Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 24
Filtrar
1.
J Perinat Med ; 52(5): 515-519, 2024 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-38640060

RESUMO

OBJECTIVES: Universal opt-out antenatal screening for Hepatitis C virus (HCV) is not currently recommened and it is recommended that maternity services offer risk-based testing. We aimed to investigate antenatal HCV testing and adherence to testing guidance. METHODS: A cross-sectional survey was circulated to maternity service providers between November-December 2020 which included testing policy, training for healthcare staff, and management of women found to be HCV positive. Descriptive data are presented. RESULTS: A total of 75 questionnaires were returned, representing 48 % of English maternity service providers. 87 % of providers reported offering antenatal HCV risk-based testing. Risk factors used to identify pregnant women for testing varied. Less than 15 % of respondents considered women that were ever homeless or with history of incarceraton or from higher HCV prevalence areas as high risk. CONCLUSIONS: Current antenatal HCV testing practices are inadequate and HCV infection likely goes undiagnosed in pregnancy, especially among vulnerable population groups. In the absence of universal antenatal screening, re-framing antenatal HCV risk-based testing and management as a quality improvement initiative and developing HCV specific pathway guidance for maternity units is required.


Assuntos
Hepatite C , Complicações Infecciosas na Gravidez , Humanos , Feminino , Gravidez , Estudos Transversais , Inglaterra/epidemiologia , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/epidemiologia , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Hepatite C/terapia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Serviços de Saúde Materna/normas , Inquéritos e Questionários , Adulto , Diagnóstico Pré-Natal/métodos
2.
Br J Radiol ; 97(1154): 324-330, 2024 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-38265306

RESUMO

Evidence-based clinical guidelines are essential to maximize patient benefit and to reduce clinical uncertainty and inconsistency in clinical practice. Gaps in the evidence base can be addressed by data acquired in routine practice. At present, there is no international consensus on management of women diagnosed with atypical lesions in breast screening programmes. Here, we describe how routine NHS breast screening data collected by the Sloane atypia project was used to inform a management pathway that maximizes early detection of cancer and minimizes over-investigation of lesions with uncertain malignant potential. A half-day consensus meeting with 11 clinical experts, 1 representative from Independent Cancer Patients' Voice, 6 representatives from NHS England (NHSE) including from Commissioning, and 2 researchers was held to facilitate discussions of findings from an analysis of the Sloane atypia project. Key considerations of the expert group in terms of the management of women with screen detected atypia were: (1) frequency and purpose of follow-up; (2) communication to patients; (3) generalizability of study results; and (4) workforce challenges. The group concurred that the new evidence does not support annual surveillance mammography for women with atypia, irrespective of type of lesion, or woman's age. Continued data collection is paramount to monitor and audit the change in recommendations.


Assuntos
Neoplasias da Mama , Tomada de Decisão Clínica , Feminino , Humanos , Consenso , Incerteza , Mama/diagnóstico por imagem , Mama/patologia , Mamografia/métodos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia
3.
Epidemiol Infect ; 151: e50, 2023 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-36960728

RESUMO

Around 0.4% of pregnant women in England have chronic hepatitis B virus (HBV) infection and need services to prevent vertical transmission. In this national audit, sociodemographic, clinical and laboratory information was requested from all maternity units in England for hepatitis B surface antigen-positive women initiating antenatal care in 2014. We describe these women's characteristics and indicators of access to/uptake of healthcare. Of 2542 pregnancies in 2538 women, median maternal age was 31 [IQR 27, 35] years, 94% (1986/2109) were non-UK born (25% (228/923) having arrived into the UK <2 years previously) and 32% (794/2473) had ⩾2 previous live births. In 39%, English levels were basic/less than basic. Antenatal care was initiated at median 11.3 [IQR 9.6, 14] gestation weeks, and 'late' (⩾20 weeks) in 10% (251/2491). In 70% (1783/2533) of pregnancies, HBV had been previously diagnosed and 11.8% (288/2450) had ⩾1 marker of higher infectivity. Missed specialist appointments were reported in 18% (426/2339). Late antenatal care and/or missed specialist appointments were more common in pregnancies among women lacking basic English, arriving in the UK ⩽2 years previously, newly HBV diagnosed, aged <25 years and/or with ⩾2 previous live births. We show overlapping groups of pregnant women with chronic HBV vulnerable to delayed or incomplete care.


Assuntos
Hepatite B Crônica , Hepatite B , Complicações Infecciosas na Gravidez , Feminino , Gravidez , Humanos , Gestantes , Hepatite B Crônica/epidemiologia , Hepatite B Crônica/prevenção & controle , Hepatite B/epidemiologia , Hepatite B/diagnóstico , Cuidado Pré-Natal , Complicações Infecciosas na Gravidez/epidemiologia , Vírus da Hepatite B , Antígenos de Superfície da Hepatite B , Inglaterra/epidemiologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle
4.
J Neurointerv Surg ; 14(2): 111-116, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33593800

RESUMO

BACKGROUND: The benefit of complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 3) over near-complete reperfusion (≥90%, mTICI 2c) remains unclear. The goal of this study is to compare clinical outcomes between mechanical thrombectomy (MT)-treated stroke patients with mTICI 2c versus 3. METHODS: This is a retrospective study from the Stroke Thrombectomy and Aneurysm Registry (STAR) comprising 33 centers. Adults with anterior circulation arterial vessel occlusion who underwent MT yielding mTICI 2c or mTICI 3 reperfusion were included. Patients were categorized based on reperfusion grade achieved. Primary outcome was modified Rankin Scale (mRS) 0-2 at 90 days. Secondary outcomes were mRS scores at discharge and 90 days, National Institutes of Health Stroke Scale score at discharge, procedure-related complications, and symptomatic intracerebral hemorrhage. RESULTS: The unmatched mTICI 2c and mTICI 3 cohorts comprised 519 and 1923 patients, respectively. There was no difference in primary (42.4% vs 45.1%; p=0.264) or secondary outcomes between the unmatched cohorts. Reperfusion status (mTICI 2c vs 3) was also not predictive of the primary outcome in non-imputed and imputed multivariable models. The matched cohorts each comprised 191 patients. Primary (39.8% vs 47.6%; p=0.122) and secondary outcomes were also similar between the matched cohorts, except the 90-day mRS which was lower in the matched mTICI 3 cohort (p=0.049). There were increased odds of the primary outcome with mTICI 3 in patients with baseline mRS ≥2 (36% vs 7.7%; p=0.011; pinteraction=0.014) and a history of stroke (42.3% vs 15.4%; p=0.027; pinteraction=0.041). CONCLUSIONS: Complete and near-complete reperfusion after MT appear to confer comparable outcomes in patients with acute stroke.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/cirurgia , Humanos , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Trombectomia , Resultado do Tratamento
5.
Stroke ; 52(11): e715-e719, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34517765

RESUMO

Background and Purpose: Epidemiological studies have shown racial and ethnic minorities to have higher stroke risk and worse outcomes than non-Hispanic Whites. In this cohort study, we analyzed the STAR (Stroke Thrombectomy and Aneurysm Registry) database, a multi-institutional database of patients who underwent mechanical thrombectomy for acute large vessel occlusion stroke to determine the relationship between mechanical thrombectomy outcomes and race. Methods: Patients who underwent mechanical thrombectomy between January 2017 and May 2020 were analyzed. Data included baseline characteristics, vascular risk factors, complications, and long-term outcomes. Functional outcomes were assessed with respect to Hispanic status delineated as non-Hispanic White (NHW), non-Hispanic Black (NHB), or Hispanic patients. Multivariate analysis was performed to identify variables associated with unfavorable outcome or modified Rankin Scale ≥3 at 90 days. Results: Records of 2115 patients from the registry were analyzed. Median age of Hispanic patients undergoing mechanical thrombectomy was 60 years (72­84), compared with 63 years (54­74) for NHB, and 71 years (60­80) for NHW patients (P<0.001). Hispanic patients had a higher incidence of diabetes (41%; P<0.001) and hypertension (82%; P<0.001) compared with NHW and NHB patients. Median procedure time was shorter in Hispanics (36 minutes) compared to NHB (39 minutes) and NHW (44 minutes) patients (P<0.001). In multivariate analysis, Hispanic patients were less likely to have favorable outcome (odds ratio, 0.502 [95% CI, 0.263­0.959]), controlling for other significant predictors (age, admission National Institutes Health Stroke Scale, onset to groin time, number of attempts, procedure time). Conclusions: Hispanic patients are less likely to have favorable outcome at 90 days following mechanical thrombectomy compared to NHW or NHB patients. Further prospective studies are required to validate our findings.


Assuntos
AVC Isquêmico/etnologia , AVC Isquêmico/cirurgia , Trombectomia/métodos , Resultado do Tratamento , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Hispânico ou Latino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros
6.
World Neurosurg ; 151: e871-e879, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33974981

RESUMO

BACKGROUND: Mechanical thrombectomy (MT) is the standard of care for the treatment of proximal anterior circulation large vessel occlusions. However, little is known about its efficacy and safety in the treatment of distal intracranial occlusions. METHODS: This is a multicenter retrospective study of patients treated with MT at 15 comprehensive centers between January 2015 and December 2018. The study cohort was divided into 2 groups based on the location of occlusion (proximal vs. distal). Distal occlusion was defined as occlusion of M3 segment of the middle cerebral artery, any segment of the anterior cerebral artery, or any segment of the posterior cerebral artery. Only isolated distal occlusion was included. Good outcome was defined as 90-day modified Rankin scale score 0-2. RESULTS: A total of 4710 patients were included in this study, of whom 189 (4%) had MT for distal occlusions. Compared with the proximal occlusion group, distal occlusion group had a higher rate of good outcome (45% vs. 36%; P = 0.03) and a lower rate of successful reperfusion (78% vs. 84%; P = 0.04). However, the differences did not retain significance in adjusted models. Otherwise there was no difference in the rate of hemorrhagic complications, mortality, or procedure-related complications between the 2 groups. Successful reperfusion, age, and admission stroke severity emerged as predictors of good functional outcome in the distal occlusion group. CONCLUSIONS: Thrombectomies of distal vessels achieve high rate of successful reperfusion with similar safety profile to those in more proximal locations.


Assuntos
Doenças Arteriais Cerebrais/patologia , Doenças Arteriais Cerebrais/cirurgia , Trombectomia/métodos , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Trombectomia/efeitos adversos , Resultado do Tratamento
8.
J Neurointerv Surg ; 12(11): 1039-1044, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32843359

RESUMO

BACKGROUND: In response to the COVID-19 pandemic, many centers altered stroke triage protocols for the protection of their providers. However, the effect of workflow changes on stroke patients receiving mechanical thrombectomy (MT) has not been systematically studied. METHODS: A prospective international study was launched at the initiation of the COVID-19 pandemic. All included centers participated in the Stroke Thrombectomy and Aneurysm Registry (STAR) and Endovascular Neurosurgery Research Group (ENRG). Data was collected during the peak months of the COVID-19 surge at each site. Collected data included patient and disease characteristics. A generalized linear model with logit link function was used to estimate the effect of general anesthesia (GA) on in-hospital mortality and discharge outcome controlling for confounders. RESULTS: 458 patients and 28 centers were included from North America, South America, and Europe. Five centers were in high-COVID burden counties (HCC) in which 9/104 (8.7%) of patients were positive for COVID-19 compared with 4/354 (1.1%) in low-COVID burden counties (LCC) (P<0.001). 241 patients underwent pre-procedure GA. Compared with patients treated awake, GA patients had longer door to reperfusion time (138 vs 100 min, P=<0.001). On multivariate analysis, GA was associated with higher probability of in-hospital mortality (RR 1.871, P=0.029) and lower probability of functional independence at discharge (RR 0.53, P=0.015). CONCLUSION: We observed a low rate of COVID-19 infection among stroke patients undergoing MT in LCC. Overall, more than half of the patients underwent intubation prior to MT, leading to prolonged door to reperfusion time, higher in-hospital mortality, and lower likelihood of functional independence at discharge.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Acidente Vascular Cerebral/terapia , Trombectomia/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral , COVID-19 , Procedimentos Endovasculares , Feminino , Mortalidade Hospitalar , Humanos , Vida Independente , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reperfusão , Trombectomia/métodos , Resultado do Tratamento , Fluxo de Trabalho
9.
Int J STD AIDS ; 29(11): 1110-1119, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29862901

RESUMO

Within a century, congenital syphilis has been reduced from a major cause of morbidity and mortality to a condition rarely seen in the UK. Here, newly-derived literature and information searches were used to create a contemporary overview of the epidemic, including its epidemiology. Although constrained by high-quality healthcare services and with an incidence below the World Health Organization elimination threshold, congenital syphilis still has the potential to cause major consequences for the health and life chances of affected infants. If the complex challenges presented by this preventable disease are to be resolved, intervention strategies need to be optimised, rigorously assessed and extended across Europe.


Assuntos
Diagnóstico Pré-Natal/estatística & dados numéricos , Sífilis Congênita/epidemiologia , Sífilis/diagnóstico , Feminino , Humanos , Incidência , Recém-Nascido , Masculino , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Sífilis/epidemiologia , Sífilis Congênita/diagnóstico , Reino Unido/epidemiologia
11.
J AOAC Int ; 101(2): 383-384, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-28821306

RESUMO

A single-laboratory validation method for the simultaneous determination of nutrient and non-nutrient metals in commercial fertilizers was reviewed by the AOAC Expert Review Panel (ERP) and Stakeholder Panel for Fertilizers at the 2017 midyear AOAC INTERNATIONAL meeting. In addition to using 15 of the original 30 fertilizer materials from the previous Method 2006.03 collaborative study, NIST Standard Certified Reference Material 695 and Magruder check sample 2009-06 were also incorporated as accuracy, recovery, and repeatability materials. Method 2017.02 is suitable for the simultaneous determination of arsenic, cadmium, calcium, chromium, cobalt, copper, iron, lead, magnesium, manganese, molybdenum, nickel, selenium, and zinc in all major types of commercial fertilizer products by microwave digestion and inductively coupled plasma-optical emission spectroscopy analysis. With recoveries ranging from 92.8 to 103.2% for analytes above the LOQs, improved RSDs, and enhanced efficiency as compared with the previous method, Method 2006.03, the ERP recommended this method for First Action Official MethodsSM Status.


Assuntos
Arsênio/análise , Fertilizantes/análise , Metais Alcalinoterrosos/análise , Metais Pesados/análise , Selênio/análise , Micro-Ondas , Espectrofotometria
12.
Euro Surveill ; 22(49)2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29233254

RESUMO

Four isolated cases of congenital syphilis born to mothers who screened syphilis negative in the first trimester were identified between March 2016 and January 2017 compared with three cases between 2010 and 2015. The mothers were United Kingdom-born and had no syphilis risk factors. Cases occurred in areas with recent increases in sexually-transmitted syphilis among women and men who have sex with men, some behaviourally bisexual, which may have facilitated bridging between sexual networks.


Assuntos
Complicações Infecciosas na Gravidez/diagnóstico , Comportamento Sexual , Sífilis Congênita/diagnóstico , Adulto , Inglaterra , Feminino , Humanos , Masculino , Gravidez
13.
Global Spine J ; 6(7): 679-685, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27781188

RESUMO

Study Design Retrospective comparative study. Objective To compare strict Biffl criteria to more-liberal criteria for computed tomography angiography (CTA) when screening for blunt cerebrovascular injury (BCVI). Methods All CTAs performed for blunt injury between 2009 and 2011 at our institution were reviewed. All patients with cervical spine fractures who were evaluated with CTA were included; patients with penetrating trauma and atraumatic reasons for imaging were excluded. We then categorized the patients' fractures based on the indications for CTA as either within or outside Biffl criteria. For included subjects, the percentage of studies ordered for loose versus strict Biffl criteria and the resulting incidences of BCVI were determined. Results During our study period, 1,000 CTAs were performed, of which 251 met inclusion criteria. Of the injuries, 192 met Biffl criteria (76%). Forty-nine were found to have BCVIs (19.5%). Forty-one injuries were related to fractures meeting Biffl criteria (21.4%), and 8 were related to fractures not meeting those criteria (13.6%). The relative risk of a patient with a Biffl criteria cervical spine injury having a vascular injury compared with those imaged outside of Biffl criteria was 1.57 (p = 0.19). Conclusions Our data demonstrates that although cervical spine injuries identified by the Biffl criteria trend toward a higher likelihood of concomitant BCVI (21.4%), a significant incidence of 13.6% also exists within the non-Biffl fracture cohort. As a result, a more-liberal screening than proposed by Biffl may be warranted.

15.
J Neurointerv Surg ; 7(11): 855-60, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25200246

RESUMO

OBJECTIVE: Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating illness with nationwide mortality rates reaching almost 50% within the first 30 days. A study was undertaken to evaluate how treatment modality, physical findings, and geo-demography contribute to the outcome of these cases, including complications and disposition status. METHODS: All cases of aSAH in the fiscal year of 2012 (July 2011-June 2012) at the Medical University of South Carolina and Palmetto Health Richland were studied. These healthcare facilities represent 88.5% of aneurysm treatment in the state of South Carolina. Information including aneurysm properties, Hunt-Hess grade, Fisher grade, and symptoms occurring at and after admission were analyzed. RESULTS: 131 patients (94 women and 37 men) with aSAH were treated. 92.4% of cases were treated endovascularly, with more than a third of all cases using balloon-assisted coiling. Hypertension, tobacco use, and hyperlipidemia were the most prevalent comorbidities. Headache, followed by hydrocephalus, motor disturbance, and nausea/vomiting were the most common presenting symptoms. The most common adverse event occurring after hospital admission was acute respiratory failure followed by urinary tract infection, hydrocephalus, and vasospasm. 42.0% were discharged home and nine patients (6.9%) died during hospitalization. CONCLUSIONS: Previously established risk factors such as hypertension and smoking were identified as the most prevalent comorbidities, with disparity between subgroups, particularly women and African Americans. Endovascular treatment was the primary modality of treatment. Mortality rates were lower than previously reported.


Assuntos
Avaliação de Resultados em Cuidados de Saúde , Hemorragia Subaracnóidea , Negro ou Afro-Americano/etnologia , Aneurisma Roto/complicações , Aneurisma Roto/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , South Carolina/epidemiologia , Hemorragia Subaracnóidea/epidemiologia , Hemorragia Subaracnóidea/mortalidade , Hemorragia Subaracnóidea/patologia , Hemorragia Subaracnóidea/terapia
16.
J AOAC Int ; 97(3): 700-11, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25051614

RESUMO

A single-laboratory validation study was conducted for the simultaneous determination of arsenic, cadmium, calcium, cobalt, copper, chromium, iron, lead, magnesium, manganese, molybdenum, nickel, selenium, and zinc in all major types of commercial fertilizer products by microwave digestion and inductively coupled plasma-optical emission spectroscopy analysis. This validation study proposes an extension and modification of AOAC 2006.03. The extension is the inclusion of calcium, copper, iron, magnesium, manganese, and zinc, and the modification is incorporation of hydrochloric acid in the digestion system. This dual acid digestion utilizes both hydrochloric and nitric acids in a 3 to 9 mL volume ratio/100 mL. In addition to 15 of the 30 original validation materials used in the 2006.03 collaborative study, National Institute of Standards and Technology Standard Reference Material 695 and Magruder 2009-06 were incorporated as accuracy materials. The main benefits of this proposed method are a significant increase in laboratory efficiency when compared to the use of both AOAC Methods 965.09 and 2006.03 to achieve the same objective and an enhanced recovery of several metals.


Assuntos
Metais/análise , Espectrofotometria Atômica/métodos , Arsênio/análise , Cádmio/análise , Cálcio/análise , Cromo/análise , Cobalto/análise , Cobre/análise , Fertilizantes/análise , Ferro/análise , Magnésio/análise , Manganês/análise , Micro-Ondas , Molibdênio/análise , Níquel/análise , Selênio/análise , Zinco/análise
17.
Neurosurgery ; 72(2): 216-20; discussion 220, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23149970

RESUMO

BACKGROUND: Endovascular coil embolization of ruptured aneurysms is performed under general anesthesia at most centers for perceived improved image quality and patient safety. OBJECTIVE: To report the feasibility of and outcomes associated with endovascular treatment of subarachnoid hemorrhage (SAH) patients with ruptured cerebral aneurysms performed under conscious sedation with local anesthetics. METHODS: Between January 2005 and December 2009, 187 patients with aneurysmal SAH were treated with coil embolization at the authors' hospital. For each patient, procedural details, mode of anesthesia, and clinical and radiographic outcomes were reviewed retrospectively (retrospective case series). RESULTS: A total of 197 coil embolizations were performed: 112 under general anesthesia, 78 under conscious sedation with local anesthetics, and 7 converted from conscious sedation to general anesthesia. None of the patients who presented with Hunt & Hess grade IV or V were treated under conscious sedation. For patients who presented with Hunt & Hess grades I, II, and III, 79.2%, 66.7%, and 32.6% of patients, respectively, underwent successful completion of treatment under conscious sedation. The symptomatic procedural complication rate was 2.5% overall and 2.4% for the conscious sedation group alone. Among the 14 interventions with intraprocedural perforation, 11 were performed under general anesthesia and 3 were performed under conscious sedation. CONCLUSION: In the authors' experience, conscious sedation with local anesthetics for endovascular treatment of ruptured intracranial aneurysms is feasible and safe in most patients with low-grade SAH. It may allow direct evaluation of the patient's neurological status, potentially leading to earlier detection and response to intraprocedural complications.


Assuntos
Anestesia Local/efeitos adversos , Aneurisma Roto/tratamento farmacológico , Aneurisma Roto/cirurgia , Sedação Consciente/efeitos adversos , Embolização Terapêutica/efeitos adversos , Complicações Pós-Operatórias/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
19.
J Neurosurg ; 116(5): 952-60, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22304447

RESUMO

OBJECT: The treatment of acute intracranial vertebrobasilar artery occlusion (VBO) has been described but often with poor results. The authors of this study set out to evaluate their institution's outcomes following multimodal treatment of VBO. METHODS: They retrospectively reviewed their endovascular database for all patients treated for acute intracranial VBO between December 2004 and June 2010. Twenty-four patients were identified. Two patients were excluded from evaluation-one because of incomplete medical records and one because the etiology was basilar stenosis and not stroke. Occlusion location, hypercoagulable causes, time to endovascular treatment, time to revascularization, comorbidities, devices used, procedural anticoagulation, and outcomes were analyzed. RESULTS: Among the 22 eligible study patients, the mean National Institutes of Health Stroke Scale (NIHSS) score at presentation was 15.3. The mean time from presentation to initiation of the endovascular procedure was 4.77 hours. The mean time for recanalization from the start of angiography was 1.63 hours. In 16 patients (73%), revascularization was successful (Thrombolysis in Myocardial Infarction [TIMI] score of 2 or 3). Thirteen (59%) of the 22 patients were discharged to home or a rehabilitation facility. One patient was transferred to a chronic care facility. The overall survival rate was 64%. The average NIHSS score for the 14 surviving patients at discharge was 3.9. At the follow-up (average 14.5 months, range 1-58 months), 10 patients (71%) had achieved good outcomes (modified Rankin Scale [mRS] score ≤ 2) and 4 (29%) had poor outcomes (mRS Score 3-6). CONCLUSIONS: Published case series have historically shown poor outcomes and high mortality rates in association with the treatment of acute VBO, prompting surgeons to be less aggressive in the treatment of this disease than they might be otherwise. Data in this series show that the revascularization of posterior circulation occlusions is feasible and that good outcomes and lower mortality rates with newer endovascular technologies are possible, and thus more prompt and aggressive treatment of this disease may be warranted.


Assuntos
Revascularização Cerebral/métodos , Procedimentos Neurocirúrgicos/métodos , Insuficiência Vertebrobasilar/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/cirurgia , Angiografia Cerebral , Interpretação Estatística de Dados , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/cirurgia , Análise de Sobrevida , Terapia Trombolítica , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Insuficiência Vertebrobasilar/mortalidade
20.
World Neurosurg ; 77(3-4): 591.e1-5, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22120371

RESUMO

BACKGROUND: The treatment of acute ischemic stroke in the setting of infective endocarditis (IE) is not well established. Although there have been a few reports on the use of intravenous thrombolysis, the role of mechanical thrombolysis through embolectomy is unknown. CASE DESCRIPTION: A 78-year-old woman with an acute middle cerebral artery stroke secondary to septic embolization underwent successful stent retrieval of the septic embolus, followed by complete revascularization and neurologic improvement. CONCLUSIONS: Mechanical thrombolysis with embolectomy may be a safe and efficacious option for selected patients with acute ischemic stroke secondary to IE.


Assuntos
Revascularização Cerebral/métodos , Infarto da Artéria Cerebral Média/cirurgia , Procedimentos Neurocirúrgicos/métodos , Sepse/cirurgia , Stents , Idoso , Isquemia Encefálica/etiologia , Isquemia Encefálica/terapia , Angiografia Cerebral , Embolectomia/métodos , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Infarto da Artéria Cerebral Média/complicações , Imageamento por Ressonância Magnética , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Terapia Trombolítica , Tomografia Computadorizada por Raios X
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA