ABSTRACT
The Spanish Society of Emergency Radiology (SERAU), the Spanish Society of Neuroradiology (SENR), the Spanish Society of Neurology through its Cerebrovascular Diseases Study Group (GEECV-SEN) and the Spanish Society of Medical Radiology (SERAM) have met to draft this consensus document that will review the use of computed tomography in the stroke code patients, focusing on its indications, the technique for its correct acquisition and the possible interpretation mistakes.
Subject(s)
Radiology , Stroke , Humans , Consensus , Stroke/diagnostic imaging , Tomography, X-Ray Computed , Societies, MedicalABSTRACT
La Sociedad Española de Radiología de Urgencias (SERAU), la Sociedad Española de Neurorradiología (SENR), la Sociedad Española de Neurología a través de su Grupo de Estudio de Enfermedades Cerebrovasculares (GEECV-SEN) y la Sociedad Española de Radiología Médica (SERAM) se han reunido para redactar este documento de consenso que repasará el uso de la tomografía computarizada en el código ictus, centrándose en sus indicaciones, la técnica para su correcta adquisición y las posibles causas de error en su interpretación (AU)
The Spanish Society of Emergency Radiology (SERAU), the Spanish Society of Neuroradiology (SENR), the Spanish Society of Neurology through its Cerebrovascular Diseases Study Group (GEECV-SEN) and the Spanish Society of Medical Radiology (SERAM) have met to draft this consensus document that will review the use of computed tomography in the stroke code patients, focusing on its indications, the technique for its correct acquisition and the possible interpretation mistakes (AU)
Subject(s)
Tomography, X-Ray Computed/methods , Stroke/diagnostic imaging , Computed Tomography Angiography , Consensus Development Conferences as Topic , Societies, Medical , SpainABSTRACT
BACKGROUND AND PURPOSE: Spain has been one of the countries more heavily stricken by SARS-CoV-2, which has had huge implications for stroke care. The aim was to analyse the impact of the COVID-19 epidemic outbreak on reperfusion therapies for acute ischaemic stroke in the northwest of Spain. METHODS: This was a Spanish multicentre retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. All patients receiving reperfusion therapy for ischaemic stroke between 30 December 2019 and 3 May 2020 were recorded, and their baseline, clinical and radiological characteristics, extra- and intra-hospital times of action, Code Stroke activation pathway, COVID-19 status, reperfusion rate, and short-term outcome before and after the setting of the emergency state were analysed. RESULTS: A total of 796 patients received reperfusion therapies for ischaemic stroke. There was a decrease in the number of patients treated per week (46.5 patients per week vs. 39.0 patients per week, P = 0.043) and a delay in out-of-hospital (95.0 vs. 110.0 min, P = 0.001) and door-to-needle times (51.0 vs. 55.0, P = 0.038). Patients receiving endovascular therapy obtained less successful reperfusion rates (92.9% vs. 86.6%, P = 0.016). COVID-19 patients had more in-hospital mortality. CONCLUSION: A decrease in the number of patients benefiting from reperfusion therapies was found, with a delay in out-of-hospital and door-to-needle times and worse reperfusion rates in northwest Spain. COVID-19 patients had more in-hospital mortality.
Subject(s)
COVID-19 , Ischemic Stroke/therapy , Pandemics , Reperfusion , Adult , Aged , Aged, 80 and over , Emergency Medical Services/statistics & numerical data , Endovascular Procedures/statistics & numerical data , Female , Humans , Ischemic Stroke/epidemiology , Length of Stay , Male , Middle Aged , Patient Admission/statistics & numerical data , Registries , Retrospective Studies , Spain/epidemiology , Thrombolytic Therapy/statistics & numerical data , Treatment OutcomeABSTRACT
BACKGROUND AND PURPOSE: The aim of this study was to describe the clinical and epidemiological characteristics of acute ischaemic stroke (AIS) in patients with atrial fibrillation (AF) previously treated with oral anticoagulants (OACs) according to the type of OAC prescribed. Also, to analyze the outcomes of the patients and the therapeutic approach adopted by the neurologist in the acute phase and for secondary prevention. METHODS: We performed a multicenter, observational study based on prospective registries. We included patients with AF treated with OACs admitted for AIS over a 1-year period. Detailed clinical data and functional outcome at 3 months (modified Rankin Scale score) were collected. Patients were divided into two groups according to their pre-AIS anticoagulant therapy: vitamin K antagonists (AIS-VKA) and direct-acting OACs (AIS-DOAC). RESULTS: We recruited 1240 patients (80.4% AIS-VKA and 19.6% AIS-DOAC). In the AIS-DOAC group, transient ischaemic attack was more frequent (18.1% vs. 10.8%; P = 0.001), symptomatic hemorrhagic transformation was less frequent (1.6% vs. 4.6%; P = 0.035) and hospital stay was shorter (median 6 vs. 7 days; P = 0.03). Intravenous thrombolysis was more commonly used in AIS-VKA (9.2% vs. 1.6%; P < 0.001). There were no differences between the groups with respect to mechanical thrombectomy, mortality and modified Rankin Scale score at 3 months. At 3 months, 54% of patients required a DOAC as antithrombotic treatment for secondary prevention. CONCLUSIONS: Patients with AF treated with DOACs who experienced AIS more frequently had transient symptoms (transient ischaemic attack), less symptomatic hemorrhagic transformation and a shorter mean stay than those treated with VKAs. Most patients who had been previously anticoagulated with AIS received long-term treatment with DOACs.
Subject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Cerebral Infarction/drug therapy , Ischemic Attack, Transient/drug therapy , Stroke/drug therapy , Aged , Aged, 80 and over , Atrial Fibrillation/complications , Cerebral Infarction/complications , Female , Hospitalization , Humans , Ischemic Attack, Transient/complications , Male , Prospective Studies , Registries , Secondary Prevention , Stroke/complicationsABSTRACT
BACKGROUND: The cerebral haemodynamic reserve (HR) is a recognised predictive factor of brain ischaemia in subjects with carotid stenosis. Our objective is to establish normal parameters which may be used for comparison with deficit states. SUBJECTS AND METHOD: The haemodynamic reserve was calculated in healthy subjects who had no evidence of previous carotid, haematological or cardiovascular pathologies. Subjects were asked to inhale CO2. The HR was then calculated as a percentage of the increase in the mean velocity in the Silvian artery for each millimetre of mercury increase of the end-tidal CO2. The median and percentiles 5 and 95 were calculated for each hemisphere, sex and age group. RESULTS: 100 subjects were studied (45 men and 55 women, mean age 51.6 years, range 18-79). Normal HR value was defined as percentile 5, with a value of 2% for men, and 2.5% for women. The only adverse reaction was dyspnea in 2 subjects. CONCLUSIONS: Values for the haemodynamic reserve of healthy subjects, which may serve as a reference for other ultrasonography laboratories, are established from an extensive control group.
Subject(s)
Carbon Dioxide/metabolism , Cerebrovascular Circulation/physiology , Hemodynamics/physiology , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Reference Values , Ultrasonography/methodsABSTRACT
FUNDAMENTO: El estado de la reserva hemodinámica cerebral (RHC) en los sujetos con estenosis carotídea es un factor predictivo reconocido del riesgo de presentar isquemia cerebral ipsilateral. Nuestro objetivo es establecer valores de referencia procedentes de la población sana que puedan ser aplicados en el estudio de estos pacientes. PACIENTES Y MÉTODO: Se calculó la RHC en sujetos sanos y sin evidencia de patología carotídea, hematológica o cardiovascular previa. El método elegido fue la inhalación de CO2, expresando la RHC como el porcentaje de incremento de la velocidad media en la arteria silviana por cada milímetro de mercurio de aumento en la concentración espiratoria final de CO2 al inducir la hipercapnia. Se calcularon las medianas y percentiles 5 y 95 por hemisferio, sexo y grupo de edad. RESULTADOS: Se estudiaron 100 sujetos (45 varones y 55 mujeres, media de edad 51,6 años, rango 18-79 años). Se consideró como límite de normalidad de la RHC el percentil 5, que fue de un 2 per cent para los varones y de un 2,5 per cent para las mujeres. El único acontecimiento adverso fue sensación disneica en 2 individuos. CONCLUSIONES: Los valores presentados son los primeros parámetros de normalidad procedentes de una serie extensa de controles publicados en la bibliografía y pueden ser de referencia para otros laboratorios de ultrasonografía. (AU)
