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Santos Neto EPD, Sousa ÍAD, Ricarte IF, Pontes-Neto OM. Reversible Cerebral Vasoconstriction Syndrome And Fibromuscular Dysplasia: An Epiphenomenon Or A Causal Relationship? Acta Neurol Taiwan 2024; 33(3):122-126. [PMID: 37968850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Fibromuscular dysplasia (FMD) is a rare non-atherosclerotic arterial disease that primarily affects middle-aged Caucasian women. Carotid web (CW) is a variant of FMD characterized by a nonatheromatous, membrane-like tissue protrusion into the carotid bulb. Reversible cerebral vasoconstriction syndrome (RCVS) is defined by severe headaches and reversible narrowing of cerebral arteries, which typically resolves within three months. While most RCVS cases have identifiable triggers, a significant portion occurs without known causes. Recent studies have reported a high prevalence of neurovascular abnormalities in RCVS patients. We present a case of a thirty-year-old woman with a sudden-onset severe headache, diagnosed with RCVS associated with carotid web. The patient had no ischemic involvement and responded well to flunarizine treatment. Follow-up imaging showed no stenosis. This case highlights a potential association between carotid web and RCVS, suggesting that FMD may contribute to vascular hyperreactivity and presents as a risk factor for RCVS. Further investigations are needed to understand the underlying mechanisms connecting these two vascular disorders. Keywords: reversible vasoconstriction syndrome; fibromuscular dysplasia; carotid web; structural abnormalities; vascular hyperreactivity.
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Affiliation(s)
- Elizeu Pereira Dos Santos Neto
- Institute of Radiology, University of São Paulo School of Medicine, Hospital das Clínicas, São Paulo SP, Brazil; Neurologist and Interventional Neuroradiologist, Department of Neurology, Hospital Getúlio Vargas, Teresina PI, Brazil
| | - Ícaro Araújo de Sousa
- Department of Neuroscience and Behavior Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Irapuá Ferreira Ricarte
- Department of Neurology and Neurosurgery, São Paulo Federal University, São Paulo, SP, Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neuroscience and Behavior Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Martins SCO, Pontes-Neto OM, Pille A, Secchi TL, Miranda Alves MAD, Rebello LC, Oliveira-Filho J, Lange MC, de Freitas GR, de Andrade JBC, Rocha LJDA, Bezerra DDC, Souza ACD, Carbonera LA, Nogueira RG, Silva GS. Reperfusion therapy for acute ischemic stroke: where are we in 2023? Arq Neuropsiquiatr 2023; 81:1030-1039. [PMID: 38157871 PMCID: PMC10756810 DOI: 10.1055/s-0043-1777721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
Over the last three decades, stroke care has undergone significant transformations mainly driven by the introduction of reperfusion therapy and the organization of systems of care. Patients receiving treatment through a well-structured stroke service have a much higher chance of favorable outcomes, thereby decreasing both disability and mortality. In this article, we reviewed the scientific evidence for stroke reperfusion therapy, including thrombolysis and thrombectomy, and its implementation in the public health system in Brazil.
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Affiliation(s)
- Sheila Cristina Ouriques Martins
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.
- Hospital Moinhos de Vento, Porto Alegre RS, Brazil.
| | | | - Arthur Pille
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.
- Hospital Moinhos de Vento, Porto Alegre RS, Brazil.
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Sousa ÍAD, Santos Neto EPD, Corrêa MR, Veras ADO, Pontes-Neto OM. Reversible cerebral vasoconstriction syndrome related to extracranial dissection associated with COVID-19: an immunological trigger? Einstein (Sao Paulo) 2023; 21:eAI0445. [PMID: 37970948 DOI: 10.31744/einstein_journal/2023ai0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/14/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- Ícaro Araújo de Sousa
- Department of Neuroscience and Behavior Sciences, Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP , Brazil
| | - Elizeu Pereira Dos Santos Neto
- Institute of Radiology, Hospital das Clínicas , Faculdade de Medicina , Universidade de São Paulo , São Paulo SP , Brazil
| | - Matheus Rodrigues Corrêa
- Department of Neurology , Faculdade de Medicina , Universidade Federal do Piauí , Teresina , PI , Brazil
| | - Arthur de Oliveira Veras
- Department of Neuroscience and Behavior Sciences, Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP , Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neuroscience and Behavior Sciences, Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP , Brazil
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Rodrigues de Oliveira LF, Camilo MR, Franciscatto L, Podolsky-Gondim GG, Alves FFA, Filho RKDVM, Dias FA, Tanaka K, Colli BO, Pontes-Neto OM. Outcomes of decompressive craniectomy for malignant middle cerebral artery stroke in an academic hospital in Brazil. Arq Neuropsiquiatr 2023; 81:778-784. [PMID: 37793399 PMCID: PMC10550345 DOI: 10.1055/s-0043-1772602] [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] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/02/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Ischemic stroke is an important cause of death in the world. The malignant middle cerebral artery infarction (MMCAI) has mortality as high as 80% when clinically treated. In this setting, decompressive craniectomy is a life-saving measure, in spite of high morbidity among survivors. OBJECTIVE To evaluate the outcomes of patients with MMCAI treated with decompressive craniectomy in a Brazilian academic tertiary stroke center. METHODS A prospective stroke database was retrospectively evaluated, and all patients treated with decompressive craniectomy for MMCAI between January 2014 and December 2017 were included. The demographics and clinical characteristics were evaluated. The functional outcome, measured by the modified Rankin Scale (mRS), was assessed at hospital discharge, after 3-months and 1-year of follow-up. RESULTS We included 53 patients on the final analysis. The mean age was 54.6 ± 11.6 years and 64.2% were males. The median time from symptoms to admission was 4.8 (3-9.7) hours and the mean time from symptoms to surgery was 36 ± 17 hours. The left hemisphere was the affected in 39.6%. The median NIHSS at admission was 20 (16-24). The in-hospital mortality was 30.2%. After a median of 337 [157-393] days, 47.1% of patients had achieved favorable outcome (mRS ≤ 4) and 39.6% had died. CONCLUSION Decompressive craniectomy is a life-saving measure in the setting of MMCAI, and its effects remains important in the scenario of a middle-income country in real-world situations.
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Affiliation(s)
- Luiz Fernando Rodrigues de Oliveira
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
| | - Millene Rodrigues Camilo
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
| | - Luisa Franciscatto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
| | - Guilherme Gozzoli Podolsky-Gondim
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento Cirurgia, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil.
| | - Frederico Fernandes Alessio Alves
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
| | - Rui Kleber do Vale Martins Filho
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
| | - Francisco Antunes Dias
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
| | - Koji Tanaka
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento Cirurgia, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil.
| | - Benedicto Oscar Colli
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento Cirurgia, Divisão de Neurocirurgia, Ribeirão Preto SP, Brazil.
| | - Octávio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil.
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Cacho RDO, Moro CHC, Bazan R, Guarda SNFD, Pinto EB, Andrade SMMDS, Valler L, Almeida KJ, Ribeiro TS, Jucá RVBDM, Minelli C, Piemonte MEP, Paschoal EHA, Pedatella MTA, Pontes-Neto OM, Fontana AP, Pagnussat ADS, Conforto AB. Reply to the letter regarding the article entitled: "Access to rehabilitation after stroke in Brazil (AReA study): multicenter study protocol". Arq Neuropsiquiatr 2023; 81:703-704. [PMID: 37494953 PMCID: PMC10371397 DOI: 10.1055/s-0043-1771266] [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] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Affiliation(s)
- Roberta de Oliveira Cacho
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz RN, Brazil
| | | | - Rodrigo Bazan
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, São Paulo SP, Brazil
| | | | - Elen Beatriz Pinto
- Escola Bahiana de Medicina e Saúde Pública, Fundação para o Desenvolvimento das Ciências, Salvador BA, Brazil
| | | | - Lenise Valler
- Universidade Federal de Campinas, Campinas SP, Brazil
| | - Kelson James Almeida
- Universidade Federal do Piauí, Centro Universitário UniFacid, Teresina PI, Brazil
| | | | | | - Cesar Minelli
- Hospital Carlos Fernando Malzoni, Instituto "Você sem AVC," Matão SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil
| | | | | | | | | | - Ana Paula Fontana
- Universidade Federal do Rio de Janeiro, Faculdade de Fisioterapia, Laboratório Pesquisa em Recuperação Funcional Após AVC, Rio de Janeiro RJ, Brazil
| | - Aline de Souza Pagnussat
- Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Fisioterapia, Porto Alegre RS, Brazil
| | - Adriana Bastos Conforto
- Universidade de São Paulo, Hospital de Clínicas, São Paulo SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo SP, Brazil
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Sousa IAD, Neto EPDS, Ricarte IF, Pontes-Neto OM. Reversible cerebral vasoconstriction syndrome associated with Chikungunya infection. BMJ Case Rep 2023; 16:e254729. [PMID: 37399350 DOI: 10.1136/bcr-2023-254729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Affiliation(s)
- Icaro Araújo de Sousa
- Department of Neuroscience and Behavior Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Elizeu Pereira Dos Santos Neto
- Department of Neurology, Hospital Santa Marcelina, Sao Paulo, São Paulo, Brazil
- Department of Interventional Neuroradiology, University of Sao Paulo Medical School, Sao Paulo, São Paulo, Brazil
| | - Irapuá Ferreira Ricarte
- Department of Neurology and Neurosurgery, Federal University of São Paulo, Sao Paulo, São Paulo, Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neuroscience and Behavior Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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dos Santos Neto EP, de Sousa ÍA, Veras ADO, de Barros-Araújo ML, Ricarte IF, Pontes-Neto OM. Case report: Flow changes in routes of collateral circulation in patients with LVO and low NIHSS: a point favor to treat. Front Neurol 2023; 14:1165484. [PMID: 37360333 PMCID: PMC10287161 DOI: 10.3389/fneur.2023.1165484] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/08/2023] [Indexed: 06/28/2023] Open
Abstract
The effectiveness of endovascular thrombectomy in patients presenting low National Institutes of Health Stroke Scale (NIHSS) scores remains controversial, and the acquisition of additional evidence is required to refine the selection of candidates who may benefit the most from this therapeutic modality. In this study, we present the case of a 62-year-old individual, with left internal carotid occlusion stroke and low NIHSS, who had compensatory collateral flow from Willis polygon via the anterior communicating artery. The patient subsequently exhibited neurological deterioration and collateral flow failure from Willis polygon, indicating the need for urgent intervention. The study of collaterals in patients with large vessel occlusion stroke has garnered considerable attention, with research suggesting that individuals with low NIHSS scores and poor collateral profiles may be at a heightened risk of early neurological deterioration. We postulate that such patients may derive significant benefits from endovascular thrombectomy, and may posit that an intensive transcranial Doppler monitoring protocol could facilitate the identification of suitable candidates for such intervention.
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Affiliation(s)
- Elizeu Pereira dos Santos Neto
- Institute of Radiology, University of São Paulo School of Medicine, Hospital das Clínicas, São Paulo, SP, Brazil
- Neurologist and Interventional Neuroradiologist, Hospital Santa Maria, Teresina, PI, Brazil
| | - Ícaro Araújo de Sousa
- Department of Neuroscience and Behavior Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Arthur de Oliveira Veras
- Department of Neuroscience and Behavior Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marx Lima de Barros-Araújo
- Institute of Radiology, University of São Paulo School of Medicine, Hospital das Clínicas, São Paulo, SP, Brazil
| | - Irapuá Ferreira Ricarte
- Department of Neurology and Neurosurgery, São Paulo Federal University, São Paulo, SP, Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neuroscience and Behavior Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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8
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Cacho RDO, Moro CHC, Bazan R, Guarda SNFD, Pinto EB, Andrade SMMDS, Valler L, Almeida KJ, Ribeiro TS, Jucá RVBDM, Minelli C, Piemonte MEP, Paschoal EHA, Pedatella MTA, Pontes-Neto OM, Fontana AP, Pagnussat ADS, Conforto AB. Access to rehabilitation after stroke in Brazil (AReA study): multicenter study protocol. Arq Neuropsiquiatr 2022; 80:1067-1074. [PMID: 36535291 PMCID: PMC9770079 DOI: 10.1055/s-0042-1758558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Most of the Brazilian population relies on public healthcare and stroke is a major cause of disability in this country of continental dimensions. There is limited information about access to rehabilitation after stroke in Brazil. OBJECTIVE To provide comprehensive information about Access to Rehabilitation After discharge from public hospitals in Brazil (AReA study), up to 6 months after stroke. METHODS The present study intends to collect information from 17 public health centers in 16 Brazilian cities in the 5 macroregions of the country. Each center will include 36 participants (n = 612). The inclusion criteria are: age ≥ 18 years old; ischemic or hemorrhagic stroke, from 6 months to 1 year prior to the interview; admission to a public hospital in the acute phase after stroke; any neurological impairment poststroke; patient or caregiver able to provide informed consent and answer the survey. Patients can only be recruited in public neurology or internal medicine outpatient clinics. Outcomes will be assessed by a standard questionnaire about rehabilitation referrals, the rehabilitation program (current status, duration in months, number of sessions per week) and instructions received. In addition, patients will be asked about preferences for locations of rehabilitation (hospitals, clinics, or at home). TRIAL STATUS The study is ongoing. Recruitment started on January 31st, 2020 and is planned to continue until June 2022. CONCLUSION The AReA study will fill a gap in knowledge about access to stroke rehabilitation in the public health system in different Brazilian regions.
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Affiliation(s)
- Roberta de Oliveira Cacho
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz RN, Brazil.,Address for correspondence Roberta de Oliveira Cacho
| | | | - Rodrigo Bazan
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, São Paulo SP, Brazil.
| | | | - Elen Beatriz Pinto
- Escola Bahiana de Medicina e Saúde Pública, Fundação para o Desenvolvimento das Ciências, Salvador BA, Brazil.
| | | | - Lenise Valler
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas SP, Brazil.
| | - Kelson James Almeida
- Universidade Federal do Piauí, Centro Universitário UniFacid, Departamento de Medicina Especializada em Neurologia, Teresina PI, Brazil.
| | - Tatiana Souza Ribeiro
- Universidade Federal do Rio Grande do Norte, Departamento de Fisioterapia, Natal RN, Brazil.
| | | | - Cesar Minelli
- Hospital Carlos Fernando Malzoni, Instituto “Você sem AVC”, Matão SP, Brazil.,Universidade de São Paulo, Departamento de Neurociências e Ciências Comportamentais, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil.
| | - Maria Elisa Pimentel Piemonte
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil.
| | | | | | | | - Ana Paula Fontana
- Universidade Federal do Rio de Janeiro, Faculdade de Fisioterapia, Laboratório Pesquisa em Recuperação Funcional Após AVC, Rio de Janeiro RJ, Brazil.
| | - Aline de Souza Pagnussat
- Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Fisioterapia, Porto Alegre RS, Brazil.
| | - Adriana Bastos Conforto
- Universidade de São Paulo, Hospital de Clínicas, Divisão de Neurologia Clínica, São Paulo SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo SP, Brazil.
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Minelli C, Luvizutto GJ, Cacho RDO, Neves LDO, Magalhães SCSA, Pedatella MTA, de Mendonça LIZ, Ortiz KZ, Lange MC, Ribeiro PW, de Souza LAPS, Milani C, da Cruz DMC, da Costa RDM, Conforto AB, Carvalho FMM, Ciarlini BS, Frota NAF, Almeida KJ, Schochat E, Oliveira TDP, Miranda C, Piemonte MEP, Lopes LCG, Lopes CG, Tosin MHDS, Oliveira BC, de Oliveira BGRB, de Castro SS, de Andrade JBC, Silva GS, Pontes-Neto OM, de Carvalho JJF, Martins SCO, Bazan R. Brazilian practice guidelines for stroke rehabilitation: Part II. Arq Neuropsiquiatr 2022; 80:741-758. [PMID: 36254447 PMCID: PMC9685826 DOI: 10.1055/s-0042-1757692] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/18/2022] [Indexed: 10/14/2022]
Abstract
The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.
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Affiliation(s)
- Cesar Minelli
- Hospital Carlos Fernando Malzoni, Matão SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
- Instituto Você sem AVC, Matão SP, Brazil
| | - Gustavo José Luvizutto
- Universidade Federal do Triângulo Mineiro, Departamento de Fisioterapia Aplicada, Uberaba MG, Brazil
| | - Roberta de Oliveira Cacho
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz RN, Brazil
| | | | | | - Marco Túlio Araújo Pedatella
- Hospital Israelita Albert Einstein, Unidade Goiânia, Goiânia GO, Brazil
- Hospital Santa Helena, Goiânia GO, Brazil
- Hospital Encore, Goiânia GO, Brazil
- Hospital Estadual Geral de Goiânia Dr. Alberto Rassi, Goiânia GO, Brazil
- Hospital de Urgência de Goiânia, Goiânia, GO, Brazil
| | - Lucia Iracema Zanotto de Mendonça
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, São Paulo SP, Brazil
- Pontíficia Universidade Católica de São Paulo, Faculdade de Ciências Humanas e da Saúde, São Paulo SP, Brazil
| | - Karin Zazo Ortiz
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Fala, Linguagem e Ciências Auditivas, São Paulo SP, Brazil
| | | | | | | | - Cristiano Milani
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Serviço de Neurologia Vascular e Emergências Neurológicas, Ribeirão Preto SP, Brazil
| | | | | | - Adriana Bastos Conforto
- Universidade de São Paulo, Hospital das Clínicas, Divisão de Neurologia Clínica, São Paulo SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo SP, Brazil
| | | | - Bruna Silva Ciarlini
- Universidade de Fortaleza, Programa de Pos-Graduação em Ciências Médicas, Fortaleza CE, Brazil
| | | | | | - Eliane Schochat
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Tatiana de Paula Oliveira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Camila Miranda
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Maria Elisa Pimentel Piemonte
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Laura Cardia Gomes Lopes
- Universidade Estadual de São Paulo, Faculdade de Medicina de Botucatu, Hospital das Clínicas, Departamento de Neurologia, Psicologia e Psiquiatria, São Paulo SP, Brazil
| | | | | | | | | | | | | | | | - Octávio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | | | - Sheila C. Ouriques Martins
- Rede Brasil AVC, Porto Alegre RS, Brazil
- Hospital Moinhos de Vento, Departamento de Neurologia, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil
| | - Rodrigo Bazan
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu SP, Brazil
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Minelli C, Bazan R, Pedatella MTA, Neves LDO, Cacho RDO, Magalhães SCSA, Luvizutto GJ, Moro CHC, Lange MC, Modolo GP, Lopes BC, Pinheiro EL, de Souza JT, Rodrigues GR, Fabio SRC, do Prado GF, Carlos K, Teixeira JJM, Barreira CMA, Castro RDS, Quinan TDL, Damasceno E, Almeida KJ, Pontes-Neto OM, Dalio MTRP, Camilo MR, Tosin MHDS, Oliveira BC, de Oliveira BGRB, de Carvalho JJF, Martins SCO. Brazilian Academy of Neurology practice guidelines for stroke rehabilitation: part I. Arq Neuropsiquiatr 2022; 80:634-652. [PMID: 35946713 PMCID: PMC9387194 DOI: 10.1590/0004-282x-anp-2021-0354] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/21/2021] [Accepted: 01/18/2022] [Indexed: 06/15/2023]
Abstract
The Guidelines for Stroke Rehabilitation are the result of a joint effort by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology aiming to guide professionals involved in the rehabilitation process to reduce functional disability and increase individual autonomy. Members of the group participated in web discussion forums with predefined themes, followed by videoconference meetings in which issues were discussed, leading to a consensus. These guidelines, divided into two parts, focus on the implications of recent clinical trials, systematic reviews, and meta-analyses in stroke rehabilitation literature. The main objective was to guide physicians, physiotherapists, speech therapists, occupational therapists, nurses, nutritionists, and other professionals involved in post-stroke care. Recommendations and levels of evidence were adapted according to the currently available literature. Part I discusses topics on rehabilitation in the acute phase, as well as prevention and management of frequent conditions and comorbidities after stroke.
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Affiliation(s)
- Cesar Minelli
- Hospital Carlos Fernando Malzoni, Matão SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | - Rodrigo Bazan
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu SP, Brazil
| | - Marco Túlio Araújo Pedatella
- Hospital Israelita Albert Einstein, Unidade Goiânia, Goiânia GO, Brazil
- Hospital Santa Helena, Goiânia GO, Brazil
- Hospital Encore, Goiânia GO, Brazil
- Hospital Geral de Goiânia, Goiania GO, Brazil
- Hospital de Urgência de Goiânia, Goiânia GO, Brazil
| | | | - Roberta de Oliveira Cacho
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz RN, Brazil
| | | | - Gustavo José Luvizutto
- Universidade Federal do Triângulo Mineiro, Departamento de Fisioterapia Aplicada, Uberaba MG, Brazil
| | - Carla Heloísa Cabral Moro
- Neurológica Joinville, Joinville SC, Brazil
- Hospital Municipal de Joinville, Joinville SC, Brazil
- Associação Brasil AVC, Joinville SC, Brazil
| | | | | | | | | | - Juli Thomaz de Souza
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu SP, Brazil
| | - Guilherme Riccioppo Rodrigues
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | | | | | - Karla Carlos
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo SP, Brazil
| | | | | | - Rodrigo de Souza Castro
- Hospital Israelita Albert Einstein, Unidade Goiânia, Goiânia GO, Brazil
- Hospital Encore, Goiânia GO, Brazil
| | | | - Eduardo Damasceno
- Hospital Santa Helena, Goiânia GO, Brazil
- Hospital Encore, Goiânia GO, Brazil
- Hospital Geral de Goiânia, Goiania GO, Brazil
- Hospital Orion, Goiania GO, Brazil
| | | | - Octávio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | - Marina Teixeira Ramalho Pereira Dalio
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Centro de Cirurgia de Epilepsia de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Millene Rodrigues Camilo
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | | | | | | | | | - Sheila Cristina Ouriques Martins
- Rede Brasil AVC, Porto Alegre RS, Brazil
- Hospital Moinhos de Vento, Departamento de Neurologia, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil
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11
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Almeida PMVD, Bazan R, Marques Pontes-Neto O, Minelli C, Corrente JE, Modolo GP, Luvizutto GJ, Mondelli AL. Translation, cross-cultural adaptation, and validation of the Los Angeles Prehospital Stroke Screen for use in Brazil. Arq Neuro-Psiquiatr 2022; 80:217-223. [DOI: 10.1590/0004-282x-anp-2020-0589] [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] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/05/2021] [Indexed: 11/22/2022]
Abstract
ABSTRACT Background: Stroke is one of the leading causes of death and neurological disability in the world. Several scales help professionals in the early recognition of the disease. However, none of these were developed in Brazil. Objectives: To translate the Los Angeles Prehospital Stroke Screen (LAPSS) into Brazilian Portuguese, and cross-culturally adapt and validate the scale in a representative sample of the Brazilian population. Methods: This study was carried out in two phases: the first consisted in the translation and cross-cultural validation of the LAPSS, and the second in a cross-sectional study with prospectively collected data in patients with suspected stroke treated in a Brazilian prehospital and referred to a stroke center. Statistical analysis was used to assess the sensitivity, specificity, and accuracy of the scale. Cohen's Kappa coefficient (κ) was used for psychometric assessment. Results: After translation and cross-cultural adaptation, the scale was applied to 86 patients. The scale presented a sensitivity of 83.8%, positive predictive value of 79.50%, specificity of 40.70%, negative predictive value of 47.80%, and accuracy of 77%. Cohen’s kappa coefficient was calculated using data from 26 (30.23%) patients and the results showed excellent inter-rater reliability in the majority of the items (52.96%). Conclusions: The scale was translated and cross-culturally adapted for use in Brazil. The scale presented high sensitivity and accuracy but low specificity, and the Cohen’s kappa demonstrated inter-rater reliability. The greatest difficulties occurred when the evaluation included subjective identifications. The scale excluded patients < 45 years old as stroke suspects.
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12
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Pacheco-Castilho AC, Miranda RPC, Norberto AMQ, Favoretto DB, Rimoli BP, Alves LBDM, Weber KT, Santos TEG, Moriguti JC, Leite JP, Dantas RO, Martino R, Pontes-Neto OM. Dysphagia is a strong predictor of death and functional dependence at three months post-stroke. Arq Neuropsiquiatr 2022; 80:462-468. [PMID: 35195229 DOI: 10.1590/0004-282x-anp-2021-0127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/12/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Few Brazilian studies investigated risk factors for dysphagia and associated complications in a large cohort. OBJECTIVE To investigate frequency, predictors, and associated outcomes of dysphagia in patients up to three months post-stroke. METHODS Prospective cohort study of consecutively admitted patients in a specialized center for acute stroke. Patients with a transient ischemic attack, subarachnoid hemorrhage, cerebral venous thrombosis, hemorrhagic stroke with secondary cause, non-acute stroke, or those who did not consent to participate were excluded. Swallowing was evaluated by speech language pathologists using Volume-Viscosity Swallow Test. General function at three months post-stroke was assessed using the following instruments: Modified Rankin scale, Barthel Index and Functional Independence Measure. RESULTS A total of 831 patients were admitted and 305 patients were included according to the inclusion and exclusion criteria. The mean age of patients was 63.6±13.3 years, mean time from stroke to swallowing assessment was 4.2±4.1 days, and 45.2% of the patients had dysphagia. Age (OR=1.02; 95%CI 1.00-1.04; p=0.017), known medical history of obstructive sleep apnea (OR=5.13; 95%CI 1.74-15.15; p=0.003), and stroke severity at hospital admission (OR=1.10; 95%CI 1.06-1.15; p<0.001) were independently associated with dysphagia. Dysphagia (OR=3.78; 95%CI 2.16-6.61; p<0.001) and stroke severity (OR=1.05; 95%CI 1.00-1.09; p=0.024) were independently associated with death or functional dependence at three months. CONCLUSIONS Dysphagia was present in almost half of stroke patients. Age, obstructive sleep apnea, and stroke severity were predictors of dysphagia, which was independently associated with death or functional dependence at three months.
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Affiliation(s)
- Aline Cristina Pacheco-Castilho
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | - Rubia Poliana Crisóstomo Miranda
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto SP, Brazil
| | - Ana Maria Queirós Norberto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Ribeirão Preto SP, Brazil
| | - Diandra Bosi Favoretto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | - Brunna Pileggi Rimoli
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | - Luciana Bezerra de Mello Alves
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | - Karina Tavares Weber
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | - Taiza Elaine Grespan Santos
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | - Julio Cesar Moriguti
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Ribeirão Preto SP, Brazil
| | - João Pereira Leite
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | - Roberto Oliveira Dantas
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Ribeirão Preto SP, Brazil
| | - Rosemary Martino
- University of Toronto, Graduate Department of Rehabilitation Science, Department of Speech-Language Pathology, Toronto, Ontario, Canada
| | - Octávio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
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13
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Machline-Carrion MJ, Pontes-Neto OM, Brant LCC, Polanczyk CA, Biolo A, Nascimento BR, Malta DC, Marinho De Souza MF, Soares GP, Xavier GF, Bittencourt MS, Teixeira R, Ribeiro ALP. Conquering stroke epidemiological statistics in Brazil an innovative initiative from the Brazilian Society of Cardiology. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2062] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Stroke has been the second major cause of death in Brazil in the last decades. A better understanding on epidemiological statistics as well as on the diseases burden is crucial for enabling stakeholders to better tackle the disease.
Purpose
This project aims to continuously monitor and evaluate the data sources on heart disease and stroke in Brazil to provide the most up-to-date information on the epidemiology of these diseases to Brazilian society annually.
Methods
This initiative is based on the Heart Disease & Stroke Statistics Update methodology of the American Heart Association, with the support of the Brazilian Society of Cardiology, the Global Burden of Diseases Brazil network and an international committee. The project incorporates official statistics provided by the Brazilian Ministry of Health and other government agencies, as well as data generated by other sources and scientific studies on heart disease, stroke, and other CVD, including GBD/IHME data.
Results
The age-standardized prevalence rates per 100.000 for ischemic stroke in 1990 was 1327,6 (1151.2 to 1516) and 870.1 (761.1 to 992.8) in 2019 representing a percent change of −34.5 (−36.7 to −0.3). The age-standardized prevalence rates for intracerebral hemorrhage in 1990 was 507.5 (438.9 to584.1) and 315.9 (275 to 361.4) in 2019 representing a percent change of −37.7 (−40.5 to −0.3). The age-standardized incidence rates for stroke in 1990 was 224.6 (201.6 to 251.8) and 127 (113.8 to 142.1) in 2019 representing a percent change of −43.5 (−44.7 to −0.4). the age-standardized mortality rates for stroke in 1990 was 137.8 (127.8 to 144) and 58.1 (52.6 to 61.8) in 2019 representing a percent change of −57.8 (−60.4 to −0.6). The age-standardized DALY rates for stroke in 1990 was 2959 (2829.6 to 3063) and 1219.6 (1142 to 1285.5) in 2019 representing a percent change of −58.8 (−61 to −0.6).
Conclusion
This project represents a fundamental step on a better understanding on the stroke epidemiology in Brazil. While we observed a significant decrease in mortality rates from 1990 to 2019, we also raise a concern on a possible shift for a plateau curve or even increased rates in the next years.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Brazilian Society of Cardiology
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Affiliation(s)
| | - O M Pontes-Neto
- Medical School of Ribeirao Preto, Neurology, Ribeirao Preto, Brazil
| | - L C C Brant
- Federal University of Minas Gerais, Cardiology, Belo Horizonte, Brazil
| | - C A Polanczyk
- Federal University of Rio Grande do Sul, Cardiology, Porto Alegre, Brazil
| | - A Biolo
- Federal University of Rio Grande do Sul, Cardiology, Porto Alegre, Brazil
| | - B R Nascimento
- Federal University of Minas Gerais, Cardiology, Belo Horizonte, Brazil
| | - D C Malta
- Federal University of Minas Gerais, Post Graduation Program, Belo Horizonte, Brazil
| | - M F Marinho De Souza
- Federal University of Minas Gerais, Post Graduation Program, Belo Horizonte, Brazil
| | - G P Soares
- University of Vassouras, Vassouras, Brazil
| | - G F Xavier
- Federal University of Minas Gerais, Library, Belo Horizonte, Brazil
| | | | - R Teixeira
- Federal University of Minas Gerais, Post Graduation Program, Belo Horizonte, Brazil
| | - A L P Ribeiro
- Federal University of Rio Grande do Sul, Cardiology, Porto Alegre, Brazil
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14
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Almeida PMVD, Bazan R, Pontes-Neto OM, Minelli C, Corrente JE, Modolo GP, Luvizutto GJ, Mondelli AL. Translation, cross-cultural adaptation and validation of the Cincinnati prehospital stroke scale in Brazil. Arq Neuropsiquiatr 2021; 79:272-277. [PMID: 33978092 DOI: 10.1590/0004-282x-anp-2020-0246] [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] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/16/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Use of internationally standardized instruments to assist healthcare professionals in accurately recognizing stroke early is recommended. The process of translation and cross-cultural adaptation is important for ensuring that scales are interpreted in the same way in different languages, thus ensuring applicability in several countries. OBJECTIVE To translate into Brazilian Portuguese, cross-culturally adapt and validate the Cincinnati Prehospital Stroke Scale, using a representative sample of the Brazilian population. METHOD The present study included patients with suspected stroke who were treated at a Brazilian emergency medical service and referred to a stroke center. A systematic process of translation and cross-cultural adaptation of the original scale and application of the final instrument was performed. Statistical analysis was used to assess the sensitivity, specificity and accuracy of the scale. Cohen's kappa coefficient was used to assess inter-rater reliability. RESULTS After translation and cross-cultural adaptation, the scale was applied to 64 patients. It showed 93.0% accuracy and 92.4% sensitivity in relation to the final "gold standard" diagnosis. Cohen's kappa coefficient was calculated using data from 26 patients (40.6%) and showed excellent inter-rater reliability between items on the scale (0.8385 to 1.0000). CONCLUSION The scale demonstrated excellent accuracy, sensitivity and inter-rater reliability. It was a useful tool for assisting healthcare professionals during initial assessments on patients with suspected stroke and significantly contributed to early recognition of stroke in a simple and quick manner.
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Affiliation(s)
| | - Rodrigo Bazan
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Campus Botucatu SP, Brazil
| | | | - César Minelli
- Hospital Carlos Fernando Malzoni, Departamento de Neurologia, Matão SP, Brazil
| | - José Eduardo Corrente
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Campus Botucatu SP, Brazil
| | - Gabriel Pinheiro Modolo
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Campus Botucatu SP, Brazil
| | | | - Alessandro Lia Mondelli
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Campus Botucatu SP, Brazil
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15
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Fornazari VR, Castro-Afonso LHD, Nakiri GS, Abud TG, Monsignore LM, Dias FA, Pontes-Neto OM, Abud DG. Analysis of 565 thrombectomies for anterior circulation stroke: A Brazilian registry. Interv Neuroradiol 2021; 28:283-290. [PMID: 34139892 DOI: 10.1177/15910199211026995] [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] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The benefits of mechanical thrombectomy in the treatment of patients with acute stroke due to large vessel occlusions (LVOs) have been extensively demonstrated by randomized trials and registries in developed countries. However, data on thrombectomy outside controlled trials are scarce in developing countries. The aim of this study was to assess the safety and efficacy, and to investigate the predictors for good and poor outcomes of thrombectomy for treatment of AIS due to anterior circulation LVOs in Brazil. MATERIALS AND METHODS This was a single center registry of thrombectomy in the treatment of stroke caused by anterior circulation LVOs. Between 2011 and 2019, a total of 565 patients were included. RESULTS the mean baseline NIHSS score on admission was 17.2. The average baseline ASPECTS was 8, and 91.0% of patients scored ≥6. Half of the patients received intravenous thrombolysis. The mean time from symptom onset to arterial puncture was 296.4 minutes. The mean procedure time was 61.4 minutes. The rates of the main outcomes were recanalization (TICI 2b-3) 85.6%, symptomatic intracranial hemorrhage (sICH) 8,1%, good clinical outcome (mRS=0-2) 43,5%, and mortality 22.1% at three months. CONCLUSIONS This study demonstrates the efficacy and safety of mechanical thrombectomy for treatment of patients with AIS of the anterior circulation in real-life conditions under limited facilities and resources. The results of the present study were relatively similar to those of large trials and population registers of developed countries.
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Affiliation(s)
- Vitor Rodrigues Fornazari
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Luís Henrique de Castro-Afonso
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Guilherme Seizem Nakiri
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Lucas Moretti Monsignore
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Francisco Antunes Dias
- Division of Neurology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Daniel Giansante Abud
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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16
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Rosa MI, Grande AJ, Lima LD, Dondossola ER, Uggioni MLR, Hernandez AV, Tse G, Liu T, Pontes-Neto OM, Biondi-Zoccai G, Neto MG, Durães AR, Sá MPBO, Resende ES, Roever L. Association Between Epicardial Adipose Tissue and Stroke. Front Cardiovasc Med 2021; 8:658445. [PMID: 33969022 PMCID: PMC8096977 DOI: 10.3389/fcvm.2021.658445] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/17/2021] [Indexed: 12/21/2022] Open
Abstract
Epicardial adipose tissue (EAT) is correlated with endothelial dysfunction, metabolic syndrome, increased mortality and recent studies showed a possible association with the increased risk of stroke. We performed a systematic review of studies evaluating the association between EAT and stroke. Eighty studies met the inclusion criteria and were consequently analyzed. The review had Five main findings. First, the increased epicardial fat thickness (EFT) may be associated with the stroke episode. Second, regardless of the imaging method (echocardiography, MRI, and CT) this association remains. Third, the association of metabolic syndrome and atrial fibrillation seems to increase the risk of stroke. Fourth, this systematic review was considered as low risk of bias. Despite being unable to establish a clear association between EAT and stroke, we have organized and assessed all the research papers on this topic, analyzing their limitations, suggesting improvements in future pieces of research and pointing out gaps in the literature. Furthermore, the mechanistic links between increased EAT and stroke incidence remains unclear, thus, further research is warranted.
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Affiliation(s)
- Maria Inês Rosa
- Laboratory of Biomedicine Translational, University of Extremo Sul Catarinense, Criciúma, Brazil
| | - Antonio José Grande
- Department of Medicine, State University of Mato Grosso Do Sul, Mato Grosso, Brazil
| | - Leticia Dorsa Lima
- Department of Medicine, State University of Mato Grosso Do Sul, Mato Grosso, Brazil
| | | | | | - Adrian V Hernandez
- Hartford Hospital Evidence-Based Practice Center, University of Connecticut, Hartford, CT, United States.,Vicerrectorado de Investigacion, Universidad San Ignacio de Loyola, Lima, Peru
| | - Gary Tse
- Xiamen Cardiovascular Hospital, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Octávio Marques Pontes-Neto
- Stroke Service, Neurology Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Mansueto Gomes Neto
- Mediterranea Cardiocentro, Naples, Italy.,Physical Therapy Department, Federal University of Bahia-Universidade Federal Da Bahia, Salvador, Brazil.,Programa de Pós-Graduação em Medicina e Saúde-Universidade Federal Da Bahia, Salvador, Brazil.,Physiotherapy Research Group, UFBA, Salvador, Brazil
| | - André Rodrigues Durães
- Physical Therapy Department, Federal University of Bahia-Universidade Federal Da Bahia, Salvador, Brazil
| | - Michel Pompeu B O Sá
- The GREAT Group, Salvador, Brazil.,Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco-PROCAPE, Recife, Brazil.,Department of Surgery, University of Pernambuco-Universidade de Pernambuco, Recife, Brazil
| | - Elmiro Santos Resende
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute-FCM/ICB, Recife, Brazil.,Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
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17
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Farias DA Guarda SN, Santos JPS, Reis MSM, Passos RDH, Correia LC, Caldas JR, Gobatto ALN, Teixeira M, Oliveira A, Ribeiro MP, Batista PBP, Calderaro M, Paschoal Junior F, Pontes-Neto OM, Ramos JGR. Realistic simulation is associated with healthcare professionals' increased self-perception of confidence in providing acute stroke care: a before-after controlled study. Arq Neuropsiquiatr 2021; 79:2-7. [PMID: 33656107 DOI: 10.1590/0004-282x-anp-2019-0369] [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] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Simulations are becoming widely used in medical education, but there is little evidence of their effectiveness on neurocritical care. Because acute stroke is a neurological emergency demanding prompt attention, it is a promising candidate for simulation training. OBJECTIVE To assess the impact of a stroke realistic simulation course on clinicians' self-perception of confidence in the management of acute stroke. METHODS We conducted a controlled, before-after study. For our intervention, 17 healthcare professionals participated in a stroke realistic simulation course. As controls, participants were chosen from a convenience sample of attendees to the courses Emergency Neurologic Life Support (ENLS) (18 participants) and Neurosonology (20 participants). All participants responded pre- and post-test questionnaires evaluating their self-perception of confidence in acute stroke care, ranging from 10 to 50 points. We evaluated the variation between pre- and post-test results to assess the change on trainees' self-perception of confidence in the management of acute stroke. Multivariate analysis was performed to control for potential confounders. RESULTS Forty-six (83.63%) subjects completed both questionnaires. The post-test scores were higher than those from the pretests in the stroke realistic simulation course group [pretest median (interquartile range - IQR): 41.5 (36.7-46.5) and post-test median (IQR): 47 (44.7-48); p=0.033], but not in the neurosonology [pretest median (IQR): 46 (44-47) and post-test median (IQR): 46 (44-47); p=0.739] or the ENLS [pretest median (IQR): 46.5 (39-48.2), post-test median (IQR): 47 (40.2-49); p=0.317] groups. Results were maintained after adjustment for covariates. CONCLUSIONS This stroke realistic simulation course was associated with an improvement on trainees' self-perception of confidence in providing acute stroke care.
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Affiliation(s)
- Suzete Nascimento Farias DA Guarda
- Rede D'Or São Luiz, Hospital São Rafael, Unidade de Cuidado Intensivo, Salvador BA, Brazil.,Universidade Federal da Bahia, Departamento de Neurociências e Saúde Mental, Salvador BA, Brazil.,Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro RJ, Brazil
| | | | | | - Rogério da Hora Passos
- Rede D'Or São Luiz, Hospital São Rafael, Unidade de Cuidado Intensivo, Salvador BA, Brazil.,Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro RJ, Brazil
| | | | - Juliana Ribeiro Caldas
- Rede D'Or São Luiz, Hospital São Rafael, Unidade de Cuidado Intensivo, Salvador BA, Brazil.,Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro RJ, Brazil.,Escola Baiana de Medicina e Saúde Pública, Salvador BA, Brazil
| | - André Luiz Nunes Gobatto
- Rede D'Or São Luiz, Hospital São Rafael, Unidade de Cuidado Intensivo, Salvador BA, Brazil.,Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro RJ, Brazil.,União Metropolitana de Educação e Cultura, Salvador BA, Brazil
| | - Maurício Teixeira
- Rede D'Or São Luiz, Hospital São Rafael, Unidade de Cuidado Intensivo, Salvador BA, Brazil.,Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro RJ, Brazil.,União Metropolitana de Educação e Cultura, Salvador BA, Brazil
| | - Adelmo Oliveira
- Rede D'Or São Luiz, Hospital São Rafael, Unidade de Cuidado Intensivo, Salvador BA, Brazil.,Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro RJ, Brazil.,União Metropolitana de Educação e Cultura, Salvador BA, Brazil
| | - Michel Pordeus Ribeiro
- Rede D'Or São Luiz, Hospital São Rafael, Unidade de Cuidado Intensivo, Salvador BA, Brazil.,Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro RJ, Brazil.,União Metropolitana de Educação e Cultura, Salvador BA, Brazil
| | - Paulo Benigno Pena Batista
- Rede D'Or São Luiz, Hospital São Rafael, Unidade de Cuidado Intensivo, Salvador BA, Brazil.,Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro RJ, Brazil.,Escola Baiana de Medicina e Saúde Pública, Salvador BA, Brazil.,União Metropolitana de Educação e Cultura, Salvador BA, Brazil
| | - Marcelo Calderaro
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil
| | | | - Octávio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil
| | - João Gabriel Rosa Ramos
- Rede D'Or São Luiz, Hospital São Rafael, Unidade de Cuidado Intensivo, Salvador BA, Brazil.,Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro RJ, Brazil
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Brisson RT, Santos RDSA, Stefano LHSS, Barreira CMA, Arruda JFDL, Dias FA, Camilo MR, Pontes-Neto OM. Association between Tomographic Characteristics of the Temporal Bone and Transtemporal Window Quality on Transcranial Color Doppler Ultrasound in Patients with Stroke or Transient Ischemic Attack. Ultrasound Med Biol 2021; 47:511-516. [PMID: 33257102 DOI: 10.1016/j.ultrasmedbio.2020.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/09/2020] [Accepted: 10/31/2020] [Indexed: 06/12/2023]
Abstract
Transcranial color-coded Doppler (TCCD) is an ultrasonographic technique used to obtain and evaluate images of the cerebral parenchyma and to assess blood flow velocities of the intracranial vessels. One of the major limitations of TCCD is the failure to insonate through the transtemporal window, which occurs in about 5%-44% of patients. Temporal bone thickness has been strongly associated with transtemporal window failure (TWF). The aims of the study were to evaluate the association between TWF on TCCD and radiologic findings on computed tomography of the skull along with the demographic characteristics of patients with acute stroke or transient ischemic attack (TIA), and to propose a classification for transcranial window quality (TWQ) on B-mode scan of TCCD. A total of 187 consecutive patients with acute stroke or TIA were included. Among them, 21.9% had TWF and 34.8% had TWQ categorized as insufficient on B-mode scan of TCCD. On logistic regression, age (odds ratio [OR] = 1.07, 95% confidence interval [CI]: 1.03-1.12, p < 0.001), female sex (OR = 5.99, 95% CI: 2.09-17.16, p = 0.001), pneumatized temporal bone (OR = 7.90, 95% CI: 1.95-32.03, p = 0.004) and temporal bone thickness (OR = 3.04, 95% CI: 1.73-5.35, p < 0.001) were independent predictors of TWF, even after adjusting for confounders. These findings may help to select patients in whom echogenic contrast or even other imaging methods could be used to assess intracranial vessels.
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Affiliation(s)
- Rodrigo Tavares Brisson
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; Department of Neurology, Hospital Naval Marcílio Dias, Rio de Janeiro, Brazil.
| | - Renata da Silva Almeida Santos
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Clara Monteiro Antunes Barreira
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Francisco Antunes Dias
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Millene Rodrigues Camilo
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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19
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Paschoal AM, Leoni RF, Foerster BU, Dos Santos AC, Pontes-Neto OM, Paiva FF. Contrast optimization in arterial spin labeling with multiple post-labeling delays for cerebrovascular assessment. MAGMA 2021; 34:119-131. [PMID: 32885356 DOI: 10.1007/s10334-020-00883-z] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/01/2020] [Accepted: 08/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Improving the readout for arterial spin labeling with multiple post-labeling delays (multi-PLD ASL) through a flip angle (FA) sweep towards increasing contrast-to-noise ratio for long PLD images. METHODS Images were acquired from 20 healthy subjects and 14 patients with severe, asymptomatic carotid artery stenosis (ACAS) in a 3T MRI scanner. Multi-PLD ASL images with conventional and proposed (FA sweep) readouts were acquired. For patients, magnetic resonance angiography was used to validate the multi-PLD ASL results. Perfusion values were calculated for brain regions irrigated by the main cerebral arteries and compared by analysis of variance. RESULTS For healthy subjects, better contrast was obtained for long PLDs when using the proposed multi-PLD method compared to the conventional. For both methods, no hemispheric difference of perfusion was observed. For patients, the proposed method facilitated the observation of delayed tissue perfusion, which was not visible for long PLD using the conventional multi-PLD ASL. CONCLUSION We successfully assessed brain perfusion of patients with asymptomatic CAS using multi-PLD ASL with FA sweep. We were able to show subtle individual differences. Moreover, prolonged arterial transit time in patients was observed, although they were considered asymptomatic, suggesting that it may not be an adequate term to characterize them.
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Affiliation(s)
- André Monteiro Paschoal
- Inbrain, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Renata Ferranti Leoni
- Inbrain, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Bernd Uwe Foerster
- Instituto de Física de São Carlos, Universidade de São Paulo, Av. Trabalhador São-Carlense, 400, São Carlos, SP, 13566-590, Brazil
| | | | | | - Fernando Fernandes Paiva
- Instituto de Física de São Carlos, Universidade de São Paulo, Av. Trabalhador São-Carlense, 400, São Carlos, SP, 13566-590, Brazil.
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20
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Pazuello GB, de Castro-Afonso LH, Fornazari VR, Nakiri GS, Abud TG, Monsignore LM, Dias FA, Martins-Filho RK, Camilo MR, Aléssio-Alves FF, Pontes-Neto OM, Abud DG. Thrombectomy for Posterior Circulation Stroke: Predictors of Outcomes in a Brazilian Registry. World Neurosurg 2020; 147:e363-e372. [PMID: 33346048 DOI: 10.1016/j.wneu.2020.12.060] [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: 10/26/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Acute basilar artery occlusion is a devastating life-threatening condition. Early recanalization is the therapeutic goal in patients with acute ischemic stroke. Despite the high rates of recanalization achieved with modern devices for basilar occlusions, many patients have had poor clinical outcomes. This study aimed to assess the predictors of good and poor outcomes among patients with basilar artery occlusion treated with thrombectomy. METHODS A consecutive registry of 80 patients was included in this retrospective study. The primary end point was to access variables associated with neurologic outcomes defined by a modified Rankin Scale (mRS) score of 0-2, symptomatic intracranial hemorrhage (sICH), and mortality at 3 months follow-up. RESULTS Recanalization was achieved in 86.2%, and the sICH rate was 8.7%. A good neurologic outcome (mRS score 0-2) was observed in 26.2% and a moderate outcome (mRS score 0-3) in 32.5% of patients. The mortality was 38.7% at 3 months follow-up. CONCLUSIONS After thrombectomy for posterior circulation strokes, young patients, V4-proximal basilar occlusion, (high) baseline posterior circulation Alberta Stroke Program Early CT Score, and complete recanalization were independent predictors of good neurologic outcomes. Failure to recanalize was strongly related to sICH and mortality. In addition, diabetes, atrial fibrillation, and baseline National Institutes of Health Stroke Scale scores ≥10 had an independent association with mortality. This study contributes to the knowledge required to optimize recanalization treatments for posterior circulation strokes and may help to improve future clinical studies.
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Affiliation(s)
- Guilherme Borghini Pazuello
- Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Luís Henrique de Castro-Afonso
- Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Vitor Rodrigues Fornazari
- Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Guilherme Seizem Nakiri
- Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Thiago Giansante Abud
- Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; Department of Interventional Neuroradiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Lucas Moretti Monsignore
- Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Francisco Antunes Dias
- Division of Neurology, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rui Kleber Martins-Filho
- Division of Neurology, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Milene Rodrigues Camilo
- Division of Neurology, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Frederico Fernandes Aléssio-Alves
- Division of Neurology, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Octávio Marques Pontes-Neto
- Division of Neurology, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Daniel Giansante Abud
- Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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21
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Camilo MR, Pontes-Neto OM. Coronary Calcium Score. Is There a Difference among Ischemic Stroke Subtypes? Arq Bras Cardiol 2020; 115:1152-1153. [PMID: 33470316 PMCID: PMC8133728 DOI: 10.36660/abc.20201192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Millene Rodrigues Camilo
- Departamento de Neurociências e Ciências do ComportamentoFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrasilDivisão de Neurologia - Departamento de Neurociências e Ciências do Comportamento - Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, Ribeirão Preto, SP - Brasil
| | - Octávio Marques Pontes-Neto
- Departamento de Neurociências e Ciências do ComportamentoFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrasilDivisão de Neurologia - Departamento de Neurociências e Ciências do Comportamento - Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, Ribeirão Preto, SP - Brasil
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22
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Pacheco-Castilho AC, de Martini Vanin G, Reichardt B, Miranda RPC, Norberto AMQ, Braga MC, Bueno TBC, Weber KT, Santos TEG, Leite JP, Dantas RO, Pontes-Neto OM, Martino R. Translation and Validation of the TOR-BSST © into Brazilian Portuguese for Adults with Stroke. Dysphagia 2020; 36:533-540. [PMID: 32766936 DOI: 10.1007/s00455-020-10167-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/17/2020] [Indexed: 11/26/2022]
Abstract
Brazil has a higher rate of dysphagia in stroke patients compared to developed countries, but does not have a fully validated method for early identification of dysphagia in this population. The aim of this study is to translate the TOR-BSST© into Brazilian Portuguese and assess the newly translated version for reliability and validity with Brazilian adult patients with stroke. The translation of the TOR-BSST© followed a multi-step process, according to the International Quality of Life Assessment project. For validation, we included patients with age ≥ 18 years and stroke diagnosis confirmed by neuroimaging and tolerance for videofluoroscopic swallowing assessment. The BR-PTfinal TOR-BSST© was administered by two trained screeners within two hours of videofluoroscopy. All assessors were independent and blinded. Estimates for reliability used the intraclass correlation coefficient (ICC) and for accuracy both sensitivity (SN) and negative predictive (NP) values were used, along with 95% confidence intervals (CI). Sixty patients were enrolled and tested for a mean (SD) of 14.4 (6.9) days from last seen normal. Of all the patients, 41 (68.3%) failed the BR-PTfinal TOR-BSST© and 21 (35%) were scored to have dysphagia on videofluoroscopy, of which 11 (52.4%) had mild dysphagia. The overall reliability between screeners was satisfactory (ICC = 0.59; 95% CI 0.32 to 0.76). The SN and NP values for the BR-PTfinal TOR-BSST© were 85.7% (95% CI 0.62-0.96) and 84.2% (95% CI 0.72-0.95), respectively. The TOR-BSST© was successfully translated to Brazilian Portuguese with the BR-PTfinal TOR-BSST© proven to have high sensitivity and negative predictive values when compared to gold standard videofluoroscopy.
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Affiliation(s)
- Aline Cristina Pacheco-Castilho
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil.
| | | | - Beatrix Reichardt
- Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
| | - Rubia Poliana Crisóstomo Miranda
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Monica Carvalho Braga
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Thatiana Barboza Carnevalli Bueno
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Karina Tavares Weber
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Taiza Elaine Grespan Santos
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - João Pereira Leite
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Roberto Oliveira Dantas
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, 14049-900, Brazil
| | - Rosemary Martino
- Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Swallowing Lab, University of Toronto, Toronto, ON, Canada
- Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
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23
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Machline-Carrion MJ, Soares RM, Damiani LP, Campos VB, Sampaio B, Fonseca FH, Izar MC, Amodeo C, Pontes-Neto OM, Santos JY, Gomes SPDC, Saraiva JFK, Ramacciotti E, Barros E Silva PGDM, Lopes RD, Brandão da Silva N, Guimarães HP, Piegas L, Stein AT, Berwanger O. Effect of a Multifaceted Quality Improvement Intervention on the Prescription of Evidence-Based Treatment in Patients at High Cardiovascular Risk in Brazil: The BRIDGE Cardiovascular Prevention Cluster Randomized Clinical Trial. JAMA Cardiol 2020; 4:408-417. [PMID: 30942842 DOI: 10.1001/jamacardio.2019.0649] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Studies have found that patients at high cardiovascular risk often fail to receive evidence-based therapies in community practice. Objective To evaluate whether a multifaceted quality improvement intervention can improve the prescription of evidence-based therapies. Design, Setting, and Participants In this 2-arm cluster randomized clinical trial, patients with established atherothrombotic disease from 40 public and private outpatient clinics (clusters) in Brazil were studied. Patients were recruited from August 2016 to August 2017, with follow-up to August 2018. Data were analyzed in September 2018. Interventions Case management, audit and feedback reports, and distribution of educational materials (to health care professionals and patients) vs routine practice. Main Outcomes and Measures The primary end point was prescription of evidence-based therapies (ie, statins, antiplatelet therapy, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) using the all-or-none approach at 12 months after the intervention period in patients without contraindications. Results Of the 1619 included patients, 1029 (63.6%) were male, 1327 (82.0%) had coronary artery disease (843 [52.1%] with prior acute myocardial infarction), 355 (21.9%) had prior ischemic stroke or transient ischemic attack, and 197 (12.2%) had peripheral vascular disease, and the mean (SD) age was 65.6 (10.5) years. Among randomized clusters, 30 (75%) were cardiology sites, 6 (15%) were primary care units, and 26 (65%) were teaching institutions. Among eligible patients, those in intervention clusters were more likely to receive a prescription of evidence-based therapies than those in control clusters (73.5% [515 of 701] vs 58.7% [493 of 840]; odds ratio, 2.30; 95% CI, 1.14-4.65). There were no differences between the intervention and control groups with regards to risk factor control (ie, hyperlipidemia, hypertension, or diabetes). Rates of education for smoking cessation were higher among current smokers in the intervention group than in the control group (51.9% [364 of 701] vs 18.2% [153 of 840]; odds ratio, 11.24; 95% CI, 2.20-57.43). The rate of cardiovascular mortality, acute myocardial infarction, and stroke was 2.6% for patients from intervention clusters and 3.4% for those in the control group (hazard ratio, 0.76; 95% CI, 0.43-1.34). Conclusions and Relevance Among Brazilian patients at high cardiovascular risk, a quality improvement intervention resulted in improved prescription of evidence-based therapies. Trial Registration ClinicalTrials.gov identifier: NCT02851732.
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Affiliation(s)
| | | | | | | | - Bruna Sampaio
- HCor Research Institute, Hospital do Coração, São Paulo, São Paulo, Brazil
| | | | | | - Celso Amodeo
- Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | - Renato D Lopes
- Brazilian Clinical Research Institute, São Paulo, São Paulo, Brazil.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Nilton Brandão da Silva
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Airton T Stein
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Otávio Berwanger
- HCor Research Institute, Hospital do Coração, São Paulo, São Paulo, Brazil
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24
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Bazan R, Luvizutto GJ, Braga GP, Bazan SGZ, Hueb JC, de Freitas CCM, Hamamoto Filho PT, Módolo GP, Trindade AP, Sobreira ML, Nunes HRDC, Leite JP, Pontes-Neto OM. Relationship of spontaneous microembolic signals to risk stratification, recurrence, severity, and mortality of ischemic stroke: a prospective study. Ultrasound J 2020; 12:6. [PMID: 32048064 PMCID: PMC7013020 DOI: 10.1186/s13089-020-0156-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/26/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction The presence of microembolic signals (MES) during the acute phase of stroke is poorly understood, and its role and clinical application in relation to risk stratification and prognosis in patients remain uncertain. We assessed the prevalence of spontaneous MES in acute stroke and their relationship with risk stratification, stroke recurrence, morbidity, and mortality. Patients and methods This was a prospective cohort study conducted in the Stroke Unit. The MES presence was evaluated by transcranial Doppler (TCD) in patients with ischemic stroke within 48 h. The outcomes (risk stratification, morbidity, mortality, and recurrence of a stroke) were followed up for 6 months. The relationship between risk stratification and MES was obtained by odds ratios and that between MES and stroke recurrence, morbidity, and mortality using multiple logistic regression; considering statistical significance at P < 0.05. Results Of the 111 patients studied, 70 were men (63.1%) and 90 were white (81.1%), with a median age of 68 years. The MES frequency was 7%. There was a significant relationship between MES and symptomatic carotid disease (OR = 22.7; 95% CI 4.1–125.7; P < 0.001), a shorter time to monitoring (OR = 12.4; 95% CI 1.4–105.4; P = 0.02), and stroke recurrence (OR = 16.83; 95% CI 2.01–141; P = .009). Discussion It was observed that the stroke recurrence adjusted for prior stroke was higher and earlier among patients with MES detection. In conclusion, MES demonstrated a significant correlation with symptomatic carotid disease and a shorter DELAY until monitoring, and could be a predictor for the early recurrence of stroke in the long term.
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Affiliation(s)
- Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil
| | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Institute of Health Sciences, UFTM-Univ Federal do Triângulo Mineiro, Uberaba, Brazil
| | - Gabriel Pereira Braga
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil
| | | | - João Carlos Hueb
- Department of Internal Medicine, Botucatu Medical School, UNESP-Univ Estadual Paulista, Botucatu, Brazil
| | - Carlos Clayton Macedo de Freitas
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil
| | - Pedro Tadao Hamamoto Filho
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil.
| | - Gabriel Pinheiro Módolo
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil
| | - André Petean Trindade
- Department of Tropical Diseases and Imaging Diagnosis, Botucatu Medical School, UNESP-Univ Estadual Paulista, Botucatu, Brazil
| | - Marcone Lima Sobreira
- Department of Surgery and Orthopedics, Botucatu Medical School, UNESP-Univ Estadual Paulista, Botucatu, Brazil
| | - Hélio Rubens de Carvalho Nunes
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil
| | - João Pereira Leite
- Department of Neuroscience and Behavior, Ribeirão Preto School of Medicine, USP-Univ São Paulo, Ribeirão Preto, Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neuroscience and Behavior, Ribeirão Preto School of Medicine, USP-Univ São Paulo, Ribeirão Preto, Brazil
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25
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Secchinato KF, Da Silva PHR, Camargo APA, Pontes-Neto OM, Leoni RF. Cerebrovascular reactivity mapping without hypercapnic challenge in patients with carotid artery stenosis. ACTA ACUST UNITED AC 2019. [DOI: 10.29384/rbfm.2019.v13.n2.p62-65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Vascular reactivity represents the ability of the vascular smooth muscle to dilate or contract in response to changes in metabolic demand or vasoactive stimulus. More specifically, the cerebrovascular reactivity (CVR) has raised interest in several studies that point to its potential to predict stroke risk in patients with cerebrovascular disease. CVR mapping is typically performed using carbon dioxide (CO2) inhalation, breath-holding, or acetazolamide injection as vasoactive challenges, while magnetic resonance imaging (MRI) based on the blood oxygenation level-dependent (BOLD) contrast is acquired. However, such challenges of hypercapnia depend on additional equipment and cooperation of the subjects, limiting their applications, especially in elderly patients. Therefore, the objective of the present study was to map the CVR using resting-state MRI-BOLD, with no hypercapnic challenge, considering the variations in BOLD signal associated with variations in the arterial partial pressure of CO2. The CVR maps obtained with resting data showed a high correlation with those obtained by the conventional experiment with CO2 inhalation (r > 0.70). In addition, the CVR changes observed for the patients were consistent with their clinical reports. These results show that the mapping of CVR obtained with resting-state data may become a useful alternative in the detection of perfusion changes in clinical applications when the hypercapnic challenge is not feasible.
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Machline-Carrion MJ, Santucci EV, Damiani LP, Bahit MC, Málaga G, Pontes-Neto OM, Martins SCO, Zétola VF, Normilio-Silva K, Rodrigues de Freitas G, Gorgulho A, De Salles A, Pacheco da Silva BG, Santos JY, de Andrade Jesuíno I, Bueno PRT, Cavalcanti AB, Guimarães HP, Xian Y, Bettger JP, Lopes RD, Peterson ED, Berwanger O. Effect of a Quality Improvement Intervention on Adherence to Therapies for Patients With Acute Ischemic Stroke and Transient Ischemic Attack: A Cluster Randomized Clinical Trial. JAMA Neurol 2019; 76:932-941. [PMID: 31058947 DOI: 10.1001/jamaneurol.2019.1012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Translating evidence into clinical practice in the management of acute ischemic stroke (AIS) and transient ischemic attack (TIA) is challenging, especially in low- and middle-income countries. Objective To assess the effect of a multifaceted quality improvement intervention on adherence to evidence-based therapies for care of patients with AIS and TIA. Design, Setting and Participants This 2-arm cluster-randomized clinical trial assessed 45 hospitals and 2336 patients with AIS and TIA for eligibility before randomization. Eligible hospitals were able to provide care for patients with AIS and TIA in Brazil, Argentina, and Peru. Recruitment started September 12, 2016, and ended February 26, 2018; follow-up ended June 29, 2018. Data were analyzed using the intention-to-treat principle. Interventions The multifaceted quality improvement intervention included case management, reminders, a roadmap and checklist for the therapeutic plan, educational materials, and periodic audit and feedback reports to each intervention cluster. Main Outcomes and Measures The primary outcome was a composite adherence score for AIS and TIA performance measures. Secondary outcomes included an all-or-none composite end point of performance measures, the individual process measure components of the composite end points, and clinical outcomes at 90 days after admission (stroke recurrence, death, and disability measured by the modified Rankin scale). Results A total of 36 hospitals and 1624 patients underwent randomization. Nineteen hospitals were randomized to the quality improvement intervention and 17 to routine care. The overall mean (SD) age of patients enrolled in the study was 69.4 (13.5) years, and 913 (56.2%) were men. Overall mean (SD) composite adherence score for the 10 performance measures in the intervention group hospitals compared with control group hospitals was 85.3% (20.1%) vs 77.8% (18.4%) (mean difference, 4.2%; 95% CI, -3.8% to 12.2%). As a secondary end point, 402 of 817 patients (49.2%) at intervention hospitals received all the therapies that they were eligible for vs 203 of 807 (25.2%) in the control hospitals (odds ratio, 2.59; 95% CI, 1.22-5.53; P = .01). Conclusions and Relevance A multifaceted quality improvement intervention did not result in a significant increase in composite adherence score for evidence-based therapies in patients with AIS or TIA. However, when using an all-or-none approach, the intervention resulted in improved adherence to evidence-based therapies. Trial Registration ClinicalTrials.gov identifier: NCT02223273.
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Affiliation(s)
| | | | | | - M Cecilia Bahit
- Fundacion Instituto de Neurología Cognitiva Rosario, Grupo Argentino Colaborativo en Investigación Clínica, Rosario, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ying Xian
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Janet Prvu Bettger
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.,Brazilian Clinical Research Institute, São Paulo, Brazil
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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Pacheco-Castilho AC, Vanin GDM, Dantas RO, Pontes-Neto OM, Martino R. Dysphagia and Associated Pneumonia in Stroke Patients from Brazil: A Systematic Review. Dysphagia 2019; 34:499-520. [PMID: 31111249 DOI: 10.1007/s00455-019-10021-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 01/15/2019] [Accepted: 05/09/2019] [Indexed: 01/22/2023]
Abstract
Dysphagia and its associated complications are expected to be relatively more frequent in stroke patients in Brazil than in similar patients treated in developed countries due to the suboptimal stroke care in many Brazilians medical services. However, there is no estimate of dysphagia and pneumonia incidence for the overall stroke population in Brazil. We conducted a systematic review of the recent literature to address this knowledge gap, first screening citations for relevance and then rating full articles of accepted citations. At both levels, judgements were made by two independent raters according to a priori criteria. Fourteen accepted articles underwent critical appraisal and data extraction. The frequency of dysphagia in stroke patients was high (59% to 76%). Few studies assessed pneumonia and only one study stratified patients by both dysphagia and pneumonia, with an increased Relative Risk for pneumonia in patients with stroke and dysphagia of 8.4 (95% CI 2.1, 34.4). Across all articles, we identified bias related to: heterogeneity in number and type of stroke; no rater blinding; and, assessments that were not reproducible, reliable or validated. Despite the high frequency of dysphagia and associated pneumonia in stroke patients in Brazil, the quality of the available literature is low and that there is little research focused on these epidemiologic data. Future rigorously designed studies are in dire need to accurately determine dysphagia incidence and its impact on stroke patients in Brazil. These data will be critical to properly allocate limited national resources that maximize the quality of stroke care.
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Affiliation(s)
- Aline Cristina Pacheco-Castilho
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, Zip Code: 14049-900, Brazil.
| | - Gabriela de Martini Vanin
- Department of Speech Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Roberto Oliveira Dantas
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, Zip Code: 14049-900, Brazil
| | - Rosemary Martino
- Department of Speech Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Canada
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de Castro Afonso LH, Borghini Pazuello G, Seizem Nakiri G, Monsignore LM, Antunes Dias F, Pontes-Neto OM, Giansante Abud D. Thrombectomy for M2 occlusions and the role of the dominant branch. Interv Neuroradiol 2019; 25:697-704. [PMID: 31088246 DOI: 10.1177/1591019919847693] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The benefits of thrombectomy for occlusion of M2 segments remain controversial. The aim of this study is to assess thrombectomy's efficacy and safety in patients with M2 segment occlusion and associations between occlusion sites and anatomic variations of M1 division. MATERIALS AND METHODS A prospective series of 30 patients with acute ischemic stroke (AIS) resulting from M2 segment occlusion of the middle cerebral artery (MCA) who underwent thrombectomy was analyzed. The primary endpoint was assessed by the Extended Treatment in Cerebral Infarction scale (eTICI). The secondary endpoints were the incidence of symptomatic hemorrhagic transformation (sICH), mortality and good functional outcome at three months. RESULTS The mean patient age was 69.2 years. The mean National Institutes Health Stroke Scale score (NIHSS) upon hospital admission was 16. The recanalization rates were eTICI 2b/3 in 90% and 2c/3 in 60% of the patients. Total recanalization of the M2 branch was achieved in 53% of patients. sICH incidence was 6.6%, the mortality rate was 30%, and a good functional outcome (mRS ≤2) was observed in 50% of the patients. Twenty-seven patients (90%) had a dominant M2 branch and all were occluded. Regarding the site of M2 occlusions, 74% of patients had proximal M2 occlusions. CONCLUSIONS Thrombectomy appears to be a safe and effective method for the treatment of acute M2 segment occlusions of the MCA. Most of the cases had a dominant M2 branch, and all of them were occluded. Larger studies are needed to verify the benefits of thrombectomy for different settings of M2 occlusions.
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Affiliation(s)
- Luís Henrique de Castro Afonso
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Guilherme Borghini Pazuello
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Guilherme Seizem Nakiri
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Lucas Moretti Monsignore
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Francisco Antunes Dias
- Department of Neurology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neurology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniel Giansante Abud
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Ouriques Martins SC, Sacks C, Hacke W, Brainin M, de Assis Figueiredo F, Marques Pontes-Neto O, Lavados Germain PM, Marinho MF, Hoppe Wiegering A, Vaca McGhie D, Cruz-Flores S, Ameriso SF, Camargo Villareal WM, Durán JC, Fogolin Passos JE, Gomes Nogueira R, Freitas de Carvalho JJ, Sampaio Silva G, Cabral Moro CH, Oliveira-Filho J, Gagliardi R, Gomes de Sousa ED, Fagundes Soares F, de Pinho Campos K, Piza Teixeira PF, Gonçalves IP, Santos Carquin IR, Muñoz Collazos M, Pérez Romero GE, Maldonado Figueredo JI, Barboza MA, Celis López MÁ, Góngora-Rivera F, Cantú-Brito C, Novarro-Escudero N, Velázquez Blanco MÁ, Arbo Oze de Morvil CA, Olmedo Bareiro AB, Meza Rojas G, Flores A, Hancco-Saavedra JA, Pérez Jimenez V, Abanto Argomedo C, Rodriguez Kadota L, Crosa R, Mora Cuervo DL, de Souza AC, Carbonera LA, Álvarez Guzmán TF, Maldonado N, Cabral NL, Anderson C, Lindsay P, Hennis A, Feigin VL. Priorities to reduce the burden of stroke in Latin American countries. Lancet Neurol 2019; 18:674-683. [PMID: 31029579 DOI: 10.1016/s1474-4422(19)30068-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/27/2019] [Accepted: 02/04/2019] [Indexed: 01/06/2023]
Abstract
The large and increasing burden of stroke in Latin American countries, and the need to meet the UN and WHO requirements for reducing the burden from non-communicable disorders (including stroke), brought together stroke experts and representatives of the Ministries of Health of 13 Latin American countries for the 1st Latin American Stroke Ministerial meeting in Gramado, Brazil, to discuss the problem and identify ways of cooperating to reduce the burden of stroke in the region. Discussions were focused on the regional and country-specific activities associated with stroke prevention and treatment, including public stroke awareness, prevention strategies, delivery and organisation of care, clinical practice gaps, and unmet needs. The meeting culminated with the adoption of the special Gramado Declaration, signed by all Ministerial officials who attended the meeting. With agreed priorities for stroke prevention, treatment, and research, an opportunity now exists to translate this Declaration into an action plan to reduce the burden of stroke.
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Affiliation(s)
- Sheila C Ouriques Martins
- Brazilian Stroke Network, Porto Alegre, Brazil; Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil; Neurology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Claudio Sacks
- Ibero-American Stroke Organization, Porto Alegre, Brazil; Neurology Department, Universidad de Valparaíso, Valparaíso, Chile
| | - Werner Hacke
- World Stroke Organization, Geneva, Switzerland; Neurology Department, University of Heidelberg, Heidelberg, Germany
| | - Michael Brainin
- World Stroke Organization, Geneva, Switzerland; Department of Neurosciences and Preventive Medicine, Danube University Krems, Krems an der Donau, Austria
| | | | | | - Pablo M Lavados Germain
- Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Vitacura, Chile; Neurology and Psychiatry Clinic, Universidad del Desarrollo, Concepción, Chile; Department of Neurological Sciences, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Maria F Marinho
- NonCommunicable Diseases and Health Promotion, Ministry of Health, Brasília, Brazil
| | - Arnold Hoppe Wiegering
- Ibero-American Stroke Organization, Porto Alegre, Brazil; Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Vitacura, Chile; Neurology and Psychiatry Clinic, Universidad del Desarrollo, Concepción, Chile
| | - Diana Vaca McGhie
- American Heart Association and American Stroke Association, Dallas, Texas, TX, USA
| | - Salvador Cruz-Flores
- Department of Neurology, Paul L Foster School of Medicine, Texas Tech University Health Sciences Center, EL Paso, TX, USA
| | - Sebastian F Ameriso
- Ibero-American Stroke Organization, Porto Alegre, Brazil; Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia, Buenos Aires, Argentina
| | | | | | | | | | | | - Gisele Sampaio Silva
- Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Rubens Gagliardi
- Brazilian Academy of Neurology, Santa Casa de São Paulo, São Paulo, Brazil
| | | | | | - Katia de Pinho Campos
- Determinants of Health, Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Brasília, Brazil
| | | | | | - Irving R Santos Carquin
- Noncommunicable Diseases Department, Ministry of Health, Santiago, Chile; Emergency Hospital Public Assistance, Santiago, Chile; Faculty of Medicine, University of Chile, Santiago, Chile
| | | | - Germán E Pérez Romero
- Colombian Stroke Network, Bogota, Colombia; Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia; Servicio de Neurología, Fundación Hospital San Carlos, Bogotá, Colombia
| | | | - Miguel A Barboza
- Neuroscience department, Hospital Dr Rafael A Calderon, CCSS-HRACG, San José, Costa Rica
| | - Miguel Á Celis López
- Instituto Nacional de Neurologia e Neurocirurgia Dr Manuel Velasco Suarez, Ministry of Health of Mexico, Mexico City, Mexico
| | - Fernando Góngora-Rivera
- Asociación Mexicana de Enfermedad Vascular Cerebral. Monterrey, Mexico; Hospital Universitario José Eleuterio González, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | | | - Miguel Á Velázquez Blanco
- National System of Telemedicine, Ministry of Public Health and Social Welfare of Paraguay, Asunción, Paraguay
| | - Carlos A Arbo Oze de Morvil
- National System of Telemedicine, Ministry of Public Health and Social Welfare of Paraguay, Asunción, Paraguay
| | | | | | - Alan Flores
- Hospital de Clínicas, Asunción, Paraguay; Stroke Unit Universidad Nacional de Asunción, Asunción, Paraguay
| | | | | | - Carlos Abanto Argomedo
- Departamento de Enfermedades Neurovasculares, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Liliana Rodriguez Kadota
- Servicio de Enfermedades vasculares y Epilepsia, Departamento de Neurología, Hospital Nacional Edgardo Rebagliati Martins Lima, Peru
| | | | | | - Ana C de Souza
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Leonardo A Carbonera
- Neurology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Nelson Maldonado
- Department of Neurology, School of Medicine, Universidad San Francisco de Quito, Hospital de los Valles, Quito, Ecuador
| | - Norberto L Cabral
- Joinville Stroke Registry, University of Joinville, Joinville, Brazil
| | - Craig Anderson
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Anselm Hennis
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
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Gagliardi RJ, Raffin CN, Noujaim JEK, Bacellar ALS, Freitas GRD, Oliveira-Filho J, Martins SCO, Silva GS, Pontes-Neto OM. The Brazilian Society of Cerebrovascular Diseases - history. Arq Neuropsiquiatr 2019; 77:208-214. [PMID: 30970134 DOI: 10.1590/0004-282x20180158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/26/2018] [Indexed: 06/09/2023]
Abstract
The present article provides the historical background of the Sociedade Brasileira de Doenças Cerebrovasculares (Brazilian Society for Cerebrovascular Diseases), including details on its function, structure, challenges and main achievements.
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Affiliation(s)
- Rubens José Gagliardi
- Santa Casa de São Paulo, Faculdade de Ciências Médicas, Departamento de Medicina, Disciplina de Neurologia, São Paulo SP, Brasil
| | | | | | | | - Gabriel Rodriguez de Freitas
- Universidade Federal Fluminense, Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Neurologia, Rio de Janeiro RJ, Brasil
| | - Jamary Oliveira-Filho
- Universidade Federal da Bahia, Programa de Pós-Graduação em Ciências da Saúde, Salvador BA, Brasil
| | - Sheila Cristina O Martins
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre e Hospital Moinhos de Vento, Porto Alegre RS, Brasil
- Universidade Federal do Rio Grande do Sul, Hospital Moinhos de Vento, Porto Alegre RS, Brasil
| | - Gisele Sampaio Silva
- Universidade Federal de São Paulo, Disciplina de Neurologia, São Paulo SP, Brasil
- Hospital Israelita Albert Einstein, Programa Integrado de Neurologia, São Paulo SP, Brasil
| | - Octávio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brasil
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Machline-Carrion MJ, Santucci EV, Damiani LP, Bahit C, Málaga G, Pontes-Neto OM, Martins SCO, Zétola VF, Normilio-Silva K, de Freitas GR, Gorgulho A, De Salles A, da Silva BGP, Santos JY, de Andrade Jesuíno I, Bueno PRT, Cavalcanti AB, Guimarães HP, Xian Y, Bettger JP, Lopes RD, Peterson ED, Berwanger O. An international cluster-randomized quality improvement trial to increase the adherence to evidence-based therapies for acute ischemic stroke and transient ischemic attack patients: Rationale and design of the BRIDGE STROKE Trial. Am Heart J 2019; 207:49-57. [PMID: 30415083 DOI: 10.1016/j.ahj.2018.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/21/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Translating evidence into clinical practice in the management of acute ischemic stroke (AIS) and transient ischemic attack (TIA) is challenging especially in low- and middle-income countries. OBJECTIVES The aim of this study is to assess the effect of a multifaceted quality improvement intervention on adherence to evidence-based therapies for AIS and TIA patients care. DESIGN We designed a pragmatic, 2-arm cluster-randomized trial involving 36 clusters and 1624 patients from Brazil, Argentina, and Peru. Hospitals are randomized to receive a multifaceted quality improvement intervention (intervention group) or to routine care (control group). The BRIDGE Stroke multifaceted quality improvement intervention includes case management, reminders, health care providers' educational materials (including treatment algorithms), interactive workshops, and audit and feedback reports. Primary outcome is a composite adherence score to AIS and TIA performance measures. Secondary outcomes include an "all or none" composite end point to performance measures, the individual components of the composite end points, and clinical outcomes at 90 days following admission (stroke recurrence, death, and disability measured by the modified Rankin scale). SUMMARY The BRIDGE Stroke Trial is an international pragmatic evaluation of a multifaceted quality improvement intervention. If effective, this intervention could be potentially extended widely to improve the quality of care and outcomes of patients with AIS or TIA.
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de Castro-Afonso LH, Nakiri GS, Moretti Monsignore L, Dias FA, Aléssio-Alves FF, Rezende MT, Trivelato FP, Pontes-Neto OM, Abud DG. Endovascular Reperfusion for Acute Isolated Cervical Carotid Occlusions: The Concept of "Hemodynamic Thrombectomy". Interv Neurol 2018; 8:27-37. [PMID: 32231693 DOI: 10.1159/000493021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/16/2018] [Indexed: 01/08/2023]
Abstract
Background/Aims Endovascular treatment improves the outcomes of patients presenting with acute large vessel occlusions. Isolated proximal carotid occlusions presenting with hemodynamic ischemic stroke may probably also benefit from endovascular treatment. We aimed to assess the clinical and radiological data findings on patients who underwent endovascular treatment for acute ischemic stroke related to an isolated cervical carotid artery occlusion. Methods Of a consecutive series of 223 patients who were admitted with acute ische-mic stroke and were treated by thrombectomy, we included 9 patients with isolated cervical internal carotid occlusions. Results The mean baseline National Institutes of Health Stroke Scale (NIHSS) score was 11.8. Complete carotid recanalization was achieved in 5 of the 9 patients (55.5%). In 2 patients, vertebral angioplasty was performed to improve the collateral flow. All patients had a modified Thrombolysis in Cerebral Infarction (mTICI) score of 3 at the end of the procedures. A good neurological outcome, defined as a modified Rankin Scale score ≤2 at the 3-month follow-up, was observed in 6 patients (66.7%). No symptomatic intracranial hemorrhages or deaths occurred during the 3 months of follow-up. Conclusions The endovascular recanalization of isolated cervical carotid occlusions presenting with acute ischemic stroke symptoms is feasible. Because isolated cervical carotid occlusions are associated with hemodynamic ischemic symptoms, if carotid recanalization cannot be achieved, stenting other cervical arteries' stenoses, with a focus on intracranial flow improvement, appears to be a reasonable strategy. Large controlled studies are necessary to assess the safety and efficacy of recanalization of acute isolated cervical carotid occlusions.
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Affiliation(s)
- Luís Henrique de Castro-Afonso
- Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Guilherme Seizem Nakiri
- Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Lucas Moretti Monsignore
- Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Francisco Antunes Dias
- Division of Neurology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Marco Túlio Rezende
- Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Felipe Padovani Trivelato
- Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Daniel Giansante Abud
- Division of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Peres ASC, Souza VH, Catunda JMY, Mazzeto-Betti KC, Santos-Pontelli TEG, Vargas CD, Baffa O, de Araújo DB, Pontes-Neto OM, Leite JP, Garcia MAC. Can somatosensory electrical stimulation relieve spasticity in post-stroke patients? A TMS pilot study. BIOMED ENG-BIOMED TE 2018; 63:501-506. [PMID: 28475487 DOI: 10.1515/bmt-2016-0162] [Citation(s) in RCA: 2] [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: 08/05/2016] [Accepted: 03/28/2017] [Indexed: 11/15/2022]
Abstract
Evidence suggests that somatosensory electrical stimulation (SES) may decrease the degree of spasticity from neural drives, although there is no agreement between corticospinal modulation and the level of spasticity. Thus, stroke patients and healthy subjects were submitted to SES (3 Hz) for 30' on the impaired and dominant forearms, respectively. Motor evoked potentials induced by single-pulse transcranial magnetic stimulation were collected from two forearm muscles before and after SES. The passive resistance of the wrist joint was measured with an isokinetic system. We found no evidence of an acute carry-over effect of SES on the degree of spasticity.
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Affiliation(s)
- André Salles Cunha Peres
- Laboratório de Neuroimagem Funcional, Instituto do Cérebro - Universidade Federal do Rio Grande do Norte - Av. Nascimento de Castro, 2155 - Morro Branco, Natal, RN 59056-450,Brazil.,Instituto Santos Dumont, Instituto Internacional de Neurociências - Rodovia RN 160, 3001 - Distrito Jundiaí, Macaíba 59280-000, Brazil
| | - Victor Hugo Souza
- Departamento de Física, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto - Universidade de São Paulo - Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP 14040-901,Brazil
| | - João Marcos Yamasaki Catunda
- Programa de Engenharia Biomédica, COPPE - Universidade Federal do Rio de Janeiro - Av. Horácio Macedo 2030, Centro de Tecnologia, Bloco H, Sala 327 - Cidade Universitária - Ilha do Fundão, Rio de Janeiro, RJ 21941-914,Brazil
| | - Kelley Cristine Mazzeto-Betti
- Departamento de Neurologia, Psiquiatria e Psicologia Médica, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo - Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP 14048-900,Brazil
| | - Taiza Elaine Grespan Santos-Pontelli
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo - Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP 14048-900,Brazil
| | - Claudia Domingues Vargas
- Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho - Universidade Federal do Rio de Janeiro - Av. Carlos Chagas Filho, 373 - Cidade Universitária - Ilha do Fundão, Rio de Janeiro, RJ 21941-902,Brazil
| | - Oswaldo Baffa
- Departamento de Física, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto - Universidade de São Paulo - Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP 14040-901,Brazil
| | - Draulio Barros de Araújo
- Laboratório de Neuroimagem Funcional, Instituto do Cérebro - Universidade Federal do Rio Grande do Norte - Av. Nascimento de Castro, 2155 - Morro Branco, Natal, RN 59056-450,Brazil
| | - Octávio Marques Pontes-Neto
- Departamento de Neurologia, Psiquiatria e Psicologia Médica, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo - Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP 14048-900,Brazil
| | - João Pereira Leite
- Departamento de Neurologia, Psiquiatria e Psicologia Médica, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo - Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP 14048-900,Brazil
| | - Marco Antonio Cavalcanti Garcia
- Departamento de Biociências e Atividades Físicas, Escola de Educação Física e Desportos - Universidade Federal do Rio de Janeiro - Avenida Carlos Chagas Filho, 540 - Cidade Universitária - Ilha do Fundão, Rio de Janeiro, RJ 21941-599,Brazil, Phone: +55(21)3938-6824,
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Minhas JS, Wang X, Arima H, Bath PM, Billot L, Broderick JP, Donnan GA, Kim JS, Lavados PM, Lee TH, Martins SCO, Olavarría VV, Pandian JD, Pontes-Neto OM, Ricci S, Sato S, Sharma VK, Thang NH, Wang JG, Woodward M, Chalmers J, Anderson CS, Robinson TG. Lipid-Lowering Pretreatment and Outcome Following Intravenous Thrombolysis for Acute Ischaemic Stroke: A Post Hoc Analysis of the Enhanced Control of Hypertension and Thrombolysis Stroke Study Trial. Cerebrovasc Dis 2018; 45:213-220. [PMID: 29705803 DOI: 10.1159/000488911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/31/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Debate exists as to whether statin pretreatment confers an increased risk of 90-day mortality and symptomatic intracranial haemorrhage (sICH) in acute ischaemic stroke (AIS) patients treated with intravenous thrombolysis. We assessed the effects of undifferentiated lipid-lowering pretreatment on outcomes and interaction with low-dose versus standard-dose alteplase in a post hoc subgroup -analysis of the Enhanced Control of Hypertension and Thrombolysis Stroke Study. METHODS In all, 3,284 thrombolysis-eligible AIS patients (mean age 66.6 years; 38% women), with information on lipid-lowering pretreatment, were randomly assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) intravenous alteplase within 4.5 h of symptom onset. Of the total number of patients, 615 (19%) received statin or other lipid-lowering pretreatment. The primary clinical outcome was combined endpoint of death or disability (modified Rankin Scale scores 2-6) at 90 days. RESULTS Compared with patients with no lipid-lowering pretreatment, those with lipid-lowering pretreatment were significantly older, more likely to be non-Asian and more likely to have a medical history including vascular co-morbidity. After propensity analysis assessment and adjustment for important baseline variables at the time of randomisation, as well as imbalances in management during the first 7 days of hospital admission, there were no significant differences in mortality (OR 0.85; 95% CI 0.58-1.25, p = 0.42), or in overall -90-day death and disability (OR 0.85, 95% CI 0.67-1.09, p = 0.19), despite a significant decrease in sICH among those with -lipid-lowering pretreatment according to the European Co-operative Acute Stroke Study 2 definition (OR 0.49, 95% CI 0.28-0.83, p = 0.009). No differences in key efficacy or safety outcomes were seen in patients with and without lipid-lowering pretreatment between low- and standard-dose alteplase arms. CONCLUSIONS Lipid-lowering pretreatment is not associated with adverse outcome in AIS patients treated with intravenous alteplase, whether assessed by 90-day death and disability or death alone.
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Affiliation(s)
- Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Xia Wang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Hisatomi Arima
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Philip M Bath
- Stroke Trials Unit, University of Nottingham, Nottingham, United Kingdom
| | - Laurent Billot
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph P Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Neuroscience Institute, Cincinnati, Ohio, USA
| | - Geoffrey A Donnan
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Pablo M Lavados
- Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Sanntiago, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile.,Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Tsong-Hai Lee
- Department of Neurology, Stroke Center, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sheila Cristina Ouriques Martins
- Neurologia Vascular, Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Verónica V Olavarría
- Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Sanntiago, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | | | - Octávio Marques Pontes-Neto
- Stroke Service, Neurology Division, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Stefano Ricci
- Uo Neurologia, USL Umbria 1, Sedi di Città di Castello e Branca, Perugia, Italy
| | - Shoichiro Sato
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Vijay K Sharma
- Yong Loo Lin School of Medicine, National University of Singapore, Division of Neurology, National University Hospital, Singapore, Singapore
| | - Nguyen H Thang
- Department of Cerebrovascular Disease, 115 People's Hospital, Ho Chi Minh City, Vietnam
| | - Ji-Guang Wang
- The Shanghai Institute for Hypertension, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mark Woodward
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - John Chalmers
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,The George Institute China at Peking University Health Sciences Center, Beijing, China
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.,National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, United Kingdom
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Cabral FB, Castro-Afonso LH, Nakiri GS, Monsignore LM, Fábio S, Dos Santos AC, Pontes-Neto OM, Abud DG. Hyper-attenuating brain lesions on CT after ischemic stroke and thrombectomy are associated with final brain infarction. Interv Neuroradiol 2017; 23:594-600. [PMID: 28950737 DOI: 10.1177/1591019917729550] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose Hyper-attenuating lesions, or contrast staining, on a non-contrast brain computed tomography (NCCT) scan have been investigated as a predictor for hemorrhagic transformation after endovascular treatment of acute ischemic stroke (AIS). However, the association of hyper-attenuating lesions and final ischemic areas are poorly investigated in this setting. The aim of the present study was to assess correlations between hyper-attenuating lesions and final brain infarcted areas after thrombectomy for AIS. Methods Data from patients with AIS of the anterior circulation who underwent endovascular treatment were retrospectively assessed. Images of the brain NCCT scans were analyzed in the first hours and late after treatment. The hyper-attenuating areas were compared to the final ischemic areas using the Alberta Stroke Program Early CT Score (ASPECTS). Results Seventy-one of the 123 patients (65.13%) treated were included. The association between the hyper-attenuating region in the post-thrombectomy CT scan and final brain ischemic area were sensitivity (58.3% to 96.9%), specificity (42.9% to 95.6%), positive predictive values (71.4% to 97.7%), negative predictive values (53.8% to 79.5%), and accuracy values (68% to 91%). The highest sensitivity values were found for the lentiform (96.9%) and caudate nuclei (80.4%) and for the internal capsule (87.5%), and the lowest values were found for the M1 (58.3%) and M6 (66.7%) cortices. Conclusions Hyper-attenuating lesions on head NCCT scans performed after endovascular treatment of AIS may predict final brain infarcted areas. The prediction appears to be higher in the deep brain regions compared with the cortical regions.
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Affiliation(s)
- F B Cabral
- 1 Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - L H Castro-Afonso
- 1 Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - G S Nakiri
- 1 Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - L M Monsignore
- 1 Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Src Fábio
- 2 Division of Neurology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - A C Dos Santos
- 3 Division of Diagnostic Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - O M Pontes-Neto
- 2 Division of Neurology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - D G Abud
- 1 Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Castro-Afonso LHD, Nakiri GS, Monsignore LM, Cougo-Pinto PT, Dias FA, Aléssio-Alves F, Pontes-Neto OM, Abud DG. The direct first pass aspiration technique in the treatment of acute ischemic stroke resulting from large vessel occlusions. Arq Neuro-Psiquiatr 2017; 75:412-418. [DOI: 10.1590/0004-282x20170059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 12/20/2016] [Indexed: 11/21/2022]
Abstract
ABSTRACT Mechanical thrombectomy using stent retrievers is the standard treatment for acute ischemic stroke that results from large vessel occlusions. The direct aspiration first pass technique (ADAPT) has been proposed as an efficient, fast, and cost-effective thrombectomy strategy. The aim of this study was to assess the safety and efficacy of ADAPT. Methods Recanalization was assessed using the modified thrombolysis in cerebral infarction (mTICI) score. Neurological outcomes were assessed using the National Institutes of Health Stroke Scale and modified Rankin Scale. Results Fifteen patients were evaluated. The mTICI score was 2b-3 in 80%, and it was 3 in 60% of patients. No intracranial hemorrhage was seen. At three months, modified Rankin Scale scores ≤ 2 were observed in 60% of patients and the mortality rate was 13.3%. Conclusions The ADAPT appears to be a safe, effective, and fast recanalization strategy for treatment of acute ischemic stroke resulting from large vessel occlusions.
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Santos EBD, Rodrigues RAP, Pontes-Neto OM. Prevalence and predictors of post stroke depression among elderly stroke survivors. Arq Neuropsiquiatr 2017; 74:621-5. [PMID: 27556372 DOI: 10.1590/0004-282x20160088] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/02/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify the prevalence of post stroke depression (PSD) and their socio-demographic and clinical predictors among elderly stroke survivors after hospital discharge to home. METHODS In this cross-sectional study, 90 elderly stroke survivors were evaluated 14 days after hospital discharge with the following scales: National Institutes of Health Stroke Scale, Functional Independence Measure, and Geriatric Depression Scale - 15 items (GDS-15). PSD was defined as a score > 5 on GDS-15. After univariate analyses, a multivariate logistic regression model was built to identify independent predictors of PSD. RESULTS Fourteen days after hospital discharge, 27.7% (95%CI 18.1 to 37.2) of elderly stroke survivors had PSD. Functional dependence was the only independent predictor of PSD (OR: 1.04 95%CI: 1.01 to 1.09; p = 0.02). CONCLUSION After stroke, depressive symptoms are common among elderly survivors. The degree of functional dependency is the main predictor of PSD among elderly stroke patients in Brazil.
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Affiliation(s)
- Emanuella Barros Dos Santos
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Departamento de Enfermagem Geral e Especializada, Ribeirão Preto SP, Brasil
| | | | - Octávio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brasil
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Leoni RF, Oliveira IAF, Pontes-Neto OM, Santos AC, Leite JP. Cerebral blood flow and vasoreactivity in aging: an arterial spin labeling study. ACTA ACUST UNITED AC 2017; 50:e5670. [PMID: 28355354 PMCID: PMC5423749 DOI: 10.1590/1414-431x20175670] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/13/2017] [Indexed: 12/29/2022]
Abstract
Regional cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) in young and elderly participants were assessed using pulsed arterial spin labeling (ASL) and blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI) techniques in combination with inhalation of CO2. Pulsed ASL and BOLD-MRI were acquired in seventeen asymptomatic volunteers (10 young adults, age: 30±7 years; 7 elderly adults, age: 64±8 years) with no history of diabetes, hypertension, and neurological diseases. Data from one elderly participant was excluded due to the incorrigible head motion. Average baseline CBF in gray matter was significantly reduced in elderly (46±9 mL·100 g-1·min-1) compared to young adults (57±8 mL·100 g-1·min-1; P=0.02). Decreased pulsed ASL-CVR and BOLD-CVR in gray matter were also observed in elderly (2.12±1.30 and 0.13±0.06 %/mmHg, respectively) compared to young adults (3.28±1.43 and 0.28±0.11 %/mmHg, respectively; P<0.05), suggesting some degree of vascular impairment with aging. Moreover, age-related decrease in baseline CBF was observed in different brain regions (inferior, middle and superior frontal gyri; precentral and postcentral gyri; superior temporal gyrus; cingulate gyri; insula, putamen, caudate, and supramarginal gyrus). In conclusion, CBF and CVR were successfully investigated using a protocol that causes minimal or no discomfort for the participants. Age-related decreases in baseline CBF and CVR were observed in the cerebral cortex, which may be related to the vulnerability for neurological disorders in aging.
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Affiliation(s)
- R F Leoni
- Departamento de Física, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - I A F Oliveira
- Departamento de Física, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - O M Pontes-Neto
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A C Santos
- Divisão de Radiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J P Leite
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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de Campos LM, Martins BM, Cabral NL, Franco SC, Pontes-Neto OM, Mazin SC, dos Reis FI. How Many Patients Become Functionally Dependent after a Stroke? A 3-Year Population-Based Study in Joinville, Brazil. PLoS One 2017; 12:e0170204. [PMID: 28107401 PMCID: PMC5249115 DOI: 10.1371/journal.pone.0170204] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 12/30/2016] [Indexed: 12/04/2022] Open
Abstract
The decrease in stroke mortality will increase the burden of survivors with functional dependence (FD). The aim of this study was to evaluate how many patients become functionally dependent over 3 years after an incident event in Joinville, Brazil. The proportion of FD (defined as a modified Rankin score 3 to 5) among stroke survivors from the Joinville Stroke Registry was assessed using a validated telephone interview. Incidence of FD after stroke in Joinville in one year was 23.24 per 100,000 population. The overall proportion of FD among stroke survivors at discharge was 32.7%. Of 303 patients with first-ever ischaemic stroke (IS), one-third were FD at discharge, and 12%, 9% and 8%, respectively at 1, 2 and 3 years. Among 37 patients with haemorrhagic stroke (HS), 38% were dependent at discharge, 16% after 1 and 2 years and 14% after 3. Among 27 patients with subarachnoid haemorrhage (SAH), 19% were dependent at discharge and 4% from 1 to 3 years. Among IS subtypes, cardioembolic ones had the worst risk of FD. (RR 19.8; 95% CI: 2.2 to 175.9). Our results showed that one-third of stroke survivors have FD during the first year after stroke in Brazil. Therefore, a city with half a million people might expect 120 new stroke patients with FD each year.
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Affiliation(s)
- Lívia Mizuki de Campos
- Department of Medicine, University of Joinville Region, Joinville, Santa Catarina, Brazil
| | - Bruna Mariah Martins
- Department of Medicine, University of Joinville Region, Joinville, Santa Catarina, Brazil
| | - Norberto Luiz Cabral
- Department of Medicine, University of Joinville Region, Joinville, Santa Catarina, Brazil
- Joinville Stroke Registry, University of Joinville Region, Joinville, Santa Catarina, Brazil
| | - Selma Cristina Franco
- Department of Medicine, University of Joinville Region, Joinville, Santa Catarina, Brazil
- * E-mail:
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Pontes-Neto OM, Cougo P, Martins SCO, Abud DG, Nogueira RG, Miranda M, Castro-Afonso LHD, Rebello LC, Caldas JGMP, Bazan R, Bezerra DC, Rezende MT, Freitas GRD, Longo A, Magalhães P, Carvalho JJFD, Montalverne FJ, Lima FO, Andrade GH, Massaro AR, Oliveira-Filho J, Gagliardi R, Silva GS. Brazilian guidelines for endovascular treatment of patients with acute ischemic stroke. Arq Neuro-Psiquiatr 2017; 75:50-56. [DOI: 10.1590/0004-282x20160174] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/10/2016] [Indexed: 11/22/2022]
Abstract
ABSTRACT These guidelines are the result of a joint effort from writing groups of the Brazilian Stroke Society, the Scientific Department of Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Stroke Network and the Brazilian Society of Diagnostic and Therapeutic Neuroradiology. Members from these groups participated in web-based discussion forums with predefined themes, followed by videoconference meetings in which controversies and position statements were discussed, leading to a consensus. This guidelines focuses on the implications of the recent clinical trials on endovascular therapy for acute ischemic stroke due to proximal arterial occlusions, and the final text aims to guide health care providers, health care managers and public health authorities in managing patients with this condition in Brazil.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Gabriel R. de Freitas
- Universidade Federal Fluminense, Brasil; Instituto D'Or de Pesquisa e Ensino, Brasil
| | | | | | | | | | | | | | | | | | | | - Gisele Sampaio Silva
- Universidade Federal de São Paulo, Brasil; Hospital Israelita Albert Einstein, Brasil
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Zanati Bazan SG, Braga GP, Luvizutto GJ, Trindade AP, Pontes-Neto OM, Bazan R. Bihemispheric Paradoxical Cerebral Embolism in a Patient with Pulmonary Thromboembolism and Presumptive Fistula Right-to-Left Shunt. J Stroke Cerebrovasc Dis 2016; 25:e95-7. [PMID: 27105566 DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.038] [Citation(s) in RCA: 2] [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: 02/03/2016] [Revised: 03/14/2016] [Accepted: 03/19/2016] [Indexed: 10/21/2022] Open
Abstract
We report a case of a bihemispheric paradoxical cerebral embolism in a patient with pulmonary thromboembolism and presumptive pulmonary arteriovenous fistula. The echocardiogram showed no intracardiac shunt, and the transcranial Doppler (TCD) revealed spontaneous microembolic signals in the middle cerebral arteries (MCAs), and late passage of a higher number of microembolic signals in the MCAs, compatible with right-to-left shunt (RLS). The TCD and the echocardiogram were useful for identifying the RLS when rapid neurological deterioration occurred.
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Affiliation(s)
- Silméia Garcia Zanati Bazan
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil
| | - Gabriel Pereira Braga
- Department of Neurology, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil
| | - Gustavo José Luvizutto
- Department of Neurology, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil.
| | - André Petean Trindade
- Department of Tropical Diseases and Diagnostic Imaging, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School-USP, São Paulo State University, São Paulo, Brazil
| | - Rodrigo Bazan
- Department of Neurology, Botucatu Medical School-UNESP, São Paulo State University, São Paulo, Brazil
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de Castro-Afonso LH, Nakiri GS, Pontes-Neto OM, dos Santos AC, Abud DG. International Survey on the Management of Wake-Up Stroke. Cerebrovasc Dis Extra 2016; 6:22-6. [PMID: 27099612 PMCID: PMC4836135 DOI: 10.1159/000444765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/16/2016] [Indexed: 11/29/2022] Open
Abstract
Background Patients who wake up having experienced a stroke while asleep represent around 20% of acute stroke admissions. According to international guidelines for the management of acute stroke, patients presenting with wake-up stroke are not currently eligible to receive revascularization treatments. In this study, we aimed to assess the opinions of stroke experts about the management of patients with wake-up stroke by using an international multicenter electronic survey. Method This study consisted of 8 questions on wake-up stroke treatment. Results Two hundred invitations to participate in the survey were sent by e-mail. Fifty-nine participants started the survey, 4 dropped out before completing it, and 55 completed the full questionnaire. We had 55 participants from 22 countries. Conclusions In this study, most stroke experts recommended a recanalization treatment for wake-up stroke. However, there was considerable disagreement among experts regarding the best brain imaging method and the best recanalization treatment. The results of ongoing randomized trials on wake-up stroke are urgently needed.
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Affiliation(s)
- Luís Henrique de Castro-Afonso
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Guilherme Seizem Nakiri
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Antônio Carlos dos Santos
- Division of Diagnostic Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Daniel Giansante Abud
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Affiliation(s)
- Bruno Lopes dos Santos-Lobato
- From the Department of Neuroscience and Behavior Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Octávio Marques Pontes-Neto
- From the Department of Neuroscience and Behavior Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Santos EBD, Rodrigues RAP, Marques S, Pontes-Neto OM. [Perceived stress in elderly stroke survivors after hospital discharge to home]. Rev Esc Enferm USP 2015; 49:797-803. [PMID: 26516750 DOI: 10.1590/s0080-623420150000500013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 05/23/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the relationship between perceived stress and comorbidities, neurological deficit, functional independence and depressive symptoms of stroke survivors after hospital discharge. METHOD Cross-sectional study with 90 elderly stroke survivors. The National Institutes of Health Stroke Scale instrument, the Functional Independence Measure instrument, the Geriatric Depression Scale and the Perceived Stress Scale were used. Bivariate Pearson correlation, independent t test and multiple regression analysis were used to evaluate the relationship between perceived stress and other variables. RESULTS The final regression model showed that higher perceived stress was related to less functional independence (p= 0.022) and more depressive symptoms (p <0.001). CONCLUSION At hospital discharge, interventions should be planned for the treatment of depressive symptoms and to create adaptation strategies to the reduction of functional independence, in order to reduce the stress of the survivors.
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Affiliation(s)
| | | | - Sueli Marques
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Bazan R, Braga GP, Luvizutto GJ, Hueb JC, Hokama NK, Zanati Bazan SG, de Carvalho Nunes HR, Leite JP, Pontes-Neto OM. Evaluation of the Temporal Acoustic Window for Transcranial Doppler in a Multi-Ethnic Population in Brazil. Ultrasound Med Biol 2015; 41:2131-2134. [PMID: 25964064 DOI: 10.1016/j.ultrasmedbio.2015.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 04/06/2015] [Accepted: 04/14/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to relate the presence of a temporal acoustic window (TAW) to the variables sex, age and race. This observational study was conducted in patients under etiologic investigation after stroke, sickle-cell anemia and hospitalization in an intensive therapy neurologic unit. TAW presence was confirmed by bilateral assessment by two neurologists via transcranial Doppler (TCD). Multiple logistic regression was performed to explain the presence of the window as a function of sex, age and race. In 20% of the 262 patients evaluated, a TAW was not present. The incidence of TAW presence was greater in men (odds ratio [OR] = 5.4, 95% confidence interval [CI] = 2.5-11.7, p < 0.01); lower with increased age (OR = 0.9, 95% CI = 0.92-0.97, p < 0.01); and lower among those of African and Asian descent (OR = 0.32, 95% CI = 0.14-0.70, p = 0.005). On the basis of the results, more men than women had TAWs, and the decrease in TAWs was associated with increased age and African or Asian descent.
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Affiliation(s)
- Rodrigo Bazan
- Botucatu Medical School, Department of Neurology and Department of Internal Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Gabriel Pereira Braga
- Botucatu Medical School, Department of Neurology and Department of Internal Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Gustavo José Luvizutto
- Botucatu Medical School, Department of Neurology and Department of Internal Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil.
| | - João Carlos Hueb
- Botucatu Medical School, Department of Neurology and Department of Internal Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Newton Key Hokama
- Botucatu Medical School, Department of Neurology and Department of Internal Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Silméia Garcia Zanati Bazan
- Botucatu Medical School, Department of Neurology and Department of Internal Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Hélio Rubens de Carvalho Nunes
- Botucatu Medical School, Department of Neurology and Department of Internal Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - João Pereira Leite
- Ribeirão Preto Medical School, Department of Neuroscience and Behavior, University of São Paulo, São Paulo, Brazil
| | - Octávio Marques Pontes-Neto
- Ribeirão Preto Medical School, Department of Neuroscience and Behavior, University of São Paulo, São Paulo, Brazil
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Castro-Afonso LHD, Nakiri GS, Monsignore LM, Santos DD, Camilo MR, Dias FA, Cougo-Pinto PT, Barreira CMA, Alessio-Alves FF, Fábio SRC, Pontes-Neto OM, Abud DG. Outcomes of carotid artery stenting at a high-volume Brazilian interventional neuroradiology center. Clinics (Sao Paulo) 2015; 70:180-4. [PMID: 26017648 PMCID: PMC4449470 DOI: 10.6061/clinics/2015(03)05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/05/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Carotid artery stenting is an emerging revascularization alternative to carotid endarterectomy. However, guidelines have recommended carotid artery stenting only if the rate of periprocedural stroke or death is < 6% among symptomatic patients and < 3% among asymptomatic patients. The aim of this study is to evaluate and compare clinical outcomes of symptomatic and asymptomatic patients who had undergone carotid artery stenting as a first-intention treatment. METHOD A retrospective analysis of patients who underwent carotid artery stenting by our interventional neuroradiology team was conducted. Patients were divided into two groups: symptomatic and asymptomatic patients. The primary endpoints were ipsilateral ischemic stroke, ipsilateral parenchymal hemorrhage and major adverse cardiac and cerebrovascular events at 30 days. The secondary endpoints included ipsilateral ischemic stroke, ipsilateral parenchymal hemorrhage, ipsilateral transient ischemic attack and major adverse cardiac and cerebrovascular events between the 1- and 12-month follow-ups. RESULTS A total of 200 consecutive patients were evaluated. The primary endpoints obtained in the symptomatic vs. asymptomatic groups were ipsilateral stroke (2.4% vs. 2.7%, p = 1.00), ipsilateral parenchymal hemorrhage (0.8% vs. 0.0%, p = 1.00) and major adverse cardiac and cerebrovascular events (4.7% vs. 2.7%, p = 0.71). The secondary endpoints obtained in the symptomatic vs. asymptomatic groups were ipsilateral ischemic stroke (0.0% vs. 0.0%), ipsilateral parenchymal hemorrhage (0.0% vs. 0.0%), ipsilateral TIA (0.0% vs. 0.0%, p = 1.00) and major adverse cardiac and cerebrovascular events (11.2% vs. 4.1%, p = 0.11). CONCLUSIONS In this retrospective study, carotid artery stenting was similarly safe and effective when performed as a first-intention treatment in both symptomatic and asymptomatic patients. The study results comply with the safety requirements from current recommendations to perform carotid artery stenting as an alternative treatment to carotid endarterectomy.
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Affiliation(s)
- Luis Henrique de Castro-Afonso
- Division of Interventional Neuroradiology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto/SP, Brazil
| | - Guilherme Seizem Nakiri
- Division of Interventional Neuroradiology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto/SP, Brazil
| | - Lucas Moretti Monsignore
- Division of Interventional Neuroradiology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto/SP, Brazil
| | - Daniela dos Santos
- Division of Interventional Neuroradiology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto/SP, Brazil
| | - Millene Rodrigues Camilo
- Division of Vascular Neurology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto/SP, Brazil
| | - Francisco Antunes Dias
- Division of Vascular Neurology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto/SP, Brazil
| | - Pedro Telles Cougo-Pinto
- Division of Vascular Neurology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto/SP, Brazil
| | - Clara Monteiro Antunes Barreira
- Division of Vascular Neurology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto/SP, Brazil
| | | | - Soraia Ramos Cabette Fábio
- Division of Vascular Neurology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto/SP, Brazil
| | - Octávio Marques Pontes-Neto
- Division of Vascular Neurology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto/SP, Brazil
| | - Daniel Giansante Abud
- Division of Interventional Neuroradiology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto/SP, Brazil
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Gonzalez MM, Timerman S, Gianotto-Oliveira R, Polastri TF, Canesin MF, Schimidt A, Siqueira AW, Pispico A, Longo A, Pieri A, Reis A, Tanaka ACS, Santos AM, Quilici AP, Ribeiro ACL, Barreto ACP, Pazin-Filho A, Timerman A, Machado CA, Franchin Neto C, Miranda CH, Medeiros CR, Malaque CMS, Bernoche C, Gonçalves DM, Sant'Ana DG, Osawa EA, Peixoto E, Arfelli E, Evaristo EF, Azeka E, Gomes EP, Wen FH, Ferreira FG, Lima FG, Mattos FR, Galas FG, Marques FRB, Tarasoutchi F, Mancuso FJN, Freitas GR, Feitosa-Filho GS, Barbosa GC, Giovanini GR, Miotto HC, Guimarães HP, Andrade JP, Oliveira-Filho J, Fernandes JG, Moraes Junior JBMX, Carvalho JJF, Ramires JAF, Cavalini JF, Teles JMM, Lopes JL, Lopes LNGD, Piegas LS, Hajjar LA, Brunório L, Dallan LAP, Cardoso LF, Rabelo MMN, Almeida MFB, Souza MFS, Favarato MH, Pavão MLRC, Shimoda MS, Oliveira Junior MT, Miura N, Filgueiras Filho NM, Pontes-Neto OM, Pinheiro PAPC, Farsky OS, Lopes RD, Silva RCG, Kalil Filho R, Gonçalves RM, Gagliardi RJ, Guinsburg R, Lisak S, Araújo S, Martins SCO, Lage SG, Franchi SM, Shimoda T, Accorsi TD, Barral TCN, Machado TAO, Scudeler TL, Lima VC, Guimarães VA, Sallai VS, Xavier WS, Nazima W, Sako YK. [First guidelines of the Brazilian Society of Cardiology on Cardiopulmonary Resuscitation and Cardiovascular Emergency Care]. Arq Bras Cardiol 2014; 101:1-221. [PMID: 24030145 DOI: 10.5935/abc.2013s006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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de Castro-Afonso LH, Abud LG, Rolo JG, dos Santos AC, de Oliveira L, Barreira CMA, Velasco TR, Pontes-Neto OM, Abud DG. Letter by de Castro-Afonso et al regarding article, "Operator's experience is the most efficient embolic protection device for carotid artery stenting". Circ Cardiovasc Interv 2014; 7:130. [PMID: 24550536 DOI: 10.1161/circinterventions.113.001133] [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: 11/16/2022]
Affiliation(s)
- Luis Henrique de Castro-Afonso
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Santos BLD, Simão GN, Pontes-Neto OM. Neurological picture. Conjugate upward gaze paralysis with unilateral ptosis caused by a unilateral midbrain infarction. J Neurol Neurosurg Psychiatry 2014; 85:114-5. [PMID: 23853137 DOI: 10.1136/jnnp-2013-305448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Bruno Lopes dos Santos
- Department of Neuroscience and Behavior Sciences, Medical School of Ribeirão Preto, University of São Paulo, , Ribeirão Preto, SP, Brazil
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Castro-Afonso LHD, Abud LG, Rolo JG, Santos ACD, Oliveira LD, Barreira CMA, Velasco TR, Pontes-Neto OM, Abud DG. Flow reversal versus filter protection: a pilot carotid artery stenting randomized trial. Circ Cardiovasc Interv 2013; 6:552-9. [PMID: 24084627 DOI: 10.1161/circinterventions.113.000479] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Carotid artery stenting (CAS) has become an alternative treatment for patients presenting symptomatic carotid artery stenosis. The improvement in clinical outcomes with CAS has been associated with the development of embolic protection devices. The trial aim is to compare flow reversal versus filter protection during CAS through femoral access. METHODS AND RESULTS Patients were randomly enrolled in CAS using flow reversal or filter protection. The primary end points were the incidence, number, and size of new ischemic brain lesions after CAS. The secondary end points included major adverse cardiac and cerebrovascular events, transient ischemic attack, and definitive ischemic brain lesions on fluid-attenuated inversion recovery magnetic resonance image at a 3-month follow-up. Ischemic brain lesions were assessed by a 3T magnetic resonance image. Neurological outcomes were evaluated by means of the National Institutes of Health Stroke Scale and the modified Rankin Scale (mRS). Forty consecutive patients were randomly assigned. Compared with flow reversal (n=21), filter protection (n=19) resulted in a significant reduction in the incidence (15.8% versus 47.6%, P=0.03), number (0.73 versus 2.6, P=0.05), and size (0.81 versus 2.23 mm, P=0.05) of new ischemic brain lesions. Two patients, 1 from each group, presented transient ischemic attack at 3-month follow-up. There were no major adverse cardiac and cerebrovascular events in the hospital or at 3-month follow-up. CONCLUSIONS In this small sample size trial, filter protection was more effective than flow reversal in reducing ischemic brain lesions during CAS through femoral approach. CLINICAL TRIAL REGISTRATION URL http://portal2.saude.gov.br/sisnep/. Unique identifier: 0538.0.004.000-10.
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Affiliation(s)
- Luis Henrique de Castro-Afonso
- Division of Interventional Neuroradiology, Division of Neuroradiology, and Division of Neurology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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