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Zapata-Arriaza E, Medina-Rodríguez M, Moniche Álvarez F, de Albóniga-Chindurza A, Aguilar-Pérez M, Ainz-Gómez L, Baena-Palomino P, Zamora A, Pardo-Galiana B, Delgado-Acosta F, Valverde Moyano R, Jiménez-Gómez E, Bravo Rey I, Oteros Fernández R, Escudero-Martínez I, Vielba-Gomez I, Morales Caba L, Díaz Pérez J, García Molina E, Mosteiro S, Castellanos Rodrigo MDM, Amaya Pascasio L, Hidalgo C, Freijo Guerrero MDM, González Díaz E, Ramírez Moreno JM, Fernández Prudencio L, Terceño Izaga M, Bashir Viturro S, Gamero-García MÁ, Jiménez Jorge S, Rosso Fernández C, Montaner J, González García A. Statistical analysis plan for the multicenter, open, randomized controlled clinical trial to assess the efficacy and safety of intravenous tirofiban vs aspirin in acute ischemic stroke due to tandem lesion, undergoing recanalization therapy by endovascular treatment (ATILA trial). Trials 2024; 25:35. [PMID: 38195586 PMCID: PMC10775524 DOI: 10.1186/s13063-023-07817-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024] Open
Abstract
RATIONALE In-stent reocclusion after endovascular therapy has a negative impact on outcomes in acute ischemic stroke (AIS) due to tandem lesions (TL). Optimal antiplatelet therapy approach in these patients to avoid in-stent reocclusion is yet to be elucidated. AIMS To assess efficacy and safety of intravenous tirofiban versus intravenous aspirin in patients undergoing MT plus carotid stenting in the setting of AIS due to TL. SAMPLE SIZE ESTIMATES Two hundred forty patients will be enrolled, 120 in every treatment arm. METHODS AND DESIGN A multicenter, prospective, randomized, controlled (aspirin group), assessor-blinded clinical trial will be conducted. Patients fulfilling the inclusion criteria will be randomized at MT onset to the experimental or control group (1:1). Intravenous aspirin will be administered at a 500-mg single dose and tirofiban at a 500-mcg bolus followed by a 200-mcg/h infusion during the first 24 h. All patients will be followed for up to 3 months. STUDY OUTCOMES Primary efficacy outcome will be the proportion of patients with carotid in-stent thrombosis within the first 24 h after MT. Primary safety outcome will be the rate of symptomatic intracranial hemorrhage. DISCUSSION This will be the first clinical trial to assess the best antiplatelet therapy to avoid in-stent thrombosis after MT in patients with TL. TRIAL REGISTRATION The trial is registered as NCT05225961. February, 7th, 2022.
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Affiliation(s)
- Elena Zapata-Arriaza
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain.
- Interventional Neuroradiology Department, Virgen del Rocío University Hospital, Neurovascular Research Laboratory, Institute of Biomedicine of Seville (IBIS), Av Manuel Siurot sn, Seville, 41013, Spain.
| | - Manuel Medina-Rodríguez
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Francisco Moniche Álvarez
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Asier de Albóniga-Chindurza
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Marta Aguilar-Pérez
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Interventional Neuroradiology Department, Virgen del Rocío University Hospital, Neurovascular Research Laboratory, Institute of Biomedicine of Seville (IBIS), Av Manuel Siurot sn, Seville, 41013, Spain
| | - Leire Ainz-Gómez
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Pablo Baena-Palomino
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Aynara Zamora
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
| | - Blanca Pardo-Galiana
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | | | | | - Elvira Jiménez-Gómez
- Interventional Neuroradiology Department, Reina Sofía University Hospital, Córdoba, Spain
| | - Isabel Bravo Rey
- Interventional Neuroradiology Department, Reina Sofía University Hospital, Córdoba, Spain
| | | | | | - Isabel Vielba-Gomez
- Interventional Neuroradiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Lluis Morales Caba
- Interventional Neuroradiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Jose Díaz Pérez
- Interventional Neuroradiology Department, Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain
| | | | - Sonia Mosteiro
- Interventional Neuroradiology Department, A Coruña University Hospital Complex, Coruña, Spain
| | | | | | - Carlos Hidalgo
- Interventional Neuroradiology Department, Torrecardenas University Hospital, Almería, Spain
| | | | - Eva González Díaz
- Interventional Neuroradiology Department, Cruces University Hospital, Vizcaya, Spain
| | | | | | - Mikel Terceño Izaga
- Department of Neurology, Doctor Josep Trueta Hospital, Girona, Spain
- Interventional Neuroradiology Unit, Doctor Josep Trueta Hospital, Girona, Spain
| | - Saima Bashir Viturro
- Department of Neurology, Doctor Josep Trueta Hospital, Girona, Spain
- Interventional Neuroradiology Unit, Doctor Josep Trueta Hospital, Girona, Spain
| | - Miguel Ángel Gamero-García
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen Macarena University Hospital, Seville, Spain
| | - Silvia Jiménez Jorge
- Clinical Research and Clinical Trials Unit (CTU), Virgen del Rocío Hospital, Seville, Spain
| | - Clara Rosso Fernández
- Clinical Research and Clinical Trials Unit (CTU), Virgen del Rocío Hospital, Seville, Spain
| | - Joan Montaner
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen Macarena University Hospital, Seville, Spain
| | - Alejandro González García
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Interventional Neuroradiology Department, Virgen del Rocío University Hospital, Neurovascular Research Laboratory, Institute of Biomedicine of Seville (IBIS), Av Manuel Siurot sn, Seville, 41013, Spain
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Thorén M, Escudero-Martínez I, Andersson T, Chen SY, Tsao N, Khurana D, Beretta S, Peeters A, Tsivgoulis G, Roffe C, Ahmed N. Reperfusion by endovascular thrombectomy and early cerebral edema in anterior circulation stroke: Results from the SITS-International Stroke Thrombectomy Registry. Int J Stroke 2023; 18:1193-1201. [PMID: 37226337 PMCID: PMC10676032 DOI: 10.1177/17474930231180451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND A large infarct and expanding cerebral edema (CED) due to a middle cerebral artery occlusion confers a 70% mortality unless treated surgically. There is still conflicting evidence whether reperfusion is associated with a lower risk for CED in acute ischemic stroke. AIM To investigate the association of reperfusion with development of early CED after stroke thrombectomy. METHODS From the SITS-International Stroke Thrombectomy Registry, we selected patients with occlusion of the intracranial internal carotid or middle cerebral artery (M1 or M2). Successful reperfusion was defined as mTICI ⩾ 2b. Primary outcome was moderate or severe CED, defined as focal brain swelling ⩾1/3 of the hemisphere on imaging scans at 24 h. We used regression methods while adjusting for baseline variables. Effect modification by severe early neurological deficits, as indicators of large infarct at baseline and at 24 h, were explored. RESULTS In total, 4640 patients, median age 70 years and median National Institutes of Health Stroke Score (NIHSS) 16, were included. Of these, 86% had successful reperfusion. Moderate or severe CED was less frequent among patients who had reperfusion compared to patients without reperfusion: 12.5% versus 29.6%, p < 0.05, crude risk ratio (RR) 0.42 (95% confidence interval (CI): 0.37-0.49), and adjusted RR 0.50 (95% CI: 0.44-0.57). Analysis of effect modification indicated that severe neurological deficits weakened the association between reperfusion and lower risk of CED. The RR reduction was less favorable in patients with severe neurological deficits, defined as NIHSS score 15 or more at baseline and at 24 h, used as an indicator for larger infarction. CONCLUSION In patients with large artery anterior circulation occlusion stroke who underwent thrombectomy, successful reperfusion was associated with approximately 50% lower risk for early CED. Severe neurological deficit at baseline seems to be a predictor for moderate or severe CED also in patients with successful reperfusion by thrombectomy.
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Affiliation(s)
- Magnus Thorén
- Stroke Research Unit, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Danderyd Hospital, Stockholm, Sweden
| | - Irene Escudero-Martínez
- Department of Neurology, Hospital Universitari i Politécnic La Fe, Valencia, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Tomas Andersson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Nicole Tsao
- Global Medical Affairs, Biogen, Cambridge, MA, USA
| | - Dheeraj Khurana
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Simone Beretta
- Department of Neurology and Stroke Unit, San Gerardo Hospital, Monza, Italy
| | - Andre Peeters
- Department of Neurology and Stroke Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Georgios Tsivgoulis
- Second Department of Neurology, National & Kapodistrian University of Athens, Athens, Greece
| | | | - Niaz Ahmed
- Stroke Research Unit, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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de Albóniga-Chindurza A, Ortega-Quintanilla J, Moniche F, San Román L, Zapata-Arriaza E, Escudero-Martínez I, Zapata M, Pérez-Sánchez S, Gamero MA, Barragán-Prieto A, Lebrato L, Pardo-Galiana B, Cabezas JA, Ainz L, Cayuela A, Montaner J, González A. Thrombectomy with embed aspiration in acute ischaemic stroke. Neurologia 2023:S2173-5808(23)00030-5. [PMID: 37116689 DOI: 10.1016/j.nrleng.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/24/2021] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND In addition to stent retrievers, direct aspiration has become a reasonable thrombectomy strategy. OBJECTIVES We carried out the thrombectomy by guiding the aspiration catheter fully over the clot and performing immediate manual aspiration; we call this procedure "embed aspiration". METHODS In this prospective, non-randomised, single-centre study, we included all patients treated at a high volume-of-care stroke centre between 2017 and 2018 for the TRIANA (Thrombectomy in Andalusia using Aspiration) registry. Thrombectomy was carried out by embed aspiration. Patients were classified according to the success (eTICI 2b67-2c-3) or failure (eTICI 0-1-2a-2b50) of the procedure. Baseline clinical data and outcomes were compared, and multivariate analysis was performed. RESULTS The embed aspiration technique was used in 370 patients. Treatment was successful in 90.3% of patients. Mean puncture-to-recanalisation time was 25 minutes. The overall rate of good outcomes (mRS 0-2) at 3 months was 64%. CONCLUSIONS This study supports real-life evidence that standardised embed aspiration may be an alternative to stent retrievers for thrombectomy.
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Affiliation(s)
- A de Albóniga-Chindurza
- Unidad de Neurorradiología Intervencionista, Servicio de Radiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - J Ortega-Quintanilla
- Unidad de Neurorradiología Intervencionista, Servicio de Radiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - F Moniche
- Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - L San Román
- Laboratorio Central Angiográfico, Unidad de Neurorradiología Intervencionista, Servicio de Radiología, Hospital Universitario Clínic de Barcelona, Barcelona, Spain
| | - E Zapata-Arriaza
- Unidad de Neurorradiología Intervencionista, Servicio de Radiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - I Escudero-Martínez
- Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M Zapata
- Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - S Pérez-Sánchez
- Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M A Gamero
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - A Barragán-Prieto
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - L Lebrato
- Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - B Pardo-Galiana
- Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J A Cabezas
- Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - L Ainz
- Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Cayuela
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain
| | - J Montaner
- Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - A González
- Unidad de Neurorradiología Intervencionista, Servicio de Radiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Laboratorio de Investigación Neurovascular, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain.
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Escudero-Martínez I, Matusevicius M, Pavia-Nunes A, Sevcik P, Nevsimalova M, Rand VM, Kõrv J, Cappellari M, Mikulik R, Toni D, Ahmed N. Association of statin pre-treatment with baseline stroke severity and outcome in patients with acute ischemic stroke and received reperfusion treatment: An observational study. Int J Stroke 2023; 18:201-207. [PMID: 35403505 DOI: 10.1177/17474930221095965] [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: 02/01/2023]
Abstract
BACKGROUND Statins have an important role in stroke prevention, especially in high-risk populations and may also affect the initial stroke severity and outcomes in patients taking them before an ischemic stroke. AIMS Our aim was to evaluate the association of statin pre-treatment with the severity in acute ischemic stroke (AIS). METHODS We analyzed AIS patients received intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT) and recorded in the SITS International Thrombolysis and Thrombectomy Registry from 2011 to 2017. We identified patients with statin information at baseline. The primary outcome was baseline National Institutes of Health Stroke Scale (NIHSS) score. Secondary outcomes were NIHSS score at 24 h, symptomatic intracerebral hemorrhage (SICH) and functional outcome at 90 days after acute intervention. Multivariable linear and logistic regression and propensity score matching (PSM) was used to quantify the effect of statin pre-treatment. RESULTS Of 93,849 patients, 23,651 (25.2%) were treated with statins prior the AIS. Statin pre-treatment group was older and had higher comorbidity. Median NIHSS at baseline was similar between groups. In the adjusted and PSM analysis, statin pre-treatment was inversely associated with baseline NIHSS (odds ratio (OR) = 0.77, 95% confidence interval (CI) = 0.6-0.99 and OR for PSM 0.73, 95% CI = 0.54-0.99, p = 0.004) and independently associated with mild stroke defined as NIHSS ⩽8 in adjusted and PSM analysis (OR = 1.21, 95% CI = 1.1-1.34, p < 0.001 and OR for PSM 1.17, 95% CI = 1.05-1.31, p = 0.007). Regarding secondary outcomes, there were no differences in functional outcomes, death nor SICH rates between groups. CONCLUSION Prior treatment with statins was associated with lower NIHSS at baseline. However, this association did not translate into any difference regarding functional outcome at 90 days. No association was found regarding SICH. These findings indicate the need of further studies to assess the effect on statin pre-treatment on initial stroke severity.
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Affiliation(s)
- Irene Escudero-Martínez
- Department of Neurology, Hospital Universitari Politècnic La Fe, Valencia, Spain.,Neurovascular Research Laboratory, Instituto Biomedicina Sevilla-IBiS, Sevilla, Spain
| | - Marius Matusevicius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Ana Pavia-Nunes
- Stroke Unit, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Petr Sevcik
- Department of Neurology, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Miroslava Nevsimalova
- Department of Neurology, Comprehensive Cerebrovascular Center, Hospital Ceske Budejovice, České Budějovice, Czech Republic
| | - Viiu-Marika Rand
- Department of Neurology, North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - Janika Kõrv
- Institute of Clinical Medicine, Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Manuel Cappellari
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Robert Mikulik
- International Clinical Research Center and Department of Neurology, St. Anne's University Hospital and Faculty of Medicine at Masaryk University, Brno, Czech Republic
| | - Danilo Toni
- Department of Human Neurosciences, University La Sapienza Rome, Rome, Italy
| | - Niaz Ahmed
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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Escudero-Martínez I, Morales-Caba L, Segura T. Atrial fibrillation and stroke: A review and new insights. Trends Cardiovasc Med 2023; 33:23-29. [PMID: 34890796 DOI: 10.1016/j.tcm.2021.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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] [Received: 09/03/2021] [Revised: 11/26/2021] [Accepted: 12/01/2021] [Indexed: 02/01/2023]
Abstract
The link between heart and brain continues to be a matter of great interest for the scientific community. One of the most established associations between the two is that the heart is a significant source of emboli and is responsible for 20-25% of all ischemic strokes. The most frequent underlying cause of cardioembolic stroke is atrial fibrillation (AF), a disease that affects almost 3 million people in the USA and 4.5 million in Europe. AF increases the risk of ischemic stroke by a factor of 3 to 5 times. It is estimated that AF is responsible for 15% of all strokes worldwide. A more comprehensive understanding of this association and development of intensive stroke prevention measures are needed, as we know that AF incidence and prevalence will increase over the coming years, becoming one of the largest epidemics and public health challenges we face.
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Affiliation(s)
- Irene Escudero-Martínez
- Stroke Unit, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe - Universidad de Valencia, Valencia, Spain.
| | - Lluis Morales-Caba
- Stroke Unit, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe - Universidad de Valencia, Valencia, Spain
| | - Tomás Segura
- Department of Medical Sciences, Faculty of Medicine of Albacete, University of Castilla-La Mancha, Albacete, Spain; Stroke Unit, Department of Neurology, Hospital General Universitario de Albacete, Spain
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Escudero-Martínez I, Thorén M, Ringleb P, Nunes AP, Cappellari M, Rand VM, Sobolewski P, Egido J, Toni D, Chen SY, Tsao N, Ahmed N. Cerebral Edema in Patients with severe Hemispheric Syndrome: Incidence, Risk Factors, and Outcomes-Data from SITS-ISTR. J Stroke 2023; 25:101-110. [PMID: 36470246 PMCID: PMC9911855 DOI: 10.5853/jos.2022.01956] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/11/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Cerebral edema (CED) in ischemic stroke can worsen prognosis and about 70% of patients who develop severe CED die if treated conservatively. We aimed to describe incidence, risk factors and outcomes of CED in patients with extensive ischemia. METHODS Oservational study based on Safe Implementation of Treatments in Stroke-International Stroke Treatment Registry (2003-2019). Severe hemispheric syndrome (SHS) at baseline and persistent SHS (pSHS) at 24 hours were defined as National Institutes of Health Stroke Score (NIHSS) >15. Outcomes were moderate/severe CED detected by neuroimaging, functional independence (modified Rankin Scale 0-2) and death at 90 days. RESULTS Patients (n=8,560) presented with SHS and developed pSHS at 24 hours; 82.2% received intravenous thrombolysis (IVT), 10.5% IVT+thrombectomy, and 7.3% thrombectomy alone. Median age was 77 and NIHSS 21. Of 7,949 patients with CED data, 3,780 (47.6%) had any CED and 2,297 (28.9%) moderate/severe CED. In the multivariable analysis, age <50 years (relative risk [RR], 1.56), signs of acute infarct (RR, 1.29), hyperdense artery sign (RR, 1.39), blood glucose >128.5 mg/dL (RR, 1.21), and decreased level of consciousness (RR, 1.14) were associated with moderate/severe CED (for all P<0.05). Patients with moderate/severe CED had lower odds to achieve functional Independence (adjusted odds ratio [aOR], 0.35; 95% confidence interval [CI], 0.23 to 0.55) and higher odds of death at 90 days (aOR, 2.54; 95% CI, 2.14 to 3.02). CONCLUSIONS In patients with extensive ischemia, the most important predictors for moderate/ severe CED were age <50, high blood glucose, signs of acute infarct, hyperdense artery on baseline scans, and decreased level of consciousness. CED was associated with worse functional outcome and a higher risk of death at 3 months.
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Affiliation(s)
- Irene Escudero-Martínez
- Department of Neurology, University Hospital La FE, Valencia, Spain,Neurovascular Research Laboratory, Biomedicine Institute IBiS, Sevilla, Spain,Correspondence: IreneEscudero-Martínez Stroke Unit, Department of Neurology, University Hospital La Fe, Av. Fernando Abril 106, 46026, Valencia, Spain Tel: +34-96-124-4000 Fax: +34-96-124-6241 E-mail:
| | - Magnus Thorén
- Department of Neurology, Danderyd Hospital, Stockholm, Sweden,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Peter Ringleb
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ana Paiva Nunes
- Department of Neurology, Sao Jose Hospital, University Hospital Lisboa, Lisboa, Portugal
| | - Manuel Cappellari
- Department of Neuroscience, Integrate University Hospital, Verona, Italy
| | - Viiu-Marika Rand
- Department of Neurology, North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - Piotr Sobolewski
- Department of Neurology and Stroke Unit in Sandomierz, Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Jose Egido
- Stroke Unit, Department of Neurology, San Carlos Clinic Hospital, Madrid, Spain
| | - Danilo Toni
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | | | - Niaz Ahmed
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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7
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Medina-Rodríguez M, Moniche F, de Albóniga-Chindurza A, Ortega-Quintanilla J, Ainz-Gómez L, Pardo-Galiana B, Cabezas-Rodríguez JA, Aguilar-Pérez M, Zamora A, Delgado-Acosta F, Jiménez-Gómez E, Bravo Rey I, Oteros Fernández R, Freijo Guerrero MDM, González Díaz E, Escudero-Martínez I, Morales Caba L, Vielba-Gomez I, Mosteiro S, Castellanos Rodrigo MDM, Amaya Pascasio L, Hidalgo C, Fernandez Prudencio L, Ramirez Moreno JM, Díaz Pérez J, Sanz-Fernandez G, Baena-Palomino P, Gamero-García MÁ, Jiménez Jorge S, Rosso Fernández C, Montaner J, González García A, Zapata-Arriaza E. Safety and efficacy of tirofiban in acute ischemic stroke due to tandem lesions undergoing mechanical thrombectomy: A multicenter randomized clinical trial (ATILA) protocol. Eur Stroke J 2022; 8:380-386. [PMID: 37021200 PMCID: PMC10069213 DOI: 10.1177/23969873221146383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/22/2022] [Indexed: 12/30/2022] Open
Abstract
Background: In-stent thrombosis after mechanical thrombectomy (MT) worsen outcomes in acute ischemic stroke (AIS) due to tandem lesions (TL). Although an optimal antiplatelet therapy is needed, the best approach to avoid in-stent thrombosis is yet to be elucidated. Hypothesis: Low-dose intravenous tirofiban is superior to intravenous aspirin in avoiding in-stent thrombosis in patients undergoing MT plus carotid stenting in the setting of AIS due to TL. Methods: The ATILA-trial is a multicenter, prospective, phase IV, randomized, controlled (aspirin group as control), assessor-blinded clinical trial. Patients fulfilling inclusion criteria (AIS due to TL, ASPECTS ⩾ 6, pre-stroke modified Rankin Scale ⩽2 and onset <24 h) will be randomized (1:1) at MT onset to experimental (intravenous tirofiban) or control group (intravenous aspirin). Intravenous aspirin will be administered at a 500 mg single dose and tirofiban at a 500 µg bolus followed by a 200 µg/h infusion during first 22 h. All patients will be followed up to 3 months. Sample size estimated is 240 patients. Outcomes: The primary efficacy outcome is the proportion of patients with carotid in-stent thrombosis within the first 24 h after MT. The primary safety outcome is the rate of symptomatic intracranial hemorrhage. Secondary outcomes include functional independence defined as modified Rankin Scale 0–2, proportion of patients undergoing rescue therapy due to in-stent aggregation during MT and carotid reocclusion at 30 days. Discussion: ATILA-trial will be the first clinical trial regarding the best antiplatelet therapy to avoid in-stent thrombosis after MT in patients with TL. Trial registration: NCT0522596.
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Affiliation(s)
- Manuel Medina-Rodríguez
- Stroke Unit, Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
- Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
| | - Francisco Moniche
- Stroke Unit, Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
- Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
| | - Asier de Albóniga-Chindurza
- Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Interventional Neuroradiology Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Joaquin Ortega-Quintanilla
- Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Interventional Neuroradiology Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Leire Ainz-Gómez
- Stroke Unit, Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
- Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
| | - Blanca Pardo-Galiana
- Stroke Unit, Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
- Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
| | - Juan Antonio Cabezas-Rodríguez
- Stroke Unit, Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
- Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
| | - Marta Aguilar-Pérez
- Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Interventional Neuroradiology Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Aynara Zamora
- Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
| | | | - Elvira Jiménez-Gómez
- Interventional Neuroradiology Department, Reina Sofía University Hospital, Córdoba, Spain
| | - Isabel Bravo Rey
- Interventional Neuroradiology Department, Reina Sofía University Hospital, Córdoba, Spain
| | | | | | - Eva González Díaz
- Interventional Neuroradiology Department, Cruces University Hospital, Vizcaya, Spain
| | | | - Lluis Morales Caba
- Interventional Neuroradiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Isabel Vielba-Gomez
- Interventional Neuroradiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Sonia Mosteiro
- Interventional Neuroradiology Department, A Coruña University Hospital Complex, A Coruña, Spain
| | | | | | - Carlos Hidalgo
- Interventional Neuroradiology Department, Torrecardenas University Hospital, Almería, Spain
| | | | | | - Jose Díaz Pérez
- Interventional Neuroradiology Department, Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain
| | | | - Pablo Baena-Palomino
- Stroke Unit, Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
- Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
| | - Miguel Ángel Gamero-García
- Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen Macarena University Hospital, Seville, Spain
| | - Silvia Jiménez Jorge
- Clinical Research and Clinical Trials Support Unit, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Clara Rosso Fernández
- Clinical Research and Clinical Trials Support Unit, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Joan Montaner
- Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen Macarena University Hospital, Seville, Spain
| | - Alejandro González García
- Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Interventional Neuroradiology Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Elena Zapata-Arriaza
- Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Interventional Neuroradiology Department, Virgen del Rocío University Hospital, Sevilla, Spain
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8
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Escudero-Martínez I, Thorén M, Matusevicius M, Cooray C, Zini A, Roffe C, Toni D, Tsivgoulis G, Ringleb P, Wahlgren N, Ahmed N. Association of cholesterol levels with hemorrhagic transformation and cerebral edema after reperfusion therapies. Eur Stroke J 2022; 8:294-300. [PMID: 37021184 PMCID: PMC10069196 DOI: 10.1177/23969873221148229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/13/2022] [Indexed: 12/30/2022] Open
Abstract
Background: The association between cholesterol levels and cerebral edema (CED) or hemorrhagic transformation (HT) as an expressions of blood-brain barrier (BBB) dysfunction after ischemic stroke is not well established. The aim of this study is to determine the association of total cholesterol (TC) levels with the incidence of HT and CED after reperfusion therapies. Methods: We analyzed SITS Thrombolysis and Thrombectomy Registry data from January 2011 to December 2017. We identified patients with data on TC levels at baseline. TC values were categorized in three groups (reference group ⩾200 mg/dl). The two primary outcomes were any parenchymal hemorrhage (PH) and moderate to severe CED on follow up imaging. Secondary outcomes included death and functional independence (mRS 0–2) at 3 months. Multivariable logistic regression analysis adjusted for baseline factors including statin pretreatment was used to assess the association between TC levels and outcomes. Results: Of 35,314 patients with available information on TC levels at baseline, 3372 (9.5%) presented with TC levels ⩽130 mg/dl, 8203 (23.2%) with TC 130–200 mg/dl and 23,739 (67.3%) with TC ⩾ 200 mg/dl. In the adjusted analyses, TC level as continuous variable was inversely associated with moderate to severe CED (OR 0.99, 95% CI 0.99–1.00, p = 0.025) and as categorical variable lower TC levels were associated with a higher risk of moderate to severe CED (aOR 1.24, 95% CI 1.10–1.40, p = 0.003). TC levels were not associated with any PH, functional independence, and mortality at 3 months. Conclusions: Our findings indicate an independent association between low levels of TC and higher odds of moderate/severe CED. Further studies are needed to confirm these findings.
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Affiliation(s)
- Irene Escudero-Martínez
- Department of Neurology, Hospital Universitari i Poltècnic La Fe, Valencia, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Magnus Thorén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Danderyd Hospital, Stockholm, Sweden
| | - Marius Matusevicius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Charith Cooray
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - Christine Roffe
- Stroke Research in Stoke, Faculty of Medicine & Health Sciences, Keele University, Staffordshire, UK
| | - Danilo Toni
- Neurology Department, University La Sapienza Rome, Rome, Italy
| | - Georgios Tsivgoulis
- Second Department of Neurology, National & Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Peter Ringleb
- Neurology Department, University Hospital Heidelberg, Heidelberg, Germany
| | - Nils Wahlgren
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Niaz Ahmed
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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9
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Palà E, Escudero-Martínez I, Penalba A, Bustamante A, Lamana-Vallverdú M, Mancha F, Ocete RF, Piñero P, Galvao-Carmona A, Gómez-Herranz M, Pérez-Sánchez S, Moniche F, González A, Montaner J. Association of blood-based biomarkers with radiologic markers and cognitive decline in atrial fibrillation patients. J Stroke Cerebrovasc Dis 2022; 31:106833. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/28/2022] [Accepted: 10/11/2022] [Indexed: 11/21/2022] Open
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10
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Cayuela A, Cayuela L, Ortega Belmonte MJ, Rodríguez-Domínguez S, Escudero-Martínez I, González A. Has stroke mortality stopped declining in Spain? Neurologia 2022; 37:550-556. [PMID: 31780318 DOI: 10.1016/j.nrl.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/06/2019] [Accepted: 06/20/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To analyse the changes in stroke mortality trends in Spain by autonomous community and by sex during the period 1980-2016, using joinpoint regression models. METHODS Mortality data were obtained from the Spanish National Statistics Institute. Crude and standardised rates were calculated for each Spanish autonomous community, and for each sex. Joinpoint analysis was used to identify the best-fitting points showing a statistically significant change in the trend. RESULTS Joinpoint analysis enabled us to differentiate between communities in which mortality rates showed a continuous decline throughout the study period in both sexes (Asturias, Cantabria, Castile and Leon, Ceuta, and Melilla) or in men only (Extremadura). In men, in all those communities in which changes in the trend were observed (all but Aragon, the Balearic Islands, and Murcia, where rates remained stable), we observed an initial period of decline (ranging from -3.4% in Catalonia and Extremadura, to -6.0% in Madrid) and a final period where the trends diverged: mortality rates continued to fall in Andalusia, Aragon, the Balearic Islands, and Madrid, but began to stabilise in Castile-La Mancha and Murcia and to increase in the Canary Islands. In women, in those communities where changes were observed (all but Aragon, Murcia, and the Basque Country, where rates remained stable), we observed an initial period of decline (ranging from -3.1% in Catalonia to -6.4% in Navarre) and a final period where divergent trends were observed: rates continued to decline in Andalusia, Aragon, Catalonia, Galicia, Madrid, and the Basque Country, but began to stabilise in Extremadura and Murcia and to increase in the Canary Islands. CONCLUSIONS Current data show that stroke mortality rates have decreased (in women in Andalusia), stabilised (in both sexes in Murcia, in men in Castile-La Mancha, and in women in Extremadura), and have even reversed (in both sexes in the Canary Islands). Further study is needed to identify the causes of these trends.
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Affiliation(s)
- A Cayuela
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España.
| | - L Cayuela
- Departamento de Medicina Interna, Hospital Severo Ochoa, Leganés, Madrid, España
| | - M J Ortega Belmonte
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España
| | | | - I Escudero-Martínez
- Unidad de Ictus, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A González
- Servicio de Neurorradiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, España
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11
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Escudero-Martínez I, Mancha F, Vega Á, Zapata M, Ocete RF, Álvarez L, Algaba P, López-Rueda A, Piñero P, Fajardo E, Fernández-Engo JR, Martín-Sánchez EM, Galvao-Carmona A, Zapata-Arriaza E, Lebrato L, Pardo B, Cabezas JA, Ayuso MI, González A, Moniche F, Montaner J. Mediterranean Diet and its Effects on Silent Brain Infarcts in a Cohort of Patients With Atrial Fibrillation. Nutr Metab Insights 2022; 15:11786388221122172. [DOI: 10.1177/11786388221122172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: The benefits of Mediterranean Diet (MeDiet) in prevention of cardiovascular diseases (CVD) in general and ischemic stroke (IS) have been extensively studied and reported. We hypothesize that the consumption of nutrients typical of MeDiet would also reduce the rate of silent brain infarcts (SBI) among AF patients. Methods and Results: Patients with a history of AF who scored 0 to 1 in the CHADS2 score, ⩾50 years and with absence of neurological symptoms were selected from Seville urban area using the Andalusian electronic healthcare database. A 3T brain MRI was performed to all participants. Demographic and clinical data and food-frequency questionnaire (FFQ) were collected. Of the 443 scanned patients, 66 presented SBI. Of them 52 accepted to be scheduled for a clinical visit and were included in the diet sub study and 41 controls were matched per age and sex. There were no statistically significant differences in baseline characteristics. After logistic regression analysis, we found that a higher consumption of fiber from fruit was independently associated with a lower risk of SBI, while a higher consumption of high glycemic load (GL) foods was associated with a higher risk of SBI in a population with AF Conclusion: Our findings support that MeDiet could be suggested as a prevention strategy for SBI in patients with AF.
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Affiliation(s)
- Irene Escudero-Martínez
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Fernando Mancha
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Ángela Vega
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Montserrat Zapata
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Rafael F Ocete
- Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Lucía Álvarez
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Pilar Algaba
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | | | - Pilar Piñero
- Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Elena Fajardo
- Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Eva M Martín-Sánchez
- Information Systems Coordination Service, Support Services of the Andalusian Health, Sevilla, Spain
| | | | - Elena Zapata-Arriaza
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
- Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Lucía Lebrato
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Blanca Pardo
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Juan Antonio Cabezas
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - María Irene Ayuso
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Alejandro González
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
- Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Francisco Moniche
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
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12
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Cayuela A, Cayuela L, Ortega Belmonte MJ, Rodríguez-Domínguez S, Escudero-Martínez I, González A. Has stroke mortality stopped declining in Spain? Neurologia (Engl Ed) 2021; 37:550-556. [PMID: 34521606 DOI: 10.1016/j.nrleng.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/20/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To analyse the changes in stroke mortality trends in Spain by autonomous community and by sex during the period 1980-2016, using joinpoint regression models. METHODS Mortality data were obtained from the Spanish National Statistics Institute. Crude and standardised rates were calculated for each Spanish autonomous community, and for each sex. Joinpoint analysis was used to identify the best-fitting points showing a statistically significant change in the trend. RESULTS Joinpoint analysis enabled us to differentiate between communities in which mortality rates showed a continuous decline throughout the study period in both sexes (Asturias, Cantabria, Castile and Leon, Ceuta, and Melilla) or in men only (Extremadura). In men, in all those communities in which changes in the trend were observed (all but Aragon, the Balearic Islands, and Murcia, where rates remained stable), we observed an initial period of decline (ranging from -3.4% in Catalonia and Extremadura, to -6.0% in Madrid) and a final period where the trends diverged: mortality rates continued to fall in Andalusia, Aragon, the Balearic Islands, and Madrid, but began to stabilise in Castile-La Mancha and Murcia and to increase in the Canary Islands. In women, in those communities where changes were observed (all but Aragon, Murcia, and the Basque Country, where rates remained stable), we observed an initial period of decline (ranging from -3.1% in Catalonia to -6.4% in Navarre) and a final period where divergent trends were observed: rates continued to decline in Andalusia, Aragon, Catalonia, Galicia, Madrid, and the Basque Country, but began to stabilise in Extremadura and Murcia and to increase in the Canary Islands. CONCLUSIONS Current data show that stroke mortality rates have decreased (in women in Andalusia), stabilised (in both sexes in Murcia, in men in Castile-La Mancha, and in women in Extremadura), and have even reversed (in both sexes in the Canary Islands). Further study is needed to identify the causes of these trends.
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Affiliation(s)
- A Cayuela
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain.
| | - L Cayuela
- Departamento de Medicina Interna, Hospital Severo Ochoa, Leganés, Madrid, Spain
| | - M J Ortega Belmonte
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain
| | | | - I Escudero-Martínez
- Unidad de Ictus, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A González
- Servicio de Neurorradiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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13
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Ahmed N, Mazya M, Nunes AP, Moreira T, Ollikainen JP, Escudero-Martínez I, Bigliardi G, Dorado L, Dávalos A, Egido JA, Tassi R, Strbian D, Zini A, Nichelli P, Herzig R, Jurák L, Hurtikova E, Tsivgoulis G, Peeters A, Nevšímalová M, Brozman M, Cavallo R, Lees KR, Mikulík R, Toni D, Holmin S. Safety and Outcomes of Thrombectomy in Ischemic Stroke With vs Without IV Thrombolysis. Neurology 2021; 97:e765-e776. [PMID: 34088873 DOI: 10.1212/wnl.0000000000012327] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/20/2021] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To test the hypothesis that IV thrombolysis (IVT) treatment before endovascular thrombectomy (EVT) is associated with better outcomes in patients with anterior circulation large artery occlusion (LAO) stroke, we examined a large real-world database, the Safe Implementation of Treatment in Stroke-International Stroke Thrombectomy Register (SITS-ISTR). METHODS We identified centers recording ≥10 consecutive patients in the SITS-ISTR, with at least 70% available modified Rankin Scale (mRS) scores at 3 months during 2014 to 2019. We defined LAO as intracranial internal carotid artery, first and second segment of middle cerebral artery, and first segment of anterior cerebral artery. Main outcomes were functional independence (mRS score 0-2) and death at 3 months and symptomatic intracranial hemorrhage (SICH) per modified SITS-Monitoring Study. We performed propensity score-matched (PSM) and multivariable logistic regression analyses. RESULTS Of 6,350 patients from 42 centers, 3,944 (62.1%) received IVT. IVT + EVT-treated patients had less frequent atrial fibrillation, ongoing anticoagulation, previous stroke, heart failure, and prestroke disability. PSM analysis showed that IVT + EVT-treated patients had a higher rate of functional independence than patients treated with EVT alone (46.4% vs 40.3%, p < 0.001) and a lower rate of death at 3 months (20.3% vs 23.3%, p = 0.035). SICH rates (3.5% vs 3.0%, p = 0.42) were similar in both groups. Multivariate adjustment yielded results consistent with PSM. CONCLUSION Pretreatment with IVT was associated with favorable outcomes in EVT-treated LAO stroke in the SITS-ISTR. These findings, while indicative of international routine clinical practice, are limited by observational design, unmeasured confounding, and possible residual confounding by indication. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that IVT before EVT increases the probability of functional independence at 3 months compared to EVT alone.
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Affiliation(s)
- Niaz Ahmed
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden.
| | - Michael Mazya
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Ana Paiva Nunes
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Tiago Moreira
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Jyrki P Ollikainen
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Irene Escudero-Martínez
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Guido Bigliardi
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Laura Dorado
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Antoni Dávalos
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Jose A Egido
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Rossana Tassi
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Daniel Strbian
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Andrea Zini
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Paolo Nichelli
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Roman Herzig
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Lubomír Jurák
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Eva Hurtikova
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Georgios Tsivgoulis
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Andre Peeters
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Miroslava Nevšímalová
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Miroslav Brozman
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Roberto Cavallo
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Kennedy R Lees
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Robert Mikulík
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Danilo Toni
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
| | - Staffan Holmin
- From the Department of Neurology (N.A., M.M., T.M.), Karolinska University Hospital; Department of Clinical Neuroscience (N.A., M.M., T.M., S.H.), Karolinska Institutet, Solna, Sweden; Stroke Unit (A.P.N.), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Department of Neurology (J.P.O.), Tampere University Hospital, Tampere, Finland; Department of Neurology (I.E.-M.), University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain; Department of Neurology (G.B.), Ospedale Civile "S.Agostino-Estense"-Azienda Ospedaliera Universitaria di Modena, Italy; Department of Neurology (L.D., A.D.), Hospital Universitari Germans Trias i Pujol, Badalona; Department of Neurology (J.A.E.), Hospital Clínico San Carlos, Madrid, Spain; Stroke Unit Azienda Ospedaliera Universitaria Senese (R.T.), Siena, Italy; Department of Neurology (D.S.), Helsinki University Central Hospital, Finland; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital; Department of Biomedical (P.N.), Metabolical and Neurosciences, Università degli studi di Modena e Reggio Emilia, Italy; Department of Neurology (R.H.), Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Czech Republic; Neurocentre (L.J.), Regional Hospital Liberec, Czech Republic; Department of Neurology University Hospital Ostrava (E.H.), Czech Republic; Second Department of Neurology (G.T., A.P.), National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.P.), Cliniques Universitaires St-Luc, Brussels; Department of Neurology (M.N.), Nemocnice Ceske Budejovice, Czech Republic; Constantine the Philosopher University Nitra (M.B.), Faculty of Social Sciences and Health, Slovakia; Department of Neurology (R.C.), Ospedale San Giovanni Bosco, Turin, Italy; School of Medicine (K.R.L.), Dentistry and Nursing, University of Glasgow, UK; International Clinical Research Center and Department of Neurology (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Human Neurosciences (D.T.), La Sapienza, Rome, Italy; and Department of Neuroradiology (S.H.), Karolinska University Hospital, Solna, Sweden
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14
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Zapata-Arriaza E, de Albóniga-Chindurza A, Ortega-Quintanilla J, Escudero-Martínez I, Moniche F, Medina-Rodríguez M, Pardo-Galiana B, Rodríguez JAC, Hernández LL, Ainz L, Pérez-Sánchez S, Domínguez-Mayoral A, Barragán A, Cayuela A, Montaner J, García AG. Clinical Outcomes of Mechanical Thrombectomy in Stroke Tandem Lesions According to Intracranial Occlusion Location. J Stroke 2021; 23:124-127. [PMID: 33600709 PMCID: PMC7900399 DOI: 10.5853/jos.2020.02747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Elena Zapata-Arriaza
- Interventional Neurorradiology Department, Stroke Research Program, Institute of Biomedicine of Seville (IBiS)/Virgen del Rocio University Hospital, Seville, Spain
| | - Asier de Albóniga-Chindurza
- Interventional Neurorradiology Department, Stroke Research Program, Institute of Biomedicine of Seville (IBiS)/Virgen del Rocio University Hospital, Seville, Spain
| | - Joaquin Ortega-Quintanilla
- Interventional Neurorradiology Department, Stroke Research Program, Institute of Biomedicine of Seville (IBiS)/Virgen del Rocio University Hospital, Seville, Spain
| | - Irene Escudero-Martínez
- Neurology Department, Institute of Biomedicine of Seville (IBiS)/Virgen del Rocio University Hospital, Seville, Spain
| | - Francisco Moniche
- Neurology Department, Institute of Biomedicine of Seville (IBiS)/Virgen del Rocio University Hospital, Seville, Spain
| | - Manuel Medina-Rodríguez
- Neurology Department, Institute of Biomedicine of Seville (IBiS)/Virgen del Rocio University Hospital, Seville, Spain
| | - Blanca Pardo-Galiana
- Neurology Department, Institute of Biomedicine of Seville (IBiS)/Virgen del Rocio University Hospital, Seville, Spain
| | | | - Lucía Lebrato Hernández
- Neurology Department, Institute of Biomedicine of Seville (IBiS)/Virgen del Rocio University Hospital, Seville, Spain
| | - Leire Ainz
- Neurology Department, Institute of Biomedicine of Seville (IBiS)/Virgen del Rocio University Hospital, Seville, Spain
| | | | | | - Ana Barragán
- Department of Neurology, Virgen Macarena University Hospital, Seville, Spain
| | - Aurelio Cayuela
- Clinical Management of Public Health, Prevention and Health Promotion Unit, Southern Health Management Area of Seville, Hospital de Valme, Seville, Spain
| | - Joan Montaner
- Department of Neurology, Virgen Macarena University Hospital, Seville, Spain
| | - Alejandro González García
- Interventional Neurorradiology Department, Stroke Research Program, Institute of Biomedicine of Seville (IBiS)/Virgen del Rocio University Hospital, Seville, Spain
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15
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Pérez-Sánchez S, Domínguez-Mayoral A, De Torres-Chacón R, Gamero-García MA, Barragán-Prieto A, Escudero-Martínez I, Ocete RF, Herrero-Lara J, Algaba P, Moniche F, González A, Cueto L, Montaner J. Cervical dissection diagnoses increase following endovascular treatments. J Int Med Res 2021; 48:300060520906740. [PMID: 32223660 PMCID: PMC7133397 DOI: 10.1177/0300060520906740] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives The detection of cervical arterial dissection (CAD) has been rising in recent years owing to advanced imaging techniques. The aim of this study was to explore whether wide implementation of endovascular treatment for ischemic stroke has an impact on the diagnosis of CAD. Methods We included all patients with CAD diagnosed at two university hospitals in Seville, Spain from January 2015 to December 2017. We collected clinical variables and information on imaging techniques used for the diagnosis. Implementation of 24 hour/365 day mechanical thrombectomy began in Seville on 15 August 2016. We compared diagnosis rates of CAD performed before and after this date. Results We identified 41 patients with CAD. We found 13 patients diagnosed before (1.1% of all ischemic strokes) and 28 (2.2%) after implementation of neurointerventional therapy. In 17 patients, diagnosis was made in the acute phase. Dissection was not suspected according to computed tomography angiography in 11 patients owing to small dissections (n = 2) or total occlusion (n = 9). Conclusions CAD diagnoses have been rising in recent years, essentially owing to continuous improvement in imaging techniques. Rapid access to arteriography for thrombectomy is increasing the diagnoses of CAD, even in patients with a low suspicion of dissection.
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Affiliation(s)
- Soledad Pérez-Sánchez
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain
| | - Ana Domínguez-Mayoral
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain
| | - Reyes De Torres-Chacón
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain
| | - Miguel A Gamero-García
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain
| | - Ana Barragán-Prieto
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain
| | - Irene Escudero-Martínez
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain.,Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Rafael F Ocete
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain.,Department of Radiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Juan Herrero-Lara
- Department of Radiology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Pilar Algaba
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain
| | - Francisco Moniche
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain.,Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Alejandro González
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain.,Department of Radiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Luis Cueto
- Department of Radiology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Joan Montaner
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Seville, Spain
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16
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González García A, Moniche F, Escudero-Martínez I, Mancha F, Tomasello A, Ribó M, Delgado-Acosta F, Ochoa JJ, de Las Heras JA, López-Mesonero L, González-Delgado M, Murias E, Gil J, Gil R, Zamarro J, Parrilla G, Mosteiro S, Fernández-Couto MD, Fernández de Alarcón L, Ramírez-Moreno JM, Luna A, Gil A, González-Mandly A, Caniego JL, Zapata-Wainberg G, García E, Alcázar PP, Ortega J, Arenillas JF, Algaba P, Zapata-Arriaza E, Alcalde-López J, de Albóniga-Chindurza A, Cayuela A, Montaner J. Clinical Predictors of Hyperperfusion Syndrome Following Carotid Stenting: Results From a National Prospective Multicenter Study. JACC Cardiovasc Interv 2020; 12:873-882. [PMID: 31072509 DOI: 10.1016/j.jcin.2019.01.247] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/11/2018] [Accepted: 01/15/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of the HISPANIAS (HyperperfusIon Syndrome Post-carotid ANgIoplasty And Stenting) study was to define CHS rates and develop a clinical predictive model for cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS). BACKGROUND CHS is a severe complication following CAS. The presence of clinical manifestations is estimated on the basis of retrospective reviews and is still uncertain. METHODS The HISPANIAS study was a national prospective multicenter study with 14 recruiting hospitals. CHS was classified as mild (headache only) and moderate-severe (seizure, impaired level of consciousness, or development of focal neurological signs). RESULTS A total of 757 CAS procedures were performed. CHS occurred in 22 (2.9%) patients, in which 16 (2.1%) had moderate-severe CHS and 6 (0.8%) had mild CHS (only headache). The rate of hemorrhages was 0.7% and was associated with high mortality (20%). Pre-operative predictors of moderate-severe CHS in multivariate analysis were female sex (odds ratio [OR]: 3.24; 95% confidence interval [CI]: 1.11 to 9.47; p = 0.03), older patients (OR: 1.09; 95% CI: 1.01 to 1.17; p = 0.02), left carotid artery treated (OR: 4.13; 95% CI: 1.11 to 15.40; p = 0.03), and chronic renal failure (OR: 6.29; 95% CI: 1.75 to 22.57; p = 0.005). The area under the curve of this clinical and radiological model was 0.86 (95% CI: 0.81 to 0.92; p = 0.001). CONCLUSIONS The rate of CHS in the HISPANIAS study was 2.9%, with moderate-severe CHS of 2.1%. CHS was independently associated with female sex, older age, history of chronic kidney disease, and a treated left carotid artery. Although further investigations are needed, the authors propose a model to identify high-risk patients and develop strategies to decrease CHS morbidity and mortality in the future.
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Affiliation(s)
- Alejandro González García
- Interventional Neuroradiology, Department of Radiology, Hospital Virgen del Rocío, Sevilla, Spain; Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain.
| | - Francisco Moniche
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain; Department of Neurology, Hospital Virgen del Rocío, Sevilla, Spain
| | - Irene Escudero-Martínez
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain; Department of Neurology, Hospital Virgen del Rocío, Sevilla, Spain
| | - Fernando Mancha
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Alejandro Tomasello
- Interventional Neuroradiology, Department of Radiology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Marc Ribó
- Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Fernando Delgado-Acosta
- Interventional Neuroradiology, Department of Radiology, Hospital Reina Sofía, Córdoba, Spain
| | - Juán José Ochoa
- Department of Neurology, Hospital Reina Sofía, Córdoba, Spain
| | - José A de Las Heras
- Interventional Neuroradiology, Department of Radiology, Hospital de Salamanca, Salamanca, Spain
| | | | | | - Eduardo Murias
- Department of Radiology, Interventional Neuroradiology, Hospital Central de Asturias, Oviedo, Spain
| | - Joaquín Gil
- Interventional Neuroradiology, Department of Radiology, Hospital Clínico de Valencia, Valencia, Spain
| | - Rosario Gil
- Department of Neurology, Hospital Clínico de Valencia, Valencia, Spain
| | - Joaquín Zamarro
- Interventional Neuroradiology, Department of Radiology, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Guillermo Parrilla
- Interventional Neuroradiology, Department of Radiology, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Sonia Mosteiro
- Interventional Neuroradiology, Department of Radiology, Hospital Juán Canalejo, A Coruña, Spain
| | | | | | | | - Alain Luna
- Department of Neurology, Hospital de Cruces, Bilbao, Spain
| | - Alberto Gil
- Interventional Neuroradiology, Department of Radiology, Hospital de Cruces, Bilbao, Spain
| | - Andrés González-Mandly
- Interventional Neuroradiology, Department of Radiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - José L Caniego
- Interventional Neuroradiology, Department of Radiology, Hospital de la Princesa, Madrid, Spain
| | | | - Ernesto García
- Interventional Neuroradiology, Department of Radiology, Hospital Virgen de las Nieves, Granada, Spain
| | - Pedro P Alcázar
- Interventional Neuroradiology, Department of Radiology, Hospital Virgen de las Nieves, Granada, Spain
| | - Joaquín Ortega
- Interventional Neuroradiology, Department of Radiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Juan F Arenillas
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Pilar Algaba
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Elena Zapata-Arriaza
- Interventional Neuroradiology, Department of Radiology, Hospital Virgen del Rocío, Sevilla, Spain
| | - Jesús Alcalde-López
- Interventional Neuroradiology, Department of Radiology, Hospital Virgen del Rocío, Sevilla, Spain
| | | | - Aurelio Cayuela
- Unit of Clinical Management of Public Health, Prevention and Promotion of Health, Area of Sanitary Management South of Sevilla, Sevilla, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain; Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
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17
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Pérez-Sánchez S, Barragán-Prieto A, Ortega-Quintanilla J, Domínguez-Mayoral A, Gamero-García MÁ, Zapata-Arriaza E, Torres-Chacón RD, de Albóniga-Chindurza A, Zapata-Hidalgo M, Moniche F, Escudero-Martínez I, Baena P, Cabezas JA, Oropesa-Ruiz JM, Sanz-Fernández G, González A, Montaner J. Sex Differences by Hospital-Level in Performance and Outcomes of Endovascular Treatment for Acute Ischemic Stroke. J Stroke 2020; 22:258-261. [PMID: 32635690 PMCID: PMC7341017 DOI: 10.5853/jos.2019.03223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/14/2020] [Indexed: 12/04/2022] Open
Affiliation(s)
- Soledad Pérez-Sánchez
- Department of Neurology, University Hospital Virgen Macarena, Sevilla, Spain.,Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IbiS, Sevilla, Spain
| | - Ana Barragán-Prieto
- Department of Neurology, University Hospital Virgen Macarena, Sevilla, Spain.,Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IbiS, Sevilla, Spain
| | - Joaquín Ortega-Quintanilla
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IbiS, Sevilla, Spain.,Department of Radiology, Interventional Neuroradiology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Ana Domínguez-Mayoral
- Department of Neurology, University Hospital Virgen Macarena, Sevilla, Spain.,Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IbiS, Sevilla, Spain
| | - Miguel Ángel Gamero-García
- Department of Neurology, University Hospital Virgen Macarena, Sevilla, Spain.,Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IbiS, Sevilla, Spain
| | - Elena Zapata-Arriaza
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IbiS, Sevilla, Spain.,Department of Radiology, Interventional Neuroradiology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Reyes de Torres-Chacón
- Department of Neurology, University Hospital Virgen Macarena, Sevilla, Spain.,Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IbiS, Sevilla, Spain
| | - Asier de Albóniga-Chindurza
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IbiS, Sevilla, Spain.,Department of Radiology, Interventional Neuroradiology, University Hospital Virgen del Rocío, Sevilla, Spain
| | | | - Francisco Moniche
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IbiS, Sevilla, Spain.,Department of Neurology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Irene Escudero-Martínez
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IbiS, Sevilla, Spain.,Department of Neurology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Pablo Baena
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IbiS, Sevilla, Spain.,Department of Neurology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Juan Antonio Cabezas
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IbiS, Sevilla, Spain.,Department of Neurology, University Hospital Virgen del Rocío, Sevilla, Spain
| | | | - Gema Sanz-Fernández
- Department of Neurology, University Hospital Juan Ramón Jiménez, Huelva, Spain
| | - Alejandro González
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IbiS, Sevilla, Spain.,Department of Radiology, Interventional Neuroradiology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Joan Montaner
- Department of Neurology, University Hospital Virgen Macarena, Sevilla, Spain.,Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IbiS, Sevilla, Spain
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18
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Moniche F, Escudero-Martínez I, Mancha F, Tomasello A, Ribó M, Delgado-Acosta F, Ochoa JJ, Gil J, Gil R, González-Delgado M, Murias E, Luna A, Gil A, Mosteiro S, Fernández-Couto MD, Alarcón LFD, Ramírez-Moreno JM, Zamarro J, Parrilla G, Caniego JL, Zapata-Wainberg G, González-Mandly A, Heras JADL, López-Mesonero L, Ortega J, Arenillas JF, García E, Alcázar PP, Zapata-Arriaza E, de Albóniga-Chindurza A, Cabezas JA, Algaba P, Cayuela A, Montaner J, García AG. The Value of Transcranial Doppler Sonography in Hyperperfusion Syndrome after Carotid Artery Stenting: A Nationwide Prospective Study. J Stroke 2020; 22:254-257. [PMID: 32635689 PMCID: PMC7341015 DOI: 10.5853/jos.2020.00682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/23/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Francisco Moniche
- Department of Neurology, Virgen del Rocio University Hospital, Sevilla, Spain.,Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBiS, Sevilla, Spain
| | - Irene Escudero-Martínez
- Department of Neurology, Virgen del Rocio University Hospital, Sevilla, Spain.,Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBiS, Sevilla, Spain
| | - Fernando Mancha
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBiS, Sevilla, Spain
| | - Alejandro Tomasello
- Interventional Neuroradiology, Department of Radiology, Vall d'Hebron Hospital, Barcelona, Spain
| | - Marc Ribó
- Department of Neurology, Vall d'Hebron Hospital, Barcelona, Spain
| | - Fernando Delgado-Acosta
- Interventional Neuroradiology, Department of Radiology, Reina Sofia Hospital, Córdoba, Spain
| | - Juán José Ochoa
- Department of Neurology, Reina Sofia Hospital, Córdoba, Spain
| | - Joaquín Gil
- Interventional Neuroradiology, Department of Radiology, Clinico de Valencia Hospital, Valencia, Spain
| | - Rosario Gil
- Department of Neurology, Valencia Clinical Hospital, Valencia, Spain
| | | | - Eduardo Murias
- Interventional Neuroradiology, Department of Radiology, Central de Asturias Hospital, Oviedo, Spain
| | - Alain Luna
- Department of Neurology, Cruces Hospital, Bilbao, Spain
| | - Alberto Gil
- Interventional Neuroradiology, Department of Radiology, Cruces Hospital, Bilbao, Spain
| | - Sonia Mosteiro
- Interventional Neuroradiology, Department of Radiology, Juan Canalejo Hospital, A Coruña, Spain
| | | | | | | | - Joaquín Zamarro
- Interventional Neuroradiology, Department of Radiology, Virgen de la Arrixaca Hospital, Murcia, Spain
| | - Guillermo Parrilla
- Interventional Neuroradiology, Department of Radiology, Virgen de la Arrixaca Hospital, Murcia, Spain
| | - José L Caniego
- Interventional Neuroradiology, Department of Radiology, Princesa Hospital, Madrid, Spain
| | | | - Andrés González-Mandly
- Interventional Neuroradiology, Department of Radiology, Marques de Valdecilla Hospital, Santander, Spain
| | - José A de Las Heras
- Interventional Neuroradiology, Department of Radiology, Salamanca Hospital, Salamanca, Spain
| | | | - Joaquín Ortega
- Interventional Neuroradiology, Department of Radiology, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Juan F Arenillas
- Department of Neurology, Univesity Clinical Hospital of Valladolid, Valladolid, Spain
| | - Ernesto García
- Interventional Neuroradiology, Department of Radiology, Virgen de las Nieves Hospital, Granada, Spain
| | - Pedro P Alcázar
- Interventional Neuroradiology, Department of Radiology, Virgen de las Nieves Hospital, Granada, Spain
| | - Elena Zapata-Arriaza
- Interventional Neuroradiology, Department of Radiology, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Asier de Albóniga-Chindurza
- Interventional Neuroradiology, Department of Radiology, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Juan Antonio Cabezas
- Department of Neurology, Virgen del Rocio University Hospital, Sevilla, Spain.,Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBiS, Sevilla, Spain
| | - Pilar Algaba
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBiS, Sevilla, Spain
| | - Aurelio Cayuela
- Unit of Clinical Management of Public Health, Prevention and Promotion of Health, Area of Sanitary Management South of Sevilla, Sevilla, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBiS, Sevilla, Spain.,Department of Neurology, Virgen Macarena Univesity Hospital, Sevilla, Spain
| | - Alejandro González García
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBiS, Sevilla, Spain.,Interventional Neuroradiology, Department of Radiology, Virgen del Rocio University Hospital, Sevilla, Spain
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19
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Abstract
Background and Purpose: Emergency measures to treat patients with coronavirus 2019 (COVID-19) and contain the outbreak is the main priority in each of our hospitals; however, these measures are likely to result in collateral damage among patients with other acute diseases. Here, we investigate whether the COVID-19 pandemic affects acute stroke care through interruptions in the stroke chain of survival. Methods: A descriptive analysis of acute stroke care activity before and after the COVID-19 outbreak is given for a stroke network in southern Europe. To quantify the impact of the pandemic, the number of stroke code activations, ambulance transfers, consultations through telestroke, stroke unit admissions, and reperfusion therapy times and rates are described in temporal relationship with the rising number of COVID-19 cases in the region. Results: Following confinement of the population, our stroke unit activity decreased sharply, with a 25% reduction in admitted cases (mean number of 58 cases every 15 days in previous months to 44 cases in the 15 days after the outbreak, P<0.001). Consultations to the telestroke network declined from 25 every 15 days before the outbreak to 7 after the outbreak (P<0.001). The increasing trend in the prehospital diagnosis of stroke activated by 911 calls stopped abruptly in the region, regressing to 2019 levels. The mean number of stroke codes dispatched to hospitals decreased (78% versus 57%, P<0.001). Time of arrival from symptoms onset to stroke units was delayed >30 minutes, reperfusion therapy cases fell, and door-to-needle time started 16 minutes later than usual. Conclusions: The COVID-19 pandemic is disruptive for acute stroke pathways. Bottlenecks in the access and delivery of patients to our secured stroke centers are among the main challenges. It is critical to encourage patients to continue seeking emergency care if experiencing acute stroke symptoms and to ensure that emergency professionals continue to use stroke code activation and telestroke networks.
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Affiliation(s)
- Joan Montaner
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain (J.M., A.B.-P., S.P.-S., J.A.S.-M., L.R.-B.)
- Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Instituto de Biomedicina de Sevilla-IBiS, Barcelona, Spain (J.M., A.G.)
| | - Ana Barragán-Prieto
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain (J.M., A.B.-P., S.P.-S., J.A.S.-M., L.R.-B.)
| | - Soledad Pérez-Sánchez
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain (J.M., A.B.-P., S.P.-S., J.A.S.-M., L.R.-B.)
| | - Irene Escudero-Martínez
- Department of Neurology (I.E.-M., F.M.), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Francisco Moniche
- Department of Neurology (I.E.-M., F.M.), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - José Antonio Sánchez-Miura
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain (J.M., A.B.-P., S.P.-S., J.A.S.-M., L.R.-B.)
- Seville Critical Care and Emergency Unit, Sevilla, Spain (J.A.S.-M.)
| | - Lidia Ruiz-Bayo
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain (J.M., A.B.-P., S.P.-S., J.A.S.-M., L.R.-B.)
| | - Alejandro González
- Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Instituto de Biomedicina de Sevilla-IBiS, Barcelona, Spain (J.M., A.G.)
- Department of Radiology, Interventional Neuroradiology (A.G.), Hospital Universitario Virgen del Rocío, Sevilla, Spain
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20
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Escudero-Martínez I, Ocete RF, Mancha F, Vega Á, Piñero P, López-Rueda A, Fajardo E, Algaba P, Fernández-Engo JR, Martín-Sánchez EM, Galvao-Carmona A, Zapata-Arriaza E, Lebrato L, Pardo-Galiana B, Cabezas JA, Ayuso MI, González A, Moniche F, Montaner J. Prevalence and risk factors of silent brain infarcts in patients with AF detected by 3T-MRI. J Neurol 2020; 267:2675-2682. [PMID: 32410017 DOI: 10.1007/s00415-020-09887-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Silent brain infarcts (SBI), a finding on neuroimaging, are associated with higher risk of future stroke. Atrial Fibrillation (AF) has been previously identified as a cause of SBI. OBJECTIVES The aim of this study is to determine the prevalence of and risk factors for SBI in patients with AF and low-to-moderate embolic risk according to CHADS2 and CHA2DS2VASc score. METHODS Patients with a history of AF based on medical records who scored 0-1 in the CHADS2 score were selected from the Seville urban area using the Andalusian electronic healthcare database (DIRAYA). Demographic and clinical data were collected and a 3T brain MRI was performed on patients older than 50 years and with absence of neurological symptoms. RESULTS 66 of the initial 443 patients (14.9%) and 41 of the 349 patients with low risk according to CHA2DS2VASc score (11.7%) presented at least 1 SBI. After adjusted multivariable analysis, an older age (OR 3.84, 95% CI 1.07-13.76) and left atrial (LA) enlargement (OR 3.13, 95% CI 1.15-8.55) were associated with SBI in the whole cohort, while only LA enlargement was associated with SBI in the low-risk cohort (OR 3.19, 95% CI 1.33-7.63). CONCLUSIONS LA enlargement on echocardiogram was associated with SBI in patients with AF and low or moderate embolic risk according to CHADS2 and in the low-risk population according to CHA2DS2VASc. Although further studies are needed, a neuroimaging screening might be justified in these patients to guide medical therapies to improve stroke prevention.
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Affiliation(s)
- Irene Escudero-Martínez
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain.,Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | - Rafael F Ocete
- Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain.,Department of Radiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Fernando Mancha
- Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | - Ángela Vega
- Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | - Pilar Piñero
- Department of Radiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Elena Fajardo
- Department of Radiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Pilar Algaba
- Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | | | - Eva M Martín-Sánchez
- Information Systems Coordination Service, Andalusian Healthcare System, Seville, Spain
| | | | - Elena Zapata-Arriaza
- Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain.,Department of Radiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Lucía Lebrato
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain.,Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | - Blanca Pardo-Galiana
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain.,Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | - Juan Antonio Cabezas
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain.,Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | - María Irene Ayuso
- Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | - Alejandro González
- Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain.,Department of Radiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Francisco Moniche
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain.,Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | - Joan Montaner
- Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain. .,Department of Neurology, Hospital Universitario Virgen Macarena, Avenida Doctor Fedriani, No. 3, 41007, Seville, Spain.
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21
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Thorén M, Dixit A, Escudero-Martínez I, Gdovinová Z, Klecka L, Rand VM, Toni D, Vilionskis A, Wahlgren N, Ahmed N. Effect of Recanalization on Cerebral Edema in Ischemic Stroke Treated With Thrombolysis and/or Endovascular Therapy. Stroke 2019; 51:216-223. [PMID: 31818228 DOI: 10.1161/strokeaha.119.026692] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 12/17/2022]
Abstract
Background and Purpose- A large infarct and expanding cerebral edema (CED) due to a middle cerebral artery occlusion confers a 70% mortality unless treated surgically. Reperfusion may cause blood-brain barrier disruption and a risk for cerebral edema and secondary parenchymal hemorrhage (PH). We aimed to investigate the effect of recanalization on development of early CED and PH after recanalization therapy. Methods- From the SITS-International Stroke Treatment Registry, we selected patients with signs of artery occlusion at baseline (either Hyperdense Artery Sign or computed tomography/magnetic resonance imaging angiographic occlusion). We defined recanalization as the disappearance of radiological signs of occlusion at 22 to 36 hours. Primary outcome was moderate to severe CED and secondary outcome was PH on 22- to 36-hour imaging scans. We used logistic regression with adjustment for baseline variables and PH. Results- Twenty two thousand one hundred eighty-four patients fulfilled the inclusion criteria (n=18 318 received intravenous thrombolysis, n=3071 received intravenous thrombolysis+thrombectomy, n=795 received thrombectomy). Recanalization occurred in 64.1%. Median age was 71 versus 71 years and National Institutes of Health Stroke Scale score 15 versus 16 in the recanalized versus nonrecanalized patients respectively. Recanalized patients had a lower risk for CED (13.0% versus 23.6%), adjusted odds ratio (aOR), 0.52 (95% CI, 0.46-0.59), and a higher risk for PH (8.9% versus 6.5%), adjusted odds ratio, 1.37 (95% CI, 1.22-1.55), than nonrecanalized patients. Conclusions- In patients with acute ischemic stroke, recanalization was associated with a lower risk for early CED even after adjustment for higher rate for PH in recanalized patients.
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Affiliation(s)
- Magnus Thorén
- From the Department of Neurology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Sweden (M.T., N.A.)
| | - Anand Dixit
- Newcastle upon Tyne NHS Foundation Trust, University of Newcastle upon Tyne, United Kingdom (A.D.)
| | - Irene Escudero-Martínez
- Department of Neurology, University Hospital Virgen del Rocío, Sevilla and Biomedicine Institute of Sevilla, Spain (I.E.-M.)
| | - Zuzana Gdovinová
- Department of Neurology, Faculty of Medicine, P.J. Safarik University Košice, Slovak republic (Z.G.)
| | - Lukas Klecka
- Departement of Neurology, Municipal hospital of Ostrava, Czech Republic (L.K.)
| | - Viiu-Marika Rand
- Department of Neurology, North Estonia Medical Centre, Tallinn (V.-M.R.)
| | - Danilo Toni
- Unità di Trattamento Neurovascolare, University La Sapienza Rome, Italy (D.T.)
| | - Aleksandras Vilionskis
- Department of Neurology, Institute of Clinical Medicine, Vilnius University, Republican Vilnius University hospital, Lithuania (A.V.)
| | - Nils Wahlgren
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden (N.W.)
| | - Niaz Ahmed
- From the Department of Neurology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Sweden (M.T., N.A.)
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22
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Escudero-Martínez I, Mancha F, Vega-Salvatierra Á, Ayuso MI, Ocete RF, Algaba P, López-Rueda A, Piñero P, Fajardo E, Fernández-Engo JR, Martín-Sánchez EM, Galvao-Carmona A, Zapata-Arriaza E, Lebrato L, Pardo-Galiana B, Cabezas JA, González A, Moniche F, Montaner J. Mediterranean Diet and Physical Activity Protect from Silent Brain Infarcts in a Cohort of Patients with Atrial Fibrillation. J Stroke 2019; 21:353-355. [PMID: 31590481 PMCID: PMC6780023 DOI: 10.5853/jos.2019.01949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/04/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
- Irene Escudero-Martínez
- Department of Neurology, University Hospital Virgen del Rocío, Sevilla, Spain.,Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBIS, Sevilla, Spain
| | - Fernando Mancha
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBIS, Sevilla, Spain
| | | | - María Irene Ayuso
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBIS, Sevilla, Spain
| | - Rafael F Ocete
- Department of Radiology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Pilar Algaba
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBIS, Sevilla, Spain
| | | | - Pilar Piñero
- Department of Radiology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Elena Fajardo
- Department of Radiology, University Hospital Virgen del Rocío, Sevilla, Spain
| | | | - Eva María Martín-Sánchez
- Information Systems Coordination Service, Support Services of the Andalusian Health Service, Seville, Spain
| | | | - Elena Zapata-Arriaza
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBIS, Sevilla, Spain.,Department of Radiology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Lucía Lebrato
- Department of Neurology, University Hospital Virgen del Rocío, Sevilla, Spain
| | | | | | - Alejandro González
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBIS, Sevilla, Spain.,Department of Radiology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Francisco Moniche
- Department of Neurology, University Hospital Virgen del Rocío, Sevilla, Spain.,Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBIS, Sevilla, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Institute of Biomedicine of Seville-IBIS, Sevilla, Spain.,Department of Neurology, University Hospital Virgen Macarena, Sevilla, Spain
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23
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Ahmed N, Audebert H, Turc G, Cordonnier C, Christensen H, Sacco S, Sandset EC, Ntaios G, Charidimou A, Toni D, Pristipino C, Köhrmann M, Kuramatsu JB, Thomalla G, Mikulik R, Ford GA, Martí-Fàbregas J, Fischer U, Thoren M, Lundström E, Rinkel GJ, van der Worp HB, Matusevicius M, Tsivgoulis G, Milionis H, Rubiera M, Hart R, Moreira T, Lantz M, Sjöstrand C, Andersen G, Schellinger P, Kostulas K, Sunnerhagen KS, Keselman B, Korompoki E, Purrucker J, Khatri P, Whiteley W, Berge E, Mazya M, Dippel DW, Mustanoja S, Rasmussen M, Söderqvist ÅK, Escudero-Martínez I, Steiner T. Consensus statements and recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 11-13 November 2018. Eur Stroke J 2019; 4:307-317. [PMID: 31903429 DOI: 10.1177/2396987319863606] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/22/2019] [Indexed: 11/16/2022] Open
Abstract
The purpose of the European Stroke Organisation-Karolinska Stroke Update Conference is to provide updates on recent stroke therapy research and to give an opportunity for the participants to discuss how these results may be implemented into clinical routine. The meeting started 22 years ago as Karolinska Stroke Update, but since 2014 it is a joint conference with European Stroke Organisation. Importantly, it provides a platform for discussion on the European Stroke Organisation guidelines process and on recommendations to the European Stroke Organisation guidelines committee on specific topics. By this, it adds a direct influence from stroke professionals otherwise not involved in committees and work groups on the guideline procedure. The discussions at the conference may also inspire new guidelines when motivated. The topics raised at the meeting are selected by the scientific programme committee mainly based on recent important scientific publications. This year's European Stroke Organisation-Karolinska Stroke Update Meeting was held in Stockholm on 11-13 November 2018. There were 11 scientific sessions discussed in the meeting including two short sessions. Each session except the short sessions produced a consensus statement (Full version with background, issues, conclusions and references are published as web-material and at www.eso-karolinska.org and http://eso-stroke.org) and recommendations which were prepared by a writing committee consisting of session chair(s), scientific secretary and speakers. These statements were presented to the 250 participants of the meeting. In the open meeting, general participants commented on the consensus statement and recommendations and the final document were adjusted based on the discussion from the general participants Recommendations (grade of evidence) were graded according to the 1998 Karolinska Stroke Update meeting with regard to the strength of evidence. Grade A Evidence: Strong support from randomised controlled trials and statistical reviews (at least one randomised controlled trial plus one statistical review). Grade B Evidence: Support from randomised controlled trials and statistical reviews (one randomised controlled trial or one statistical review). Grade C Evidence: No reasonable support from randomised controlled trials, recommendations based on small randomised and/or non-randomised controlled trials evidence.
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Affiliation(s)
- Niaz Ahmed
- Department of Neurology, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (N Ahmed, Conference Chair)
| | - Heinrich Audebert
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences & Université de Paris & INSERM U1266, Paris, France
| | - Charlotte Cordonnier
- Department of Neurology, Stroke Unit, Roger Salengro Hospital, 59037 Lille, France
| | - Hanne Christensen
- Department of Neurology Neurology, Stroke Consultant at Bispebjerg & Frederiksberg Hospitals, Copenhagen, Denmark
| | - Simona Sacco
- Department of Applied Clinical sciences and Biotechnology, Section of Neurology, University of L'Alquila, L'Alquila, Italy
| | | | - George Ntaios
- Department of Internal Medicine, Larissa University Hospital, School of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Andreas Charidimou
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Danilo Toni
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Pristipino
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Köhrmann
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Joji B Kuramatsu
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Götz Thomalla
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Mikulik
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Gary A Ford
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Joan Martí-Fàbregas
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Urs Fischer
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Magnus Thoren
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Erik Lundström
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Gabriel Je Rinkel
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - H Bart van der Worp
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Marius Matusevicius
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Georgios Tsivgoulis
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Haralampos Milionis
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Marta Rubiera
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Hart
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Tiago Moreira
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Lantz
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Christina Sjöstrand
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Grethe Andersen
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Schellinger
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Konstantinos Kostulas
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Stibrant Sunnerhagen
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Boris Keselman
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Eleni Korompoki
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Purrucker
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Pooja Khatri
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - William Whiteley
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Eivind Berge
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Mazya
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Diederik Wj Dippel
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Satu Mustanoja
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Mads Rasmussen
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Åsa Kuntze Söderqvist
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Irene Escudero-Martínez
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Thorsten Steiner
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
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24
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Zapata-Arriaza E, Mancha F, Bustamante A, Moniche F, Pardo-Galiana B, Serrano-Gotarredona P, Navarro-Herrero S, Pallisa E, Faura J, Vega-Salvatierra Á, Penalba A, Escudero-Martínez I, Ramos-Herrero VD, Azurmendi L, Charles Sanchez J, Montaner J. Biomarkers predictive value for early diagnosis of Stroke-Associated Pneumonia. Ann Clin Transl Neurol 2019; 6:1882-1887. [PMID: 31365180 PMCID: PMC6764629 DOI: 10.1002/acn3.50849] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 04/25/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/20/2022] Open
Abstract
To confirm the diagnostic accuracy of candidate biomarkers in stroke-associated pneumonia (SAP), we prospectively enrolled ischemic stroke patients with NIHSS ≥ 10 on admission from March-2016 to August-2017. Blood samples were collected at baseline, 24 and 48 h after stroke onset. Biomarkers (MR-proADM, suPAR, SAA) were determined by immunoassays. Regarding biomarkers, MR-proADM at 24 h (P = 0.04) and both suPAR and SAA at 48 h (P = 0.036 and P = 0.057) were associated with pneumonia. The combination of SAA > 25.15 mg/dL and suPAR> 3.14 ng/mL at 48 h had 80% sensitivity and 95.8% specificity when both biomarkers were above the cut-off. The evaluated biomarkers represent promising tools to be evaluated in future large, prospective studies on SAP. An accurate SAP diagnosis by thorax CT might help to reduce variability in such studies.
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Affiliation(s)
- Elena Zapata-Arriaza
- Stroke Research Program, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Seville, Spain
| | - Fernando Mancha
- Stroke Research Program, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Seville, Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory. Vall d'Hebron Institute of Research (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Francisco Moniche
- Stroke Research Program, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Seville, Spain.,Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Blanca Pardo-Galiana
- Stroke Research Program, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Seville, Spain.,Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | | | - Esther Pallisa
- Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Julia Faura
- Neurovascular Research Laboratory. Vall d'Hebron Institute of Research (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Ángela Vega-Salvatierra
- Stroke Research Program, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Seville, Spain
| | - Anna Penalba
- Neurovascular Research Laboratory. Vall d'Hebron Institute of Research (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Irene Escudero-Martínez
- Stroke Research Program, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Seville, Spain.,Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Víctor Darío Ramos-Herrero
- Stroke Research Program, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Seville, Spain
| | - Leire Azurmendi
- Department of Human Protein Sciences, University of Geneva, Geneve, Switzerland
| | | | - Joan Montaner
- Stroke Research Program, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Seville, Spain
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25
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Zapata-Arriaza E, Serrano-Gotarredona P, Navarro-Herrero S, Moniche F, Pardo-Galiana B, Pallisa E, Vega-Salvatierra Á, Mancha F, Escudero-Martínez I, Bustamante A, Montaner J. Chest Computed Tomography Findings and Validation of Clinical Criteria of Stroke Associated Pneumonia. J Stroke 2019; 21:217-219. [PMID: 30991796 PMCID: PMC6549062 DOI: 10.5853/jos.2018.03251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/18/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Elena Zapata-Arriaza
- Stroke Research Program, Institute of Biomedicine of Seville (IBIS)/ University Hospital Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | | | | | - Francisco Moniche
- Stroke Research Program, Institute of Biomedicine of Seville (IBIS)/ University Hospital Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - Blanca Pardo-Galiana
- Stroke Research Program, Institute of Biomedicine of Seville (IBIS)/ University Hospital Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - Esther Pallisa
- Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ángela Vega-Salvatierra
- Stroke Research Program, Institute of Biomedicine of Seville (IBIS)/ University Hospital Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - Fernando Mancha
- Stroke Research Program, Institute of Biomedicine of Seville (IBIS)/ University Hospital Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - Irene Escudero-Martínez
- Stroke Research Program, Institute of Biomedicine of Seville (IBIS)/ University Hospital Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Joan Montaner
- Stroke Research Program, Institute of Biomedicine of Seville (IBIS)/ University Hospital Virgen del Rocio/CSIC/University of Seville, Seville, Spain.,Department of Neurology, University Hospital Virgen Macarena, Seville, Spain
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26
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Alcalde-López J, Zapata-Arriaza E, Cayuela A, Moniche F, Escudero-Martínez I, Ortega-Quintanilla J, de Torres-Chacón R, Montaner J, Mayol A, González A. Safety of Early Carotid Artery Stenting for Symptomatic Stenosis in Daily Practice. Eur J Vasc Endovasc Surg 2018; 56:776-782. [PMID: 30177414 DOI: 10.1016/j.ejvs.2018.07.026] [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: 01/17/2018] [Accepted: 07/20/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE/BACKGROUND In 2006, the American Heart Association recommended that for preference carotid endarterectomy (CEA) or, alternatively, carotid angioplasty and stenting (CAS) for symptomatic carotid artery stenosis should ideally occur within 14 days of an ischaemic event. The aim was to determine the safety of CAS according to those recommendations in daily practice. METHODS A retrospective analysis was performed of all consecutive patients (2000-16), with ipsilateral carotid symptoms who underwent CAS for extracranial carotid stenosis ≥70%, who were previously included in a prospective database. Thirty day morbidity was assessed (any stroke without transient ischaemic attack [TIA]/amaurosis fugax), along with mortality of the procedure in the early (≤14 days after stroke onset) and delayed phases (15-180 days after stroke onset). Patients who received CAS and/or mechanical thrombectomy for acute ischaemic stroke treatment were not included. RESULTS In total, 1227 patients with symptomatic carotid stenosis who underwent CAS were identified. Early and delayed CAS was performed in 291 and 936 patients, respectively. Morbidity (any stroke) and mortality was 2.2% (n = 27) in the whole cohort (n = 8 [2.7%] in early vs. n = 19 [2%] in delayed CAS; p = .47). There were no differences in morbidity between early and delayed CAS regarding TIA (n = 15 vs. 36 [5.2% vs. 3.9%]; p = .33), minor stroke (n = 4 vs. 5 [1.4% vs. 0.5%]; p = .14), or major stroke (n = 2 vs. 6 [0.7% vs. 0.6%]; p = .59). Two patients (0.7%) died after early CAS and eight (0.9%) after delayed CAS (p = .56). CONCLUSION CAS may be safely performed in the early phase after an ischaemic stroke with low clinical complication rates. Further studies are needed to validate CAS safety conducted even earlier in the acute phase of ischaemic stroke.
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Affiliation(s)
- Jesús Alcalde-López
- Interventional Neuroradiology, Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Elena Zapata-Arriaza
- Interventional Neuroradiology, Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain
| | - Aurelio Cayuela
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain
| | - Francisco Moniche
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Joaquín Ortega-Quintanilla
- Interventional Neuroradiology, Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Joan Montaner
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain; Head of Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Antonio Mayol
- Interventional Neuroradiology, Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Alejandro González
- Interventional Neuroradiology, Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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27
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Zapata-Arriaza E, Moniche F, Blanca PG, Bustamante A, Escudero-Martínez I, Uclés O, Ollero-Ortiz Á, Sánchez-García JA, Gamero MÁ, Quesada Á, Vidal De Francisco D, Romera M, De la Cruz C, Sanz G, Montaner J. External Validation of the ISAN, A2DS2, and AIS-APS Scores for Predicting Stroke-Associated Pneumonia. J Stroke Cerebrovasc Dis 2017; 27:673-676. [PMID: 29103860 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.059] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 07/24/2017] [Accepted: 09/27/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The Prestroke Independence, Sex, Age, National Institutes of Health Stroke Scale (ISAN), Age, Atrial Fibrillation, Dysphagia, male sex, and National Institutes of Health Stroke Scale (A2DS2), and acute ischemic stroke-associated pneumonia score (AIS-APS) scores were created to predict stroke-associated pneumonia (SAP), one of the most important medical stroke complications. External validation of all such scores in an acute stroke population was the aim of our study. METHODS Patients with ischemic or hemorrhagic stroke were prospectively enrolled in the multicenter Stroke-Induced Pneumonia in Andalucía project between October 2014 and May 2016. Receiver operating characteristic curves and linear regression analyses were used to determine discrimination ability of the scores. The Hosmer-Lemeshow goodness-of-fit test and the plot of observed versus predicted SAP risk were used to assess model calibration. RESULTS Among 201 included patients, SAP rate was 15.5% (31). Higher ISAN, A2DS2, and AIS-APS scores were related to SAP (all P < .001). The C statistic was .83 (95% confidence interval [CI], .76-.91) for the ISAN score, .80 (95% CI, .70-.89) for the A2DS2 score, and .82 (95% CI, .74-.90) for the AIS-APS score, suggesting good discrimination. The ISAN and AIS-APS scores showed good calibration (Cox and Snell R2 = .206 and .174, respectively). The A2DS2 score showed the highest sensitivity (87%), and the AIS-APS score showed the highest specificity (92.8%). CONCLUSIONS In our cohort, the external validation of ISAN, A2DS2, and AIS-APS scores have demonstrated their accurate prediction of SAP and the ability of these scores as screening tools to better manage SAP. The AIS-APS score would be recommendable for the development of future clinical trials.
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Affiliation(s)
- Elena Zapata-Arriaza
- Neurology Department, Biomedicine Institute of Seville (IBIS), University Hospital Virgen del Rocio and Macarena, Seville, Spain
| | - Francisco Moniche
- Neurology Department, Biomedicine Institute of Seville (IBIS), University Hospital Virgen del Rocio and Macarena, Seville, Spain
| | - Pardo-Galiana Blanca
- Neurology Department, Biomedicine Institute of Seville (IBIS), University Hospital Virgen del Rocio and Macarena, Seville, Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Irene Escudero-Martínez
- Neurology Department, Biomedicine Institute of Seville (IBIS), University Hospital Virgen del Rocio and Macarena, Seville, Spain
| | - Oscar Uclés
- Neurology Department, Biomedicine Institute of Seville (IBIS), University Hospital Virgen del Rocio and Macarena, Seville, Spain
| | | | | | - Miguel Ángel Gamero
- Neurology Department, University Hospital Virgen de Macarena, Seville, Spain
| | - Ángeles Quesada
- Neurology Department, University Hospital Virgen de Macarena, Seville, Spain
| | | | - Mercedes Romera
- Neurology Department, University Hospital Virgen de Valme, Seville, Spain
| | - Carlos De la Cruz
- Neurology Department, University Hospital Virgen de la Victoria, Málaga, Spain
| | - Gema Sanz
- Neurology Department, Huelva Universitary Hospital Complex, Huelva, Spain
| | - Joan Montaner
- Neurology Department, Biomedicine Institute of Seville (IBIS), University Hospital Virgen del Rocio and Macarena, Seville, Spain.
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28
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Zapata-Arriaza E, Moniche F, González A, Bustamante A, Escudero-Martínez I, De la Torre Laviana FJ, Prieto M, Mancha F, Montaner J. Predictors of Restenosis Following Carotid Angioplasty and Stenting. Stroke 2016; 47:2144-7. [DOI: 10.1161/strokeaha.116.012650] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/26/2016] [Indexed: 01/05/2023]
Abstract
Background and Purpose—
Restenosis after carotid angioplasty (with or without stent) is associated with increased rate of stroke and death. Our aim was to determine risk and predictive factors related to carotid restenosis post carotid angioplasty and its association to recurrent cerebrovascular events.
Methods—
All consecutive patients with carotid stenosis treated with angioplasty (n=1060) in a single University Hospital were included (from 2002 to 2013). Follow-up was done prospectively evaluating restenosis, ipsilateral stroke, or death. Restenosis was defined as a narrowing of ≥70% of a previously treated vessel evaluated by ultrasonography.
Results—
Of the 1060 patients treated, 9.2% (97) of patients experienced restenosis during follow up (median 12 [9–32] months). Occurrence of restenosis was associated with ipsilateral stroke during follow-up (
P
=0.049). After Cox regression analysis, hypertension (hazard ratio, 6.2 [1.9–19.9];
P
=0.002), impaired vasoreactivity (hazard ratio, 1.7 [1.09–2.8];
P
=0.019), and angioplasty without stent (hazard ratio, 2.9 [1.2–6.8];
P
=0.012) were independent risk predictors of >70% restenosis.
Conclusions—
Carotid restenosis after carotid angioplasty is associated with ipsilateral stroke occurrence. In our sample, hypertension, angioplasty without stent, and impaired vasoreactivity identify patients at high risk of restenosis and could help to select patients for follow-up ultrasonography imaging.
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Affiliation(s)
- Elena Zapata-Arriaza
- From the Neurology Department, Biomedicine Institute of Seville (IBIS) (E.Z.-A., F.M., I.E.-M., F.J.D.l.T.L., M.P., F.M., J.M.), and Radiology Department, Interventional Neuroradiology Unit (A.G.), University Hospital Virgen del Rocio, Seville, Spain; and Neurovascular Research Laboratory, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain (A.B.)
| | - Francisco Moniche
- From the Neurology Department, Biomedicine Institute of Seville (IBIS) (E.Z.-A., F.M., I.E.-M., F.J.D.l.T.L., M.P., F.M., J.M.), and Radiology Department, Interventional Neuroradiology Unit (A.G.), University Hospital Virgen del Rocio, Seville, Spain; and Neurovascular Research Laboratory, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain (A.B.)
| | - Alejandro González
- From the Neurology Department, Biomedicine Institute of Seville (IBIS) (E.Z.-A., F.M., I.E.-M., F.J.D.l.T.L., M.P., F.M., J.M.), and Radiology Department, Interventional Neuroradiology Unit (A.G.), University Hospital Virgen del Rocio, Seville, Spain; and Neurovascular Research Laboratory, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain (A.B.)
| | - Alejandro Bustamante
- From the Neurology Department, Biomedicine Institute of Seville (IBIS) (E.Z.-A., F.M., I.E.-M., F.J.D.l.T.L., M.P., F.M., J.M.), and Radiology Department, Interventional Neuroradiology Unit (A.G.), University Hospital Virgen del Rocio, Seville, Spain; and Neurovascular Research Laboratory, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain (A.B.)
| | - Irene Escudero-Martínez
- From the Neurology Department, Biomedicine Institute of Seville (IBIS) (E.Z.-A., F.M., I.E.-M., F.J.D.l.T.L., M.P., F.M., J.M.), and Radiology Department, Interventional Neuroradiology Unit (A.G.), University Hospital Virgen del Rocio, Seville, Spain; and Neurovascular Research Laboratory, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain (A.B.)
| | - Francisco Javier De la Torre Laviana
- From the Neurology Department, Biomedicine Institute of Seville (IBIS) (E.Z.-A., F.M., I.E.-M., F.J.D.l.T.L., M.P., F.M., J.M.), and Radiology Department, Interventional Neuroradiology Unit (A.G.), University Hospital Virgen del Rocio, Seville, Spain; and Neurovascular Research Laboratory, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain (A.B.)
| | - María Prieto
- From the Neurology Department, Biomedicine Institute of Seville (IBIS) (E.Z.-A., F.M., I.E.-M., F.J.D.l.T.L., M.P., F.M., J.M.), and Radiology Department, Interventional Neuroradiology Unit (A.G.), University Hospital Virgen del Rocio, Seville, Spain; and Neurovascular Research Laboratory, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain (A.B.)
| | - Fernando Mancha
- From the Neurology Department, Biomedicine Institute of Seville (IBIS) (E.Z.-A., F.M., I.E.-M., F.J.D.l.T.L., M.P., F.M., J.M.), and Radiology Department, Interventional Neuroradiology Unit (A.G.), University Hospital Virgen del Rocio, Seville, Spain; and Neurovascular Research Laboratory, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain (A.B.)
| | - Joan Montaner
- From the Neurology Department, Biomedicine Institute of Seville (IBIS) (E.Z.-A., F.M., I.E.-M., F.J.D.l.T.L., M.P., F.M., J.M.), and Radiology Department, Interventional Neuroradiology Unit (A.G.), University Hospital Virgen del Rocio, Seville, Spain; and Neurovascular Research Laboratory, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain (A.B.)
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29
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Masjuán J, Álvarez-Sabín J, Arias-Rivas S, Blanco M, de Felipe A, Escudero-Martínez I, Fuentes B, Gállego-Culleré J, Moniche-Álvarez F, Muñoz L, Pérez de la Ossa-Herrero N, Sahuquillo P, Santamarina E, Sanz B, Tembl JI, Zandio B. [Urgent stroke care in hospitals with a stroke unit. Quick Project]. Rev Neurol 2016; 62:303-310. [PMID: 26988168] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION A stroke is a time-dependent medical emergency. Swiftness in its recognition and in the care received by the patients plays a key role in the prognosis. AIMS To analyse the medical intervention times, to evaluate possible areas where improvements can be made and to examine the allocation of resources in the centres. PATIENTS AND METHODS The study was based on a prospective register of patients with suspected stroke and stroke code activation treated in eight experienced Spanish stroke units. Onset-to-door, door-to-computed tomography (CT), door-to-needle, CT-to-needle and onset-to-needle times were collected. Information about the means of transport used to get to the hospital, the type of stroke and reperfusion therapies was also collected. With regard to the structural resources of the centres, data were gathered about the nurse-to-patient ratio, bed monitoring, availability of multimodal CT and magnetic resonance, and doing information or training courses. RESULTS Altogether 197 patients were included, of whom 181 (151 infarctions and 30 brain haemorrhages) were valid. The medians (p25-p75) in minutes were: onset-to-door, 104 (70-188); door-to-CT, 27 (19-41); CT-to-needle, 30 (21-43); door-to-needle, 64 (49-83); and onset-to-needle, 156 (129-202). Reperfusion therapies were applied in 68 patients (45% of the cerebral infarctions), of which 81% were intravenous thrombolyses; 7%, endovascular treatments; and 12%, a combination of the two. The resources available in the centres were in accordance with those recommended by the clinical guidelines. There was a low percentage of patients who were studied by means of magnetic resonance. CONCLUSION The percentage of patients treated with thrombolysis was very high and although the times of the in-hospital circuits were good, there is still room for further improvement.
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Affiliation(s)
- Jaime Masjuán
- Hospital Universitario Ramon y Cajal, 28034 Madrid, Espana
| | | | - Susana Arias-Rivas
- Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Espana
| | - Miguel Blanco
- Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Espana
| | | | | | | | | | | | - Lucía Muñoz
- Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Espana
| | | | | | | | - Borja Sanz
- Hospital Universitario La Paz, Madrid, Espana
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Cayuela A, Cayuela L, Escudero-Martínez I, Rodríguez-Domínguez S, González A, Moniche F, Jiménez MD, Montaner J. Analysis of cerebrovascular mortality trends in Spain from 1980 to 2011. Neurologia 2014; 31:370-8. [PMID: 25524042 DOI: 10.1016/j.nrl.2014.09.002] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 05/21/2014] [Accepted: 09/06/2014] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION In recent decades, mortality rates for cerebrovascular diseases (CVD) have declined significantly in many countries. This study analyses changes in CVD mortality rates in Spain (1980-2011) to determine if previously observed trends remain. PATIENTS AND METHODS Data on CVD mortality rates and the population data needed for the analysis were provided by Spain's National Statistics Institute. We calculated age-specific mortality rate, age-standardised overall mortality, and age-truncated mortality (35-64 years) using the direct method and standard European population structure. Joinpoint analysis was used to estimate the percentage of annual change in rates and identify significant changes in trends. RESULTS CVD mortality rate decreased considerably and continuously over the last 32 years in all age groups and in both sexes in Spain. For both sexes, joinpoint analysis identifies a final period with more marked decline: 2005-2011 in women (-6.3%) and 2007-2011 in men (-7.2%). CONCLUSIONS CVD mortality rates displayed a marked and continuous decline in Spain between 1980 and 2011. Due to the ageing of the population, doctors expect an increase in CVD prevalence and therefore its magnitude in terms of disability and healthcare costs, which poses a challenge to our health system.
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Affiliation(s)
- A Cayuela
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España
| | - L Cayuela
- Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - I Escudero-Martínez
- Unidad de Ictus, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | | | - A González
- Servicio de Neurorradiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - F Moniche
- Unidad de Ictus, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M D Jiménez
- Unidad de Ictus, Unidad de Gestión Clínica de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J Montaner
- Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona, España; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Sevilla, España
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