1
|
Ostos F, Rodríguez-López A, Martin Jiménez P, Sánchez CS, Martínez-Salio A, Ballenilla F, Lizasoaín I, Calleja-Castaño P. Use of Tenecteplase in Acute Ischemic Stroke in the Time of SARS-CoV-2. Neurohospitalist 2023; 13:266-271. [PMID: 37441211 PMCID: PMC10334066 DOI: 10.1177/19418744231167491] [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: 07/15/2023] Open
Abstract
Tenecteplase (TNK) is a fibrinolytic drug that is administrated in a single bolus, recommended in eligible patients with acute ischemic stroke prior to mechanical thrombectomy. This study explores its usefulness in adverse situations, such as the SARS-CoV-2 pandemic. We conducted a retrospective study involving consecutive patients with suspected acute ischemic stroke treated either with intravenous fibrinolysis with alteplase during 2019 or with TNK (.25 mg/kg) between March 2020 and February 2021. A comparative analysis was made to compare patient treatment times and prognosis. A total of 117 patients treated with alteplase and 92 with TNK were included. No significant differences were observed in age, main vascular risk factors or previous treatments. The median National Institutes of Health Stroke Scale was 8 in the alteplase group and 10 in those treated with TNK (P = .13). Combined treatment with mechanical thrombectomy was performed in 47% in the alteplase group and 46.7% in the TNK group; Thrombolysis In Cerebral Infarction scale 2b-3 recanalization was achieved in 83% and 90.7%, respectively (P = .30). There was a decrease in onset-to-needle median time (165 min vs 140 min, P < .01) and no significant variations in door-needle median time. There was no significant difference in the incidence of symptomatic hemorrhagic transformation in mortality or functional independence at 3 months. The easier administration of TNK has improved the accessibility of fibrinolytic therapy, even in adverse circumstances, such as the COVID-19 pandemic. Its use appears to be safe and effective, even in patients who are not candidates for mechanical thrombectomy.
Collapse
Affiliation(s)
- Fernando Ostos
- Stroke Center, Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | | | - Paloma Martin Jiménez
- Stroke Center, Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmen Sánchez Sánchez
- Stroke Center, Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Antonio Martínez-Salio
- Stroke Center, Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Federico Ballenilla
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ignacio Lizasoaín
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
- Unidad de Investigación Neurovascular, Department of Pharmacology, Faculty of Medicine, Universidad Complutense, Madrid, Spain
| | - Patricia Calleja-Castaño
- Stroke Center, Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| |
Collapse
|
2
|
Marto JP, Strambo D, Ntaios G, Nguyen TN, Herzig R, Czlonkowska A, Demeestere J, Mansour OY, Salerno A, Wegener S, Baumgartner P, Cereda CW, Bianco G, Beyeler M, Arnold M, Carrera E, Machi P, Altersberger V, Bonati L, Gensicke H, Bolognese M, Peters N, Wetzel S, Magriço M, Ramos JN, Sargento-Freitas J, Machado R, Maia C, Machado E, Nunes AP, Ferreira P, Pinho e Melo T, Dias MC, Paula A, Correia MA, Castro P, Azevedo E, Albuquerque L, Alves JN, Ferreira-Pinto J, Meira T, Pereira L, Rodrigues M, Araujo AP, Rodrigues M, Rocha M, Pereira-Fonseca Â, Ribeiro L, Varela R, Malheiro S, Cappellari M, Zivelonghi C, Sajeva G, Zini A, Gentile M, Forlivesi S, Migliaccio L, Sessa M, La Gioia S, Pezzini A, Sangalli D, Zedde M, Pascarella R, Ferrarese C, Beretta S, Diamanti S, Schwarz G, Frisullo G, Marcheselli S, Seners P, Sabben C, Escalard S, Piotin M, Maïer B, Charbonnier G, Vuillier F, Legris L, Cuisenier P, Vodret FR, Marnat G, Liegey JS, Sibon I, Flottmann F, Broocks G, Gloyer NO, Bohmann FO, Schaefer JH, Nolte C, Audebert HJ, Siebert E, Sykora M, Lang W, Ferrari J, Mayer-Suess L, Knoflach M, Gizewski ER, Stolp J, Stolze LJ, Coutinho JM, Nederkoorn P, van den Wijngaard I, De Meris J, Lemmens R, De Raedt S, Vandervorst F, Rutgers MP, Guilmot A, Dusart A, Bellante F, Calleja-Castaño P, Ostos F, González-Ortega G, Martín-Jiménez P, García-Madrona S, Cruz-Culebras A, Vera R, Matute MC, Fuentes B, Alonso-de-Leciñana M, Rigual R, Díez-Tejedor E, Perez-Sanchez S, Montaner J, Díaz-Otero F, Pérez-de-la-Ossa N, Flores-Pina B, Muñoz-Narbona L, Chamorro A, Rodríguez-Vázquez A, Renú A, Ayo-Martin O, Hernández-Fernández F, Segura T, Tejada-Meza H, Sagarra-Mur D, Serrano-Ponz M, Hlaing T, See I, Simister R, Werring D, Kristoffersen ES, Nordanstig A, Jood K, Rentzos A, Šimůnek L, Krajíčková D, Krajina A, Mikulik R, Cviková M, Vinklárek J, Školoudík D, Roubec M, Hurtikova E, Hrubý R, Ostry S, Skoda O, Pernicka M, Jurak L, Eichlová Z, Jíra M, Kovar M, Panský M, Mencl P, Palouskova H, Tomek A, Janský P, Olšerová A, Sramek M, Havlicek R, Malý P, Trakal L, Fiksa J, Slovák M, Karlinski MA, Nowak M, Sienkiewicz-Jarosz H, Bochynska A, Wrona P, Homa T, Sawczynska K, Slowik A, Wlodarczyk E, Wiacek M, Tomaszewska-Lampart I, Sieczkowski B, Bartosik-Psujek H, Bilik M, Bandzarewicz A, Dorobek M, Zielinska-Turek J, Nowakowska-Kotas M, Obara K, Urbanowski P, Budrewicz S, Guziński M, Świtońska M, Rutkowska I, Sobieszak-Skura P, Labuz-Roszak BM, Debiec A, Staszewski J, Stępień A, Zwiernik J, Wasilewski G, Tiu C, Terecoasă EO, Radu RA, Negrila A, Dorobat B, Panea C, Tiu V, Petrescu S, Ozdemir A, Mahmoud M, El-Samahy H, Abdelkhalek H, Al-Hashel J, Ismail II, Salmeen A, Ghoreishi A, Sabetay SI, Gross H, Klein P, Abdalkader M, Jabbour P, El Naamani K, Tjoumakaris S, Abbas R, Mohamed GA, Chebl A, Min J, Hovingh M, Tsai JP, Khan M, Nalleballe K, Onteddu S, Masoud H, Michael M, Kaur N, Maali L, Abraham MG, Khandelwal P, Bach I, Ong M, Babici D, Khawaja AM, Hakemi M, Rajamani K, Cano-Nigenda V, Arauz A, Amaya P, Llanos N, Arango A, Vences MÁ, Barrientos Guerra JD, Caetano R, Martins RT, Scollo SD, Yalung PM, Nagendra S, Gaikwad A, Seo KD, Georgiopoulos G, Nogueira RG, Michel P. Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry. Neurology 2023; 100:e739-e750. [PMID: 36351814 PMCID: PMC9969910 DOI: 10.1212/wnl.0000000000201537] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/23/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES COVID-19-related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19. METHODS This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS Of a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour mortality (OR 2.47; 95% CI 1.58-3.86), and 3-month mortality (OR 1.88; 95% CI 1.52-2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION Patients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring, and establishing prognosis. TRIAL REGISTRATION INFORMATION The study was registered under ClinicalTrials.gov identifier NCT04895462.
Collapse
Affiliation(s)
- João Pedro Marto
- Department of Neurology (J.P.M., M.M.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; Stroke Centre (D.S., A.S., P.M.), Neurology Service, Department of Neurological Sciences, Lausanne University Hospital, Switzerland; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology, Radiology (T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Department of Neurology (R.H., L.S., D.K.), Comprehensive Stroke Centre, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic; 2nd Department of Neurology (A.C., M.A.K., M.N.), Institute of Psychiatry and Neurology, Warsaw, Poland; Neurology Department (J.D., R.L.), Leuven University Hospital, Belgium; Alexandria University Hospitals and Affiliated Stroke Network (O.Y.M.), Egypt; Department of Neurology (S.W., P.B.), University Hospital of Zurich, Switzerland; Stroke Center (C.W.C., G.B.), Neurocenter of Southern Switzerland, EOC, Lugano; Stroke Center (M.B, M.A.), Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland; Stroke Centre (E.C.), Geneva University Hospital, Switzerland; Department of Neuroradiology (P.M.), Geneva University Hospital, Switzerland; Stroke Centre (V.A, L.B., H.G.), University Hospital Basel and University of Basel, Switzerland; Stroke Centre (M.B.), Kantonsspital Lucerne, Switzerland; Stroke Centre (N.P., S.W.), Hirslanden Hospital, Zurich, Switzerland; Department of Neuroradiology (J.N.R.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; Department of Neurology (J.S.-F., R.M., C.M.), Centro Hospitalar Universitário de Coimbra, Portugal; Department of Neuroradiology (E.M.), Centro Hospitalar Universitário de Coimbra, Portugal; Stroke Unit (A.P.N., P.F.), Hospital de São José, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Stroke Unit (T.P.e.M., M.C.D., A.P.), Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Department of Neuroradiology (M.A.C.), Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Department of Neurology (P.C., E.A.), Centro Hospitalar Universitário São João, Porto, Portugal; Department of Neuroradiology (L.A.), Centro Hospitalar Universitário São João, Porto, Portugal; Departments of Neurology (J.N.A., J.F.-P.), and Neuroradiology (T.M.), Hospital de Braga, Portugal; Department of Neurology (L.P., M.R.), Hospital Garcia de Orta, Almada, Portugal; Department of Neuroradiology (A.P.A., M.R.), Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Department of Neurology (M.R.), Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Department of Neurology (A.P.-F, L.R.), Unidade Local de Saúde de Matosinhos, Portugal; Department of Neurology (R.V., S.M.), Centro Hospitalar Universitário do Porto, Portugal; Stroke Unit (M.C., C.Z.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z., M.G., S.F., L.M.), Department of Neurology and Stroke Centre, Maggiore Hospital, Bologna, Italy; Department of Neurology (M.S., S.L.G.), ASST Papa Giovanni XXIII, Bergamo, Italy; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Italy; Department of Neurology and Stroke Unit (D.S.), Azienda Socio Sanitaria Territoriale, Lecco, Italy; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria-IRCCS di Reggio Emilia, Italy; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria-IRCCS di Reggio Emilia, Italy; Department of Neurology (C.F., S.B., S.D.), San Gerardo Hospital, Department of Medicine and Surgery and Milan Centre for Neuroscience, University of Milano Bicocca, Monza, Italy; Stroke Unit (G.S.), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Neurology (G.F.), Policlinico Universitario Agostino Gemelli, Rome, Italy; Emergency Neurology and Stroke Unit (S.M.), IRCCS Humanitas Clinical and Research Center, Rozzano, Italy; Department of Neurology (C.S., S.E.), Hôpital Fondation Ade Rothschild, Paris, France; Department of Interventional Neuroradiology (M.P., B.M.), Hôpital Fondation Ade Rothschild, Paris, France; Department of Interventional Neuroradiology (G.C., F.V.), Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz, Besançon, France; Neurology (F.L., P.C, F.R.V.), Stroke Unit, Centre Hospitalier Universitaire, Grenoble Alpes, France; Department of Interventional and Diagnostic Neuroradiology (J.-S.L., I.S.), Bordeaux University Hospital, France; Department of Diagnostic and Interventional Neuroradiology (F.F, G.B., N.-O.G.), University Medical Center-Hamburg-Eppendorf, Germany; Department of Neurology (F.O.B., J.H.S.), University Hospital Frankfurt, Goethe University, Germany; Department of Neurology and Centre for Stroke Research (H.J.A.), Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Germany; Department of Neuroradiology (E.S.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.S, W.L., J.F.), St. John's Hospital, Vienna, Austria; Departments of Neurology (L.M.-S., M.K.), and Neuroradiology (E.R.G.), Medical University of Innsbruck, Austria; Department of Neurology (J.S., L.J.S., J.M.C.), Amsterdam University Medical Centers, Netherlands; Department of Neurology (I.v.d.W., J.d.M.), Haaglanden Medical Centre, Hague and Department of Radiology, Leiden University Medical Centre, Netherlands; Department of Neurology (S.D.R., F.V.), Universitair Ziekenhuis Brussel, Centre for Neurosciences, Vrije Universiteit Brussel, Belgium; Department of Neurology (M.P.R, A.G.), Stroke Unit, Europe Hospitals, Brussels, Belgium; Department of Neurology (A.D., F.B.), Centre Hospitalier Universitaire de Charleroi, Belgium; Department of Neurology and Stroke Centre (P.C.-C., F.O., P.M.-J.), Hospital Universitario de OctubreInstituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain; Department of Neurology and Stroke Centre (A.C.-C., R.V., M.C.M.), Hospital Universitario Ramón y Cajal, Ramon y Cajal Institute for Health Research (IRYCIS), Madrid, Spain; Department of Neurology and Stroke (B.F, M.A.d.L., R.R., E.D.D.), Centre Hospital La Paz Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Spain; Department of Neurology (S.P.-S., J.M.), Hospital Universitario Virgen Macarena, Seville, Spain; Stroke Centre (F.D-.O.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; Stroke Unit (B.F.-P., J.M.-N.), Germans Trias Hospital, Barcelona, Spain; Department of Neurology (A.C, A.R.-V., A.R), Comprehensive Stroke Centre, Hospital Clinic from Barcelona, Spain; Department of Neurology (O.A.-M, F.H.-F.), Complejo Hospitalario Universitario de Albacete; Stroke Unit (H.T.-M.), Department of Neurology, and Interventional Neuroradiology Unit, Hospital Universitario Miguel Servet, Spain; Stroke Unit (D.S.-M, M.F.P.), Department of Neurology, Hospital Universitario Miguel Servet, Spain; Stroke and Geriatric Medicine (T.H.), Aintree University Hospital, United Kingdom; Comprehensive Stroke Service (I.S., R.S.), University College London Hospitals NHS Foundation Trust and Stroke Research Centre, University College London, United Kingdom.; University College London (D.W.), Queen Square Institute of Neurology, London, United Kingdom; Department of Neurology (E.S.K.), Akershus University Hospital, Lørenskog and Department of General Practice, University of Oslo, Norway; Department of Clinical Neuroscience (A.N, K.J.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology (A.N, K.J.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Radiology (A.R.), Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg and Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Radiology (A.K.), Comprehensive Stroke Centre, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic; International Clinical Research Centre (R.M., M.C., J.V.) and Department of Neurology, St. Anne´s University Hospital and Faculty of Medicine at Masaryk University, Brno, Czech Republic; Center for Health Research (D.S., M.R, E.H.), Faculty of Medicine, University of Ostrava, Czech Republic; Department of Neurology (R.H, S.V.), České Budějovice Hospital, Czech Republic; Department of Neurology (O.S., M.P.), Jihlava Hospital, Czech Republic; Neurocenter (L.J., Z.E., M.J.), Regional Hospital Liberec, Czech Republic; Cerebrovascular Centre (M.K., M.P., P.M.), Na Homolce Hospital, Prague, Czech Republic; Department of Neurology (H.P.), Karviná Miners Hospital Inc., Czech Republic; Cerebrovascular Centre (A.T, P.J, A.O.), University Hospital in Motol, Prague, Czech Republic; Cerebrovascular Centre (M.S., R.H, P.M., L.T.), Central Military Hospital, Prague, Czech Republic; Cerebrovascular Centre (J.F., M.S.), General University Hospital, Prague, Czech Republic; 1th Department of Neurology (H.S.-J, A.B.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (P.W, T.H., K.S., A.S), University Hospital, Jagiellonian University, Cracow, Poland; Department of Neurology (M.W., L.T.-L., B.S.), Institute of Medical Sciences, Medical College of Rzeszow University, Poland; Department of Neurology and Stroke (M.B, A.B.), St. John Paul II Western Hospital, Grodzisk Mazowiecki, Poland; Department of Neurology (M.D, J.Z.), Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland; Departments of Neurology (M.N.-K., K.O., P.U.), and Radiology (M.G.), Wroclaw Medical University, Poland; Department of Neurosurgery and Neurology (M.S.), Nicolaus Copernicus University in Torun Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland; Stroke Intervention Centre (I.R., P.S.-S.), Department of Neurosurgery and Neurology, Jan Biziel University Hospital, Bydgoszcz, Poland; Department of Neurology (B.M.L.-R.), Institute of Medical Sciences, University of Opole, Poland; Clinic of Neurology (A.D., J.S., A.S.), Military Institute of Medicine, Warsaw, Poland; Department of Neurology (J.Z.), University of Warmia and Mazury, Olsztyn, Poland; Department of Radiology (C.W.), Provincial Specialist Hospital, Olsztyn, Poland; Department of Neurology (C.T., E.O.T., R.A.R., A.N.), University Emergency Hospital Bucharest, University of Medicine and Pharmacy "Carol Davila", Romania; Department of Radiology (B.D.), University Emergency Hospital Bucharest, Romania; Department of Neurology and Stroke Unit (C.P, V.T, S.P.), Elias University Emergency Hospital, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania; Department of Neurology (A.O.), Eskisehir Osmangazi University, Turkey; Ain Shams University Affiliated Saudi German Hospital (M.M., H.E.-S.), Egypt; Neuropsychiatry Department (H.A.), Tanta University, Egypt; Department of Neurology (J.A.-H.), Ibn Sina Hospital, Kuwait; Department of Neurology (I.I.I.), Jaber Al-Ahmad Hospital, Kuwait; Department of Neurology (A.G.), School of Medicine, Zanjan University of Medical Sciences, Iran; Stroke Unit (S.I.S.), Neurology Department, Hillel Yaffe Medical Center, Hadera, Israel; Department of Neurosurgery (P.J., K.E.N, S.T., R.A.), Thomas Jefferson University Hospital, PA; Departments of Radiology (G.A.M., P.G.N.), Neurology and Neurosurgery, Grady Memorial Hospital, Atlanta, GA; Department of Neurology (A.C.), Henry Ford Hospital, Detroit, MI; Comprehensive Stroke Centre and Department of Neurosciences (J.M., M.H., M.K.), Spectrum Health and Michigan State University; Department of Neurology (K.N., S.O.), University of Arkansas for Medical Sciences, Little Rock, AR; Department of Neurology (M.K.), Upstate University Hospital, NY; Department of Neurology (L.M., M.G.A.), University of Kansas Medical Centre; Endovascular Neurological Surgery and Neurology (P.K., I.B, M.O., M.B.), Rutgers, The State University of New Jersey, Newark; Department of Neurology (A.M.K.), Wayne State University, Detroit Medical Center, MI; Stroke Clinic (V.C.-N, A.A.), Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico; Department of Neurology (P.A.), Fundación Valle del Lili, Cali, Colombia; Centro de Investigaciones Clínicas (N.L., A.A.), Fundación Valle del Lili, Cali, Colombia; Department of Neurology (M.A.V.), Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Péru; Hospital General San Juan de Dios (J.D.B.G.), Guatemala; Department of Neurology (R.C., R.T.M.), Hospital Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil; Ramos Mejía Hospital (S.D.S.), Stroke Unit, Buenos Aires, Argentina; St. Luke's Medical Center (P.M.Y.), Global City, Philippines; Department of Neurology (S.N., A.G.), Grant Medical College and Sir JJ Hospital, Mumbai, India; Department of Neurology (K.-D.S.), National Health Insurance Service Ilsan Hospital, Goyang, Korea; School of Biomedical Engineering and Imaging Sciences (G.G.), St Thomas Hospital, King's College London, UK; Department of Clinical Therapeutics (G.G.), National and Kapodistrian University of Athens, Greece.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Martín-Jiménez P, San Pedro-Murillo E, Ostos F, Ballenilla F, Calleja-Castaño P. [Primary vasculitis of the nervous system with arterial and venous involvement]. Rev Neurol 2022; 74:66-67. [PMID: 35014022 DOI: 10.33588/rn.7402.2021418] [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] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - F Ostos
- Hospital Universitario 12 de Octubre, Madrid, España
| | - F Ballenilla
- Hospital Universitario 12 de Octubre, Madrid, España
| | | |
Collapse
|
4
|
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
|
5
|
Naranjo L, Ostos F, Gil-Etayo FJ, Hernández-Gallego J, Cabrera-Marante Ó, Pleguezuelo DE, Díaz-Simón R, Cerro M, Lora D, Martínez-Salio A, Serrano A. Presence of Extra-Criteria Antiphospholipid Antibodies Is an Independent Risk Factor for Ischemic Stroke. Front Cardiovasc Med 2021; 8:665741. [PMID: 34012984 PMCID: PMC8126615 DOI: 10.3389/fcvm.2021.665741] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/01/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Ischemic stroke is the most common and severe arterial thrombotic event in Antiphospholipid syndrome (APS). APS is an autoimmune disease characterized by the presence of thrombosis and antiphospholipid antibodies (aPL), which provide a pro-coagulant state. The aPL included in the classification criteria are lupus anticoagulant, anti-cardiolipin (aCL) and anti-β2-glycoprotein-I antibodies (aB2GPI) of IgG and IgM isotypes. Extra-criteria aPL, especially IgA aB2GPI and IgG/IgM anti-phosphatidylserine/prothrombin antibodies (aPS/PT), have been strongly associated with thrombosis. However, their role in the general population suffering from stroke is unknown. We aim (1) to evaluate the aPL prevalence in ischemic stroke patients, (2) to determine the role of aPL as a risk factor for stroke, and (3) to create an easy-to-use tool to stratify the risk of ischemic stroke occurrence considering the presence of aPL and other risk factors. Materials and Methods: A cohort of 245 consecutive ischemic stroke patients was evaluated in the first 24 h after the acute event for the presence of classic aPL, extra-criteria aPL (IgA aB2GPI, IgG, and IgM aPS/PT) and conventional cardiovascular risk factors. These patients were followed-up for 2-years. A group of 121 healthy volunteers of the same age range and representative of the general population was used as reference population. The study was approved by the Ethics Committee for Clinical Research (Reference numbers CEIC-14/354 and CEIC-18/182). Results: The overall aPL prevalence in stroke patients was 28% and IgA aB2GPI were the most prevalent (20%). In the multivariant analysis, the presence of IgA aB2GPI (OR 2.40, 95% CI: 1.03–5.53), dyslipidemia (OR 1.70, 95% CI: 1.01–2.84), arterial hypertension (OR 1.82, 95% CI: 1.03–3.22), atrial fibrillation (OR 4.31, 95% CI: 1.90–9.78), and active smoking (OR 3.47, 95% CI: 1.72–6.99) were identified as independent risk factors for ischemic stroke. A risk stratification tool for stroke was created based on these factors (AUC: 0.75). Conclusions: IgA aB2GPI are an important independent risk factor for ischemic stroke. Evaluation of aPL (including extra-criteria) in cardiovascular risk factor assessment for stroke can potentially increase the identification of patients at risk of thrombotic event, facilitating a decision on preventive treatments.
Collapse
Affiliation(s)
- Laura Naranjo
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Fernando Ostos
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Francisco Javier Gil-Etayo
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jesús Hernández-Gallego
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Óscar Cabrera-Marante
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Daniel Enrique Pleguezuelo
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Raquel Díaz-Simón
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Internal Medicine Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Mercedes Cerro
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Department of Nursing, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - David Lora
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Epidemiology Department, Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Faculty of Statistical Studies, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio Martínez-Salio
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Antonio Serrano
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| |
Collapse
|
6
|
Mahammedi A, Ramos A, Bargalló N, Gaskill M, Kapur S, Saba L, Carrete H, Sengupta S, Salvador E, Hilario A, Revilla Y, Sanchez M, Perez-Nuñez M, Bachir S, Zhang B, Oleaga L, Sergio J, Koren L, Martin-Medina P, Wang L, Benegas M, Ostos F, Gonzalez-Ortega G, Calleja P, Udstuen G, Williamson B, Khandwala V, Chadalavada S, Woo D, Vagal A. Brain and Lung Imaging Correlation in Patients with COVID-19: Could the Severity of Lung Disease Reflect the Prevalence of Acute Abnormalities on Neuroimaging? A Global Multicenter Observational Study. AJNR Am J Neuroradiol 2021; 42:1008-1016. [PMID: 33707278 DOI: 10.3174/ajnr.a7072] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/04/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Our aim was to study the association between abnormal findings on chest and brain imaging in patients with coronavirus disease 2019 (COVID-19) and neurologic symptoms. MATERIALS AND METHODS In this retrospective, international multicenter study, we reviewed the electronic medical records and imaging of hospitalized patients with COVID-19 from March 3, 2020, to June 25, 2020. Our inclusion criteria were patients diagnosed with Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection with acute neurologic manifestations and available chest CT and brain imaging. The 5 lobes of the lungs were individually scored on a scale of 0-5 (0 corresponded to no involvement and 5 corresponded to >75% involvement). A CT lung severity score was determined as the sum of lung involvement, ranging from 0 (no involvement) to 25 (maximum involvement). RESULTS A total of 135 patients met the inclusion criteria with 132 brain CT, 36 brain MR imaging, 7 MRA of the head and neck, and 135 chest CT studies. Compared with 86 (64%) patients without acute abnormal findings on neuroimaging, 49 (36%) patients with these findings had a significantly higher mean CT lung severity score (9.9 versus 5.8, P < .001). These patients were more likely to present with ischemic stroke (40 [82%] versus 11 [13%], P < .0001) and were more likely to have either ground-glass opacities or consolidation (46 [94%] versus 73 [84%], P = .01) in the lungs. A threshold of the CT lung severity score of >8 was found to be 74% sensitive and 65% specific for acute abnormal findings on neuroimaging. The neuroimaging hallmarks of these patients were acute ischemic infarct (28%), intracranial hemorrhage (10%) including microhemorrhages (19%), and leukoencephalopathy with and/or without restricted diffusion (11%). The predominant CT chest findings were peripheral ground-glass opacities with or without consolidation. CONCLUSIONS The CT lung disease severity score may be predictive of acute abnormalities on neuroimaging in patients with COVID-19 with neurologic manifestations. This can be used as a predictive tool in patient management to improve clinical outcome.
Collapse
Affiliation(s)
- A Mahammedi
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - A Ramos
- Departments of Neuroradiology (A.R., E.S., A.H., L.K., P.M.-M.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - N Bargalló
- Neurology (S.S., D.W.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - M Gaskill
- Departments of Neuroradiology (L.O., N.B.), Hospital Clínic de Barcelona, Sunyer Biomedical Research Institute, Barcelona, Spain
| | - S Kapur
- Cardiopulmonary Imaging, (S.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - L Saba
- Department of Neuroradiology (L.S.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - H Carrete
- Department of Neuroradiology (H.C.), Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - S Sengupta
- Neurology (S.S., D.W.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - E Salvador
- Departments of Neuroradiology (A.R., E.S., A.H., L.K., P.M.-M.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Hilario
- Departments of Neuroradiology (A.R., E.S., A.H., L.K., P.M.-M.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Y Revilla
- Cardiopulmonary Imaging (Y.R., M.P.-N.) Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Sanchez
- Department of Neuroradiology (L.S.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - M Perez-Nuñez
- Cardiopulmonary Imaging (Y.R., M.P.-N.) Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - L Oleaga
- Departments of Neuroradiology (L.O., N.B.), Hospital Clínic de Barcelona, Sunyer Biomedical Research Institute, Barcelona, Spain
| | - J Sergio
- Department of Neuroradiology (L.S.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - L Koren
- Departments of Neuroradiology (A.R., E.S., A.H., L.K., P.M.-M.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Martin-Medina
- Departments of Neuroradiology (A.R., E.S., A.H., L.K., P.M.-M.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Wang
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - M Benegas
- Department of Neuroradiology (L.S.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
| | - F Ostos
- Neurology (F.O., G.G.-O., P.C.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - G Gonzalez-Ortega
- Neurology (F.O., G.G.-O., P.C.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Calleja
- Neurology (F.O., G.G.-O., P.C.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - G Udstuen
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - B Williamson
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - V Khandwala
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | | | - D Woo
- Neurology (S.S., D.W.), University of Cincinnati Medical Center, Cincinnati, Ohio
| | - A Vagal
- From the Departments of Neuroradiology, (A.M., A.V., M.G., L.W., G.U., B.W., V.K.), University of Cincinnati Medical Center, Cincinnati, Ohio
| |
Collapse
|
7
|
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
|
8
|
Ntaios G, Michel P, Georgiopoulos G, Guo Y, Li W, Xiong J, Calleja P, Ostos F, González-Ortega G, Fuentes B, Alonso de Leciñana M, Díez-Tejedor E, García-Madrona S, Masjuan J, DeFelipe A, Turc G, Gonçalves B, Domigo V, Dan GA, Vezeteu R, Christensen H, Christensen LM, Meden P, Hajdarevic L, Rodriguez-Lopez A, Díaz-Otero F, García-Pastor A, Gil-Nuñez A, Maslias E, Strambo D, Werring DJ, Chandratheva A, Benjamin L, Simister R, Perry R, Beyrouti R, Jabbour P, Sweid A, Tjoumakaris S, Cuadrado-Godia E, Campello AR, Roquer J, Moreira T, Mazya MV, Bandini F, Matz K, Iversen HK, González-Duarte A, Tiu C, Ferrari J, Vosko MR, Salzer HJF, Lamprecht B, Dünser MW, Cereda CW, Quintero ÁBC, Korompoki E, Soriano-Navarro E, Soto-Ramírez LE, Castañeda-Méndez PF, Bay-Sansores D, Arauz A, Cano-Nigenda V, Kristoffersen ES, Tiainen M, Strbian D, Putaala J, Lip GYH. Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke: The Global COVID-19 Stroke Registry. Stroke 2020; 51:e254-e258. [PMID: 32787707 PMCID: PMC7359900 DOI: 10.1161/strokeaha.120.031208] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [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] [Indexed: 12/14/2022]
Abstract
Supplemental Digital Content is available in the text. Recent case-series of small size implied a pathophysiological association between coronavirus disease 2019 (COVID-19) and severe large-vessel acute ischemic stroke. Given that severe strokes are typically associated with poor prognosis and can be very efficiently treated with recanalization techniques, confirmation of this putative association is urgently warranted in a large representative patient cohort to alert stroke clinicians, and inform pre- and in-hospital acute stroke patient pathways. We pooled all consecutive patients hospitalized with laboratory-confirmed COVID-19 and acute ischemic stroke in 28 sites from 16 countries. To assess whether stroke severity and outcomes (assessed at discharge or at the latest assessment for those patients still hospitalized) in patients with acute ischemic stroke are different between patients with COVID-19 and non-COVID-19, we performed 1:1 propensity score matching analyses of our COVID-19 patients with non-COVID-19 patients registered in the Acute Stroke Registry and Analysis of Lausanne Registry between 2003 and 2019. Between January 27, 2020, and May 19, 2020, 174 patients (median age 71.2 years; 37.9% females) with COVID-19 and acute ischemic stroke were hospitalized (median of 12 patients per site). The median National Institute of Health Stroke Scale was 10 (interquartile range [IQR], 4–18). In the 1:1 matched sample of 336 patients with COVID-19 and non-COVID-19, the median National Institute of Health Stroke Scale was higher in patients with COVID-19 (10 [IQR, 4–18] versus 6 [IQR, 3–14]), P=0.03; (odds ratio, 1.69 [95% CI, 1.08–2.65] for higher National Institute of Health Stroke Scale score). There were 48 (27.6%) deaths, of which 22 were attributed to COVID-19 and 26 to stroke. Among 96 survivors with available information about disability status, 49 (51%) had severe disability at discharge. In the propensity score-matched population (n=330), patients with COVID-19 had higher risk for severe disability (median mRS 4 [IQR, 2–6] versus 2 [IQR, 1–4], P<0.001) and death (odds ratio, 4.3 [95% CI, 2.22–8.30]) compared with patients without COVID-19. Our findings suggest that COVID-19 associated ischemic strokes are more severe with worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.
Collapse
Affiliation(s)
- George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N.)
| | - Patrik Michel
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, Switzerland (P.M., E.M., D. Strambo)
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom (G.G.)
| | - Yutao Guo
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China (Y.G.)
| | - Wencheng Li
- Department of Urology (W.L.), Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, China
| | - Jing Xiong
- Department of Nephrology (J.X.), Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, China
| | - Patricia Calleja
- Department of Neurology and Stroke Center, Doce de Octubre University Hospital, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (P.C., F.O., G.G.-O.)
| | - Fernando Ostos
- Department of Neurology and Stroke Center, Doce de Octubre University Hospital, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (P.C., F.O., G.G.-O.)
| | - Guillermo González-Ortega
- Department of Neurology and Stroke Center, Doce de Octubre University Hospital, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (P.C., F.O., G.G.-O.)
| | - Blanca Fuentes
- Department of Neurology and Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Madrid, Spain (B.F., M.A.d.L., E.D.-T.)
| | - María Alonso de Leciñana
- Department of Neurology and Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Madrid, Spain (B.F., M.A.d.L., E.D.-T.)
| | - Exuperio Díez-Tejedor
- Department of Neurology and Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Madrid, Spain (B.F., M.A.d.L., E.D.-T.)
| | - Sebastian García-Madrona
- Department of Neurology and Stroke Centre, Ramón y Cajal University Hospital, IRYCIS Health Research Institute, Madrid, Spain (S.G.-M., J.M., A.D.)
| | - Jaime Masjuan
- Department of Neurology and Stroke Centre, Ramón y Cajal University Hospital, IRYCIS Health Research Institute, Madrid, Spain (S.G.-M., J.M., A.D.)
| | - Alicia DeFelipe
- Department of Neurology and Stroke Centre, Ramón y Cajal University Hospital, IRYCIS Health Research Institute, Madrid, Spain (S.G.-M., J.M., A.D.)
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, and FHU Neurovasc, France (G.T., B.G., V.D.)
| | - Bruno Gonçalves
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, and FHU Neurovasc, France (G.T., B.G., V.D.).,Intensive Care Unit, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil (B.G.)
| | - Valerie Domigo
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, and FHU Neurovasc, France (G.T., B.G., V.D.)
| | - Gheorghe-Andrei Dan
- Colentina University Hospital, Medicine Faculty, University of Medicine "Carol Davila"-Bucharest, Romania (G.-A.D., R.V.)
| | - Roxana Vezeteu
- Colentina University Hospital, Medicine Faculty, University of Medicine "Carol Davila"-Bucharest, Romania (G.-A.D., R.V.)
| | - Hanne Christensen
- Bispebjerg Hospital & University of Copenhagen, Denmark (H.C., L.M.C., P.M., L.H.)
| | | | - Per Meden
- Bispebjerg Hospital & University of Copenhagen, Denmark (H.C., L.M.C., P.M., L.H.)
| | - Lejla Hajdarevic
- Bispebjerg Hospital & University of Copenhagen, Denmark (H.C., L.M.C., P.M., L.H.)
| | - Angela Rodriguez-Lopez
- Vascular Neurology Section - Stroke Center, Hospital General Universitario Gregorio Marañón, Madrid, Spain (A.R.L., F.D.O., A.G.P., A.G.-N.)
| | - Fernando Díaz-Otero
- Vascular Neurology Section - Stroke Center, Hospital General Universitario Gregorio Marañón, Madrid, Spain (A.R.L., F.D.O., A.G.P., A.G.-N.)
| | - Andrés García-Pastor
- Vascular Neurology Section - Stroke Center, Hospital General Universitario Gregorio Marañón, Madrid, Spain (A.R.L., F.D.O., A.G.P., A.G.-N.)
| | - Antonio Gil-Nuñez
- Vascular Neurology Section - Stroke Center, Hospital General Universitario Gregorio Marañón, Madrid, Spain (A.R.L., F.D.O., A.G.P., A.G.-N.)
| | - Errikos Maslias
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, Switzerland (P.M., E.M., D. Strambo)
| | - Davide Strambo
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, Switzerland (P.M., E.M., D. Strambo)
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W., A.C., L.B., R.S., R.P., R.B.)
| | - Arvind Chandratheva
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W., A.C., L.B., R.S., R.P., R.B.)
| | - Laura Benjamin
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W., A.C., L.B., R.S., R.P., R.B.)
| | - Robert Simister
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W., A.C., L.B., R.S., R.P., R.B.)
| | - Richard Perry
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W., A.C., L.B., R.S., R.P., R.B.)
| | - Rahma Beyrouti
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W., A.C., L.B., R.S., R.P., R.B.)
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (P.J., A.S., S.T.)
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (P.J., A.S., S.T.)
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (P.J., A.S., S.T.)
| | - Elisa Cuadrado-Godia
- Stroke Unit, Department of Neurology, Hospital del Mar (E.C.-G., A.R.C., J.R.).,Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona, Spain (E.C.-G., A.R.C., J.R.)
| | - Ana Rodríguez Campello
- Stroke Unit, Department of Neurology, Hospital del Mar (E.C.-G., A.R.C., J.R.).,Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona, Spain (E.C.-G., A.R.C., J.R.)
| | - Jaume Roquer
- Stroke Unit, Department of Neurology, Hospital del Mar (E.C.-G., A.R.C., J.R.).,Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona, Spain (E.C.-G., A.R.C., J.R.)
| | - Tiago Moreira
- Department of Clinical Neuroscience (T.M., M.V.M.), Karolinska Institutet, Stockholm, Sweden.,Department of Neurology (T.M., M.V.M.), Karolinska Institutet, Stockholm, Sweden
| | - Michael V Mazya
- Department of Clinical Neuroscience (T.M., M.V.M.), Karolinska Institutet, Stockholm, Sweden.,Department of Neurology (T.M., M.V.M.), Karolinska Institutet, Stockholm, Sweden
| | - Fabio Bandini
- Department of Neurology, San Paolo Hospital, Savona, Italy (F.B.)
| | - Karl Matz
- Landesklinikum Mödling, Neurologische Abteilung und Donau-Universität Krems, Zentrum für Vaskuläre Prävention, Krems, Austria (K.M.)
| | - Helle K Iversen
- Stroke Centre Rigshospitalet, Department of Neurology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (H.K.I.)
| | - Alejandra González-Duarte
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, a COVID Center, Mexico City (A.G.-D.)
| | - Cristina Tiu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania (C.T.).,University Emergency Hospital, Bucharest, Romania (C.T.)
| | - Julia Ferrari
- Department of Neurology, Krankenhaus Barmherzige Brüder, Vienna, Austria (J.F.)
| | - Milan R Vosko
- Department of Neurology 2 (M.R.V.), Kepler University Hospital, Linz, Austria
| | - Helmut J F Salzer
- Department of Pulmonary Medicine (H.J.F.S., B.L.), Kepler University Hospital, Linz, Austria
| | - Bernd Lamprecht
- Department of Pulmonary Medicine (H.J.F.S., B.L.), Kepler University Hospital, Linz, Austria
| | - Martin W Dünser
- Department of Anesthesiology and Intensive Care Medicine, Johannes Kepler University, Linz, Austria (M.W.D.)
| | - Carlo W Cereda
- Stroke Center EOC, Neurocenter of Southern Switzerland, Lugano (C.W.C.)
| | | | - Eleni Korompoki
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Greece (E.K.)
| | - Eduardo Soriano-Navarro
- Internal Medicine, Fundación Clínica Médica Sur, Mexico City (E.S.-N., L.E.S.-R., P.F.C.-M., D.B.-S.)
| | - Luis Enrique Soto-Ramírez
- Internal Medicine, Fundación Clínica Médica Sur, Mexico City (E.S.-N., L.E.S.-R., P.F.C.-M., D.B.-S.)
| | - Paulo F Castañeda-Méndez
- Internal Medicine, Fundación Clínica Médica Sur, Mexico City (E.S.-N., L.E.S.-R., P.F.C.-M., D.B.-S.)
| | - Daniela Bay-Sansores
- Internal Medicine, Fundación Clínica Médica Sur, Mexico City (E.S.-N., L.E.S.-R., P.F.C.-M., D.B.-S.)
| | - Antonio Arauz
- Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City (A.A., V.C.-N.)
| | - Vanessa Cano-Nigenda
- Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City (A.A., V.C.-N.)
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Norway (E.S.K.).,Department of General Practice, HELSAM, University of Oslo (E.S.K.)
| | - Marjaana Tiainen
- Department of Neurology, Helsinki University Hospital, Finland (M.T., D. Strbian, J.P.)
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, Finland (M.T., D. Strbian, J.P.)
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, Finland (M.T., D. Strbian, J.P.)
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, United Kingdom (G.Y.H.L.).,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| |
Collapse
|
9
|
Adrover JM, Aroca-Crevillén A, Crainiciuc G, Ostos F, Rojas-Vega Y, Rubio-Ponce A, Cilloniz C, Bonzón-Kulichenko E, Calvo E, Rico D, Moro MA, Weber C, Lizasoaín I, Torres A, Ruiz-Cabello J, Vázquez J, Hidalgo A. Programmed 'disarming' of the neutrophil proteome reduces the magnitude of inflammation. Nat Immunol 2020; 21:135-144. [PMID: 31932813 PMCID: PMC7223223 DOI: 10.1038/s41590-019-0571-2] [Citation(s) in RCA: 165] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 12/03/2019] [Indexed: 12/20/2022]
Abstract
The antimicrobial functions of neutrophils are facilitated by a defensive armamentarium of proteins stored in granules, and by the formation of neutrophil extracellular traps (NETs). However, the toxic nature of these structures poses a threat to highly vascularized tissues, such as the lungs. Here, we identified a cell-intrinsic program that modified the neutrophil proteome in the circulation and caused the progressive loss of granule content and reduction of the NET-forming capacity. This program was driven by the receptor CXCR2 and by regulators of circadian cycles. As a consequence, lungs were protected from inflammatory injury at times of day or in mouse mutants in which granule content was low. Changes in the proteome, granule content and NET formation also occurred in human neutrophils, and correlated with the incidence and severity of respiratory distress in pneumonia patients. Our findings unveil a 'disarming' strategy of neutrophils that depletes protein stores to reduce the magnitude of inflammation.
Collapse
Affiliation(s)
- Jose M Adrover
- Area of Cell and Developmental Biology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Alejandra Aroca-Crevillén
- Area of Cell and Developmental Biology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Georgiana Crainiciuc
- Area of Cell and Developmental Biology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Fernando Ostos
- Unidad de Investigación Neurovascular, Department of Pharmacology, Faculty of Medicine, Universidad Complutense and Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Yeny Rojas-Vega
- Advanced Imaging Unit, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Andrea Rubio-Ponce
- Area of Cell and Developmental Biology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Catia Cilloniz
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona, and Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Ciber de Enfermedades, Barcelona, Spain
| | - Elena Bonzón-Kulichenko
- Cardiovascular Proteomics Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Enrique Calvo
- Cardiovascular Proteomics Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Daniel Rico
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - María A Moro
- Unidad de Investigación Neurovascular, Department of Pharmacology, Faculty of Medicine, Universidad Complutense and Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Christian Weber
- Institute for Cardiovascular Prevention, Ludwig-Maximillians University, Munich, Germany
- German Cardiovascular Research Centre (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Ignacio Lizasoaín
- Unidad de Investigación Neurovascular, Department of Pharmacology, Faculty of Medicine, Universidad Complutense and Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Antoni Torres
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona, and Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Ciber de Enfermedades, Barcelona, Spain
| | - Jesús Ruiz-Cabello
- Advanced Imaging Unit, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- CIC biomaGUNE, Donostia-San Sebastián, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
- Ciber de Enfermedades Respiratorias, Madrid, Spain
- Universidad Complutense Madrid, Madrid, Spain
| | - Jesús Vázquez
- Cardiovascular Proteomics Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Andrés Hidalgo
- Area of Cell and Developmental Biology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
- Institute for Cardiovascular Prevention, Ludwig-Maximillians University, Munich, Germany.
| |
Collapse
|
10
|
Peña-Martínez C, Durán-Laforet V, García-Culebras A, Ostos F, Hernández-Jiménez M, Bravo-Ferrer I, Pérez-Ruiz A, Ballenilla F, Díaz-Guzmán J, Pradillo JM, Lizasoain I, Moro MA. Pharmacological Modulation of Neutrophil Extracellular Traps Reverses Thrombotic Stroke tPA (Tissue-Type Plasminogen Activator) Resistance. Stroke 2019; 50:3228-3237. [DOI: 10.1161/strokeaha.119.026848] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background and Purpose—
Recanalization of the occluded artery is a primary goal in stroke treatment. Unfortunately, endovascular treatment is not always available, and tPA (tissue-type plasminogen activator) therapy is limited by its narrow therapeutic window; importantly, the rate of early arterial recanalization after tPA administration is low, especially for platelet-rich thrombi. The mechanisms for this tPA resistance are not well known. Since neutrophil extracellular traps (NETs) have been implicated in this setting, our aim was to study whether NET pharmacological modulation can reverse tPA resistance and the role of TLR4 (Toll-like receptor 4), previously related to NET formation, in thrombosis.
Methods—
To this goal, we have used a mouse photothrombotic stroke model, which produces a fibrin-free thrombus composed primarily of aggregated platelets and thrombi obtained from human stroke patients.
Results—
Our results demonstrate that (1) administration of DNase-I, which promotes NETs lysis, but not of tPA, recanalizes the occluded vessel improving photothrombotic stroke outcome; (2) a preventive treatment with Cl-amidine, impeding NET formation, completely precludes thrombotic occlusion; (3) platelet TLR4 mediates NET formation after photothrombotic stroke; and (4) ex vivo fresh platelet-rich thrombi from ischemic stroke patients are effectively lysed by DNase-I.
Conclusions—
Hence, our data open new avenues for recanalization of platelet-rich thrombi after stroke, especially to overcome tPA resistance.
Collapse
Affiliation(s)
- Carolina Peña-Martínez
- From the Unidad de Investigación Neurovascular, Departamento Farmacología y Toxicología, Facultad de Medicina, Instituto Universitario de Investigación en Neuroquímica, Universidad Complutense de Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.M.P., I.L., M.A.M.)
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.D.-G., J.M.P., I.L., M.A.M.)
| | - Violeta Durán-Laforet
- From the Unidad de Investigación Neurovascular, Departamento Farmacología y Toxicología, Facultad de Medicina, Instituto Universitario de Investigación en Neuroquímica, Universidad Complutense de Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.M.P., I.L., M.A.M.)
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.D.-G., J.M.P., I.L., M.A.M.)
| | - Alicia García-Culebras
- From the Unidad de Investigación Neurovascular, Departamento Farmacología y Toxicología, Facultad de Medicina, Instituto Universitario de Investigación en Neuroquímica, Universidad Complutense de Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.M.P., I.L., M.A.M.)
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.D.-G., J.M.P., I.L., M.A.M.)
| | - Fernando Ostos
- From the Unidad de Investigación Neurovascular, Departamento Farmacología y Toxicología, Facultad de Medicina, Instituto Universitario de Investigación en Neuroquímica, Universidad Complutense de Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.M.P., I.L., M.A.M.)
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.D.-G., J.M.P., I.L., M.A.M.)
- Servicio de Neurología (F.O., J.D.-G.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Macarena Hernández-Jiménez
- From the Unidad de Investigación Neurovascular, Departamento Farmacología y Toxicología, Facultad de Medicina, Instituto Universitario de Investigación en Neuroquímica, Universidad Complutense de Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.M.P., I.L., M.A.M.)
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.D.-G., J.M.P., I.L., M.A.M.)
| | - Isabel Bravo-Ferrer
- From the Unidad de Investigación Neurovascular, Departamento Farmacología y Toxicología, Facultad de Medicina, Instituto Universitario de Investigación en Neuroquímica, Universidad Complutense de Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.M.P., I.L., M.A.M.)
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.D.-G., J.M.P., I.L., M.A.M.)
| | - Alberto Pérez-Ruiz
- From the Unidad de Investigación Neurovascular, Departamento Farmacología y Toxicología, Facultad de Medicina, Instituto Universitario de Investigación en Neuroquímica, Universidad Complutense de Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.M.P., I.L., M.A.M.)
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.D.-G., J.M.P., I.L., M.A.M.)
| | - Federico Ballenilla
- Servicio de Radiología (F.B.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jaime Díaz-Guzmán
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.D.-G., J.M.P., I.L., M.A.M.)
- Servicio de Neurología (F.O., J.D.-G.), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jesús M. Pradillo
- From the Unidad de Investigación Neurovascular, Departamento Farmacología y Toxicología, Facultad de Medicina, Instituto Universitario de Investigación en Neuroquímica, Universidad Complutense de Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.M.P., I.L., M.A.M.)
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.D.-G., J.M.P., I.L., M.A.M.)
| | - Ignacio Lizasoain
- From the Unidad de Investigación Neurovascular, Departamento Farmacología y Toxicología, Facultad de Medicina, Instituto Universitario de Investigación en Neuroquímica, Universidad Complutense de Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.M.P., I.L., M.A.M.)
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.D.-G., J.M.P., I.L., M.A.M.)
| | - María A. Moro
- From the Unidad de Investigación Neurovascular, Departamento Farmacología y Toxicología, Facultad de Medicina, Instituto Universitario de Investigación en Neuroquímica, Universidad Complutense de Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.M.P., I.L., M.A.M.)
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (C.P.-M., V.D.-L., A.G.-C., F.O., M.H.-J., I.B.-F., A.P.-R., J.D.-G., J.M.P., I.L., M.A.M.)
| |
Collapse
|
11
|
Castillo-García IM, Maestro G, Puerta S, Ostos F, Nava P, Losada I. Clozapine-induced paralytic ileus. Actas Esp Psiquiatr 2016; 44:44-45. [PMID: 26905889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 01/01/2016] [Indexed: 06/05/2023]
Affiliation(s)
| | - Guillermo Maestro
- Médico adjunto del Servicio de Meidicina Interna del Hospital Universitario 12 de Octubre
| | - Sergio Puerta
- Médico residente del Servicio de Psiquiatría del Hospital Universitario 12 de Octubre
| | - Fernando Ostos
- Médico residente del Servicio de Neurología del Hospital Universitario 12 de Octubre
| | - Patricia Nava
- Médico residente del Servicio de Psiquiatría del Hospital Universitario 12 de Octubre
| | - Irene Losada
- Médico adjunto del Servicio de Psiquiatría del Hospital Universitario 12 de Octubre
| |
Collapse
|
12
|
Tejerina T, Ramajo M, Navarro-Dorado J, Ostos F, Urraca C, Garcés Z, Reguillo F, Redondo S, Medina-Moreno U. Role of transcription factors on the release and functionality of endothelial progenitor cells of patients undergoing cardiac surgery. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.340] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
13
|
Medina U, Navarro-Dorado J, Ramajo M, Ostos F, Urraca C, Garces Z, Reguillo F, Redondo S, Tejerina T. Role of endoglin and its association with adhesion molecules in patients with hypercholesterolemia or hypertension. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.332] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
14
|
Tejerina T, Medina U, Redondo S, Ostos F, Navarro‐Dorado J, Ramajo M. Role of Ets‐2 in CD144 expression in human peripheral blood mononuclear cells and early‐outgrowth cells. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.875.1] [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] [Indexed: 11/11/2022]
Affiliation(s)
- Teresa Tejerina
- PharmacologySchool of MedicineUniversidad Complutense de MadridMadridSpain
| | - Ursula Medina
- PharmacologySchool of MedicineUniversidad Complutense de MadridMadridSpain
| | - Santiago Redondo
- PharmacologySchool of MedicineUniversidad Complutense de MadridMadridSpain
| | - Fernando Ostos
- PharmacologySchool of MedicineUniversidad Complutense de MadridMadridSpain
| | | | - Marta Ramajo
- PharmacologySchool of MedicineUniversidad Complutense de MadridMadridSpain
| |
Collapse
|