez-Villatoro N, Rodríguez-Luna D, Deck M, Ribo M, Molina CA, Meler P, Romero V, Dalmases G, Rodríguez-Samaniego MT, Calleja L, Gutierrez T, Peña L, Gallego JC, Lorenzo E, Gonzalez Y, Moreno R, Rubiera M. Management of acute stroke. Specific nursing care and treatments in the stroke unit. Neurologia 2023:S2173-5808(23)00022-6. [PMID: 37120108 DOI: 10.1016/j.nrleng.2020.07.026] [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: 06/04/2020] [Accepted: 07/29/2020] [Indexed: 05/01/2023] Open
Abstract
OBJECTIVE This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres' internal protocols, serving as a reference for nursing care. METHODS We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification. RESULTS The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient's arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital. CONCLUSIONS These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.
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Affiliation(s)
- E Sanjuan
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - O Pancorbo
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - K Santana
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - O Miñarro
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - V Sala
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - M Muchada
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - S Boned
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - J M Juega
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - J Pagola
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Á García-Tornel
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - M Requena
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - N Rodríguez-Villatoro
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - D Rodríguez-Luna
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - M Deck
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - M Ribo
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - C A Molina
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - P Meler
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - V Romero
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - G Dalmases
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - M T Rodríguez-Samaniego
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - L Calleja
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - T Gutierrez
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - L Peña
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - J C Gallego
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - E Lorenzo
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Y Gonzalez
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - R Moreno
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - M Rubiera
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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3
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Sanjuan E, Pancorbo O, Santana K, Miñarro O, Sala V, Muchada M, Boned S, Juega JM, Pagola J, García-Tornel Á, Requena M, Rodríguez-Villatoro N, Rodríguez-Luna D, Deck M, Ribo M, Molina CA, Meler P, Romero V, Dalmases G, Rodríguez-Samaniego MT, Calleja L, Gutierrez T, Peña L, Gallego JC, Lorenzo E, Gonzalez Y, Moreno R, Rubiera M. Management of acute stroke. Specific nursing care and treatments in the stroke unit. Neurologia 2020; 38:S0213-4853(20)30291-7. [PMID: 33153769 DOI: 10.1016/j.nrl.2020.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres' internal protocols, serving as a reference for nursing care. METHODS We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification. RESULTS The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient's arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital. CONCLUSIONS These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.
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Affiliation(s)
- E Sanjuan
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España.
| | - O Pancorbo
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | - K Santana
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - O Miñarro
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - V Sala
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - M Muchada
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - S Boned
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - J M Juega
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - J Pagola
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - Á García-Tornel
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - M Requena
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - N Rodríguez-Villatoro
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - D Rodríguez-Luna
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - M Deck
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - M Ribo
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - C A Molina
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - P Meler
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - V Romero
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - G Dalmases
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - M T Rodríguez-Samaniego
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - L Calleja
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - T Gutierrez
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - L Peña
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - J C Gallego
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - E Lorenzo
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - Y Gonzalez
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - R Moreno
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
| | - M Rubiera
- Unidad de Ictus, Servicio de Neurología, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
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Contreras Muruaga M, Reig G, Vivancos J, González A, Cardona P, Ramírez-Moreno J, Martí-Fábregas J, Suárez Fernández C, Pose A, Díaz JA, Rodríguez M, Pena M, Arias S, Larrosa D, González Á, Rodríguez E, González M, Fernández D, Barbagelata C, Raña N, Freire S, Cerqueiro JM, Guerrero H, Ramos L, Álvarez L, de Lis JM, Caro C, Seijo M, Mederer S, de Zarraga MA, Ferreiro J, Terrero JM, Arias M, Pérez R, Sánchez J, Maciñeiras J, Fernández J, Jaén F, Esteva D, Zamora M, Navarrete N, García J, Mérida L, Corrales MÁ, Quirós R, Cantero J, Barrero FJ, Villegas I, Castro J, Foronda J, Carrillo D, Vega J, Trujillo JA, Montero M, Jurado A, Sánchez C, Agüera-Morales E, Sánchez M, Durán P, Fernández de la Puerta R, Pérez de la Blanca M, Martínez MP, Fernández Ó, Tamayo JA, Bustamante R, Serrano PJ, Arjona A, Fernández J, Payan M, Gómez R, Peña D, Cabrerizo E, Salgado F, Ivanova Georgieva R, Gil-Núñez A, Bello E, Díaz F, Medina A, Castellano A, Miranda Y, Fabre Ó, García Polo I, Ibáñez P, Sainz C, Sierra F, Aragón E, Díaz J, Aguilar F, Ortega MÁ, Egido JA, Pontes JC, García MÁ, Cabrera F, Batalla B, Culla A, Molina C, Flores A, Seró L, Muchada M, Meler P, Boned-Riera S, Cánovas D, Estela J, Font J, Purroy F, Benabdelhak I, Sanahuja J, Roquer J, Rodríguez A, Ois Á, Cuadrado E, Jiménez J, Nogués X, Kuprinski J, German A, Irigoyen D, Cara JJ, Font MÀ, Huertas S, Martínez-Domeño A, Arroyo JA, Delgado-Mederos R, Gómez-Choco MJ, Mengual JJ, García SM, Castellanos MDM, van Eedenburg C, Cañas I, Espinosa J, Montull S, Quesada H, Ustrell X, Homedes C, Navalpotro I, Casanova J, Lago AP, Morata C, Gorriz D, Moreno I, Tembl J, Ponz A, Fonseca MJ, Chamarro R, Gil R, Oliver V, Pampliega A, Artero A, Puchades F, Landete L, Vilar C, Jiménez C, Vives B, Moragues MD, Díaz R, Tur S, Escribano JB, Lucas C, Martínez F, Pons JM, Romero A, García D, Pérez J, Villaverde R, Martínez S, Rodríguez A, Tejero C, Pérez C, Mostacero E, Fernández C, Luna A, Pérez T, González F, de Arce A, Martínez M, Díez N, Gállego J, Zandio B, Herrera M, Aymerich N, Muñoz R, Marta J, Artal J, Errea JM, Timiraos JJ, Moreno MP, Freijo M, García JM, Gil MC, Revilla MÁ, Palacio E, Vázquez JL, Bestué M, Latorre A, Calvo E, Ballester L, Serrano M, Juega JM, López MÁ, Irimia P, Imaz L, Fuentes B, Sanz BE, Beltrán L, Ruiz G, Martínez P, Sánchez D, Barroso E, Molina I, Budiño MA, Masjuan J, de Felipe A, Matute C, Tejada J, Morán A, Fernández E, Riveira MDC, Carnedo J, Manquillo A, González R, Fernández JC, Guillan M, Yebra M, Trejo JM, Saiz J, Martínez-Acitores JC, Bravo Y, Arenillas JF, Calleja A, Cortijo E, Reyes J, López L, Muñoz PL, Fidalgo MÁ, Hernández J, Gómez JC, Morán JC, Gonzalo S, Marrero J, Satué JÁ, Belinchón JC, Moniche F, Calderón E, Escudero I, de la Torre J, Casado I, Antón J, Portilla JC, Luengo J, Rosal J, Calzado E, Anglada JC, Girón J, Ramírez JM, Pijierro A, Roa A, Romero J, Aguayo M, Borrachero C, Sanz G, Gómez MJ, Rico MÁ, Cayon A, Carmona E, Cerro R, López R, Aguirre A, Lozano F, Rivera JM. Factors associated with poor anticoagulation control with vitamin K antagonists among outpatients attended in Internal Medicine and Neurology. The ALADIN study. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.04.018] [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: 10/28/2022]
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Martins N, Aires A, Mendez B, Boned S, Rubiera M, Tomasello A, Coscojuela P, Hernandez D, Muchada M, Rodríguez-Luna D, Rodríguez N, Juega JM, Pagola J, Molina CA, Ribó M. Ghost Infarct Core and Admission Computed Tomography Perfusion: Redefining the Role of Neuroimaging in Acute Ischemic Stroke. Interv Neurol 2018; 7:513-521. [PMID: 30410531 DOI: 10.1159/000490117] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 04/22/2018] [Indexed: 12/13/2022]
Abstract
Background Determining the size of infarct extent is crucial to elect patients for reperfusion therapies. Computed tomography perfusion (CTP) based on cerebral blood volume may overestimate infarct core on admission and consequently include ghost infarct core (GIC) in a definitive lesional area. Purpose Our goal was to confirm and better characterize the GIC phenomenon using CTP cerebral blood flow (CBF) as the reference parameter to determine infarct core. Methods We performed a retrospective, single-center analysis of consecutive thrombectomies of middle cerebral or intracranial internal carotid artery occlusions considering noncontrast CT Alberta Stroke Program Early CT Score ≥6 in patients with pretreatment CTP. We used the RAPID® software to measure admission infarct core based on initial CBF. The final infarct was extracted from follow-up CT. GIC was defined as initial core minus final infarct > 10 mL. Results A total of 123 patients were included. The median National Institutes of Health Stroke Scale score was 18 (13-20), the median time from symptoms to CTP was 188 (67-288) min, and the recanalization rate (Thrombolysis in Cerebral Infarction score 2b, 2c, or 3) was 83%. Twenty patients (16%) presented with GIC. GIC was associated with shorter time to recanalization (150 [105-291] vs. 255 [163-367] min, p = 0.05) and larger initial CBF core volume (38 [26-59] vs. 6 [0-27] mL, p < 0.001). An adjusted logistic regression model identified time to recanalization < 302 min (OR 4.598, 95% CI 1.143-18.495, p = 0.032) and initial infarct volume (OR 1.01, 95% CI 1.001-1.019, p = 0.032) as independent predictors of GIC. At 24 h, clinical improvement was more frequent in patients with GIC (80 vs. 49%, p = 0.01). Conclusions CTP CBF < 30% may overestimate infarct core volume, especially in patients imaged in the very early time window and with fast complete reperfusion. Therefore, the CTP CBF technique may exclude patients who would benefit from endovascular treatment.
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Affiliation(s)
- Nuno Martins
- Department of Internal Medicine, Hospital Fernando Fonseca, Amadora, Portugal
| | - Ana Aires
- Department of Neurology, São João Hospital Center, Porto, Portugal.,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Beatriz Mendez
- Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Sandra Boned
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain.,Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain.,Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Alejandro Tomasello
- Department of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Pilar Coscojuela
- Department of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - David Hernandez
- Department of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marián Muchada
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain.,Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - David Rodríguez-Luna
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain.,Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Noelia Rodríguez
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain.,Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jesús M Juega
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain.,Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jorge Pagola
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain.,Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain.,Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Marc Ribó
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain.,Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
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6
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Rodriguez-Villatoro N, Rodriguez-Luna D, Ribø M, Muchada M, Requena M, Pagola J, Boned S, Juega JM, Coscojuela P, Vert C, Rubiera M, Molina C, Tomasello A. Abstract WMP40: A Comparison of Three Different Endovascular Approaches for Extracranial Internal Carotid Artery Lesions in the Setting of Tandem Occlusions. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.wmp40] [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] [Indexed: 11/16/2022]
Abstract
Background:
Endovascular treatment (EVT) of extracranial internal carotid artery (ICA) lesions in the setting of tandem occlusions is a challenge, being angioplasty alone (AA) or angioplasty+stenting (AS) the two current approaches. Hemorrhagic transformation (HT) is a major problem when a conventional [self-expanding (SX)] stent is placed, regarding the need of early double antiplatelet therapy. Interestingly, balloon-expanding (BX) stents, due to their less thrombogenicity, may constitute an alternative, so they do not need early antiplatelets. We aimed to study differences in ICA restenosis, HT, clinical outcome and stroke recurrence between patients treated with AA or AS.
Methods:
Prospective study of consecutive patients with non-cardioembolic ischemic stroke and tandem occlusions, who underwent <6hours EVT from April 2013 to April 2017. We compared rate of ICA high-degree stenosis/occlusion at 24h, HT, clinical outcome (change in NIHSS at 24h and at discharge over NIHSS at admission, and mRS≥2 at 3 months) and stroke recurrence within 3 months between AA and AS (SX and BX stents) groups.
Results:
Ninety-two patients fulfilled inclusion criteria: mean age 64.6±12.6 years. Forty (43.5%) received AA and 52 (56.5%) AS (61.5% SX stents, 38.5% BX stents). Both groups were comparable in baseline characteristics. Fifty (54.3%) received IV rtPA. Patients who underwent AA presented ICA high-degree stenosis/occlusion at 24h more frequently than those who underwent AS (86.5% vs. 21.2%,
p
<0.001). No differences were found in HT, clinical outcome and stroke recurrence (
p
>0.05 for all comparisons). In the AS group, all SX stents received antiplatelets after EVT, whereas in 75% of cases in the BX group no antiplatelets were started within 24h. However, no differences were found in ICA high-degree stenosis /occlusion at 24h, clinical outcome and stroke recurrence (
p
>0.05). We neither found differences in HT. Nevertheless, all cases were asymptomatic in the BX stents group.
Conclusions:
Emergent ICA stenting seems to have a lower risk of restenosis compared to AA, without a significant increase of HT and stroke recurrence or a worse clinical outcome. BX stents, without early antiplatelet therapy, are a promising alternative to conventional carotid stents.
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Affiliation(s)
| | | | - Marc Ribø
- Stroke Unit, Vall d’Hebron Univ Hosp, Barcelona, Spain
| | | | | | - Jorge Pagola
- Stroke Unit, Vall d’Hebron Univ Hosp, Barcelona, Spain
| | - Sandra Boned
- Stroke Unit, Vall d’Hebron Univ Hosp, Barcelona, Spain
| | | | | | - Carla Vert
- Neuroradiology Dept, Vall d’Hebron Univ Hosp, Barcelona, Spain
| | - Marta Rubiera
- Stroke Unit, Vall d’Hebron Univ Hosp, Barcelona, Spain
| | - Carlos Molina
- Stroke Unit, Vall d’Hebron Univ Hosp, Barcelona, Spain
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7
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Rodriguez-Luna D, Coscojuela P, Rodriguez-Villatoro N, Juega JM, Boned S, Muchada M, Pagola J, Rubiera M, Ribo M, Tomasello A, Demchuk AM, Goyal M, Molina CA. Multiphase CT Angiography Improves Prediction of Intracerebral Hemorrhage Expansion. Radiology 2017; 285:932-940. [DOI: 10.1148/radiol.2017162839] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- David Rodriguez-Luna
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Pilar Coscojuela
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Noelia Rodriguez-Villatoro
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Jesús M. Juega
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Sandra Boned
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Marián Muchada
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Jorge Pagola
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Marta Rubiera
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Marc Ribo
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Alejandro Tomasello
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Andrew M. Demchuk
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Mayank Goyal
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Carlos A. Molina
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
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8
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Rodriguez-Luna D, Rodriguez-Villatoro N, Juega JM, Boned S, Muchada M, Sanjuan E, Pagola J, Rubiera M, Ribo M, Coscojuela P, Molina CA. Prehospital Systolic Blood Pressure Is Related to Intracerebral Hemorrhage Volume on Admission. Stroke 2017; 49:204-206. [PMID: 29167387 DOI: 10.1161/strokeaha.117.018485] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 06/30/2017] [Revised: 10/08/2017] [Accepted: 10/26/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Ultra-early blood pressure (BP) management in the prehospital setting could improve the efficacy of this treatment on attenuating intracerebral hemorrhage (ICH) expansion. We aimed to determine the association of prehospital systolic BP (SBP) with ICH volume, ultra-early hematoma growth, and the spot sign on admission. METHODS We conducted a retrospective study of a prospective database of 219 consecutive patients with spontaneous ICH admitted to the emergency department of a tertiary stroke center during a 3-year period. Prehospital SBP and ICH volume, ultra-early hematoma growth (ICH volume/onset-to-imaging time), and presence of the spot sign on admission were prospectively recorded. Primary outcome was ICH volume on admission. Secondary outcomes included ultra-early hematoma growth and frequency of the spot sign in patients scanned within 6 hours from symptom onset (hyperacute group). RESULTS Prehospital SBP was positively correlated with both SBP (r=0.552; P<0.001) and ICH volume (ρ=0.189; P=0.006) on admission. Patients with ICH volume above the median value presented higher prehospital SBP (172.3±35.0 versus 163.7±27.8 mm Hg; P=0.049). This association remained significant in adjusted multiple logistic regression analysis (odds ratio, 1.01 for a 1-U increase in SBP; 95% confidence interval, 1.01-1.02; P=0.018). In the hyperacute group (n=126), prehospital SBP was unrelated to ultra-early hematoma growth (ρ=0.115; P=0.203) nor the presence of the spot sign (172.2±27.6 versus 171.8±31.6 mm Hg; P=0.959). CONCLUSIONS Prehospital SBP is correlated with SBP on admission and independently associated with ICH volume on admission. These findings support the rationale of testing whether prehospital initiation of BP-lowering attenuates ICH expansion.
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Affiliation(s)
- David Rodriguez-Luna
- From the Stroke Unit, Department of Neurology (D.R.-L., N.R.-V., J.M.J., S.B., M.M., E.S., J.P., M. Rubiera, M. Ribo, C.A.M.) and Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Noelia Rodriguez-Villatoro
- From the Stroke Unit, Department of Neurology (D.R.-L., N.R.-V., J.M.J., S.B., M.M., E.S., J.P., M. Rubiera, M. Ribo, C.A.M.) and Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jesús M Juega
- From the Stroke Unit, Department of Neurology (D.R.-L., N.R.-V., J.M.J., S.B., M.M., E.S., J.P., M. Rubiera, M. Ribo, C.A.M.) and Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sandra Boned
- From the Stroke Unit, Department of Neurology (D.R.-L., N.R.-V., J.M.J., S.B., M.M., E.S., J.P., M. Rubiera, M. Ribo, C.A.M.) and Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marián Muchada
- From the Stroke Unit, Department of Neurology (D.R.-L., N.R.-V., J.M.J., S.B., M.M., E.S., J.P., M. Rubiera, M. Ribo, C.A.M.) and Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Estela Sanjuan
- From the Stroke Unit, Department of Neurology (D.R.-L., N.R.-V., J.M.J., S.B., M.M., E.S., J.P., M. Rubiera, M. Ribo, C.A.M.) and Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jorge Pagola
- From the Stroke Unit, Department of Neurology (D.R.-L., N.R.-V., J.M.J., S.B., M.M., E.S., J.P., M. Rubiera, M. Ribo, C.A.M.) and Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marta Rubiera
- From the Stroke Unit, Department of Neurology (D.R.-L., N.R.-V., J.M.J., S.B., M.M., E.S., J.P., M. Rubiera, M. Ribo, C.A.M.) and Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marc Ribo
- From the Stroke Unit, Department of Neurology (D.R.-L., N.R.-V., J.M.J., S.B., M.M., E.S., J.P., M. Rubiera, M. Ribo, C.A.M.) and Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Pilar Coscojuela
- From the Stroke Unit, Department of Neurology (D.R.-L., N.R.-V., J.M.J., S.B., M.M., E.S., J.P., M. Rubiera, M. Ribo, C.A.M.) and Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Carlos A Molina
- From the Stroke Unit, Department of Neurology (D.R.-L., N.R.-V., J.M.J., S.B., M.M., E.S., J.P., M. Rubiera, M. Ribo, C.A.M.) and Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital, Barcelona, Spain
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