Publications (6)8.6 Total impact
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Article: Efficacy of intravenous thrombolysis according to stroke subtypes: the Madrid Stroke Network Data.
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ABSTRACT: OBJECTIVES: To identify possible differences in the early response to intravenous thrombolysis (IVT) or in stroke outcome at 3 months, based on stroke subtype in patients with acute ischaemic stroke (IS). METHODS: Multicenter stroke registry, with prospective inclusion of consecutive patients with acute IVT-treated IS in five acute stroke units. We compared clinical improvement (NIHSS) at 24 h and at day 7 as well as functional outcome at 3 months (Modified Rankin Scale, mRS) amongst the different stroke subtypes (ICD-10). RESULTS: One thousand four hundred and seventy-nine patients were included; 178 (12%) had large vessel disease (LVD) with carotid stenosis ≥ 50%, 175 (11.8%) had other LVD, 638 (43%) had cardioembolism, 60 (4.1%) had lacunar infarction, 72 (4.9%) were patients with IS of other/unusual cause and 356 (24.1%) were of unknown/multiple causes. Patients with lacunar infarction had lower stroke severity (median NIHSS 6) whilst cardioembolic IS was the most severe (median NIHSS 14) (P < 0.001). No differences in NIHSS improvement were found at 24 h. LVD patients with carotid stenosis (OR 0.544; 95% CI 0.383-0.772; P = 0.001) were less likely to improve at day 7 after adjustment for age, gender, vascular risk factors and stroke severity. However, adjusted multivariate analysis showed no influence of stroke subtype on stroke outcome (mRS) at 3 months. Age, systolic blood pressure on admission and stroke severity were independently associated with mRS > 2 at 3 months. CONCLUSION: Although LVD patients with arterial stenosis ≥ 50% improve less than the other aetiologies at day 7, stroke aetiological subtype does not determine differences in IS outcome at 3 months after IVT.European Journal of Neurology 06/2012; · 3.69 Impact Factor -
Article: Diabetes and previous stroke: hazards for intravenous thrombolysis?
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ABSTRACT: Alteplase licensing approval in Europe does not advocate intravenous thrombolysis (IVT) for diabetic ischaemic stroke (IS) patients with previous cerebral infarction (PCI). Our aim was to assess whether concomitant diabetes mellitus (DM) and PCI are associated with symptomatic intracerebral haemorrhage (SICH) and poor outcome after IVT. Multicentre prospective registry, which included consecutive IVT-treated, acute IS patients from January 2003 to December 2010. The frequency of SICH (SITS-MOST criteria) and 3-month outcomes (mRS) were compared between the following groups: (i) diabetic patients with PCI (DM+/PCI+); (ii) diabetic patients without PCI (DM+/PCI-); (iii) non-diabetic patients with PCI (DM-/PCI+); and (iv) patients without diabetes or PCI (DM-/PCI-). A total of 1475 patients were included. Thirty-four patients (2.3%) had known DM and PCI, 258 (17.5%) were diabetics without PCI, and 119 (8.1%) had a PCI and no DM. Thirty-six patients (2.6%) developed SICH, with no differences between groups (P = 985). Fifteen (40.9%) DM+/PCI+ patients, 113 (46.5%) DM+/PCI- patients, 47 (42%) DM-/PCI+ patients and 414 (40.9%) DM-/PCI- patients had mRS ≥ 3 at 3 months (P = 427). The presence neither of DM nor of PCI, nor their combination, had any impact on the risk of SICH or on outcome at 3 months after adjusting for age, stroke severity and glucose levels on admission. Acute IS diabetic patients with PCI who were treated with IVT had similar outcomes to patients without such history, with no increase in the rates of SICH. Thus, they should not be excluded from IVT only on the basis of DM and PCI.European Journal of Neurology 11/2011; 19(4):587-93. · 3.69 Impact Factor -
Article: Guidelines for the preventive treatment of ischaemic stroke and TIA (II). Recommendations according to aetiological sub-type.
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ABSTRACT: BACKGROUND AND OBJECTIVE: To update the ad hoc Committee of the Cerebrovascular Diseases Study Group of The Spanish Neurological Society guidelines on prevention of ischemic stroke (IS) and Transient Ischaemic Attack (TIA). METHODS: We reviewed the available evidence on ischaemic stroke and TIA prevention according to aetiological subtype. Levels of evidence and recommendation levels are based on the classification of the Centre for Evidence-Based Medicine. RESULTS: In atherothrombotic IS, antiplatelet therapy and revascularization procedures in selected cases of ipsilateral carotid stenosis (70-99%) reduce the risk of recurrences. In cardioembolic IS (atrial fibrillation, valvular diseases, prosthetic valves and myocardial infarction with mural thrombus) prevention is based on the use of oral anticoagulants. Preventive therapies for uncommon causes of IS will depend on the aetiology. In the case of cerebral venous thrombosis oral anticoagulation is effective. CONCLUSIONS: We conclude with recommendations for clinical practice in prevention of IS according to the aetiological subtype presented by the patient.Neurologia 09/2011; -
Article: Guidelines for the preventive treatment of ischaemic stroke and TIA (I). update of risk factors and life style.
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ABSTRACT: OBJECTIVE: To update the ad hoc Committee of the Cerebrovascular Diseases Study Group of The Spanish Neurological Society guidelines on prevention of ischaemic stroke (IS) and transient ischaemic attack (TIA). METHODS: We reviewed available evidence on risk factors and the measures for their modification to prevent ischaemic stroke and TIA. Levels of evidence and recommendation grades are based on the classification of the Centre for Evidence-Based Medicine. RESULTS: In this first part the recommendations for action on the following factors are summarised: blood pressure, diabetes, lipids, tobacco and alcohol consumption, diet and physical activity, cardio-embolic diseases, asymptomatic carotid stenosis, hormone replacement therapy and contraceptives, hyperhomocysteinemia, prothrombotic states and sleep apnea syndrome. CONCLUSIONS: The change in lifestyle and pharmacological treatment of hypertension, diabetes mellitus and dyslipidemia, according to criteria of primary and secondary prevention, are recommended in preventing ischemic stroke.Neurologia 09/2011; -
Article: Intracranial mechanical recanalization and fibrinolysis using a single hyperglide balloon microcatheter. Technical note.
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ABSTRACT: Endovascular treatment of acute blockage of the middle cerebral artery may require a combination of mechanical recanalization and chemical fibrinolysis. Using a single microcatheter to perform both techniques helps shorten procedure time.Interventional Neuroradiology 09/2005; 11(3):277-80. · 0.56 Impact Factor -
Article: [Transient ischemic attacks: risk factors, duration and neuroimaging in a series of 173 patients].
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ABSTRACT: The appearance of transient ischemic attacks (TIA) is an important sign of vascular risk. The maximum time the deficit lasts has been set arbitrarily at 24 hours. It is assumed that TIA does not entail permanent vascular lesions. A retrospective review of the clinical records of patients diagnosed as suffering from TIA in our centre between 1996 and 1997. Analysis of associated risk factors (RF), duration and findings in neuroimaging. The clinical records of 173 patients (106 males) were examined. The RF identified were similar to those described for ischemic strokes. 45.6% of patients with a history of vascular pathologies received no preventative treatment. 58% of the TIA were resolved within the first 30 minutes and 71% within the first hour. Cranial CT was normal in 69%, showed old lesions in 26% and lesions that were compatible with the clinical signs of TIA in 5% (in the latter case the duration of the episodes was greater). TIA shares the same RF and aetiopathogenic mechanisms as ischemic stroke and should, therefore, be considered as such. There is a need to revise the concept of TIA paying special attention to the findings of neuroimaging or to establish duration limits that are better matched to the practical reality. TIA maintains a practical interest since it provides a simple method of identifying patients with a high vascular risk.Revista de neurologia 35(2):107-10. · 0.65 Impact Factor
