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3. Endovascular Treatment for Acute Ischemic Stroke

Author

Ciccone, A, Valvassori, L, Nichelatti, M, Sgoifo, A, Ponzio, M, Sterzi, R, Boccardi, E, SYNTHESIS Expansion Investigators: Gatti, A, Guccione, A, Motto, C, Santilli, I, Tortorella, R, Ferrante, E, Imbesi, F, Marazzi, R, Jann, S, Protti, A, Rizzone, M, Tiraboschi, P, Pero, G, Quilici, L, Piano, M, Zini, A, Casoni, F, Cavazzuti, M, Falzone, F, Nichelli, P, Vallone, S, Carpeggiani, P, Menetti, F, Guidotti, M, Checcarelli, N, Muscia, F, Martegani, A, Torgano, G, Mandelli, C, Zecca, B, Baron, P, Bersano, A, Branca, V, Isalberti, M, Papa, R, Paolucci, A, Magoni, M, Costa, A, Gamba, M, Gasparotti, R, Federico, F, Petruzzellis, M, Tartaglione, B, Mezzapesa, D, Chiumarulo, L, De Blasi, R, Agostoni, E, Botto, E, Longoni, M, Ballarini, V, Reganati, P, Malfatto, L, Rizzi, D, Serrati, C, Balestrino, M, Gandolfo, C, Castellan, L, Mavilio, N, Allegretti, L, Delodovici, Ml, Carimati, F, Verrengia, Ep, Bono, G, Perlasca, F, Craparo, G, Giorgianni, A, Azzini, C, De Vito, A, Tola, M, Saletti, A, Pozzessere, C, Corsi, F, Scifoni, G, Anticoli, S, Pezzella, Fr, Cotroneo, E, Gigli, R, Nencini, P, Palumbo, V, Pantoni, L, Inzitari, D, Mangiafico, S, Chinaglia, M, Russo, M, L'Erario, R, Amistà, P, Malferrari, G, Nucera, A, Zedde, Ml, Dallari, A, Deberti, G, Falaschi, F, Martignoni, A, Zappoli, F, Marcheselli, S, Stival, B, Presbitero, P, Rossi, Ml, Belli, G, Paciaroni, M, Caso, V, Agnelli, Gc, Hamam, M, Bovi, P, Piovan, Enrico, Sessa, M, Scomazzoni, F, Arnaboldi, M, Tancredi, L, Peroni, R, Censori, B, Poloni, M, Lunghi, S, Bonaldi, G, Donati, E, Magni, E, Pavia, M, Cobelli, M, Bottacchi, E, Corso, G, Tosi, P, Cordera, S, Di Giovanni, M, Giardini, G, Meloni, T, Cristoferi, M, Natrella, M, Ruiz, L, Dell'Acqua, Ml, Rolandi, G, Gallesio, I, Sandercock, P, Candelise, L, del Zoppo, G, Ciceri, E, Doneda, P, Daolio, M, Caputo, D, del Zotto, E, Cantisani, T., Ciccone, A, Valvassori, L, Nichelatti, M, Sgoifo, M, Ponzio, M, Sterzi, R, Boccardi, E, and Comi, Giancarlo

Subjects
Adult, Male, OCCLUSION, Psychoanalysis, RECANALIZATION, Neuroimaging, Article, law.invention, Brain Ischemia, TISSUE-PLASMINOGEN-ACTIVATOR, Randomized controlled trial, Fibrinolytic Agents, law, Case fatality rate, medicine, Humans, Single-Blind Method, PROUROKINASE, cardiovascular diseases, Adverse effect, Infusions, Intravenous, Stroke, Aged, Cerebral Hemorrhage, Thrombectomy, business.industry, Standard treatment, Endovascular Procedures, TISSUE-PLASMINOGEN-ACTIVATOR, CEREBRAL-ARTERY STROKE, RANDOMIZED-TRIAL, INTRAARTERIAL THROMBOLYSIS, INTRAVENOUS THROMBOLYSIS, OCCLUSION, REVASCULARIZATION, RECANALIZATION, PROUROKINASE, THROMBECTOMY, Atrial fibrillation, General Medicine, Odds ratio, Middle Aged, medicine.disease, INTRAARTERIAL THROMBOLYSIS, Combined Modality Therapy, RANDOMIZED-TRIAL, Cerebral Angiography, Treatment Outcome, Anesthesia, Tissue Plasminogen Activator, Acute Disease, REVASCULARIZATION, Female, INTRAVENOUS THROMBOLYSIS, CEREBRAL-ARTERY STROKE, business, Fibrinolytic agent
Abstract

In patients with ischemic stroke, endovascular treatment results in a higher rate of recanalization of the affected cerebral artery than systemic intravenous thrombolytic therapy. However, comparison of the clinical efficacy of the two approaches is needed.We randomly assigned 362 patients with acute ischemic stroke, within 4.5 hours after onset, to endovascular therapy (intraarterial thrombolysis with recombinant tissue plasminogen activator [t-PA], mechanical clot disruption or retrieval, or a combination of these approaches) or intravenous t-PA. Treatments were to be given as soon as possible after randomization. The primary outcome was survival free of disability (defined as a modified Rankin score of 0 or 1 on a scale of 0 to 6, with 0 indicating no symptoms, 1 no clinically significant disability despite symptoms, and 6 death) at 3 months.A total of 181 patients were assigned to receive endovascular therapy, and 181 intravenous t-PA. The median time from stroke onset to the start of treatment was 3.75 hours for endovascular therapy and 2.75 hours for intravenous t-PA (P0.001). At 3 months, 55 patients in the endovascular-therapy group (30.4%) and 63 in the intravenous t-PA group (34.8%) were alive without disability (odds ratio adjusted for age, sex, stroke severity, and atrial fibrillation status at baseline, 0.71; 95% confidence interval, 0.44 to 1.14; P=0.16). Fatal or nonfatal symptomatic intracranial hemorrhage within 7 days occurred in 6% of the patients in each group, and there were no significant differences between groups in the rates of other serious adverse events or the case fatality rate.The results of this trial in patients with acute ischemic stroke indicate that endovascular therapy is not superior to standard treatment with intravenous t-PA. (Funded by the Italian Medicines Agency, ClinicalTrials.gov number, NCT00640367.).

Published
2013

4. Validation of the UNESP-Botucatu unidimensional composite pain scale for assessing postoperative pain in cattle.

Author

de Oliveira FA, Luna SP, do Amaral JB, Rodrigues KA, Sant'Anna AC, Daolio M, and Brondani JT

Subjects
Animals, Behavior, Animal, Cattle, Cattle Diseases surgery, Male, Pain Measurement methods, Pain, Postoperative diagnosis, Reproducibility of Results, Cattle Diseases diagnosis, Orchiectomy adverse effects, Pain Measurement veterinary, Pain, Postoperative veterinary
Abstract

Background: The recognition and measurement of pain in cattle are important in determining the necessity for and efficacy of analgesic intervention. The aim of this study was to record behaviour and determine the validity and reliability of an instrument to assess acute pain in 40 cattle subjected to orchiectomy after sedation with xylazine and local anaesthesia. The animals were filmed before and after orchiectomy to record behaviour. The pain scale was based on previous studies, on a pilot study and on analysis of the camera footage. Three blinded observers and a local observer assessed the edited films obtained during the preoperative and postoperative periods, before and after rescue analgesia and 24 hours after surgery. Re-evaluation was performed one month after the first analysis. Criterion validity (agreement) and item-total correlation using Spearman's coefficient were employed to refine the scale. Based on factor analysis, a unidimensional scale was adopted., Results: The internal consistency of the data was excellent after refinement (Cronbach's α coefficient = 0.866). There was a high correlation (p < 0.001) between the proposed scale and the visual analogue, simple descriptive and numerical rating scales. The construct validity and responsiveness were confirmed by the increase and decrease in pain scores after surgery and rescue analgesia, respectively (p < 0.001). Inter- and intra-observer reliability ranged from moderate to very good. The optimal cut-off point for rescue analgesia was > 4, and analysis of the area under the curve (AUC = 0.963) showed excellent discriminatory ability., Conclusion: The UNESP-Botucatu unidimensional pain scale for assessing acute postoperative pain in cattle is a valid, reliable and responsive instrument with excellent internal consistency and discriminatory ability. The cut-off point for rescue analgesia provides an additional tool for guiding analgesic therapy.

Published
2014
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