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[Introduction] Acute ischemic stroke therapy has improved in recent decades, decreasing the rates of disability and death among stroke patients. Unfortunately, all health care systems have geographical disparities in infrastructure for stroke patients. A centralized telestroke network might be a low-cost strategy to reduce differences in terms of geographical barriers, equitable access, and quality monitoring across different hospitals., [Aims] We aimed to quantify changes in stroke patients’ geographic access to specialized evaluation by neurologists and to intravenous acute stroke reperfusion treatments following the rapid implementation of a centralized telestroke network in the large region of Andalusia (8.5 million inhabitants)., [Methods] We conducted an observational study using spatial and analytical methods to examine how a centralized telestroke network influences the quality and accessibility of stroke care for a large region., [Results] In the pre-implementation period, 5,005,477 (59.72% of the Andalusian population) had access to specialized stroke care in less than 30 min. After the 5-month process of implementing the telestroke network, 7,832,988 (93.5%) inhabitants had an access time of less than 30 min, bridging the gap in acute stroke care in rural hospitals., [Conclusions] A centralized telestroke network may be an efficient tool to reduce the differences in stroke care access and quality monitoring across different hospitals, especially in large regions with low population density.

[Resumen] Introducción. En los últimos años se ha establecido el uso del Teleictus como una herramienta fundamental para extender la atención a los pacientes con ictus agudo hasta hospitales que no disponen de neurólogos de guardia. El objetivo principal de este trabajo es describir la existencia y funcionamiento de los distintos sistemas y redes de Teleictus (ST) en España. Método. Estudio transversal de la situación actual del Teleictus en España mediante la realización de una encuesta estructurada dirigida a los miembros del Grupo de Estudio de Enfermedades Cerebrovasculares de la Sociedad Española de Neurología. Resultados. Han respondido a la encuesta desde 12 de las 17 comunidades autónomas, de las cuales 10 tenían ST. Además, en la búsqueda bibliográfica se han encontrado otros 2 sistemas funcionando. Doce de las 17 comunidades autónomas de España disponen de ST, consiguiendo una cobertura de al menos el 20% de la población española. De estos 10 ST, 7 tienen una organización regional, 2 provincial y otro, hospitalaria. En la mayoría de los ST (9) se realizan al menos TC simple y angio-TC, y en 4 ST también imagen de perfusión. Nueve ST funcionan con equipos de videoconferencia profesionales. Sin embargo, la calidad subóptima de la exploración por videoconferencia es el principal problema identificado en el 50% de los ST. Otros problemas detectados son la dificultad en la obtención de datos de los registros y la transferencia de imágenes entre hospitales. Conclusión. En los últimos años, se ha observado una expansión significativa de los ST en España, lo que ha permitido mejorar la accesibilidad de la atención especializada en casos de síntomas de ictus agudo. Este estudio permite describir los diferentes tipos de ST en España, detectar áreas de mejora y crecimiento, y podría contribuir a definir estrategias regionales para implementar el Teleictus con el fin de ofrecer una atención de calidad a toda la población., [Abstract] Introduction. In recent years, Telestroke programmes have been established as a fundamental tool for extending acute stroke care to hospitals that lack an on-call neurology service. The main objective of this study is to describe the existence and functioning of the different Telestroke systems and networks (TS) in Spain. Method. We conducted a cross-sectional study to analyse the current situation of TS in Spain using a structured survey distributed among the members of the Stroke Study Group of the Spanish Society of Neurology. Results. Responses were received from 12 of the 17 Spanish autonomous communities, of which 10 had implemented TS. In addition, a literature search revealed that 2 other systems were in operation. Twelve of the 17 regions in the country have TS, achieving coverage of at least 20% of the Spanish population. Of these 10 TS, organisation was regional in 7, provincial in 2, and hospital-based in one. Most TS (9) included at least simple CT and angio-CT studies; 4 also included perfusion imaging. Nine TS operated with professional videoconferencing equipment. However, the suboptimal quality of examination via videoconferencing scan was the main problem identified in 50% of TS. Other problems detected are difficulty obtaining data from registries and the transfer of images between hospitals. Conclusion. In recent years, a significant expansion of TS has taken place in Spain, which has improved the accessibility of specialised care in patients with symptoms of acute stroke. This study allows us to describe the different types of TS in Spain and to detect areas for improvement and expansion, and could contribute to defining regional telestroke implementation strategies to offer quality care to the whole population.

Introducción: El ictus es una enfermedad tiempo dependiente que supone un problema de salud grave, con gran impacto sociosanitario. En Andalucía se ha calculado de 220 pacientes por cada 100.000 habitantesaño, lo que sumaría unos 20 000 ictus al año . Se trata de la primera causa de muerte en España en mujeres y la segunda en hombres, así como la primera causa de discapacidad física. Además, se prevé un aumento de incidencia en los últimos años. Dada la dispersión geográfica de Andalucía, el 30% de la población estaría a más de media hora de un centro donde pudieran aplicar tratamiento si fuera necesario, y de ellos, un 25% estaría a más de una hora. En este contexto, surge la necesidad de desarrollar sistemas que permitan una atención rápida y especializada a los pacientes con ictus de toda la región, por lo que se diseña el Centro Andaluz de Teleictus (CATI) con la hipótesis de que su implantación homogeneizaría las indicaciones de tratamiento, aportando equidad y aumentando las tasas de tratamiento en zonas rurales. Objetivos: Los objetivos del estudio incluyeron la evaluación de la implantación de sistemas de teleictus a nivel nacional, el análisis de la accesibilidad de la población andaluza a centros con capacidad de atención al ictus agudo por un neurólogo vascular especializado antes y después de la implementación del CATI, la demostración de la utilidad de una red regional de telemedicina para actuar sobre inequidades en la atención, y la exploración de la capacidad del CATI para monitorizar y mejorar de forma continua y aportar soluciones efectivas ante problemas detectados. Material y Método: Tras un análisis de los recursos disponibles y la distancia de la población a estos recursos, se decidió implantar el sistema de teleictus en hospitales comarcales y de alta resolución seleccionados . El CATI es una red que conecta neurólogos vasculares expertos con hospitales remotos mediante telemedicina. El flujo de trabajo implica que un paciente que llega a un h

Aims: Carotid reocclusion (CRO) after mechanical thrombectomy (MT) in acute ischemic stroke (AIS) due to tandem lesion (TL) or isolated internal carotid occlusion (ICO) is associated with worse clinical outcomes. Our aim was to analyze the predictors and clinical impact of CRO. Methods: A retrospective single-center analysis of all patients with anterior circulation strokes who underwent MT prospectively included in a registry between 2017 and 2020 was performed. ICO and TL as stroke causes were included. Stent deployment was left to the discretion of the interventionist. All patients received at least intravenous aspirin during MT. CRO was assessed using ultrasound within the first 24 h after MT. Efficacy and safety of stenting were assessed. Results: Among 1304 AIS cases, 218 (16.7%) were related to TL or ICO. Of them, 5% (n=11) were associated with internal CRO 24 h after the endovascular procedure. After adjusting per confounders, multivariate analysis showed that the independent variables associated with CRO were the TICI recanalization grade [TICI 2b–3; OR 0.1, 95% confidence interval (CI) 0.01–0.89, p=0.040], pial collateral circulation presence (OR 0.09, 95% CI 0.02–0.45, p=0.03), stent deployment during MT (OR 0.17, 95% CI 0.03–0.84, p=0.030), and general anesthesia use (OR 2.92, 95% CI 1.13–7.90, p=0.034). CRO showed a trend toward worst outcomes (modified Rankin scale 3–6) at 3 months (OR 3.4, 95% CI 0.96–12, p=0.057). After multivariate analysis, variables independently associated with worse outcomes at 90 days were intrastent platelet aggregation phenomena during endovascular therapy, admission National Institute of Health Stroke Scale, and age. Conversely, intravenous thrombolysis and TICI 2b–3 recanalization grade were identified as independent predictors of good outcomes at 90 days. Conclusions: CRO has a relevant clinical impact in our study, associating lower rates of good functional outcomes at 3 months. Independent factors of CRO were the recanal

[Objective] Spain’s so-called Stroke Belt is an area with high prevalence of vascular disease. We aimed to determine the prevalence of undetected obstructive sleep apnea–hypopnea syndrome (OSAHS) among patients with acute ischemic stroke (AIS) in southern Spain., [Methods] We conducted a cross-sectional study at the Virgen Macarena University Hospital Stroke Unit during 2018 to 2019. We included patients <72 hours after AIS with a neuroimaging lesion and performed sleep tests., [Results] Seventy-two patients were included. The median participant age was 72 years. Mean body mass index was 27.07 kg/m2, and 40.28% were daily alcohol drinkers. Hypertension, atrial fibrillation, ischemic cardiomyopathy, and previous stroke were detected in 63.9%, 11.1%, 15.3%, and 17.6% of patients, respectively. Polygraphy was feasible in 91.38% of patients. The prevalence of OSAHS was 84.72% (apnea–hypopnea index ≥5). Patients with moderate and severe OSAHS were more likely to be obese and to have a larger neck circumference and facial palsy. The diagnostic criteria of central sleep apnea syndrome were met in only 1.38% of patients., [Conclusions] The high prevalence of OSAHS found in the Spanish Stroke Belt justifies further investigation and development of a screening program as a strategy to identify patients with undetected OSAHS.

[Objectives] The detection of cervical arterial dissection (CAD) has been rising in recent years owing to advanced imaging techniques. The aim of this study was to explore whether wide implementation of endovascular treatment for ischemic stroke has an impact on the diagnosis of CAD., [Methods] We included all patients with CAD diagnosed at two university hospitals in Seville, Spain from January 2015 to December 2017. We collected clinical variables and information on imaging techniques used for the diagnosis. Implementation of 24 hour/365 day mechanical thrombectomy began in Seville on 15 August 2016. We compared diagnosis rates of CAD performed before and after this date., [Results] We identified 41 patients with CAD. We found 13 patients diagnosed before (1.1% of all ischemic strokes) and 28 (2.2%) after implementation of neurointerventional therapy. In 17 patients, diagnosis was made in the acute phase. Dissection was not suspected according to computed tomography angiography in 11 patients owing to small dissections (n = 2) or total occlusion (n = 9)., [Conclusions] CAD diagnoses have been rising in recent years, essentially owing to continuous improvement in imaging techniques. Rapid access to arteriography for thrombectomy is increasing the diagnoses of CAD, even in patients with a low suspicion of dissection.