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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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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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Zapata-Wainberg G, Masjuan J, Quintas S, Ximénez-Carrillo Á, García Pastor A, Martínez Zabaleta M, Cardona P, Freijo Guerrero MM, Llull L, Benavente Fernández L, Castellanos Rodrigo M, Egido J, Serena J, Vivancos J. The neurologist's approach to cerebral infarct and transient ischaemic attack in patients receiving anticoagulant treatment for non-valvular atrial fibrillation: ANITA-FA study. Eur J Neurol 2018; 26:230-237. [DOI: 10.1111/ene.13792] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 08/17/2018] [Indexed: 12/18/2022]
Affiliation(s)
- G. Zapata-Wainberg
- Neurology Department; Hospital Universitario de La Princesa; Instituto de Investigación Sanitaria Princesa; Madrid Spain
| | - J. Masjuan
- Neurology Department; Hospital Universitario Ramón y Cajal; Red INVICTUS PLUS; Departamento de Medicina; Universidad de Alcalá (IRYCIS); Madrid Spain
| | - S. Quintas
- Neurology Department; Hospital Universitario de La Princesa; Instituto de Investigación Sanitaria Princesa; Madrid Spain
| | - Á. Ximénez-Carrillo
- Neurology Department; Hospital Universitario de La Princesa; Instituto de Investigación Sanitaria Princesa; Madrid Spain
| | - A. García Pastor
- Neurology Department; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | | | - P. Cardona
- Neurology Department; Hospital Universitari de Bellvitge; Barcelona Spain
| | | | - L. Llull
- Neurology Department; Hospital Universitari Clinic; Barcelona Spain
| | | | | | - J. Egido
- Hospital Clínico Universitario San Carlos; Madrid Spain
| | - J. Serena
- Neurology Department; Hospital Universitario Dr Josep Trueta; Girona Spain
| | - J. Vivancos
- Neurology Department; Hospital Universitario de La Princesa; Red INVICTUS PLUS; Instituto de Investigación Sanitaria La Princesa; Madrid Spain
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Zapata-Wainberg G, Quintas S, Ximénez-Carrillo Rico A, Benavente Fernández L, Masjuan Vallejo J, Gállego Culleré J, Freijó Guerrero MDM, Egido J, Gómez Sánchez J, Martínez Domeño A, Purroy F, Vives Pastor B, Rodríguez Yáñez M, Vivancos J. Factores pronósticos y análisis de la mortalidad de las hemorragias cerebrales asociadas a anticoagulantes orales antagonistas de la vitamina K. Resultados del Estudio TAC Registry. Neurologia 2018; 33:419-426. [DOI: 10.1016/j.nrl.2016.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/06/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022] Open
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