Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 6 de 6
Filtrar
1.
Neurol Sci ; 44(12): 4401-4410, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37458843

RESUMO

INTRODUCTION: The aim of this study was to compare the outcomes of patients treated with intravenous thrombolysis (IVT) <4.5 h after symptom onset plus mechanical thrombectomy (MT) <6 h with those treated with IVT alone <4.5 h for minor stroke (NIHSS ≤5) with large vessel occlusion (LVO) in the anterior circulation. PATIENTS AND METHODS: Patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) and in the Italian centers included in the SITS-ISTR were analyzed. RESULTS: Among the patients with complete data on 24-h ICH type, 236 received IVT plus MT and 382 received IVT alone. IVT plus MT was significantly associated with unfavorable shift on 24-h ICH types (from no ICH to PH-2) (OR, 2.130; 95% CI, 1.173-3.868; p=0.013) and higher rate of PH (OR, 4.363; 95% CI, 1.579-12.055; p=0.005), sICH per ECASS II definition (OR, 5.527; 95% CI, 1.378-22.167; p=0.016), and sICH per NINDS definition (OR, 3.805; 95% CI, 1.310-11.046; p=0.014). Among the patients with complete data on 3-month mRS score, 226 received IVT plus MT and 262 received IVT alone. No significant difference was reported between IVT plus MT and IVT alone on mRS score 0-1 (72.1% versus 69.1%), mRS score 0-2 (79.6% versus 79%), and death (6.2% versus 6.1%). CONCLUSIONS: Compared with IVT alone, IVT plus MT was associated with unfavorable shift on 24-h ICH types and higher rate of 24-h PH and sICH in patients with minor stroke and LVO in the anterior circulation. However, no difference was reported between the groups on 3-month functional outcome measures.


Assuntos
Isquemia Encefálica , Trombólise Mecânica , Acidente Vascular Cerebral , Humanos , Terapia Trombolítica/efeitos adversos , Trombólise Mecânica/efeitos adversos , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/complicações , Resultado do Tratamento , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/complicações , Trombectomia/efeitos adversos , Fibrinolíticos/uso terapêutico
2.
Neuroradiology ; 63(7): 1087-1091, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33410950

RESUMO

PURPOSE: We describe the reorganization carried out during the COVID-19 outbreak at one of the stroke centers in Italy and report on the clinical features and procedural variables of stroke patients in need of endovascular treatment. METHODS: From 1 March to 10 May 2020, we retrospectively analyzed data from stroke patients in need of urgent neurointerventional treatment. Clinical presentation, demographics, and clinical history were collected along with procedural variables (door-to-needle time, needle-to-mTiCi time). Each patient underwent a nasal swab (polymerase chain reaction test), clinical screening, and chest CT scan to assess the risk of SARS-CoV-2 infection. Technical success, procedural safety (including staff SARS-CoV-2 infection), and clinical outcome at discharge were retrieved. A comparison was made with the same patient population treated between 1 March and 10 May 2019 to highlight possible differences in the characteristics or outcomes of the patients. RESULTS: One hundred thirty-six ischemic stroke patients were admitted to our facility from 1 March to 10 May 2020. Of these, 12 patients (9%) were classified as "high risk" for SARS-CoV-2 infection. Radiological suspicion of COVID-19 was confirmed in all cases by pharyngeal swab. Five SARS-CoV-2 patients (42%) needed endovascular therapy. None of the staff members tested positive for IgG against SARS-CoV-2. Compared to the same period in 2019, an increase in the mean interval from the first symptoms to hospital arrival was observed (p < 0.05). CONCLUSION: Endovascular treatment of stroke presented several challenges during the COVID-19 outbreak. Within the hospital, special pathways can be used to maintain both procedural safety and procedural times.


Assuntos
COVID-19/epidemiologia , Procedimentos Endovasculares , Planejamento de Instituições de Saúde , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Idoso , COVID-19/diagnóstico , Teste para COVID-19 , Diagnóstico por Imagem , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Retrospectivos , SARS-CoV-2
3.
Radiol Med ; 122(1): 16-21, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27738787

RESUMO

OBJECTIVE: The aim of the study was to compare the atherosclerotic disease in the coronary and carotid arteries in patients who underwent non-invasive imaging for suspected stable coronary artery disease (CAD). MATERIALS AND METHODS: 107 patients (64 men, age 59 ± 12) with atypical chest pain underwent cardiac CT (CCT) and carotid ultrasound (US) on the same day. Severity (obstructive or not-obstructive disease), location, shape, and composition of atherosclerotic plaques in the two districts were evaluated. RESULTS: Patients presented normal coronary arteries in 36 % (n = 38), not-obstructive CAD in 36 % (n = 39), and obstructive CAD in 28 % (n = 30), while had normal carotid arteries in 53 % (n = 57), not-obstructive disease in 44 % (n = 47), and obstructive disease in 3 % (n = 3) (p < 0.05). The coronary plaques were located in 7 % at ostial sites, in 29 % at non-ostial sites, and in 64 % at both locations. The carotid plaques were located at the origin of the internal and external carotid arteries in 56 %, at the bifurcation in 20 %, and at both locations in 24 % (p < 0.05). Coronary plaques were calcified in 25 %, non-calcified in 19 %, and mixed in 56 %; carotid plaques were calcified in 8 %, non-calcified in 8 %, and mixed in 84 % of patients (p < 0.05). CONCLUSION: Atherosclerotic disease presents different imaging findings in the coronary tree and in the carotid district with respect to lesion severity, position along the vessel course, and composition of plaque.


Assuntos
Aterosclerose/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia , Técnicas de Imagem de Sincronização Cardíaca , Meios de Contraste , Angiografia Coronária , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Iopamidol/análogos & derivados , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
4.
J Comput Assist Tomogr ; 40(3): 393-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27192500

RESUMO

OBJECTIVE: The aim of our study was to evaluate the diagnostic performance of cardiac computed tomography (CCT) in the evaluation of coronary artery stenosis in patients with ascending aorta aneurysm detected at transthoracic echocardiography. METHODS: We conducted a retrospective analysis of patients with an aneurysm 45 mm or greater at transthoracic echocardiography who underwent CCT from 2012 to 2014 in our hospital. We calculated the sensitivity, specificity, and positive and negative predictive values of CCT for the assessment of coronary artery stenosis (<50% or ≥50% stenosis) in patients who underwent conventional coronary angiography. RESULTS: We included 104 patients (73 men, aged 64 [SD, 10.8] years) in our study. Obstructive coronary artery disease was found in 22.1% of patients. Sensitivity, specificity, and positive and negative predictive values of CCT for detecting significant stenoses were 100%, 98%, and 82% and 100% on a segment-by-segment analysis and 100%, 83%, and 65% and 100% on a per-patient analysis, respectively. CONCLUSIONS: Cardiac computed tomography provides a comprehensive evaluation of ascending aorta aneurysms and coronary artery tree.


Assuntos
Aorta/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Ecocardiografia , Tomografia Computadorizada por Raios X , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
5.
J Neurosurg Case Lessons ; 8(7)2024 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-39133943

RESUMO

BACKGROUND: Vertebral hemangioma is the most common benign tumor of the spine, diagnosed incidentally in most cases. In 0.4% of patients, the lesion is considered aggressive, causing neurological deficits. This subtype of hemangioma is characterized by strong postcontrast enhancement, cortical lysis, and epidural extension causing myelopathy and/or radiculopathy. OBSERVATIONS: A 52-year-old man presented with myelopathy symptoms, namely lower-limb hypoesthesia up to the T4-5 sensory level, right leg hyposthenia, and urinary incontinence. Imaging studies revealed a giant dumbbell-shaped lesion causing spinal cord compression, associated with signal alteration of the T3 vertebral body. The diagnosis of schwannoma was not certain given the radiological features, so a biopsy was planned and confirmed the diagnosis of vertebral hemangioma. Preoperative embolization, spinal fusion, and gross-total resection of the extravertebral component of the lesion were performed. LESSONS: This report should raise awareness of the differential diagnosis of dumbbell-shaped spinal tumors and the therapeutic strategies available for aggressive vertebral hemangiomas, a rare lesion that should be managed in a multidisciplinary setting. https://thejns.org/doi/10.3171/CASE24190.

6.
Neurology ; 101(3): e336-e342, 2023 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-36859406

RESUMO

We report the case of a middle-aged man who presented with acute painless monocular vision loss. His medical history was remarkable for chronic total occlusion of the ipsilateral internal carotid artery (ICA) and a recent carotid endarterectomy (CEA) on the contralateral ICA. In a stepwise multidisciplinary approach assessment, we review the differential diagnosis of acute vision loss and investigate how the patient's intracranial and extracranial hemodynamic reorganization after chronic ICA occlusion may affect the clinical reasoning. Early complications of CEA and the differential diagnosis of new-onset anisocoria are also discussed.


Assuntos
Doenças das Artérias Carótidas , Estenose das Carótidas , Endarterectomia das Carótidas , Masculino , Pessoa de Meia-Idade , Humanos , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Artéria Carótida Interna/diagnóstico por imagem , Visão Monocular , Doenças das Artérias Carótidas/complicações , Raciocínio Clínico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA