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Rodriguez-Luna D, Pancorbo O, Llull L, Silva Y, Prats-Sanchez L, Muchada M, Rudilosso S, Terceño M, Ramos-Pachón A, Hernandez Guillamon M, Coscojuela P, Blasco J, Perez-Hoyos S, Chamorro A, Molina CA. Effects of Achieving Rapid, Intensive, and Sustained Blood Pressure Reduction in Intracerebral Hemorrhage Expansion and Functional Outcome. Neurology 2024; 102:e209244. [PMID: 38598746 DOI: 10.1212/wnl.0000000000209244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The time taken to achieve blood pressure (BP) control could be pivotal in the benefits of reducing BP in acute intracerebral hemorrhage (ICH). We aimed to assess the relationship between the rapid achievement and sustained maintenance of an intensive systolic BP (SBP) target with radiologic, clinical, and functional outcomes. METHODS Rapid, Intensive, and Sustained BP lowering in Acute ICH (RAINS) was a multicenter, prospective, observational cohort study of adult patients with ICH <6 hours and SBP ≥150 mm Hg at 4 Comprehensive Stroke Centers during a 4.5-year period. Patients underwent baseline and 24-hour CT scans and 24-hour noninvasive BP monitoring. BP was managed under a rapid (target achievement ≤60 minutes), intensive (target SBP <140 mm Hg), and sustained (target stability for 24 hours) BP protocol. SBP target achievement ≤60 minutes and 24-hour SBP variability were recorded. Outcomes included hematoma expansion (>6 mL or >33%) at 24 hours (primary outcome), early neurologic deterioration (END, 24-hour increase in NIH Stroke Scale score ≥4), and 90-day ordinal modified Rankin scale (mRS) score. Analyses were adjusted by age, sex, anticoagulation, onset-to-imaging time, ICH volume, and intraventricular extension. RESULTS We included 312 patients (mean age 70.2 ± 13.3 years, 202 [64.7%] male). Hematoma expansion occurred in 70/274 (25.6%) patients, END in 58/291 (19.9%), and the median 90-day mRS score was 4 (interquartile range, 2-5). SBP target achievement ≤60 minutes (178/312 [57.1%]) associated with a lower risk of hematoma expansion (adjusted odds ratio [aOR] 0.43, 95% confidence interval [CI] 0.23-0.77), lower END rate (aOR 0.43, 95% CI 0.23-0.80), and lower 90-day mRS scores (aOR 0.48, 95% CI 0.32-0.74). The mean 24-hour SBP variability was 21.0 ± 7.6 mm Hg. Higher 24-hour SBP variability was not related to expansion (aOR 0.99, 95% CI 0.95-1.04) but associated with higher END rate (aOR 1.15, 95% CI 1.09-1.21) and 90-day mRS scores (aOR 1.06, 95% CI 1.04-1.10). DISCUSSION Among patients with acute ICH, achieving an intensive SBP target within 60 minutes was associated with lower hematoma expansion risk. Rapid SBP reduction and stable sustention within 24 hours were related to improved clinical and functional outcomes. These findings warrant the design of randomized clinical trials examining the impact of effectively achieving rapid, intensive, and sustained BP control on hematoma expansion. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that in adults with spontaneous ICH and initial SBP ≥150 mm Hg, lowering SBP to <140 mm Hg within the first hour and maintaining this for 24 hours is associated with decreased hematoma expansion.
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Affiliation(s)
- David Rodriguez-Luna
- From the Department of Neurology (D.R.-L., M.M., C.A.M.), Vall d'Hebron University Hospital; Stroke Research Group (D.R.-L., O.P., M.M., C.A.M.), Vall d'Hebron Research Institute; Department of Medicine (D.R.-L., O.P.), Autonomous University of Barcelona; Department of Neuroscience (L.L., S.R., A.C.), Comprehensive Stroke Center, Hospital Clinic, Barcelona; Department of Neurology (Y.S., M.T.), Hospital Universitari Dr. Josep Trueta, Girona; Department of Neurology (L.P.-S., A.R.-P.), Hospital de la Santa Creu i Sant Pau; Neurovascular Research Group (M.H.G.), Vall d'Hebron Research Institute; Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital; Department of Interventional Neuroradiology (J.B.), CDI, Hospital Clínic; and Statistics and Bioinformatics Unit (S.P.-H.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - Olalla Pancorbo
- From the Department of Neurology (D.R.-L., M.M., C.A.M.), Vall d'Hebron University Hospital; Stroke Research Group (D.R.-L., O.P., M.M., C.A.M.), Vall d'Hebron Research Institute; Department of Medicine (D.R.-L., O.P.), Autonomous University of Barcelona; Department of Neuroscience (L.L., S.R., A.C.), Comprehensive Stroke Center, Hospital Clinic, Barcelona; Department of Neurology (Y.S., M.T.), Hospital Universitari Dr. Josep Trueta, Girona; Department of Neurology (L.P.-S., A.R.-P.), Hospital de la Santa Creu i Sant Pau; Neurovascular Research Group (M.H.G.), Vall d'Hebron Research Institute; Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital; Department of Interventional Neuroradiology (J.B.), CDI, Hospital Clínic; and Statistics and Bioinformatics Unit (S.P.-H.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - Laura Llull
- From the Department of Neurology (D.R.-L., M.M., C.A.M.), Vall d'Hebron University Hospital; Stroke Research Group (D.R.-L., O.P., M.M., C.A.M.), Vall d'Hebron Research Institute; Department of Medicine (D.R.-L., O.P.), Autonomous University of Barcelona; Department of Neuroscience (L.L., S.R., A.C.), Comprehensive Stroke Center, Hospital Clinic, Barcelona; Department of Neurology (Y.S., M.T.), Hospital Universitari Dr. Josep Trueta, Girona; Department of Neurology (L.P.-S., A.R.-P.), Hospital de la Santa Creu i Sant Pau; Neurovascular Research Group (M.H.G.), Vall d'Hebron Research Institute; Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital; Department of Interventional Neuroradiology (J.B.), CDI, Hospital Clínic; and Statistics and Bioinformatics Unit (S.P.-H.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - Yolanda Silva
- From the Department of Neurology (D.R.-L., M.M., C.A.M.), Vall d'Hebron University Hospital; Stroke Research Group (D.R.-L., O.P., M.M., C.A.M.), Vall d'Hebron Research Institute; Department of Medicine (D.R.-L., O.P.), Autonomous University of Barcelona; Department of Neuroscience (L.L., S.R., A.C.), Comprehensive Stroke Center, Hospital Clinic, Barcelona; Department of Neurology (Y.S., M.T.), Hospital Universitari Dr. Josep Trueta, Girona; Department of Neurology (L.P.-S., A.R.-P.), Hospital de la Santa Creu i Sant Pau; Neurovascular Research Group (M.H.G.), Vall d'Hebron Research Institute; Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital; Department of Interventional Neuroradiology (J.B.), CDI, Hospital Clínic; and Statistics and Bioinformatics Unit (S.P.-H.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - Luis Prats-Sanchez
- From the Department of Neurology (D.R.-L., M.M., C.A.M.), Vall d'Hebron University Hospital; Stroke Research Group (D.R.-L., O.P., M.M., C.A.M.), Vall d'Hebron Research Institute; Department of Medicine (D.R.-L., O.P.), Autonomous University of Barcelona; Department of Neuroscience (L.L., S.R., A.C.), Comprehensive Stroke Center, Hospital Clinic, Barcelona; Department of Neurology (Y.S., M.T.), Hospital Universitari Dr. Josep Trueta, Girona; Department of Neurology (L.P.-S., A.R.-P.), Hospital de la Santa Creu i Sant Pau; Neurovascular Research Group (M.H.G.), Vall d'Hebron Research Institute; Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital; Department of Interventional Neuroradiology (J.B.), CDI, Hospital Clínic; and Statistics and Bioinformatics Unit (S.P.-H.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marián Muchada
- From the Department of Neurology (D.R.-L., M.M., C.A.M.), Vall d'Hebron University Hospital; Stroke Research Group (D.R.-L., O.P., M.M., C.A.M.), Vall d'Hebron Research Institute; Department of Medicine (D.R.-L., O.P.), Autonomous University of Barcelona; Department of Neuroscience (L.L., S.R., A.C.), Comprehensive Stroke Center, Hospital Clinic, Barcelona; Department of Neurology (Y.S., M.T.), Hospital Universitari Dr. Josep Trueta, Girona; Department of Neurology (L.P.-S., A.R.-P.), Hospital de la Santa Creu i Sant Pau; Neurovascular Research Group (M.H.G.), Vall d'Hebron Research Institute; Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital; Department of Interventional Neuroradiology (J.B.), CDI, Hospital Clínic; and Statistics and Bioinformatics Unit (S.P.-H.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - Salvatore Rudilosso
- From the Department of Neurology (D.R.-L., M.M., C.A.M.), Vall d'Hebron University Hospital; Stroke Research Group (D.R.-L., O.P., M.M., C.A.M.), Vall d'Hebron Research Institute; Department of Medicine (D.R.-L., O.P.), Autonomous University of Barcelona; Department of Neuroscience (L.L., S.R., A.C.), Comprehensive Stroke Center, Hospital Clinic, Barcelona; Department of Neurology (Y.S., M.T.), Hospital Universitari Dr. Josep Trueta, Girona; Department of Neurology (L.P.-S., A.R.-P.), Hospital de la Santa Creu i Sant Pau; Neurovascular Research Group (M.H.G.), Vall d'Hebron Research Institute; Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital; Department of Interventional Neuroradiology (J.B.), CDI, Hospital Clínic; and Statistics and Bioinformatics Unit (S.P.-H.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - Mikel Terceño
- From the Department of Neurology (D.R.-L., M.M., C.A.M.), Vall d'Hebron University Hospital; Stroke Research Group (D.R.-L., O.P., M.M., C.A.M.), Vall d'Hebron Research Institute; Department of Medicine (D.R.-L., O.P.), Autonomous University of Barcelona; Department of Neuroscience (L.L., S.R., A.C.), Comprehensive Stroke Center, Hospital Clinic, Barcelona; Department of Neurology (Y.S., M.T.), Hospital Universitari Dr. Josep Trueta, Girona; Department of Neurology (L.P.-S., A.R.-P.), Hospital de la Santa Creu i Sant Pau; Neurovascular Research Group (M.H.G.), Vall d'Hebron Research Institute; Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital; Department of Interventional Neuroradiology (J.B.), CDI, Hospital Clínic; and Statistics and Bioinformatics Unit (S.P.-H.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - Anna Ramos-Pachón
- From the Department of Neurology (D.R.-L., M.M., C.A.M.), Vall d'Hebron University Hospital; Stroke Research Group (D.R.-L., O.P., M.M., C.A.M.), Vall d'Hebron Research Institute; Department of Medicine (D.R.-L., O.P.), Autonomous University of Barcelona; Department of Neuroscience (L.L., S.R., A.C.), Comprehensive Stroke Center, Hospital Clinic, Barcelona; Department of Neurology (Y.S., M.T.), Hospital Universitari Dr. Josep Trueta, Girona; Department of Neurology (L.P.-S., A.R.-P.), Hospital de la Santa Creu i Sant Pau; Neurovascular Research Group (M.H.G.), Vall d'Hebron Research Institute; Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital; Department of Interventional Neuroradiology (J.B.), CDI, Hospital Clínic; and Statistics and Bioinformatics Unit (S.P.-H.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - Mar Hernandez Guillamon
- From the Department of Neurology (D.R.-L., M.M., C.A.M.), Vall d'Hebron University Hospital; Stroke Research Group (D.R.-L., O.P., M.M., C.A.M.), Vall d'Hebron Research Institute; Department of Medicine (D.R.-L., O.P.), Autonomous University of Barcelona; Department of Neuroscience (L.L., S.R., A.C.), Comprehensive Stroke Center, Hospital Clinic, Barcelona; Department of Neurology (Y.S., M.T.), Hospital Universitari Dr. Josep Trueta, Girona; Department of Neurology (L.P.-S., A.R.-P.), Hospital de la Santa Creu i Sant Pau; Neurovascular Research Group (M.H.G.), Vall d'Hebron Research Institute; Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital; Department of Interventional Neuroradiology (J.B.), CDI, Hospital Clínic; and Statistics and Bioinformatics Unit (S.P.-H.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - Pilar Coscojuela
- From the Department of Neurology (D.R.-L., M.M., C.A.M.), Vall d'Hebron University Hospital; Stroke Research Group (D.R.-L., O.P., M.M., C.A.M.), Vall d'Hebron Research Institute; Department of Medicine (D.R.-L., O.P.), Autonomous University of Barcelona; Department of Neuroscience (L.L., S.R., A.C.), Comprehensive Stroke Center, Hospital Clinic, Barcelona; Department of Neurology (Y.S., M.T.), Hospital Universitari Dr. Josep Trueta, Girona; Department of Neurology (L.P.-S., A.R.-P.), Hospital de la Santa Creu i Sant Pau; Neurovascular Research Group (M.H.G.), Vall d'Hebron Research Institute; Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital; Department of Interventional Neuroradiology (J.B.), CDI, Hospital Clínic; and Statistics and Bioinformatics Unit (S.P.-H.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jordi Blasco
- From the Department of Neurology (D.R.-L., M.M., C.A.M.), Vall d'Hebron University Hospital; Stroke Research Group (D.R.-L., O.P., M.M., C.A.M.), Vall d'Hebron Research Institute; Department of Medicine (D.R.-L., O.P.), Autonomous University of Barcelona; Department of Neuroscience (L.L., S.R., A.C.), Comprehensive Stroke Center, Hospital Clinic, Barcelona; Department of Neurology (Y.S., M.T.), Hospital Universitari Dr. Josep Trueta, Girona; Department of Neurology (L.P.-S., A.R.-P.), Hospital de la Santa Creu i Sant Pau; Neurovascular Research Group (M.H.G.), Vall d'Hebron Research Institute; Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital; Department of Interventional Neuroradiology (J.B.), CDI, Hospital Clínic; and Statistics and Bioinformatics Unit (S.P.-H.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - Santiago Perez-Hoyos
- From the Department of Neurology (D.R.-L., M.M., C.A.M.), Vall d'Hebron University Hospital; Stroke Research Group (D.R.-L., O.P., M.M., C.A.M.), Vall d'Hebron Research Institute; Department of Medicine (D.R.-L., O.P.), Autonomous University of Barcelona; Department of Neuroscience (L.L., S.R., A.C.), Comprehensive Stroke Center, Hospital Clinic, Barcelona; Department of Neurology (Y.S., M.T.), Hospital Universitari Dr. Josep Trueta, Girona; Department of Neurology (L.P.-S., A.R.-P.), Hospital de la Santa Creu i Sant Pau; Neurovascular Research Group (M.H.G.), Vall d'Hebron Research Institute; Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital; Department of Interventional Neuroradiology (J.B.), CDI, Hospital Clínic; and Statistics and Bioinformatics Unit (S.P.-H.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - Angel Chamorro
- From the Department of Neurology (D.R.-L., M.M., C.A.M.), Vall d'Hebron University Hospital; Stroke Research Group (D.R.-L., O.P., M.M., C.A.M.), Vall d'Hebron Research Institute; Department of Medicine (D.R.-L., O.P.), Autonomous University of Barcelona; Department of Neuroscience (L.L., S.R., A.C.), Comprehensive Stroke Center, Hospital Clinic, Barcelona; Department of Neurology (Y.S., M.T.), Hospital Universitari Dr. Josep Trueta, Girona; Department of Neurology (L.P.-S., A.R.-P.), Hospital de la Santa Creu i Sant Pau; Neurovascular Research Group (M.H.G.), Vall d'Hebron Research Institute; Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital; Department of Interventional Neuroradiology (J.B.), CDI, Hospital Clínic; and Statistics and Bioinformatics Unit (S.P.-H.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - Carlos A Molina
- From the Department of Neurology (D.R.-L., M.M., C.A.M.), Vall d'Hebron University Hospital; Stroke Research Group (D.R.-L., O.P., M.M., C.A.M.), Vall d'Hebron Research Institute; Department of Medicine (D.R.-L., O.P.), Autonomous University of Barcelona; Department of Neuroscience (L.L., S.R., A.C.), Comprehensive Stroke Center, Hospital Clinic, Barcelona; Department of Neurology (Y.S., M.T.), Hospital Universitari Dr. Josep Trueta, Girona; Department of Neurology (L.P.-S., A.R.-P.), Hospital de la Santa Creu i Sant Pau; Neurovascular Research Group (M.H.G.), Vall d'Hebron Research Institute; Department of Neuroradiology (P.C.), Vall d'Hebron University Hospital; Department of Interventional Neuroradiology (J.B.), CDI, Hospital Clínic; and Statistics and Bioinformatics Unit (S.P.-H.), Vall d'Hebron Research Institute, Barcelona, Spain
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Rodrigo-Gisbert M, García-Tornel A, Requena M, Vielba-Gómez I, Bashir S, Rubiera M, De Dios Lascuevas M, Olivé-Gadea M, Piñana C, Rizzo F, Muchada M, Rodriguez-Villatoro N, Rodríguez-Luna D, Juega J, Pagola J, Hernández D, Molina CA, Terceño M, Tomasello A, Ribo M. Clinico-radiological features of intracranial atherosclerosis-related large vessel occlusion prior to endovascular treatment. Sci Rep 2024; 14:2945. [PMID: 38316891 PMCID: PMC10844212 DOI: 10.1038/s41598-024-53354-z] [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: 09/15/2023] [Accepted: 01/31/2024] [Indexed: 02/07/2024] Open
Abstract
The identification of large vessel occlusion with underlying intracranial atherosclerotic disease (ICAS-LVO) before endovascular treatment (EVT) continues to be a challenge. We aimed to analyze baseline clinical-radiological features associated with ICAS-LVO that could lead to a prompt identification. We performed a retrospective cross-sectional study of consecutive patients with stroke treated with EVT from January 2020 to April 2022. We included anterior LVO involving intracranial internal carotid artery and middle cerebral artery. We analyzed baseline clinical and radiological variables associated with ICAS-LVO and evaluated the diagnostic value of a multivariate logistic regression model to identify ICAS-LVO before EVT. ICAS-LVO was defined as presence of angiographic residual stenosis or a trend to re-occlusion during EVT procedure. A total of 338 patients were included in the study. Of them, 28 patients (8.3%) presented with ICAS-LVO. After adjusting for confounders, absence of atrial fibrillation (OR 9.33, 95% CI 1.11-78.42; p = 0.040), lower hypoperfusion intensity ratio (HIR [Tmax > 10 s/Tmax > 6 s ratio], (OR 0.69, 95% CI 0.50-0.95; p = 0.025), symptomatic intracranial artery calcification (IAC, OR .15, 95% CI 1.64-26.42, p = 0.006), a more proximal occlusion (ICA, MCA-M1: OR 4.00, 95% CI 1.23-13.03; p = 0.021), and smoking (OR 2.91, 95% CI 1.08-7.90; p = 0.035) were associated with ICAS-LVO. The clinico-radiological model showed an overall well capability to identify ICAS-LVO (AUC = 0.88, 95% CI 0.83-0.94; p < 0.001). In conclusion, a combination of clinical and radiological features available before EVT can help to identify an ICAS-LVO. This approach could be useful to perform a rapid assessment of underlying etiology and suggest specific pathophysiology-based measures. Prospective studies are needed to validate these findings in other populations.
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Affiliation(s)
- Marc Rodrigo-Gisbert
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alvaro García-Tornel
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Isabel Vielba-Gómez
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Saima Bashir
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Marta Olivé-Gadea
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Piñana
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Federica Rizzo
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marian Muchada
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Noelia Rodriguez-Villatoro
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Rodríguez-Luna
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesus Juega
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge Pagola
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Hernández
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mikel Terceño
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Alejandro Tomasello
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Terceño M, Bashir S, Puig J, I-Estadella JD, Murias E, Jiménez JM, Díaz EG, Monso JF, Bravo-Rey I, Romero V, Werner M, López-Rueda A, Román LS, Anadaluz JB, Doncel-Moriano A, Rosati S, Pérez-García C, Remollo S, Caamaño IR, Aixut S, Chaparro OSC, Garcia JMS, Porto-Álvarez J, Mendez-Cendón JC, Rayon-Aledo JC, Aguilar Y, Parrilla G, Castaño M, Serena J, Silva Y. Impact of Balloon Guide Catheters in Elderly Patients Treated with Mechanical Thrombectomy: Insights from the ROSSETTI Registry. AJNR Am J Neuroradiol 2023; 44:1275-1281. [PMID: 37827717 PMCID: PMC10631533 DOI: 10.3174/ajnr.a8003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/17/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND PURPOSE Several nonrandomized studies have demonstrated the effectiveness of balloon guide catheters in treating patients with anterior circulation large-vessel occlusion. However, their impact on the elderly populations has been underreported. We aimed to analyze the effect of balloon guide catheters in a cohort of elderly patients (80 years of age or older) with anterior circulation large-vessel occlusion. MATERIALS AND METHODS Consecutive patients from June 2019 to June 2022 were collected from the ROSSETTI Registry. Demographic and clinical data, angiographic endovascular technique, and clinical outcome were compared between balloon guide catheter and non-balloon guide catheter groups. We studied the association between balloon guide catheters and the rate of complete recanalization after a single first-pass effect modified TICI 2c-3, as well as their association with functional independence at 3 months. RESULTS A total of 808 patients were included during this period, 465 (57.5%) of whom were treated with balloon guide catheters. Patients treated with balloon guide catheters were older, had more neurologic severity at admission and lower baseline ASPECTS, and were less likely to receive IV fibrinolytics. No differences were observed in terms of the modified first-pass effect between groups (45.8 versus 39.9%, P = .096). In the multivariable regression analysis, balloon guide catheter use was not independently associated with a modified first-pass effect or the final modified TICI 2c-3, or with functional independence at 3 months. CONCLUSIONS In our study, balloon guide catheter use during endovascular treatment of anterior circulation large-vessel occlusion in elderly patients did not predict the first-pass effect, near-complete final recanalization, or functional independence at 3 months. Further studies, including randomized clinical trials, are needed to confirm these results.
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Affiliation(s)
- Mikel Terceño
- From the Stroke Unit, Department of Neurology (M.T., S.B., J.S., Y.S.), Hospital Universitari Doctor Josep Trueta de, Girona, Girona Biomedical Research Institute, Girona, Spain
| | - Saima Bashir
- From the Stroke Unit, Department of Neurology (M.T., S.B., J.S., Y.S.), Hospital Universitari Doctor Josep Trueta de, Girona, Girona Biomedical Research Institute, Girona, Spain
| | - Josep Puig
- Department of Radiology (J.P.), Hospital Universitari de Girona Doctor Josep Trueta, Girona, Catalunya, Spain
| | - Josep Daunis- I-Estadella
- Department of Computer Science (J.D.-I.-E.), Applied Mathematics and Statistics, University of Girona, Girona, Catalunya, Spain
| | - Eduardo Murias
- Department of Radiology (E.M., J.M.J.), Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Jose María Jiménez
- Department of Radiology (E.M., J.M.J.), Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Eva González Díaz
- Department of Interventional Neuroradiology (E.G.D., J.F.M.), Department of Radiology, Cruces University Hospital, Barakaldo, PaísVasco, Spain
| | - Jon Fondevila Monso
- Department of Interventional Neuroradiology (E.G.D., J.F.M.), Department of Radiology, Cruces University Hospital, Barakaldo, PaísVasco, Spain
| | - Isabel Bravo-Rey
- Diagnostic and Therapeutical Neuroradiology Unit (I.B.-R., V.R.), Reina Sofia University Hospital, Cordoba, Andalucía, Spain
| | - Veredas Romero
- Diagnostic and Therapeutical Neuroradiology Unit (I.B.-R., V.R.), Reina Sofia University Hospital, Cordoba, Andalucía, Spain
| | - Mariano Werner
- Neurointerventional Department CDI (M.W.), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Antonio López-Rueda
- Department of Interventional Neuroradiology (A.L.-R., L.S.R., J.B.A.), Clinic University Hospital, Barcelona, Barcelona, Spain
| | - Luis San Román
- Department of Interventional Neuroradiology (A.L.-R., L.S.R., J.B.A.), Clinic University Hospital, Barcelona, Barcelona, Spain
| | - Jordi Blasco Anadaluz
- Department of Interventional Neuroradiology (A.L.-R., L.S.R., J.B.A.), Clinic University Hospital, Barcelona, Barcelona, Spain
| | | | - Santiago Rosati
- Department of Interventional Neurorradiology (S.R., C.P.-G.), Department of Radiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Carlos Pérez-García
- Department of Interventional Neurorradiology (S.R., C.P.-G.), Department of Radiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Sebastian Remollo
- Department of Interventional Neuroradiology (S.R., I.R.C.), Hospital universitari Germans Trias i Pujol, Badalona, Spain
| | - Isabel Rodríguez Caamaño
- Department of Interventional Neuroradiology (S.R., I.R.C.), Hospital universitari Germans Trias i Pujol, Badalona, Spain
| | - Sonia Aixut
- Department of Interventional Neuroradiology (S.A., O.S.C.C.), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oscar Sabino Chirife Chaparro
- Department of Interventional Neuroradiology (S.A., O.S.C.C.), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Jacobo Porto-Álvarez
- Department of Neuroradiology (J.P.-A.), Complexo Hospitalario Universitario de Santiago de, Compostela, Galicia, Spain
| | - Jose Carlos Mendez-Cendón
- Interventional Neuroradiology Unit (J.C.M.-C.), Department of Radiology, Hospital Ramón y Cajal, Madrid, Spain
| | - Jose Carlos Rayon-Aledo
- Department of Interventional Neuroradiology (J.C.R.-A.), Hospital General Universitario de Alicante, Alicante, Valenciana, Spain
| | - Yeray Aguilar
- Department of Radiology (Y.A.), Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Guillermo Parrilla
- Department of Interventional Neuroradiology (G.P.), Department of Radiology, Hospital Clínico Universitario Virgen de la, Murcia, Spain
| | - Miguel Castaño
- Department of Interventional Neuroradiology (M.S.), Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Joaquín Serena
- From the Stroke Unit, Department of Neurology (M.T., S.B., J.S., Y.S.), Hospital Universitari Doctor Josep Trueta de, Girona, Girona Biomedical Research Institute, Girona, Spain
| | - Yolanda Silva
- From the Stroke Unit, Department of Neurology (M.T., S.B., J.S., Y.S.), Hospital Universitari Doctor Josep Trueta de, Girona, Girona Biomedical Research Institute, Girona, Spain
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Ramos-Pachón A, Rodríguez-Luna D, Martí-Fàbregas J, Millán M, Bustamante A, Martínez-Sánchez M, Serena J, Terceño M, Vera-Cáceres C, Camps-Renom P, Prats-Sánchez L, Rodríguez-Villatoro N, Cardona-Portela P, Urra X, Solà S, del Mar Escudero M, Salvat-Plana M, Ribó M, Abilleira S, Pérez de la Ossa N, Silva Y. Effect of Bypassing the Closest Stroke Center in Patients with Intracerebral Hemorrhage: A Secondary Analysis of the RACECAT Randomized Clinical Trial. JAMA Neurol 2023; 80:1028-1036. [PMID: 37603325 PMCID: PMC10442788 DOI: 10.1001/jamaneurol.2023.2754] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/05/2023] [Indexed: 08/22/2023]
Abstract
Importance Prehospital transfer protocols are based on rapid access to reperfusion therapies for patients with ischemic stroke. The effect of different protocols among patients receiving a final diagnosis of intracerebral hemorrhage (ICH) is unknown. Objective To determine the effect of direct transport to an endovascular treatment (EVT)-capable stroke center vs transport to the nearest local stroke center. Design, Setting, and Participants This was a prespecified secondary analysis of RACECAT, a multicenter, population-based, cluster-randomized clinical trial conducted from March 2017 to June 2020 in Catalonia, Spain. Patients were evaluated by a blinded end point assessment. All consecutive patients suspected of experiencing a large vessel occlusion stroke (Rapid Arterial Occlusion Evaluation Scale [RACE] score in the field >4 on a scale of 0 to 9, with lower to higher stroke severity) with final diagnosis of ICH were included. A total of 1401 patients were enrolled in RACECAT with suspicion of large vessel occlusion stroke. The current analysis was conducted in October 2022. Intervention Direct transport to an EVT-capable stroke center (n = 137) or to the closest local stroke center (n = 165). Main Outcomes and Measures The primary outcome was tested using cumulative ordinal logistic regression to estimate the common odds ratio (OR) and 95% CI of the shift analysis of disability at 90 days as assessed by the modified Rankin Scale (mRS) score (range, 0 [no symptoms] to 6 [death]) in the intention-to-treat population. Secondary outcomes, included 90-day mortality, death or severe functional dependency, early neurological deterioration, early mortality, ICH volume and enlargement, rate of neurosurgical treatment, rate of clinical complications during initial transport, and rate of adverse events until day 5. Results Of 1401 patients enrolled, 1099 were excluded from this analysis (32 rejected informed consent, 920 had ischemic stroke, 29 had transient ischemic attack, 12 had subarachnoid hemorrhage, and 106 had stroke mimic). Thus, 302 patients were included (204 [67.5%] men; mean [SD] age 71.7 [12.8] years; and median [IQR] RACE score, 7 [6-8]). For the primary outcome, direct transfer to an EVT-capable stroke center (mean [SD] mRS score, 4.93 [1.38]) resulted in worse functional outcome at 90 days compared with transfer to the nearest local stroke center (mean [SD] mRS score, 4.66 [1.39]; adjusted common OR, 0.63; 95% CI, 0.41-0.96). Direct transfer to an EVT-capable stroke center also suggested potentially higher 90-day mortality compared with transfer to the nearest local stroke center (67 of 137 [48.9%] vs 62 of 165 [37.6%]; adjusted hazard ratio, 1.40; 95% CI, 0.99-1.99). The rates of medical complications during the initial transfer (30 of 137 [22.6%] vs 9 of 165 patients [5.6%]; adjusted OR, 5.29; 95% CI, 2.38-11.73) and in-hospital pneumonia (49 of 137 patients [35.8%] vs 29 of 165 patients [17.6%]; OR, 2.61; 95% CI, 1.53-4.44) were higher in the EVT-capable stroke center group. Conclusions and Relevance In this secondary analysis of the RACECAT randomized clinical trial, bypassing the closest stroke center resulted in reduced chances of functional independence at 90 days for patients who received a final diagnosis of ICH. Trial Registration ClinicalTrials.gov Identifier: NCT02795962.
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Affiliation(s)
- Anna Ramos-Pachón
- Stroke Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, and Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
- Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | | | - Joan Martí-Fàbregas
- Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Mònica Millán
- Stroke Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, and Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
| | - Alejandro Bustamante
- Stroke Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, and Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
| | - Marina Martínez-Sánchez
- Stroke Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, and Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
| | - Joaquín Serena
- Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain
| | - Mikel Terceño
- Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain
| | | | - Pol Camps-Renom
- Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Luis Prats-Sánchez
- Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | | | - Pere Cardona-Portela
- Stroke Unit, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain
| | - Xabier Urra
- Stroke Unit, Hospital Clínic, and August Pi i Sunyer Biomedical Research Institute Barcelona, Barcelona, Spain
| | - Silvia Solà
- Sistema d’Emergències Mèdiques, Barcelona, Spain
| | | | - Mercè Salvat-Plana
- Catalan Stroke Program, Agency for Health Quality and Assessment of Catalonia, and CIBER Epidemiology and Public Health, Barcelona, Spain
| | - Marc Ribó
- Stroke Unit, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Sònia Abilleira
- Catalan Stroke Program, Agency for Health Quality and Assessment of Catalonia, and CIBER Epidemiology and Public Health, Barcelona, Spain
| | - Natalia Pérez de la Ossa
- Stroke Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, and Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
| | - Yolanda Silva
- Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain
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5
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Remollo S, Werner M, Blasco J, López-Rueda A, San Roman L, Jimenez-Gomez E, Bravo Rey I, Vega P, Murias E, Rosati S, Pérez-García C, González E, Manso X, Aixut S, Chirife Chaparro O, Terceño M, Bashir S, Pumar JM, Ruiz-González E, Méndez JC, Aguilar Tejedor Y, Zamarro J, Castaño M, Daunis-I-Estadella P, Puig J. First-Pass Effect in M1-Occlusion Stroke Patients Treated with Combined Stent-Retriever/Large-Bore Distal Aspiration Catheter Thrombectomy. Clin Neuroradiol 2023; 33:701-708. [PMID: 36856786 DOI: 10.1007/s00062-023-01264-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/17/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Combined stent-retriever/large-bore distal aspiration catheter (LB-DAC) thrombectomy was recently introduced to treat large-vessel occlusion; however, it is unclear whether larger inner diameters improve outcomes. We compared angiographic and clinical outcomes in patients with occlusions of the M1 segment of the middle cerebral artery treated with mechanical thrombectomy using extra-LB-DAC versus LB-DAC in combination with stent-retrievers. METHODS We analyzed consecutive patients with M1 occlusion included in the ROSSETTI registry treated with non-balloon guide catheter combined LB-DAC/stent-retriever thrombectomy between June 2019 and April 2022. We compared demographics, baseline clinical variables, procedural variables, angiographic outcomes, and clinical outcomes [National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) and modified Rankin scale score at 3 months] between patients treated with extra-LB-DAC (Sofia Plus, MIVI Q6, Catalyst7; inner diameter, 0.068″-0.070″) versus LB-DAC (Sofia 5F, MIVI Q5, Catalyst 6; inner diameter, 0.055″-0.064″). Primary outcome was the first-pass effect (FPE) rate, defined as near-complete/complete reperfusion (mTICI 2c-3) after a single pass of the device. RESULTS We included 324 patients (extra-LB-DAC, 185, 57.1% patients). Demographics, clinical data, and clinical outcomes were similar between the two groups; however, there was a trend towards improvement in National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) in the cohort treated with extra-LB-DAC 9 points (IQR 4;16 points) vs. 12 points (IQR 4;18 points, P = 0.083). Patients treated with extra-LB-DAC had higher FPE rate (47% vs. 30.9%; P = 0.003) and higher modified FPE (mTICI ≥ 2b after a single pass) rate (65.9% vs 46.8%; P = 0.001). The use of extra-LB-DAC was an independent factor in predicting FPE (odds ratio 1.982, 95% confidence interval 1.250-3.143, P = 0.004). CONCLUSION Our results suggest that in combined LB-DAC/stent-retriever thrombectomy, a larger aspiration catheter inner diameter is associated with higher rates of FPE and mFPE.
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Affiliation(s)
- S Remollo
- Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - M Werner
- Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - J Blasco
- Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A López-Rueda
- Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - L San Roman
- Neurointerventional Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
| | - E Jimenez-Gomez
- Diagnostic and Therapeutical Neuroradiology Unit, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - I Bravo Rey
- Neuroradiology Department, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - P Vega
- Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - E Murias
- Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - S Rosati
- Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - C Pérez-García
- Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - E González
- Interventional Neuroradiology, Radiology Department, Cruces University Hospital, Barakaldo, Spain
| | - X Manso
- Interventional Neuroradiology, Radiology Department, Cruces University Hospital, Barakaldo, Spain
| | - S Aixut
- Neuroradiology Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Llobregat, Spain
| | - O Chirife Chaparro
- Neuroradiology Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Llobregat, Spain
| | - M Terceño
- Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - S Bashir
- Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - J M Pumar
- Neuroradiology Department, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - E Ruiz-González
- Interventional Neuroradiology, Hospital General Universitario de Alicante, Alicante, Spain
| | - J C Méndez
- Interventional Neuroradiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Y Aguilar Tejedor
- Radiology Department, Hospital Universitario Insular de Gran Canaria, Gran Canaria, Spain
| | - J Zamarro
- Interventional Neuroradiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - M Castaño
- Interventional Neuroradiology Unit, Department of Radiology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - P Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - J Puig
- Department of Radiology (IDI) and Institut d'Investigació Biomèdica de Girona, Hospital Universitari Doctor Josep Trueta, Girona, Spain.
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Silva Y, Sánchez-Cirera L, Terceño M, Dorado L, Valls A, Martínez M, Abilleira S, Rubiera M, Quesada H, Llull L, Rodríguez-Campello A, Martí-Fàbregas J, Seró L, Purroy F, Payo I, García S, Cánovas D, Krupinski J, Mas N, Palomeras E, Cocho D, Font MÀ, Catena E, Puiggròs E, Pedroza C, Marín G, Carrión D, Costa X, Almendros MC, Torres I, Colom C, Velasquez JA, Diaz G, Jiménez X, Subirats T, Deulofeu A, Hidalgo V, Salvat-Plana M, Pérez de la Ossa N. Sex and gender differences in acute stroke care: metrics, access to treatment and outcome. A territorial analysis of the Stroke Code System of Catalonia. Eur Stroke J 2023; 8:557-565. [PMID: 37231687 PMCID: PMC10334164 DOI: 10.1177/23969873231156260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/23/2023] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Previous studies have reported differences in the management and outcome of women stroke patients in comparison with men. We aim to analyze sex and gender differences in the medical assistance, access to treatment and outcome of acute stroke patients in Catalonia. PATIENTS AND METHODS Data were obtained from a prospective population-based registry of stroke code activations in Catalonia (CICAT) from January/2016 to December/2019. The registry includes demographic data, stroke severity, stroke subtype, reperfusion therapy, and time workflow. Centralized clinical outcome at 90 days was assessed in patients receiving reperfusion therapy. RESULTS A total of 23,371 stroke code activations were registered (54% men, 46% women). No differences in prehospital time metrics were observed. Women more frequently had a final diagnosis of stroke mimic, were older and had a previous worse functional situation. Among ischemic stroke patients, women had higher stroke severity and more frequently presented proximal large vessel occlusion. Women received more frequently reperfusion therapy (48.2% vs 43.1%, p < 0.001). Women tended to present a worse outcome at 90 days, especially for the group receiving only IVT (good outcome 56.7% vs 63.8%; p < 0.001), but not for the group of patients treated with IVT + MT or MT alone, although sex was not independently associated with clinical outcome in logistic regression analysis (OR 1.07; 95% CI, 0.94-1.23; p = 0.27) nor in the analysis after matching using the propensity score (OR 1.09; 95% CI, 0.97-1.22). DISCUSSION AND CONCLUSION We found some differences by sex in that acute stroke was more frequent in older women and the stroke severity was higher. We found no differences in medical assistance times, access to reperfusion treatment and early complications. Worse clinical outcome at 90 days in women was conditioned by stroke severity and older age, but not by sex itself.
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Affiliation(s)
| | | | | | - Laura Dorado
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Adrián Valls
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marina Martínez
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Marta Rubiera
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Helena Quesada
- Hospital Universitari de Bellvitge, L’Hospitalet de llobregat, Spain
| | - Laura Llull
- Hospital Clínic of Barcelona, Barcelona, Spain
| | | | | | - Laia Seró
- Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | - Iago Payo
- Hospital Verge de la Cinta, Tortosa, Spain
| | - Sònia García
- Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | | | | | | | | | | | | | - Esther Catena
- Consorci Sanitari Alt Penedès-Garraf, Vilafranca del Penedès, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mercè Salvat-Plana
- Pla Director de les Malalties Vasculars Cerebrals. Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS) CIBER en Epidemiolgia i Salut Pública (CBERESP), Departament de Salut, Barcelona, Spain
| | - Natalia Pérez de la Ossa
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Pla Director de les Malalties Vasculars Cerebrals. Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS) CIBER en Epidemiolgia i Salut Pública (CBERESP), Departament de Salut, Barcelona, Spain
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7
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García-Tornel Á, Flores A, Terceño M, Cardona P, Amaro S, Gomis M, Zaragoza J, Krupinski J, Gómez-Choco M, Mas N, Cocho D, Catena E, Purroy F, Deck M, Rubiera M, Pagola J, Rodriguez-Luna D, Juega J, Rodríguez-Villatoro N, Molina CA, Soro C, Jimenez X, Salvat-Plana M, Dávalos A, Jovin TG, Abilleira S, Pérez de la Ossa N, Ribó M. Association of Time of Day With Outcomes Among Patients Triaged for a Suspected Severe Stroke in Nonurban Catalonia. Stroke 2023; 54:770-780. [PMID: 36848432 DOI: 10.1161/strokeaha.122.041013] [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: 03/01/2023]
Abstract
BACKGROUND We aim to assess whether time of day modified the treatment effect in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion Trial), a cluster-randomized trial that did not demonstrate the benefit of direct transportation to a thrombectomy-capable center versus nearest local stroke center for patients with a suspected large vessel stroke triaged in nonurban Catalonia between March 2017 and June 2020. METHODS We performed a post hoc analysis of RACECAT to evaluate if the association between initial transport routing and functional outcome differed according to trial enrollment time: daytime (8:00 am-8:59 pm) and nighttime (9:00 pm-7:59 am). Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with ischemic stroke. Subgroup analyses according to stroke subtype were evaluated. RESULTS We included 949 patients with an ischemic stroke, of whom 258 patients(27%) were enrolled during nighttime. Among patients enrolled during nighttime, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days (adjusted common odds ratio [acOR], 1.620 [95% CI, 1.020-2.551]); no significant difference between trial groups was present during daytime (acOR, 0.890 [95% CI, 0.680-1.163]; P
interaction=0.014). Influence of nighttime on the treatment effect was only evident in patients with large vessel occlusion(daytime, acOR 0.766 [95% CI, 0.548-1.072]; nighttime, acOR, 1.785 [95% CI, 1.024-3.112] ; P
interaction<0.01); no heterogeneity was observed for other stroke subtypes (P
interaction>0.1 for all comparisons). We observed longer delays in alteplase administration, interhospital transfers, and mechanical thrombectomy initiation during nighttime in patients allocated to local stroke centers. CONCLUSIONS Among patients evaluated during nighttime for a suspected acute severe stroke in non-urban areas of Catalonia, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days. This association was only evident in patients with confirmed large vessel occlusion on vascular imaging. Time delays in alteplase administration and interhospital transfers might mediate the observed differences in clinical outcome. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02795962.
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Affiliation(s)
- Álvaro García-Tornel
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
| | - Alan Flores
- Department of Neurology, Hospital Universitari Joan XXIII, Tarragona, Spain (A.F.)
| | - Mikel Terceño
- Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T.)
| | - Pedro Cardona
- Stroke Unit, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.)
| | - Sergi Amaro
- Stroke Unit, Hospital Clínic, Barcelona, Spain (S.A.)
| | - Meritxell Gomis
- Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (M.G., A.D., N.P.d.l.O.)
| | - Josep Zaragoza
- Department of Neurology, Hospital Verge de la Cinta, Tortosa, Spain (J.Z.)
| | - Jerzy Krupinski
- Department of Neurology, Hospital Mútua Terrassa, Spain (J.K.)
| | - Manuel Gómez-Choco
- Department of Neurology, Hospital Moisés Broggi, Sant Joan Despí, Spain (M.G.-C.)
| | - Natalia Mas
- Department of Neurology, Hospital Sant Joan de Déu - Fundació Althaia, Manresa, Spain (N.M.)
| | - Dolores Cocho
- Department of Neurology, Hospital General Granollers, Spain (D.C.)
| | - Esther Catena
- Department of Neurology, Consorci Sanitari Alt Penedès-Garraf, Spain (E.C.)
| | - Francesc Purroy
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P.)
| | - Matias Deck
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
| | - Jorge Pagola
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
| | - David Rodriguez-Luna
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
| | - Jesús Juega
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
| | - Noelia Rodríguez-Villatoro
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
| | - Cristina Soro
- Sistema d'Emergències Mèdiques, Barcelona, Spain (C.S., X.J.)
| | - Xavier Jimenez
- Sistema d'Emergències Mèdiques, Barcelona, Spain (C.S., X.J.)
| | - Mercè Salvat-Plana
- Stroke Program, Catalan Health Department, Agency for Health Quality and Assesment of Catalonia (AQuAS), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain (M.S.-P., S.A.)
| | - Antoni Dávalos
- Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (M.G., A.D., N.P.d.l.O.)
| | - Tudor G Jovin
- Neurological Institute, Cooper University Hospital, Camden, NJ (T.G.J.)
| | - Sonia Abilleira
- Stroke Program, Catalan Health Department, Agency for Health Quality and Assesment of Catalonia (AQuAS), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain (M.S.-P., S.A.)
| | - Natalia Pérez de la Ossa
- Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (M.G., A.D., N.P.d.l.O.)
| | - Marc Ribó
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
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8
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Garcia-Tornel Garcia-Camba A, Lozano P, Requena M, Rodriguez-Luna D, Rodriguez-Villatoro N, Rubiera M, Muchada M, Olive-Gadea M, Rizzo F, boned S, Ribo M, Molina CA, Pagola J, Juega J, Dorado L, Jimenez-Fabrega X, Cardona P, Urra X, Purroy F, Terceño M, Flores AF, Chamorro A, Silva Y, Ustrell X, Zaragoza J, Roquer J, Krupinski J, Cocho D, Palomeras E, Gomez-Choco MJ, Canovas D, Martí-Fàbregas J, Mas N, Fagundez O, Abilleira S, Molina CA, Perez de la Ossa N. Abstract WP4: Intravenous Thrombolysis And Outcomes In Patients With Large-vessel Stroke Directly Admitted Or Transferred To A Thrombectomy-capable Center. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective:
To assess whether the effect of intravenous thrombolysis in patients with large-vessel occlusion differed between patients directly admitted to thrombectomy-capable centers and patients transferred from local stroke centers without thrombectomy capabilities.
Methods:
We included 3206 patients with an acute ischemic large-vessel stroke with first imaging within 7 hours after onset that were directly admitted to thrombectomy-capable centers and treated with thrombectomy, or transferred from local stroke centers for thrombectomy evaluation, between 2017 and 2021 in Catalonia, Spain. Primary outcome was the degree of disability at 90 days, as evaluated by the shift analysis on the mRs score. Secondary outcomes included mortality at 90 days and the rate of parenchymal hemorrhage and successful reperfusion. Inverse-probability weighting clustered at the type of stroke center was used to estimate the effects.
Results:
The analysis included 2268 patients (975[49%] treated with thrombolysis) directly admitted to thrombectomy-capable centers and 938 patients (580[66%] treated with thrombolysis and 616[67%] treated with thrombectomy) transferred from local stroke centers (mean age 72±13 years, median NIHSS score 17[IQR 12-21], 1363 female[48%]). Patients treated with intravenous thrombolysis were younger, had shorter time from onset to first image acquisition, and higher rates of wake-up stroke, atrial fibrillation and anticoagulation intake. The effect of intravenous thrombolysis on the primary outcome was similar in patients directly admitted to thrombectomy-capable centers (acOR 1.50, 95% CI 1.24-1.81) and patients transferred from local stroke centers (acOR 1.44, 95% CI 1.04 to 2.01)(p
interaction
=0.68). Patients treated with intravenous thrombolysis had lower mortality rate, higher rate of parenchymal hematoma and similar rate of successful reperfusion, with no difference according to type of center (p
interaction
>0.1).
Conclusion:
Administration of intravenous thrombolysis in patients with a large-vessel stroke with intention to thrombectomy was associated with higher odds of good functional outcome and higher rates of parenchymal hematoma, independently of the type of stroke center were it was administered.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jesús Juega
- HOSPITAL VALL HEBRON - UNITAT ICTUS, Barcelona
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9
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Terceño M, Silva Y, Bashir S, Chamorro Á, Pérez de la Ossa N, Hernandez-Pérez M, Castaño C, Camps-Renom P, Wenger D, Cardona P, Molina C, Rodríguez-Campello A, Cánovas D, Purroy F, Salvat-Plana M, Serena J, On Behalf Of The Catalan Stroke Code And Reperfusion Consortium Cat-Scr. First pass effect in posterior circulation occlusions: Analysis from the CICAT registry. Int J Stroke 2023; 18:221-228. [PMID: 35272563 DOI: 10.1177/17474930221089772] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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 The first pass effect (FPE) is an independent predictor of functional independence in patients with large vessel occlusion in anterior circulation ischemic strokes. However, whether it predicts outcome in posterior circulation large vessel occlusion (PC-LVO) is uncertain. We aimed to study the frequency, characteristics, and predictors of FPE and its association with clinical outcomes in PC-LVO. METHOD We performed an analysis from the prospective CICAT Registry. All patients with PC-LVO who underwent endovascular therapy between January 2016 and January 2020 were included. A centrally assessed clinical follow-up was performed at 3 months by blinded investigators. FPE was defined as the achievement of modified Thrombolysis In Cerebral Infarction 3 in a single pass of the endovascular thrombectomy device, and multi-pass effect (MPE) if it was achieved in more than one pass. A multivariable analysis was performed to identify whether FPE is an independent predictor of functional independence defined as a modified Rankin Score of 0-2. RESULTS We analyzed data from 265 patients in who FPE was achieved in 105 (39.6%). Patients with FPE were more likely to achieve functional independence compared to the non-FPE group (52.4% vs 25.1%, p < .001) and the MPE group (52.4% vs 26.7%, p < .001). FPE was independently associated with functional independence (adjusted odds ratio (aOR): 2.10, 95% confidence interval (CI) 1.01-4.37) but MPE was not (aOR: 0.92, 95% CI 0.40-2.13). Independent predictors of FPE were the use of direct aspiration, embolic mechanism of stroke, and the absence of general anesthesia (GA) use. CONCLUSIONS FPE is an independent predictor of functional independence in PC-LVO and was associated with a significantly better outcome than MPE.
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Affiliation(s)
- Mikel Terceño
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Doctor Josep Trueta Hospital, Girona, Spain.,Interventional Neuroradiology Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona, Spain
| | - Yolanda Silva
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Doctor Josep Trueta Hospital, Girona, Spain
| | - Saima Bashir
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Doctor Josep Trueta Hospital, Girona, Spain
| | - Ángel Chamorro
- Stroke Unit, Department of Neurology, Clinic Hospital, Barcelona, Spain
| | - Natalia Pérez de la Ossa
- Stroke Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona, Spain.,Stroke Program/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - María Hernandez-Pérez
- Stroke Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona, Spain
| | - Carlos Castaño
- Interventional Neuroradiology Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona, Spain
| | - Pol Camps-Renom
- Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Denisse Wenger
- Stroke Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona, Spain
| | - Pere Cardona
- Stroke Unit, Department of Neurology, Bellvitge Hospital, Barcelona, Spain
| | - Carlos Molina
- Stroke Unit, Department of Neurology, Vall d'Hebron Hospital, Barcelona, Spain
| | | | - David Cánovas
- Stroke Unit, Department of Neurology, Parc Taulí Hospital, Sabadell, Spain
| | - Francisco Purroy
- Stroke Unit, Department of Neurology, Arnau de Vilanova Hospital, IRBLleida, University of Lleida, Lleida, Spain
| | - Mercè Salvat-Plana
- Catalan Stroke Programme, Catalan Public Health Department, Barcelona, Spain
| | - Joaquín Serena
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Doctor Josep Trueta Hospital, Girona, Spain
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10
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Zangana L, Valls A, Munuera J, Werner M, Remollo S, Dorado L, Serena J, Puig J, Perez de la Ossa N, Gomis M, Bustamante A, Pina BF, Castaño C, Muñoz L, Palomeras E, Massuet A, Terceño M, Davalos A, Millan M, Hernandez-Perez M. Abstract WP99: Impact Of Venous Delay Evaluated Before And After Mechanical Thrombectomy On Stroke Outcome. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
We aimed to evaluate venous delay before and after treatment as a marker of radiological and clinical outcome in stroke patients receiving endovascular treatment (EVT).
Methods:
Prospective cohort of patients with anterior intracranial occlusion undergoing EVT. Brain MRI was performed on arrival (pre-EVT), <2h after EVT (post-EVT), and 5 days after stroke. Final infarct volume was segmented on DWI at 5 days. We evaluated the veins of Labbé, Trolard and the superficial middle cerebral vein at both hemispheres on the dynamic MR angiography (dmRA) pre-EVT and post-EVT. For each vein we calculated a standardized venous delay measure:[(time to maximum venous contrast filling in the healthy hemisphere-time to maximum venous contrast filling in the affected hemisphere)/time to maximum venous contrast filling in the healthy hemisphere]x100. We defined venous delay as the value of the most delayed vein in each patient. We assessed the association between venous delay pre-EVT and post-EVT and final infarct volume and modified Rankin Scale (mRS) at 90 days, using multivariable regressions adjusted by successful reperfusion (mTICI≥2b) and other relevant variables.
Results:
From 98 included patients (median NIHSS 17, final mTICI≥2b 86%), 89 pre-EVT dMRIs and 88 post-EVT dMRIs were evaluable. The median venous delay pre-EVT and post-EVT were -31.9[-58.1;-16.7]% and -13.5[-34.5;-7.5]%, respectively. Venous delay pre-EVT was not related to infarct volume or clinical outcome. When final mTICI≥2B, venous asymmetry decreased but still persisted. For each 10% of increment in venous delay post-EVT, there was an adjusted increase of 0.12[0.05-0.19]ml in the final infarct volume. Venous delay post-EVT was independently associated with mRS at 90 days (cOR 1.013 [95%CI 1.001-1.0256]).
Conclusion:
Cortical vein delay assessed after but not before EVT, is associated with a larger final infarct volume and with a worse clinical outcome.
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Affiliation(s)
- Lara Zangana
- Amsterdam Univ Med Cntrs, Univ of Amsterdam, Amsterdam, Netherlands
| | - Adrian Valls
- Neurosciences, Germans Trias I Pujol Univ Hosp, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - Mariano Werner
- Neurosciences, Germans Trias I Pujol Univ Hosp, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Sebastiàn Remollo
- Neurosciences, Germans Trias I Pujol Univ Hosp, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Laura Dorado
- Germans Trias I Pujol Univ Hosp, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - Josep Puig
- Radiology, Dr. Josep Trueta Univ Hosp, Girona, Spain
| | - Natalia Perez de la Ossa
- Neurosciences, Germans Trias I Pujol Univ Hosp, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Meritxell Gomis
- Germans Trias I Pujol Univ Hosp, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Alejandro Bustamante
- Neurosciences, Germans Trias I Pujol Univ Hosp, Universitat Autònoma de Barcelona,, Badalona, Spain
| | - Belen F. Pina
- Neurosciences, Germans Trias I Pujol Univ Hosp, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Carlos Castaño
- Neurosciences, Germans Trias I Pujol Univ Hosp, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Lucia Muñoz
- Neurosciences, Germans Trias I Pujol Univ Hosp, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - Anna Massuet
- Diagnostic Imaging Institute, Germans Trias i Pujol Univ Hosp, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Mikel Terceño
- Neurology, Dr. Josep Trueta Univ Hosp, Girona, Spain
| | - Antonio Davalos
- Germans Trias I Pujol Univ Hosp, Universitat Autònoma de Barcelona, Badalona Barcelona, Spain
| | - Monica Millan
- Germans Trias I Pujol Univ Hosp, Universitat Autònoma de Barcelona, Badalona, Spain
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11
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Valls A, Puig J, Palomar A, Laredo C, Werner M, Remollo Friedemann S, Dorado L, Serena J, Munuera J, Perez de la Ossa N, Gomis M, Bustamante A, Carbonell J, Larrañaga C, Castaño C, Muñoz L, Palomeras E, Domenech S, Terceño M, Davalos A, Millan M, Hernandez-Perez M. Abstract TMP70: Relevance Of Persistent Perfusion Deficits On Clinical Outcome After Sucessful Endovascular Treatment. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tmp70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
After achieving successful reperfusion some acute stroke patients still exhibit persistent perfusion deficits. These deficits have been defined in a heterogeneous manner by using CBF, CBV or Tmax maps as a perfusion deficit in the previous ischemic penumbra (impaired microcirculation perfusion-IMP) or inside the infarcted tissue (no reflow-NR). The significance, frequency and pathophysiology of this phenomenon are so far unknown.
Methods:
Prospective cohort of patients with isolated anterior intracranial occlusion undergoing endovascular treatment (EVT) and achieving complete recanalization (final mTICI≥2B). Brain MRI was performed on arrival (pre-EVT) and <2h after EVT (post-EVT). Infarcted tissue was segmented on DWI pre-EVT. Pre and post-EVT perfusion maps were obtained with Olea software. NR was defined in the post-EVT perfusion maps as the region inside the infarcted tissue which showed a CBV<15% compared to the contralateral side, while IMP was the equivalent area inside the previous tissue in penumbra. We evaluated the association between both NR and IMP and NIHSS at 24h, NIHSS at discharge and modified Rankin score (mRS) at three months adjusting by baseline NIHSS and final mTICI.
Results:
Thirty-five patients were included. All of them had IMP areas and 25 (71%) had NR areas. The median volume of NR and IMP was 3.43ml [IQR 1.43-8.81], corresponding to 17.9% of the infarcted tissue [IQR 4.2-50.3] and 33.9ml [IQR 14.0-69.3] (27.7% [IQR 8.2-51.2] of the penumbra) respectively. Patients with NR areas had higher NIHSS at 24 h and at discharge and higher mRS at 3 months. Volume of NR was independently associated with higher NIHSS at 24 h and at discharge. No independent association was found with IMP volume. Neither NR nor IMP were associated with hemorrhagic transformation. Patients receiving rTPA previous to EVT showed higher perfusion values inside the infarct than patients with primary EVT (2.31 mL/100g [1.48-2.43] vs 0.92 [0.7-1.47] p=0.02), although NR areas appeared in the same proportion in both groups.
Conclusions:
No reflow phenomenon can be a marker of poor outcome in the early evaluation of successfully recanalized stroke patients especially when the persistent perfusion deficit is located inside the infarcted tissue.
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Affiliation(s)
- Adrian Valls
- Hosp Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Alicia Palomar
- Canon Med Systems Spain and Portugal, Cornellà de Llobregat, Spain
| | - Carlos Laredo
- Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | | | | | - Laura Dorado
- Hosp Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | | | | | | | | | | | - Carlos Castaño
- Hosp Universitari Germans Trias i Pujol, Badalona, Spain
| | - Lucía Muñoz
- Hosp Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Sira Domenech
- Hosp Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mikel Terceño
- Hosp Universitari Germans Trias i Pujol, Badalona, Spain
| | - Antoni Davalos
- Hosp Universitari Germans Trias i Pujol, Badalona, Spain
| | - Monica Millan
- Hosp Universitari Germans Trias i Pujol, Badalona, Spain
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12
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Hernández-Pérez M, Werner M, Remollo S, Martín C, Cortés J, Valls A, Ramos A, Dorado L, Serena J, Munuera J, Puig J, Pérez de la Ossa N, Gomis M, Carbonell J, Castaño C, Muñoz-Narbona L, Palomeras E, Domenech S, Massuet A, Terceño M, Davalos A, Millán M. Early and Delayed Infarct Growth in Patients Undergoing Mechanical Thrombectomy: A Prospective, Serial MRI Study. Stroke 2023; 54:217-225. [PMID: 36325911 DOI: 10.1161/strokeaha.122.039090] [Citation(s) in RCA: 4] [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: 11/06/2022]
Abstract
BACKGROUND We studied the evolution over time of diffusion weighted imaging (DWI) lesion volume and the factors involved on early and late infarct growth (EIG and LIG) in stroke patients undergoing endovascular treatment (EVT) according to the final revascularization grade. METHODS This is a prospective cohort of patients with anterior large artery occlusion undergoing EVT arriving at 1 comprehensive stroke center. Magnetic resonance imaging was performed on arrival (pre-EVT), <2 hours after EVT (post-EVT), and on day 5. DWI lesions and perfusion maps were evaluated. Arterial revascularization was assessed according to the modified Thrombolysis in Cerebral Infarction (mTICI) grades. We recorded National Institutes of Health Stroke Scale at arrival and at day 7. EIG was defined as (DWI volume post-EVT-DWI volume pre-EVT), and LIG was defined as (DWI volume at 5d-DWI volume post-EVT). Factors involved in EIG and LIG were tested via multivariable lineal models. RESULTS We included 98 patients (mean age 70, median National Institutes of Health Stroke Scale score 17, final mTICI≥2b 86%). Median EIG and LIG were 48 and 63.3 mL in patients with final mTICI<2b, and 3.6 and 3.9 cc in patients with final mTICI≥2b. Both EIG and LIG were associated with higher National Institutes of Health Stroke Scale at day 7 (ρ=0.667; P<0.01 and ρ=0.614; P<0.01, respectively). In patients with final mTICI≥2b, each 10% increase in the volume of DWI pre-EVT and each extra pass leaded to growths of 9% (95% CI, 7%-10%) and 14% (95% CI, 2%-28%) in the DWI volume post-EVT, respectively. Furthermore, each 10% increase in the volume of DWI post-EVT, each extra pass, and each 10 mL increase in TMax6s post-EVT were associated with growths of 8% (95% CI, 6%-9%), 9% (95% CI, 0%-19%), and 12% (95% CI, 5%-20%) in the volume of DWI post-EVT, respectively. CONCLUSIONS Infarct grows during and after EVT, especially in nonrecanalizers but also to a lesser extent in recanalizers. In recanalizers, number of passes and DWI volume influence EIG, while number of passes, DWI, and hypoperfused volume after the procedure determine LIG.
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Affiliation(s)
- María Hernández-Pérez
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Mariano Werner
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Sebastián Remollo
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Carlota Martín
- Universitat Politècnica de Catalunya, Statistics Faculty, Badalona, Spain (C.M., J.C.)
| | - Jordi Cortés
- Universitat Politècnica de Catalunya, Statistics Faculty, Badalona, Spain (C.M., J.C.)
| | - Adrian Valls
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Anna Ramos
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Laura Dorado
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Joaquin Serena
- Department of Neurology, Stroke Unit, Dr Josep Trueta University Hospital, Girona, Spain (J.S., M.T.)
| | - Josep Munuera
- Diagnostic Imaging, Sant Joan de Dèu Hospital, Esplugues de Llobregat, Barcelona, Spain (J.M.)
| | - Josep Puig
- Department of Radiology, IDIBGI Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain (J.P.)
| | - Natalia Pérez de la Ossa
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Meritxell Gomis
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Jaime Carbonell
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Carlos Castaño
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Lucia Muñoz-Narbona
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Ernest Palomeras
- Department of Medicine, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain (E.P.)
| | - Sira Domenech
- Diagnostic Imaging Institute, Germans Trias i Pujol University Hospital, Spain (S.D., A.M.)
| | - Anna Massuet
- Diagnostic Imaging Institute, Germans Trias i Pujol University Hospital, Spain (S.D., A.M.)
| | - Mikel Terceño
- Department of Neurology, Stroke Unit, Dr Josep Trueta University Hospital, Girona, Spain (J.S., M.T.)
| | - Antoni Davalos
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
| | - Monica Millán
- Department of Neurociences, Germans Trias I Pujol University Hospital, Universitat Autònoma de Barcelona, Badalona, Spain (M.H.-P., M.W., S.R., A.V., A.R., L.D., N.P.d.l.O., M.G., J.C., C.C., L.M.-N., A.D., M.M.)
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13
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Terceño M, Bashir S, Cienfuegos J, Murillo A, Vera-Monge VA, Pardo L, Reina M, Gubern-Mérida C, Puigoriol-Illamola D, Carballo L, Costa A, Buxó M, Serena J, Silva Y. General anesthesia versus conscious sedation during endovascular treatment in posterior circulation large vessel occlusion: A systematic review and meta-analysis. Eur Stroke J 2022; 8:85-92. [PMID: 37021193 PMCID: PMC10069205 DOI: 10.1177/23969873221127738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/02/2022] [Indexed: 11/15/2022] Open
Abstract
Purpose: The optimal anesthetic approach in the endovascular treatment (EVT) of patients with posterior circulation large vessel occlusion (PC-LVO) strokes is not clear. Little data has been published and no randomized clinical trials have been conducted so far. We aimed to perform an updated meta-analysis to compare clinical and procedural outcomes between conscious sedation (CS) and general anesthesia (GA). Methods: We reviewed the literature of the studies reporting CS and GA in patients with endovascularly-treated PC-LVO. The primary outcome was the functional outcome at 3 months measured using the modified Rankin Scale (mRS). A good functional outcome was defined as having a mRS 0–2. Secondary outcomes were mortality at 3 months, final successful recanalization (modified Thrombolysis in Cerebral Infarction (mTICI) scale from 2b to 3) and complete recanalization (mTICI of 3) and times from stroke onset to EVT completion. Random-effects models were completed to pool the outcomes and the I2 value was calculated to assess heterogeneity. Findings: Eight studies with a total of 1351 patients were included. The pooled results reveal that CS use was associated with higher rates of good outcome (OR 2.41, 95% CI 1.58–3.64, I2 = 49.67%) and with lower mortality at 3 months (OR 0.48, 95% CI 0.28–0.82, I2 =57.11%). No significant differences were observed in the final reperfusion rates, procedural duration, and time from stroke onset to EVT completion. Conclusion: In this meta-analysis, GA was associated with significantly lower rates of functional independence at 3 months in patients with PC-LVO strokes.
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Affiliation(s)
- Mikel Terceño
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
- Mikel Terceño, Unitat d’Ictus, Servei de Neurologia, Hospital Universitari Doctor Josep Trueta de Girona, Av de França s/n, Girona 17007, Spain.
| | - Saima Bashir
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Juan Cienfuegos
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Alan Murillo
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Víctor Augusto Vera-Monge
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Laura Pardo
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Montserrat Reina
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Carme Gubern-Mérida
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Dolors Puigoriol-Illamola
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Laia Carballo
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Anna Costa
- Department of Anesthesiology and Critical Care Medicine, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
| | - Maria Buxó
- Statistical and Methodological Department, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Joaquín Serena
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Yolanda Silva
- Stroke Unit, Department of Neurology, Hospital Universitari Doctor Josep Trueta de Girona, Girona, Spain
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
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14
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Carballo-Perich L, Puigoriol-Illamola D, Bashir S, Terceño M, Silva Y, Gubern-Mérida C, Serena J. Clinical Parameters and Epigenetic Biomarkers of Plaque Vulnerability in Patients with Carotid Stenosis. Int J Mol Sci 2022; 23:ijms23095149. [PMID: 35563540 PMCID: PMC9101730 DOI: 10.3390/ijms23095149] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 12/24/2022] Open
Abstract
Atheromatous disease is the first cause of death and dependency in developed countries and carotid artery atherosclerosis is one of the main causes of severe ischaemic strokes. Current management strategies are mainly based on the degree of stenosis and patient selection has limited accuracy. This information could be complemented by the identification of biomarkers of plaque vulnerability, which would permit patients at greater and lesser risk of stroke to be distinguished, thus enabling a better selection of patients for surgical or intensive medical treatment. Although several circulating protein-based biomarkers with significance for both the diagnosis of carotid artery disease and its prognosis have been identified, at present, none have been clinically implemented. This review focuses especially on the most relevant clinical parameters to take into account in routine clinical practice and summarises the most up-to-date data on epigenetic biomarkers of carotid atherosclerosis and plaque vulnerability.
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Affiliation(s)
- Laia Carballo-Perich
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), RICORS-ICTUS, Parc Hospitalari Martí I Julià, Edifici M2, 17190 Salt, Spain; (L.C.-P.); (D.P.-I.)
| | - Dolors Puigoriol-Illamola
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), RICORS-ICTUS, Parc Hospitalari Martí I Julià, Edifici M2, 17190 Salt, Spain; (L.C.-P.); (D.P.-I.)
| | - Saima Bashir
- Cerebrovascular Pathology Research Group, Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, RICORS-ICTUS, Av. França s/n (7a Planta), 17007 Girona, Spain; (S.B.); (M.T.); (J.S.)
| | - Mikel Terceño
- Cerebrovascular Pathology Research Group, Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, RICORS-ICTUS, Av. França s/n (7a Planta), 17007 Girona, Spain; (S.B.); (M.T.); (J.S.)
| | - Yolanda Silva
- Cerebrovascular Pathology Research Group, Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, RICORS-ICTUS, Av. França s/n (7a Planta), 17007 Girona, Spain; (S.B.); (M.T.); (J.S.)
- Correspondence: (Y.S.); (C.G.-M.); Tel.: +34-872-987-087 (C.G.-M.)
| | - Carme Gubern-Mérida
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), RICORS-ICTUS, Parc Hospitalari Martí I Julià, Edifici M2, 17190 Salt, Spain; (L.C.-P.); (D.P.-I.)
- Correspondence: (Y.S.); (C.G.-M.); Tel.: +34-872-987-087 (C.G.-M.)
| | - Joaquín Serena
- Cerebrovascular Pathology Research Group, Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, RICORS-ICTUS, Av. França s/n (7a Planta), 17007 Girona, Spain; (S.B.); (M.T.); (J.S.)
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15
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Renú A, Millán M, San Román L, Blasco J, Martí-Fàbregas J, Terceño M, Amaro S, Serena J, Urra X, Laredo C, Barranco R, Camps-Renom P, Zarco F, Oleaga L, Cardona P, Castaño C, Macho J, Cuadrado-Godía E, Vivas E, López-Rueda A, Guimaraens L, Ramos-Pachón A, Roquer J, Muchada M, Tomasello A, Dávalos A, Torres F, Chamorro Á. Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: The CHOICE Randomized Clinical Trial. JAMA 2022; 327:826-835. [PMID: 35143603 PMCID: PMC8832304 DOI: 10.1001/jama.2022.1645] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE It is estimated that only 27% of patients with acute ischemic stroke and large vessel occlusion who undergo successful reperfusion after mechanical thrombectomy are disability free at 90 days. An incomplete microcirculatory reperfusion might contribute to these suboptimal clinical benefits. OBJECTIVE To investigate whether treatment with adjunct intra-arterial alteplase after thrombectomy improves outcomes following reperfusion. DESIGN, SETTING, AND PARTICIPANTS Phase 2b randomized, double-blind, placebo-controlled trial performed from December 2018 through May 2021 in 7 stroke centers in Catalonia, Spain. The study included 121 patients with large vessel occlusion acute ischemic stroke treated with thrombectomy within 24 hours after stroke onset and with an expanded Treatment in Cerebral Ischemia angiographic score of 2b50 to 3. INTERVENTIONS Participants were randomized to receive intra-arterial alteplase (0.225 mg/kg; maximum dose, 22.5 mg) infused over 15 to 30 minutes (n = 61) or placebo (n = 52). MAIN OUTCOMES AND MEASURES The primary outcome was the difference in proportion of patients achieving a score of 0 or 1 on the 90-day modified Rankin Scale (range, 0 [no symptoms] to 6 [death]) in all patients treated as randomized. Safety outcomes included rate of symptomatic intracranial hemorrhage and death. RESULTS The study was terminated early for inability to maintain placebo availability and enrollment rate because of the COVID-19 pandemic. Of 1825 patients with acute ischemic stroke treated with thrombectomy at the 7 study sites, 748 (41%) patients fulfilled the angiographic criteria, 121 (7%) patients were randomized (mean age, 70.6 [SD, 13.7] years; 57 women [47%]), and 113 (6%) were treated as randomized. The proportion of participants with a modified Rankin Scale score of 0 or 1 at 90 days was 59.0% (36/61) with alteplase and 40.4% (21/52) with placebo (adjusted risk difference, 18.4%; 95% CI, 0.3%-36.4%; P = .047). The proportion of patients with symptomatic intracranial hemorrhage within 24 hours was 0% with alteplase and 3.8% with placebo (risk difference, -3.8%; 95% CI, -13.2% to 2.5%). Ninety-day mortality was 8% with alteplase and 15% with placebo (risk difference, -7.2%; 95% CI, -19.2% to 4.8%). CONCLUSIONS AND RELEVANCE Among patients with large vessel occlusion acute ischemic stroke and successful reperfusion following thrombectomy, the use of adjunct intra-arterial alteplase compared with placebo resulted in a greater likelihood of excellent neurological outcome at 90 days. However, because of study limitations, these findings should be interpreted as preliminary and require replication. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03876119; EudraCT Number: 2018-002195-40.
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Affiliation(s)
- Arturo Renú
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mónica Millán
- Stroke Unit, Department of Neuroscience, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Luis San Román
- Neuroradiology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Jordi Blasco
- Neuroradiology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Joan Martí-Fàbregas
- Department of Neurology, Stroke Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Mikel Terceño
- Neuroradiology Service, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Sergio Amaro
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
| | - Joaquín Serena
- Neurology Service, Stroke Unit, Institut d’Investigació Biomèdica de Girona (IDIBGI), Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Xabier Urra
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
| | - Carlos Laredo
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Roger Barranco
- Department of Interventional Neuroradiology, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Pol Camps-Renom
- Department of Neurology, Stroke Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Federico Zarco
- Neuroradiology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Laura Oleaga
- Neuroradiology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Pere Cardona
- Department of Neurology, Bellvitge University Hospital, Barcelona, Spain
| | - Carlos Castaño
- Interventional Neuroradiology Unit, Department of Neuroscience, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Juan Macho
- Neuroradiology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Elisa Cuadrado-Godía
- Department of Neurology, Institut Hospital del Mar d’Investigacions Mèdiques, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elio Vivas
- Department of Neuroradiology, Hospital del Mar, Barcelona, Spain
| | | | | | - Anna Ramos-Pachón
- Stroke Unit, Department of Neuroscience, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jaume Roquer
- Department of Neurology, Institut Hospital del Mar d’Investigacions Mèdiques, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marian Muchada
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Alejandro Tomasello
- Department of Neuroradiology, Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Dávalos
- Stroke Unit, Department of Neuroscience, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Neurology, Stroke Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ferran Torres
- Medical Statistics Core Facility, Clinical Pharmacology Service, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
- Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángel Chamorro
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
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16
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Sánchez-Cirera L, Bashir S, Ciscar A, Marco C, Cruz V, Terceño M, Silva Y, Serena J. Prevalence of the Frank's sign by aetiopathogenic stroke subtype: A prospective analysis. PLoS One 2021; 16:e0261080. [PMID: 34910754 PMCID: PMC8673637 DOI: 10.1371/journal.pone.0261080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE The Frank's sign is a diagonal earlobe crease running from the tragus to the edge of the auricle at an angle of 45°. Many studies have associated this sign with coronary artery disease and some with cerebrovascular disease. The objective of this study was to analyse the prevalence of the Frank's sign in patients suffering from acute stroke with a particular focus on its prevalence in each of the five aetiopathogenic stroke subtypes. Special interest is given to embolic stroke of undetermined source (ESUS), correlating the sign with clinical and radiological markers that support an underlying causal profile in this subgroup. METHODS Cross-sectional descriptive study including 124 patients admitted consecutively to a stroke unit after suffering an acute stroke. The Frank's sign was evaluated by the same blinded member of the research team from photographs taken of the patients. The stroke subtype was classified following SSS-TOAST criteria and the aetiological study was performed following the ESO guidelines. RESULTS The Frank's sign was present in 75 patients and was more prevalent in patients with an ischaemic stroke in comparison with haemorrhagic stroke (63.9 vs. 37.5, p<0.05). A similar prevalence was found in the different ischaemic stroke subtypes. The Frank's sign was significantly associated with age, particularly in patients older than 70 who had vascular risk factors. Atherosclerotic plaques found in carotid ultrasonography were significantly more frequent in patients with the Frank's sign (63.6%, p<0.05). Analysing the ESUS, we also found an association with age and a higher prevalence of the Frank's sign in patients with vascular risk factors and a tendency to a high prevalence of atherosclerosis markers. CONCLUSION The Frank's sign is prevalent in all aetiopathogenic ischaemic stroke subtypes, including ESUS, where it could be helpful in suspecting the underlying cardioembolic or atherothrombotic origin and guiding the investigation of atherosclerosis in patients with ESUS and the Frank's sign.
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Affiliation(s)
- Laura Sánchez-Cirera
- Fellow of Neurology, Stroke Unit, Department of Neurology, Hospital Universitary Doctor Josep Trueta de Girona, Girona, Spain
| | - Saima Bashir
- Neurologist, Stroke Unit, Department of Neurology, Hospital Universitary Doctor Josep Trueta de Girona, Institut d’Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain
| | - Adina Ciscar
- Student of Medicine, Medicine Faculty, University of Girona, Girona, Spain
| | - Carla Marco
- Neurologist, Stroke Unit, Department of Neurology, Hospital Universitary Doctor Josep Trueta de Girona, Institut d’Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain
| | - Verónica Cruz
- Nurse of Neurology, Stroke Unit, Department of Neurology, Hospital Universitary Doctor Josep Trueta de Girona, Girona, Spain
| | - Mikel Terceño
- Neurologist, Stroke Unit, Department of Neurology, Hospital Universitary Doctor Josep Trueta de Girona, Institut d’Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain
| | - Yolanda Silva
- Neurologist, Stroke Unit, Department of Neurology, Hospital Universitary Doctor Josep Trueta de Girona, Institut d’Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain
| | - Joaquín Serena
- Stroke Unit, Department of Neurology, Hospital Universitary Doctor Josep Trueta de Girona, Institut d’Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain
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17
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Millán M, Ramos-Pachón A, Dorado L, Bustamante A, Hernández-Pérez M, Rodríguez-Esparragoza L, Gomis M, Remollo S, Castaño C, Werner M, Wenger D, Rubio S, Domínguez-Lizarbe M, Terceño M, Paipa AJ, Rodríguez-Vázquez A, Boned S, Camps-Renom P, Cánovas D, Giralt E, López-Cancio E, Dávalos A, Ros-Roig J, Pérez de la Ossa N. Predictors of Functional Outcome After Thrombectomy in Patients With Prestroke Disability in Clinical Practice. Stroke 2021; 53:845-854. [PMID: 34702065 DOI: 10.1161/strokeaha.121.034960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy (MT) in ischemic stroke patients with poor prestroke conditions remains controversial. We aimed to analyze the frequency of previously disabled patients treated with MT in clinical practice, the safety and clinical response to MT of patients with preexisting disability, and the disabled patient characteristics associated with a better response to MT. METHODS We studied all consecutive patients with anterior circulation occlusion treated with MT from January 2017 to December 2019 included in the Codi Ictus Catalunya registry-a government-mandated, prospective, hospital-based data set. Prestroke disability was defined as modified Rankin Scale score 2 or 3. Functional outcome at 90 days was centrally assessed by a blinded evaluator of the Catalan Stroke Program. Favorable outcome (to return at least to prestroke modified Rankin Scale at 90 days) and safety and secondary outcomes were compared with patients without previous disability. Logistic regression analysis was used to assess the association between prestroke disability and outcomes and to identify a disabled patient profile with favorable outcome after MT. RESULTS Of 2487 patients included in the study, 409 (17.1%) had prestroke disability (313 modified Rankin Scale score 2 and 96 modified Rankin Scale score 3). After adjustment for covariates, prestroke disability was not associated with a lower chance of achieving favorable outcome at 90 days (24% versus 30%; odds ratio, 0.79 [0.57-1.08]), whereas it was independently associated with a higher risk of symptomatic intracranial hemorrhage (5% versus 3%; odds ratio, 2.04 [1.11-3.72]) and long-term mortality (31% versus 18%; odds ratio, 1.74 [1.27-2.39]) compared with patients without disability. Prestroke disabled patients without diabetes, Alberta Stroke Program Early CT Score >8 and National Institutes of Health Stroke Scale score <17 showed similar safety and outcome results after MT as patients without prestroke disability. CONCLUSIONS Despite a higher mortality and risk of symptomatic intracranial hemorrhage, prestroke-disabled patients return as often as independent patients to their prestroke level of function, especially those nondiabetic patients with favorable early ischemic signs profile. These data support a potential benefit of MT in patients with previous mild or moderate disability after large anterior vessel occlusion stroke.
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Affiliation(s)
- Mònica Millán
- Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Badalona, Spain (M.M., A.R.-P., L.D., A.B., M.H.-P., L.R.-E., M.G., S.R., C.C., M.W., D.W., S.R., M.D.-L., A.D., N.P.d.l.O.)
| | - Anna Ramos-Pachón
- Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Badalona, Spain (M.M., A.R.-P., L.D., A.B., M.H.-P., L.R.-E., M.G., S.R., C.C., M.W., D.W., S.R., M.D.-L., A.D., N.P.d.l.O.)
| | - Laura Dorado
- Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Badalona, Spain (M.M., A.R.-P., L.D., A.B., M.H.-P., L.R.-E., M.G., S.R., C.C., M.W., D.W., S.R., M.D.-L., A.D., N.P.d.l.O.)
| | - Alejandro Bustamante
- Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Badalona, Spain (M.M., A.R.-P., L.D., A.B., M.H.-P., L.R.-E., M.G., S.R., C.C., M.W., D.W., S.R., M.D.-L., A.D., N.P.d.l.O.)
| | - María Hernández-Pérez
- Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Badalona, Spain (M.M., A.R.-P., L.D., A.B., M.H.-P., L.R.-E., M.G., S.R., C.C., M.W., D.W., S.R., M.D.-L., A.D., N.P.d.l.O.)
| | - Luís Rodríguez-Esparragoza
- Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Badalona, Spain (M.M., A.R.-P., L.D., A.B., M.H.-P., L.R.-E., M.G., S.R., C.C., M.W., D.W., S.R., M.D.-L., A.D., N.P.d.l.O.)
| | - Meritxell Gomis
- Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Badalona, Spain (M.M., A.R.-P., L.D., A.B., M.H.-P., L.R.-E., M.G., S.R., C.C., M.W., D.W., S.R., M.D.-L., A.D., N.P.d.l.O.)
| | - Sebastia Remollo
- Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Badalona, Spain (M.M., A.R.-P., L.D., A.B., M.H.-P., L.R.-E., M.G., S.R., C.C., M.W., D.W., S.R., M.D.-L., A.D., N.P.d.l.O.)
| | - Carlos Castaño
- Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Badalona, Spain (M.M., A.R.-P., L.D., A.B., M.H.-P., L.R.-E., M.G., S.R., C.C., M.W., D.W., S.R., M.D.-L., A.D., N.P.d.l.O.)
| | - Mariano Werner
- Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Badalona, Spain (M.M., A.R.-P., L.D., A.B., M.H.-P., L.R.-E., M.G., S.R., C.C., M.W., D.W., S.R., M.D.-L., A.D., N.P.d.l.O.)
| | - Denisse Wenger
- Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Badalona, Spain (M.M., A.R.-P., L.D., A.B., M.H.-P., L.R.-E., M.G., S.R., C.C., M.W., D.W., S.R., M.D.-L., A.D., N.P.d.l.O.)
| | - Sara Rubio
- Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Badalona, Spain (M.M., A.R.-P., L.D., A.B., M.H.-P., L.R.-E., M.G., S.R., C.C., M.W., D.W., S.R., M.D.-L., A.D., N.P.d.l.O.)
| | - Manuel Domínguez-Lizarbe
- Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Badalona, Spain (M.M., A.R.-P., L.D., A.B., M.H.-P., L.R.-E., M.G., S.R., C.C., M.W., D.W., S.R., M.D.-L., A.D., N.P.d.l.O.)
| | - Mikel Terceño
- Stroke Unit, Neurology Service, Hospital Dr. Josep Trueta, Girona, Spain (M.T.)
| | - Andrés Julián Paipa
- Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat Barcelona, Spain (A.J.P.)
| | | | - Sandra Boned
- Stroke Unit, Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain (S.B.)
| | - Pol Camps-Renom
- Stroke Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (P.C.-R.)
| | - David Cánovas
- Stroke Unit, Neurology Department, Hospital Parc Taulí, Sabadell, Spain (D.C.)
| | - Eva Giralt
- Stroke Unit, Neurology Department, Hospital del Mar, Barcelona, Spain (E.G.)
| | - Elena López-Cancio
- Stroke Unit, Neurology Department, Hospital Universitario Central de Asturias, Spain (E.L.-C.)
| | - Antoni Dávalos
- Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Badalona, Spain (M.M., A.R.-P., L.D., A.B., M.H.-P., L.R.-E., M.G., S.R., C.C., M.W., D.W., S.R., M.D.-L., A.D., N.P.d.l.O.)
| | - Josep Ros-Roig
- Catalan Stroke Programme, Catalan Public Health Department (J.R.-R., N.P.d.l.O.)
| | - Natalia Pérez de la Ossa
- Stroke Unit and Interventional Neuroradiology Section, Department of Neurosciences, Hospital Germans Trias, Universitat Autònoma de Barcelona, Badalona, Spain (M.M., A.R.-P., L.D., A.B., M.H.-P., L.R.-E., M.G., S.R., C.C., M.W., D.W., S.R., M.D.-L., A.D., N.P.d.l.O.).,Catalan Stroke Programme, Catalan Public Health Department (J.R.-R., N.P.d.l.O.)
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18
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Rudilosso S, Ríos J, Rodríguez A, Gomis M, Vera V, Gómez-Choco M, Renú A, Matos N, Llull L, Purroy F, Amaro S, Terceño M, Obach V, Serena J, Martí-Fàbregas J, Cardona P, Molina C, Rodríguez-Campello A, Cánovas D, Krupinski J, Ustrell X, Torres F, Román LS, Salvat-Plana M, Jiménez-Fàbrega FX, Palomeras E, Catena E, Colom C, Cocho D, Baiges J, Aragones JM, Diaz G, Costa X, Almendros MC, Rybyeba M, Barceló M, Carrión D, Lòpez MN, Sanjurjo E, de la Ossa NP, Urra X, Chamorro Á. Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry. J Stroke 2021; 23:401-410. [PMID: 34649384 PMCID: PMC8521260 DOI: 10.5853/jos.2021.00962] [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: 03/14/2021] [Accepted: 05/10/2021] [Indexed: 11/28/2022] Open
Abstract
Background and Purpose In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score ≤2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score <6, proximal vertebrobasilar occlusion, supratherapeutic international normalized ratio >3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups’ criteria).
Results Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3).
Conclusions Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors.
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Affiliation(s)
- Salvatore Rudilosso
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain.,Clinical and Experimental Neuroscience: Cerebrovascular Diseases, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - José Ríos
- Medical Statistics Core Facility, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Hospital Clinic, Barcelona, Spain.,Biostatistics Unit, Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Alejandro Rodríguez
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Meritxell Gomis
- Stroke Unit, Department of Neuroscience, Germans Trias Hospital, Badalona, Spain
| | - Víctor Vera
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain
| | | | - Arturo Renú
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain.,Clinical and Experimental Neuroscience: Cerebrovascular Diseases, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Núria Matos
- Department of Neurology, Althaia Foundation Hospital, Manresa, Spain
| | - Laura Llull
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain.,Clinical and Experimental Neuroscience: Cerebrovascular Diseases, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Francisco Purroy
- Stroke Unit, Department of Neurology, University Hospital Arnau of Vilanova, Lleida, Spain
| | - Sergio Amaro
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain.,Clinical and Experimental Neuroscience: Cerebrovascular Diseases, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Mikel Terceño
- Stroke Unit, Department of Neurology, Josep Trueta University Hospital, Girona, Spain
| | - Víctor Obach
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Joaquim Serena
- Stroke Unit, Department of Neurology, Josep Trueta University Hospital, Girona, Spain
| | - Joan Martí-Fàbregas
- Stroke Unit, Department of Neurology, Santa Creu i Sant Pau, Barcelona, Spain
| | - Pedro Cardona
- Stroke Unit, Department of Neurology, Bellvitge University Hospital, Barcelona, Spain
| | - Carlos Molina
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - David Cánovas
- Department of Neurology, Parc Taulí Hospital, Sabadell, Spain
| | - Jerzy Krupinski
- Department of Neurology, Mutua de Terrassa University Hospital, Terrassa, Spain
| | - Xavier Ustrell
- Stroke Unit, Department of Neurology, Joan XXIII University Hospital, Terragona, Spain
| | - Ferran Torres
- Medical Statistics Core Facility, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Hospital Clinic, Barcelona, Spain.,Biostatistics Unit, Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Luis San Román
- Department of Radiology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Mercè Salvat-Plana
- Department of Health, Pla Director Malaltia Vascular Cerebral (Catalan Stroke Program), Barcelona, Spain
| | | | | | - Esther Catena
- Department of Neurology, Consorci Sanitari Garraf Hospital, Sant Pere de Ribes, Spain
| | - Carla Colom
- Department of Emergency, Hospital of Igualada, Igualada, Spain
| | - Dolores Cocho
- Department of Emergency, Hospital of Granollers, Granollers, Spain
| | - Juanjo Baiges
- Department of Emergency, Verge de la Cinta Hospital, Tortosa, Spain
| | | | - Gloria Diaz
- Department of Emergency, Hospital of Campdevànol, Campdevànol, Spain
| | - Xavier Costa
- Department of Emergency, Hospital of Figueres, Figueres, Spain
| | | | - Maria Rybyeba
- Department of Emergency, Hospital of Olot, Olot, Spain
| | - Miquel Barceló
- Department of Emergency, Cerdanya Hospital, Puigcerdá, Spain
| | - Dolors Carrión
- Department of Emergency, Hospital of Móra d'Ebre, Móra d'Ebre, Spain
| | | | | | - Natalia Pérez de la Ossa
- Stroke Unit, Department of Neuroscience, Germans Trias Hospital, Badalona, Spain.,Department of Health, Pla Director Malaltia Vascular Cerebral (Catalan Stroke Program), Barcelona, Spain
| | - Xabier Urra
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain.,Clinical and Experimental Neuroscience: Cerebrovascular Diseases, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Ángel Chamorro
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain.,Clinical and Experimental Neuroscience: Cerebrovascular Diseases, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | -
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain
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19
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Terceño M, Silva Y, Bashir S, Vera-Monge VA, Cardona P, Molina C, Chamorro Á, de la Ossa NP, Hernández-Pérez M, Werner M, Camps-Renom P, Rodríguez-Campello A, Cánovas D, Purroy F, Serena J. Impact of general anesthesia on posterior circulation large vessel occlusions after endovascular thrombectomy. Int J Stroke 2021; 16:792-797. [DOI: 10.1177/1747493020976247] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background The impact of general anesthesia on functional outcome in patients with large vessel occlusion remains unclear. Most studies have focused on anterior circulation large vessel occlusion; however, little is known about the effect of general anesthesia in patients with posterior circulation—large vessel occlusion. Methods We performed a retrospective analysis from the prospective CICAT registry. All patients with posterior circulation—large vessel occlusion—and undergoing endovascular therapy between January 2016 and January 2020 were included. Demographics, baseline characteristics, procedural data, and anesthesia modality (general anesthesia or conscious sedation) were evaluated. The primary outcome was the proportion of patients with good clinical outcome (modified Rankin Scale score of 0–2) at three months. Results 298 patients underwent endovascular treatment with posterior circulation—large vessel occlusion—were included. Age, diabetes mellitus, renal insufficiency, baseline National Institutes of Health Stroke Scale score, puncture to recanalization length, ≥3 device passes, absent of successful recanalization (defined as treatment in cerebral ischemia of 3), and general anesthesia were statistically associated with poor outcome (mRS: 3-6). In the multivariable regression, general anesthesia and ≥3 device passes were independently associated with poor outcome (aOR: 3.11, (95% CI: 1.34–7.2); P = 0.01 and 3.77, (95% CI: 1.29–11.01); P = 0.02, respectively). Patients treated with general anesthesia were less likely to have a good outcome at three months compared to conscious sedation (19.7% vs. 45.1%, P < 0.001). Conclusions In our study population, general anesthesia use is associated with poor clinical outcome in patients with posterior circulation—large vessel occlusion—treated endovascularly.
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Affiliation(s)
- Mikel Terceño
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Doctor Josep Trueta Hospital, Girona, Spain
- Interventional Neuroradiology Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona, Spain
| | - Yolanda Silva
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Doctor Josep Trueta Hospital, Girona, Spain
| | - Saima Bashir
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Doctor Josep Trueta Hospital, Girona, Spain
| | - Víctor A Vera-Monge
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Doctor Josep Trueta Hospital, Girona, Spain
| | - Pere Cardona
- Stroke Unit, Department of Neurology, Bellvitge Hospital, Barcelona, Spain
| | - Carlos Molina
- Stroke Unit, Department of Neurology, Vall d’Hebron Hospital, Barcelona, Spain
| | - Ángel Chamorro
- Stroke Unit, Department of Neurology, Clinic Hospital, Barcelona, Spain
| | - Natalia P de la Ossa
- Stroke Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona, Spain
- Stroke Program/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - María Hernández-Pérez
- Stroke Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona, Spain
| | - Mariano Werner
- Interventional Neuroradiology Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona, Spain
| | - Pol Camps-Renom
- Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | | | - David Cánovas
- Stroke Unit, Department of Neurology, Parc Taulí Hospital, Sabadell, Spain
| | - Francisco Purroy
- Stroke Unit, Department of Neurology, Arnau de Vilanova Hospital, Lleida, Spain
| | - Joaquín Serena
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Doctor Josep Trueta Hospital, Girona, Spain
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20
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Blasco J, Puig J, López-Rueda A, Daunis-I-Estadella P, Llull L, Zarco F, Macias N, Macho J, González E, Labayen I, Vega P, Murias E, Jimenez-Gomez E, Bravo Rey I, Moreu M, Pérez-García C, Chirife Chaparro O, Aixut S, Terceño M, Werner M, Pumar JM, Aguilar Tejedor Y, Mendez JC, Moliner S, Nogueira RG, San Roman L. Addition of intracranial aspiration to balloon guide catheter does not improve outcomes in large vessel occlusion anterior circulation stent retriever based thrombectomy for acute stroke. J Neurointerv Surg 2021; 14:863-867. [PMID: 34452989 DOI: 10.1136/neurintsurg-2021-017760] [Citation(s) in RCA: 3] [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: 05/07/2021] [Accepted: 08/08/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Balloon guide catheter (BGC) in stent retriever based thrombectomy (BGC+SR) for patients with large vessel occlusion strokes (LVOS) improves outcomes. It is conceivable that the addition of a large bore distal access catheter (DAC) to BGC+SR leads to higher efficacy. We aimed to investigate whether the combined BGC+DAC+SR approach improves angiographic and clinical outcomes compared with BGC+SR alone for thrombectomy in anterior circulation LVOS. METHODS Consecutive patients with anterior circulation LVOS from June 2019 to November 2020 were recruited from the ROSSETTI registry. Demographic, clinical, angiographic, and outcome data were compared between patients treated with BGC+SR alone versus BGC+DAC+SR. The primary outcome was first pass effect (FPE) rate, defined as near complete/complete revascularization (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) after single device pass. RESULTS We included 401 patients (BGC+SR alone, 273 (66.6%) patients). Patients treated with BGC+SR alone were older (median age 79 (IQR 68-85) vs 73.5 (65-82) years; p=0.033) and had shorter procedural times (puncture to revascularization 24 (14-46) vs 37 (24.5-63.5) min, p<0.001) than the BGC+DAC+SR group. Both approaches had a similar FPE rate (52% in BGC+SR alone vs 46.9% in BGC+DAC+SR, p=0.337). Although the BGC+SR alone group showed higher rates for final successful reperfusion (mTICI ≥2b (86.8% vs 74.2%, p=0.002) and excellent reperfusion, mTICI ≥2 c (76.2% vs 55.5%, p<0.001)), there were no significant differences in 24 hour National Institutes of Health Stroke Scale score or rates of good functional outcome (modified Rankin Scale score of 0-2) at 3 months across these techniques. CONCLUSIONS Our data showed that addition of distal intracranial aspiration catheters to BGC+SR based thrombectomy in patients with acute anterior circulation LVO did not provide higher rates of FPE or improved clinical outcomes.
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Affiliation(s)
- Jordi Blasco
- Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Josep Puig
- IDI-Radiology, Doctor Josep Trueta University Hospital of Girona, Girona, Spain
| | - Antonio López-Rueda
- Department of Interventional Neuroradiology, Clinic University Hospital, Barcelona, Barcelona, Spain
| | - Pepus Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Catalunya, Spain
| | - Laura Llull
- Neurology Department, Hospital Clinic de Barcelona, Barcelona, Catalonia, Spain
| | - Federico Zarco
- Comprehensive Stroke Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Napoleon Macias
- Comprehensive Stroke Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Juan Macho
- Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Eva González
- Interventional Neuroradiology, Radiology, Hospital Cruces, Bilbao, Spain
| | - Ion Labayen
- Cruces University Hospital, Barakaldo, País Vasco, Spain
| | - Pedro Vega
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Eduardo Murias
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Elvira Jimenez-Gomez
- Diagnostic and Therapeutical Neuroradiology Unit, Hospital Reina Sofía, Córdoba, Spain
| | - Isabel Bravo Rey
- Neurorradiologia, Hospital universitario Reina Sofia, Córdoba, Spain
| | - Manuel Moreu
- Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Carlos Pérez-García
- Interventional Neuroradiology, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | | | - Sonia Aixut
- Neuroradiology, Hospital Universitari de Bellvitge, Barcelona, Cataluña, Spain
| | - Mikel Terceño
- Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain.,Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mariano Werner
- Department of Radiology, Hospital Clinic I Provincial de Barcelona, University Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - José Manuel Pumar
- Neuroradiology, Hospital Clinico Universitario, Santiago de Compostela, Spain
| | - Yeray Aguilar Tejedor
- Radiology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Canarias, Spain
| | - Jose Carlos Mendez
- Interventional Neuroradiology Unit, Radiology, Hospital Ramón y Cajal, Madrid, Spain
| | - Sarai Moliner
- Interventional Neuroradiology, Hospital General Universitario de Alicante, Alicante, Valenciana, Spain
| | - Raul G Nogueira
- Neurology and Interventional Neuroradiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Luis San Roman
- Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Spain
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21
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Remollo S, Terceño M, Werner M, Castaño C, Hernández-Pérez M, Blasco J, San Román L, Daunis-I-Estadella P, Thió-Henestrosa S, Cuba V, Gimeno A, Puig J. Combined Approach to Stroke Thrombectomy Using a Novel Short Flexible Aspiration Catheter with a Stent Retriever : Preliminary Clinical Experience. Clin Neuroradiol 2021; 32:393-400. [PMID: 34286344 PMCID: PMC9187553 DOI: 10.1007/s00062-021-01065-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Large-bore aspiration catheters enabling greater flow rates and suction force for mechanical thrombectomy might improve outcomes in patients with stroke secondary to large-vessel occlusion. Complete or near-complete reperfusion after a single thrombectomy pass (first-pass effect) is associated with improved clinical outcomes. We assessed the efficacy and safety of novel MIVI Q™ aspiration catheters in combination with stent-retriever devices. METHODS We retrospectively analyzed demographics, procedure characteristics, and clinical data from consecutive patients with acute anterior large-vessel occlusion treated with a combined approach using MIVI Q™ aspiration catheters and stent retrievers. Reperfusion was defined according to the modified thrombolysis in cerebral infarction (mTICI) score. Clinical outcomes were measured by the National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores. RESULTS We included 52 patients (median age, 75 y IQR: 64-83); 31 (59.6%) women; 14 (26.9%) with terminal internal carotid artery occlusions, 26 (50%) middle cerebral artery (MCA) segment M1 occlusions, and 12 (23.1%) MCA segment M2 occlusions; median NIHSS score at admission was 19 (IQR: 13-22). After the first pass, 25 (48%) patients had mTICI ≥ 2c. At the end of the procedure, 47 (90.4%) had mTICI ≥ 2b and 35 (67.3%) had mTICI ≥ 2c. No serious device-related adverse events were observed. Symptomatic intracranial hemorrhage developed in 1 patient. Mean NIHSS score was 13 at 24 h and 5 at discharge. At 90 days, 24 (46.2%) patients were functionally independent (mRS 0-2). CONCLUSION This preliminary study found good efficacy and safety for MIVI Q™ aspiration catheters used in combination with stent-retriever devices.
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Affiliation(s)
- Sebastian Remollo
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Interventional Neuroradiology Unit, Carretera del Canyet, s/n, 08946, Badalona, Spain.
| | - Mikel Terceño
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Interventional Neuroradiology Unit, Carretera del Canyet, s/n, 08946, Badalona, Spain.,Stroke Unit, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Mariano Werner
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Interventional Neuroradiology Unit, Carretera del Canyet, s/n, 08946, Badalona, Spain
| | - Carlos Castaño
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Interventional Neuroradiology Unit, Carretera del Canyet, s/n, 08946, Badalona, Spain
| | - María Hernández-Pérez
- Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jordi Blasco
- Neurointerventional Department C.D.I, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Luis San Román
- Neurointerventional Department C.D.I, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Pepus Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - Santiago Thió-Henestrosa
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - Víctor Cuba
- Interventional Neuroradiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Alfredo Gimeno
- Radiology Department, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Josep Puig
- IDI-Radiology, University Hospital Dr Josep Trueta, Girona, Spain
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22
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Suñer-Soler R, Grau-Martín A, Terceño M, Silva Y, Maldonado E, Gras ME, Font-Mayolas S, Rodrigo-Gil J, Serena J. A clinical trial comparing smoking cessation interventions at two levels of intensity in stroke patients, stratified by the presence of insular cortex lesions. Nicotine Tob Res 2021; 24:44-52. [PMID: 34245288 DOI: 10.1093/ntr/ntab144] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/09/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Smoking is a stroke risk factor but the most efficient way to promote cessation is unknown. The smoking behavior in patients during the first 2 years post-stroke is studied comparing brief advice and intensive behavioral counseling interventions, taking into consideration biological, psychological, and social factors. METHODS Randomized clinical trial of 196 stroke patients, stratified by the presence or not of an insular cortex lesion, with two levels of smoking cessation intervention. RESULTS The study retention rate was 85.2%. Abstinence point prevalence at three months after stroke was 50% in the brief advice group and 51.7% in the intensive behavioral counseling group (p =.82) and at 24 months, 48.3% in the brief group and 47.5% in the intensive group (p =.92). Most relapses occurred in the first weeks. After 3 months the curves separated with fewer events in the intensive group and at 24 months the Hazard Ratio was 0.91 (95% CI = 0.61 to 1.37; p =.67).Twenty-four months after stroke, patients with an insular lesion were more likely to be abstinent (OR 3.60, 95% CI = 1.27 to 10.14), as were those who lived with a partner (OR 2.31, 95% CI = 1.17 to 4.55) and those who were less dependent (OR 0.84, 95% CI = 0.73 to 0.97). CONCLUSIONS A high percentage of patients gave up smoking in both intervention groups with no significant differences between the two. The effect of the insular lesion on smoking cessation, which is early and continued after two years, is particularly notable.
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Affiliation(s)
- Rosa Suñer-Soler
- Department of Nursing and Health and Health Care Research Group, University of Girona, Girona, Catalonia, Spain
| | - Armand Grau-Martín
- Fundació Salut Empordà, Figueres Hospital and Quality of Life Research Institute, University of Girona, Catalonia, Spain
| | - Mikel Terceño
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta de Girona, IDIBGI, Girona, Catalonia, Spain
| | - Yolanda Silva
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta de Girona, IDIBGI, Girona, Catalonia, Spain
| | | | - Maria Eugenia Gras
- Quality of Life Research Institute, University of Girona, Catalonia, Spain
| | | | - Joana Rodrigo-Gil
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta de Girona, IDIBGI, Girona, Catalonia, Spain
| | - Joaquín Serena
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta de Girona, IDIBGI, Girona, Catalonia, Spain
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23
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Blasco J, Puig J, Daunis-I-Estadella P, González E, Fondevila Monso JJ, Manso X, Oteros R, Jimenez-Gomez E, Bravo Rey I, Vega P, Murias E, Jimenez JM, López-Rueda A, Renú A, Aixut S, Chirife Chaparro O, Rosati S, Moreu M, Remollo S, Aguilar Tejedor Y, Terceño M, Mosqueira A, Nogueira RG, San Roman L. Balloon guide catheter improvements in thrombectomy outcomes persist despite advances in intracranial aspiration technology. J Neurointerv Surg 2021; 13:773-778. [PMID: 33632881 DOI: 10.1136/neurintsurg-2020-017027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/27/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND First-pass effect (FPE) has been established as a key metric for technical success and strongly correlates with better clinical outcomes. Most data supporting improved outcomes with the use of a balloon guide catheter (BGC) predate the advent of last-generation large-bore intracranial aspiration catheters. We aim to evaluate the impact of BGC in FPE and clinical outcomes in a large cohort of patients treated with contemporary technology. METHODS Patients were recruited from the prospectively ongoing ROSSETTI registry. This registry includes all consecutive patients with anterior circulation large-vessel occlusion (LVO) from 10 comprehensive stroke centers in Spain. Demographic, clinical, angiographic, and clinical outcome data were compared between BGC and non-BGC groups. FPE was defined as the achievement of mTICI2c-3 after a single device pass. RESULTS 426 patients were included out of which 271 (63.62%) used BCG. BGC-treated patients had higher FPE rate (45.8% vs 27.7%; P<0.001), higher final mTICI ≥2 c recanalization rate (76.8% vs 50.3%, respectively; P<0.001), shorter procedural time [median (IQR), 30 (19-58) vs 43 (33-71) min; P<0.001], higher NIHSS difference from admission to 24 hours [median (IQR), 8 (2-12) vs 3 (0-10); P=0.001], and lower mortality rate (17.6% vs 29.8%, P=0.026) compared with non-BGC patients. BGC use was an independent predictor of FPE (OR 2.197, 95% CI 1.436 to 3.361; P<0.001), and excellent clinical outcome at 3 months (OR 0.34, 95% CI 0.17 to 0.68; P=0.002). CONCLUSIONS Our results support the benefit of BGC use on angiographic and clinical outcomes in anterior circulation LVO ischemic stroke remain significant even when considering recent improvements in intracranial aspiration technology.
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Affiliation(s)
- Jordi Blasco
- Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Josep Puig
- IDI-Radiology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Catalunya, Spain
| | - Pepus Daunis-I-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Catalunya, Spain
| | - Eva González
- Interventional Neuroradiology, Radiology, Cruces University Hospital, Barakaldo, País Vasco, Spain
| | | | - Xabier Manso
- Interventional Neuroradiology, Radiology, Hospital Universitario Cruces, Bilbao, País Vasco, Spain
| | - Rafael Oteros
- Diagnostic and Therapeutical Neuroradiology Unit, Reina Sofia University Hospital, Cordoba, Andalucía, Spain
| | - Elvira Jimenez-Gomez
- Diagnostic and Therapeutical Neuroradiology Unit, Reina Sofia University Hospital, Cordoba, Andalucía, Spain
| | - Isabel Bravo Rey
- Neurorradiologia, Reina Sofia University Hospital, Cordoba, Andalucía, Spain
| | - Pedro Vega
- Radiology, HUCA, Oviedo, Asturias, Spain
| | | | | | - Antonio López-Rueda
- Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Arturo Renú
- Comprehensive Stroke Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Sonia Aixut
- Neuroradiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Oscar Chirife Chaparro
- Interventional Neuroradiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Santiago Rosati
- Department of Radiology, Clinical San Carlos Hospital, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Manuel Moreu
- Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Sebastian Remollo
- Interventional Neuroradiology Unit, University Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Yeray Aguilar Tejedor
- Radiology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Canarias, Spain
| | - Mikel Terceño
- Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain.,Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Antonio Mosqueira
- Neuroradiology Department, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Raul G Nogueira
- Neurology and Interventional Neuroradiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Luis San Roman
- Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
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24
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Ramos-Pachón A, López-Cancio E, Bustamante A, Pérez de la Ossa N, Millán M, Hernández-Pérez M, Garcia-Berrocoso T, Cardona P, Rubiera M, Serena J, Ustrell X, Garcés M, Terceño M, Dávalos A, Montaner J. D-Dimer as Predictor of Large Vessel Occlusion in Acute Ischemic Stroke. Stroke 2021; 52:852-858. [PMID: 33563016 DOI: 10.1161/strokeaha.120.031657] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Improving prehospital triage of large vessel occlusion (LVO) would reduce time to reperfusion therapies. We aimed to study early predictors of LVO in acute ischemic stroke to identify candidates for endovascular treatment. METHODS The Stroke-Chip was a prospective observational study conducted at 6 Stroke Centers in Catalonia. Blood samples were obtained in the first 6 hours from symptom onset of consecutive patients. Stroke severity was evaluated with National Institutes of Health Stroke Scale (NIHSS) and LVO was assessed. Independent association of multiple blood biomarkers with LVO was evaluated using logistic regression models adjusted by covariates. Sensitivity, specificity, and predictive values were assessed for NIHSS and the combination of NIHSS and selected serum biomarkers levels. RESULTS One thousand three hundred eight suspected strokes were enrolled for a 17-month period. LVO was not assessed in 131 patients. One thousand one hundred seventy-seven patients were selected for analysis (mean age 69.3 years, 56% men, median baseline NIHSS of 6, and median time to blood collection 2.5 hours). LVO was detected in 262 patients. LVO patients were older, had higher baseline NIHSS, history of atrial fibrillation, and lower time from stroke onset to admission. After logistic regression analysis, D-dimer remained an independent predictor of LVO (odds ratio, 1.59 [1.31-1.92]). Specificity and positive predictive value to exclude or detect LVO were higher when using combined D-dimer levels and NIHSS score assessment rather than NIHSS alone. CONCLUSIONS Early D-dimer levels are an independent predictor of LVO and may be useful to better optimize prehospital patient transport to the appropriate stroke center.
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Affiliation(s)
- Anna Ramos-Pachón
- Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.R.-P., A.B., N.P.d.l.O., M.M., M.H.-P., A.D.)
| | - Elena López-Cancio
- Neurology Department, Hospital Universitario Central de Asturias, Oviedo, Spain (E.L.-C.)
| | - Alejandro Bustamante
- Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.R.-P., A.B., N.P.d.l.O., M.M., M.H.-P., A.D.)
| | - Natàlia Pérez de la Ossa
- Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.R.-P., A.B., N.P.d.l.O., M.M., M.H.-P., A.D.)
| | - Mònica Millán
- Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.R.-P., A.B., N.P.d.l.O., M.M., M.H.-P., A.D.)
| | - Maria Hernández-Pérez
- Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.R.-P., A.B., N.P.d.l.O., M.M., M.H.-P., A.D.)
| | - Teresa Garcia-Berrocoso
- Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Spain (T.G.-B., J.M.)
| | - Pere Cardona
- Neurology Department, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.)
| | - Marta Rubiera
- Neurology Department, Hospital Universitari Vall D'Hebron-VHIR, Barcelona, Spain (M.R.)
| | - Joaquín Serena
- Neurology Department, Hospital Universitari Josep Trueta, Girona, Spain (J.S., M.T.)
| | - Xavier Ustrell
- Neurology Department, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U.)
| | - Moisés Garcés
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain (M.G.)
| | - Mikel Terceño
- Neurology Department, Hospital Universitari Josep Trueta, Girona, Spain (J.S., M.T.)
| | - Antoni Dávalos
- Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.R.-P., A.B., N.P.d.l.O., M.M., M.H.-P., A.D.)
| | - Joan Montaner
- Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.R.-P., A.B., N.P.d.l.O., M.M., M.H.-P., A.D.).,Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Spain (T.G.-B., J.M.)
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25
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Abraira L, Santamarina E, Cazorla S, Bustamante A, Quintana M, Toledo M, Fonseca E, Grau-López L, Jiménez M, Ciurans J, Luis Becerra J, Millán M, Hernández-Pérez M, Cardona P, Terceño M, Zaragoza J, Cánovas D, Gasull T, Ustrell X, Rubiera M, Castellanos M, Montaner J, Álvarez-Sabín J. Blood biomarkers predictive of epilepsy after an acute stroke event. Epilepsia 2020; 61:2244-2253. [PMID: 32857458 DOI: 10.1111/epi.16648] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Blood biomarkers have not been widely investigated in poststroke epilepsy. In this study, we aimed to describe clinical factors and biomarkers present during acute stroke and analyze their association with the development of epilepsy at long term. METHODS A panel of 14 blood biomarkers was evaluated in patients with ischemic and hemorrhagic stroke. Biomarkers were normalized and standardized using Z-scores. Stroke and epilepsy-related variables were also assessed: stroke severity, determined by National Institutes of Health Stroke Scale (NIHSS) score, stroke type and cause, time from stroke to onset of late seizures, and type of seizure. Multiple Cox regression models were used to identify clinical variables and biomarkers independently associated with epilepsy. RESULTS From a cohort of 1115 patients, 895 patients were included. Mean ± standard deviation (SD) age was 72.0 ± 13.1 years, and 57.8% of patients were men. Fifty-one patients (5.7%) developed late seizures, with a median time to onset of 232 days (interquartile range [IQR] 86-491). NIHSS score ≥8 (P < .001, hazard ratio [HR] 4.013, 95% confidence interval [CI] 2.123-7.586) and a history of early onset seizures (P < .001, HR 4.038, 95% CI 1.802-9.045) were factors independently associated with a risk of developing epilepsy. Independent blood biomarkers predictive of epilepsy were high endostatin levels >1.203 (P = .046, HR 4.300, 95% CI 1.028-17.996) and low levels of heat shock 70 kDa protein-8 (Hsc70) <2.496 (P = .006, HR 3.795, 95% CI 1.476-9.760) and S100B <1.364 (P = .001, HR 2.955, 95% CI 1.534-5.491). The risk of epilepsy when these biomarkers were combined increased to 17%. The area under the receiver-operating characteristic (ROC) curve of the predictive model was stronger when clinical variables were combined with blood biomarkers (74.3%, 95% CI 65.2%-83.3%) than when they were used alone (68.9%, 95% CI 60.3%-77.6%). SIGNIFICANCE Downregulated S100B and Hsc70 and upregulated endostatin may assist in prediction of poststroke epilepsy and may provide additional information to clinical risk factors. In addition, these data are hypothesis-generating for the epileptogenic process.
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Affiliation(s)
- Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sonia Cazorla
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Stroke Unit - Neurology department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laia Grau-López
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Marta Jiménez
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Jordi Ciurans
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Juan Luis Becerra
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Mónica Millán
- Stroke Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | | | - Pere Cardona
- Stroke Unit, Bellvitge University Hospital, Barcelona, Spain
| | - Mikel Terceño
- Stroke Unit, Josep Trueta University Hospital, Girona, Spain
| | - Josep Zaragoza
- Stroke Unit, Verge de la Cinta University Hospital, Tortosa, Spain
| | - David Cánovas
- Neurology Department, Parc Taulí University Hospital, Sabadell, Spain
| | - Teresa Gasull
- Cellular and Molecular Neurobiology Research Group, Germans Trias i Pujol Research Institute, Barcelona, Spain
| | - Xavier Ustrell
- Stroke Unit, Joan XXIII University Hospital, Tarragona, Spain
| | - Marta Rubiera
- Stroke Unit - Neurology department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Castellanos
- Department of Neurology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose Álvarez-Sabín
- Stroke Unit - Neurology department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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26
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Abraira L, Giannini N, Santamarina E, Cazorla S, Bustamante A, Quintana M, Toledo M, Grau-López L, Jiménez M, Ciurans J, Becerra JL, Millán M, Cardona P, Terceño M, Zaragoza J, Cánovas D, Gasull T, Ustrell X, Rubiera M, Castellanos M, Dávalos A, Montaner J, Álvarez-Sabin J. Corrigendum to "Correlation of blood biomarkers with early-onset seizures after an acute stroke event" [Epilepsy Behav 104(Pt B) (2020 Mar)]. Epilepsy Behav 2020; 106:107045. [PMID: 32248061 DOI: 10.1016/j.yebeh.2020.107045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Nicola Giannini
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Departament de Medicina, Universitat Autònoma de Barcelona, Spain.
| | - Sonia Cazorla
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Spain; Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Laia Grau-López
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Marta Jiménez
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Jordi Ciurans
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Juan Luis Becerra
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Mónica Millán
- Stroke Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Pere Cardona
- Stroke Unit, Bellvitge University Hospital, Barcelona, Spain
| | - Mikel Terceño
- Stroke Unit, Verge de la Cinta University Hospital, Tortosa, Spain
| | - Josep Zaragoza
- Stroke Unit, Joan XXIII University Hospital, Tarragona, Spain; Neurology Department, Parc Taulí University Hospital, Sabadell, Spain
| | - David Cánovas
- Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Teresa Gasull
- Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Xavier Ustrell
- Stroke Unit, Josep Trueta University Hospital, Girona, Spain
| | - Marta Rubiera
- Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Mar Castellanos
- Department of Neurology, Complejo Hospitalario Universitario A Coruña, Spain
| | - Antoni Dávalos
- Stroke Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Spain
| | - Jose Álvarez-Sabin
- Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
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27
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Puig J, Shankar J, Liebeskind D, Terceño M, Nael K, Demchuk AM, Menon B, Dowlatshahi D, Leiva-Salinas C, Wintermark M, Thomalla G, Silva Y, Serena J, Pedraza S, Essig M. From "Time is Brain" to "Imaging is Brain": A Paradigm Shift in the Management of Acute Ischemic Stroke. J Neuroimaging 2020; 30:562-571. [PMID: 32037629 DOI: 10.1111/jon.12693] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 11/30/2022] Open
Abstract
Arterial recanalization to restore the blood supply and limit the brain damage is the primary goal in the management of acute ischemic stroke (AIS). Since the publication of pivotal randomized clinical trials in 2015, endovascular thrombectomy has become part of the standard of care in selected cases of AIS from large-vessel occlusions up to 6 hours after the onset of symptoms. However, the association between endovascular reperfusion and improved functional outcome is not strictly time dependent. Rather than on rigid time windows, candidates should be selected based on vascular and physiologic information. This approach places imaging data at the center of treatment decisions. Advances in imaging-based management of AIS provide crucial information about vessel occlusion, infarct core, ischemic penumbra, and degree of collaterals. This information is invaluable in identifying patients who are likely to benefit from reperfusion therapies and excluding those who are unlikely to benefit or are at risk of adverse effects. The approach to reperfusion therapies continues to evolve, and imaging is acquiring a greater role in the diagnostic work-up and treatment decisions as shown in recent clinical trials with extended time window. The 2018 American Heart Association/American Stroke Association guidelines reflect a paradigm shift in the management of AIS from "Time is Brain" to "Imaging is Brain." This review discusses the essential role of multimodal imaging developing from recent trials on therapy for AIS.
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Affiliation(s)
- Josep Puig
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Radiology, Hospital Universitari Dr Josep Trueta - IDIBGI, Girona, Spain
| | - Jai Shankar
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Liebeskind
- Department of Neurology, Neurovascular Imaging Research Core and UCLA Stroke Center, University of California, Los Angeles, CA
| | - Mikel Terceño
- Department of Neurology, Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Girona, Spain
| | - Kambiz Nael
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Andrew M Demchuk
- Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Bijoy Menon
- Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Dar Dowlatshahi
- Department of Medicine (Neurology), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Max Wintermark
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Stanford, CA
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yolanda Silva
- Department of Neurology, Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Girona, Spain
| | - Joaquin Serena
- Department of Neurology, Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Girona, Spain
| | - Salvador Pedraza
- Department of Radiology, Hospital Universitari Dr Josep Trueta - IDIBGI, Girona, Spain
| | - Marco Essig
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
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28
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Terceño M, Silva Y, Bashir S, Vera-Monge V, Buxó M, Serena J. Troponin T Predicts Cardioembolic Aetiology and Clinical Outcome in Undetermined Ischaemic Stroke in Hyperacute Phase. J Stroke Cerebrovasc Dis 2019; 29:104528. [PMID: 31806451 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Elevated high-sensitivity cardiac troponin T (hs-cTnT) levels have been related to clinical outcome in stroke patients. However, the role of hs-cTnT and its potential as a biomarker in ischaemic stroke (IS) has not been well established. This study aims to determine whether basal hs-cTnT determination in the hyperacute phase of undetermined IS and transient ischaemic attack (TIA) can predict the cardioembolic aetiology and clinical outcome. METHODS We prospectively studied 110 consecutive patients with undetermined acute IS and TIA. hs-cTnT levels were determined at hospital arrival. Large vessel stenosis/occlusion and previously known aetiologies at admission were exclusion criteria for this study. All patients were subjected to a complete aetiological evaluation. A 12-month follow-up was performed in all patients. The subtype of IS was evaluated following the SSS-TOAST criteria. We established two groups at admission: cardioembolic aetiology (group A) and noncardioembolic aetiologies (group B). RESULTS The number of patients in each group was similar (group A: 52, 47.27%; group B, 58, 52.73%). Patients in group A had elevated hs-cTnT more frequently (61.54% versus 17.24%; P < .001). Group A patients had significantly higher mortality at 3 months (14.29% versus 1.82%, P = .025). In the multivariate analysis, elevated hs-cTnT was the only independent predictor of cardioembolic aetiology (odds ratio: 14.821; 95% confidence interval: 3.717-59.102, P < .001). CONCLUSION Baseline hs-cTnT assessment in undetermined strokes and TIA during the hyperacute phase is independently associated with cardioembolic aetiology.
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Affiliation(s)
- Mikel Terceño
- Department of Neurology, Stroke Unit, Hospital Universitari Doctor Josep Trueta de Giron, IDIBGI, Girona, Spain.
| | - Yolanda Silva
- Department of Neurology, Stroke Unit, Hospital Universitari Doctor Josep Trueta de Giron, IDIBGI, Girona, Spain
| | - Saima Bashir
- Department of Neurology, Stroke Unit, Hospital Universitari Doctor Josep Trueta de Giron, IDIBGI, Girona, Spain
| | - Victor Vera-Monge
- Department of Neurology, Stroke Unit, Hospital Universitari Doctor Josep Trueta de Giron, IDIBGI, Girona, Spain
| | - Maria Buxó
- Unitat d'Assessorament Estadístic i Metodològic, IDIBGI, Girona, Spain
| | - Joaquín Serena
- Department of Neurology, Stroke Unit, Hospital Universitari Doctor Josep Trueta de Giron, IDIBGI, Girona, Spain
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Terceño M, Remollo S, Silva Y, Bashir S, Castaño C, Serena J. Intracranial Hemorrhage Secondary to a Delayed Cerebral Pseudoaneurysm Rupture 18 Years after Cranial Trauma. Case Rep Neurol 2019; 11:325-329. [DOI: 10.1159/000503812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 09/29/2019] [Indexed: 11/19/2022] Open
Abstract
We report the case of a 38-year-old male with a previous history of severe cranial trauma and subsequent large subdural and subarachnoid hemorrhage on whom an emergent hematoma evacuation was performed with a good outcome and follow-up. Despite a good clinical evolution, the patient experienced a further intracranial hematoma 18 years after the trauma, with severe aphasia and mild right hemiparesis. After complete etiological study, two cranial pseudoaneurysms were observed in the cerebral angiography. Endovascular treatment was successfully completed, achieving full embolization without complications. No rebleeding was detected during follow-up. The patient had a good clinical outcome at 3 months and achieved complete recovery. Cranial pseudoaneurysm rupture is a rare cause of intracerebral hemorrhage, especially if the trauma occurs years before the bleeding.
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Terceño M, Serena J, Bashir S, Vera-Monge VA, Puig J, Blasco G, Puig M, Silva Y. Serotonin Reuptake Inhibitor Drugs Are Associated with Contrast Extravasation and Clinical Outcome in Patients with Intracerebral Haemorrhage. Eur Neurol 2019; 81:254-261. [PMID: 31655802 DOI: 10.1159/000503561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Antidepressants that inhibit the reuptake of serotonin (SRIs) have been related to the appearance of intracerebral haemorrhage (ICH). Some studies have described bigger haematoma volumes in these patients. So far, no studies have demonstrated an association between SRIs and contrast extravasation (CE). We propose to investigate the relationship of SRIs with CE and clinical outcome. PATIENTS AND METHODS We aimed a prospective registry of 294 patients with ICH. All previous treatments were registered, including SRIs intake. The presence of CE and the number of spot sign in CT angiography were collected. Early neurological deterioration (END) and late neurological deterioration (LND) were registered. Follow-up was completed at day 90. RESULTS Two hundred and ninety-four patients were included, mean age 66.5 years, 27.6% female. A total of 28 (9.5%) were taking SRIs at the time of the ICH. This group of patients presented statistically significantly more CE (46.4 vs. 19.9%, p = 0.012), ≥2 spot sign (25 vs. 6.8%, p = 0.017), END (46.4 vs. 25.2%, p = 0.018) and LND (14.3 vs. 4.9%, p = 0.032). In addition, this group of patients showed a tendency to have higher mortality (32.1 vs. 22.2%, p = 0.553) and a lower functional independence (modified Rankin Scale 0-2) at day 90 (25 vs. 36.5%, p = 0.230). In the multivariate analysis, SRIs intake was identified as an independent predictor of CE (adjusted OR 3.37; 95% CI 1.033-10.989; p = 0.044) together with hematoma volume at baseline and alcohol use. CONCLUSIONS In our studied population, previous SRIs intake in patients with ICH was independently associated to CE. Further studies are needed to confirm this association.
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Affiliation(s)
- Mikel Terceño
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Hospital Universitari Dr Josep Trueta, Girona, Spain,
| | - Joaquín Serena
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - Saima Bashir
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - Victor Augusto Vera-Monge
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - Josep Puig
- Research Unit of Diagnostic Imaging Institute (IDI), Department of Radiology, Girona Biomedical Research Institute (IDIBGI), Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Gerard Blasco
- Research Unit of Diagnostic Imaging Institute (IDI), Department of Radiology, Girona Biomedical Research Institute (IDIBGI), Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Marc Puig
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - Yolanda Silva
- Stroke Unit, Department of Neurology, Girona Biomedical Research Institute (IDIBGI), Hospital Universitari Dr Josep Trueta, Girona, Spain
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Puig J, Blasco G, Terceño M, Daunis-I-Estadella P, Schlaug G, Hernandez-Perez M, Cuba V, Carbó G, Serena J, Essig M, Figley CR, Nael K, Leiva-Salinas C, Pedraza S, Silva Y. Predicting Motor Outcome in Acute Intracerebral Hemorrhage. AJNR Am J Neuroradiol 2019; 40:769-775. [PMID: 31000524 DOI: 10.3174/ajnr.a6038] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/15/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Predicting motor outcome following intracerebral hemorrhage is challenging. We tested whether the combination of clinical scores and DTI-based assessment of corticospinal tract damage within the first 12 hours of symptom onset after intracerebral hemorrhage predicts motor outcome at 3 months. MATERIALS AND METHODS We prospectively studied patients with motor deficits secondary to primary intracerebral hemorrhage within the first 12 hours of symptom onset. Patients underwent multimodal MR imaging including DTI. We assessed intracerebral hemorrhage and perihematomal edema location and volume, and corticospinal tract involvement. The corticospinal tract was considered affected when the tractogram passed through the intracerebral hemorrhage or/and the perihematomal edema. We also calculated affected corticospinal tract-to-unaffected corticospinal tract ratios for fractional anisotropy, mean diffusivity, and axial and radial diffusivities. Motor impairment was graded by the motor subindex scores of the modified NIHSS. Motor outcome at 3 months was classified as good (modified NIHSS 0-3) or poor (modified NIHSS 4-8). RESULTS Of 62 patients, 43 were included. At admission, the median NIHSS score was 13 (interquartile range = 8-17), and the median modified NIHSS score was 5 (interquartile range = 2-8). At 3 months, 13 (30.23%) had poor motor outcome. Significant independent predictors of motor outcome were NIHSS and modified NIHSS at admission, posterior limb of the internal capsule involvement by intracerebral hemorrhage at admission, intracerebral hemorrhage volume at admission, 72-hour NIHSS, and 72-hour modified NIHSS. The sensitivity, specificity, and positive and negative predictive values for poor motor outcome at 3 months by a combined modified NIHSS of >6 and posterior limb of the internal capsule involvement in the first 12 hours from symptom onset were 84%, 79%, 65%, and 92%, respectively (area under the curve = 0.89; 95% CI, 0.78-1). CONCLUSIONS Combined assessment of motor function and posterior limb of the internal capsule damage during acute intracerebral hemorrhage accurately predicts motor outcome.
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Affiliation(s)
- J Puig
- From the Department of Radiology (J.P., M.E., C.R.F.), University of Manitoba. Winnipeg, Manitoba, Canada
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - G Blasco
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - M Terceño
- Department of Neurology (M.T., J.S., Y.S.), Girona Biomedical Research Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - P Daunis-I-Estadella
- Department of Computer Science (P.D.-i.-E.), Applied Mathematics and Statistics, University of Girona, Girona, Spain
| | - G Schlaug
- Neuroimaging and Stroke Recovery Laboratory (G.S.), Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - M Hernandez-Perez
- Department of Neurosciences (M.H.-P.), Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Badalona, Spain
| | - V Cuba
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - G Carbó
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - J Serena
- Department of Neurology (M.T., J.S., Y.S.), Girona Biomedical Research Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - M Essig
- From the Department of Radiology (J.P., M.E., C.R.F.), University of Manitoba. Winnipeg, Manitoba, Canada
| | - C R Figley
- From the Department of Radiology (J.P., M.E., C.R.F.), University of Manitoba. Winnipeg, Manitoba, Canada
| | - K Nael
- Department of Radiology (K.N.), Icahn School of Medicine at Mount Sinai, New York
| | - C Leiva-Salinas
- Department of Radiology (C.L.-S.), University of Missouri, Columbia, Missouri
| | - S Pedraza
- Department of Radiology (J.P., G.B., V.C., G.C., S.P.), Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain
| | - Y Silva
- Department of Neurology (M.T., J.S., Y.S.), Girona Biomedical Research Institute, Dr Josep Trueta University Hospital, Girona, Spain
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Castaño C, Cubells C, Remollo S, García-Sort MR, Terceño M. Use of a complete autologous blood recovery system (the Sorin Xtra® Autotransfusion System) during mechanical thrombectomy of extensive cerebral venous sinus thrombosis. Interv Neuroradiol 2017; 23:531-537. [PMID: 28732458 DOI: 10.1177/1591019917720908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The endovascular therapy for cerebral venous sinus thrombosis (CVST) is currently accepted as a second-line treatment for patients who have failed or those in whom systemic anticoagulation is contraindicated or in a subgroup of patients presenting with rapid neurologic deterioration. A number of different mechanical and pharmacologic endovascular strategies have been reported, either as separate or combined approaches. These new catheters and aspiration systems have a high power and vacuum capacity, which carries a risk of anemization of the patient and hypovolemic shock, being necessitating the transfusion of the patient. Material and methods Because of the problems that donor blood transfusion can bring, we describe the use of a Sorin Xtra® Autotransfusion System (ATS). This complete autologous blood recovery system was designed for use in procedures where medium- to high-volume blood loss occurs, such as major surgeries. We have adapted it to recover all the blood aspirated during the mechanical thrombectomy procedures of the dural cerebral venous sinuses, since they are procedures that can cause a significant loss of blood. One advantage to this is the patient receives his or her own blood instead of donor blood, so there is no risk of contracting outside diseases or transfusion reactions. Conclusions This technical note describes a novel and previously unpublished technical approach to CVST that can be immediately applied to clinical practice. It also raises awareness among the interventional neuroradiologist and anesthesiologist communities about novel, potentially lifesaving endovascular treatments in patients with extensive CVST.
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Affiliation(s)
- C Castaño
- 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - C Cubells
- 2 Anesthesiology Department, Hospital Universitario Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - S Remollo
- 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - M R García-Sort
- 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - M Terceño
- 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Barcelona, Spain
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Bustamante A, López-Cancio E, Pich S, Penalba A, Giralt D, García-Berrocoso T, Ferrer-Costa C, Gasull T, Hernández-Pérez M, Millan M, Rubiera M, Cardona P, Cano L, Quesada H, Terceño M, Silva Y, Castellanos M, Garces M, Reverté S, Ustrell X, Marés R, Baiges JJ, Serena J, Rubio F, Salas E, Dávalos A, Montaner J. Blood Biomarkers for the Early Diagnosis of Stroke: The Stroke-Chip Study. Stroke 2017; 48:2419-2425. [PMID: 28716979 DOI: 10.1161/strokeaha.117.017076] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [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: 02/16/2017] [Revised: 06/23/2017] [Accepted: 06/27/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Stroke diagnosis could be challenging in the acute phase. We aimed to develop a blood-based diagnostic tool to differentiate between real strokes and stroke mimics and between ischemic and hemorrhagic strokes in the hyperacute phase. METHODS The Stroke-Chip was a prospective, observational, multicenter study, conducted at 6 Stroke Centers in Catalonia. Consecutive patients with suspected stroke were enrolled within the first 6 hours after symptom onset, and blood samples were drawn immediately after admission. A 21-biomarker panel selected among previous results and from the literature was measured by immunoassays. Outcomes were differentiation between real strokes and stroke mimics and between ischemic and hemorrhagic strokes. Predictive models were developed by combining biomarkers and clinical variables in logistic regression models. Accuracy was evaluated with receiver operating characteristic curves. RESULTS From August 2012 to December 2013, 1308 patients were included (71.9% ischemic, 14.8% stroke mimics, and 13.3% hemorrhagic). For stroke versus stroke mimics comparison, no biomarker resulted included in the logistic regression model, but it was only integrated by clinical variables, with a predictive accuracy of 80.8%. For ischemic versus hemorrhagic strokes comparison, NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) >4.9 (odds ratio, 2.40; 95% confidence interval, 1.55-3.71; P<0.0001) and endostatin >4.7 (odds ratio, 2.02; 95% confidence interval, 1.19-3.45; P=0.010), together with age, sex, blood pressure, stroke severity, atrial fibrillation, and hypertension, were included in the model. Predictive accuracy was 80.6%. CONCLUSIONS The studied biomarkers were not sufficient for an accurate differential diagnosis of stroke in the hyperacute setting. Additional discovery of new biomarkers and improvement on laboratory techniques seem necessary for achieving a molecular diagnosis of stroke.
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Affiliation(s)
- Alejandro Bustamante
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Elena López-Cancio
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Sara Pich
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Anna Penalba
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Dolors Giralt
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Teresa García-Berrocoso
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Carles Ferrer-Costa
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Teresa Gasull
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - María Hernández-Pérez
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Mónica Millan
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Marta Rubiera
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Pedro Cardona
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Luis Cano
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Helena Quesada
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Mikel Terceño
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Yolanda Silva
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Mar Castellanos
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Moisés Garces
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Silvia Reverté
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Xavier Ustrell
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Rafael Marés
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Joan Josep Baiges
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Joaquín Serena
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Francisco Rubio
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Eduardo Salas
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Antoni Dávalos
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.)
| | - Joan Montaner
- From the Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain (A.B., A.P., D.G., T.G.-B., J.M.); Stroke Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain (E.L.-C., M.H.-P., M.M., A.D.); Gendiag.exe, S.L., Barcelona, Spain (S.P., C.F.-C., E.S.); Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain (T.G.); Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M.R., J.M.); Stroke Unit, Hospital Universitari de Bellvitge, Barcelona, Spain (P.C., L.C., H.Q., F.R.); Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T., Y.S., J.S.); Complejo Hospitalario Universitario A Coruña, Spain (M.C.); Stroke Unit, Hospital Universitari Verge de la Cinta de Tortosa, Spain (M.G., S.R., J.J.B.); and Stroke Unit, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., R.M.).
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Castaño C, Terceño M, Remollo S, García-Sort MR, Domínguez C. Endovascular treatment of wide-neck intracranial bifurcation aneurysms with 'Y'-configuration, double Neuroform® stents-assisted coiling technique: Experience in a single center. Interv Neuroradiol 2017; 23:362-370. [PMID: 28587530 DOI: 10.1177/1591019917708568] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Intracranial wide-neck aneurysms at the arterial bifurcations, especially in the aneurysms where the bifurcating branches emanate directly from the base of the aneurysm, have been particularly difficult on which to perform endovascular treatment. The 'Y'-configuration, double stent-assisted coil embolization is an option for the treatment of these difficult aneurysms, allowing the closure of the aneurysm, preserving the parent arteries. Material and methods In a nine-year period, 546 intracranial aneurysms in 493 patients were treated at our center by endovascular approach. We have reviewed the medical records and arteriographies from November 2007 to January 2017 of 45 patients who were treated using 'Y'-configuration double Neuroform® stent-assisted coil embolization. Results All patients were successfully treated. The location of the aneurysms were: middle cerebral artery (MCA) 20 (44.4%), anterior communicating artery (AComA) 17 (37.7%), basilar four (8.9%), internal carotid artery (ICA) bifurcation three (6.6%) and posterior communicating artery (PComA) one (2.2%). The mRS at hospital discharge was: mRS 0: 42 (93.3%), mRS 1: 1 (2.2%), mRS 2: 1 (2.2%) and mRS 5: 1 (2.2%). The Modified Raymond-Roy Occlusion Classification, in the control at six months, was: Class I: 41 (91.1%), Class II: 2 (4.4%), Class IIIa: 1 (2.2%) and Class IIIb: 1 (2.2%). Forty-four (97.8%) patients had a good outcome (mRS < 2) at six months. One (2.2%) patient had a poor outcome (mRS > 2) at six months that was due to sequelae of SAH. There was no mortality at six months. Conclusions This technique is safe and effective for the endovascular treatment of difficult wide-neck bifurcation aneurysms, allowing the stable closure of the aneurysm, preserving the parent arteries.
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Affiliation(s)
- C Castaño
- 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Spain
| | - M Terceño
- 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Spain
| | - S Remollo
- 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Spain
| | - M R García-Sort
- 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Spain
| | - C Domínguez
- 2 Neurosurgery Department, Hospital Universitario Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Spain
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Castaño C, Remollo S, García-Sort R, Domínguez C, Terceño M. Treatment of Barrow type 'B' carotid cavernous fistulas with flow diverter stent (Pipeline). Neuroradiol J 2017; 30:607-614. [PMID: 28374616 DOI: 10.1177/1971400917695319] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Carotid cavernous fistulas (CCFs) Barrow type 'B' are dural shunts between the meningeal branches of the internal carotid artery and the cavernous sinus. The symptoms include vision deterioration, ophthalmoplegia with diplopia, exophthalmos, conjunctival injection, chemosis, ocular bruit, seizures, or neurological deficit. Endovascular treatment remains the gold standard for treatment through the transvenous or transarterial routes. The transvenous approaches have been proved to be the first option. Endovascular access through the superior ophthalmic vein (SOV) or inferior petrosal sinus have been widely used. The problem arises when there is no vascular access. For these cases, different approaches have been described, such as: direct access to the SOV; combining direct access to the SOV along with blind probing of the proximal occluded SOV; and a direct puncture of the cavernous sinus. But these techniques are very aggressive and can cause serious complications. As a result of the above, we describe a new alternative technique, which is effective and less invasive for the treatment of these special cases. Case reports We report two cases of Barrow type 'B' CCFs that did not have vascular access (neither arterial nor venous) to embolise fistulas with coils or glue, and which were successfully resolved with a flow diverter (Pipeline) stent in the internal carotid artery. To our knowledge, this treatment has not previously been described for this pathology. Conclusions The placement of a flow diverter stent in the internal carotid artery is an effective alternative technique in those cases of Barrow type 'B' CCFs that have no vascular access (neither venous nor arterial).
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Affiliation(s)
- Carlos Castaño
- 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Spain
| | - Sebastián Remollo
- 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Spain
| | - Rosa García-Sort
- 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Spain
| | - Carlos Domínguez
- 2 Neurosurgery Department, Hospital Universitario Germans Trias i Pujol, Spain
| | - Mikel Terceño
- 1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Spain
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Bustamante A, Terceño M, Giralt D, van Eendenburg C, López-Cancio E, Cardona P, García-Berrocoso T, Canovas D, Garces M, Rubiera M, Baldrich E, Castellanos M, Serena J, Dávalos A, Montaner J. Abstract 42: Blood Biomarkers Refect Tissue Viability in Acute Ischemic Stroke. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Assessment of tissue viability, usually performed by multimodal neuroimaging, allows the use of reperfusion therapies in selected patients, even out of the therapeutic time-window. However, multimodal imaging is still a scarce and expensive tool. The availability of blood biomarkers reflecting tissue viability could be a useful tool to manage reperfusion therapies. We aimed to test whether selected candidate biomarkers may reflect tissue viability in relation to Alberta Stroke Program Early CT score (ASPECTS) and multimodal imaging.
Methods:
The StrokeChip was a prospective, observational study, conducted at six Hospitals in Catalonia. Patients with suspected stroke were enrolled at Emergency Departments. Blood samples were obtained within the first six hours after symptoms onset to measure a 21-biomarker panel. Acute brain neuroimaging was dichotomized into normal (ASPECTS=10) or pathological (ASPECTS<10). For those patients with perfusion imaging, comparison was performed between patients with and without significant mismatch (>20%).
Results:
From August-2012 to December-2013, 941 out of 1308 patients were ischemic strokes. ASPECTS was obtained in admission neuroimaging in 927 patients. Among them, 25% displayed pathological neuroimaging. Levels of Apo-CIII disclosed a positive correlation with ASPECTS, while negative correlations were found for D-dimer, IL-6, GroA, NT-proBNP and IGFBP-3. In logistic regression analysis, Apo-CIII [OR=0.52(0.36-0.75)], D-dimer [OR=2.47(1.39-4.39)] and IGFBP-3 [OR=2.28(1.51-3.43)] were independently associated with ASPECTS <10, after adjustment by age, sex and NIHSS. Moreover, in 103 patients with baseline perfusion imaging (70% with mismatch >20%), Apo-CIII was an independent predictor of the presence of mismatch after adjustment by age, sex and NIHSS [OR=0.27(0.10-0.75)].
Conclusions:
Assessment of tissue viability with blood biomarkers seems feasible. Apo-CIII might represent a surrogate marker for tissue viability assessment.
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Affiliation(s)
- Alejandro Bustamante
- Neurovascular Rsch Laboratory, Institut de Recerca, Hosp Universitari Vall d’Hebron, Barcelona, Spain
| | - Mikel Terceño
- Stroke Unit, Hosp Universitari Josep Trueta, Girona, Spain
| | - Dolors Giralt
- Neurovascular Rsch Laboratory, Institut de Recerca, Hosp Universitari Vall d’Hebron, Barcelona, Spain
| | | | - Elena López-Cancio
- Stroke Unit, Hosp Universitari Germans Trias i Pujol, Barcelona, Barcelona, Spain
| | - Pere Cardona
- Stroke Unit, Hosp Universitari de Bellvitge, Barcelona, Barcelona, Spain
| | - Teresa García-Berrocoso
- Neurovascular Rsch Laboratory, Institut de Recerca, Hosp Universitari Vall d’Hebron, Barcelona, Spain
| | | | - Moises Garces
- Stroke Unit, Hosp Universitari Verge de la Cinta de Tortosa, Tortosa, Spain
| | - Marta Rubiera
- Stroke Unit, Hosp Universitari Vall d’Hebron, Barcelona, Spain
| | - Eva Baldrich
- Nanotechnology and Nanomedicine, Institut de Recerca, Hosp Universitari Vall d’Hebron, Barcelona, Spain
| | | | - Joaquín Serena
- Neurovascular Rsch Laboratory, Hosp Universitari Josep Trueta, Girona, Spain
| | - Antoni Dávalos
- Stroke Unit, Hosp Universitari Germans Trias i Pujol, Barcelona, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Rsch Laboratory, Institut de Recerca, Hosp Universitari Vall d’Hebron, Barcelona, Spain
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Bustamante A, López-Cancio E, Giralt D, Cardona P, García-Berrocoso T, Canovas D, Garces M, Terceño M, Serena J, Baldrich E, Rubiera M, Dávalos A, Montaner J. Abstract 67: Blood Biomarkers for Prediction of Cardiac Complications in the Stroke Unit. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Cardiac complications such as acute coronary syndrome (ACS) or acute congestive heart failure (ACHF) account for 2-6%of mortality after stroke. Early detection of the patients at the highest risk to suffer from cardiac complications could be of interest to indicate a closer monitoring or therapeutic measures. We aimed to test whether a panel of blood biomarkers could predict the development of cardiac complications during stroke unit admission.
Methods:
The StrokeChip was a prospective, observational study, conducted at six Hospitals in Catalonia. Patients with suspected stroke were enrolled at Emergency Departments. Blood samples were obtained within the first six hours after symptom onset to measure a 21-biomarker panel. In-hospital development of cardiac complications (ACS and ACHF) was recorded. The association between the measured biomarkers and the development of complications was assessed by logistic regression analysis.
Results:
From August-2012 to December-2013, 941 out of 1308 patients enrolled were ischemic strokes. Cardiac complications were developed by 25 patients, including 19 ACHF and six cases of ACS. Due to the small number of ACS, just ACHF were further analyzed. Patients with ACHF had higher baseline levels of D-dimer, endostatin, VAP-1, NT-proBNP, FasL and vWF, and lower levels of IGFBP-3. After logistic regression analysis, NT-proBNP [OR=3.56(1.17-10.84)], FasL [OR=4.94(1.60-15.26)], VAP-1 [OR=6.56(2.21-19.46)] and IGFBP-3 [OR=0.21(0.07-0.67)] were independently associated with ACHF after adjustment by clinical predictors such as stroke severity, previous disability or history of coronary disease. Addition of the biomarker panel over clinical predictors resulted in improved accuracy (AUC from 0.808 to 0.925, p=0.05).
Conclusions:
Baseline measurement of blood biomarkers in acute stroke could be useful to predict the development of cardiac complications during stroke unit admission.
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Affiliation(s)
- Alejandro Bustamante
- Neurovascular Rsch Laboratory, Institut de Recerca, Hosp Universitari Vall d’Hebron, Barcelona, Spain
| | - Elena López-Cancio
- Stroke Unit,, Hosp Universitari Germans Trias i Pujol, Barcelona, Barcelona, Spain
| | - Dolors Giralt
- Neurovascular Rsch Laboratory, Institut de Recerca, Hosp Universitari Vall d’Hebron, Barcelona, Spain
| | - Pere Cardona
- Stroke Unit, Hosp Universitari de Bellvitge, Barcelona, Barcelona, Spain
| | - Teresa García-Berrocoso
- Neurovascular Rsch Laboratory, Institut de Recerca, Hosp Universitari Vall d’Hebron, Barcelona, Spain
| | | | - Moises Garces
- Stroke Unit, Hosp Universitari Verge de la Cinta de Tortosa, Tortosa, Spain
| | - Mikel Terceño
- Stroke Unit, Hosp Universitari Josep Trueta, Girona, Spain
| | - Joaquín Serena
- Stroke Unit, Hosp Universitari Josep Trueta, Girona, Spain
| | - Eva Baldrich
- Nanotechnology and Nanomedicine, Institut de Recerca, Hosp Universitari Vall d’Hebron, Barcelona, Spain
| | - Marta Rubiera
- Stroke Unit, Hosp Universitari Vall d’Hebron, Barcelona, Spain
| | - Antoni Dávalos
- Stroke Unit, Hosp Universitari Germans Trias i Pujol, Barcelona, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Rsch Laboratory, Institut de Recerca, Hosp Universitari Vall d’Hebron, Barcelona, Spain
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Terceño M, Serena J, Bragado I, Silva Y. Contrast extravasation through MRI precedes cerebral hemorrhage in a patient with eclampsia. Neurol Sci 2016; 38:693-694. [PMID: 27885447 DOI: 10.1007/s10072-016-2781-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Mikel Terceño
- Department of Neurology, Doctor Josep Trueta Hospital, IDIBGI, Av de França s/n, 17007, Girona, Spain.
| | - Joaquín Serena
- Department of Neurology, Doctor Josep Trueta Hospital, IDIBGI, Av de França s/n, 17007, Girona, Spain
| | - Irene Bragado
- Department of Neurology, Doctor Josep Trueta Hospital, IDIBGI, Av de França s/n, 17007, Girona, Spain
| | - Yolanda Silva
- Department of Neurology, Doctor Josep Trueta Hospital, IDIBGI, Av de França s/n, 17007, Girona, Spain
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Castellanos M, van Eendenburg C, Sobrino T, Puig J, Blasco G, García-Yébenes I, Lizasoain I, Silva Y, Terceño M, Castillo J, Serena J. Abstract W MP26: Blood Brain Barrier Permeability and Neurovascular Unit Markers of Hemorrhagic Transformation After Rt-pa Administration. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.wmp26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:
The administration of rt-PA increases the risk of hemorrhagic transformation (HT) due to an increase in the permeability of the neurovascular unit which allows the extravasation of erythrocytes. In this study we compared the predictive capacity of different neurovascular unit components and their correlation with blood brain barrier (BBB) permeability abnormalities evaluated by advanced neuroimaging.
Patients and methods:
Eighty-three patients with hemispheric stroke treated with rt-PA who had angio-CT perfusion before fibrinolysis were evaluated. Lesion volumes were calculated on perfusion and permeability maps. HT was assessed in the cranial CT at 24±12h after rt-PA and classified following ECASS II criteria. HT was considered symptomatic (sHT) when it was associated with an increase ≥ 4 points in the NIHSS. The levels of cellular-fibronectin (cFn), total MMP-9, laminin, heparan-sulphate, collagen type IV and protein S100β pre-rtPA and at 2, 24 and 72h post-rtPA were analyzed.
Results:
Fourteen patients (16.8%) had HT, which was symptomatic in 3 (3.6%). On comparing patients with and without HT independently of the type, only MMP-9 and protein S100β levels at 24h were found to be higher in the HT group. However, baseline cFn levels were higher in patients with PH2 (12.5±5.6 vs. 6.6±3.8μg/mL, p=0.013) and sHT (13.8±6.7 vs. 6.7± 3.9μg/mL, p=0.003) and laminin levels were also lower in patients with PH2 (1.5±0.8 vs. 3.5±2.5ng/mL, p=0.016). In the multivariate analysis, only cFn levels remained as an independent predictor of sHT (OR 1.40;CI 95%, 1.02-1.93; p=0.037). The analysis of the permeability maps yielded cut-off values for the prediction of HT with high specificity and negative predictive values regardless of the threshold used for visualization of the abnormal permeability area.
Conclusions:
Among different neurovascular unit markers, this study seems to confirm the utility of cFn levels as potential predictors of sHT after rt-PA. Permeability maps would seem to predict the likelihood of not bleeding with high probability.
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Affiliation(s)
- Mar Castellanos
- Neurology, Hosp Dr. Josep Trueta of Girona/Girona Biomedical Rsch Institute, Girona, Spain
| | - Cecile van Eendenburg
- Neurology, Hosp Dr. Josep Trueta of Girona/Girona Biomedical Rsch Institute, Girona, Spain
| | - Tomás Sobrino
- Neurology, Hosp Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Josep Puig
- Radiology, Hosp Dr. Josep Trueta of Girona/Girona Biomedical Rsch Institute, Girona, Spain
| | - Gerard Blasco
- Neurology, Hosp Dr. Josep Trueta of Girona/Girona Biomedical Rsch Institute, Girona, Spain
| | | | | | - Yolanda Silva
- Neurology, Hosp Dr. Josep Trueta of Girona/Girona Biomedical Rsch Institute, Girona, Spain
| | - Mikel Terceño
- Neurology, Hosp Dr. Josep Trueta of Girona/Girona Biomedical Rsch Institute, Girona, Spain
| | - José Castillo
- Neurology, Hosp Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Joaquín Serena
- Neurology, Hosp Dr. Josep Trueta of Girona/Girona Biomedical Rsch Institute, Girona, Spain
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van Eendenburg C, Puig J, Blasco G, Serena J, Pedraza S, Silva Y, Terceño M, Castellanos M. Abstract 186: Poor Leptomeningeal Collateral Circulation Baseline Status Is a Predictor of Malignant Infarction in Patients Treated With tPA. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Malignant infarction (MI) is a life-threatening complication in patients with hemispheric stroke. Although few biochemical and neuroimaging markers have been published to be useful for the prediction of MI development, information about predictors of this complication is scarce. Leptomeningeal collateral circulation (LMC) has been associated in few studies with poor clinical outcome and infarct growth in patients with acute ischemic stroke, but no data have been reported about the possible association about LMC and MI. In this study, we investigated wether LMC baseline status can be a predictor of MI in patients treated with tissue plasminogen activator (tPA).
Methods:
One hundred and thirty-six patients with hemispheric stroke treated with tPA and angio-CT perfusion before tPA administration were evaluated. MI was diagnosed following Schwab et al. criteria (complete space-occupying MCA infarction with midline shift and compression of the basal cisterns on follow-up CT and further neurological deterioration consisting of a decrease in the level of consciousness to somnolence or stupor compared with baseline clinical status at admission). ASPECTS score was evaluated on CT at admission. LMC baseline status was also scored on CT angiography maps before tPA and classified as good or poor according to Tan et al. criteria and Lima et al. criteria
Results:
Sixty-six patients (48.2%) had good LMC and 70 patients (51.1%) had poor LMC, regardless of the classification used. Patients with poor LMC had a significantly higher NIHSS at admission and ASPECTS score < 7 was also found more frequently in this group. With regards to LMC, 14 patients (93%) developed MI in the group with poor LMC whereas just 1 patient (6.7%) had MI in the group with good LMC (p<0.001). In the multivariate analysis, only poor LMC at admission remained as an independent predictor of this complication (OR 12.8; CI 95%, 1.58-104.13; p=0.017).
Conclusions:
Poor LMC at admission is a predictor of MI in patients treated with tPA and, so this neuroimaging finding might be useful to identify those patients at higher risk to develop this fatal complication.
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Affiliation(s)
- Cecile van Eendenburg
- Neurology, Hosp Dr. Josep Trueta of Girona. Girona Biomedical Rsch Institute, Girona, Spain
| | - Josep Puig
- Neurology, Radiological Dept, Hosp Dr. Josep Trueta. Girona Biomedical Rsch Institute, Girona, Spain
| | - Gerard Blasco
- Radiology, Radiological Dept, Hosp Dr. Josep Trueta. Girona Biomedical Rsch Institute, Girona, Spain
| | - Joaquín Serena
- Neurology, Hosp Dr. Josep Trueta of Girona. Girona Biomedical Rsch Institute, Girona, Spain
| | - Salvador Pedraza
- Radiology, Hosp Dr. Josep Trueta of Girona. Girona Biomedical Rsch Institute, Girona, Spain
| | - Yolanda Silva
- Neurology, Hosp Dr. Josep Trueta of Girona. Girona Biomedical Rsch Institute, Girona, Spain
| | - Mikel Terceño
- Neurology, Hosp Dr. Josep Trueta of Girona. Girona Biomedical Rsch Institute, Girona, Spain
| | - Mar Castellanos
- Neurology, Hosp Dr. Josep Trueta of Girona. Girona Biomedical Rsch Institute, Girona, Spain
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van Eendenburg C, Serena J, Silva Y, Terceño M, Puig J, Blasco G, Pedraza S, Kazimierczak M, Castellanos M. Abstract T P65: Prior Stroke but Not Diabetes Mellitus Is Associated with Symptomatic Intracranial Hemorrhage after Rt-PA Administration. Stroke 2014. [DOI: 10.1161/str.45.suppl_1.tp65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The European drug license for rt-PA considers diabetes plus previous stroke as an exclusion criterion for the administration of the treatment due to an increased risk of symptomatic intracranial hemorrhage (SICH). However, given that data from different studies have not confirmed this association, we were interested in analyzing whether the presence of these pathologies was associated with the development of SICH in our population of rt-PA-treated patients.
Patients and methods:
For the purpose of this study, we evaluated 667 patients treated with rt-PA at our center between October 1999 and December 2012. The existence of bleeding was assessed in the cranial CT performed at 24±12 h after rt-PA administration and was considered to be symptomatic when it was associated with neurological deterioration, which was defined as an increase ≥4 points in the NIHSS. Previous history of diabetes and stroke was collected from all patients.
Results:
176 (26.4%) had hemorrhagic transformation (HT), which was symptomatic in 30 cases (4.5%). In the univariate analysis, neither diabetes and previous stroke together, nor alone, were associated with HT. However, previous stroke (10% vs. 4%, p=0.028) but not diabetes or both, was associated with SICH. After adjustment for the rest of the variables associated with the development of SICH, only the history of prior stroke remained as an independent predictor of this complication (OR 4.3;CI 95%, 1.12-16.19; p=0.03).
Conclusions:
In our large cohort of patients treated with rt-PA, only a prior history of stroke predicted the development of SICH. No association was found with diabetes.
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Affiliation(s)
- Cecile van Eendenburg
- Neurology, Dr. Josep Trueta Univ Hosp of Girona/Biomedical Rsch Institute of Girona, Girona, Spain
| | - Joaquín Serena
- Neurology, Dr. Josep Trueta Univ Hosp of Girona/Biomedical Rsch Institute of Girona, Girona, Spain
| | - Yolanda Silva
- Neurology, Dr. Josep Trueta Univ Hosp of Girona/Biomedical Rsch Institute of Girona, Girona, Spain
| | - Mikel Terceño
- Neurology, Dr. Josep Trueta Univ Hosp of Girona/Biomedical Rsch Institute of Girona, Girona, Spain
| | - Josep Puig
- Radiology, Dr. Josep Trueta Univ Hosp of Girona/Biomedical Rsch Institute of Girona, Girona, Spain
| | - Gerard Blasco
- Radiology, Dr. Josep Trueta Univ Hosp of Girona/Biomedical Rsch Institute of Girona, Girona, Spain
| | - Salvador Pedraza
- Radiology, Dr. Josep Trueta Univ Hosp of Girona/Biomedical Rsch Institute of Girona, Girona, Spain
| | - Martha Kazimierczak
- Neurology, Dr. Josep Trueta Univ Hosp of Girona/Biomedical Rsch Institute of Girona, Girona, Spain
| | - Mar Castellanos
- Neurology, Dr. Josep Trueta Univ Hosp of Girona/Biomedical Rsch Institute of Girona, Girona, Spain
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