RESUMEN
BACKGROUND: Heart failure (HF) is the second most important cardiac risk factor for stroke after atrial fibrillation (AF). Few data are available on mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients with HF. METHODS: The source of data is the multicentre Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS). All AIS patients ≥ 18 years receiving MT were categorised in two groups: HF and no-HF. Baseline clinical and neuroradiological findings on admission were analysed. RESULTS: Of 8924 patients, 642 (7.2%) had HF. Compared to the no-HF group, HF patients had higher prevalence of cardiovascular risk factors. Rate of complete recanalisation (TICI 2b-3) was 76.9% in HF vs 78.1% in no-HF group (p = 0.481). Rate of symptomatic intracerebral haemorrhage at 24-h non-contrast computed tomography (NCCT) was 7.6% in HF vs 8.3% in no-HF patients (p = 0.520). At 3 months, 36.4% of HF patients and 48.2% of no-HF patients (p < 0.001) had mRS 0-2, and mortality was, respectively, 30.7% and 18.5% (p < 0.001). In multivariate logistic regression, HF was independently associated with mortality at 3 months (OR 1.53, 1.24-1.88 95% CI, p < 0.001). In multivariate ordinal regression, HF patients had a probability of transitioning to a higher mRS level of 1.23 (1.05-1.44 95% CI, p = 0.012). The propensity score analysis of two groups matched for age, sex, and NIHSS at admission yielded the same results. CONCLUSION: MT is safe and effective in HF patients with AIS. Patients with HF and AIS suffered from higher 3-month mortality and unfavourable outcome regardless of acute treatments.
Asunto(s)
Isquemia Encefálica , Procedimientos Endovasculares , Insuficiencia Cardíaca , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Accidente Cerebrovascular Isquémico/etiología , Trombectomía/efectos adversos , Resultado del Tratamiento , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/cirugía , Insuficiencia Cardíaca/complicaciones , Sistema de Registros , Estudios Retrospectivos , Isquemia Encefálica/complicaciones , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/epidemiología , Procedimientos Endovasculares/efectos adversosRESUMEN
The sudden worldwide outbreak of Coronavirus Disease 2019 (COVID-19) has certainly provided new challenges in the management of acute ischaemic stroke, and the risk-benefit ratio of intravenous thrombolysis in COVID-19 positive patients is not well known. We describe four COVID-19 patients treated with intravenous thrombolysis for acute ischaemic stroke. Although rt-PA administration is the main therapeutic strategy, our patients experienced unpredictable complications and showed atypical features: the overall mortality was very high. In conclusion, in this article, we provide information about these cases and discuss the possible explanation behind this trend.
Asunto(s)
Betacoronavirus , Isquemia Encefálica/tratamiento farmacológico , Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica/métodos , Activador de Tejido Plasminógeno/administración & dosificación , Administración Intravenosa , Anciano , Isquemia Encefálica/complicaciones , Isquemia Encefálica/diagnóstico por imagen , COVID-19 , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico por imagen , Proteínas Recombinantes/administración & dosificación , SARS-CoV-2 , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagenRESUMEN
OBJECTIVE: We evaluated a prospective cohort of 150 patients under observation in our centre for lacunar strokes. The purpose of this study was to investigate if lacunar stroke of varying size, shape and locations had different risk factors between them and possibly different mechanisms and causes. PATIENTS AND METHODS: 150 patients with a lacunar stroke were included in the present study. Infarcts were classified by size, shape and location. We evaluated the correlation between several risk factors of stroke and the radiological characteristics of the infarcts. RESULTS: Older age was associated with the presence of a basal ganglia lesion (p < 0.001) and with the presence of a smaller lesion (trend to statistical significance, p = 0.07). Patients with infarcts >15 mm had higher NIHSS score at admission (p 0.01). CONCLUSION: The different subtypes of lacunar infarcts have distinct pathogenesis. Further studies, with a larger numbers of patients, are necessary to confirm our data.
Asunto(s)
Enfermedad Cerebrovascular de los Ganglios Basales/diagnóstico por imagen , Infartos del Tronco Encefálico/diagnóstico por imagen , Accidente Vascular Cerebral Lacunar/diagnóstico por imagen , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Adulto JovenAsunto(s)
Isquemia Encefálica/diagnóstico por imagen , Neoplasias del Colon/diagnóstico por imagen , Endocarditis Bacteriana/diagnóstico por imagen , Aneurisma Intracraneal/diagnóstico por imagen , Infecciones Estreptocócicas/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Adenocarcinoma/complicaciones , Adenocarcinoma/diagnóstico por imagen , Adulto , Isquemia Encefálica/etiología , Neoplasias del Colon/complicaciones , Diagnóstico Diferencial , Endocarditis Bacteriana/etiología , Humanos , Aneurisma Intracraneal/etiología , Aneurisma Intracraneal/microbiología , Masculino , Infecciones Estreptocócicas/complicaciones , Streptococcus gallolyticus/aislamiento & purificación , Accidente Cerebrovascular/etiologíaAsunto(s)
Encéfalo/patología , Trastornos Migrañosos/patología , Radioterapia/efectos adversos , Accidente Cerebrovascular/patología , Neoplasias Cerebelosas/radioterapia , Neoplasias Cerebelosas/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Meduloblastoma/radioterapia , Meduloblastoma/cirugía , Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/fisiopatología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Síndrome , Adulto JovenRESUMEN
Emphysematous pyelonephritis is a rare and severe renal parenchyma necrotizing infection visible just in diabetic patients which results in gas presence--probably produced through the glucose fermentation process--in the collecting system, renal parenchyma and perirenal tissue. We present a case of a not known diabetic female patient with emphysematous pyelonephritis of the left kidney and emphysematous pyelitis of the controlateral kidney.