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Ribas D, Del Riego J, Perendreu J. Role of diagnostic imaging technologists during the COVID-19 pandemic: the importance of organization and planning in the first line. Radiologia (Engl Ed) 2021; 63:50-55. [PMID: 33176927 PMCID: PMC7833328 DOI: 10.1016/j.rx.2020.09.006] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/07/2020] [Accepted: 09/18/2020] [Indexed: 12/04/2022]
Abstract
The COVID-19 pandemic and the consequent declaration of a state of alarm have required changes throughout the entire health system and diagnostic imaging departments are no exception. In our department, these circumstances led to an immediate restructuring of the working dynamics of our group of imaging technologists that had an important role in the front lines of the battle. To ensure that these new needs were met, the staff had to be trained and distributed into different areas and working groups; moreover, new protective measures and protocols had to be adopted in the working environment. We also defined different care circuits for patients with COVID-19 and those without COVID-19, incorporating new technologies, adapting existing resources to the new scenario, and creating a circuit for the rapid diagnosis of COVID-19. This paper also provides detailed recommendations for organizing radiology departments in the case of new outbreaks of COVID-19.
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Affiliation(s)
- D Ribas
- Servicio de Radiología, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España.
| | - J Del Riego
- Servicio de Radiología, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - J Perendreu
- Servicio de Radiología, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
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Ribas D, del Riego J, Perendreu J. Role of diagnostic imaging technologists during the COVID-19 pandemic: The importance of organization and planning in the first line. Radiología (English Edition) 2021. [PMCID: PMC7832139 DOI: 10.1016/j.rxeng.2020.09.010] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The COVID-19 pandemic and the consequent declaration of a state of alarm have required changes throughout the entire health system and diagnostic imaging departments are no exception. In our department, these circumstances led to an immediate restructuring of the working dynamics of our group of imaging technologists that had an important role in the front lines of the battle. To ensure that these new needs were met, the staff had to be trained and distributed into different areas and working groups; moreover, new protective measures and protocols had to be adopted in the working environment. We also defined different care circuits for patients with COVID-19 and those without COVID-19, incorporating new technologies, adapting existing resources to the new scenario, and creating a circuit for the rapid diagnosis of COVID-19. This paper also provides detailed recommendations for organizing radiology departments in the case of new outbreaks of COVID-19.
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3
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Abilleira S, Ribera A, Cardona P, Rubiera M, López-Cancio E, Amaro S, Rodríguez-Campello A, Camps-Renom P, Cánovas D, de Miquel MA, Tomasello A, Remollo S, López-Rueda A, Vivas E, Perendreu J, Gallofré M, Martí-Fàbregas J, Delgado-Mederos R, Martínez-Domeño A, Marín R, Roquer J, Ois Á, Jiménez-Conde J, Guimaraens L, Chamorro Á, Obach V, Urra X, Macho J, Blasco J, San Roman L, Martínez-Yélamos A, Quesada H, Lara B, Cayuela N, Aja L, Mora P, Molina C, Ribó M, Pagola J, Rodríguez-Luna D, Muchada M, Coscojuela P, Dávalos A, Millán M, Pérez de la Ossa N, Gomis M, Dorado L, Castaño C, Garcia M, Estela J, Krupinski J, Huertas-Folch S, Nicolás-Herrerias M, Gómez-Choco M, García S, Martínez R, Sanahuja J, Purroy F, Serena J, Castellanos M, Silva Y, Marés R, Pellisé A, Ustrell X, Baiges J, Garcés M, Saura J, Soler-Insa J, Aragonés J, Cocho D, Palomeras E. Outcomes After Direct Thrombectomy or Combined Intravenous and Endovascular Treatment Are Not Different. Stroke 2017; 48:375-378. [DOI: 10.1161/strokeaha.116.015857] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 10/24/2016] [Accepted: 11/15/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Whether intravenous thrombolysis adds a further benefit when given before endovascular thrombectomy (EVT) is unknown. Furthermore, intravenous thrombolysis delays time to groin puncture, mainly among drip and ship patients.
Methods—
Using region-wide registry data, we selected cases that received direct EVT or combined intravenous thrombolysis+EVT for anterior circulation strokes between January 2011 and October 2015. Treatment effect was estimated by stratification on a propensity score. The average odds ratios for the association of treatment with good outcome and death at 3 months and symptomatic bleedings at 24 hours were calculated with the Mantel–Haenszel test statistic.
Results—
We included 599 direct EVT patients and 567 patients with combined treatment. Stratification through propensity score achieved balance of baseline characteristics across treatment groups. There was no association between treatment modality and good outcome (odds ratio, 0.97; 95% confidence interval, 0.74–1.27), death (odds ratio, 1.07; 95% confidence interval, 0.74–1.54), or symptomatic bleedings (odds ratio, 0.56; 95% confidence interval, 0.25–1.27).
Conclusions—
This observational study suggests that outcomes after direct EVT or combined intravenous thrombolysis+EVT are not different. If confirmed by a randomized controlled trial, it may have a significant impact on organization of stroke systems of care.
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Affiliation(s)
- Sònia Abilleira
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Aida Ribera
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Pedro Cardona
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Marta Rubiera
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Elena López-Cancio
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Sergi Amaro
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Ana Rodríguez-Campello
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Pol Camps-Renom
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - David Cánovas
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Maria Angels de Miquel
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Alejandro Tomasello
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Sebastian Remollo
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Antonio López-Rueda
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Elio Vivas
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Joan Perendreu
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
| | - Miquel Gallofré
- From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d’Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital
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4
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Pérez de la Ossa N, Abilleira S, Dorado L, Urra X, Ribó M, Cardona P, Giralt E, Martí-Fàbregas J, Purroy F, Serena J, Cánovas D, Garcés M, Krupinski J, Pellisé A, Saura J, Molina C, Dávalos A, Gallofré M, Delgado Mederos R, Martínez Domeño A, Marín Bueno R, Roquer J, Rodríguez-Campello A, Ois Á, Jiménez-Conde J, Cuadrado-Godia E, Guimaraens L, Chamorro A, Obach V, Amaro S, Macho JM, Blasco J, San Roman Manzanera L, López A, Martínez-Yélamos A, Quesada H, Lara B, Cayuela N, Aja L, de Miquel MA, Mora P, Rubiera M, Pagola J, Rodríguez-Luna D, Muchada M, Tomasello A, Coscojuela P, Millán M, Gomis M, López-Cancio E, Castaño C, Remollo S, Del Carmen Garcia M, Estela J, Perendreu J, Huertas S, Nicolás MC, Gómez-Choco M, García S, Martínez R, Sanahuja J, Castellanos M, Silva Y, van Eendenburg C, Marés R, Ustrell X, Baiges J, Soler Insa JM, Aragonés JM, Cocho Calderón L, Otermin P, Palomeras E. Access to Endovascular Treatment in Remote Areas. Stroke 2016; 47:1381-4. [DOI: 10.1161/strokeaha.116.013069] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 02/24/2016] [Indexed: 01/19/2023]
Abstract
Background and Purpose—
Since demonstration of the benefit of endovascular treatment (EVT) in acute ischemic stroke patients with proximal arterial occlusion, stroke care systems need to be reorganized to deliver EVT in a timely and equitable way. We analyzed differences in the access to EVT by geographical areas in Catalonia, a territory with a highly decentralized stroke model.
Methods—
We studied 965 patients treated with EVT from a prospective multicenter population-based registry of stroke patients treated with reperfusion therapies in Catalonia, Spain (SONIIA). Three different areas were defined: (A) health areas primarily covered by Comprehensive Stroke Centers, (B) areas primarily covered by local stroke centers located less than hour away from a Comprehensive Stroke Center, and (C) areas primarily covered by local stroke centers located more than hour away from a Comprehensive Stroke Center. We compared the number of EVT×100 000 inhabitants/year and time from stroke onset to groin puncture between groups.
Results—
Baseline characteristics were similar between groups. Throughout the study period, there were significant differences in the population rates of EVT across geographical areas. EVT rates by 100 000 in 2015 were 10.5 in A area, 3.7 in B, and 2.7 in C. Time from symptom onset to groin puncture was 82 minutes longer in group B (312 minutes [245–435]) and 120 minutes longer in group C (350 minutes [284–408]) compared with group A (230 minutes [160–407];
P
<0.001).
Conclusions—
Accessibility to EVT from remote areas is hampered by lower rate and longer time to treatment compared with areas covered directly by Comprehensive Stroke Centers.
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Affiliation(s)
- Natalia Pérez de la Ossa
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Sònia Abilleira
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Laura Dorado
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Xabier Urra
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Marc Ribó
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Pere Cardona
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Eva Giralt
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Joan Martí-Fàbregas
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Francisco Purroy
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Joaquín Serena
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - David Cánovas
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Moisés Garcés
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Jurek Krupinski
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Anna Pellisé
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Júlia Saura
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Carlos Molina
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Antoni Dávalos
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
| | - Miquel Gallofré
- From the Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (N.P.d.l.O.); Stroke Program/Agency for Health Quality and Assessment of Catalonia (CIBER Epidemiología y Salud Pública, CIBERESP) (S.A.); Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (L.D.); Hospital Clínic, Barcelona, Spain (X.U.); Hospital Vall d’Hebrón, Barcelona, Spain (M.R.); Hospital Bellvitge, Barcelona, Spain (P.C.); Hospital del Mar, Barcelona, Spain (E.G.); Hospital Santa Creu i Sant Pau, Barcelona, Spain (J
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Urra X, Abilleira S, Dorado L, Ribó M, Cardona P, Millán M, Chamorro A, Molina C, Cobo E, Dávalos A, Jovin TG, Gallofré M, Delgado Mederos R, Martínez Domeño A, Marín Bueno R, Roquer J, Rodríguez-Campello A, Ois Á, Cuadrado-Godia E, Giralt E, Vivas E, Guimaraens L, Obach V, Amaro S, Macho JM, Blasco J, San Roman Manzanera L, López A, Martínez-Yélamos A, Quesada H, Cano L, Aja L, de Miquel MA, Mora P, Molina C, Rubiera M, Pagola J, Santamarina E, Álvarez-Sabín J, Tomasello A, Coscojuela P, Pérez de la Ossa N, Gomis M, López-Cancio E, Castaño C, Cánovas D, del Carmen Garcia M, Estela J, Perendreu J, Krupinski J, Huertas Folch S, Herrerias MCN, Gómez-Choco M, García S, Martínez R, Purroy F, Sanahuja J, Serena J, Castellanos M, Silva Y, van Eendenburg C, Marés R, Pellisé A, Ustrell X, Baiges J, Garcés M, Saura J, Soler Insa JM, Aragonés JM, Cocho Calderón L, Otermin Vallejo P, Palomeras E. Mechanical Thrombectomy in and Outside the REVASCAT Trial: Insights From a Concurrent Population-Based Stroke Registry. Stroke 2015; 46:3437-42. [PMID: 26508752 DOI: 10.1161/strokeaha.115.011050] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/17/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Recent trials have shown the superiority of endovascular thrombectomy (EVT) over medical therapy alone in certain stroke patients with proximal arterial occlusion. Using data from the Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke due to Anterior Circulation Large Vessel Occlusion Presenting Within 8-Hours of Symptom Onset (REVASCAT) and a parallel reperfusion treatment registry, we sought to assess the utilization of EVT in a defined patient population, comparing the outcomes of patients treated in and outside the REVASCAT trial. METHODS SONIIA [Sistema Online d'Informació de l'Ictus Agut], a population-based, government-mandated, prospective registry of reperfusion therapies for stroke encompassing the entire population of Catalonia, was used as data source. The registry documents 5 key inclusion criteria of the REVASCAT trial: age, stroke severity, time to treatment, baseline functional status, and occlusion site. We compared procedural, safety, and functional outcomes in patients treated inside and outside the trial. RESULTS From November 2012 to December 2014, out of 17596 ischemic stroke patients in Catalonia (population 7.5 million), 2576 patients received reperfusion therapies (17/100000 inhabitants-year), mainly intravenous thrombolysis only (2036). From the remaining 540 treated with EVT, 103 patients (out of 206 randomized) were treated within REVASCAT and 437 outside the trial. Of these, 399 did not fulfill some of the study criteria, and 38 were trial candidates (8 treated at REVASCAT centers and 30 at 2 non-REVASCAT centers). The majority of procedural, safety, and functional outcomes were similar in patients treated with EVT within and outside REVASCAT. CONCLUSIONS REVASCAT enrolled nearly all eligible patients representing one third of all patients treated with EVT. Patients treated with EVT within and outside REVASCAT had similar outcomes, reinforcing the therapeutic value of EVT. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01692379.
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Affiliation(s)
- Xabier Urra
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.).
| | - Sònia Abilleira
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Laura Dorado
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Marc Ribó
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Pere Cardona
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Mònica Millán
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Angel Chamorro
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Carlos Molina
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Erik Cobo
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Antoni Dávalos
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Tudor G Jovin
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
| | - Miquel Gallofré
- From the Stroke Unit, Hospital Clínic, Barcelona, Spain (X.U., A.C.); August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (X.U., A.C.); Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., M.G.); Department of Neuroscience. Hospital Germans Trias, Badalona, Spain (L.D., M.M., A.D.); Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain (M.R., C.M.); Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.); Statistics and Operations Research, Barcelona-Tech, Spain (E.C.); and Stroke Institute, Department of Neurology, UPMC, Pittsburgh, PA (T.G.J.)
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Abilleira S, Ribera A, Dávalos A, Ribó M, Chamorro A, Cardona P, Molina CA, Martínez-Yélamos A, Urra X, Dorado L, Roquer J, Martí-Fàbregas J, Aja L, Tomasello A, Castaño C, Blasco J, Cánovas D, Castellanos M, Krupinski J, Guimaraens L, Perendreu J, Ustrell X, Purroy F, Gómez-Choco M, Baiges JJ, Cocho D, Saura J, Gallofré M. Functional outcome after primary endovascular therapy or IV thrombolysis alone for stroke. An observational, comparative effectiveness study. Cerebrovasc Dis 2014; 38:328-36. [PMID: 25428822 DOI: 10.1159/000368433] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/17/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Among the acute ischemic stroke patients with large vessel occlusions and contraindications for the use of IV thrombolysis, mainly on oral anticoagulation or presenting too late, primary endovascular therapy is often performed as an alternative to the standard therapy even though evidence supporting the use of endovascular reperfusion therapies is not yet established. Using different statistical approaches, we compared the functional independence rates at 3 months among patients undergoing primary endovascular therapy and patients treated only with IV thrombolysis. METHODS We used data from a prospective, government-mandated and externally audited registry of reperfusion therapies for ischemic stroke (January 2011 to November 2012). Patients were selected if treated with either IV thrombolysis alone (n = 1,582) or primary endovascular thrombectomy (n = 250). A series of exclusions were made to homogenize the clinical characteristics among the two groups. We then carried out multivariate logistic regression and propensity score matching analyses on the final study sample (n = 1,179) to compare functional independence at 3 months, as measured by the modified Rankin scale scores 0-2, between the two groups. RESULTS The unadjusted likelihood of good outcome was poorer among the endovascular group (OR: 0.69; 95% CI: 0.47-1.0). After adjustment, no differences by treatment modality were seen (OR: 1.51; 95% CI: 0.93-2.43 for primary endovascular therapy). Patients undergoing endovascular thrombectomy within 180-270 min (OR: 2.89; 95% CI: 1.17-7.15) and patients with severe strokes (OR: 1.84; 95% CI: 1.02-3.35) did better than their intravenous thrombolysis counterparts. The propensity score-matched analyses with and without adjustment by additional covariates showed that endovascular thrombectomy was as effective as intravenous thrombolysis alone in achieving functional independence (OR for unadjusted propensity score matched: 1.35; 95% CI: 0.9-2.02, OR for adjusted propensity score matched: 1.45; 95% CI: 0.91-2.32). CONCLUSION This comparative effectiveness study shows that in ischemic stroke patients with contraindications for IV thrombolysis, primary endovascular treatment might be an alternative therapy at least as effective as IV thrombolysis alone. Randomized controlled trials are urgently needed.
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Affiliation(s)
- Sònia Abilleira
- Stroke Program, Agency for Health Quality and Assessment of Catalonia, Spain
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Santos C, Ventura A, Gomes AM, Pereira S, Almeida C, Seabra J, Segelmark M, Mattsson L, Said S, Olde B, Solem K, Yu X, Zhang B, Sun B, Mao H, Xing C, Gruss E, Portoles J, Tato A, Lopez-Sanchez P, Jimenez P, de la Cruz R, Furaz K, Martinez S, Mas M, Andres MM, Corchete E, Kim YO, Kim HG, Kim BS, Song HC, Choi EJ, Ibeas J, Vallespin J, Fortuno JR, Rodriguez-Jornet A, Grau C, Merino J, Branera J, Perendreu J, Granados I, Mateos A, Jimeno V, Moya C, Ramirez J, Falco J, Gimenez A, Garcia M, Morgado E, Pinho A, Guedes A, Guerreiro R, Mendes P, Bexiga I, Silva A, Marques J, Neves P, Shibata K, Iwamoto T, Murakami T, Ono S, Kaneda T, Kuji T, Kawata S, Satta H, Tamura K, Toya Y, Yanagi M, Umemura S, Yasuda G, Yong OL, Lim WWL, Yong KM, Tay KH, Lim EK, Yang WS, Tan SG, Choong HL, Hill A, Blatter D, Kim YO, Kim HG, Song HC, Choi EJ, Kim SY, Min JK, Park WD, Kim HG, Kim YO, Kim BS, Kim SY, Min JK, Park WD, Ibeas J, Fortuno JR, Branera J, Rodriguez- Jornet A, Perendreu J, Marcet M, Vinuesa X, Mateo A, Jimeno V, Fernandez M, Moya C, Rivera J, Falco J, Garcia M, Shibahara H, Shibahara N, Takahashi S, Shibahara H, Shibahara N, Takahashi S, Kanaa M, Wright MJ, Sandoe JAT, Freudiger H, Dupret J, Jacquemoud MC, Rossi L, Kampouris C, Hatzimpaloglou A, Karamouzis M, Pliakos C, Malindretos P, Roudenko I, Grekas D, Costa AC, Santana A, Neves F, Costa AGD, Chaudhry M, Bhola C, Joarder M, Lok C, Coentrao L, Faria B, Frazao J, Pestana M, Sun XF, Yang Y, Wang J, Lin HL, Li JJ, Yao L, Zhao JY, Zhang ZM, Lun LD, Zhang JR, Zhang YM, Li MX, Jiang SM, Wang Y, Zhu HY, Chen XM, Caeiro F, Carvalho D, Cruz J, Ribeiro dos Santos J, Nolasco F, Bartlett R, Pandya B, Viana N, Machado S, Gil C, Lucas C, Mendes A, Barata J, Freitas L, Campos M, Rikker C, Juhasz E, Toth A, Vizi I, Tornoci L, Rosivall L, Tovarosi S, Cho S, Kim S, Lee YJ, Kanai H, Harada K, Nasu S, Shinozaki M, Shibahara N, Shibahara H, Takahashi S, Esenturk M, Zengin M, Ogun F, Akdemir A, Colak C, Pekince G, Gerasimovska V, Oncevski A, Gerasimovska-Kitanovska B, Sikole A, Kiselev N, Chernyshev S, Zlokazov V, Idov E, Bacallao Mendez R, Avila A, Salgado J, Llerena B, Badell A, Aties M, Severn A, Metcalfe W, Traynor J, Boyd J, Kerssens J, Henderson A, Simpson K, Roca-Tey R, Samon S, Ibrik O, Roda E, Gonzalez JC, Viladoms J, Malindretos P, Bamidis P, Liaskos C, Papagiannis A, Vrochides D, Frantzidis C, Sarafidis P, Lasaridis A, Chryssogonidis I, Nikolaidis P, Ibeas J, Vallespin J, Fortuno JR, Merino J, Rodriguez-Jornet A, Branera J, Grau C, Granados I, Mateos A, Jimeno V, Perndreu J, Moya C, Rivera J, Falco J, Gimenez A, Garcia M, Moyses Neto M, Ferreira V, Martinez R, Tercariol CAS, Lima DAFS, Figueiredo JFC, Costa JAC, Alayoud A, Hamzi A, Akhmouch I, Aatif T, Oualim Z, Jankovic A, Ilic M, Damjanovic T, Djuric Z, Popovic J, Adam J, Dimkovic N. Vascular access. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.39] [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: 11/12/2022] Open
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Querol R, Pericay C, Pisa A, Dotor E, Perendreu J, Falcó J, Moya I, Pampols M, Seguí M, Saigí E. Long-term follow-up of treatment of acute malignant colorectal obstruction with self-expanding metallic stent as a preoperative brigde to surgery. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14098] [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: 11/20/2022] Open
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Vergara M, Gil M, Dalmau B, Ribot R, Navarro C, Martín A, Penafreta M, Puig J, Martín J, Perendreu J, Falcó J, Bella R. [Natural history of hepatocellular carcinoma in a cohort of pacients from a county hospital]. Rev Esp Enferm Dig 2008; 100:682-687. [PMID: 19159171 DOI: 10.4321/s1130-01082008001100003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND hepatocellular carcinoma (HCC) is a cancer with high incidence and mortality. OBJECTIVE our aim was to describe the natural history of a patient cohort with HCC, and to identify the factors associated with survival. PATIENTS AND METHODS a retrospective and descriptive study of patients diagnosed with HCC between 1995 and 2002. Qualitative variables were expressed as frequencies and percentages. Quantitative variables were expressed as medians and standard deviations. Survival was calculated using the Kaplan-Meier method and log rank. RESULTS a total of 154 patients were analyzed. The men-to-women ratio was 2.9/1. Mean age was 68 +/- 9 years. 82% of patients died during a median follow-up of 28 months. Median survival was 21.5 months (95% CI: 16.98-26.04). Curative treatment was done in 40.3% of diagnosed patients, and 59.7% of patients received palliative treatment. Factors associated with survival were: ascites, number of lesions at diagnosis, and curative treatment. No statistical differences were found for the next factors: age, sex, etiology of cirrhosis, and Child-Pugh stage at diagnosis. CONCLUSIONS factors associated with low survival in patients with HCC were ascites and number of lesions. Curative treatment is associated with a higher survival when compared to palliative treatment.
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Affiliation(s)
- M Vergara
- Unidad de Enfermedades Digestivas, Barcelona, Spain.
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Perendreu J, Fortuno J, Falcó J, Branera J, Bermudez P. Abstract No. 269: Embolization as a Treatment in Upper Gastrointestinal Bleeding after Failure of Endoscopy or Surgery Treatment. J Vasc Interv Radiol 2008. [DOI: 10.1016/j.jvir.2007.12.303] [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: 10/22/2022] Open
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Puig J, Perendreu J, Fortuño JR, Branera J, Falcó J. Transarterial embolization of an inferior genicular artery pseudoaneurysm with arteriovenous fistula after arthroscopy. Korean J Radiol 2007; 8:173-5. [PMID: 17420636 PMCID: PMC2626778 DOI: 10.3348/kjr.2007.8.2.173] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Arthroscopic meniscectomy of the knee is generally a safe and effective procedure with a low rate of vascular complications. We report here on a unique case of a 55-year-old man with a lateral inferior genicular artery pseudoaneurysm and a concomitant arteriovenous fistula that developed after arthroscopic meniscectomy; this was successfully treated with selective angiographic embolization. This case illustrates the effectiveness of an endovascular approach as a minimally invasive treatment for this uncommon complication that occurs after an arthroscopic procedure.
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Affiliation(s)
- Josep Puig
- Department of Radiology, Dr Josep Trueta University Hospital, Av FranCa s/n, Girona, Spain.
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Rimola J, Perendreu J, Falcó J, Fortuño JR, Massuet A, Branera J. Percutaneous Arterial Embolization in the Management of Rectus Sheath Hematoma. AJR Am J Roentgenol 2007; 188:W497-502. [PMID: 17515337 DOI: 10.2214/ajr.06.0861] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Spontaneous rectus sheath hematoma can become clinically relevant and necessitate hemostatic intervention. The aim of this study was to describe the efficacy of percutaneous arterial embolization in the management of this condition. CONCLUSION Selective transcatheter embolization is effective hemostatic treatment of patients with large, clinically relevant rectus sheath hematoma.
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Affiliation(s)
- Jordi Rimola
- Department of Radiology, UDIAT-CD, Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
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Cánovas D, Perendreu J, Rovira A, Estela J. [Extravasation of contrast medium after carotid stent with brain infarction symptoms]. Neurologia 2007; 22:187-90. [PMID: 17364259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
Angioplasty, with or without stent placement, as a carotid revascularisation technique, has become an alternative treatment for carotid stenosis, it being considered under certain circumstances the treatment of choice. The main concern about this technique is the distal embolisation during the procedure, while other, less frequent, complícations have also been described such as dissection, vasospasm or even arterial rupture. Some of the infrequent complications include the hyperperfusion syndrome, and, more exceptionally, cases of extravasation of the contrast medium. We present the case of a patient who was subjected to angioplasty and stent insertion due to carotid stenosis with signs of calcification who suffered a stroke-like disorder in her right medial brain artery as a consequence of the extravasation of contrast medium after the rupture of the angioplasty balloon, a situation which has never been described in the literature before.
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Affiliation(s)
- D Cánovas
- Servicio de Neurología, Hospital Parc Tauli, Sabadell (Barcelona), Spain.
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14
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Abstract
Ischemic cerebral infarcts represent a serious health problem with important social and economic repercussions in the western world. The presence of carotid stenosis is one of the main risk factors for the appearance of cerebral infarcts. Carotid stenosis represents a challenge for the medical community, both because of the enormous amount of scientific information available and because of the constant advances in diagnostic procedures and especially in revascularization techniques for treatment. General radiologists as well as those specializing in vascular pathology need to have ample knowledge of how to reach the diagnosis and of the different treatment options for this pathology if they are to play a successful role in multidisciplinary teams dealing with carotid stenosis. This update aims to present the basic information that we consider to be essential in a simple way to enable radiologists to meet this challenge.
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Affiliation(s)
- J R Fortuño
- Unidad de Radiología Vascular e Intervencionista, Corporación Sanitaria Parc Taulí Sabadell, España.
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15
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Castañer E, Gallardo X, Rimola J, Pallardó Y, Mata JM, Perendreu J, Martin C, Gil D. Congenital and acquired pulmonary artery anomalies in the adult: radiologic overview. Radiographics 2006; 26:349-71. [PMID: 16549603 DOI: 10.1148/rg.262055092] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Various congenital and acquired anomalies may affect the pulmonary arteries in adult patients. Congenital anomalies (proximal interruption, anomalous origin of the left pulmonary artery [pulmonary artery sling], and idiopathic dilatation of the pulmonary trunk) are usually found incidentally at chest radiography or computed tomography (CT). Acquired anomalies include diffuse or focal enlargement of the arteries because of pulmonary hypertension, aneurysm, and intravascular pulmonary metastasis; decreased arterial diameter because of bronchial carcinoma, mediastinal fibrosis, and Takayasu arteritis; and intraluminal filling defects due to pulmonary thromboembolism and pulmonary artery sarcoma. An awareness of the radiologic manifestations of the disease entities and potential pulmonary artery complications secondary to infection or vasculitis may enable an early diagnosis. CT angiography is becoming the standard method for evaluating patients in whom the presence of pulmonary embolism is suspected. CT assessment of the extent of heart effects in patients with pulmonary hypertension and pulmonary embolism is particularly important because such effects largely determine the prognosis.
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Affiliation(s)
- Eva Castañer
- Department of Radiology, SDI UDIAT-CD, Institut Universitari Parc Taulí-UAB, Corporació Parc Taulí, Parc Taulí s/n, Sabadell 08208, Barcelona, Spain.
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16
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Rodríguez Jornet A, Ibeas J, Ribera L, Real J, Perendreu J, Falcó J, Vallespín J, Allegué N, Giménez Gaibar A, García García M. [Ischemic renal disease: revascularization or conservative treatment?]. Nefrologia 2005; 25:258-68. [PMID: 16053007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Ischemic nephropathy is recognized as a distinct cause of renal insufficiency and it is defined as a significant reduction in glomerular filtration rate in patients with hemodynamically significant renovascular occlusive disease. We argue the epidemiologic and clinical manifestations of atherosclerotic renovascular disease, and we evaluate the pronostic agents. Published studies of the outcome of revascularization for renal-artery stenosis have been excellent, offering a durable patency and functional improvement but they have had numerous limitations. The atherosclerosis is a systemic disease and it provides the general prognosis of patients. We conclude that ischemic renal disease is a nephropathy of smoker men, with proteinuria excretion similar to nephropathy with unilateral stenosis. The age of patients is the clinical feature that decide the treatment: surgery, angioplasty/stent or medical management. Comparative analysis of percutaneous transluminal angioplasty and operation for renal revascularization and medically treated patients have proved that the advanced chronic renal insufficiency is associated with an unfavourable response of treatment of the ischemic nephropathy. But, in this nephropathy the revascularization can be the better therapy for selected patients. The revascularization with angioplasty/stent for patients with unilateral renal stenosis and chronic renal insufficiency has a doubtful effectiveness, as the chronic renal failure is result of nephroangiosclerosis.
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17
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Ribera L, Rodríguez Jornet A, Falcó J, Perendreu J. [Arteriovenous fistula: complication of renal biopsy. Superselective embolization]. Nefrologia 2004; 24:372-5. [PMID: 15455499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
The arteriovenous fistula can be a major and late complication of percutaneous renal biopsies of native kidneys. The incidence of arteriovenous fistulas appears to be low and has been infrequently mentioned in large series of biopsies although there are a number of individual reports. In most part of cases, no systemic effects of the arteriovenous fistulas were observed, so they close by themselves. Optimization of renal biopsy techniques aims not only at obtaining kidney tissue technically adequate for diagnosis, but at reducing biopsy-induced complications. When these complications are done, the new transvascular techniques can get the healing of fistula with the embolism by catheters. We describe the case of a 37-year-old woman who had chronic renal failure by a possible chronic glomerulonephritis. She developed deterioration of renal function after the percutaneous renal biopsy. An arteriovenous fistula of high flow was detected by Doppler ultrasound. Then, it was confirmed angiographically and closed by embolism's catheter without damage of renal tissue.
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Affiliation(s)
- L Ribera
- Servicio de Nefrología y Unitat de Diagnòstic per la Imatge d'Alta Tecnologia (UDIAT), Corporació Parc Tauli, Sabadell, Barcelona.
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18
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Abstract
The diagnosis of panarteritis nodosa is usually difficult because of the variability of clinical manifestations. Herein is presented a case of occult liver involvement by polyarteritis nodosa. Several biopsies were performed but the diagnosis was made with the contribution of a hepatic arteriography.
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Affiliation(s)
- M Gumà
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
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Escudero D, Muchart J, Sánchez-Ojanguren J, Millán M, Perendreu J. [Angioplasty for intracranial internal carotid artery stenosis]. Rev Neurol 2000; 31:538-41. [PMID: 11055058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Percutaneous transluminal angioplastia has in recent years become an alternative to surgery and increasingly used for revascularization of the extracranial arteries in patients with cerebral ischemia. However, intracranial angioplasty is a technique which is still not widely used since it is technically more difficult and until now endoprotheses (stents) have not been available specifically designed for intracranial territory. CLINICAL CASE A 73 year old patient with extensive extracranial and intracranial atheromatous lesions, multiple vascular risk factors and cardiac ischemia which contraindicated surgical treatment which was treated consecutively by angioplasty and angioplasty with implantation of stents in both carotid bifurcations. Subsequently, he was treated by angioplasty for a stenosing lesion of 90% of the right carotid siphon with clinical and hemodynamic repercussions. Following the procedure, which was well-tolerated by the patient, there was clinical and angiographic improvement and return to normal of the hemodynamic parameters measured by transcranial Doppler. CONCLUSIONS Angioplasty is a technique which may be used in intracranial stenosing atheromatous lesions. Even without perfect angiographic correction, adequate blood flow is established in the hemodynamically affected lesions. As far as we know this is the first case of intracranial angioplasty of a lesion of the carotid siphon reported in Spain.
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Affiliation(s)
- D Escudero
- Servicio de Neurología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Muchart J, Perendreu J, Casas JD, Díaz-Ruíz MJ. Balloon catheter sphincteroplasty and biliary stone expulsion into the duodenum in patients with an indwelling T tube. Abdom Imaging 1999; 24:69-71. [PMID: 9933677 DOI: 10.1007/s002619900443] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To present an alternate approach for treating residual biliary stones in patients with indwelling T tube that uses the immature tract created by the T tube to carry out both sphincteroplasty and expulsion of the calculi with the same angioplasty balloon catheter. METHODS This technique was performed in five patients. Access to the bile duct was through an 8-Fr T tube. First a guidewire was inserted and advanced beyond the obstructing stone to the duodenal lumen. The T tube was removed over the guidewire, and a balloon catheter was introduced. Sphincteroplasty was carried out. Then the balloon was deflated and retracted to a position proximal to the stone. It was then reinflated and used to push the stone, expelling it into the duodenum. RESULTS In all cases, all biliary stones were expelled without pain, in a single session, and with no immediate complications. All patients showed rapid clinical and analytic improvement. During clinical and echographic follow-up of 2-22 months (mean = 12.4 months), there were no complications or relapses. CONCLUSIONS Our limited experience indicates that sphincteroplasty and expulsion of biliary stones with angioplasty balloon catheters through the T tube immature tract is a simple, safe, low-cost technique that gives good results.
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Affiliation(s)
- J Muchart
- Department of Radiology, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, E-08916, Spain
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Casas JD, Perendreu J, Gallart A, Muchart J. Intercostal artery pseudoaneurysm after a percutaneous biliary procedure: diagnosis with CT and treatment with transarterial embolization. J Comput Assist Tomogr 1997; 21:729-30. [PMID: 9294561 DOI: 10.1097/00004728-199709000-00010] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- J D Casas
- Department of Radiology, Universitary Hospital Germans Trias i Pujol, Badalona, Spain
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Perendreu J, Montanya X, Callejas JM, Garcia L, Mitjavila JM, Fernandez-Llamazares J. [Cost-effectiveness of and morbidity from digital subtraction angiography. A study of 5,817 cases]. Ann Radiol (Paris) 1996; 39:153-60. [PMID: 9163968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study was based on 5,817 patients examined by digital subtraction angiography (DSA) between 1984 and 1990. 5,209 patients received an intravenous injection of contrast agent and 608 received an intra-arterial injection. Digital subtraction angiography has become a routine procedure for the diagnosis of vascular disease in the various fields studied, as it provides images of diagnostic quality in 97% of cases: diagnostic quality of 95% after intravenous injection and 99% after intra-arterial injection. The morbidity is 1.65% for the intravenous route and 4.8% for the intra-arterial route. The morbidity of brachial artery catheterization is 5.5% DSA by intravenous injection is a low-risk angiographic technique which represents a major economy in terms of the cost of the examination and the examination time, a reduction of hospital stay and waiting lists; these advantages are very important in the current context of public health.
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Affiliation(s)
- J Perendreu
- Service de Radiologie Vasculaire, Clinique Platon--Fondation Privée, Barcelone, Espagne
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