A Cruz Culebras

Hospital Universitario Ramón y Cajal, Madrid, Madrid, Spain

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Publications (3)5.52 Total impact

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    ABSTRACT: Background: The use of Neurovascular Intervention (NVI) for the treatment of acute ischemic stroke is increasing. NVI provides a high recanalization rate but its clinical benefit is still unproven. There are few studies comparing clinical efficacy and security of NVI and intravenous thrombolysis (IVT). Methods: Comparative analysis of 2 prospective registries of patients from 5 stroke centres. One registry recorded patients treated with IVT and the other one included patients treated with NVI. NVI was considered in patients with exclusion criteria for IVT, lack of improvement after IVT or basilar artery occlusion. Intra-arterial thrombolysis, thrombectomy, thrombus disruption and angioplasty+stenting were used separately or in combination. NVI was only available from Monday to Friday in working hours. Results: Since 2004, 60 patients have been recorded in the NVI registry and 1143 in the IVT registry. Patients treated with NVI were younger (mean SD: 59+/-16 vs 67+/-14 years, p<0.001), presented more severe strokes (median (P25-P75) baseline NIHSS: 15 (12.5-21) vs 13 (8-18), p=0.001, and time-to-treatment (TTT) was longer (median (P25-P75): 317.5 (245-480) vs 140 (115-170) min, p<0.001). There were no significant differences in good outcome (defined as modified Rankin Scale score of 0 to 2 at 3 months) between NVI and IVT (48.9% and 58.5% p=0.2), adjusted OR for age, sex,vascular territory, baseline NIHSS and TTT: 1.2 (95% CI: 0.4-3.3). Mortality rate was similar in both groups (20% vs 12.4%, p=0,13), adjusted OR 0.4 (95% CI: 0.1-2.1). Symptomatic intracerebral hemorrhage rate was low for NVI and IVT (5% and 3.4%, p=0,5), adjusted OR 1.9 (95% CI: 0.4-9.6). Conclusions: Both NVI and IVT are effective and safe therapeutic options for acute ischemic stroke which can be used depending on patient's characteristics.
    Cerebrovascular Diseases 01/2011; 31:258 ST - Is it just a question of time? Compariso. · 2.81 Impact Factor
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    ABSTRACT: Background and purposeEndovascular therapies in acute ischaemic stroke may offer benefits to patients that are not eligible for standard use of intravenous tissue activator plasminogen (iv t-PA) or when this is not effective. Our aim is to present the initial experience in with endovascular techniques in the Community of Madrid.
    Neurologia (Barcelona, Spain) 06/2010; 25(5):279-286. · 1.35 Impact Factor
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    ABSTRACT: Endovascular therapies in acute ischaemic stroke may offer benefits to patients that are not eligible for standard use of intravenous tissue activator plasminogen (iv t-PA) or when this is not effective. Our aim is to present the initial experience in with endovascular techniques in the Community of Madrid. We present data from our registry of acute ischaemic strokes treated with endovascular re-perfusion therapies in five University Hospitals in Madrid (Spain) during the period 2005-2009. We recorded demographic data, vascular risk factors, risk severity with the NIHSS (National Institute of Health Stroke Scale), endovascular techniques, complications and mortality rates. Functional outcome and neurological disability at 90 days was defined by the modified Rankin scale (mRs). A total of 41 patients were treated with endovascular therapies. Mean age was 58.6 ± 19.9, and 56.1% were males. Of those 22 patients had an anterior circulation stroke and 19 had a posterior circulation stroke. Baseline NIHSS score was: median, 17 [range, 2-34]; 7 patients had previously received iv t-PA. The following endovascular techniques were performed: mechanical disruption (26 patients), intra-arterial infusion of t-PA (26 patients), angioplasty and stenting (5 patients), mechanical use of MERCI device (3 patients). Partial or total re-canalization was achieved in 32 patients (78%). Only one patient had a symptomatic cerebral haemorrhage. Three months after stroke, 53.6% of the patients were independent (mRs ≤ 2) and overall mortality rate was 19.5%. Acute ischaemic stroke is a potentially treatable medical emergency within the first hours after the onset of symptoms. Stroke endovascular procedures constitute an alternative for patients with iv t-PA exclusion criteria or when this is not effective.
    Neurologia (Barcelona, Spain) 06/2010; 25(5):279-86. · 1.35 Impact Factor