RESUMO
BACKGROUND: The impact of thrombolytics directed towards different thrombus components regarding site of occlusion in combination with mechanical thrombectomy (MT) to achieve endovascular complete recanalization is unclear. METHODS: Retrospective analysis of a prospective database in two stroke centers. Intracranial thrombi retrieved by MT were analyzed using hematoxylin-eosin staining for fibrin and red blood cell proportions, and CD61 immunostaining for platelets proportion in thrombus (PLTPT) assessment. Thrombi composition, baseline variables, etiology, treatment features and occlusion location were analyzed. RESULTS: Overall, 221 patients completed the per protocol analysis and 110 cases achieved a final expanded Thrombolysis in Cerebral Infarction (eTICI) 3 (49%) of which 70 were MT (32%) by first pass effect (FPE). Thrombi from medium distal vessel occlusions had higher PLTPT compared with thrombi from proximal large vessel occlusions (68% vs 61%, P=0.026). In particular, middle cerebral artery M2-M3 segment thrombi had the highest PLTPT (70%), and basilar artery thrombi the lowest PLTPT (41%). After logistic regression analysis adjusted for occlusion location and intravenous fibrinolysis, lower baseline National Institutes of Health Stroke Scale score (adjusted OR (aOR) 0.95, 95% CI 0.913 to 0.998) and PLTPT (aOR 0.97, 95% CI 0.963 to 0.993) were independently associated with FPE. Fewer MT passes (aOR 0.67, 95% CI 0.538 to 0.842) and platelet poor thrombus (<62% PLTPT; aOR 2.39, 95% CI 1.288 to 4.440) were independently associated with final eTICI 3. CONCLUSIONS: Occlusion location might be a surrogate parameter for thrombus composition. Platelet poor clots and fewer MT passes were independently associated with complete endovascular recanalization. Clinical trials testing the benefits of combining selective intra-arterial platelet antagonists with MT to improve endovascular outcomes are warranted.
RESUMO
Apesar dos benefícios gerados pelo exercício físico, são elevadas as taxas de sedentarismo no mundo. As respostas afetivas ao exercício têm sido apontadas como relevantes para o aumento da adesão ao exercício. O objetivo deste estudo foi comparar o efeito de duas prescrições aeróbias, uma baseada no nível de atividade física (PBAF) e outra baseada no VO2máx (PBVO2máx), sobre desfechos relacionados a adesão ao exercício. Vinte e quatro indivíduos foram submetidos a três sessões experimentais em esteira rolante. Na primeira visita foram realizadas as medidas antropométricas e um teste cardiopulmonar de exercício para a estimativa do VO2máx. Nas visitas subsequentes, foram realizadas as atividades aeróbias (PBAF e PBVO2máx) em ordem sorteada. Durante as atividades foram registradas a frequência cardíaca, a percepção de esforço e a escala de sensações para a quantificação do afeto. Um teste t pareado demonstrou maior intensidade (p<0,01) e duração (p<0,05) na PBAF comparada a PBVO2máx. A percepção de esforço não apresentou diferença significativa entre as condições (p>0,05). Uma análise de razão de chance (RC) demonstrou que a PBVO2máx gerou maior chance de ocorrência dos desfechos positivos (Conclusão do treino: RC=2,89; Manutenção do estado estável: RC=2,87; e Aumento do afeto: RC=1,84) e menor chance de ocorrência dos desfechos negativos (Afeto negativo: RC=0,33; Redução do afeto: RC=0,60; e Negativação do afeto: RC=0,34). A PBVO2máx gerou melhores respostas para desfechos associados à adesão em uma sessão de treinamento aeróbio. É recomendável a utilização da PBVO2Max em conjunção à monitoração das respostas afetivas para a configuração de sessões aeróbias.
Despite the benefits of exercise there are still high rates of physical inactivity. The affective responses to exercise has been identified as relevant to increase exercise adherence. The aim of this study was to compare the effect of two aerobic prescriptions, one based on physical activity level (PBAF) and another based on VO2max (PBVO2max) on outcomes related to exercise adherence. Twenty-four subjects underwent three experimental sessions on the treadmill. On the first visit, anthropometric measurements and a cardiopulmonary exercise test (to estimate VO2max) were performed. In subsequent visits, aerobic activities (PBAF and PBVO2max) were performed in a randomized order. During the sessions, heart rate, perceived exertion and the Feeling Scale (for the affective response measurement) were recorded. A paired t-test showed greater intensity (p<0.01) and duration (p<0.05) in PBAF compared to PBVO2max. The perceived exertion was not significantly different between conditions (p>0.05). An analysis of odds ratio (OR) showed that PBVO2max generated greater frequency of positive outcomes (Training completion: OR = 2.89; Maintenance of steady state: OR=2.87; Increase of affect: RC=1.84) and less chance of occurrence of negative outcomes (Negative affect: OR=0.33; Reduction of affect: OR=0.60, and Affect negativization: RC=0.34). The PBVO2max generated better responses for outcomes related to exercise adherence in a single session of aerobic training. We recommend the use of PBVO2max in addition to the evaluation of affective responses to prescribe aerobic sessions.