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Background: Endovascular ther apy (EVT) with stent retrievers has been shown to be superior and safe (in the anterior circulation) in comparison to intravenous thrombolysis (IVT) alone or no specifi c ther apy. We compared clinical outcome between patients undergo ing EVT admitted directly to comprehensive stroke centers (CSCs) and patients transfer red from primary stroke centers (PSCs) to a CSC. Materials and methods: Demographics, risk factors, and medical history of all consecutive EVT-treated stroke patients in col laborat ing stroke centers were col lected. Patients were divided into three groups: treatment with IVT in a PSC before transfer to a CSC for EVT; treatment with IVT directly in a CSC with subsequent EVT in the same center; no treatment with IVT before EVT. Neurological status us ing the National Institutes of Health Stroke Scale (NIHSS) on admis sion and at day 7 and self-suffi ciency us ing the modified Rankin Scale (mRS) at day 90 were as ses sed. Favorable clinical outcome was defi ned as an mRS score of 0- 2. Fol low-up computed tomography or magnetic resonance imag ing was done to determine symp tomatic intracerebral hemor rhage (SICH). Results: A total of 568 patients (313 males; mean age, 66.1 ± 13.2 years) were registered from January 2006 to the end of July 2015. Patients in all three groups did not diff er in baseline characteristics except for the time to the start of EVT. The average delay of EVT start in patients transfer red from PSC to CSC was 45 min. Subgroups did not diff er signifi cantly in SICH prevalence (over all prevalence 5.5%) and favorable clinical outcome (over all 46.7%). Conclusion: The benefi t of direct transfer to a CSC merits further investigation. The present study showed that both approaches to stroke patient transport organization in the Czech Republic are comparably effi cient and safe. [ABSTRACT FROM AUTHOR]

Aim: The aim of the pilot study was to assess correlation between three diagnostic methods - contrast transesophageal echocardiography (cTEE), contrast transcranial Doppler (cTCD) and Flow detection system AnazenTM (FDS) - in detecting right-to-left shunts in young patients aged under 55 years with ischemic stroke or transient ischemic attack (TIA). Patients and methods: All consecutive patients presenting with acute ischemic stroke or TIA aged 18-55 years and able to perform sufficient Valsalva maneuver who signed informed consent were enrolled to the study from 8/2014 to 4/2015. Brain-computed tomography or magnetic resonance imaging as well as detection of right-to-left shunt using the cTEE, cTCD and FDS were performed in all patients after an onset of stroke/TIA. Correlations of the results between the methods and sensitivity, specificity, positive anc negative predictive values of cTCD and FDS compared to cTEE as a gold standard were statistically evaluated. Results: In total, 30 patients (21 males, mean age 46.2 ± 8.5 years) were included in the study. Right-to-left shunt was detected in the same eight (26.7%) patients using the cTEE and cTCD, and in one additional patient (totally nine, 30.0%) using FDS. Spearman's coefficient for cTEE and FDS was 0.92 and for cTEE and cTCD 1.00. Interclass correlation coefficient was 0.975. Sensitivity, specificity, positive and negative predictive values were 100%, 100%, 100%, 100%, respectively, for cTCD and 100%, 95.5%, 88.9%, 100%, respectively, for FDS. Conclusion: Correlation between cTCD and FDS as a new method with cTEE as a gold standard in right-to-left shunt detection appear to be high. Considering the ease of their use, both cTCD and FDS appear as suitable screening methods. [ABSTRACT FROM AUTHOR]