1
|
Vera A, Cecconi A, Ximénez-Carrillo Á, Ramos C, Martínez-Vives P, Lopez-Melgar B, Sanz-García A, Ortega G, Aguirre C, Montes Á, Vivancos J, Jiménez-Borreguero LJ, Alfonso F. Left Atrial Strain Predicts Stroke Recurrence and Death in Patients With Cryptogenic Stroke. Am J Cardiol 2024; 210:51-57. [PMID: 37898159 DOI: 10.1016/j.amjcard.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/24/2023] [Accepted: 10/01/2023] [Indexed: 10/30/2023]
Abstract
Left atrial strain (LAS) has been widely studied as a predictor of atrial fibrillation (AF) after cryptogenic stroke (CS). However, the evidence about its prognostic role in terms of stroke recurrence and death in this setting remains scarce. A total of 92 consecutive patients with ischemic stroke or transient ischemic attack with ABCD2 scale ≥4 of unknown etiology were prospectively recruited. Echocardiography, including LAS was performed during admission. The primary outcome measure was the composite of stroke recurrence or death. The mean age was 77.5 ± 7.7, and 58% of patients were female. After a median follow up of 28 months, the primary outcome measure occurred in 15 patients (16%). The primary outcome was more frequent in patients with diabetes (53% vs 21%, p = 0.02), chronic kidney disease (33% vs 10%, p = 0.034), and a history of heart failure (13% vs 0%, p = 0.025). LAS reservoir (LASr) and LAS conduit (LAScd) were lower in patients developing the primary outcome (21% ± 7% vs 28.8% ± 11%, p = 0.017 and 7.7% ± 3.9% vs 13.7% ± 7%, p = 0.007, respectively). On multivariate analysis, LASr (hazard ratio 0.9, 95% confidence interval 0.85 to 0.99, p = 0.048) and diabetes (hazard ratio 3.3, 95% confidence interval 1.03 to 10.4, p = 0.045) were associated with stroke recurrence or all-cause death after CS. On the log-rank test (using the discriminatory cut-off value of LASr <23%), LASr (p = 0.009) was associated with higher risk of the primary outcome. In conclusion, lower values of the LAS reservoir were associated with a higher risk of stroke recurrence or death after CS. LAS may identify patients at higher risk of thromboembolism and stress conditions.
Collapse
Affiliation(s)
- Alberto Vera
- Cardiology Department, La Princesa University Hospital, Autonomous University of Madrid, IIS-IP, CIBER-CV, Madrid, Spain
| | - Alberto Cecconi
- Cardiology Department, La Princesa University Hospital, Autonomous University of Madrid, IIS-IP, CIBER-CV, Madrid, Spain.
| | - Álvaro Ximénez-Carrillo
- Stroke Center, Neurology Department, La Princesa University Hospital, Autonomous University of Madrid, IIS-IP, Madrid, Spain
| | - Carmen Ramos
- Stroke Center, Neurology Department, La Princesa University Hospital, Autonomous University of Madrid, IIS-IP, Madrid, Spain
| | - Pablo Martínez-Vives
- Cardiology Department, La Princesa University Hospital, Autonomous University of Madrid, IIS-IP, CIBER-CV, Madrid, Spain
| | - Beatriz Lopez-Melgar
- Cardiology Department, La Princesa University Hospital, Autonomous University of Madrid, IIS-IP, CIBER-CV, Madrid, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, Castilla la Mancha University, Talavera de la Reina, Spain
| | - Guillermo Ortega
- Data Analysis Unit, Health Research Institute, La Princesa University Hospital, Madrid, Spain
| | - Clara Aguirre
- Stroke Center, Neurology Department, La Princesa University Hospital, Autonomous University of Madrid, IIS-IP, Madrid, Spain
| | - Álvaro Montes
- Cardiology Department, La Princesa University Hospital, Autonomous University of Madrid, IIS-IP, CIBER-CV, Madrid, Spain
| | - José Vivancos
- Stroke Center, Neurology Department, La Princesa University Hospital, Autonomous University of Madrid, IIS-IP, Madrid, Spain
| | - Luis Jesús Jiménez-Borreguero
- Cardiology Department, La Princesa University Hospital, Autonomous University of Madrid, IIS-IP, CIBER-CV, Madrid, Spain
| | - Fernando Alfonso
- Cardiology Department, La Princesa University Hospital, Autonomous University of Madrid, IIS-IP, CIBER-CV, Madrid, Spain
| |
Collapse
|
2
|
Vera A, Cecconi A, Ximénez-Carrillo Á, Ramos C, Martínez-Vives P, Lopez-Melgar B, Sanz-García A, Ortega G, Aguirre C, Montes Á, Vivancos J, Jiménez-Borreguero LJ, Alfonso F. Risk of recurrent stroke and mortality after cryptogenic stroke in diabetic patients. Heart Vessels 2023; 38:817-824. [PMID: 36695856 DOI: 10.1007/s00380-023-02235-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Diabetes mellitus is a highly prevalent and growing chronic disease that is associated with increased risk of recurrence among several stroke subtypes. However, evidence on the prognostic role of diabetes in the setting of cryptogenic stroke (CS) remains scarce. METHODS From April 2019 to November 2021, we recruited prospectively 78 consecutive patients with CS. Patients were classified according to the presence of diabetes. Main outcome was the composite of stroke recurrence and death. Secondary outcome was stroke recurrence. RESULTS Mean age of the cohort was 78 ± 7.7 years and 18 patients (23%) had diabetes. After a median clinical follow-up of 23 months the incidence of stroke recurrence and mortality [HR 5.8 (95% CI 1.9-19), p = 0.002] and the incidence of stroke recurrence [HR 16.6 (95% CI 1.8-149), p = 0.012], were higher in patients with diabetes. After adjusting for potential confounders diabetes was identified as an independent predictor of stroke recurrence and death in patients with CS [HR 33.8 (95% CI 2.1-551), p = 0.013]. Other independent predictors of stroke recurrence and mortality were hypertension [HR 31.4 (95% CI 1.8-550), p = 0.018], NTproBNP [HR 1.002 (95% CI 1.001-1.004), p = 0.013] and chronic kidney disease (CKD) [HR 27.4 (95% CI 1.4-549) p = 0.03]. Furthermore, diabetes was an independent predictor of stroke recurrence [HR 103 (95% CI 1.3-8261), p = 0.038]. CONCLUSION Diabetic patients with CS are at higher risk of stroke recurrence and death. Hypertension CKD and NTproBNP are also independent predictors of stroke recurrence and death after CS.
Collapse
Affiliation(s)
- Alberto Vera
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, c/Diego de León 62, 28006, Madrid, Spain
| | - Alberto Cecconi
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, c/Diego de León 62, 28006, Madrid, Spain.
| | - Álvaro Ximénez-Carrillo
- Stroke Center, Neurology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carmen Ramos
- Stroke Center, Neurology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Pablo Martínez-Vives
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, c/Diego de León 62, 28006, Madrid, Spain
| | - Beatriz Lopez-Melgar
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, c/Diego de León 62, 28006, Madrid, Spain
| | - Ancor Sanz-García
- Data Analysis Unit, Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa, Madrid, Spain
| | - Guillermo Ortega
- Data Analysis Unit, Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa, Madrid, Spain
| | - Clara Aguirre
- Stroke Center, Neurology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Álvaro Montes
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, c/Diego de León 62, 28006, Madrid, Spain
| | - José Vivancos
- Stroke Center, Neurology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Luis Jesús Jiménez-Borreguero
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, c/Diego de León 62, 28006, Madrid, Spain.
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, c/Diego de León 62, 28006, Madrid, Spain
| | | |
Collapse
|
3
|
Aguirre C, Trillo S, Ramos C, Zapata-Wainberg G, Sanz-García A, Ximénez-Carrillo Á, Barbosa A, Caniego JL, Vivancos J. Predictive value of ischemia location on multimodal CT in thrombectomy-treated patients. Neuroradiol J 2022:19714009221128658. [DOI: 10.1177/19714009221128658] [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] Open
Abstract
Objective Alberta Stroke Program Early CT Score (ASPECTS) applied to CT-perfusion (CTP) and CT-angiography-source-images (CTA-SI) may improve outcome prediction in large vessel occlusion (LVO) stroke if compared to non-contrast CT (NCCT) alone. Besides, ischemia location may have enhanced capabilities, compared to ischemia volume alone, in predicting stroke outcomes. We aim to evaluate the association between ischemia location as measured by ASPECTS regions in NCCT, CTP maps and CTA-SI and 3 months outcome in patients with LVO treated with mechanical thrombectomy (MT). Material and methods Consecutive patients with anterior circulation stroke treated with MT were recorded in a prospectively maintained database at a single center. Modified Rankin scale (mRS) at 3 months >2 was considered a poor outcome. Association of patients’ characteristics, NCCT, CTP, and CTA-SI parameters with outcome was evaluated using single-variable analysis and binary logistic regression multivariate analysis for each imaging technique. Results 177 patients were included. 115 (65%) patients reached a favorable outcome. The involvement of lenticular, caudate, M1, or M2 in all imaging techniques, insula in NCCT and CTA-SI and M5 in CBV maps and CTA-SI was related to functional outcome in bivariate analysis. However, in the multivariate analysis, none ischemia location was independently related to outcome, no matter the imaging technique studied. This finding remained unchanged when restricted to patients with good recanalization and when analyzing subpopulations according to hemisphere involvement or territories association. Conclusions Our study suggests ischemia location shouldn’t be used solely for decision-making in LVO stroke patients. Its predictive value may be taken in consideration together with other clinical and radiological variables.
Collapse
Affiliation(s)
- Clara Aguirre
- Stroke Center, Neurology Department, Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa, Madrid, Spain
| | - Santiago Trillo
- Stroke Center, Neurology Department, Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa, Madrid, Spain
| | - Carmen Ramos
- Stroke Center, Neurology Department, Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa, Madrid, Spain
| | - Gustavo Zapata-Wainberg
- Stroke Center, Neurology Department, Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa, Madrid, Spain
| | - Ancor Sanz-García
- Data Analysis Unit, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | - Álvaro Ximénez-Carrillo
- Stroke Center, Neurology Department, Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa, Madrid, Spain
| | - Antonio Barbosa
- Neuroradiology Department, Hospital Universitario de La Princesa., Madrid, Spain
| | - José L Caniego
- Neuroradiology Department, Hospital Universitario de La Princesa., Madrid, Spain
| | - José Vivancos
- Stroke Center, Neurology Department, Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa, Madrid, Spain
| |
Collapse
|
4
|
Ximénez-Carrillo Á, Zapata-Wainberg G, Sastre R, Álvarez-Pasquín MJ, Javierre AP, Lozano T, Samir E, Perosanz L, González B, Sobrado M, Vivancos J. Detection of hidden atrial fibrillation in primary care using a long-term band-based ECG registration system: The DESCUUBRE-FA study. J Stroke Cerebrovasc Dis 2022; 31:106642. [PMID: 35863263 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106642] [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: 03/01/2022] [Revised: 06/14/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To assess whether the use of a band-based electrocardiographic (ECG) monitoring system improves the diagnostic accuracy of traditional diagnostic methods for the detection of atrial fibrillation (AF). METHODS Multicenter and observational study of primary care patients at risk of AF. To be included, patients had to be aged ≥70 years, with no known AF, and have at least 1 major criterion (obesity, hyperthyroidism, heart failure) or 2 minor criteria (hypertension, diabetes, female sex, ischemic stroke, transient ischemic attack or systemic embolism, COPD, dyslipidemia, ischemic heart disease, peripheral artery disease). All patients were monitored using the Nuubo™ system for a single 2-week period. RESULTS A total of 600 patients were included (median age 77 years; 70% women; 84.3% hypertension, 27.2% diabetes, 9.2% prior stroke). The global rate of diagnosis of new AF in the overall population was 2.83%. All patients with AF were anticoagulated. In numerical terms, patients with AF (vs no AF) had a higher number of supraventricular extrasystoles and episodes of supraventricular tachycardia, as well as longer P wave duration; however, these differences did not reach statistical significance. Overall, participants were very satisfied with the device, and no relevant limitations in daily activities were observed during the 2-week study period. CONCLUSIONS In an elderly population at risk of AF, a band-based ECG monitoring approach applied for only 2 weeks detected approximately 3% of new cases of AF, leading to a change in antithrombotic therapy. Most participants considered the device easy to use and comfortable.
Collapse
Affiliation(s)
- Álvaro Ximénez-Carrillo
- Stroke Center, Neurology Department, La Princesa Health Research Institute, University Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Gustavo Zapata-Wainberg
- Stroke Center, Neurology Department, La Princesa Health Research Institute, University Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rocío Sastre
- Primary Care University Center Santa Hortensia, Madrid, Spain
| | | | | | | | - Eva Samir
- Primary Care University Center Canal de Panamá, Madrid, Spain
| | - Lara Perosanz
- Primary Care University Center Ciudad Jardín, Madrid, Spain
| | - Beatriz González
- Stroke Center, Neurology Department, La Princesa Health Research Institute, University Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Mónica Sobrado
- Stroke Center, Neurology Department, La Princesa Health Research Institute, University Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - José Vivancos
- Stroke Center, Neurology Department, La Princesa Health Research Institute, University Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
5
|
Vera A, Cecconi A, Ximénez-Carrillo Á, Ramos C, Martínez-Vives P, Lopez-Melgar B, Sanz-García A, Ortega G, Aguirre C, Vivancos J, Jiménez-Borreguero LJ, Alfonso F. A Comprehensive Model to Predict Atrial Fibrillation in Cryptogenic Stroke: The Decryptoring Score. J Stroke Cerebrovasc Dis 2021; 31:106161. [PMID: 34689053 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106161] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 12/18/2022] Open
Abstract
OBJETIVE Cryptogenic stroke (CS) represents up to 30% of ischemic strokes (IS). Since atrial fibrillation (AF) can be detected in up to 30% of CS, there is a clinical need for estimating the probability of underlying AF in CS to guide the optimal secondary prevention strategy. The aim of the study was to develop the first comprehensive predictive score including clinical conditions, biomarkers, and left atrial strain (LAS), to predict AF detection in this setting. METHODS Sixty-three consecutive patients with IS or transient ischemic attack with ABCD2 scale ≥ 4 of unknown etiology were prospectively recruited. Clinical, laboratory, and echocardiographic variables were collected. All patients underwent 15 days wearable Holter-ECG monitoring. Main objective was the Decryptoring score creation to predict AF in CS. Score variables were selected by a univariate analysis and, thereafter, score points were derived according to a multivariant analysis. RESULTS AF was detected in 15 patients (24%). Age > 75 (9 points), hypertension (1 point), Troponin T > 40 ng/L (8.5 points), NTproBNP > 200 pg/ml (0.5 points), LAS reservoir < 25.3% (24.5 points) and LAS conduct < 10.4% (0.5 points) were included in the score. The rate of AF detection was 0% among patients with a score of < 10 and 80% among patients with a score > 35. The comparison of the predictive validity between the proposed score and AF-ESUS score resulted in an AUC of 0.94 for Decryptoring score and of 0.65 for the AF-ESUS score(p < 0.001). CONCLUSION This novel score offers an accurate AF prediction in patients with CS; however these results will require validation in an independent cohort using this model before they may be translated into clinical practice.
Collapse
Affiliation(s)
- Alberto Vera
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP, CIBER-CV, Madrid, Spain.
| | - Alberto Cecconi
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP, CIBER-CV, Madrid, Spain.
| | - Álvaro Ximénez-Carrillo
- Stroke Center, Neurology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. Madrid, Spain.
| | - Carmen Ramos
- Stroke Center, Neurology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. Madrid, Spain.
| | - Pablo Martínez-Vives
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP, CIBER-CV, Madrid, Spain.
| | - Beatriz Lopez-Melgar
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP, CIBER-CV, Madrid, Spain.
| | - Ancor Sanz-García
- Data Analysis Unit, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain.
| | - Guillermo Ortega
- Data Analysis Unit, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain.
| | - Clara Aguirre
- Stroke Center, Neurology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. Madrid, Spain.
| | - José Vivancos
- Stroke Center, Neurology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP. Madrid, Spain.
| | - Luis Jesús Jiménez-Borreguero
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP, CIBER-CV, Madrid, Spain.
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP, CIBER-CV, Madrid, Spain.
| | | |
Collapse
|
6
|
Rodríguez-Pardo J, Gilo-Arrojo F, Ruiz-Ares G, Sánchez-Manso JC, Valiente-Gordillo E, de Celis E, Fuentes B, Ximénez-Carrillo Á, Alonso de Leciñana M, Rigual R, Vivancos-Mora J, Díez-Tejedor E. Thrombosis and Thrombocytopenia Syndrome Causing Isolated Symptomatic Carotid Occlusion after Covid-19 Vaccine. Thromb Haemost 2021; 122:300-303. [PMID: 34670287 DOI: 10.1055/a-1674-0341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Jorge Rodríguez-Pardo
- Department of Neurology, Hospital La Paz Institute for Health Research - IdIPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Francisco Gilo-Arrojo
- Department of Neurology, La Princesa University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Gerardo Ruiz-Ares
- Department of Neurology, Hospital La Paz Institute for Health Research - IdIPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Juan Carlos Sánchez-Manso
- Department of Neurology, Hospital La Paz Institute for Health Research - IdIPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Esther Valiente-Gordillo
- Department of Neurology, La Princesa University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena de Celis
- Department of Neurology, Hospital La Paz Institute for Health Research - IdIPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Blanca Fuentes
- Department of Neurology, Hospital La Paz Institute for Health Research - IdIPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Álvaro Ximénez-Carrillo
- Department of Neurology, La Princesa University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Alonso de Leciñana
- Department of Neurology, Hospital La Paz Institute for Health Research - IdIPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Ricardo Rigual
- Department of Neurology, Hospital La Paz Institute for Health Research - IdIPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - José Vivancos-Mora
- Department of Neurology, La Princesa University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Exuperio Díez-Tejedor
- Department of Neurology, Hospital La Paz Institute for Health Research - IdIPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| |
Collapse
|
7
|
Fuentes B, Alonso de Leciñana M, Rigual R, García-Madrona S, Díaz-Otero F, Aguirre C, Calleja P, Egido-Herrero JA, Carneado-Ruiz J, Ruiz-Ares G, Rodríguez-Pardo J, Rodríguez-López Á, Ximénez-Carrillo Á, de Felipe A, Ostos F, González-Ortega G, Simal P, Gómez Escalonilla CI, Gómez-Porro-Sánchez P, Cabal-Paz B, Reig G, Gil-Núñez A, Masjuán J, Díez Tejedor E. Fewer COVID-19-associated strokes and reduced severity during the second COVID-19 wave: The Madrid Stroke Network. Eur J Neurol 2021; 28:4078-4089. [PMID: 34528353 PMCID: PMC8653205 DOI: 10.1111/ene.15112] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/01/2021] [Accepted: 09/09/2021] [Indexed: 12/15/2022]
Abstract
Background and purpose The experience gained during the first COVID‐19 wave could have mitigated the negative impact on stroke care in the following waves. Our aims were to analyze the characteristics and outcomes of patients with stroke admitted during the second COVID‐19 wave and to evaluate the differences in the stroke care provision compared with the first wave. Methods This retrospective multicenter cohort study included consecutive stroke patients admitted to any of the seven hospitals with stroke units (SUs) and endovascular treatment facilities in the Madrid Health Region. The characteristics of the stroke patients with or without a COVID‐19 diagnosis were compared and the organizational changes in stroke care between the first wave (25 February to 25 April 2020) and second wave (21 July to 21 November 2020) were analyzed. Results A total of 550 and 1191 stroke patients were admitted during the first and second COVID‐19 waves, respectively, with an average daily admission rate of nine patients in both waves. During the second wave, there was a decrease in stroke severity (median National Institutes of Health Stroke Scale 5 vs. 6; p = 0.000), in‐hospital strokes (3% vs. 8.1%) and in‐hospital mortality (9.9% vs. 15.9%). Furthermore, fewer patients experienced concurrent COVID‐19 (6.8% vs. 19.1%), and they presented milder COVID‐19 and less severe strokes. Fewer hospitals reported a reduction in the number of SU beds or deployment of SU personnel to COVID‐19 dedicated wards during the second wave. Conclusions During the second COVID‐19 wave, fewer stroke patients were diagnosed with COVID‐19, and they had less stroke severity and milder COVID‐19.
Collapse
Affiliation(s)
- Blanca Fuentes
- Department of Neurology and Stroke Center, La Paz University Hospital, Madrid, Spain
| | | | - Ricardo Rigual
- Department of Neurology and Stroke Center, La Paz University Hospital, Madrid, Spain
| | | | - Fernando Díaz-Otero
- Department of Neurology and Stroke Center, University Hospital Gregorio Marañón, Madrid, Spain
| | - Clara Aguirre
- Department of Neurology and Stroke Center, University Hospital La Princesa, Madrid, Spain
| | - Patricia Calleja
- Department of Neurology, University Hospital 12 de octubre, Madrid, Spain
| | | | | | - Gerardo Ruiz-Ares
- Department of Neurology and Stroke Center, La Paz University Hospital, Madrid, Spain
| | - Jorge Rodríguez-Pardo
- Department of Neurology and Stroke Center, La Paz University Hospital, Madrid, Spain
| | - Ángela Rodríguez-López
- Department of Neurology and Stroke Center, University Hospital Gregorio Marañón, Madrid, Spain
| | | | - Alicia de Felipe
- Department of Neurology and Stroke Center, University Hospital Ramón y Cajal, Madrid, Spain
| | - Fernando Ostos
- Department of Neurology, University Hospital 12 de octubre, Madrid, Spain
| | | | - Patricia Simal
- Department of Neurology, University Hospital Clinic San Carlos, Madrid, Spain
| | | | | | - Borja Cabal-Paz
- Department of Neurology, University Hospital Puerta de Hierro, Madrid, Spain
| | - Gemma Reig
- Department of Neurology and Stroke Center, University Hospital La Princesa, Madrid, Spain
| | - Antonio Gil-Núñez
- Department of Neurology and Stroke Center, University Hospital Gregorio Marañón, Madrid, Spain
| | - Jaime Masjuán
- Department of Neurology and Stroke Center, University Hospital Ramón y Cajal, Madrid, Spain
| | - Exuperio Díez Tejedor
- Department of Neurology and Stroke Center, La Paz University Hospital, Madrid, Spain
| |
Collapse
|
8
|
Gonzalez-Martinez A, Trillo S, Benavides-Bernaldo de Quirós C, Casado-Fernández L, De Toledo M, Barbosa-Del Olmo A, Vega Piris L, Ramos C, Manzanares-Soler R, Ximénez-Carrillo Á, Vivancos J. Predictors of perfusion computed tomography alterations in stroke mimics attended as stroke code. Eur J Neurol 2021; 28:1939-1948. [PMID: 33609295 DOI: 10.1111/ene.14783] [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] [Received: 02/01/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Stroke mimics (SMs) account for a significant number of patients attended as stroke code (SC) with an increasing number over the years. Recent studies show perfusion computed tomography (PCT) alterations in some SMs, especially in seizures. The objective of our study was to evaluate the clinical characteristics and PCT alterations in SMs attended as SC in order to identify potential predictors of PCT alterations in SMs. METHODS A retrospective study was performed including all SC activations undergoing a multimodal CT study including non-enhanced computed tomography (CT), CT angiography and PCT, as part of our SC protocol, over 39 months. Patients with a final diagnosis of SM after complete diagnosis work-up were therefore selected. Clinical variables, diagnosis, PCT alteration patterns and type of map affected (Tmax or time to peak, cerebral blood flow and cerebral blood volume) were registered. RESULTS Stroke mimics represent up to 16% (284/1761) of SCs with a complete multimodal study according to our series. Amongst SMs, 26% (74/284) showed PCT alterations. PCT abnormalities are more prevalent in seizures and status epilepticus and the main pattern is alteration of the time to peak map, of unilateral hemispheric distribution or of non-vascular territory. In our series, the independent predictors of alteration in PCT in SMs are aphasia, female sex and older age. CONCLUSIONS Perfusion computed tomography alterations can be found amongst almost a third of SMs attended as SC, especially older women presenting with aphasia with a final diagnosis of epileptic seizures and status epilepticus.
Collapse
Affiliation(s)
- Alicia Gonzalez-Martinez
- Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain
| | - Santiago Trillo
- Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Laura Casado-Fernández
- Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain
| | - María De Toledo
- Epilepsy Unit, Department of Neurology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Antonio Barbosa-Del Olmo
- Neuroradiology Unit, Department of Radiology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Lorena Vega Piris
- Methodological Support Unit, Hospital Universitario de La Princesa, Madrid, Spain
| | - Carmen Ramos
- Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain
| | - Rafael Manzanares-Soler
- Neuroradiology Unit, Department of Radiology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Álvaro Ximénez-Carrillo
- Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain
| | - José Vivancos
- Stroke Unit, Department of Neurology and, Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain
| |
Collapse
|
9
|
Fuentes B, Alonso de Leciñana M, García-Madrona S, Díaz-Otero F, Aguirre C, Calleja P, Egido JA, Carneado-Ruiz J, Ruiz-Ares G, Rodríguez-Pardo J, Rodríguez-López Á, Ximénez-Carrillo Á, de Felipe A, Ostos F, González-Ortega G, Simal P, Gómez Escalonilla CI, Gómez-Porro-Sánchez P, Desanvicente Z, Reig G, Gil-Núñez A, Masjuán J, Díez-Tejedor E. Stroke Acute Management and Outcomes During the COVID-19 Outbreak: A Cohort Study From the Madrid Stroke Network. Stroke 2021; 52:552-562. [PMID: 33406872 DOI: 10.1161/strokeaha.120.031769] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The coronavirus disease 2019 (COVID-19) outbreak has added challenges to providing quality acute stroke care due to the reallocation of stroke resources to COVID-19. Case series suggest that patients with COVID-19 have more severe strokes; however, no large series have compared stroke outcomes with contemporary non-COVID-19 patients. Purpose was to analyze the impact of COVID-19 pandemic in stroke care and to evaluate stroke outcomes according to the diagnosis of COVID-19. METHODS Retrospective multicenter cohort study including consecutive acute stroke patients admitted to 7 stroke centers from February 25 to April 25, 2020 (first 2 months of the COVID-19 outbreak in Madrid). The quality of stroke care was measured by the number of admissions, recanalization treatments, and time metrics. The primary outcome was death or dependence at discharge. RESULTS A total of 550 acute stroke patients were admitted. A significant reduction in the number of admissions and secondary interhospital transfers was found. COVID-19 was confirmed in 105 (19.1%) patients, and a further 19 patients were managed as suspected COVID-19 (3.5%). No differences were found in the rates of reperfusion therapies in ischemic strokes (45.5% non-COVID-19, 35.7% confirmed COVID-19, and 40% suspected COVID-19; P=0.265). However, the COVID-19 group had longer median door-to-puncture time (110 versus 80 minutes), which was associated with the performance of chest computed tomography. Multivariate analysis confirmed poorer outcomes for confirmed or suspected COVID-19 (adjusted odds ratios, 2.05 [95% CI, 1.12-3.76] and 3.56 [95% CI, 1.15-11.05], respectively). CONCLUSIONS This study confirms that patients with COVID-19 have more severe strokes and poorer outcomes despite similar acute management. A well-established stroke care network helps to diminish the impact of such an outbreak in stroke care, reducing secondary transfers and allowing maintenance of reperfusion therapies, with a minor impact on door-to-puncture times, which were longer in patients who underwent chest computed tomography.
Collapse
Affiliation(s)
- Blanca Fuentes
- Department of Neurology and Stroke Center, Hospital Universitario La Paz, Madrid, Spain (B.F., M.A.d.L., G.R.-A., J.R.-P., E.D.T.)
| | - María Alonso de Leciñana
- Department of Neurology and Stroke Center, Hospital Universitario La Paz, Madrid, Spain (B.F., M.A.d.L., G.R.-A., J.R.-P., E.D.T.)
| | - Sebastián García-Madrona
- Department of Neurology and Stroke Center, Hospital Universitario Ramón y Cajal, Madrid, Spain (S.G.-M., A.d.F., J.M.)
| | - Fernando Díaz-Otero
- Department of Neurology, Hospital Universitario Gregorio Marañón, Madrid, Spain (F.D.-O., A.R.-L., A.G.N.)
| | - Clara Aguirre
- Department of Neurology and Stroke Center, Hospital Universitario La Princesa, Madrid, Spain (C.A., A.X.C., G.R.)
| | - Patricia Calleja
- Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C., F.O., G.G.-O.)
| | - José A Egido
- Department of Neurology, Hospital Clínico Universitario San Carlos, Madrid, Spain (J.A.E.-H., P.S., C.I.G.E.)
| | - Joaquín Carneado-Ruiz
- Department of Neurology, Hospital Universitario Puerta de Hierro, Madrid, Spain (J.C.-R., P.G.-P.-S., Z.D.)
| | - Gerardo Ruiz-Ares
- Department of Neurology and Stroke Center, Hospital Universitario La Paz, Madrid, Spain (B.F., M.A.d.L., G.R.-A., J.R.-P., E.D.T.)
| | - Jorge Rodríguez-Pardo
- Department of Neurology and Stroke Center, Hospital Universitario La Paz, Madrid, Spain (B.F., M.A.d.L., G.R.-A., J.R.-P., E.D.T.)
| | - Ángela Rodríguez-López
- Department of Neurology, Hospital Universitario Gregorio Marañón, Madrid, Spain (F.D.-O., A.R.-L., A.G.N.)
| | - Álvaro Ximénez-Carrillo
- Department of Neurology and Stroke Center, Hospital Universitario La Princesa, Madrid, Spain (C.A., A.X.C., G.R.)
| | - Alicia de Felipe
- Department of Neurology and Stroke Center, Hospital Universitario Ramón y Cajal, Madrid, Spain (S.G.-M., A.d.F., J.M.)
| | - Fernando Ostos
- Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain (P.C., F.O., G.G.-O.)
| | | | - Patricia Simal
- Department of Neurology, Hospital Clínico Universitario San Carlos, Madrid, Spain (J.A.E.-H., P.S., C.I.G.E.)
| | - Carlos I Gómez Escalonilla
- Department of Neurology, Hospital Clínico Universitario San Carlos, Madrid, Spain (J.A.E.-H., P.S., C.I.G.E.)
| | - Pablo Gómez-Porro-Sánchez
- Department of Neurology, Hospital Universitario Puerta de Hierro, Madrid, Spain (J.C.-R., P.G.-P.-S., Z.D.)
| | - Zayrho Desanvicente
- Department of Neurology, Hospital Universitario Puerta de Hierro, Madrid, Spain (J.C.-R., P.G.-P.-S., Z.D.)
| | - Gemma Reig
- Department of Neurology and Stroke Center, Hospital Universitario La Princesa, Madrid, Spain (C.A., A.X.C., G.R.)
| | - Antonio Gil-Núñez
- Department of Neurology, Hospital Universitario Gregorio Marañón, Madrid, Spain (F.D.-O., A.R.-L., A.G.N.)
| | - Jaime Masjuán
- Department of Neurology and Stroke Center, Hospital Universitario Ramón y Cajal, Madrid, Spain (S.G.-M., A.d.F., J.M.)
| | - Exuperio Díez-Tejedor
- Department of Neurology and Stroke Center, Hospital Universitario La Paz, Madrid, Spain (B.F., M.A.d.L., G.R.-A., J.R.-P., E.D.T.)
| |
Collapse
|
10
|
Quintas S, Zapata-Wainberg G, Arias-Rivas S, Ximénez-Carrillo Á, Castillo J, Benavente Fernández L, Masjuan Vallejo J, Freijó Guerrero MDM, Egido J, García Pastor A, Cardona P, Lago A, Castellanos Rodrigo M, Fuentes B, Sobrado M, Vivancos J. Time Trends in Intracerebral Hemorrhage Associated with Oral Anticoagulation and Its Risks Factors in Spain from 2008 to 2015. Eur Neurol 2020; 84:16-21. [PMID: 33321486 DOI: 10.1159/000511603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/08/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is 7- to 10-fold higher in anticoagulated patients. Given the more extended use of oral anticoagulants, an increase in the prevalence of ICH associated with oral anticoagulation (ICH-OAC) could be expected. However, there is no previous study that assesses the time trends of ICH-OAC in Spain. METHODS We conducted a combined data analysis after creating a joint database of the 3 most important epidemiological studies on ICH-OAC of our country: the EPICES study (2008-2009), the TAC Registry (TR) study (2012-2013) and the TAC Registry 2 (TR2) study (2015). We finally included 65, 235, and 366 patients from the EPICES, TR, and TR2 studies, respectively. RESULTS We have observed a 3.73-fold increase in the crude annual incidence of ICH-OAC throughout the period of study, with proportion of ICH-OAC out of total ICH increasing from 8.4% in 2008 to 18.2% in 2015. Age, dyslipidemia, and prior antiplatelet treatment increased during the study, but we found no statistically significant differences in other risk factors for ICH-OAC. CONCLUSIONS The incidence of ICH-OAC is increasing in our country. It might at least be partly explained by aging of the population, with mean age at presentation being higher in the last years.
Collapse
Affiliation(s)
- Sonia Quintas
- Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain,
| | - Gustavo Zapata-Wainberg
- Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | | | - Álvaro Ximénez-Carrillo
- Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Jose Castillo
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Jaime Masjuan Vallejo
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | | | - José Egido
- Hospital Clínico San Carlos, Madrid, Spain
| | | | - Pere Cardona
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Aida Lago
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Mar Castellanos Rodrigo
- Complejo Hospitalario Universitario A Coruña, Instituto de Investigacion Biomédica A Coruña, Coruña, Spain
| | - Blanca Fuentes
- Instituto de Investigación Sanitaria La Paz, Departamento de Medicina, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Mónica Sobrado
- Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Jose Vivancos
- Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| |
Collapse
|
11
|
Rodríguez-Pardo J, Secades-García S, Riera-López N, Alonso de Leciñana M, Real-Martínez V, Carneado-Ruiz J, Díaz-Guzmán J, Díez-Tejedor E, Egido-Herrero J, Gil-Núñez A, Matute-Lozano MC, Trillo S, Vera-Lechuga R, Vivancos-Mora J, Ximénez-Carrillo Á, Fuentes B. Contraindications to intravenous thrombolysis in prehospital triage of thrombectomy candidates. Eur J Neurol 2020; 27:2439-2445. [PMID: 32638466 DOI: 10.1111/ene.14429] [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: 06/08/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The existence of contraindications to intravenous thrombolysis (IVT) is considered a criterion for direct transfer of patients with suspected acute stroke to thrombectomy-capable centers in the prehospital setting. Our aim was to assess the utility of this criterion in a setting where routing protocols are defined by the Madrid - Direct Referral to Endovascular Center (M-DIRECT) prehospital scale. METHODS This was a post hoc analysis of the M-DIRECT study. Reported contraindications to IVT were retrospectively collected from emergency medical services reports and categorized into late window, anticoagulant treatment and other contraindications. Final diagnosis and treatment rates were compared between patients with and without reported IVT contraindications and according to anticoagulant treatment or late window categories. RESULTS The M-DIRECT study included 541 patients. Reported IVT contraindications were present in 227 (42.0%) patients. Regarding final diagnosis no significant differences were found between patients with or without reported IVT contraindications: ischaemic stroke (any) 65.6% vs. 62.1%, ischaemic stroke with large vessel occlusion (LVO) 32.2% vs. 28.3%, hemorrhagic stroke 15.4% vs. 15.6%, stroke mimic 18.9% vs. 22.3% respectively. Amongst patients with LVO, endovascular thrombectomy (EVT) was performed less often in the presence of IVT contraindications (56.2% vs. 74.2%). M-DIRECT-positive patients had higher rates of LVO and EVT compared with M-DIRECT-negative patients independent of reported IVT contraindications. CONCLUSIONS Reported IVT contraindications alone do not increase EVT likelihood and should not be considered to determine routing in urban stroke networks.
Collapse
Affiliation(s)
- J Rodríguez-Pardo
- Department of Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - S Secades-García
- Department of Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - N Riera-López
- Stroke Code Coordination Center, Servicio de Emergencias Médicas SUMMA-112, Madrid, Spain
| | - M Alonso de Leciñana
- Department of Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - V Real-Martínez
- Stroke Code Coordination Center, Servicio de Emergencias Médicas SUMMA-112, Madrid, Spain
| | - J Carneado-Ruiz
- Department of Neurology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - J Díaz-Guzmán
- Department of Neurology, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - E Díez-Tejedor
- Department of Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - J Egido-Herrero
- Department of Neurology, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - A Gil-Núñez
- Department of Neurology, Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - M C Matute-Lozano
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Spain
| | - S Trillo
- Department of Neurology, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - R Vera-Lechuga
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Spain
| | - J Vivancos-Mora
- Department of Neurology, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Á Ximénez-Carrillo
- Department of Neurology, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - B Fuentes
- Department of Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
12
|
Fuentes B, Alonso de Leciñana M, Calleja-Castaño P, Carneado-Ruiz J, Egido-Herrero J, Gil-Núñez A, Masjuán-Vallejo J, Vivancos-Mora J, Rodríguez-Pardo J, Riera-López N, Ximénez-Carrillo Á, Cruz-Culebras A, Gómez-Escalonilla C, Díez-Tejedor E. Impact of the COVID-19 pandemic on the organisation of stroke care. Madrid Stroke Care Plan. Neurología (English Edition) 2020. [PMCID: PMC7334907 DOI: 10.1016/j.nrleng.2020.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
13
|
Fuentes B, Alonso de Leciñana M, Calleja-Castaño P, Carneado-Ruiz J, Egido-Herrero J, Gil-Núñez A, Masjuán-Vallejo J, Vivancos-Mora J, Rodríguez-Pardo J, Riera-López N, Ximénez-Carrillo Á, Cruz-Culebras A, Gómez-Escalonilla C, Díez-Tejedor E. Impact of the COVID-19 pandemic on the organisation of stroke care. Madrid Stroke Care Plan. Neurologia 2020; 35:363-371. [PMID: 32563566 PMCID: PMC7241395 DOI: 10.1016/j.nrl.2020.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 11/21/2022] Open
Abstract
Introducción La sobrecarga asistencial y los cambios organizativos frente a la pandemia de COVID-19 podrían estar repercutiendo en la atención al ictus agudo en la Comunidad de Madrid. Métodos Encuesta estructurada en bloques: características del hospital, cambios en infraestructura y recursos, circuitos de código ictus, pruebas diagnósticas, rehabilitación y atención ambulatoria. Análisis descriptivo según el nivel de complejidad en la atención del ictus (disponibilidad o no de unidad de ictus y de trombectomía mecánica). Resultados De los 26 hospitales del SERMAS que atienden urgencias en adultos, 22 cumplimentaron la encuesta entre el 16 y 27 de abril. El 95% han cedido neurólogos para atender a pacientes afectados por la COVID-19. Se han reducido camas de neurología en el 89,4%, modificado los circuitos en urgencias para ictus en el 81%, con circuitos específicos para sospecha de infección por SARS-CoV2 en el 50%, y en el 42% de los hospitales los pacientes con ictus agudo positivos para SARS-CoV2 no ingresan en camas de neurología. Ha mejorado el acceso al tratamiento, con trombectomía mecánica las 24 h en el propio hospital en 10 hospitales, y se han reducido los traslados interhospitalarios secundarios. Se ha evitado el ingreso de pacientes con ataque isquémico transitorio o ictus leve (45%) y se han incorporado consultas telefónicas para seguimiento en el 100%. Conclusiones Los cambios organizativos de los hospitales de la Comunidad de Madrid frente a la pandemia por SARS-Co2 han modificado la dedicación de recursos humanos e infraestructuras de las unidades de neurología y los circuitos de atención del ictus, realización de pruebas diagnósticas, ingreso de los pacientes y seguimiento.
Collapse
Affiliation(s)
- B Fuentes
- Servicio de Neurología y Centro de Ictus, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPAZ, Madrid, España.
| | - M Alonso de Leciñana
- Servicio de Neurología y Centro de Ictus, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPAZ, Madrid, España
| | - P Calleja-Castaño
- Servicio de Neurología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - J Carneado-Ruiz
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, España
| | - J Egido-Herrero
- Servicio de Neurología, Hospital Clínico Universitario San Carlos, Universidad Complutense de Madrid, Madrid, España
| | - A Gil-Núñez
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, España
| | - J Masjuán-Vallejo
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá de Henares, ALcalá de Henares (Madrid), España
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - J Rodríguez-Pardo
- Servicio de Neurología y Centro de Ictus, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPAZ, Madrid, España
| | - N Riera-López
- Servicio de Urgencias Médicas de Madrid, SUMMA 112, Madrid, España
| | - Á Ximénez-Carrillo
- Servicio de Neurología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - A Cruz-Culebras
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá de Henares, ALcalá de Henares (Madrid), España
| | - C Gómez-Escalonilla
- Servicio de Neurología, Hospital Clínico Universitario San Carlos, Universidad Complutense de Madrid, Madrid, España
| | - E Díez-Tejedor
- Servicio de Neurología y Centro de Ictus, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Instituto de Investigación IdiPAZ, Madrid, España
| | | |
Collapse
|
14
|
Trillo S, Ramos MC, Aguirre C, Caniego JL, Bárcena E, Bashir S, Zapata-Wainberg G, Alcántara-Miranda P, Díaz-Pérez C, Barbosa A, Manzanares R, Ximénez-Carrillo Á, Garrido J, Nombela F, Vivancos J. Assessment of Collateral Circulation Using Perfusion CT in Middle Cerebral Artery Thrombectomy-Treated Patients. J Stroke Cerebrovasc Dis 2020; 29:104805. [PMID: 32334917 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/27/2020] [Accepted: 03/04/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The prognostic value of leptomeningeal collateral circulation in thrombectomy-treated patients remains unclear. We evaluated the construct validity of assessing leptomeningeal collateral circulation using a new regional perfusion CT source image-based approach, the Perfusion Acquisition for THrombectomy Scale (PATHS). We also compared the prognostic value of PATHS with a further 6 scales based on various techniques: CT-angiography, perfusion CT, and digital subtraction angiography. Additionally, we studied the relationship between the scores for the different scales. PATIENTS AND METHODS We performed a retrospective study of consecutive patients with stroke and M1/terminal carotid occlusion treated with thrombectomy in our center. Leptomeningeal collateral circulation was prospectively evaluated using 7 scales: Tan and Miteff (CT Angiography); Calleja, Cao, American Society of Intervention and Therapeutic Neuroradiology/Society of Interventional Radiology, and PATHS (perfusion); and Christoforidis (Digital Subtraction Angiography). Correlations were studied using the Spearman method. RESULTS The study population comprised 108 patients. All scales predicted the modified Rankin Scale at 3 months (P ≤ .02) and all but 1 (Christoforidis) correlated with 24-hour brain infarct volume (P ≤ .02). These correlations were higher with PATHS (rho = -0.47, P < .001 for 3-month modified Rankin Scale; rho = -0.35, P < .001 for follow-up infarct volume). The multivariate analysis showed PATHS to be an independent predictor of modified Rankin Scale at 3 months less than equal to 2. A crosscorrelation analysis revealed a better correlation between scales that used the same techniques. CONCLUSIONS PATHS can be used to assess leptomeningeal collateral circulation. PATHS had better prognostic value than other scales; therefore, it might be considered for assessment of leptomeningeal collateral circulation in candidates for thrombectomy. The moderate correlation between scales suggests that scores are not interchangeable.
Collapse
Affiliation(s)
- Santiago Trillo
- Stroke Unit, Neurology Department, La Princesa University Hospital, La Princesa Institute for Health Research, Madrid, Spain.
| | - María Carmen Ramos
- Stroke Unit, Neurology Department, La Princesa University Hospital, La Princesa Institute for Health Research, Madrid, Spain
| | - Clara Aguirre
- Stroke Unit, Neurology Department, La Princesa University Hospital, La Princesa Institute for Health Research, Madrid, Spain
| | - José Luis Caniego
- Neurointerventional Radiology, Radiology Department, La Princesa University Hospital, La Princesa Institute for Health Research, Madrid, Spain
| | - Eduardo Bárcena
- Neurointerventional Radiology, Radiology Department, La Princesa University Hospital, La Princesa Institute for Health Research, Madrid, Spain
| | - Saima Bashir
- Stroke Unit, Neurology Department, La Princesa University Hospital, La Princesa Institute for Health Research, Madrid, Spain
| | - Gustavo Zapata-Wainberg
- Stroke Unit, Neurology Department, La Princesa University Hospital, La Princesa Institute for Health Research, Madrid, Spain
| | - Pilar Alcántara-Miranda
- Stroke Unit, Neurology Department, La Princesa University Hospital, La Princesa Institute for Health Research, Madrid, Spain
| | - Carolina Díaz-Pérez
- Stroke Unit, Neurology Department, La Princesa University Hospital, La Princesa Institute for Health Research, Madrid, Spain
| | - Antonio Barbosa
- Diagnostic Neuroradiology, Radiology Department, La Princesa University Hospital, La Princesa Institute for Health Research, Madrid, Spain
| | - Rafael Manzanares
- Diagnostic Neuroradiology, Radiology Department, La Princesa University Hospital, La Princesa Institute for Health Research, Madrid, Spain
| | - Álvaro Ximénez-Carrillo
- Stroke Unit, Neurology Department, La Princesa University Hospital, La Princesa Institute for Health Research, Madrid, Spain
| | - Jesús Garrido
- Methodological Support Unit, La Princesa University Hospital, La Princesa Institute for Health Research, Madrid, Spain
| | - Florentino Nombela
- Stroke Unit, Neurology Department, La Princesa University Hospital, La Princesa Institute for Health Research, Madrid, Spain
| | - José Vivancos
- Stroke Unit, Neurology Department, La Princesa University Hospital, La Princesa Institute for Health Research, Madrid, Spain
| |
Collapse
|
15
|
García-Pastor A, Gil-Núñez A, Ramírez-Moreno JM, González-Nafría N, Tejada J, Moniche F, Portilla-Cuenca JC, Martínez-Sánchez P, Fuentes B, Gamero-García MÁ, Alonso de Leciñana M, Masjuan J, Cánovas D, Aladro Y, Parkhutik V, Lago A, De Arce AM, Usero-Ruiz M, Delgado-Mederos R, Pampliega A, Ximénez-Carrillo Á, Bártulos-Iglesias M, Castro-Reyes E. Progression of carotid near-occlusion to complete occlusion: related factors and clinical implications. J Neurointerv Surg 2020; 12:1180-1185. [DOI: 10.1136/neurintsurg-2019-015638] [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: 11/17/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 11/04/2022]
Abstract
BackgroundThe clinical consequences and factors related to the progression from a carotid near-occlusion (CNO) to a complete occlusion are not well established. Our aim is to describe the rate, predictive factors and clinical implications of the progression to complete carotid occlusion (PCCO) in a population of patients with symptomatic CNO.MethodsWe conducted a multicenter, nationwide, prospective study from January 2010 to May 2016. Patients with angiography-confirmed CNO were included. We collected information on demographic data, clinical manifestations, radiological and hemodynamic findings, and treatment modalities. A 24 month carotid-imaging follow-up of the CNO was performed.Results141 patients were included in the study, and carotid-imaging follow-up was performed in 122 patients. PCCO occurred in 40 patients (32.8%), and was more frequent in medically-treated patients (34 out of 61; 55.7%) compared with patients treated with revascularization (6 out of 61; 9.8%) (p<0.001). 7 of the 40 patients with PCCO (17.5%) suffered ipsilateral symptoms. Factors independently related with PCCO in the multivariate analysis were: age ≥75 years (OR 2.93, 95% CI 1.05 to 8.13), revascularization (OR 0.07, 95% CI 0.02 to 0.20), and collateral circulation through the ipsilateral ophthalmic artery (OR 3.25, 95% CI 1.01 to 10.48).ConclusionsPCCO occurred within 24 months in more than half of the patients under medical treatment. Most episodes of PCCO were not associated with ipsilateral symptoms. Revascularization reduces the risk of PCCO.
Collapse
|
16
|
Zapata-Wainberg G, Masjuan J, Quintas S, Ximénez-Carrillo Á, García Pastor A, Martínez Zabaleta M, Cardona P, Freijo Guerrero MM, Llull L, Benavente Fernández L, Castellanos Rodrigo M, Egido J, Serena J, Vivancos J. The neurologist's approach to cerebral infarct and transient ischaemic attack in patients receiving anticoagulant treatment for non-valvular atrial fibrillation: ANITA-FA study. Eur J Neurol 2018; 26:230-237. [DOI: 10.1111/ene.13792] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 08/17/2018] [Indexed: 12/18/2022]
Affiliation(s)
- G. Zapata-Wainberg
- Neurology Department; Hospital Universitario de La Princesa; Instituto de Investigación Sanitaria Princesa; Madrid Spain
| | - J. Masjuan
- Neurology Department; Hospital Universitario Ramón y Cajal; Red INVICTUS PLUS; Departamento de Medicina; Universidad de Alcalá (IRYCIS); Madrid Spain
| | - S. Quintas
- Neurology Department; Hospital Universitario de La Princesa; Instituto de Investigación Sanitaria Princesa; Madrid Spain
| | - Á. Ximénez-Carrillo
- Neurology Department; Hospital Universitario de La Princesa; Instituto de Investigación Sanitaria Princesa; Madrid Spain
| | - A. García Pastor
- Neurology Department; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | | | - P. Cardona
- Neurology Department; Hospital Universitari de Bellvitge; Barcelona Spain
| | | | - L. Llull
- Neurology Department; Hospital Universitari Clinic; Barcelona Spain
| | | | | | - J. Egido
- Hospital Clínico Universitario San Carlos; Madrid Spain
| | - J. Serena
- Neurology Department; Hospital Universitario Dr Josep Trueta; Girona Spain
| | - J. Vivancos
- Neurology Department; Hospital Universitario de La Princesa; Red INVICTUS PLUS; Instituto de Investigación Sanitaria La Princesa; Madrid Spain
| | | |
Collapse
|
17
|
Zapata-Wainberg G, Ximénez-Carrillo Á, Trillo S, Fuentes B, Cruz-Culebras A, Aguirre C, Alonso de Leciñana M, Vera R, Bárcena E, Fernández-Prieto A, Méndez-Cendón JC, Caniego JL, Díez-Tejedor E, Masjuan J, Vivancos J. Mechanical thrombectomy in orally anticoagulated patients with acute ischemic stroke. J Neurointerv Surg 2017; 10:834-838. [PMID: 29275325 DOI: 10.1136/neurintsurg-2017-013504] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE To investigate the efficacy and safety of mechanical thrombectomy in patients with acute ischemic stroke according to the oral anticoagulation medication taken at the time of stroke onset. MATERIALS AND METHODS A retrospective multicenter study of prospectively collected data based on data from the registry the Madrid Stroke Network was performed. We included consecutive patients with acute ischemic stroke treated with mechanical thrombectomy and compared the frequency of intracranial hemorrhage and the modified Rankin Scale (mRS) score at 3 months according to anticoagulation status. RESULTS The study population comprised 502 patients, of whom 389 (77.5%) were not anticoagulated, 104 (20.7%) were taking vitamin K antagonists, and 9 (1.8%) were taking direct oral anticoagulants. Intravenous thrombolysis had been performed in 59.8% and 15.0% of non-anticoagulated and anticoagulated patients, respectively. Rates of intracranial hemorrhage after treatment were similar between non-anticoagulated and anticoagulated patients, as were rates of recanalization. After 3 months of follow-up, the mRS score was ≤2 in 56.3% and 55.7% of non-anticoagulated and anticoagulated patients, respectively (P=NS). Mortality rates were similar in the two groups (13.1%and12.4%, respectively). Among anticoagulated patients, no differences were found for intracranial bleeding, mRS score, or mortality rates between patients taking vitamin K antagonists and those taking direct oral anticoagulants. CONCLUSIONS Mechanical thrombectomy is feasible in anticoagulated patients with acute ischemic stroke. The outcomes and safety profile are similar to those of patients with no prior anticoagulation therapy.
Collapse
Affiliation(s)
- Gustavo Zapata-Wainberg
- Neurology Department, Hospital Universitario de La Princesa, Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.,Invictus Plus, Red Nacional de Investigación en Ictus, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Álvaro Ximénez-Carrillo
- Neurology Department, Hospital Universitario de La Princesa, Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.,Invictus Plus, Red Nacional de Investigación en Ictus, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Santiago Trillo
- Neurology Department, Hospital Universitario de La Princesa, Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.,Invictus Plus, Red Nacional de Investigación en Ictus, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Blanca Fuentes
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.,Neurology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Antonio Cruz-Culebras
- Neurology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá (IRYCIS), Madrid, Spain
| | - Clara Aguirre
- Neurology Department, Hospital Universitario de La Princesa, Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.,Invictus Plus, Red Nacional de Investigación en Ictus, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - María Alonso de Leciñana
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.,Neurology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Rocío Vera
- Neurology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá (IRYCIS), Madrid, Spain
| | - Eduardo Bárcena
- Neurology Department, Hospital Universitario de La Princesa, Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Andrés Fernández-Prieto
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.,Neurology Department, Hospital Universitario La Paz, Madrid, Spain
| | - José Carlos Méndez-Cendón
- Neurology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá (IRYCIS), Madrid, Spain
| | - Jose Luis Caniego
- Neurology Department, Hospital Universitario de La Princesa, Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Exuperio Díez-Tejedor
- Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.,Neurology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Jaime Masjuan
- Neurology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá (IRYCIS), Madrid, Spain
| | - José Vivancos
- Neurology Department, Hospital Universitario de La Princesa, Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.,Invictus Plus, Red Nacional de Investigación en Ictus, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | | |
Collapse
|
18
|
Quintas S, López Ruiz R, Trillo S, Gago-Veiga AB, Zapata-Wainberg G, Dotor García-Soto J, Ximénez-Carrillo Á, Vivancos J. Clinical, imaging and electroencephalographic characterization of three cases of HaNDL syndrome. Cephalalgia 2017; 38:1402-1406. [DOI: 10.1177/0333102417735846] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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 syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) may mimic stroke when patients present with acute/subacute focal neurological deficits. It would be helpful to identify investigations that assist the neurologist in differentiating between HaNDL and stroke. Case reports We describe three cases that proved to be HaNDL, but were initially considered to be strokes. Hypoperfusion was noted in the CT perfusion (CTP) studies in all three cases, which extended beyond any single cerebral arterial supply. The CTP findings suggested a stroke mimic, and there was no improvement on thrombolysis. MRI failed to show any abnormalities in diffusion and EEGs showed non-epileptiform changes. Lumbar punctures demonstrated a lymphocytic pleocytosis. Conclusion The diagnosis of HaNDL is based on clinical and CSF criteria, but neuroimaging, including CT perfusion, can be helpful in differentiating the clinical syndrome from stroke.
Collapse
Affiliation(s)
- Sonia Quintas
- Department of Neurology, Hospital Universitario de la Princesa, Instituto de Investigaciœn Sanitaria La Princesa, Madrid, Spain
| | - Rocío López Ruiz
- Department of Neurology, Hospital Universitario de la Princesa, Instituto de Investigaciœn Sanitaria La Princesa, Madrid, Spain
| | - Santiago Trillo
- Department of Neurology, Hospital Universitario de la Princesa, Instituto de Investigaciœn Sanitaria La Princesa, Madrid, Spain
| | - Ana Beatriz Gago-Veiga
- Department of Neurology, Hospital Universitario de la Princesa, Instituto de Investigaciœn Sanitaria La Princesa, Madrid, Spain
| | - Gustavo Zapata-Wainberg
- Department of Neurology, Hospital Universitario de la Princesa, Instituto de Investigaciœn Sanitaria La Princesa, Madrid, Spain
| | - Julio Dotor García-Soto
- Department of Neurology, Hospital Universitario de la Princesa, Instituto de Investigaciœn Sanitaria La Princesa, Madrid, Spain
| | - Álvaro Ximénez-Carrillo
- Department of Neurology, Hospital Universitario de la Princesa, Instituto de Investigaciœn Sanitaria La Princesa, Madrid, Spain
| | - Jose Vivancos
- Department of Neurology, Hospital Universitario de la Princesa, Instituto de Investigaciœn Sanitaria La Princesa, Madrid, Spain
| |
Collapse
|
19
|
Rodríguez-Pardo J, Fuentes B, Alonso de Leciñana M, Ximénez-Carrillo Á, Zapata-Wainberg G, Álvarez-Fraga J, Barriga FJ, Castillo L, Carneado-Ruiz J, Díaz-Guzman J, Egido-Herrero J, de Felipe A, Fernández-Ferro J, Frade-Pardo L, García-Gallardo Á, García-Pastor A, Gil-Núñez A, Gómez-Escalonilla C, Guillán M, Herrero-Infante Y, Masjuan-Vallejo J, Ortega-Casarrubios MÁ, Vivancos-Mora J, Díez-Tejedor E. The Direct Referral to Endovascular Center criteria: a proposal for pre-hospital evaluation of acute stroke in the Madrid Stroke Network. Eur J Neurol 2017; 24:509-515. [DOI: 10.1111/ene.13233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/24/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - B. Fuentes
- Department of Neurology; La Paz University Hospital; Madrid Spain
| | | | | | | | - J. Álvarez-Fraga
- Department of Neurology; La Paz University Hospital; Madrid Spain
| | - F. J. Barriga
- Department of Neurology; Alcorcon University Hospital Foundation; Madrid Spain
| | - L. Castillo
- Department of Neurology; Alcorcon University Hospital Foundation; Madrid Spain
| | - J. Carneado-Ruiz
- Department of Neurology; Puerta de Hierro-Majadahonda University Hospital; Madrid Spain
| | - J. Díaz-Guzman
- Department of Neurology; 12 de Octubre University Hospital; Madrid Spain
| | - J. Egido-Herrero
- Department of Neurology; San Carlos University Hospital; Madrid Spain
| | - A. de Felipe
- Department of Neurology; Ramón y Cajal University Hospital; Madrid Spain
| | - J. Fernández-Ferro
- Department of Neurology; Rey Juan Carlos University Hospital; Madrid Spain
| | - L. Frade-Pardo
- Department of Neurology; La Paz University Hospital; Madrid Spain
| | | | - A. García-Pastor
- Department of Neurology; Gregorio Marañón University Hospital; Madrid Spain
| | - A. Gil-Núñez
- Department of Neurology; Gregorio Marañón University Hospital; Madrid Spain
| | | | - M. Guillán
- Department of Neurology; Rey Juan Carlos University Hospital; Madrid Spain
| | | | - J. Masjuan-Vallejo
- Department of Neurology; Ramón y Cajal University Hospital; Madrid Spain
| | | | - J. Vivancos-Mora
- Department of Neurology; La Princesa University Hospital; Madrid Spain
| | - E. Díez-Tejedor
- Department of Neurology; La Paz University Hospital; Madrid Spain
| | | |
Collapse
|
20
|
Alonso de Leciñana M, Kawiorski MM, Ximénez-Carrillo Á, Cruz-Culebras A, García-Pastor A, Martínez-Sánchez P, Fernández-Prieto A, Caniego JL, Méndez JC, Zapata-Wainberg G, De Felipe-Mimbrera A, Díaz-Otero F, Ruiz-Ares G, Frutos R, Bárcena-Ruiz E, Fandiño E, Marín B, Vivancos J, Masjuan J, Gil-Nuñez A, Díez-Tejedor E, Fuentes B. Mechanical thrombectomy for basilar artery thrombosis: a comparison of outcomes with anterior circulation occlusions. J Neurointerv Surg 2016; 9:1173-1178. [DOI: 10.1136/neurintsurg-2016-012797] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/22/2016] [Accepted: 11/25/2016] [Indexed: 11/04/2022]
Abstract
Background and purposeThe benefits of mechanical thrombectomy (MT) in basilar artery occlusions (BAO) have not been explored in recent clinical trials. We compared outcomes and procedural complications of MT in BAO with anterior circulation occlusions.MethodsData from the Madrid Stroke Network multicenter prospective registry were analyzed, including baseline characteristics, procedure times, procedural complications, symptomatic intracranial hemorrhage (SICH), modified Rankin Scale (mRS), and mortality at 3 months.ResultsOf 479 patients treated with MT, 52 (11%) had BAO. The onset to reperfusion time lapse was longer in patients with BAO (median (IQR) 385 min (320–540) vs 315 min (240–415), p<0.001), as was the duration of the procedures (100 min (40–130) vs 60 min (39–90), p=0.006). Moreover, the recanalization rate was lower (75% vs 84%, p=0.01). A trend toward more procedural complications was observed in patients with BAO (32% vs 21%, p=0.075). The frequency of SICH was 2% vs 5% (p=0.25). At 3 months, patients with BAO had a lower rate of independence (mRS 0–2) (40% vs 58%, p=0.016) and higher mortality (33% vs 12%, p<0.001). The rate of futile recanalization was 50% in BAO versus 35% in anterior circulation occlusions (p=0.05). Age and duration of the procedure were significant predictors of futile recanalization in BAO.ConclusionsMT is more laborious and shows more procedural complications in BAO than in anterior circulation strokes. The likelihood of futile recanalization is higher in BAO and is associated with greater age and longer procedure duration. A refinement of endovascular procedures for BAO might help optimize the results.
Collapse
|
21
|
Vivancos J, Gilo F, Frutos R, Maestre J, García-Pastor A, Quintana F, Ximénez-Carrillo Á. Clinical practice guidelines for subarachnoid haemorrhage. Diagnosis and treatment. Neurología (English Edition) 2016. [DOI: 10.1016/j.nrleng.2014.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
22
|
Quintas S, López Ruiz R, Ximénez-Carrillo Á, Zapata-Wainberg G, Gilo F, Bárcena-Ruiz E, Vivancos J. Early recurrence of cardioembolic stroke successfully treated with a second thrombectomy. Neurologia 2016; 32:551-554. [PMID: 26964510 DOI: 10.1016/j.nrl.2015.12.015] [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: 07/28/2015] [Revised: 12/15/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- S Quintas
- Departamento de Neurología, Hospital Universitario de la Princesa, Madrid, España.
| | - R López Ruiz
- Departamento de Neurología, Hospital Universitario de la Princesa, Madrid, España
| | - Á Ximénez-Carrillo
- Departamento de Neurología, Hospital Universitario de la Princesa, Madrid, España
| | - G Zapata-Wainberg
- Departamento de Neurología, Hospital Universitario de la Princesa, Madrid, España
| | - F Gilo
- Departamento de Neurología, Hospital Universitario de la Princesa, Madrid, España
| | - E Bárcena-Ruiz
- Departamento de Neurorradiología, Radiología intervencionista, Hospital Universitario de la Princesa, Madrid, España
| | - J Vivancos
- Departamento de Neurología, Hospital Universitario de la Princesa, Madrid, España
| |
Collapse
|
23
|
Alonso de Leciñana M, Fuentes B, Ximénez-Carrillo Á, Vivancos J, Masjuan J, Gil-Nuñez A, Martínez-Sánchez P, Zapata-Wainberg G, Cruz-Culebras A, García-Pastor A, Díaz-Otero F, Fandiño E, Frutos R, Caniego JL, Méndez JC, Fernández-Prieto A, Bárcena-Ruiz E, Díez-Tejedor E. A collaborative system for endovascular treatment of acute ischaemic stroke: the Madrid Stroke Network experience. Eur J Neurol 2015; 23:297-303. [DOI: 10.1111/ene.12749] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 04/06/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - B. Fuentes
- Hospital Universitario La Paz IdiPAZ; Universidad Autónoma de Madrid; Madrid Spain
| | - Á. Ximénez-Carrillo
- Hospital Universitario La Princesa; IIS Princesa; Universidad Autónoma de Madrid; Madrid Spain
| | - J. Vivancos
- Hospital Universitario La Princesa; IIS Princesa; Universidad Autónoma de Madrid; Madrid Spain
| | - J. Masjuan
- Hospital Universitario Ramón y Cajal; IRYCIS; Universidad de Alcalá; Madrid Spain
| | - A. Gil-Nuñez
- Hospital Universitario Gregorio Marañón; IiSGM; Universidad Complutense de Madrid; Madrid Spain
| | - P. Martínez-Sánchez
- Hospital Universitario La Paz IdiPAZ; Universidad Autónoma de Madrid; Madrid Spain
| | - G. Zapata-Wainberg
- Hospital Universitario La Princesa; IIS Princesa; Universidad Autónoma de Madrid; Madrid Spain
| | - A. Cruz-Culebras
- Hospital Universitario Ramón y Cajal; IRYCIS; Universidad de Alcalá; Madrid Spain
| | - A. García-Pastor
- Hospital Universitario Gregorio Marañón; IiSGM; Universidad Complutense de Madrid; Madrid Spain
| | - F. Díaz-Otero
- Hospital Universitario Gregorio Marañón; IiSGM; Universidad Complutense de Madrid; Madrid Spain
| | - E. Fandiño
- Hospital Universitario Ramón y Cajal; IRYCIS; Universidad de Alcalá; Madrid Spain
| | - R. Frutos
- Hospital Universitario Ramón y Cajal; IRYCIS; Universidad de Alcalá; Madrid Spain
| | - J.-L. Caniego
- Hospital Universitario La Princesa; IIS Princesa; Universidad Autónoma de Madrid; Madrid Spain
| | - J.-C. Méndez
- Hospital Universitario Ramón y Cajal; IRYCIS; Universidad de Alcalá; Madrid Spain
| | - A. Fernández-Prieto
- Hospital Universitario La Paz IdiPAZ; Universidad Autónoma de Madrid; Madrid Spain
| | - E. Bárcena-Ruiz
- Hospital Universitario La Princesa; IIS Princesa; Universidad Autónoma de Madrid; Madrid Spain
| | - E. Díez-Tejedor
- Hospital Universitario La Paz IdiPAZ; Universidad Autónoma de Madrid; Madrid Spain
| | | |
Collapse
|
24
|
Vivancos J, Gilo F, Frutos R, Maestre J, García-Pastor A, Quintana F, Ximénez-Carrillo Á. Clinical practice guidelines for subarachnoid haemorrhage. Diagnosis and treatment. Neurologia 2015; 31:649-650. [PMID: 25649194 DOI: 10.1016/j.nrl.2014.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 10/09/2014] [Indexed: 11/29/2022] Open
|