Nationwide Access to Endovascular Treatment for Acute Ischemic Stroke in Portugal

INTRODUCTION

Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding endovascular treatment in mainland Portugal and its administrative districts.

MATERIAL AND METHODS

A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between stroke onset, first-door, and puncture.

RESULTS

A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000 inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged from 212 to 432 minutes, reflecting regional heterogeneity.

DISCUSSION

Overall endovascular treatment rates and procedural times in Portugal are comparable to other international registries. We found geographic heterogeneity, with lower endovascular treatment rates and longer onset-to-puncture time in southern and inner regions.

CONCLUSION

The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in high-volume tertiary hospitals.

Inter- and Intra-Individual Analysis of Post-Exercise Hypotension Following a Single Bout of High-Intensity Interval Exercise and Continuous Exercise: A Pilot Study

Recently, post-exercise blood pressure (BP) has been considered a predictive tool to identify individuals who are responsive or not to BP reductions with exercise training (i. e., "high" and "low responders"). This study aimed to analyze the inter- and intra-individual BP responsiveness following a single bout of high-intensity interval exercise (HIIE) and continuous exercise (CE) in normotensive men (n=14; 24.5±4.2 years). Mean change in BP during the 60 min period post-exercise was analyzed and minimal detectable change (MDC) was calculated to classify the subjects as "low" (no post-exercise hypotension [PEH]) and "high responders" (PEH occurrence) following each exercise protocol (inter-individual analysis). The MDC for systolic and diastolic BP was 5.8 and 7.0 mmHg. In addition, a difference equal/higher than MDC between the exercise protocols was used to define an occurrence of intra-individual variability in BP responsiveness. There were "low" and "high" PEH responders following both exercise protocols (inter-individual variability) as well as subjects who presented higher PEH following a specific exercise protocol (intra-individual variability between exercise protocols). These results were observed mainly for systolic BP. In summary, PEH is a heterogeneous physiological phenomenon and, for some subjects, seems to be exercise-protocol dependent. Further investigations are necessary to confirm our preliminary findings.

Dynamics of a haemodynamic headache: A case report and literature review of headache secondary to flow inversion of the internal jugular vein

Background

Haemodialysis arteriovenous fistulas have common local and regional complications, but are rarely associated with neurological symptoms.

Case report

A 43-year-old woman presented with short acute episodes of unilateral, non-throbbing, severe headache, vertigo and left lateropulsion. She had undergone renal transplantation and had a still-functioning left brachial arteriovenous fistula. No abnormality was detected on neurological examination or on brain parenchymal imaging. Colour Doppler ultrasonography showed a subclavian steal syndrome of the left vertebral artery and reversed flow in the left internal jugular vein. Ligation of the arteriovenous fistula had to be delayed as a result of renal graft dysfunction. Six months later she developed a headache attributed to intracranial hypertension. All symptoms subsided after ligation of the arteriovenous fistula.

Literature review

We identified 16 case reports of central neurological complications attributed to haemodialysis brachial fistulas. Headache descriptions were scarce and were not fully detailed.

Conclusions

The case of our patient suggests that unilateral, episodic, non-throbbing, non-postural headache with transient neurological symptoms can be caused by combined arterial and venous flow abnormalities secondary to a high-flow arteriovenous brachial fistula. In this setting, this pattern of headache may precede overt signs of intracranial hypertension and may be used as a warning sign of cerebral venous congestion.

Is the mouse follicle culture a good model for the goat with respect to the development of preantral follicles in vitro?

The present study evaluated the efficiency of using 2 culture media developed for mice and for goats in the in vitro preantral follicle culture of each species. Murine and caprine secondary follicles were cultured in vitro with human recombinant follicle-stimulating hormone (murine medium) or with bovine recombinant follicle-stimulating hormone in association with growth hormone (caprine medium). The results showed that murine follicles cultured in caprine medium had lower (P < 0.05) rates of follicular survival and growth, whereas for caprine follicles, these variables were not affected by the type of medium used (P > 0.05). After in vitro maturation, a higher (P < 0.05) number of oocytes that resumed meiosis were observed in the murine medium for both species. In contrast, only in the caprine species estradiol production was significantly superior when the caprine medium was used. Higher progesterone production was observed in the presence of the murine medium only for murine follicles (P < 0.05). In conclusion, murine and caprine preantral follicles cultured under the same in vitro culture medium conditions respond differently; caprine oocytes grown in vitro in the presence of the murine medium show the greatest developmental competence among the tested combinations. Therefore, under the present experimental conditions, the mouse follicle culture has proved be a good model for the development of new culture media for caprine preantral follicles.