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1. Endovascular Treatment of Patients With Acute Ischemic Stroke With Tandem Lesions Presenting With Low Alberta Stroke Program Early Computed Tomography Score

Author: Milagros Galecio‐Castillo, Mudassir Farooqui, Waldo R. Guerrero, Marc Ribo, Ameer E. Hassan, Mouhammad A. Jumaa, Afshin A. Divani, Michael G. Abraham, Nils H. Petersen, Johanna T. Fifi, Amer Malik, James E. Siegler, Thanh N. Nguyen, Sunil A. Sheth, Guillermo Linares, Nazli Janjua, Jazba Soomro, Darko Quispe‐Orozco, Marta Olivé‐Gadea, Wondewossen G. Tekle, Syed F. Zaidi, Sara Y. Sabbagh, Tiffany Barkley, Ayush Prasad, Reade A. De Leacy, Mohamad Abdalkader, Sergio Salazar‐Marioni, Weston Gordon, Charoskhon Turabova, Aaron Rodriguez‐Calienes, Mahmoud Dibas, Maxim Mokin, Dileep R. Yavagal, Albert J. Yoo, Amrou Sarraj, Tudor G. Jovin, and Santiago Ortega‐Gutierrez
Subjects: internal carotid artery, large infarct core, stroke, thrombectomy, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background Recent trials confirmed the efficacy and safety of endovascular thrombectomy in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS); however, evidence in tandem lesions is limited. This study evaluates endovascular thrombectomy safety and efficacy in patients with acute large‐vessel occlusion with tandem lesions, stratified by baseline ASPECTS. Methods and Results We conducted a retrospective analysis of data from 16 centers. Inclusion criteria included the following: age ≥18 years, anterior circulation tandem lesions, endovascular thrombectomy
Published: 2024
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2. Clinico-radiological features of intracranial atherosclerosis-related large vessel occlusion prior to endovascular treatment

Author: Marc Rodrigo-Gisbert, Alvaro García-Tornel, Manuel Requena, Isabel Vielba-Gómez, Saima Bashir, Marta Rubiera, Marta De Dios Lascuevas, Marta Olivé-Gadea, Carlos Piñana, Federica Rizzo, Marian Muchada, Noelia Rodriguez-Villatoro, David Rodríguez-Luna, Jesus Juega, Jorge Pagola, David Hernández, Carlos A. Molina, Mikel Terceño, Alejandro Tomasello, and Marc Ribo
Subjects: Medicine, Science
Abstract: Abstract The identification of large vessel occlusion with underlying intracranial atherosclerotic disease (ICAS-LVO) before endovascular treatment (EVT) continues to be a challenge. We aimed to analyze baseline clinical-radiological features associated with ICAS-LVO that could lead to a prompt identification. We performed a retrospective cross-sectional study of consecutive patients with stroke treated with EVT from January 2020 to April 2022. We included anterior LVO involving intracranial internal carotid artery and middle cerebral artery. We analyzed baseline clinical and radiological variables associated with ICAS-LVO and evaluated the diagnostic value of a multivariate logistic regression model to identify ICAS-LVO before EVT. ICAS-LVO was defined as presence of angiographic residual stenosis or a trend to re-occlusion during EVT procedure. A total of 338 patients were included in the study. Of them, 28 patients (8.3%) presented with ICAS-LVO. After adjusting for confounders, absence of atrial fibrillation (OR 9.33, 95% CI 1.11–78.42; p = 0.040), lower hypoperfusion intensity ratio (HIR [Tmax > 10 s/Tmax > 6 s ratio], (OR 0.69, 95% CI 0.50–0.95; p = 0.025), symptomatic intracranial artery calcification (IAC, OR .15, 95% CI 1.64–26.42, p = 0.006), a more proximal occlusion (ICA, MCA-M1: OR 4.00, 95% CI 1.23–13.03; p = 0.021), and smoking (OR 2.91, 95% CI 1.08–7.90; p = 0.035) were associated with ICAS-LVO. The clinico-radiological model showed an overall well capability to identify ICAS-LVO (AUC = 0.88, 95% CI 0.83–0.94; p
Published: 2024
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3. Cultivar-Dependent Variations in the Microbiome of Grapevine Leaves

Author: Raúl Castanera, Víctor M. González-Miguel, Glòria Escolà, Marta Olivé, Neus Teixidó, Robert Savé, Josep María Casacuberta, and Blanca San Segundo
Subjects: bacteria, Botrytis cinerea, fungi, grapevine, leaf microbiome, pathogen, Plant culture, SB1-1110
Abstract: The grapevine (Vitis vinifera) is a major fruit crop of economic importance worldwide. Commercial grapevine cultivars are susceptible to infection by pathogenic microorganisms that cause diseases both in leaves and fruits, and it is known that the leaf microbiome plays an important role in plant health and fitness. In this study, shotgun metagenomic sequencing was used to characterize the microbial communities associated with grapevine leaves in three commercial varieties, Cabernet Sauvignon, Garnacha, and Marselan, grown in the same biogeographical unit. Metagenomic data revealed a differential enrichment of the microbial communities living inside grapevine leaves or on the leaf surface in the three varieties. The most abundant fungal taxa associated with grapevine leaves belong to the phylum Ascomycota, which included relevant pathogenic fungi for grapevines, such as Botrytis cinerea, Sclerotinia sclerotium, and Alternaria alternata, as well as several fungal species potentially pathogenic for grapevines (e.g., members of the Colletotrichum, Aspergillus, and Penicillium genera). Basidiomycota constituted a minor fraction of the fungal microbial communities. Grapevine leaves also harbored a diversity of bacterial taxa. At the phylum level, bacterial communities in all three varieties were primarily composed of Pseudomonadata, Bacillota, Bacteroidota, and a lower proportion of Actinomycetota. Differences in the fungal and bacterial community structures were observed between varieties, although they were more important in fungi. In particular, S. sclerotiorum and B. cinerea were found to preferentially colonize leaves in the Marselan and Garnacha varieties, respectively. These findings further support that the host genotype can shape its own microbiome in grapevines. A better understanding of the leaf microbiome in grapevines will provide the basis for the development of tailored strategies to prevent diseases in vineyards while helping to increase sustainability in grapevine production.
Published: 2024
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4. Clinical and Safety Outcomes of Endovascular Therapy 6 to 24 Hours After Large Vessel Occlusion Ischemic Stroke With Tandem Lesions

Author: Milagros Galecio-Castillo, Mudassir Farooqui, Ameer E. Hassan, Mouhammad A. Jumaa, Afshin A. Divani, Marc Ribo, Michael Abraham, Nils H. Petersen, Johanna T. Fifi, Waldo R. Guerrero, Amer M. Malik, James E. Siegler, Thanh N. Nguyen, Sunil Sheth, Albert J. Yoo, Guillermo Linares, Nazli Janjua, Darko Quispe-Orozco, Wondwossen Tekle, Syed F. Zaidi, Sara Y. Sabbagh, Marta Olivé-Gadea, Tiffany Barkley, Reade De Leacy, Kenyon W. Sprankle, Mohamad Abdalkader, Sergio Salazar-Marioni, Jazba Soomro, Weston Gordon, Charoskhon Turabova, Juan Vivanco-Suarez, Aaron Rodriguez-Calienes, Maxim Mokin, Dileep R. Yavagal, Tudor Jovin, and Santiago Ortega-Gutierrez
Subjects: ischemic stroke, carotid artery diseases, tandem lesions, thrombectomy, early window, late window, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background and Purpose Effect of endovascular therapy (EVT) in acute large vessel occlusion (LVO) patients with tandem lesions (TLs) within 6–24 hours after last known well (LKW) remains unclear. We evaluated the clinical and safety outcomes among TL-LVO patients treated within 6–24 hours. Methods This multicenter cohort was divided into two groups, based on LKW to puncture time: early window (
Published: 2023
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5. Stroke-associated pneumonia according to mCDC criteria: impact on prognosis and antibiotic therapy

Author: Neus Rabaneda-Lombarte, Júlia Faura, Garbiñe Ezcurra-Díaz, Marta Olivé-Gadea, Marta Álvarez-Larruy, Diana Vidal-de Francisco, Ana Domínguez-Mayoral, Carla Avellaneda, Mari Mar Freijo, Elena Zapata-Arriaza, Gemma Serrano-Heras, Cristian Alcahut-Rodríguez, Isabel Fernández-Pérez, Francisco Moniche, Soledad Pérez-Sánchez, Mònica Millán, Marta Rubiera, Laura Dorado, Olga Maisterra, Joan Montaner, and Alejandro Bustamante
Subjects: antibiotics, infections, mCDC criteria, outcome, stroke-associated pneumonia, Neurology. Diseases of the nervous system, RC346-429
Abstract: ObjectiveThe modified Centers for Disease Control and Prevention (mCDC) criteria have been proposed for diagnosing and managing stroke-associated pneumonia (SAP). The objective was to investigate the impact of SAP on stroke outcome depending on whether or not it conforms to mCDC criteria. Our secondary objective was to identify the responsible factors for antibiotic initiation in stroke patients.MethodsWe conducted a prospective, multicenter, observational study of ischemic stroke patients with moderate to severe stroke (NIHSS≥4) admitted within 24 h. For 7 days, mCDC criteria were assessed daily, and infections and antibiotics were recorded. Pneumonias were divided into those fulfilling mCDC criteria (mCDC-SAP) or not (other pneumonias, OPn). The effect of each type of pneumonia on 3-month outcome was evaluated in separated logistic regression models. Factors associated with antibiotic initiation were explored using a random forest analysis.ResultsOf the 342 patients studied, infections were diagnosed in 72 (21.6%), including 39 (11.7%) cases of pneumonia. Of them, 25 (7.5%) fulfilled mCDC criteria. Antibiotics were used in 92% of mCDC-SAP and 64.3% of OPn. In logistic regression analysis, mCDC-SAP, but not OPn, was an independent predictor of poor outcome [OR, 4.939 (1.022–23.868)]. The random forest analysis revealed that fever had the highest importance for antibiotic initiation.InterpretationThe mCDC criteria might be useful for detecting clinically relevant SAP, which is associated with poor outcomes. Isolated signs of infection were more important for antibiotic initiation than compliance with pre-defined criteria. Therefore, adherence to mCDC criteria might result in antibiotic saving without compromising clinical outcome.
Published: 2024
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6. Abstract 012: First‐line Stent Retriever Versus Contact Aspiration or Combined Technique for Posterior Cerebral Artery Occlusion EVT

Author: Piers Klein, Thanh N Nguyen, Mohamad Abdalkader, Muhammad M Qureshi, Patrik Michel, Davide Strambo, Daniel Strbian, Christian Herweh, Markus A Möhlenbruch, Silja Räty, Marta Olivé‐Gadea, Marc Ribo, Marios Psychogios, Urs Fischer, Anh Nguyen, Joji Kuramatsu, David Haupenthal, Martin Köhrmann, Cornelius Deuschl, Jordi Kühne Escolà, Shadi Yaghi, Liqi Shu, Volker Puetz, Simon Nagel, Hend Abdelhamid, Negar Asdaghi, Judith Clark, Dominique P Cornelius Marterstock, Bruno Cunha, Guilherme Dabus, Jelle Demeestere, Shashvat Desai, Francesco Diana, Tobias Engelhorn, Johanna T Fifi, Isabel Fragata, Uta Hanning, Diogo Haussen, Ashutosh P Jadhav, Jessica Jesser, Maximilian Kaeder, Johannes Kaeshmacher, Daniel Kaiser, Kimmo Lappalainen, Italo L'Infante, Joao Pedro Marto, Hesham Masoud, Stavros Matsoukas, Volker Maus, Thomas R. Meinel, Lukas Meyer, Milena Miszczuk, Mahmoud Mohammaden, Maxim Mokin, Adnan Mujanovic, Raul Nogueira, Christian H Nolte, Sven Poli, Khouloud Poli, Joao Nuno Ramos, Christoph Riegler, Michele Romoli, Vasu Saini, Sergio A Salazar‐Marioni, Sunil A Sheth, Eberhard Siebert, James Siegler, Neil Suryadareva, Lieselotte Vandewalle, Pekka Virtanen, and Charlotte S Weyland
Subjects: Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Introduction The optimal reperfusion technique in patients with isolated posterior cerebral artery (PCA) occlusion is uncertain. Previous studies in LVO and MeVO have demonstrated a correlation between good clinical outcomes and the first pass effect (FPE, eTICI 2c/3 on the first pass) but no differences in FPE rates or clinical outcomes between first‐line endovascular therapy techniques.1‐6 We compared clinical and technical outcomes with first‐line stent‐retriever (SR), contact aspiration (CA), or combined techniques in patients with isolated PCA occlusion. Methods This international cohort study was conducted at 30 sites in Europe and North America and included consecutive patients with isolated PCA occlusion and pre‐stroke modified Rankin Scale (mRS) 0‐3, presenting within 24 hours of time last seen well from January 2015 to August 2022.7 The primary outcome was the first‐pass effect (FPE), defined as eTICI 2c/3 on the first pass. Secondary outcomes included final successful reperfusion (eTICI 2b‐3), 90‐day excellent outcome (mRS 0 to 1), 90‐day functional independence (mRS 0 to 2), sICH, and 90‐day mortality. Patients treated with SR, CA, or combined technique were compared with multivariable logistic regression. This study was registered under NCT05291637. Results There were 326 patients who met inclusion criteria, consisting of 56.1% male, median age 75 (IQR 65‐82) years and median NIHSS 8 (5‐12). Occlusion segments were PCA P1 (53.1%), P2 (40.5%), and other (6.4%). Intravenous thrombolysis was administered in 39.6%. First‐line technique was SR, CA, and combined technique in 43 (13.2%), 106 (32.5%), and 177 (54.3%) patients, respectively; FPE was achieved in 62.8%, 42.5%, and 39.6%, respectively. Compared to SR, FPE was lower in patients treated with first‐line combined technique and similar in patients treated with first‐line CA (combined vs. SR: aOR 0.35 [0.016‐0.80], p=0.01; CA vs. SR: aOR 0.45 [0.19‐1.06], p=0.07). Final successful reperfusion (eTICI 2b‐3) was present in 81% of cases with no differences between treatment groups. Excellent outcome (mRS 0‐1) occurred in 30.7% of patients and functional independence (mRS 0‐2) occurred in 50.0% of patients. There were lower odds of functional independence in the first‐line CA versus SR alone group (aOR 0.52 [0.28‐0.95], p=0.04). FPE was associated with higher rates of favorable outcomes (mRS 0‐2: 58% vs. 43.4%, p=0.01; mRS 0‐1: 36.6% vs. 25.8%, p=0.05). sICH was observed in 5.6% (18/326) and mortality in 10.9% (35/326) with no differences between first‐line technique. Conclusion In patients with isolated PCA occlusion undergoing EVT, first line SR was associated with a higher rate of FPE compared to CA or combined techniques with no difference in final successful reperfusion. Functional independence at 90‐days was more likely with first‐line SR compared to CA in adjusted analyses. FPE was associated with higher rates of 90‐day excellent outcomes and functional independence. No difference in sICH or mortality was noted across the three techniques. As the endovascular field evolves to treat patients with distal vessel occlusion and milder severity of stroke, optimizing the efficacy and safety of the procedure is essential.8
Published: 2023
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7. Abstract 049: Effect of the ICA Lesion Severity in Outcomes after Endovascular Treatment of Acute Tandem LVO

Author: Milagros Galecio Castillo, Mudassir Farooqui, Ameer Hassan, Mouhammad Jumaa, Afshin Divani, Marc Ribo, Michael Abraham, Nils Petersen, Johanna Fifi, Waldo Guerrero, Amer Malik, James Siegler, Thanh Nguyen, Sunil Sheth, Albert Yoo, Guillermo Linares, Nazli Janjua, Darko Quispe‐Orozco, Wondwossen Tekle, Syed Zaidi, Asad Ikram, Marta Olivé‐Gadea, Abid Qureshi, Alex Devarajan, Linda Zhang, Mohamad Abdalkader, Cynthia Zevallos, Sergio Salazar Marioni, Jazba Sooomro, Weston Gordon, Charoskhon Turabova, Juan Vivanco‐Suarez, Aaron Rodriguez‐Calienes, Maxim Mokin, Dileep Yavagal, and Santiago Ortiz‐Gutierrez
Subjects: Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Introduction Tandem Lesions (TLs) pose unique challenges in the endovascular management of acute ischemic stroke.(1) The absence of anterograde blood flow in the carotid occluded segment may limit the effectiveness of endovascular interventions, resulting in delayed reperfusion or suboptimal recanalization.(2,3) Thus, the presence of unpaired blood flow through the ICA in the context of TLs is believed to exacerbate the extension of ischemic lesions. (4,5) This study compared the clinical and procedural outcomes of patients with TLs and extracranial internal carotid artery occlusion versus those with stenosis. Methods A retrospective analysis was performed on a multicenter cohort of patients with TLs who underwent endovascular treatment. The patients were categorized into two groups: those with extracranial ICA stenosis and those with occlusion. Clinical outcomes, including functional independence, hemorrhagic events, and procedural time metrics including puncture to reperfusion time were assessed. Sensitivity analyses were conducted to evaluate these differences segregating patients according to varying degrees of stenosis, and in pre‐specified subgroups. Results A total of 513 patients with TLs were included in the study. 281 (54.8%) presented with ICA occlusion, and 232 (45.2%) presented stenosis >=70% (Table 1). The comparison between the stenosis and occlusion groups revealed no significant differences in the main outcomes, including mTICI 2c‐3 (47.5% vs. 50.6%, aOR 1.07, 95% CI 0.70‐1.64, p=.751) (Figure 1), mRS 0‐2 at 90 days (43.6% vs. 48.9%, aOR 0.79, 95% CI 0.52‐1.20, p=.271), sICH rates (4.7% vs. 5.6%, aOR 0.72, 95% CI 0.31‐1.71, p=.458), and puncture to reperfusion time (58 [40‐80.5] vs. 52.5 [35.2‐80], ratio 1.04, 95% CI 0.88‐1.23, p=.64). Similar analyses performed comparing different degrees of stenosis and occlusion, and in patients treated with the antegrade approach only, did not show significant differences either. Conclusion Our findings indicate that although more severe degrees of stenosis or occlusion of the ICA prolong the time from puncture to reperfusion, no significant differences in clinical outcomes exist. The clinical implications of these findings need to be further evaluated to fully comprehend the specific needs of patients affected by TLs.
Published: 2023
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8. Abstract 268: Validation of an automated method to assess 24‐hour infarct volume in stroke patients

Author: Magda Jablonska, João André Sousa, Marc Molina, Pere Canals, Alvaro Garcia‐Tornel, Marc Rodrigo‐Gisbert, Federica Rizzo, Marta Olivé‐Gadea, Manuel Requena, David Rodriguez‐Luna, Noelia Rodriguez‐Villatoro, Jesús M. Juega, Marián Muchada, Jorge Pagola, Marta Rubiera, Alejandro Tomasello, Carlos A. Molina, Leonardo Tanzi, Victor Salvia, Cristian Marti, and Marc Ribo
Subjects: Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Introduction In stroke patients, accurate infarct volume assessment at 24 hours typically requires manual segmentation of lesions that often are not well defined. We aimed to validate an automated machine learning algorithm (MethinksFIV) specifically trained to automatically segment and measure subacute infarcts on non‐contrast CT (NCCT) scans. Methods We retrospectively studied stroke patients with a large vessel occlusion prospectively admitted to a comprehensive stroke center. The final infarct volume was segmented on the 24h NCCT manually (man‐FIV) and with the automated method (auto‐FIV). Both measurements were correlated with clinical outcomes. Results We included 346 patients. On 24h‐NCCT median auto‐FIV was lower than man‐FIV (8.6 ml [2.3‐40.7] vs. 16.9 ml [1.1‐70.8], p2 at three months (OR: 1.02 95%CI 1.01‐1.13, p=0.002) than manual segmentation (OR=1.01, 95%CI 1.00‐1.01, p=0.01). In a multivariable analysis, only auto‐FIV remained a significant predictor of mRS>2 at three months (aOR: 1.03 95% CI 1.01‐1.05, p=0.004). Conclusion An automated method to measure subacute infarct volumes in stroke patients is accurate and correlates well with further clinical outcomes. The method appears to outperform manual segmentation and may be used to facilitate infarct characterization in large clinical trials.
Published: 2023
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9. Abstract 200: ICA Lesion Etiology does not affect the Outcomes after Endovascular Treatment of Acute Tandem LVO

Author: Milagros R. Galecio Castillo, Mudassir Farooqui, Ameer Hassan, Mouhammad Jumaa, Afshin Divani, Marc Ribo, Michael Abraham, Nils Petersen, Johanna Fifi, Waldo Guerrero, Amer Malik, James Siegler, Thanh Nguyen, Sunil Sheth, Albert Yoo, Guillermo Linares, Nazli Janjua, Darko Quispe‐Orozco, Wondewossen Tekle, Syed Zahid Ali, Asad Ikram, Cynthia Zevallos, Marta Olivé‐Gadea, Abid Qureshi, Alex Devarajan, Nicholas Vigilante, Mohamad Abdalkader, Sergio Salazar‐Marioni, Jazba Soomro, Weston Gordon, Charoskhon Turabova, Juan Vivanco‐Suarez, Aaron Rodriguez‐Calienes, Maxim Mokin, Dileep Yavagal, and Santiago Ortega‐Gutierrez
Subjects: Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Introduction Tandem lesions (TLs) are present in up to 15% of patients with stroke due to acute large vessel occlusions.(1) Nevertheless, published research on endovascular treatment outcomes in this population is scarce. Although TLs are most commonly of atherosclerotic etiology, some patients present with dissection of the ICA.(2, 3) In this study, we compared the clinical outcomes of TL patients with the two etiologies. Methods A retrospective analysis was performed on a multicenter cohort of patients with TLs who underwent endovascular treatment. The patients were categorized into two groups according to the etiology of the ICA lesion: atherosclerosis and dissection. Patients were matched by baseline characteristics. Clinical outcomes, including recanalization success, functional independence and hemorrhagic events were assessed with multivariable analyses. Results Of 691 patients from the database, 526 met the inclusion criteria of this study. 467 (88.8%) patients presented with atherosclerosis of the ICA, and 59 (11.2%) patients presented dissection. Univariable differences were found in median age (69 y. [IQR 61 ‐ 76] vs. 52 y. [IQR 44 ‐ 63], p
Published: 2023
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10. Thrombolysis in Patients With Large‐Vessel Occlusion Directly Admitted or Transferred to a Thrombectomy Center: A Population‐Based Study

Author: Alvaro Garcia‐Tornel, Prudencio Lozano, Marta Rubiera, Manuel Requena, Marta Olivé‐Gadea, Marian Muchada, Jesus Juega, Federica Rizzo, Noelia Rodriguez‐Villatoro, Jorge Pagola, David Rodriguez‐Luna, Sandra Boned, Laura Dorado, Xavier Jiménez, Angels Soto, Pere Cardona, Xabier Urra, Angel Chamorro, Francesc Purroy, Mikel Terceño, Yolanda Silva, Alan Flores, Xavier Ustrell, Josep Zaragoza, Jaume Roquer, Jerzy Kuprinski, Dolores Cocho, Ernest Palomeras, Manuel Gomez‐Choco, David Canovas, Joan Martí‐Fabregas, Natalia Mas, Sonia Abilleira, Carlos Molina, Marc Ribó, and Natalia Pérez de la Ossa
Subjects: acute stroke, emergency medical services, nonurban areas, thrombectomy, thrombolysis, Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background Our goal is to evaluate whether the administration of thrombolytic treatment has varying effects on clinical and radiological outcomes in patients with large‐vessel occlusion stroke, based on the type of stroke center where the treatment was given (thrombectomy‐capable center versus local stroke center). Methods We included patients with an acute ischemic large‐vessel occlusion stroke who were directly admitted to thrombectomy‐capable centers and treated with endovascular thrombectomy, or were transferred from local stroke centers as thrombectomy candidates, in Catalonia, Spain, between 2017 and 2021. The primary outcome was the shift analysis on the modified Rankin scale score at 90 days. Secondary outcomes included death at 90 days and the rate of parenchymal hemorrhage and successful reperfusion. Inverse‐probability weighting clustered at the type of stroke center was used to estimate the effects. Results The analysis included 2268 patients directly admitted to thrombectomy‐capable centers, of whom 975 (49%) were treated with thrombolysis, and 938 patients transferred from local stroke centers, of whom 580 (66%) were treated with thrombolysis and 616 (67%) were treated with thrombectomy. Mean age was 72 (SD ±13) years, median National Institute of Health Stroke Scale score was 17 (interquartile range, 12–21), and 1363 patients were women (48%). Patients treated with intravenous thrombolysis were younger, had shorter time from onset to first image, higher Alberta Stroke Program Early Computed Tomography Score, and lower rates of wake‐up stroke, atrial fibrillation, and anticoagulation intake. Patients treated with thrombolysis had better functional outcome at 90 days, with no difference between patients directly admitted to thrombectomy‐capable centers (adjusted common odds ratio [acOR], 1.50 [95% CI, 1.24–1.81]) and patients transferred from local stroke centers (acOR, 1.44 [95% CI, 1.04–2.01]). Patients treated with intravenous thrombolysis had lower death rate, higher rate of parenchymal hematoma, and similar rate of successful reperfusion, with no difference according to type of center (Pinteraction>0.1). Conclusion Administration of intravenous thrombolysis in patients with a large‐vessel stroke with intention of thrombectomy was associated with lower degrees of disability, lower death rate, and higher rates of parenchymal hematoma both in thrombectomy‐capable centers and in local stroke centers.
Published: 2023
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11. Balloon‐Expandable Stenting as a Bridging Therapy in Patients With Acute Stroke and Tandem Occlusions

Author: Noelia Rodríguez‐Villatoro, David Rodríguez‐Luna, Marian Muchada, Olalla Pancorbo, Matías Deck, Prudencio Lozano, Sandra Boned, Álvaro García‐Tornel, Marta Olivé, Jesús Juega, Jorge Pagola, Marta Rubiera, David Hernández, Carlos Molina, Carlos Piñana, Isabel Rodriguez, Marta De Dios, Jose Luis Cuevas, Manuel Requena, Laura Ludovica Gramegna, Marc Ribó, and Alejandro Tomasello
Subjects: antiplatelet therapy, endovascular thrombectomy, internal carotid artery, stent, stroke, Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background Stenting extracranial internal carotid artery (ICA) lesions in acute ischemic stroke with tandem lesions is technically challenging. Its safety is highly debated because of the requirement of dual‐antiplatelet therapy. The optimal stenting device, timing, and periprocedural antiplatelet therapy for extracranial ICA stenting in the setting of acute tandem occlusion are still unclear. Methods We performed a retrospective study of patients with acute ischemic stroke attributable to tandem lesions who underwent endovascular treatment during a 5‐year period receiving either conventional self‐expanding carotid stents (SX) or balloon‐expandable carotid stent (BX). BX stents were restented with an SX in the subacute phase. Primary outcomes of interest were extracranial ICA patency at follow‐up and symptomatic intracranial hemorrhage. Results A total of 112 patients admitted from April 2016 to April 2021 were included. Dual‐antiplatelet therapy immediately following endovascular treatment was more frequently administered in the SX group (35/39 [89.7%]) compared with the BX group (20/73 [27.4%]) (P
Published: 2023
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12. Abstract Number ‐ 241: Simultaneous IV tPA During Thrombectomy Reduces Post‐Procedure Hypoperfusion Volumes in Anterior LVO Patients

Author: Marc Ribo, Alvaro Garcia‐Tornel, Marta Olivé‐Gadea, Manuel Requena, Federica Rizzo, Marc Rodrigo, Jorge Pagola, Jesus Juega, Marian Muchada, David Rodriguez‐Luna, Noelia Rodriguez‐Villatoro, Carlos Molina, and Marta Rubiera
Subjects: Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Introduction Simultaneous tPA administration during mechanical thrombectomy may induce synergistic benefits (1). We aimed to characterize the hypoperfusion status after thrombectomy according to the timing of tPA administration and the degree of final recanalization. Methods We studied consecutive anterior circulation large vessel occlusion (LVO) stroke patients treated with mechanical thrombectomy who received a CT perfusion (CTP) immediately after endovascular procedure (2). Patients were divided in three groups according to: no iv tPA treatment (non‐tPA), tPA administration before 120 minutes (tPA>120) or iv tPA administration within 120 min (tPA< 120) of groin puncture. The extend of post‐procedure hypoperfusion (volume Tmax>6s) and relative hypoperfusion reduction compared with admission CTP (volume post‐procedure – admission Tmax>6s/admission Tmax>6s) according to final TICI scores were compared between the three study groups. Results One hundred and sixty‐nine patients were included in the study, mean age 72 years and median baseline NIHSS of 15. Thirty (17.8%) patients received iv tPA more than 2h before groin puncture (tPA>120), 32(18.9%) within 2h of the puncture (tPA < 120) and 107(63.3%) were non‐tPA. No difference on stroke severity, pre‐procedure hypoperfusion volume or occlusion location before thrombectomy were detected between groups. The rate of complete recanalization (TICI 3, 38.5%) was also similar in the 3 study groups (p = 0.12). Overall, the post‐procedure hypoperfusion volume was significantly lower in the tPA< 120 group (19.9±4.6cc vs 35.0±5.5, p = 0.04), and the relative hypoperfusion reduction was higher in tPA< 120 (0.86 vs 0.66, p = 0.05) as compared to non‐tPA. No significant differences were detected between non‐tPA and tPA>120 groups. For each final TICI score the post‐procedure hypoperfusion tended to be lower in the tPA< 120‐group, with a stronger reduction in patients with lower degree of recanalization (Figure). Conclusions A reduction of post‐thrombectomy hypoperfusion volumes was detected in patients treated with iv tPA during or shortly before thrombectomy, which could be a surrogate marker of the beneficial effect of tPA on the microcirculation. The specific reperfusion synergistic effect of tPA and mechanical thrombectomy beyond LVO recanalization warrants future studies.
Published: 2023
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13. Complete Sudden Recanalization: There Is Hope Beyond the First Pass Effect

Author: Manuel Requena, Álvaro García‐Tornel, Isabel Rodríguez, Marta Olivé‐Gadea, Marta De Dios, Marc Rodrigo‐Gisbert, Eila Rivera, Marian Muchada, Carlos Piñana, Sandra Boned, Laura Ludovica Gramegna, Marta Rubiera, David Hernández, Carlos Molina, Marc Ribo, and Alejandro Tomasello
Subjects: endovascular treatment, mechanical thrombectomy, stroke, Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background In the endovascular treatment of stroke, achieving complete recanalization in a minimum number of attempts is the main procedural objective. We aimed to explore the effect of the per pass recanalization pattern in patients with final complete recanalization. Methods We analyzed all patients admitted in our center from 2014 to 2022 with a terminal internal carotid artery or M1‐middle cerebral artery occlusion who received endovascular treatment and achieved complete recanalization (expanded thrombolysis in cerebral infarction 2c–3) in our center. Complete sudden recanalization (cSR) was considered when expanded thrombolysis in cerebral infarction improved from 0–1 to 2c–3 in a single pass as opposed to complete progressive recanalization when partial recanalization (2a or 2b) was observed after interim passes. Results Among the 400 included patients with final complete recanalization, 301 (75%) showed a cSR pattern. There were no differences in baseline demographic characteristics between patients with cSR and complete progressive recanalization, including intravenous tissue plasminogen activator treatment (42.2% versus 44.4%; P=0.69). The rate of terminal carotid artery occlusion (28.6% versus 44.4%; P=0.003), median number of passes (1 [interquartile range 1—2] versus 2 [2–3]; P2 passes: 63.6%; P=0.825). Conclusion Among stroke patients with a large vessel occlusion, the cSR pattern predicted favorable outcome independently of the number of thrombectomy passes.
Published: 2023
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14. Infarct Patterns in Patients With Symptomatic Carotid Webs

Author: Sleiman El Jamal, Raul G. Nogueira, Nirav R. Bhatt, Catarina Perry da Câmara, Alhamza R. Al‐Bayati, Jason W. Allen, Song J. Kim, Marta Olivé‐Gadea, Michael Frankel, Fadi Nahab, and Diogo C. Haussen
Subjects: carotid web, cryptogenic stroke, infarct pattern, MRI, stroke, Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background Carotid webs (CaWs) may explain embolic strokes particularly in young patients with cerebral embolism of otherwise undetermined cause. We aim to describe the radiological patterns of infarction in patients with symptomatic CaWs. Methods Retrospective analysis of a symptomatic CaW database (September 2014–July 2019) from 2 comprehensive stroke centers. Magnetic resonance imaging scans were reviewed independently by 2 blinded raters. Patterns of acute infarction included territorial (involving ≥2 arterial subdivisions), cortical (affecting 1 arterial subdivision), 1or multiple small cortical infarcts, borderzone infarcts (cortical or internal), striatocapsular lacunes (
Published: 2022
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15. Bridging intravenous thrombolysis in patients with atrial fibrillation

Author: Adnan Mujanovic, Christoph C. Kurmann, Tomas Dobrocky, Marta Olivé-Gadea, Christian Maegerlein, Laurent Pierot, Vitor Mendes Pereira, Vincent Costalat, Marios Psychogios, Patrik Michel, Morin Beyeler, Eike I. Piechowiak, David J. Seiffge, Pasquale Mordasini, Marcel Arnold, Jan Gralla, Urs Fischer, Johannes Kaesmacher, Thomas R. Meinel, and The BEYOND-SWIFT Investigators
Subjects: atrial fibrillation, oral anticoagulation, ischemic stroke, mechanical thrombectomy, intravenous thrombolysis, Neurology. Diseases of the nervous system, RC346-429
Abstract: Background and purpose40% of acute ischemic stroke patients treated by mechanical thrombectomy (MT) have a clinical history of atrial fibrillation (AF). The safety of bridging intravenous thrombolysis (IVT) (MT + IVT) is currently being discussed. We aimed to analyze the interaction between oral anticoagulation (OAC) status or AF with bridging IVT, regarding the occurrence of symptomatic intracranial hemorrhage (sICH) and functional outcome.Materials and MethodsMulticentric observational cohort study (BEYOND-SWIFT registry) of consecutive patients undergoing MT between 2010 and 2018 (n = 2,941). Multinomial regression models were adjusted for prespecified baseline and plausible pathophysiological covariates identified on a univariate analysis to assess the association of AF and OAC status with sICH and good outcomes (90-day modified Rankin Scale score 0–2).ResultsIn the total cohort (median age 74, 50.6% women), 1,347 (45.8%) patients had AF. Higher admission National Institutes of Health Stroke Scale (NIHSS) score (aOR 1.04 [95% 1.02–1.06], per point of increase) and prior medication with Vitamin K antagonists (VKA) (aOR 2.19 [95% 1.27–3.66]) were associated with sICH. Neither AF itself (aOR 0.71 [95% 0.41–1.24]) nor bridging IVT (aOR 1.08 [0.67–1.75]) were significantly associated with increased sICH. Receiving bridging IVT (aOR 1.61 [95% 1.24–2.11]) was associated with good 90-day outcome, with no interaction between AF and IVT (p = 0.92).ConclusionBridging IVT appears to be a reasonable clinical option in selected patients with AF. Given the increased sICH risk in patients with VKA, subgroup analysis of the randomized controlled trials should analyze whether patients with VKA might benefit from withholding bridging IVT.Registrationclinicaltrials.gov; Unique identifier: NCT03496064.
Published: 2022
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16. Effect of Root Colonization by Arbuscular Mycorrhizal Fungi on Growth, Productivity and Blast Resistance in Rice

Author: Sonia Campo, Héctor Martín-Cardoso, Marta Olivé, Eva Pla, Mar Catala-Forner, Maite Martínez-Eixarch, and Blanca San Segundo
Subjects: Arbuscular mycorrhiza, Funneliformis mosseae, Japonica, Magnaporthe oryzae, Resistance, Rhizophagus irregularis, Plant culture, SB1-1110
Abstract: Abstract Background Arbuscular mycorrhizal (AM) fungi form symbiotic associations with roots in most land plants. AM symbiosis provides benefits to host plants by improving nutrition and fitness. AM symbiosis has also been associated with increased resistance to pathogen infection in several plant species. In rice, the effects of AM symbiosis is less studied, probably because rice is mostly cultivated in wetland areas, and plants in such ecosystems have traditionally been considered as non-mycorrhizal. In this study, we investigated the effect of AM inoculation on performance of elite rice cultivars (Oryza sativa, japonica subspecies) under greenhouse and field conditions, focusing on growth, resistance to the rice blast fungus Magnaporthe oryzae and productivity. Results The response to inoculation with either Funneliformis mosseae or Rhizophagus irregularis was evaluated in a panel of 12 rice cultivars. Root colonization was confirmed in all rice varieties. Under controlled greenhouse conditions, R. irregularis showed higher levels of root colonization than F. mosseae. Compared to non-inoculated plants, the AM-inoculated plants had higher Pi content in leaves. Varietal differences were observed in the growth response of rice cultivars to inoculation with an AM fungus, which were also dependent on the identity of the fungus. Thus, positive, negligible, and negative responses to AM inoculation were observed among rice varieties. Inoculation with F. mosseae or R. irregularis also conferred protection to the rice blast fungus, but the level of mycorrhiza-induced blast resistance varied among host genotypes. Rice seedlings (Loto and Gines varieties) were pre-inoculated with R. irregularis, transplanted into flooded fields, and grown until maturity. A significant increase in grain yield was observed in mycorrhizal plants compared with non-mycorrhizal plants, which was related to an increase in the number of panicles. Conclusion Results here presented support that rice plants benefit from the AM symbiosis while illustrating the potential of using AM fungi to improve productivity and blast resistance in cultivated rice. Differences observed in the mycorrhizal responsiveness among the different rice cultivars in terms of growth promotion and blast resistance indicate that evaluation of benefits received by the AM symbiosis needs to be carefully evaluated on a case-by-case basis for efficient exploitation of AM fungi in rice cultivation.
Published: 2020
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17. Functional Recovery and Serum Angiogenin Changes According to Intensity of Rehabilitation Therapy After Stroke

Author: Nicolás Garcia-Rodriguez, Susana Rodriguez, Pedro Ignacio Tejada, Zuberoa Maite Miranda-Artieda, Natalia Ridao, Xavi Buxó, María Engracia Pérez-Mesquida, Maria Rosario Beseler, Juan B. Salom, Laura M. Pérez, Marco Inzitari, Sergio Otero-Villaverde, Rosa Martin-Mourelle, Mercedes Molleda, Manuel Quintana, Marta Olivé-Gadea, Anna Penalba, and Anna Rosell
Subjects: angiogenin, intensive therapy, rehabilitation, biomarker, recovery, Neurology. Diseases of the nervous system, RC346-429
Abstract: Background: Rehabilitation is still the only treatment available to improve functional status after the acute phase of stroke. Most clinical guidelines highlight the need to design rehabilitation treatments considering starting time, intensity, and frequency, according to the tolerance of the patient. However, there are no homogeneous protocols and the biological effects are under investigation.Objective: To investigate the impact of rehabilitation intensity (hours) after stroke on functional improvement and serum angiogenin (ANG) in a 6-month follow-up study.Methods: A prospective, observational, longitudinal, and multicenter study with three cohorts: strokes in intensive rehabilitation therapy (IRT, minimum 15 h/week) vs. conventional therapy (NO-IRT,
Published: 2021
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18. Eosinophilic annular erythema in adults: report of two cases and review of the literature

Author: Marta Olivé Heras, Noelia Pérez Muñoz, Maribel Iglesias Sancho, and Pablo Umbert Millet
Subjects: Cellulitis, Clobetasol, Eosinophils, Erythema, Steroids, Dermatology, RL1-803
Abstract: Abstract We herein report two cases of eosinophilic annular erythema in adults, which is rare. In both patients, lesions developed rapidly in few days and were located mainly on the trunk, buttocks, and extremities. Diagnosis was histopathological, with typical features including acute dermal inflammatory infiltrate with abundant eosinophils. One of the patients recurred after treatment on three occasions and finally cured spontaneously. The second patient recurred once and was then successfully treated with topical clobetasol. Clinical and histopathological features of eosinophilic annular erythema in adults have rarely been reported. A review of the literature and discussion of relationship with Wells syndrome are also included.
Published: 2017
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19. The doctor-patient perception mismatch: Improving approaches to assessing outcomes after ischemic stroke treated with reperfusion therapy

Author: Khalife, Jane, Penckofer, Mary, Dubinski, Michael J., Brown, Danielle C., Sprankle, Kenyon, Hester, Taryn, Gadea, Marta Olive, Rizzo, Federica, Ribo, Marc, Schumacher, H.Christian, Thon, Jesse M., Jovin, Tudor G., Koneru, Manisha, and Hanafy, Khalid A.
Published: 2025
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20. Association of Time of Day With Outcomes Among Patients Triaged for a Suspected Severe Stroke in Nonurban Catalonia

Author: García-Tornel, Álvaro, Flores, Alan, Terceño, Mikel, Cardona, Pedro, Amaro, Sergi, Gomis, Meritxell, Zaragoza, Josep, Krupinski, Jerzy, Gómez-Choco, Manuel, Mas, Natalia, Cocho, Dolores, Catena, Esther, Purroy, Francesc, Deck, Matias, Rubiera, Marta, Pagola, Jorge, Rodriguez-Luna, David, Juega, Jesús, Rodríguez-Villatoro, Noelia, Molina, Carlos A., Soro, Cristina, Jimenez, Xavier, Salvat-Plana, Mercè, Dávalos, Antoni, Jovin, Tudor G, Abilleira, Sonia, Pérez de la Ossa, Natalia, Ribó, Marc, Sanjuan, Estela, Santana, Katherine, Maisterra, Olga, Santamarina, Estevo, Muchada, Marian, Boned, Sandra, Franco, Antonio Palasi, Gadea, Marta Olivé, Deck, Matías, Requena, Manuel, Sala, Victoria, Muñoz, Lucía, Millán, Mónica, López-Cancio, Elena, Dorado, Laura, Hernández-Pérez, María, Ciurans, Jordi, Samaniego, Daniela, Canento, Tamara, Martin, Lorena, Planas, Anna, Broto, Joaquin, Sorrentino, Agustín, Paré, Martí, Zhu, Nuole, Garrido, Alicia, Grau, Laia, Crespo, Ane Miren, Presas, Silvia, Almendrote, Miriam, Ramos, Alba, Lucente, Giuseppe, Ispierto, Lourdes, Lozano, Manuel, Becerra, Juan Luis, Jiménez, Marta, Rolán, Dolores Vilas, Guanyabens, Nicolas, Sanchez-Ojanguren, Josep, Martínez-Piñeiro, Alicia, Forcén, Sara, Gea, Mireia, Álvarez, Marta, Ramos, Anna, Lizarbe, Manuel Domínguez, Guerra, Rubio, Bragado, Irene, Arbex, Andrea, Rodríguez, Luis, Bustamante, Alejandro, Portela, Pere Cardona, García, Helena Quesada, Rodríguez, Blanca Lara, Cayuela, Nuria, Miró, Julia, Marzal, Clara, Paipa, Andrés, Campoy, Sergio, Núñez, Ana, Arroyo, Pablo, Besora, Sarah, Adell, Vanessa, Campdelacreu, Jaume, Martí, Montse Alemany, González, Belén, Vila, Laura Bau, Crespo, Marta Fiter, Berbel, Anna, Urbaneja, Ma. Cristina Villaescusa, Guillen, Núria, Vidal, Nuria, Santamaria, Patricia Valentina Vérez, Navarro, Diego Herrero, Simó, Marta, Falip, Mercedes, Matas, Elisabeth, Ochoa, Neus Mongay, Gifreu, Ariadna, Muñoz, Albert, Romero, Lucía, Portell, Eduard, Perez, Guillermo Hernández, Esteve, F. Ruiz, Teixidor, Silvia, Talavera, Augusto Salazar, Gómez, Roser, Nuin, Xabier Urra, Vargas, Martha, Chamorro, Ángel, Llull, Laura, Renú, Arturo, Rudilosso, Salvatore, del Valle, Raquel Sánchez, Ariño, Helena, Solà, Nuria, la Puma, Delón, Gil, Francisco, Gómez, Juan Bernardo, Matos, Nuria, Falgàs, Neus, Borrego, Sergi, Sánchez, Almudena, Balasa, Mircea, Montejo, Carmen, Guasp, Mar, Reyes, David, Cervilla, Pablo Sánchez, Contador, Jose Miguel, Monge, Victor Augusto Vera, Ramos, Oscar, Rodríguez, Alejandro, Campello, Ana Rodríguez, Ballester, Gemma Romeral, Trujillano, Mireia Llop, Steinhauer, Eva Giralt, Godia, Elisa Cuadrado, Santiago, Angel Javier Ois, Conde, Jordi Jimenez, Fábregas, Joan Martí, Guisado, Daniel, Prats, Luís, Camps, Pol, Delgado, Raquel, Domeño, Alejandro Martínez, Marín, Rebeca, Cànovas, David, Estela, Jordi, Ros, Marta, Aranceta, Sonsoles, Espinosa, Jordi, Rubio, Marta, Lafuente, Cristina, Barrachina, Oriol, Anguita, Alicia, Reverter, Anna, García, Carmen, Sansa, Gemma, Hervas, Mariona, Crosas, Monica, Delgado, Tania, Folch, Dra Sonia Huertas, Gamito, Gemma Muñoz, Alvarez, Josep Trenado, Subirana, Teresa, Molina, Jessica, Besora, Sarah, Romero, Laura Comes, Valls, Gemma Guardia, Jover, Miriam, Sotova, Javier Joaquín, García Sánchez, Sonia Mª, Valenzuela, Sebastian, Mengual, Juan José, Font, M. Àngels, Gómez Ruiz, Mª Isabel, Zubizarreta, Irati, González, Susana Fernández, Gubieras, Laura, Cobos, Carmen E., Romo, Luis Mena, Caballol, Nuria, Cano, Luis, Leal, Joaquín Serena, Blas, Yolanda Silva, Trigo, Irene Bragado, Viturro, Saima Bashir, Albiñana, Laura Pardo, Garrido, Montserrat Reina, Cazcarra, Carla Marco, Uscamaita, Karol Enrique, Márquez, Fabian, Coll, Cristina, Villlas, Mar Irida Lloret, Vila, Berta Solano, Perna, Berta Alemany, Domínguezl, Daniel López, de Lera, Mercedes, Foraster, Anna Cots, Monge, Victor Augusto Vera, Bojaryn, Urszula, Benabdelhak, Ikram, Capdevila, Gerard Mauri, Montesinos, Jordi Sanahuja, Vázquez, Daniel, Hervás, José Vicente, González, Cristina, Quílez, Alejandro, Pascual, Mikel Vicente, Ruiz, María, Riba, Yolanda, Villar, M. Pilar Gil, García, Cristina, Roig, Xavier Ustrell, Mora, Mònica Baldrich, Guinjoan, Anna Pellisé, Borras, Judit, Martínez, Alba Mañé, Marés, Rafael, Viñas i Gaya, Jaume, Seró, Laia, Rodríguez, Paula, Castilho, Gislaine, Ortega, Angela Monterde, Reverté, Silvia, Baiges, Joan Josep, Ozaeta, Gisela Martín, Escalante, Sonia, Belloch, Patricia Esteve, Payo, Iago, Salvado, Júlia Saura, Soler Insa, Josep M, Vilamala, Ester Tio, Navarro, Josep Abos, Tabuenca, Héctor Cruz, Sánchez, Tamara Canento, Ros, Marta, Matos, Nuria, Roldán, Elisabet, Rubiol, Elsa Puiggrós, Franquet, Elisabet, Fuentes, Lidia, Donaire, Javier, Martí, Elena, Giménez, Laura, Vázquez, Junior Gil, Ambrós, Eloisa Nieto Clara Gris, Rodríguez, Puri, Oletta, José Félix, Mellado, Pilar Pons, Gómez, Bárbara, Raileau, Vergilin, Pardina, Oscar, Mercadal, Jordi, López-Diéguez, María, Pérez, Pilar, Gabarró, Lourdes, Orriols, María, Molina, José Carlos, Canet, Joan Josep, Roca, Mireia, Álvaro, Muriel, Boneu, Francesc, Giménez, Georgina, Albà, Jaume, Gibert, Francesc, Garcia, Jéssica, Barragan, Patricia, Jurado, Gustavo, Pascual_Medicina Interna, Vanesa, Ortega, Josep Sabaté, Solano, Joan Amaurys Martínez, Fernández, Víctor, Torres, Mónica, Alvaredo, Ana Belén Montero, Parejo, Laura Redondo, Aragonés, Josep Maria, Bullón, Anna, Loste, Cora, González, Paula, Bejarano, Neker, Sanchez, Francisco, Lucchetti, Gianni, Pla, Xavier, Gimeno, Dr Javier, Reynaga, Esteban, Barcons, Montse, Celedón, Gabriel, Ortiz, Juan, Anastasovski, Dr Goran, Mascaró, Dr Oscar, de los Ríos, Dr Javier Diez, Feliu, Meritxell, Ribera, Anna, Ruiz, Cristhian, Corominas, Gerard, Nunes, Dra Daniella, Roca, Claudia, Latorre, Nadina, Yataco, Lizbeth, Cruz, Maricelys, Blanco, Nerea, Castejón, Santiago, Sunyer, Claustre Pont, Garcia, Jordi Espinosa, Martin, Rodrigo Paz, de Luis Sanchez, Albert, Vivas, Dolores Espinosa, Molina, Juan Valencia, Palome, Planels, Chaume, Laia Tomas, Vilella, Ares Villagrasa, Bustamante, Marco, Boltes, Anunciación, Rodríguez, Fernando, Arrieta, Itziar, Molist, Jordi Ciurans, Andreu, Barnés, Soler, Ernest Palomeras, Buscà, Nicolau Guanyabens, López, Manuel Daza, Farreres, Jordi Bigas, Ruiz, Virginia Casado, Batiste, Desiree Muriana, Sanz Cartagena, Mª Pilar, de Vega, Eulalia Cabot, Real, Josep Bassa, Roman, Hector Pelaez, Socolich, César, Alonso Camp, Josep Mª, Orgaz, Antonio Tomás Cano, Fossas Felip, Mª Pilar, Morón, Nicolás, Bacca, Sandra, Molina, Mauricio, Casarramona, Francesc, Elias, Lorena, Bukaei, Muhammad Zidane, Gutierrez, Jose Antonio Martos, Escuin, Judith Lopez, Olaizola, Cristina, Vargas, Yolexis López, Oyonarte, Juan Jiménez, Soultana, Rashida, Golpe, Eduardo Sanjurjo, Salvador, Esther, Vila, Guillem, Serrano, Marcos, Claverol, Matilde Nuria López, Lamolla, Marian, Amate, Miquel, Rodriguez, Adriana, Romero, Ruth, del Carpio, Montgomery, Hernandez, Ana Isabel, Martín, Julián, Rosas, M Carmen, Nogueroles, Antonio, Encarnación, Sorilandy, Robles, Augusto, Herrera, Jose Antonio, Gavilán, Roger, Mameghani, Toghrol, Araujo, Gastón, Morales, M.Angeles Garrido, Segui, Enric Ramon Albert, Climent, Eva Fernandez, Pujol, Francesc Paris, Seira, Mireia Judit Garrofé, Pía, Lucía Gómez, Nuñez, Fernando Salleres, Peñalver, Cristina Aguar, Lopes, Cristina Vaz, Tasa, Elisenda Ribera, Vilchez, Carmen Repullo, Zambrana, Modesto Sánchez, Ribas, Beatriu Suescun, Panés, Inés Vilà, Planavila, Montserrat Vila, Lorenzo, Alicia Vaqueiro, Guixes, Meritxell Sabartés, Medina, Jorge, Sambrano, David, Zamarreño, Javi, Pirela, Carmen, Vélez, Paola, Cajamarca, Luis, Pérez, Honey, Martínez, Yarles, Gonçalves, Jesus Alexander, Regordosa, Carles, Mormeneo, Claudia, Griu, Laura, Colina, Maria Francia, Farik, Enric, Duch, Dolors Carrión, Badenas, Carles, Bernal, Oscar, Agramunt, Núria, Morales, Shyrlei, Reynoso, Victoria, Guerrero, Miguel, Cid, Primitivo Romera, Folqué, Mònica, Pedroza, Claudia, Hachem, Adnan, Martínez, Íñigo Soteras, García, Xavier Verdera, Amorós, Mercè López, Subirós, Xavier Costa, Benet, Marta Cufí, Van Eendenburg, Cecile, Osuna, Teresa, Santos, Dra Gina, Pallisera, Dra Mireia, Oliva, Dr Lluís Gonzalo, Sanchez, Dra Gemma, Basurto, Dr Xavier, Vivoda, Dr Ludgi, Van der Kleyn, Dr Richard, Robles, Dra Laura, Barranco, Ana Cabanelas, Almendros, Mª Cruz, Oliveras, Marc Pérez, Álvarez, Amelia Fernández, Rybyeva, Maria, Viñas, Antoni, Barcons, Maria, Tavera, Joaquim Danès Alberto, Burbano, Pablo, López, Cintie, Cruz, David, Bisbe, Paula, Fernández, Nora, Palacio, Juan Carlos, Fraiz, Eduardo, Aguiló, Oriol, Amorodjo, Rollmy, Velázquez, John, Sánchez, Elena, Español, Jaume, Perez de Celis, Judit, Coll, Anna, Díaz, Glòria, Vergés i Sala, Margarida, Casas Capdevila, Mª Ángels, Ferrini, Yosmairy Yoselin, Gorriz, Aitor, Navarro, Diego-Javier Cucurell, Velásquez, Dulce, Pla Soler, Jaume, González, Josep, Higuera, Julian David, Cuellar, Lina, Miniello, Liza Margarita, Pujol, Lluis, Cracan, Sorin, Vives, Mora, Angela, M, Lopez, Lopez, Molist, Montse Gorchs, Anna, Delofeu, Muñoz, Silvia Solà, Yolanda, Ferreres, Pujalte, Carol, Marín, Elisabeth Téllez, Casas, Yolanda Font, Luque, Sara Hernández, Sendra, Joaquim Mejias, Valero, Francesca Mellado, Escala, Campos, De Lacanal, Galup, Diaz, Lopez, Paramio, Castillo, Estopà, Català, Moreda, Español, Majo, Calafell, Almeida, Carballo, Naval, Castro, Elena, M, Ruiz, Cregut, Lluis, Pere, Font, Deulofeu, Sanjuan, Fabregat, Pere, Joan, Gorchs, Fontquerni, Bellés, Forés, Antoni, Joan, Herrera, Gomez, Carlos, Juan, Prades, Hijazo, Torvisco, Itzaina, Rovira, Marti, Gonzalez, Obiols, Cavero, Olive, Gil, Querol, Soledad, M, Rodriguez, Rico, Sambernardo, Rios, Molina, Ropero, Ramon, Jose, Valero, Sanchez, Arevalo, Santos, Jose, Maria, Garcia, Soto, Angeles, Maria, Escribano, Tebar, Garcia, Torres, José, Pedro, Carrion, Verdes, Isabel, M, Lopez, Verge, Jose, Juan, Canela, Lopez, Angeles, M, Guarque, Lucas, Alvarez, Morales, Arnulfo, Jorge, Fornieles, Morell, Gomez, Subirats, Teresa, Maria, Masa, Miquel, Torello, Lopez, Val, Mercedes, Maria, Reyes, Palmero, Manuel, Juan, Forne, Rodriguez, Turiel, Ruana, Gonzalez, Sanchez, Gornals, Sebastia, Rico, Abrio, Falip, Albert Gual, Oliveros, Aznar, Perotti, Brugues, Molinero, Calvet, Franco, Catells, Medina, Corrales, Miro, Daroca, Marquez, Duran, Pradas, Feliu, Casanova, Figueras, Tortajada, Garcia, Gallego, Grajera, del Mar, Azahara, Arroyo, Las, de Jesus, Dulcenombre, Sanz, Laserreta, Vidal, Llambrich, Corral, Monllao, de la Cruz, Morales, Blanco, Moreno, Orgaz, Orejuela, Suazo, Piñana, Minguillon, Pons, Gómez, Rodríguez, Carlos, José, Pereira, Rodriguez, Porcel, Anna, Sedo, Villar, Sevil, Lopez, Sierra, Romero, Torres, Calveres, Anna, Trepat, Arnella, Ventura, Gil, Acera, Teresa, M, Vico, Biesot, Galea, Castro, Maria, Rosa, Chafer, Escorcia, Antonio, Juan, Moreda, Español, Faure, Gil, Luque, Hernandez, Delgado, Jimenez, Gay, Mallafre, Angel, M., Sanzo, Olivares, Fondevila, Pubill, Fort, Sabate, Agámez, Segovia, Carlos, Antonio, Longaretti, Turata, Hernandez, Valle, Guixens, Trayner, Valor, Aguilar, Alvarez, Aguirre, Naval, Alastrue, Baquero, Alferez, Marne, Alonso, Orozco, Aloy, Colino, Alvarez, Peñuela, Alvarez, Cirilo, Ameller, Vanessa, Maria, Guerrero, Andujar, Remedios, Estefania, Sillero, Auladell, Sorbet, Azcarate, Genesca, Basany, Barduena, Benavent, Tudela, Benito, Pardo, Blanch, Pla, Boluda, Gonzalez, Bonilla, Serramalera, Bru, Andreu, Burnat, Calvo-Rayo, Caballero, Casellas, Calvo, Mombiela, Camps, Bresme, Cano, Fernandez, Carcelen, Solà, Caro, Matavacas, Casasas, Bolado, Castanedo, Cortina, Cerdeña, Jane, Abella, Borrego, Laia Collado, Orri, Colom, Vilanova, Comellas, Sole, Conillera, Torres, Cots, Estepa, Cuchi, de Sostoa Graell, Marc, del Rio Lopez, Laura, Compte, Delgado, Bueno, Diaz, Maneiro, Diaz, Lucia, Andrea, Palau, Domenech, Carme, M., Carasso, Duran, Javier, Pablo, Marquez, Duran, Abidi, El, Martin, Escoda, Casanovas, Esteve, Perez, Fernandez, Quintero, Ferre, Escobar, Flores, Abad, Fontcuberta, del Valle, Fortes, del Valle, Fortes, Luisa, Mª, Quesada, Franco, Maria, Sara, Romero, Franco, Teresa, Maria, Francisco, Gallego, Gala, Gamiz, Castañeda, Garcia, Rodriguez, Garcia, Gemma, Casajuana, Arroyo, Gomez, Girbau, Gomez, Fernandez, Gonzalez, Gonzalez, Gonzalez, Gonzalez, Gonzalez, Lopez, Gonzalez, Obeso, Gual, Blanco, Guerrero, Roca, Guillemas, Eudaldo, Guillermo, Hernandez, Sebastia, Covas, Homar, Alvarez, Hostench, Royo, Huerta, Barcelo, Ibañez, Cruz, Izquiero, Etxetxikia, Jaione Urdangarin, Gimenez, Juárez, Alami, Khlifi, Gasco, Laparra, Moreales, Lara, Arroyo, Las, de Jesus, Dulcenombre, Medina, Lasaosa, Lourdes, Maria, Cava, Lazaro, Berrar, Leon, Maturana, López, Ramirez, Lopez, Romero, López, Marco, Lorente, Martin, Lorenzo, Casals, Lozano, Nicola, Lujan, Diaz, Madrid, Antonio, Jose, Morales, Maria Teresa Peris, Clemente, Marti, Castaño, Martinez, Natanael, David, Gamez, Martinez, Gonzalez, Martinez, Quesada, Martinez, de la Cabeza, Maria, Fusté, Marzà, Lasheras, Melendo, Mestre, Miralles, Pastalle, Montserrat Puig, Vidal, Montserrate, Mellado, Mora, Ponce, Morales, Fornieles, Morell, Cabre, Morera, Vivet, Morera, Souza, Mundi, Quiles, Muñoz, Rosa, Navea, Iglesias, Neira, Asuncion, M, Manrique, Nuñez, Pilar, Mª, Martinez, Obiols, Reig, Pallares, Torres, Partegas, Berengueras, Pascual, Gamez, Perez, Oset, Perez, Restrepo, Perez, Alejandra, Maria, Yeste, Planas, Mangado, Planells, Minguillon, Pons, Carbonell, Puertas, Blanco, Quinteiro, Benavente, Rebollar, Fernandez, Recasens, Gomez, Reyes, del Carmen, Maria, Pou, Roca, Ferrer, Rodriguez, Franco, Rodriguez, Fuertes, Rodriguez, Muñoz, Rodriguez, Navarro, Rodriguez, Iniesta, Roig, Gracia, Romero, Brunet, Rovira, de Eugenio, Rovira, Baena, Rubio, Llorens, Ruiz, Llamazares, Sala, Alaez, San Juan, Segura, Sanchez, Soldevilla, Santasusana, Salmeron, Sanz, Perez, Segura, Balcells, Serra, Dumitras, Sorina, Montoya, Teixidor, Vicente, Tena, Salinas, Tierno, Ines, Ester, Testa, Toledo, Figueras, Tomàs, Ruperez, Tomas, Garcia-Penche, Torrano, Esparza, Torres, Blanco, Vazquez, De la Paz, Vazquez, Gil, Vazquez, Gonzalez, Vazquez, Meler, Vidal, Cots, Vilalta, Jimenez, Vilches, Jose, Maria, Fernandez, Visser, Gavin, Viu, Vives, Vives, Jimenez, Carmona, Jose, Francisco, Vilches, Galobardes, Gomez, Gonzalez, Manzanera, Jodar, Cortes, Marimon, Orive, Marrodan, Bosch, Martin, Jose, Maria, Lopez, Martorell, Roca, Millares, Jesus, M, Guri, Miralles, Hernandez, Muliterno, Oliva, Muñoz, Pujol, Pons, Conde, Postius, Arruñada, Prieto, Antonio, Jose, Mathé, Quintana, Mata, Rosell, Alvarez, Aguirre, Alvarez, Alvarin, Flores, Arrufat, Pago, Bañuelos, Andreu, Burnat, Vilar, Campo, Hidalgo, Cardus, Gil, Castello, Gloria, Maria, Montsesinos, Castrillo, Estopà, Català, Garces, Clave, Sanroma, Comes, Sequi, Descalzo, Ricol, Errando, Campillo, Escudero, del Mar, Maria, Alvarez, Fernandez, Gomez, Fernandez, Perez, Fernandez, Espinosa, Franch, Graells, Freixes, Plaza, Garcia, Gallego, Garcia-Marron, Simancas, Hernandez, Covas, Homar, Royo, Huerta, Armas, Jaraba, Ramos, Jimenez, Canela, Lopez, Angeles, M, Lopez, Lopez, Oganissian, Lopez, Romero, Madrona, Rosa, M, Millan, Martinez, Morón, Martínez, Encinas, Merchan, Fornieles, Morell, Jimenez, Moreno, Rico, Muñoz, Rodriguez, Navarro, Ibañez, Nogales, Maria, Rita, Viera, Novillo, Torrabadella, Parella, Alba, Mari, Villar, Pera, Montserrat, Carla, Carbonell, Puertas, Miralles, Rabella, Trilles, Ramis, Ortiz, Ribera, Fuertes, Rodriguez, Gonzalez, Sanchez, Perez, Sastre, Perez, Segura, Borrega, Soro, Garcia, Soto, Angeles, Maria, Fores, Tapia, Bernad, Tellez, Alvarez, Trenado, Moreda, Español, Martin, Felix, Perez, Herrero, Manzanera, Jodar, Fuster, Lanau, Gomariz, Lopez, Orive, Marrodan, Bosch, Martin, Jose, Maria, Guri, Miralles, Oliva, Muñoz, Lozano, Pardo, Pujol, Pons, Altimiras, Quintana, Lopez, Ventosa, Damian, Almodovar, Colino, Alvarez, Monterroso, Alvarez, Comas, Arambudo, Garzon, Boullon, Capella, Burgos, Garcia, Campuzano, Del Mar, Maria, Olivas, Capdevila, Fernandez, Carcelen, Solà, Caro, Marti, Carre, Isabel, Clara, Bacaicoa, Carretero, Gil, Castello, Gloria, Maria, Montsesinos, Castrillo, Calderon, Cazorla, Osuna, Chacon, Planas, Cortes, Olio, Cortit, Estany, Delhomme, Carasso, Duran, Javier, Pablo, Campillo, Escudero, del Mar, Maria, Martinez, Fructuos, Lopez, Garcia, Luis, Pascual, Plaza, Garcia, Vallve, Genis Amill, Arroyo, Gomez, Girbau, Gomez, Muñoz, Gonzalez, Ventura, Hernaez, Covas, Homar, Gimenez, Lavernia, Rojo, Martin, Medina, Martínez, Millan, Martinez, Barrera, Mayol, Pi, Mercader, Dalmau, Merino, Campodarbe, Miguel, Pastalle, Montserrat Puig, de la Cruz, Morales, Fornieles, Morell, Sanchez, Moreno, Javier, Francisco, Reig, Pallares, Torrabadella, Parella, Alba, Mari, Barrameda, Penela, Ajenjo, Prieto, Benavente, Rebollar, Pareja, Rodriguez, Piñar, Rodríguez, Javier, Francisco, Tello, Rodriguez, Pereda, Romero, Saborido, Sainz, Martin, Santacana, Martinez, Santos, Chavez, Sierra, Testa, Toledo, Figueras, Tomàs, Garcia, Torres, José, Pedro, Torres, Turbau, Domenech, Vicente, Esteo, Villena, Pertegaz, Vives, Gonzalez, Baena, Pont, Bagaria, Sanchez, Beltran, Alarcon, Bonet, Ballescà, Borch, Clanchet, Buhils, Garcia, Closa, Carril, Colomina, Sanchez, Cristina Fernandez, Toledo, Edurne Judith Fernandez, Rodriguez, Espases, Resa, Espert, Xavier, F, Sol, Fernández, Lugo, Gonzalez, Llesera, Gracia, Lendinez, Herrada, Liesa, Juliench, Alicia, Sandra, Ortega, Lopez, Yuste, Lopez, Villanueva, Lozano, Soto, Lucia Sola, Castellano, Madrid, Cano, Megias, Jesus, Daniel, Ponce, Montasell, Sospedra, Montesinos, Martinez, Moya, Herrera, Muñoz, Isabel, M, Fernandez, Ocaña, Jose, Maria, Bernal, Palau, Sole, Perez, Carbonell, Ramon, Lop, Ribas, López, Rubio, Lopez, Rueda, Castaño, Sabat, Lara, Sabata, Ramírez, Salmerón, Gornals, Sebastia, Creus, Serra, Dalmau, Serrano, Mainero, Sumasi, Gabriel, Gonzalo, Masa, Torello, Primo, Valencia, Muñoz, Ana Maria Viñuales, Roig, Josep, and Hidalgo, Verònica
Published: 2023
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21. A fully automatic method for vascular tortuosity feature extraction in the supra-aortic region: unraveling possibilities in stroke treatment planning.

Author: Pere Canals, Simone Balocco, Oliver Díaz, Jiahui Li, álvaro García-Tornel, Alejandro Tomasello, Marta Olivé-Gadea, and Marc Ribó
Published: 2023
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22. Association of Time of Day With Outcomes Among Patients Triaged for a Suspected Severe Stroke in Nonurban Catalonia

Author: Álvaro García-Tornel, Alan Flores, Mikel Terceño, Pedro Cardona, Sergi Amaro, Meritxell Gomis, Josep Zaragoza, Jerzy Krupinski, Manuel Gómez-Choco, Natalia Mas, Dolores Cocho, Esther Catena, Francesc Purroy, Matias Deck, Marta Rubiera, Jorge Pagola, David Rodriguez-Luna, Jesús Juega, Noelia Rodríguez-Villatoro, Carlos A. Molina, Cristina Soro, Xavier Jimenez, Mercè Salvat-Plana, Antoni Dávalos, Tudor G Jovin, Sonia Abilleira, Natalia Pérez de la Ossa, Marc Ribó, Estela Sanjuan, Katherine Santana, Olga Maisterra, Estevo Santamarina, Marian Muchada, Sandra Boned, Antonio Palasi Franco, Marta Olivé Gadea, Matías Deck, Manuel Requena, Victoria Sala, Lucía Muñoz, Mónica Millán, Elena López-Cancio, Laura Dorado, María Hernández-Pérez, Jordi Ciurans, Daniela Samaniego, Tamara Canento, Lorena Martin, Anna Planas, Joaquin Broto, Agustín Sorrentino, Martí Paré, Nuole Zhu, Alicia Garrido, Laia Grau, Ane Miren Crespo, Silvia Presas, Miriam Almendrote, Alba Ramos, Giuseppe Lucente, Lourdes Ispierto, Manuel Lozano, Juan Luis Becerra, Marta Jiménez, Dolores Vilas Rolán, Nicolas Guanyabens, Josep Sanchez-Ojanguren, Alicia Martínez-Piñeiro, Sara Forcén, Mireia Gea, Marta Álvarez, Anna Ramos, Manuel Domínguez Lizarbe, Rubio Guerra, Irene Bragado, Andrea Arbex, Luis Rodríguez, Alejandro Bustamante, Pere Cardona Portela, Helena Quesada García, Blanca Lara Rodríguez, Nuria Cayuela, Julia Miró, Clara Marzal, Andrés Paipa, Sergio Campoy, Ana Núñez, Pablo Arroyo, Sarah Besora, Vanessa Adell, Jaume Campdelacreu, Montse Alemany Martí, Belén González, Laura Bau Vila, Marta Fiter Crespo, Anna Berbel, Ma. Cristina Villaescusa Urbaneja, Núria Guillen, Nuria Vidal, Patricia Valentina Vérez Santamaria, Diego Herrero Navarro, Marta Simó, Mercedes Falip, Elisabeth Matas, Neus Mongay Ochoa, Ariadna Gifreu, Albert Muñoz, Lucía Romero, Eduard Portell, Guillermo Hernández Perez, F. Ruiz Esteve, Silvia Teixidor, Augusto Salazar Talavera, Roser Gómez, Xabier Urra Nuin, Martha Vargas, Ángel Chamorro, Laura Llull, Arturo Renú, Salvatore Rudilosso, Raquel Sánchez del Valle, Helena Ariño, Nuria Solà, Delón la Puma, Francisco Gil, Juan Bernardo Gómez, Nuria Matos, Neus Falgàs, Sergi Borrego, Almudena Sánchez, Mircea Balasa, Carmen Montejo, Mar Guasp, David Reyes, Pablo Sánchez Cervilla, Jose Miguel Contador, Victor Augusto Vera Monge, Oscar Ramos, Alejandro Rodríguez, Ana Rodríguez Campello, Gemma Romeral Ballester, Mireia Llop Trujillano, Eva Giralt Steinhauer, Elisa Cuadrado Godia, Angel Javier Ois Santiago, Jordi Jimenez Conde, Joan Martí Fábregas, Daniel Guisado, Luís Prats, Pol Camps, Raquel Delgado, Alejandro Martínez Domeño, Rebeca Marín, David Cànovas, Jordi Estela, Marta Ros, Sonsoles Aranceta, Jordi Espinosa, Marta Rubio, Cristina Lafuente, Oriol Barrachina, Alicia Anguita, Anna Reverter, Carmen García, Gemma Sansa, Mariona Hervas, Monica Crosas, Tania Delgado, Dra Sonia Huertas Folch, Gemma Muñoz Gamito, Josep Trenado Alvarez, Teresa Subirana, Jessica Molina, Laura Comes Romero, Gemma Guardia Valls, Miriam Jover, Javier Joaquín Sotova, Sonia Mª García Sánchez, Sebastian Valenzuela, Juan José Mengual, M. Àngels Font, Mª Isabel Gómez Ruiz, Irati Zubizarreta, Susana Fernández González, Laura Gubieras, Carmen E. Cobos, Luis Mena Romo, Nuria Caballol, Luis Cano, Joaquín Serena Leal, Yolanda Silva Blas, Irene Bragado Trigo, Saima Bashir Viturro, Laura Pardo Albiñana, Montserrat Reina Garrido, Carla Marco Cazcarra, Karol Enrique Uscamaita, Fabian Márquez, Cristina Coll, Mar Irida Lloret Villlas, Berta Solano Vila, Berta Alemany Perna, Daniel López Domínguezl, Mercedes de Lera, Anna Cots Foraster, Urszula Bojaryn, Ikram Benabdelhak, Gerard Mauri Capdevila, Jordi Sanahuja Montesinos, Daniel Vázquez, José Vicente Hervás, Cristina González, Alejandro Quílez, Mikel Vicente Pascual, María Ruiz, Yolanda Riba, M. Pilar Gil Villar, Cristina García, Xavier Ustrell Roig, Mònica Baldrich Mora, Anna Pellisé Guinjoan, Judit Borras, Alba Mañé Martínez, Rafael Marés, Jaume Viñas i Gaya, Laia Seró, Paula Rodríguez, Gislaine Castilho, Angela Monterde Ortega, Silvia Reverté, Joan Josep Baiges, Gisela Martín Ozaeta, Sonia Escalante, Patricia Esteve Belloch, Iago Payo, Júlia Saura Salvado, Josep M Soler Insa, Ester Tio Vilamala, Josep Abos Navarro, Héctor Cruz Tabuenca, Tamara Canento Sánchez, Elisabet Roldán, Elsa Puiggrós Rubiol, Elisabet Franquet, Lidia Fuentes, Javier Donaire, Elena Martí, Laura Giménez, Junior Gil Vázquez, Eloisa Nieto Clara Gris Ambrós, Puri Rodríguez, José Félix Oletta, Pilar Pons Mellado, Bárbara Gómez, Vergilin Raileau, Oscar Pardina, Jordi Mercadal, María López-Diéguez, Pilar Pérez, Lourdes Gabarró, María Orriols, José Carlos Molina, Joan Josep Canet, Mireia Roca, Muriel Álvaro, Francesc Boneu, Georgina Giménez, Jaume Albà, Francesc Gibert, Jéssica Garcia, Patricia Barragan, Gustavo Jurado, Vanesa Pascual_Medicina Interna, Josep Sabaté Ortega, Joan Amaurys Martínez Solano, Víctor Fernández, Mónica Torres, Ana Belén Montero Alvaredo, Laura Redondo Parejo, Josep Maria Aragonés, Anna Bullón, Cora Loste, Paula González, Neker Bejarano, Francisco Sanchez, Gianni Lucchetti, Xavier Pla, Dr Javier Gimeno, Esteban Reynaga, Montse Barcons, Gabriel Celedón, Juan Ortiz, Dr Goran Anastasovski, Dr Oscar Mascaró, Dr Javier Diez de los Ríos, Meritxell Feliu, Anna Ribera, Cristhian Ruiz, Gerard Corominas, Dra Daniella Nunes, Claudia Roca, Nadina Latorre, Lizbeth Yataco, Maricelys Cruz, Nerea Blanco, Santiago Castejón, Claustre Pont Sunyer, Jordi Espinosa Garcia, Rodrigo Paz Martin, Albert de Luis Sanchez, Dolores Espinosa Vivas, Juan Valencia Molina, Planels Palome, Laia Tomas Chaume, Ares Villagrasa Vilella, Marco Bustamante, Anunciación Boltes, Fernando Rodríguez, Itziar Arrieta, Jordi Ciurans Molist, Barnés Andreu, Ernest Palomeras Soler, Nicolau Guanyabens Buscà, Manuel Daza López, Jordi Bigas Farreres, Virginia Casado Ruiz, Desiree Muriana Batiste, Mª Pilar Sanz Cartagena, Eulalia Cabot de Vega, Josep Bassa Real, Hector Pelaez Roman, César Socolich, Josep Mª Alonso Camp, Antonio Tomás Cano Orgaz, Mª Pilar Fossas Felip, Nicolás Morón, Sandra Bacca, Mauricio Molina, Francesc Casarramona, Lorena Elias, Muhammad Zidane Bukaei, Jose Antonio Martos Gutierrez, Judith Lopez Escuin, Cristina Olaizola, Yolexis López Vargas, Juan Jiménez Oyonarte, Rashida Soultana, Eduardo Sanjurjo Golpe, Esther Salvador, Guillem Vila, Marcos Serrano, Matilde Nuria López Claverol, Marian Lamolla, Miquel Amate, Adriana Rodriguez, Ruth Romero, Montgomery del Carpio, Ana Isabel Hernandez, Julián Martín, M Carmen Rosas, Antonio Nogueroles, Sorilandy Encarnación, Augusto Robles, Jose Antonio Herrera, Roger Gavilán, Toghrol Mameghani, Gastón Araujo, M.Angeles Garrido Morales, Enric Ramon Albert Segui, Eva Fernandez Climent, Francesc Paris Pujol, Mireia Judit Garrofé Seira, Lucía Gómez Pía, Fernando Salleres Nuñez, Cristina Aguar Peñalver, Cristina Vaz Lopes, Elisenda Ribera Tasa, Carmen Repullo Vilchez, Modesto Sánchez Zambrana, Beatriu Suescun Ribas, Inés Vilà Panés, Montserrat Vila Planavila, Alicia Vaqueiro Lorenzo, Meritxell Sabartés Guixes, Jorge Medina, David Sambrano, Javi Zamarreño, Carmen Pirela, Paola Vélez, Luis Cajamarca, Honey Pérez, Yarles Martínez, Jesus Alexander Gonçalves, Carles Regordosa, Claudia Mormeneo, Laura Griu, Maria Francia Colina, Enric Farik, Dolors Carrión Duch, Carles Badenas, Oscar Bernal, Núria Agramunt, Shyrlei Morales, Victoria Reynoso, Miguel Guerrero, Primitivo Romera Cid, Mònica Folqué, Claudia Pedroza, Adnan Hachem, Íñigo Soteras Martínez, Xavier Verdera García, Mercè López Amorós, Xavier Costa Subirós, Marta Cufí Benet, Cecile Van Eendenburg, Teresa Osuna, Dra Gina Santos, Dra Mireia Pallisera, Dr Lluís Gonzalo Oliva, Dra Gemma Sanchez, Dr Xavier Basurto, Dr Ludgi Vivoda, Dr Richard Van der Kleyn, Dra Laura Robles, Ana Cabanelas Barranco, Mª Cruz Almendros, Marc Pérez Oliveras, Amelia Fernández Álvarez, Maria Rybyeva, Antoni Viñas, Maria Barcons, Joaquim Danès Alberto Tavera, Pablo Burbano, Cintie López, David Cruz, Paula Bisbe, Nora Fernández, Juan Carlos Palacio, Eduardo Fraiz, Oriol Aguiló, Rollmy Amorodjo, John Velázquez, Elena Sánchez, Jaume Español, Judit Perez de Celis, Anna Coll, Glòria Díaz, Margarida Vergés i Sala, Mª Ángels Casas Capdevila, Yosmairy Yoselin Ferrini, Aitor Gorriz, Diego-Javier Cucurell Navarro, Dulce Velásquez, Jaume Pla Soler, Josep González, Julian David Higuera, Lina Cuellar, Liza Margarita Miniello, Lluis Pujol, Sorin Cracan, Mora Vives, M Angela, Lopez Lopez, Montse Gorchs Molist, Delofeu Anna, Silvia Solà Muñoz, Ferreres Yolanda, Carol Pujalte, Elisabeth Téllez Marín, Yolanda Font Casas, Sara Hernández Luque, Joaquim Mejias Sendra, Francesca Mellado Valero, Campos Escala, Galup De Lacanal, Lopez Diaz, Castillo Paramio, Català Estopà, Español Moreda, Calafell Majo, Carballo Almeida, Castro Naval, M Elena, Cregut Ruiz, Pere Lluis, Deulofeu Font, Fabregat Sanjuan, Joan Pere, Fontquerni Gorchs, Forés Bellés, Joan Antoni, Gomez Herrera, Juan Carlos, Hijazo Prades, Itzaina Torvisco, Marti Rovira, Obiols Gonzalez, Olive Cavero, Querol Gil, M Soledad, Rico Rodriguez, Rios Sambernardo, Ropero Molina, Jose Ramon, Sanchez Valero, Santos Arevalo, Maria Jose, Soto Garcia, Maria Angeles, Tebar Escribano, Torres Garcia, Pedro José, Verdes Carrion, M Isabel, Verge Lopez, Juan Jose, Lopez Canela, M Angeles, Lucas Guarque, Morales Alvarez, Jorge Arnulfo, Morell Fornieles, Subirats Gomez, Maria Teresa, Torello Masa, Miquel, Val Lopez, Maria Mercedes, Palmero Reyes, Juan Manuel, Rodriguez Forne, Ruana Turiel, Sanchez Gonzalez, Sebastia Gornals, Abrio Rico, Albert Gual Falip, Aznar Oliveros, Brugues Perotti, Calvet Molinero, Catells Franco, Corrales Medina, Daroca Miro, Duran Marquez, Feliu Pradas, Figueras Casanova, Garcia Tortajada, Grajera Gallego, Azahara del Mar, Las Arroyo, Dulcenombre de Jesus, Laserreta Sanz, Llambrich Vidal, Monllao Corral, Morales de la Cruz, Moreno Blanco, Orejuela Orgaz, Piñana Suazo, Pons Minguillon, Rodríguez Gómez, José Carlos, Rodriguez Pereira, Sedo Porcel, Anna, Sevil Villar, Sierra Lopez, Torres Romero, Trepat Calveres, Anna, Ventura Arnella, Acera Gil, M Teresa, Biesot Vico, Castro Galea, Rosa Maria, Escorcia Chafer, Juan Antonio, Gil Faure, Hernandez Luque, Jimenez Delgado, Mallafre Gay, M. Angel, Olivares Sanzo, Pubill Fondevila, Sabate Fort, Segovia Agámez, Antonio Carlos, Turata Longaretti, Valle Hernandez, Trayner Guixens, Aguilar Valor, Aguirre Alvarez, Alastrue Naval, Alferez Baquero, Alonso Marne, Aloy Orozco, Alvarez Colino, Alvarez Peñuela, Ameller Cirilo, Maria Vanessa, Andujar Guerrero, Estefania Remedios, Auladell Sillero, Azcarate Sorbet, Basany Genesca, Benavent Barduena, Benito Tudela, Blanch Pardo, Boluda Pla, Bonilla Gonzalez, Bru Serramalera, Burnat Andreu, Caballero Calvo-Rayo, Calvo Casellas, Camps Mombiela, Cano Bresme, Carcelen Fernandez, Caro Solà, Casasas Matavacas, Castanedo Bolado, Cerdeña Cortina, Abella Jane, Laia Collado Borrego, Colom Orri, Comellas Vilanova, Conillera Sole, Cots Torres, Cuchi Estepa, Marc de Sostoa Graell, Laura del Rio Lopez, Delgado Compte, Diaz Bueno, Diaz Maneiro, Andrea Lucia, Domenech Palau, M. Carme, Duran Carasso, Pablo Javier, El Abidi, Escoda Martin, Esteve Casanovas, Fernandez Perez, Ferre Quintero, Flores Escobar, Fontcuberta Abad, Fortes del Valle, Mª Luisa, Franco Quesada, Sara Maria, Franco Romero, Gallego Francisco, Gamiz Gala, Garcia Castañeda, Garcia Rodriguez, Casajuana Gemma, Gomez Arroyo, Gomez Girbau, Gonzalez Fernandez, Gonzalez Gonzalez, Gonzalez Lopez, Gual Obeso, Guerrero Blanco, Guillemas Roca, Guillermo Eudaldo, Sebastia Hernandez, Homar Covas, Hostench Alvarez, Huerta Royo, Ibañez Barcelo, Izquiero Cruz, Jaione Urdangarin Etxetxikia, Juárez Gimenez, Khlifi Alami, Laparra Gasco, Lara Moreales, Lasaosa Medina, Maria Lourdes, Lazaro Cava, Leon Berrar, López Maturana, Lopez Ramirez, López Romero, Lorente Marco, Lorenzo Martin, Lozano Casals, Lujan Nicola, Madrid Diaz, Jose Antonio, Maria Teresa Peris Morales, Marti Clemente, Martinez Castaño, David Natanael, Martinez Gamez, Martinez Gonzalez, Martinez Quesada, Maria de la Cabeza, Marzà Fusté, Melendo Lasheras, Miralles Mestre, Montserrat Puig Pastalle, Montserrate Vidal, Mora Mellado, Morales Ponce, Morera Cabre, Morera Vivet, Mundi Souza, Muñoz Quiles, Navea Rosa, Neira Iglesias, M Asuncion, Nuñez Manrique, Mª Pilar, Obiols Martinez, Pallares Reig, Partegas Torres, Pascual Berengueras, Perez Gamez, Perez Oset, Perez Restrepo, Maria Alejandra, Planas Yeste, Planells Mangado, Puertas Carbonell, Quinteiro Blanco, Rebollar Benavente, Recasens Fernandez, Reyes Gomez, Maria del Carmen, Roca Pou, Rodriguez Ferrer, Rodriguez Franco, Rodriguez Fuertes, Rodriguez Muñoz, Rodriguez Navarro, Roig Iniesta, Romero Gracia, Rovira Brunet, Rovira de Eugenio, Rubio Baena, Ruiz Llorens, Sala Llamazares, San Juan Alaez, Sanchez Segura, Santasusana Soldevilla, Sanz Salmeron, Segura Perez, Serra Balcells, Sorina Dumitras, Teixidor Montoya, Tena Vicente, Tierno Salinas, Ester Ines, Toledo Testa, Tomàs Figueras, Tomas Ruperez, Torrano Garcia-Penche, Torres Esparza, Vazquez Blanco, Vazquez De la Paz, Vazquez Gil, Vazquez Gonzalez, Vidal Meler, Vilalta Cots, Vilches Jimenez, Visser Fernandez, Viu Gavin, Vives Vives, Carmona Jimenez, Francisco Jose, Galobardes Vilches, Gonzalez Gomez, Jodar Manzanera, Marimon Cortes, Marrodan Orive, Martin Bosch, Martorell Lopez, Millares Roca, M Jesus, Miralles Guri, Muliterno Hernandez, Muñoz Oliva, Pons Pujol, Postius Conde, Prieto Arruñada, Quintana Mathé, Rosell Mata, Alvarin Alvarez, Arrufat Flores, Bañuelos Pago, Campo Vilar, Cardus Hidalgo, Castello Gil, Maria Gloria, Castrillo Montsesinos, Clave Garces, Comes Sanroma, Descalzo Sequi, Errando Ricol, Escudero Campillo, Maria del Mar, Fernandez Alvarez, Fernandez Gomez, Franch Espinosa, Freixes Graells, Garcia Plaza, Garcia-Marron Gallego, Hernandez Simancas, Jaraba Armas, Jimenez Ramos, Lopez Oganissian, Madrona Romero, M Rosa, Martinez Millan, Martínez Morón, Merchan Encinas, Moreno Jimenez, Muñoz Rico, Navarro Rodriguez, Nogales Ibañez, Rita Maria, Novillo Viera, Parella Torrabadella, Mari Alba, Pera Villar, Carla Montserrat, Rabella Miralles, Ramis Trilles, Ribera Ortiz, Sastre Perez, Soro Borrega, Tapia Fores, Tellez Bernad, Trenado Alvarez, Felix Martin, Herrero Perez, Lanau Fuster, Lopez Gomariz, Pardo Lozano, Quintana Altimiras, Ventosa Lopez, Almodovar Damian, Alvarez Monterroso, Arambudo Comas, Boullon Garzon, Burgos Capella, Campuzano Garcia, Maria Del Mar, Capdevila Olivas, Carre Marti, Clara Isabel, Carretero Bacaicoa, Cazorla Calderon, Chacon Osuna, Cortes Planas, Cortit Olio, Delhomme Estany, Fructuos Martinez, Garcia Lopez, Pascual Luis, Genis Amill Vallve, Gonzalez Muñoz, Hernaez Ventura, Lavernia Gimenez, Martin Rojo, Martínez Medina, Mayol Barrera, Mercader Pi, Merino Dalmau, Miguel Campodarbe, Moreno Sanchez, Francisco Javier, Penela Barrameda, Prieto Ajenjo, Rodriguez Pareja, Rodríguez Piñar, Rodriguez Tello, Romero Pereda, Sainz Saborido, Santacana Martin, Santos Martinez, Sierra Chavez, Turbau Torres, Vicente Domenech, Villena Esteo, Vives Pertegaz, Baena Gonzalez, Bagaria Pont, Beltran Sanchez, Bonet Alarcon, Borch Ballescà, Buhils Clanchet, Closa Garcia, Colomina Carril, Cristina Fernandez Sanchez, Edurne Judith Fernandez Toledo, Espases Rodriguez, Espert Resa, F Xavier, Fernández Sol, Gonzalez Lugo, Gracia Llesera, Herrada Lendinez, Juliench Liesa, Sandra Alicia, Lopez Ortega, Lopez Yuste, Lozano Villanueva, Lucia Sola Soto, Madrid Castellano, Megias Cano, Daniel Jesus, Montasell Ponce, Montesinos Sospedra, Moya Martinez, Muñoz Herrera, Ocaña Fernandez, Palau Bernal, Perez Sole, Ramon Carbonell, Ribas Lop, Rubio López, Rueda Lopez, Sabat Castaño, Sabata Lara, Salmerón Ramírez, Serra Creus, Serrano Dalmau, Sumasi Mainero, Gonzalo Gabriel, Torello Masa, Valencia Primo, Ana Maria Viñuales Muñoz, Josep Roig, and Verònica Hidalgo
Subjects: Advanced and Specialized Nursing, Neurology (clinical), Cardiology and Cardiovascular Medicine
Abstract: Background: We aim to assess whether time of day modified the treatment effect in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion Trial), a cluster-randomized trial that did not demonstrate the benefit of direct transportation to a thrombectomy-capable center versus nearest local stroke center for patients with a suspected large vessel stroke triaged in nonurban Catalonia between March 2017 and June 2020. Methods: We performed a post hoc analysis of RACECAT to evaluate if the association between initial transport routing and functional outcome differed according to trial enrollment time: daytime (8:00 am –8:59 pm ) and nighttime (9:00 pm –7:59 am ). Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with ischemic stroke. Subgroup analyses according to stroke subtype were evaluated. Results: We included 949 patients with an ischemic stroke, of whom 258 patients(27%) were enrolled during nighttime. Among patients enrolled during nighttime, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days (adjusted common odds ratio [acOR], 1.620 [95% CI, 1.020–2.551]); no significant difference between trial groups was present during daytime (acOR, 0.890 [95% CI, 0.680–1.163]; P interaction =0.014). Influence of nighttime on the treatment effect was only evident in patients with large vessel occlusion(daytime, acOR 0.766 [95% CI, 0.548–1.072]; nighttime, acOR, 1.785 [95% CI, 1.024–3.112] ; P interaction P interaction >0.1 for all comparisons). We observed longer delays in alteplase administration, interhospital transfers, and mechanical thrombectomy initiation during nighttime in patients allocated to local stroke centers. Conclusions: Among patients evaluated during nighttime for a suspected acute severe stroke in non-urban areas of Catalonia, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days. This association was only evident in patients with confirmed large vessel occlusion on vascular imaging. Time delays in alteplase administration and interhospital transfers might mediate the observed differences in clinical outcome. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02795962.
Published: 2023
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23. Intracranial Artery Calcifications Profile as a Predictor of Recanalization Failure in Endovascular Stroke Treatment

Author: Marc Rodrigo-Gisbert, Manuel Requena, Marta Rubiera, Jane Khalife, Prudencio Lozano, Marta De Dios Lascuevas, Álvaro García-Tornel, Marta Olivé-Gadea, Carlos Piñana, Federica Rizzo, Sandra Boned, Marian Muchada, Noelia Rodríguez-Villatoro, David Rodríguez-Luna, Jesús Juega, Jorge Pagola, David Hernández, Carlos A. Molina, Alejandro Tomasello, and Marc Ribo
Subjects: Advanced and Specialized Nursing, Neurology (clinical), Cardiology and Cardiovascular Medicine
Abstract: Background: Acute ischemic stroke with large or medium-vessel occlusion associated with intracranial artery calcification (IAC) is an infrequent phenomenon presumably associated with intracranial atherosclerotic disease. We aimed to characterize IAC and its impact on endovascular treatment outcomes. Methods: We performed a retrospective cross-sectional study of consecutive patients with stroke treated with thrombectomy from January 2020 to July 2021 in our institution. We described IAC findings (length, density, and location pattern) on baseline noncontrast computed tomography. Patients were divided into 3 groups: IAC related to the occlusion location (symptomatic-IAC group), unrelated to the occlusion (asymptomatic-IAC group), and absence of any IAC (non-IAC group). We analyzed the association between the IAC profile and outcomes using logistic regression models. Intracranial angioplasty and stenting were considered rescue treatments. Results: Of the 393 patients included, 26 (6.6%) patients presented a symptomatic-IAC, 77 (19.6%) patients an asymptomatic-IAC, and in 290 (73.8%) patients no IAC was observed. The rate of failed recanalization (expanded Thrombolysis in Cerebral Infarction 0-2a) before rescue treatment was higher in symptomatic-IAC (65.4%) than in asymptomatic-IAC (15.6%; P P P P P P =0.004), and poor functional outcome (90-day modified Rankin Scale score ≥3; odds ratio, 3.51 [95% CI, 1.02–12.00]; P =0.046). Conclusions: The presence of IAC related to the occlusion location is associated with worse angiographic and functional outcomes. Therefore, identification of symptomatic-IAC on baseline imaging may guide optimal endovascular treatment strategy, predicting the need for intracranial stenting and angioplasty.
Published: 2023
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24. Workflows and Outcomes in Patients With Suspected Large Vessel Occlusion Stroke Triaged in Urban and Nonurban Areas

Author: Alvaro Garcia-Tornel, Monica Millan, Marta Rubiera, Alejandro Bustamante, Manuel Requena, Laura Dorado, Marta Olivé-Gadea, Xavier Jiménez, Angels Soto, Marisol Querol, Maria Hernández-Pérez, Meritxell Gomis, Pere Cardona, Xabier Urra, Francesc Purroy, Yolanda Silva, Xavier Ustrell, Patricia Esteve, Mercè Salvat-Plana, Miquel Gallofré, Carlos Molina, Antoni Dávalos, Tudor Jovin, Sonia Abilleira, Marc Ribo, Natalia Pérez de la Ossa, Marc Ribó Jacobi, Estela Sanjuan, Katherine Santana, Noelia Rodríguez, Jorge Pagola, David Rodriguez-Luna, Olga Maisterra, Estevo Santamarina, Marian Muchada, Jesús Juega, Sandra Boned, Antonio Palasi Franco, Álvaro García -Tornel, Matías Deck, Victoria Sala, Lucía Muñoz, Mónica Millán, Elena López-Cancio, María Hernández-Pérez, Jordi Ciurans, Daniela Samaniego, Tamara Canento, Lorena Martin, Anna Planas, Joaquin Broto, Agustín Sorrentino, Martí Paré, Nuole Zhu, Alicia Garrido, Laia Grau, Ane Miren Crespo, Silvia Presas, Miriam Almendrote, Alba Ramos, Giuseppe Lucente, Lourdes Ispierto, Manuel Lozano, Juan Luis Becerra, Marta Jiménez, Dolores Vilas Rolán, Nicolas Guanyabens, Josep Sanchez-Ojanguren, Alicia Martínez-Piñeiro, Sara Forcén, Mireia Gea, Marta Álvarez, Anna Ramos, Manuel Domínguez Lizarbe, Sara, Rubio Guerra, Irene Bragado, Andrea Arbex, Luis Rodríguez, Pere Cardona Portela, Helena Quesada García, Blanca Lara Rodríguez, Nuria Cayuela, Julia Miró, Clara Marzal, Andrés Paipa, Sergio Campoy, Ana Núñez, Pablo Arroyo, Sarah Besora, Vanessa Adell, Jaume Campdelacreu, Montse Alemany Martí, Belén González, Laura Bau Vila, Marta Fiter Crespo, Anna Berbel, Ma. Cristina Villaescusa Urbaneja, Núria Guillen, Nuria Vidal, Patricia Valentina Vérez Santamaria, Diego Herrero Navarro, Marta Simó, Mercedes Falip, Elisabeth Matas, Neus Mongay Ochoa, Ariadna Gifreu, Albert Muñoz, Lucía Romero, Eduard Portell, Guillermo Hernández Perez, F. Ruiz Esteve, Silvia Teixidor, Augusto Salazar Talavera, Roser Gómez, Xabier Urra Nuin, Martha Vargas, Ángel Chamorro, Sergio Amaro, Laura Llull, Arturo Renú, Salvatore Rudilosso, Raquel Sánchez del Valle, Helena Ariño, Nuria Solà, Delón la Puma, Francisco Gil, Juan Bernardo Gómez, Nuria Matos, Neus Falgàs, Sergi Borrego, Almudena Sánchez, Mircea Balasa, Carmen Montejo, Mar Guasp, David Reyes, Pablo Sánchez Cervilla, Jose Miguel Contador, Victor Augusto Vera Monge, Oscar Ramos, Alejandro Rodríguez, Ana Rodríguez Campello, Gemma Romeral Ballester, Mireia Llop Trujillano, Eva Giralt Steinhauer, Elisa Cuadrado Godia, Angel Javier Ois Santiago, Jordi Jimenez Conde, Joan Martí Fábregas, Daniel Guisado, Luís Prats, Pol Camps, Raquel Delgado, Alejandro Martínez Domeño, Rebeca Marín, David Cànovas, Jordi Estela, Marta Ros, Sonsoles Aranceta, Jordi Espinosa, Marta Rubio, Cristina Lafuente, Oriol Barrachina, Alicia Anguita, Anna Reverter, Carmen García, Gemma Sansa, Mariona Hervas, Monica Crosas, Tania Delgado, Jerzy Krupinski, Sonia Huertas Folch, Gemma Muñoz Gamito, Josep Trenado Alvarez, Teresa Subirana, Jessica Molina, Laura Comes Romero, Gemma Guardia Valls, Miriam Jover, Javier Joaquín Sotova, Sonia Mª García Sánchez, Sebastian Valenzuela (intensivista), Manuel Gómez-Choco, Juan José Mengual, M. Àngels Font, Mª Isabel Gómez Ruiz, Irati Zubizarreta, Susana Fernández González, Laura Gubieras, Carmen E. Cobos, Luis Mena Romo, Nuria Caballol, Luis Cano, Joaquín Serena Leal, Mikel Terceño Izarra, Irene Bragado Trigo, Saima Bashir Viturro, Laura Pardo Albiñana, Montserrat Reina Garrido, Carla Marco Cazcarra, Karol Enrique Uscamaita, Fabian Márquez, Cristina Coll, Mar Irida Lloret Villlas, Berta Solano Vila, Berta Alemany Perna, Daniel López Domínguezl, Mercedes de Lera, Anna Cots Foraster, Urszula Bojaryn, Ikram Benabdelhak, Gerard Mauri Capdevila, Jordi Sanahuja Montesinos, Daniel Vázquez, José Vicente Hervás, Cristina González, Alejandro Quílez, Mikel Vicente Pascual, María Ruiz, Yolanda Riba, M. Pilar Gil Villar, Cristina García, Xavier Ustrell Roig, Mònica Baldrich Mora, Anna Pellisé Guinjoan, Judit Borras, Alba Mañé Martínez, Rafael Marés, Jaume Viñas i Gaya, Laia Seró, Alan Flores, Paula Rodríguez, Gislaine Castilho, Angela Monterde Ortega, Silvia Reverté, Josep Zaragoza, Joan Josep Baiges, Gisela Martín Ozaeta, Sonia Escalante, Iago Payo, Júlia Saura Salvado, Natalia Mas Sala, Josep M Soler Insa, Ester Tio Vilamala, Josep Abos Navarro, Héctor Cruz Tabuenca, Tamara Canento Sánchez, Elisabet Roldán, Elsa Puiggrós Rubiol, Elisabet Franquet, Lidia Fuentes, Javier Donaire, Elena Martí, Laura Giménez, Junior Gil Vázquez, Eloisa Nieto Clara Gris Ambrós, Puri Rodríguez, José Félix Oletta, Pilar Pons Mellado, Catena, Bárbara Gómez, Vergilin Raileau, Esther Catena Ruíz, Oscar Pardina, Jordi Mercadal, María López-Diéguez, Pilar Pérez, Lourdes Gabarró, María Orriols, Joan Josep Canet, Mireia Roca, Muriel Álvaro, Francesc Boneu, Georgina Giménez, Jaume Albà, Francesc Gibert, Jéssica Garcia, Patricia Barragan, Gustavo Jurado, Josep Sabaté Ortega, Joan Amaurys Martínez Solano, Víctor Fernández, Mónica Torres, Ana Belén Montero Alvaredo, Laura Redondo Parejo, Josep Maria Aragonés, Anna Bullón, Cora Loste, Paula González, Neker Bejarano, Francisco Sanchez, Gianni Lucchetti, Xavier Pla, Javier Gimeno, Esteban Reynaga, Montse Barcons, Gabriel Celedón, Juan Ortiz, Goran Anastasovski, Oscar Mascaró, Javier Diez de los Ríos, Meritxell Feliu, Anna Ribera, Cristhian Ruiz, Gerard Corominas, Daniella Nunes, Claudia Roca, Nadina Latorre, Lizbeth Yataco, Maricelys Cruz, Nerea Blanco, Santiago Castejón, Dolores Cocho Calderón, Claustre Pont Sunyer, Jordi Espinosa Garcia, Rodrigo Paz Martin, Albert de Luis Sanchez, Dolores Espinosa Vivas, Juan Valencia Molina, Gemma, Planels Palome, Laia Tomas Chaume, Ares Villagrasa Vilella, Marco Bustamante, Anunciación Boltes, Fernando Rodríguez, Itziar Arrieta, Jordi Ciurans Molist, Barnés Andreu, Ernest Palomeras Soler, Nicolau Guanyabens Buscà, Manuel Daza López, Jordi Bigas Farreres, Virginia Casado Ruiz, Desiree Muriana Batiste, Mª Pilar Sanz Cartagena, Eulalia Cabot de Vega, Josep Bassa Real, Hector Pelaez Roman, César Socolich, Josep Mª Alonso Camp, Antonio Tomás Cano Orgaz, Mª Pilar Fossas Felip, Nicolás Morón, Sandra Bacca, Mauricio Molina, Francesc Casarramona, Lorena Elias, Muhammad Zidane Bukaei, Jose Antonio Martos Gutierrez, Judith Lopez Escuin, Cristina Olaizola, Yolexis López Vargas, Juan Jiménez Oyonarte, Rashida Soultana, Eduardo Sanjurjo Golpe, Esther Salvador, Guillem Vila, Marcos Serrano, Matilde Nuria López Claverol, Marian Lamolla, Miquel Amate, Adriana Rodriguez, Ruth Romero, Montgomery del Carpio, Ana Isabel Hernandez, Julián Martín, M Carmen Rosas, Antonio Nogueroles, Sorilandy Encarnación, Augusto Robles, Jose Antonio Herrera, Roger Gavilán, Toghrol Mameghani, Gastón Araujo, M.Angeles Garrido Morales, Enric Ramon Albert Segui, Eva Fernandez Climent, Francesc Paris Pujol, Mireia Judit Garrofé Seira, Lucía Gómez Pía, Fernando Salleres Nuñez, Cristina Aguar Peñalver, Cristina Vaz Lopes, Elisenda Ribera Tasa, Carmen Repullo Vilchez, Modesto Sánchez Zambrana, Beatriu Suescun Ribas, Inés Vilà Panés, Montserrat Vila Planavila, Alicia Vaqueiro Lorenzo, Meritxell Sabartés Guixes, Jorge Medina, David Sambrano, Javi Zamarreño, Carmen Pirela, Paola Vélez, Luis Cajamarca, Honey Pérez, Yarles Martínez, Jesus Alexander Gonçalves, Carles Regordosa, Claudia Mormeneo, Laura Griu, Maria Francia Colina, Enric Farik, Dolors Carrión Duch, Carles Badenas, Oscar Bernal, Núria Agramunt, Shyrlei Morales, Victoria Reynoso, Miguel Guerrero, Primitivo Romera Cid, Mònica Folqué, Claudia Pedroza, Adnan Hachem, Íñigo Soteras Martínez, Xavier Verdera García, Mercè López Amorós, Xavier Costa Subirós, Marta Cufí Benet, Cecile Van Eendenburg, Teresa Osuna, Dra Gina Santos, Mireia Pallisera, Lluís Gonzalo Oliva, Gemma Sanchez, Xavier Basurto, Ludgi Vivoda, Richard Van der Kleyn, Laura Robles, Ana Cabanelas Barranco, Mª Cruz Almendros, Marc Pérez Oliveras, Amelia Fernández Álvarez, Maria Rybyeva, Antoni Viñas, Maria Barcons, Joaquim Danès Alberto Tavera, Pablo Burbano, Cintie López, David Cruz, Paula Bisbe, Nora Fernández, Juan Carlos Palacio, Eduardo Fraiz, Oriol Aguiló, Rollmy Amorodjo, John Velázquez, Elena Sánchez, Jaume Español, Judit Perez de Celis, Anna Coll, Glòria Díaz, Margarida Vergés i Sala, Mª Ángels Casas Capdevila, Yosmairy Yoselin Ferrini, Aitor Gorriz, Diego-Javier Cucurell Navarro, Dulce Velásquez, Jaume Pla Soler, Josep González, Julian David Higuera, Lina Cuellar, Liza Margarita Miniello, Lluis Pujol, Sorin Cracan, Mora Vives, M Angela, Lopez Lopez, null Anabel, Montse Gorchs Molist, Delofeu Anna, Silvia Solà Muñoz, Ferreres Yolanda, Carol Pujalte, Elisabeth Téllez Marín, Yolanda Font Casas, Sara Hernández Luque, Joaquim Mejias Sendra, Francesca Mellado Valero, Campos Escala, Galup De Lacanal, Lopez Diaz, Castillo Paramio, Català Estopà, Español Moreda, Calafell Majo, Carballo Almeida, Castro Naval, M Elena, Cregut Ruiz, Pere Lluis, Deulofeu Font, Fabregat Sanjuan, Joan Pere, Fontquerni Gorchs, Forés Bellés, Joan Antoni, Gomez Herrera, Juan Carlos, Hijazo Prades, Itzaina Torvisco, Marti Rovira, Obiols Gonzalez, Olive Cavero, Querol Gil, M Soledad, Rico Rodriguez, Rios Sambernardo, Ropero Molina, Jose Ramon, Sanchez Valero, Santos Arevalo, Maria Jose, Soto Garcia, Maria Angeles, Tebar Escribano, Torres Garcia, Pedro José, Verdes Carrion, M Isabel, Verge Lopez, Juan Jose, Lopez Canela, M Angeles, Lucas Guarque, Morales Alvarez, Jorge Arnulfo, Morell Fornieles, Subirats Gomez, Maria Teresa, Torello Masa, Val Lopez, Maria Mercedes, Palmero Reyes, Juan Manuel, Rodriguez Forne, Ruana Turiel, Sanchez Gonzalez, Sebastia Gornals, Abrio Rico, Albert Gual Falip, Aznar Oliveros, Brugues Perotti, Calvet Molinero, Catells Franco, Corrales Medina, Daroca Miro, Duran Marquez, Feliu Pradas, Figueras Casanova, Garcia Tortajada, Grajera Gallego, Azahara del Mar, Las Arroyo, Dulcenombre de Jesus, Laserreta Sanz, Llambrich Vidal, Monllao Corral, Morales de la Cruz, Moreno Blanco, Orejuela Orgaz, Piñana Suazo, Pons Minguillon, Rodríguez Gómez, José Carlos, Rodriguez Pereira, Sedo Porcel, Sevil Villar, Sierra Lopez, Torres Romero, Trepat Calveres, Ventura Arnella, Acera Gil, M Teresa, Biesot Vico, Castro Galea, Rosa Maria, Escorcia Chafer, Juan Antonio, Gil Faure, Hernandez Luque, Jimenez Delgado, Mallafre Gay, M. Angel, Olivares Sanzo, Pubill Fondevila, Sabate Fort, Segovia Agámez, Antonio Carlos, Turata Longaretti, Valle Hernandez, Trayner Guixens, Aguilar Valor, Aguirre Alvarez, Alastrue Naval, Alferez Baquero, Alonso Marne, Cristina, Aloy Orozco, Alvarez Colino, Alvarez Peñuela, Ameller Cirilo, Maria Vanessa, Andujar Guerrero, Estefania Remedios, Auladell Sillero, Azcarate Sorbet, Basany Genesca, Benavent Barduena, Benito Tudela, Blanch Pardo, Boluda Pla, Bonilla Gonzalez, Bru Serramalera, Burnat Andreu, Caballero Calvo-Rayo, Calvo Casellas, Camps Mombiela, Cano Bresme, Carcelen Fernandez, Caro Solà, Casasas Matavacas, Castanedo Bolado, Cerdeña Cortina, Abella Jane, Laia Collado Borrego, Colom Orri, Comellas Vilanova, Conillera Sole, Cots Torres, Cuchi Estepa, de Sostoa Graell, del Rio Lopez, Delgado Compte, Diaz Bueno, Diaz Maneiro, Andrea Lucia, Domenech Palau, M. Carme, Duran Carasso, Pablo Javier, El Abidi, Escoda Martin, Esteve Casanovas, Fernandez Perez, Ferre Quintero, Flores Escobar, Fontcuberta Abad, Fortes del Valle, Mª Luisa, Franco Quesada, Sara Maria, Franco Romero, Gallego Francisco, Gamiz Gala, Alicia, Garcia Castañeda, Garcia Rodriguez, Casajuana Gemma, Gomez Arroyo, Gomez Girbau, Gonzalez Fernandez, Gonzalez Gonzalez, Gonzalez Lopez, Gual Obeso, Guerrero Blanco, Guillemas Roca, Guillermo Eudaldo, Hernandez Sebastia, Homar Covas, Hostench Alvarez, Huerta Royo, Ibañez Barcelo, Izquiero Cruz, Jaione Urdangarin Etxetxikia, Juárez Gimenez, Khlifi Alami, Laparra Gasco, Lara Moreales, Lasaosa Medina, Maria Lourdes, Lazaro Cava, Leon Berrar, López Maturana, Lopez Ramirez, López Romero, Lorente Marco, Lorenzo Martin, Lozano Casals, Lujan Nicola, Madrid Diaz, Jose Antonio, Maria Teresa Peris Morales, Marti Clemente, Martinez Castaño, David Natanael, Martinez Gamez, Martinez Gonzalez, Martinez Quesada, Maria de la Cabeza, Marzà Fusté, Mireia, M Conillera, Melendo Lasheras, Miralles Mestre, Montserrat Puig Pastalle, Montserrate Vidal, Mora Mellado, Morales Ponce, Morera Cabre, Morera Vivet, Mundi Souza, Muñoz Quiles, Navea Rosa, Neira Iglesias, M Asuncion, Nuñez Manrique, Mª Pilar, Obiols Martinez, Pallares Reig, Partegas Torres, Pascual Berengueras, Perez Gamez, Perez Oset, Perez Restrepo, Maria Alejandra, Planas Yeste, Planells Mangado, Puertas Carbonell, Quinteiro Blanco, Rebollar Benavente, Recasens Fernandez, Reyes Gomez, Maria del Carmen, Roca Pou, Rodriguez Ferrer, Rodriguez Franco, Rodriguez Fuertes, Rodriguez Muñoz, Rodriguez Navarro, Roig Iniesta, Romero Gracia, Rovira Brunet, Rovira de Eugenio, Rubio Baena, Ruiz Llorens, Sala Llamazares, San Juan Alaez, Sanchez Segura, Santasusana Soldevilla, Sanz Salmeron, Segura Perez, Serra Balcells, Sorina Dumitras, Teixidor Montoya, Tena Vicente, Tierno Salinas, Ester Ines, Toledo Testa, Tomàs Figueras, Tomas Ruperez, Torrano Garcia-Penche, Torres Esparza, Florenc Uku, Vazquez Blanco, Vazquez De la Paz, Vazquez Gil, Vazquez Gonzalez, Vidal Meler, Vilalta Cots, Vilches Jimenez, Visser Fernandez, Viu Gavin, Vives Vives, Carmona Jimenez, Francisco Jose, Galobardes Vilches, Gonzalez Gomez, Jodar Manzanera, Marimon Cortes, Marrodan Orive, Martin Bosch, Martorell Lopez, Millares Roca, M Jesus, Miralles Guri, Muliterno Hernandez, Muñoz Oliva, Pons Pujol, Postius Conde, Prieto Arruñada, Quintana Mathé, Rosell Mata, Alvarin Alvarez, Arrufat Flores, Bañuelos Pago, Campo Vilar, Cardus Hidalgo, Castello Gil, Maria Gloria, Castrillo Montsesinos, Clave Garces, Comes Sanroma, Descalzo Sequi, Errando Ricol, Escudero Campillo, Maria del Mar, Fernandez Alvarez, Fernandez Gomez, Franch Espinosa, Freixes Graells, Garcia Plaza, Garcia-Marron Gallego, Hernandez Simancas, Jaraba Armas, Jimenez Ramos, Lopez Oganissian, Madrona Romero, M Rosa, Martinez Millan, Martínez Morón, Merchan Encinas, Moreno Jimenez, Muñoz Rico, Navarro Rodriguez, Nogales Ibañez, Rita Maria, Novillo Viera, Parella Torrabadella, Mari Alba, Pera Villar, Carla Montserrat, Rabella Miralles, Ramis Trilles, Ribera Ortiz, Sastre Perez, Soro Borrega, Tapia Fores, Tellez Bernad, Trenado Alvarez, Felix Martin, Herrero Perez, Lanau Fuster, Lopez Gomariz, Pardo Lozano, Quintana Altimiras, Ventosa Lopez, Almodovar Damian, Alvarez Monterroso, Arambudo Comas, Boullon Garzon, Burgos Capella, Campuzano Garcia, Maria Del Mar, Capdevila Olivas, Carre Marti, Clara Isabel, Carretero Bacaicoa, Cazorla Calderon, Chacon Osuna, Cortes Planas, Cortit Olio, Delhomme Estany, Fructuos Martinez, Garcia Lopez, Pascual Luis, Genis Amill Vallve, Gonzalez Muñoz, Hernaez Ventura, Lavernia Gimenez, Martin Rojo, Martínez Medina, Mayol Barrera, Mercader Pi, Merino Dalmau, Miguel Campodarbe, Moreno Sanchez, Francisco Javier, Alba Mari, Penela Barrameda, Prieto Ajenjo, Rodriguez Pareja, Rodríguez Piñar, Javier Francisco, Rodriguez Tello, Romero Pereda, Sainz Saborido, Santacana Martin, Santos Martinez, Sierra Chavez, Turbau Torres, Vicente Domenech, Villena Esteo, Vives Pertegaz, Baena Gonzalez, Bagaria Pont, Beltran Sanchez, Bonet Alarcon, Borch Ballescà, Buhils Clanchet, Closa Garcia, Colomina Carril, Cristina Fernandez Sanchez, Fernandez Toledo Edurne Judith, Espases Rodriguez, Espert Resa, F Xavier, Fernández Sol, Gonzalez Lugo, Gracia Llesera, Herrada Lendinez, Juliench Liesa, Sandra Alicia, Lopez Ortega, Lopez Yuste, Lozano Villanueva, Lucia Sola Soto, Madrid Castellano, Megias Cano, Daniel Jesus, Montasell Ponce, Montesinos Sospedra, Moya Martinez, Muñoz Herrera, Ocaña Fernandez, Palau Bernal, Perez Sole, Ramon Carbonell, Ribas Lop, Rubio López, Rueda Lopez, Sabat Castaño, Sabata Lara, Salmerón Ramírez, Serra Creus, Serrano Dalmau, Sumasi Mainero, Gonzalo Gabriel, Valencia Primo, Ana Maria Viñuales Muñoz, Josep Roig, and Verònica Hidalgo.
Subjects: Stroke, Advanced and Specialized Nursing, Treatment Outcome, Endovascular Procedures, Humans, Neurology (clinical), Cardiology and Cardiovascular Medicine, Brain Ischemia, Ischemic Stroke, Thrombectomy, Workflow
Abstract: Background: We aim to compare the outcome of patients from urban areas, where the referral center is able to perform thrombectomy, with patients from nonurban areas enrolled in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion). Methods: Patients with suspected large vessel occlusion stroke, as evaluated by a Rapid Arterial Occlusion Evaluation score of ≥5, from urban catchment areas of thrombectomy-capable centers during RACECAT trial enrollment period were included in the Stroke Code Registry of Catalonia. Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with an ischemic stroke. Secondary outcomes included mortality at 90 days, rate of thrombolysis and thrombectomy, time from onset to thrombolysis, and thrombectomy initiation. Propensity score matching was used to assemble a cohort of patients with similar characteristics. Results: The analysis included 1369 patients from nonurban areas and 2502 patients from urban areas. We matched 920 patients with an ischemic stroke from urban areas and nonurban areas based on their propensity scores. Patients with ischemic stroke from nonurban areas had higher degrees of disability at 90 days (median [interquartle range] modified Rankin Scale score, 3 [2–5] versus 3 [1–5], common odds ratio, 1.25 [95% CI, 1.06–1.48]); the observed average effect was only significant in patients with large vessel stroke (common odds ratio, 1.36 [95% CI, 1.08–1.65]). Mortality rate was similar between groups(odds ratio, 1.02 [95% CI, 0.81–1.28]). Patients from nonurban areas had higher odds of receiving thrombolysis (odds ratio, 1.36 [95% CI, 1.16–1.67]), lower odds of receiving thrombectomy(odds ratio, 0.61 [95% CI, 0.51–0.75]), and longer time from stroke onset to thrombolysis (mean difference 38 minutes [95% CI, 25–52]) and thrombectomy(mean difference 66 minutes [95% CI, 37–95]). Conclusions: In Catalonia, Spain, patients with large vessel occlusion stroke triaged in nonurban areas had worse neurological outcomes than patients from urban areas, where the referral center was able to perform thrombectomy. Interventions aimed at improving organizational practices and the development of thrombectomy capabilities in centers located in remote areas should be pursued. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02795962.
Published: 2022
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25. Intensive 90-day textile wearable Holter monitoring: an alternative to detect paroxysmal atrial fibrillation in selected patients with cryptogenic stroke

Author: Jorge Pagola, Jesus Juega, Jaume Francisco-Pascual, Maite Rodriguez, Laura Dorado, Raquel Martinez, Mercedes De Lera-Alfonso, Juan F. Arenillas, Juan Antonio Cabezas, Francisco Moniche, Reyes de Torres, Joan Montaner, Marian Muchada, Sandra Boned, Manuel Requena, Alvaro García-Tornel, Noelia Rodríguez-Villatoro, David Rodríguez-Luna, Matías Deck, Marta Olivé, Marta Rubiera, Marc Ribó, Jose Alvarez-Sabin, and Carlos A. Molina
Subjects: Ischemic stroke, Atrial volume, Holter, Cryptogenic stroke, Cardiology and Cardiovascular Medicine, Atrial fibrillation
Abstract: We aimed to demonstrate the feasibility of 90-day cardiac monitoring with an external Holter device and to find a target population able to benefit from such a technique. Cryptogenic stroke patients were continuously monitored for 90 days with a textile wearable Holter (TWH). Compliance and quality of the monitoring were assessed by the number of hours of ECG stored per month. Mean predictors of pAF, including age, gender, stroke severity, and atrial size (LAVI), were evaluated. One-year follow-up assessed pAF detection outside per protocol monitoring. Out of 224 patients included in 5 stroke centers, 163 patients (72.76%) fulfilled the criteria for the protocol. Median monitoring time was similar among the three months. Per protocol pAF detection reached 35.37% at 90 days. The age (OR 1.095; 95% CI 1.03-1.14) and the LAVI (OR 1.055; 95% CI 1.01-1.09) independently predicted pAF. The cut-off point of 70 years (AUC 0.68) (95% CI 0.60-0.76) predicted pAF with a sensitivity of 75.8% and specificity of 50.5%. The LAVI cut-off point of 28.5 (AUC 0.67) (95% CI 0.56-0.77) had a sensitivity of 63.6% and a specificity of 61.8% to detect pAF. The combination of both markers enhanced the validity of pAF detection sensitivity to 89.6%, with a specificity of 27.59%. These patients had increased risk of pAF during the 90-day monitoring HR 3.23 (chi(2) 7.15) and beyond 90 days (chi(2) 5.37). Intensive 90-days TWH monitoring detected a high percentage of pAF. However, a significant number of patients did not complete the monitoring. Patients older than 70 years and with enlarged left atria benefitted more from the protocol.
Published: 2022
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26. Evaluation of self‐stigma in patients with epilepsy: Validation of the self‐stigma scale to Spanish (ESSS‐S)

Author: Isabel Manzanares, Izumi Kuramochi, Marta Olivera, María Centeno, Mariam Khawaja, Luis Pintor, Antonio Donaire, María delMar Carreño, and Estefanía Conde‐Blanco
Subjects: anxiety, depression, epilepsy, quality of life, stigma, Neurology. Diseases of the nervous system, RC346-429
Abstract: Abstract Objective The Epilepsy Self‐Stigma Scale (ESSS) has been developed in Japan for patients with epilepsy (PWE). We aimed to validate the scale in Spanish and examine its validity and reliability. Methods The transcultural adaptation of the ESSS was conducted using translation and back‐translation, along with pilot testing and an expert panel review. An online questionnaire was used to assess construct validity, criterion validity, and internal consistency. Results A total of 260 out of 628 participants completed the questionnaires. We found a two‐factor structure that explained 61.3% of the total variance: factor 1 “self‐perceived discrimination” with a Cronbach's alpha of 0.80, and factor 2 “social isolation” with a Cronbach's alpha of 0.75. The reliability of overall ESSS‐S 8‐item scores was high (Cronbach's alpha = 0.74). Convergent validity was tested and demonstrated a significant correlation. P. Self‐perceived discrimination scores were associated with higher anxiety and depression scores (r = 0.53/0.54; p
Published: 2024
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27. Functional and Safety Outcomes of Carotid Artery Stenting and Mechanical Thrombectomy for Large Vessel Occlusion Ischemic Stroke With Tandem Lesions

Author: Farooqui, Mudassir, primary, Zaidat, Osama O., additional, Hassan, Ameer E., additional, Quispe-Orozco, Darko, additional, Petersen, Nils, additional, Divani, Afshin A., additional, Ribo, Marc, additional, Abraham, Michael, additional, Fifi, Johanna, additional, Guerrero, Waldo R., additional, Malik, Amer M., additional, Siegler, James E., additional, Nguyen, Thanh N., additional, Sheth, Sunil, additional, Yoo, Albert J., additional, Linares, Guillermo, additional, Janjua, Nazli, additional, Galecio-Castillo, Milagros, additional, Tekle, Wondewossen G., additional, Ringheanu, Victor M., additional, Oliver, Marion, additional, Dawod, Giana, additional, Kobsa, Jessica, additional, Prasad, Ayush, additional, Ikram, Asad, additional, Lin, Eugene, additional, Below, Kristine, additional, Zevallos, Cynthia B., additional, Gadea, Marta Olivé, additional, Qureshi, Abid, additional, Dajles, Andres, additional, Matsoukas, Stavros, additional, Rana, Ameena, additional, Abdalkader, Mohamad, additional, Salazar-Marioni, Sergio, additional, Soomro, Jazba, additional, Gordon, Weston, additional, Vivanco-Suarez, Juan, additional, Turabova, Charoskhon, additional, Mokin, Maxim, additional, Yavagal, Dileep R., additional, Jumaa, Mouhammad A., additional, and Ortega-Gutierrez, Santiago, additional
Published: 2023
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28. Predictors of Functional Outcome After Thrombectomy in Patients With Prestroke Disability in Clinical Practice

Author: Mònica Millán, Anna Ramos-Pachón, Laura Dorado, Alejandro Bustamante, María Hernández-Pérez, Luís Rodríguez-Esparragoza, Meritxell Gomis, Sebastia Remollo, Carlos Castaño, Mariano Werner, Denisse Wenger, Sara Rubio, Manuel Domínguez-Lizarbe, Mikel Terceño, Andrés Julián Paipa, Alejandro Rodríguez-Vázquez, Sandra Boned, Pol Camps-Renom, David Cánovas, Eva Giralt, Elena López-Cancio, Antoni Dávalos, Josep Ros-Roig, Natalia Pérez de la Ossa, Pere Cardona, Helena Quesada, Blanca Lara, Ana Nuñez Guillen, Roger Barranco, Lucia Aja, Paloma Mora, Oscar Chirife, Sonia Aixut, Maria Angeles de Miquel, Toni Martínez-Yelamos, Carlos Molina, Marta Rubiera, Jorge Pagola, David Rodríguez-Luna, Marian Muchada, Alejandro Tomasello, Marc Ribó, Carlos Piñana, Manuel Requena, Matías Deck, Alvaro Garcia-Tornel, Marta Olivé, Noelia Rodriguez, Jesus Jueg, Ángel Chamorro, Sergio Amaro, Xabier Urra, Laura Llull, Arturo Renú, Salvatore Rudiloso, Juan M. Macho, Jordi Blasco, Luis San Roman Manzanera, Antonio López, Federico Zarco, Ramón Torné, Ricard Valero, Víctor Obach, Víctor Vera, Martha Vargas, Carlos Laredo, Joan Martí-Fàbregas, Raquel Delgado-Mederos, Alejandro Martínez-Domeño, Luis Prats-Sánchez, Daniel Guisado-Alonso, Marina Guasch-Jiménez, Rebeca Marín Bueno, Jordi Branera-Pujol, José Pablo Martínez, Lavinia Dinia, Anna Pellisé, Xavier Ustrell, Alan Flores, Laia Seró, Joaquín Serena, Yolanda Silva, Saima Bashir, Alan Murillo, Jerzy Krupinski, Sonia Huertas, Jessica Molina, Georgina Figueras, Sarah Besora, Ana Rodríguez-Campello, Jaume Roquer, Ángel Ois, Elisa cuadrado-Godia, Jordi Jiménez-Conde, Elio Vivas, Polo Guimaraens, Maria del Carmen Garcia, Jordi Estela, Joan Perendreu, Nicolas Romero, Roberto Eduardo Correa, Oriol Barrachina, Moisès Broggi, Manuel Gómez-Choco, Sonia M. García, Maria Àngels Font Padrós, Juan José Mengual Chirife, Luis Mena Romo, Ernest Palomeras, Virginia Casado, Nicolau Guanyabens, Marta Álvarez, Esther Catena, José Luis Camacho Velasquez, Francisco Purroy, Gerard Mauri, Cristina Garcia, Jessica García Alhama, Irene Bragado Trigo, Jordi Monedero, Mònica Perecaula, Luis Guillermo Casanovas, Carla Colom, Dolores Cocho, Adela Rios González, Juanjo Baiges, Josep Zaragoza, Gisela Martin, Sonia Escalante, Patricia Esteve, Iago Payo, Lidia Binela, Josep Maria Aragonés, Núria Matos, Josep Maria Soler-Insa, Natalia Mas, Glòria Diaz, Margarida Vergés, Xavier Costa, Liseth Molina, M. Cruz Almendros, Marc Pérez, Ana Cabanelas, Olga Belchi, Maria Rybyeba, Miquel Barceló, Dolors Carrión, Carmen Repullo, Eduard Sanjurjo, Mercè Salvat-Plana, Josep Roig, Verònica Hidalgo, Olga Fagúndez, Victòria Sala, Anabel Alonso, Marisol Querol, Montse Gorchs, Xavier Jiménez, and Maria Àngels Mora
Subjects: Male, medicine.medical_specialty, Treatment outcome, Outcome (game theory), Humans, Medicine, Disabled Persons, In patient, Prospective Studies, Registries, Stroke, Aged, Ischemic Stroke, Thrombectomy, Aged, 80 and over, Advanced and Specialized Nursing, business.industry, Middle Aged, medicine.disease, Mechanical thrombectomy, Clinical Practice, Spain, Ischemic stroke, Physical therapy, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Abstract: Background and Purpose: Mechanical thrombectomy (MT) in ischemic stroke patients with poor prestroke conditions remains controversial. We aimed to analyze the frequency of previously disabled patients treated with MT in clinical practice, the safety and clinical response to MT of patients with preexisting disability, and the disabled patient characteristics associated with a better response to MT. Methods: We studied all consecutive patients with anterior circulation occlusion treated with MT from January 2017 to December 2019 included in the Codi Ictus Catalunya registry—a government-mandated, prospective, hospital-based data set. Prestroke disability was defined as modified Rankin Scale score 2 or 3. Functional outcome at 90 days was centrally assessed by a blinded evaluator of the Catalan Stroke Program. Favorable outcome (to return at least to prestroke modified Rankin Scale at 90 days) and safety and secondary outcomes were compared with patients without previous disability. Logistic regression analysis was used to assess the association between prestroke disability and outcomes and to identify a disabled patient profile with favorable outcome after MT. Results: Of 2487 patients included in the study, 409 (17.1%) had prestroke disability (313 modified Rankin Scale score 2 and 96 modified Rankin Scale score 3). After adjustment for covariates, prestroke disability was not associated with a lower chance of achieving favorable outcome at 90 days (24% versus 30%; odds ratio, 0.79 [0.57–1.08]), whereas it was independently associated with a higher risk of symptomatic intracranial hemorrhage (5% versus 3%; odds ratio, 2.04 [1.11–3.72]) and long-term mortality (31% versus 18%; odds ratio, 1.74 [1.27–2.39]) compared with patients without disability. Prestroke disabled patients without diabetes, Alberta Stroke Program Early CT Score >8 and National Institutes of Health Stroke Scale score Conclusions: Despite a higher mortality and risk of symptomatic intracranial hemorrhage, prestroke-disabled patients return as often as independent patients to their prestroke level of function, especially those nondiabetic patients with favorable early ischemic signs profile. These data support a potential benefit of MT in patients with previous mild or moderate disability after large anterior vessel occlusion stroke.
Published: 2022
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29. Derivation and validation of three intracerebral hemorrhage expansion scores using different CT modalities

Author: David Rodriguez-Luna, Olalla Pancorbo, Pilar Coscojuela, Prudencio Lozano, Federica Rizzo, Marta Olivé-Gadea, Manuel Requena, Álvaro García-Tornel, Noelia Rodríguez-Villatoro, Jesús M. Juega, Sandra Boned, Marián Muchada, Jorge Pagola, Marta Rubiera, Marc Ribo, Alejandro Tomasello, and Carlos A. Molina
Subjects: Radiology, Nuclear Medicine and imaging, General Medicine
Published: 2023
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30. Functional and Safety Outcomes of Carotid Artery Stenting and Mechanical Thrombectomy for Large Vessel Occlusion Ischemic Stroke With Tandem Lesions

Author: Mudassir Farooqui, Osama O. Zaidat, Ameer E. Hassan, Darko Quispe-Orozco, Nils Petersen, Afshin A. Divani, Marc Ribo, Michael Abraham, Johanna Fifi, Waldo R. Guerrero, Amer M. Malik, James E. Siegler, Thanh N. Nguyen, Sunil Sheth, Albert J. Yoo, Guillermo Linares, Nazli Janjua, Milagros Galecio-Castillo, Wondewossen G. Tekle, Victor M. Ringheanu, Marion Oliver, Giana Dawod, Jessica Kobsa, Ayush Prasad, Asad Ikram, Eugene Lin, Kristine Below, Cynthia B. Zevallos, Marta Olivé Gadea, Abid Qureshi, Andres Dajles, Stavros Matsoukas, Ameena Rana, Mohamad Abdalkader, Sergio Salazar-Marioni, Jazba Soomro, Weston Gordon, Juan Vivanco-Suarez, Charoskhon Turabova, Maxim Mokin, Dileep R. Yavagal, Mouhammad A. Jumaa, Santiago Ortega-Gutierrez, Institut Català de la Salut, [Farooqui M, Quispe-Orozco D] Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City. [Zaidat OO] Department of Neurology, Saint Vincent Mercy Hospital, Toledo, Ohio. [Hassan AE] Department of Neurology, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen. [Petersen N] Department of Neurology, Yale University School of Medicine, New Haven, Connecticut. [Divani AA] Department of Neurology, University of New Mexico Health Science Center, Albuquerque. [Ribo M, Gadea MO] Servei de Neurologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
Subjects: Isquèmia cerebral, Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Stroke [DISEASES], Vasos sanguinis - Cirurgia, intervenciones quirúrgicas::procedimientos quirúrgicos cardiovasculares::procedimientos quirúrgicos vasculares::trombectomía [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Vascular Surgical Procedures::Thrombectomy [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], General Medicine, Equipment and Supplies::Prostheses and Implants::Stents [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::accidente cerebrovascular [ENFERMEDADES], enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::enfermedades de las arterias carótidas::estenosis carotídea [ENFERMEDADES], Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Carotid Artery Diseases::Carotid Stenosis [DISEASES], equipos y suministros::prótesis e implantes::stents [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS]
Abstract: ImportanceApproximately 10% to 20% of large vessel occlusion (LVO) strokes involve tandem lesions (TLs), defined as concomitant intracranial LVO and stenosis or occlusion of the cervical internal carotid artery. Mechanical thrombectomy (MT) may benefit patients with TLs; however, optimal management and procedural strategy of the cervical lesion remain unclear.ObjectiveTo evaluate the association of carotid artery stenting (CAS) vs no stenting and medical management with functional and safety outcomes among patients with TL-LVOs.Design, Setting, and ParticipantsThis cross-sectional study included consecutive patients with acute anterior circulation TLs admitted across 17 stroke centers in the US and Spain between January 1, 2015, and December 31, 2020. Data analysis was performed from August 2021 to February 2022. Inclusion criteria were age of 18 years or older, endovascular therapy for intracranial occlusion, and presence of extracranial internal carotid artery stenosis (>50%) demonstrated on pre-MT computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography.ExposuresPatients with TLs were divided into CAS vs nonstenting groups.Main Outcomes and MeasuresPrimary clinical and safety outcomes were 90-day functional independence measured by a modified Rankin Scale (mRS) score of 0 to 2 and symptomatic intracranial hemorrhage (sICH), respectively. Secondary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2b), discharge mRS score, ordinal mRS score, and mortality at 90 days.ResultsOf 685 patients, 623 (mean [SD] age, 67 [12.2] years; 406 [65.2%] male) were included in the analysis, of whom 363 (58.4%) were in the CAS group and 260 (41.6%) were in the nonstenting group. The CAS group had a lower proportion of patients with atrial fibrillation (38 [10.6%] vs 49 [19.2%], P = .002), a higher proportion of preprocedural degree of cervical stenosis on digital subtraction angiography (90%-99%: 107 [32.2%] vs 42 [20.5%], P P = .003), a lower median (IQR) National Institutes of Health Stroke Scale score (15 [10-19] vs 17 [13-21], P P = .007), favorable shift in mRS scores (aOR, 1.46; 95% CI, 1.02-2.10; P = .04), and successful reperfusion (aOR, 1.70; 95% CI, 1.02-3.60; P = .002) were significantly higher for the CAS group compared with the nonstenting group. Both groups had similar odds of sICH (aOR, 0.90; 95% CI, 0.46-2.40; P = .87) and 90-day mortality (aOR, 0.78; 95% CI, 0.50-1.20; P = .27). No heterogeneity was noted for 90-day functional outcome and sICH in prespecified subgroups.Conclusions and RelevanceIn this multicenter, international cross-sectional study, CAS of the cervical lesion during MT was associated with improvement in functional outcomes and reperfusion rates without an increased risk of sICH and mortality in patients with TLs.
Published: 2023

31. Systematic CT perfusion acquisition in acute stroke increases vascular occlusion detection and thrombectomy rates

Author: Prudencio Lozano, Marc Ribó, Sandra Boned, Carlos Piñana, Jorge Pagola, Álvaro García-Tornel, Alejandro Tomasello, Marta Rubiera, Noelia Rodriguez-Villatoro, Matias Deck, Cristian Marti, Carlos A. Molina, Marta Olivé-Gadea, David Rodriguez-Luna, David Uriarte Hernández, Marian Muchada, Manuel Requena, Facundo Diaz, and Jesus Juega
Subjects: medicine.medical_specialty, Cytidine Triphosphate, Tissue residue, Perfusion scanning, Vascular occlusion, Brain Ischemia, medicine, Humans, In patient, Stroke, Ischemic Stroke, Retrospective Studies, Thrombectomy, Acute stroke, medicine.diagnostic_test, business.industry, General Medicine, medicine.disease, Cerebral Angiography, Perfusion, Angiography, Surgery, Neurology (clinical), Radiology, medicine.symptom, Tomography, X-Ray Computed, business
Abstract: BackgroundIn patients with stroke, current guidelines recommend non-invasive vascular imaging to identify intracranial vessel occlusions (VO) that may benefit from endovascular treatment (EVT). However, VO can be missed in CT angiography (CTA) readings. We aim to evaluate the impact of consistently including CT perfusion (CTP) in admission stroke imaging protocols.MethodsFrom April to October 2020 all patients admitted with a suspected acute ischemic stroke underwent urgent non-contrast CT, CTA and CTP and were treated accordingly. Hypoperfusion areas defined by time-to-maximum of the tissue residue function (Tmax) >6 s, congruent with the clinical symptoms and a vascular territory, were considered VO (CTP-VO). In addition, two experienced neuroradiologists blinded to CTP but not to clinical symptoms retrospectively evaluated non-contrast CT and CTA to identify intracranial VO (CTA-VO).ResultsOf the 338 patients included in the analysis, 157 (46.5%) presented with CTP-VO (median Tmax >6s: 73 (29–127) mL). CTA-VO was identified in 83 (24.5%) of the cases. Overall CTA-VO sensitivity for the detection of CTP-VO was 50.3% and specificity was 97.8%. Higher hypoperfusion volume was associated with increased CTA-VO detection (OR 1.03; 95% CI 1.02 to 1.04). EVT was performed in 103 patients (30.5%; Tmax >6s: 102 (63–160) mL), representing 65.6% of all CTP-VO. Overall CTA-VO sensitivity for the detection of EVT-VO was 69.9% and specificity was 95.3%. Among patients who received EVT, the rate of false negative CTA-VO was 30.1% (Tmax >6s: 69 (46–99.5) mL).ConclusionSystematically including CTP in acute stroke admission imaging protocols may increase the diagnosis of VO and rate of EVT.
Published: 2021
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32. Ischemic Core Overestimation on Computed Tomography Perfusion

Author: Manuel Requena, David Rodriguez-Luna, Jorge Pagola, Marc Ribo, Alejandro Tomasello, Carlos A. Molina, Daniel Campos, José Alvarez-Sabín, Noelia Rodriguez-Villatoro, Estela Sanjuan, Matias Deck, Carlos Piñana, David Hernández, Marian Muchada, Sandra Boned, Marta Rubiera, Ludovico Ciolli, Jesus Juega, Álvaro García-Tornel, and Marta Olivé-Gadea
Subjects: Male, medicine.medical_specialty, Perfusion Imaging, Hemodynamics, Infarction, Perfusion scanning, Brain Ischemia, Interquartile range, Internal medicine, medicine, Humans, Stroke, Aged, Retrospective Studies, Aged, 80 and over, Advanced and Specialized Nursing, business.industry, Brain, Odds ratio, medicine.disease, Cerebral blood flow, Cerebrovascular Circulation, Cardiology, Female, Neurology (clinical), Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business, Perfusion
Abstract: Background and Purpose: Different studies have pointed that CT perfusion (CTP) could overestimate ischemic core in early time window. We aim to evaluate the influence of time and collateral status on ischemic core overestimation. Methods: Retrospective single-center study including patients with anterior circulation large-vessel stroke that achieved reperfusion after endovascular treatment. Ischemic core and collateral status were automatically estimated on baseline CTP using commercially available software. CTP-derived core was considered as tissue with a relative reduction of cerebral blood flow 6 seconds with time to maximum of tissue residue function >10 seconds). Final infarct volume was measured on 24 to 48 hours noncontrast CT. Ischemic core overestimation was considered when CTP-derived core was larger than final infarct. Results: Four hundred and seven patients were included in the analysis. Median CTP-derived core and final infarct volume were 7 mL (interquartile range, 0–27) and 20 mL (interquartile range, 5–55), respectively. Median hypoperfusion intensity ratio was 0.46 (interquartile range, 0.23–0.59). Eighty-three patients (20%) presented ischemic core overestimation (median overestimation, 12 mL [interquartile range, 41–5]). Multivariable logistic regression analysis adjusted by CTP-derived core and confounding variables showed that poor collateral status (per 0.1 hypoperfusion intensity ratio increase; adjusted odds ratio, 1.41 [95% CI, 1.20–1.65]) and earlier onset to imaging time (per 60 minutes earlier; adjusted odds ratio, 1.14 [CI, 1.04–1.25]) were independently associated with core overestimation. No significant association was found with imaging to reperfusion time (per 30 minutes earlier; adjusted odds ratio, 1.17 [CI, 0.96–1.44]). Poor collateral status influence on core overestimation differed according to onset to imaging time, with a stronger size of effect on early imaging patients( P interaction Conclusions: In patients with large-vessel stroke that achieve reperfusion after endovascular therapy, poor collateral status might induce higher rates of ischemic core overestimation on CTP, especially in patients in earlier window time. CTP reflects a hemodynamic state rather than tissue fate; collateral status and onset to imaging time are important factors to consider when estimating core on CTP.
Published: 2021
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33. Editorial: The effects of music on cognition and action, volume II

Author: Franco Delogu, Riccardo Brunetti, Cunmei Jang, and Marta Olivetti Belardinelli
Subjects: gamma music, time perception in percussionists, tempo, music in preterm infants, music in cognitive neuromodulation, transfer effects, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Published: 2025
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34. Deep Learning Based Software to Identify Large Vessel Occlusion on Noncontrast Computed Tomography

Author: Alexander Soler, Carlos Crespo, Natalia Pérez de la Ossa, Marc Ribó, Cristina Granes, Xabier Urra, María Hernández-Pérez, Cristian Marti, Carlos Laredo, Paloma Puyalto, Marta Olivé-Gadea, J. Soler, and Patricia Cuadras
Subjects: Advanced and Specialized Nursing, middle cerebral artery, medicine.medical_specialty, medicine.diagnostic_test, area under the curve, business.industry, Deep learning, deep learning, Computed tomography, Software, thrombectomy, medicine.artery, Middle cerebral artery, medicine, Neurology (clinical), Radiology, Artificial intelligence, Endovascular treatment, Cardiology and Cardiovascular Medicine, business, patient transfer, Large vessel occlusion
Abstract: Background and Purpose: Reliable recognition of large vessel occlusion (LVO) on noncontrast computed tomography (NCCT) may accelerate identification of endovascular treatment candidates. We aim to validate a machine learning algorithm (MethinksLVO) to identify LVO on NCCT. Methods: Patients with suspected acute stroke who underwent NCCT and computed tomography angiography (CTA) were included. Software detection of LVO (MethinksLVO) on NCCT was tested against the CTA readings of 2 experienced radiologists (NR-CTA). We used a deep learning algorithm to identify clot signs on NCCT. The software image output trained a binary classifier to determine LVO on NCCT. We studied software accuracy when adding National Institutes of Health Stroke Scale and time from onset to the model (MethinksLVO+). Results: From 1453 patients, 823 (57%) had LVO by NR-CTA. The area under the curve for the identification of LVO with MethinksLVO was 0.87 (sensitivity: 83%, specificity: 71%, positive predictive value: 79%, negative predictive value: 76%) and improved to 0.91 with MethinksLVO+ (sensitivity: 83%, specificity: 85%, positive predictive value: 88%, negative predictive value: 79%). Conclusions: In patients with suspected acute stroke, MethinksLVO software can rapidly and reliably predict LVO. MethinksLVO could reduce the need to perform CTA, generate alarms, and increase the efficiency of patient transfers in stroke networks.
Published: 2020
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35. Computed Tomography Perfusion After Thrombectomy

Author: Marta Rubiera, Alejandro Tomasello, Daniel Campos, Manuel Requena, Sandra Boned, Jesus Juega, Carlos Piñana, David Hernández, Marc Ribó, Carlos A. Molina, Marta Olivé-Gadea, Jorge Pagola, Matias Deck, Marian Muchada, David Rodriguez-Luna, Estela Sanjuan, Carla Vert, Álvaro García-Tornel, and Noelia Rodriguez-Villatoro
Subjects: Male, medicine.medical_specialty, Computed tomography perfusion, Brain Ischemia, Humans, Medicine, Endovascular treatment, Stroke, Aged, Thrombectomy, Acute stroke, Aged, 80 and over, Advanced and Specialized Nursing, business.industry, Surrogate endpoint, Endovascular Procedures, medicine.disease, Cerebral blood volume, Cerebrovascular Circulation, Acute Disease, Female, Neurology (clinical), Radiology, Tomography, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business, Biomarkers
Abstract: Background and Purpose— Despite recanalization, almost 50% of patients undergoing endovascular treatment (EVT) experience poor outcome. We aim to evaluate the value of computed tomography perfusion as immediate outcome predictor postendovascular treatment. Methods— Consecutive patients receiving endovascular treatment who achieved recanalization (modified Thrombolysis in Cerebral Ischemia [mTICI] 2a-3) underwent computed tomography perfusion within 30 minutes from recanalization (CTPpost). Hypoperfusion was defined as the Tmax>6 second volume; hyperperfusion as visually increased cerebral blood flow/cerebral blood volume with reduced Tmax compared with unaffected hemisphere. Dramatic clinical recovery (DCR) was defined as 24-hour National Institutes of Health Stroke Scale score ≤2 or ≥8 points drop. Delayed recovery was defined as no-DCR with favorable outcome (modified Rankin Scale score 0–2) at 3 months. Results— We included 151 patients: median National Institutes of Health Stroke Scale score 16 (interquartile range, 10–21), median admission ASPECTS 9 (interquartile range, 8–10). Final recanalization was the following: mTICI2a 11 (7.3%), mTICI2b 46 (30.5%), and mTICI3 94 (62.3%). On CTPpost, 80 (52.9%) patients showed hypoperfusion (median Tmax>6 seconds: 4 cc [0–25]) and 32 (21.2%) hyperperfusion. There was an association between final TICI and CTPpost hypoperfusion(median Tmax>6: 91 [56–117], 15 [0–37.5], and 0 [0–7] cc, for mTICI 2a, 2b, and 3, respectively, P P P P P Conclusions— Hypoperfusion on CTPpost constitutes an immediate accurate surrogate marker of success after endovascular treatment and identifies those patients with delayed recovery and favorable outcome.
Published: 2020
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36. Evolution of quality indicators in acute stroke during the RACECAT Trial: Impact in the general population

Author: Marta Olivé-Gadea, Natalia Pérez de la Ossa, Tudor Jovin, Sonia Abilleira, Xavier Jiménez, Pere Cardona, Angel Chamorro, Alan Flores, Yolanda Silva, Francesc Purroy, Joan Martí-Fabregas, Ana Rodríguez-Campello, Josep Zaragoza, Jerzy Krupinski, David Canovas, Manuel Gomez Choco, Natalia Mas, Ernest Palomeras, Dolores Cocho, Josep M Aragonès, Carmen Repullo, Eduard Sanjurjo, Dolores Carrion, Esther Catena, Xavier Costa, M Cruz Almendros, Miquel Barceló, Jordi Monedero, Maria Rybyeva, Gloria Diaz, and Marc Ribó
Subjects: territorial disparities, Neurology, workflow, Stroke network
Abstract: Background: Acute ischemic stroke patients not referred directly to a comprehensive stroke center (CSC) have reduced access to endovascular treatment (EVT). The RACECAT trial is a population-based cluster-randomized trial, designed to compare mothership and drip-and-ship strategies in acute ischemic stroke patients outside the catchment area of a CSC. Aims: To analyze the evolution of performance indicators in the regions that participated in RACECAT. Methods: This retrospective longitudinal observational study included all stroke alerts evaluated by emergency medical services in Catalonia between February 2016 and February 2020. Cases were classified geographically according to the nearest SC: local SC (Local-SC) and CSC catchment areas. We analyzed the evolution of EVT rates and relevant workflow times in Local-SC versus CSC catchment areas over three study periods: P1 (February 2016 to April 2017: before RACECAT initiation), P2 (May 2017 to September 2018), and P3 (October 2018 to February 2020). Results: We included 20603 stroke alerts, 10,694 (51.9%) of which were activated within Local-SC catchment areas. The proportion of patients receiving EVT within Local-SC catchment areas increased (P1 vs. P3: 7.5% (95% confidence interval (CI), 6.4–8.7) to 22.5% (95% CI, 20.8–24.4) p Conclusion: An increase in EVT rates in Local-SC regions with a significant decrease in workflow times occurred during the period of the RACECAT trial.
Published: 2022

37. Multiparametric Neuroimaging and Its Association with Non-Contrast Computed Tomography in Late-Window Large Vessel Occlusion Acute Stroke

Author: Marc Rodrigo-Gisbert, Manuel Requena, Marta De Dios Lascuevas, Álvaro García-Tornel, Marta Olivé-Gadea, Sandra Boned, Marian Muchada, Matías Deck, Noelia Rodríguez-Villatoro, David Rodríguez-Luna, Jesús Juega, Jorge Pagola, Alejandro Tomasello, Carlos Piñana, David Hernández, Pilar Coscojuela, Marc Ribó, Carlos A. Molina, and Marta Rubiera
Subjects: Neurology, Neurology (clinical), Cardiology and Cardiovascular Medicine
Abstract: Introduction: Endovascular treatment (EVT) for acute ischemic stroke (AIS) between 6 and 24 h is established as a standard of care among patients selected by multiparametric neuroimaging. We aimed to explore neuroimaging parameters in late-window large vessel occlusion (LVO) patients and its association with non-contrast computed tomography (NCCT) findings. Methods: We included consecutive AIS patients within 6–24 h from the symptoms onset with LVO. We described multiparametric imaging findings, the rate of patients who fulfilled imaging perfusion criteria according to the DAWN and DEFUSE-3 trials that define the computed tomography perfusion mismatch (CTP-MM) group and its association with NCCT focused on Alberta Stroke Program Early CT Score (ASPECTS). We also analyzed the association between neuroimaging parameters and the clinical outcome determined by the 90-day modified Rankin scale (mRS). Results: We included 206 patients, of them, 176 (85.4%) presented CTP-MM and 184 (89.3%) presented an ASPECTS ≥6 on admission. The rate of CTP-MM was 90.8% in patients with ASPECTS ≥6, compared with 40.9% in those with low ASPECTS. ASPECTS was moderately correlated with ischemic core determined by cerebral blood flow p < 0.001). In EVT-treated patients (185, 89.8%), after adjusting for identifiable confounders, the presence of CTP-MM was a predictor of 90-day functional independence (OR: 3.38; 95% CI: 1.01–11.29; p = 0.048). We did not find an association between CTP-MM and 90-day functional disability (ordinal mRS shift, aOR: 1.39; 95% CI: 0.58–3.34; p = 0.459). Conclusions: A great majority of patients who presented a LVO in the late window fulfilled guidelines imaging criteria to undergo EVT, especially those with high ASPECTS (≥6). Our data suggest that NCCT with CT angiography could be a reasonable approach for AIS treatment selection also in the late window.
Published: 2022

38. Abstract 36: Endovascular Thrombectomy Beyond 24 Hours From Last Known Well: A Pooled Multicenter International Cohort

Author: Amrou Sarraj, Ameer E Hassan, Michael G Abraham, Pere Cardona Portela, Nathan W Manning, Dennis Cordato, Timothy J Kleinig, Nitin Goyal, Spiros Blackburn, Margy E McCullough-Hicks, Marc Ribo, Teddy Y Wu, Jordi Blasco, Navdeep Sangha, Juan F Arenillas, Adam Wallace, Deep K Pujara, Faris Shaker, Mercedes de Lera Alfonso, Arturo Renu, Marta Olivé Gadea, Daniel Gibson, Colleen G Lechtenberg, Laith N Maali, Mohammad A Abdulrazzak, Tareq S Almaghrabi, James Beharry, Balaji Krishnaiah, Megan Miller, Najwa Khalil, Gagan J Sharma, Aristeidis H Katsanos, Ali Fadhil, Kelsey R Duncan, Yin Hu, clark W sitton, Sheryl B Martin-schild, Georgios K Tsivgoulis, Peter J Mitchell, Adam S Arthur, Mark Parsons, James C Grotta, Bruce C Campbell, and Gregory W Albers
Subjects: Advanced and Specialized Nursing, Neurology (clinical), Cardiology and Cardiovascular Medicine
Abstract: Background: Limited data are available on endovascular thrombectomy (EVT) efficacy and safety in large vessel occlusion (LVO) patients presenting >24hr from last known well (LKW). We compared outcomes between patients receiving EVT and best medical management (MM) in a multicenter international cohort. Methods: Consecutive patients with anterior circulation LVO presenting >24h after LKW from 13 centers from 7/2012-4/2021 were analyzed. Multivariable models for 90d mRS distribution and symptomatic ICH were adjusted for age, NIHSS, glucose, IV tPA, transfer status, clot location, time from LKW, CT ASPECTS and ischemic core (rCBF6s volumes. Results: Of 240 patients with a median (IQR) LKW to presentation 28.3h (24.9-38.2), 153 (64%) received EVT. Baseline characteristics were similar except for NIHSS (EVT: 13 (8-20) vs MM: 17 (10-22), p=0.005), CT ASPECTS (EVT: 8(6-9) vs MM: 4(3-6), p Conclusions: EVT may be associated with better functional outcomes, despite numerically increased risk of sICH in patients presenting with anterior circulation LVO beyond 24 hours. Further prospective studies are warranted.
Published: 2022
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39. Association of Endovascular Thrombectomy vs Medical Management With Functional and Safety Outcomes in Patients Treated Beyond 24 Hours of Last Known Well

Author: Amrou Sarraj, Timothy J. Kleinig, Ameer E. Hassan, Pere Cardona Portela, Santiago Ortega-Gutierrez, Michael G. Abraham, Nathan W. Manning, James E. Siegler, Nitin Goyal, Laith Maali, Spiros Blackburn, Teddy Y. Wu, Jordi Blasco, Arturu Renú, Navdeep S. Sangha, Juan F. Arenillas, Margy E. McCullough-Hicks, Adam Wallace, Daniel Gibson, Deep K. Pujara, Faris Shaker, Mercedes de Lera Alfonso, Marta Olivé-Gadea, Mudassir Farooqui, Juan S. Vivanco Suarez, Zachary Iezzi, Jane Khalife, Colleen G. Lechtenberg, Syed K. Qadri, Rami B. Moussa, Mohammad A. Abdulrazzak, Tareq S. Almaghrabi, Osman Mir, James Beharry, Balaji Krishnaiah, Megan Miller, Najwa Khalil, Gagan J. Sharma, Aristeidis H. Katsanos, Ali Fadhil, Kelsey R. Duncan, Yin Hu, Sheryl B. Martin-Schild, Georgios K. Tsivgoulis, Dennis Cordato, Anthony Furlan, Leonid Churilov, Peter J. Mitchell, Adam S. Arthur, Mark W. Parsons, James C. Grotta, Clark W. Sitton, Marc Ribo, Gregory W. Albers, and Bruce C. V. Campbell
Subjects: Neurology (clinical)
Abstract: ImportanceThe role of endovascular thrombectomy is uncertain for patients presenting beyond 24 hours of the time they were last known well.ObjectiveTo evaluate functional and safety outcomes for endovascular thrombectomy (EVT) vs medical management in patients with large-vessel occlusion beyond 24 hours of last known well.Design, Setting, and ParticipantsThis retrospective observational cohort study enrolled patients between July 2012 and December 2021 at 17 centers across the United States, Spain, Australia, and New Zealand. Eligible patients had occlusions in the internal carotid artery or middle cerebral artery (M1 or M2 segment) and were treated with EVT or medical management beyond 24 hours of last known well.InterventionsEndovascular thrombectomy or medical management (control).Main Outcomes and MeasuresPrimary outcome was functional independence (modified Rankin Scale score 0-2). Mortality and symptomatic intracranial hemorrhage (sICH) were safety outcomes. Propensity score (PS)–weighted multivariable logistic regression analyses were adjusted for prespecified clinical characteristics, perfusion parameters, and/or Alberta Stroke Program Early CT Score (ASPECTS) and were repeated in subsequent 1:1 PS-matched cohorts.ResultsOf 301 patients (median [IQR] age, 69 years [59-81]; 149 female), 185 patients (61%) received EVT and 116 (39%) received medical management. In adjusted analyses, EVT was associated with better functional independence (38% vs control, 10%; inverse probability treatment weighting adjusted odds ratio [IPTW aOR], 4.56; 95% CI, 2.28-9.09; P P = .003). This association persisted after PS-based matching on (1) clinical characteristics and ASPECTS (EVT, 35%, vs control, 19%; aOR, 3.14; 95% CI, 1.02-9.72; P = .047); (2) clinical characteristics and perfusion parameters (EVT, 35%, vs control, 17%; aOR, 4.17; 95% CI, 1.15-15.17; P = .03); and (3) clinical characteristics, ASPECTS, and perfusion parameters (EVT, 45%, vs control, 21%; aOR, 4.39; 95% CI, 1.04-18.53; P = .04). Patients receiving EVT had lower odds of mortality (26%) compared with those in the control group (41%; IPTW aOR, 0.49; 95% CI, 0.27-0.89; P = .02).Conclusions and RelevanceIn this study of treatment beyond 24 hours of last known well, EVT was associated with higher odds of functional independence compared with medical management, with consistent results obtained in PS-matched subpopulations and patients with presence of mismatch, despite increased odds of sICH. Our findings support EVT feasibility in selected patients beyond 24 hours. Prospective studies are warranted for confirmation.
Published: 2023
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40. Thrombectomy versus Medical Management in Mild Strokes due to Large Vessel Occlusion: Exploratory Analysis from the EXTEND-IA Trials and a Pooled International Cohort

Author: Amrou, Sarraj, Gregory W, Albers, Jordi, Blasco, Juan F, Arenillas, Marc, Ribo, Ameer E, Hassan, Natalia Pérez, de la Ossa, Teddy Yuan-Hao, Wu, Pere, Cardona Portela, Michael G, Abraham, Michael, Chen, Laith, Maali, Timothy J, Kleinig, Dennis, Cordato, Adam Nathan, Wallace, Joanna D, Schaafsma, Navdeep, Sangha, Daniel P, Gibson, Spiros L, Blackburn, Mercedes, De Lera Alfonso, Deep, Pujara, Faris, Shaker, Margy E, McCullough-Hicks, Javier Luis, Moreno Negrete, Arturo, Renu, James, Beharry, Cecilia, Cappelen-Smith, Luis, Rodríguez-Esparragoza, Marta, Olivé-Gadea, Manuel, Requena, Tareq, Almaghrabi, Vitor, Mendes Pereira, Clark, Sitton, Sheryl, Martin-Schild, Sarah, Song, Henry, Ma, Leonid, Churilov, Peter J, Mitchell, Mark W, Parsons, Anthony, Furlan, James C, Grotta, Geoffrey A, Donnan, Stephen M, Davis, and Bruce C V, Campbell
Subjects: Stroke, Treatment Outcome, Neurology, Endovascular Procedures, Humans, Neurology (clinical), Prospective Studies, Brain Ischemia, Cerebral Hemorrhage, Thrombectomy
Abstract: Objective This study was undertaken to evaluate functional and safety outcomes for endovascular thrombectomy (EVT) versus medical management (MM) in patients with large vessel occlusion (LVO) and mild neurological deficits, stratified by perfusion imaging mismatch. Methods The pooled cohort consisted of patients with National Institutes of Health Stroke Scale (NIHSS) < 6 and internal carotid artery (ICA), M1, or M2 occlusions from the Extending the Time for Thrombolysis in Emergecy Neurological Deficits - Intra-Arterial (EXTEND-IA) Trial, Tenecteplase vs Alteplase before Endovascular Thrombectomy in Ischemic Stroke (EXTEND-IA TNK) trials Part I/II and prospective data from 15 EVT centers from October 2010 to April 2020. RAPID software estimated ischemic core and mismatch. Patients receiving primary EVT (EVTpri) were compared to those who received primary MM (MMpri), including those who deteriorated and received rescue EVT, in overall and propensity score (PS)-matched cohorts. Patients were stratified by target mismatch (mismatch ratio >= 1.8 and mismatch volume >= 15ml). Primary outcome was functional independence (90-day modified Rankin Scale = 0-2). Secondary outcomes included safety (symptomatic intracerebral hemorrhage [sICH], neurological worsening, and mortality). Results Of 540 patients, 286 (53%) received EVTpri and demonstrated larger critically hypoperfused tissue (Tmax > 6 seconds) volumes (median [IQR]: 64 [26-96] ml vs MMpri: 40 [14-76] ml, p < 0.001) and higher presentation NIHSS (median [IQR]: 4 [2-5] vs MMpri: 3 [2-4], p < 0.001). Functional independence was similar (EVTpri: 77.4% vs MMpri: 75.6%, adjusted odds ratio [aOR] = 1.29, 95% confidence interval [CI] = 0.82-2.03, p = 0.27). EVT had worse safety regarding sICH (EVTpri: 16.3% vs MMpri: 1.3%, p < 0.001) and neurological worsening (EVTpri: 19.6% vs MMpri: 6.7%, p < 0.001). In 414 subjects (76.7%) with target mismatch, EVT was associated with improved functional independence (EVTpri: 77.4% vs MMpri: 72.7%, aOR = 1.68, 95% CI = 1.01-2.81, p = 0.048), whereas there was a trend toward less favorable outcomes with primary EVT (EVTpri: 77.4% vs MMpri: 83.3%, aOR = 0.39, 95% CI = 0.12-1.34, p = 0.13) without target mismatch (p(interaction) = 0.06). Similar findings were observed in a propensity score-matched subpopulation. Interpretation Overall, EVT was not associated with improved clinical outcomes in mild strokes due to LVO, and sICH was increased. However, in patients with target mismatch profile, EVT was associated with increased functional independence. Perfusion imaging may be helpful to select mild stroke patients for EVT. ANN NEUROL 2022
Published: 2022

41. Workflow Times and Outcomes in Patients Triaged for a Suspected Severe Stroke

Author: Álvaro, García-Tornel, Laia, Seró, Xabier, Urra, Pere, Cardona, Josep, Zaragoza, Jerzy, Krupinski, Manuel, Gómez-Choco, Natalia Mas, Sala, Esther, Catena, Ernest, Palomeras, Joaquin, Serena, Maria, Hernandez-Perez, Sandra, Boned, Marta, Olivé-Gadea, Manuel, Requena, Marian, Muchada, Alejandro, Tomasello, Carlos A, Molina, Mercè, Salvat-Plana, Mar, Escudero, Xavier, Jimenez, Antoni, Davalos, Tudor G, Jovin, Francesc, Purroy, Sonia, Abilleira, Marc, Ribo, and Natalia Perez, de la Ossa
Subjects: Stroke, Time Factors, Treatment Outcome, Neurology, Endovascular Procedures, Humans, Neurology (clinical), Triage, Thrombectomy, Time-to-Treatment, Workflow
Abstract: Introduction Current recommendations for regional stroke destination suggest that patients with severe acute stroke in non-urban areas should be triaged based on the estimated transport time to a referral thrombectomy-capable center. Methods We performed a post hoc analysis to evaluate the association of pre-hospital workflow times with neurological outcomes in patients included in the RACECAT trial. Workflow times evaluated were known or could be estimated before transport allocation. Primary outcome was the shift analysis on the modified Rankin score at 90 days. Results Among the 1,369 patients included, the median time from onset to emergency medical service (EMS) evaluation, the estimated transport time to a thrombectomy-capable center and local stroke center, and the estimated transfer time between centers were 65 minutes (interquartile ratio [IQR] = 43-138), 61 minutes (IQR = 36-80), 17 minutes (IQR = 9-27), and 62 minutes (IQR = 36-73), respectively. Longer time intervals from stroke onset to EMS evaluation were associated with higher odds of disability at 90 days in the local stroke center group (adjusted common odds ratio (acOR) for each 30-minute increment = 1.03, 95% confidence interval [CI] = 1.01-1.06), with no association in the thrombectomy-capable center group (acOR for each 30-minute increment = 1.01, 95% CI = 0.98-1.01, p(interaction) = 0.021). No significant interaction was found for other pre-hospital workflow times. In patients evaluated by EMS later than 120 minutes after stroke onset, direct transport to a thrombectomy-capable center was associated with better disability outcomes (acOR = 1.49, 95% CI = 1.03-2.17). Conclusion We found a significant heterogeneity in the association between initial transport destination and neurological outcomes according to the elapse of time between the stroke onset and the EMS evaluation (: NCT02795962). ANN NEUROL 2022
Published: 2022

42. Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion

Author: Johannes Kaesmacher, Urs Fischer, Mohamad Abdalkader, Carlos Ynigo Lopez, Mohammad W. Kassem, Ameena Rana, Samer Abdul Kareem, Alicia C. Castonguay, Patrik Michel, Osama O. Zaidat, Syed F Zaidi, Jan Gralla, Ajit S. Puri, Sunil A Sheth, Diogo C Haussen, Marta Olivé-Gadea, Behzad Farzin, Mahmoud H. Mohammad, Anna Luisa Kühn, François Caparros, Stefania Nannoni, Simon Nagel, Muhammad M. Qureshi, Fatih Seker, Thanh N. Nguyen, Peter A. Ringleb, Anvitha Sathya, Markus A Möhlenbruch, Piers Klein, Tudor G Jovin, Sergio Salazar-Marioni, Hesham Masoud, Marc Ribó, James E. Siegler, Charlotte Cordonnier, Santiago Ortega-Gutierrez, Artem Kaliaev, Raul G Nogueira, William Boisseau, Hilde Hénon, Mudassir Farooqui, and Jean Raymond
Subjects: Mechanical Thrombolysis, Perfusion Imaging, Arterial Occlusive Diseases, Cohort Studies, Modified Rankin Scale, Occlusion, Medical imaging, Clinical endpoint, Online First, Medicine, Humans, 610 Medicine & health, Stroke, Original Investigation, medicine.diagnostic_test, business.industry, Research, Magnetic resonance imaging, Odds ratio, medicine.disease, Magnetic Resonance Imaging, Featured, Treatment Outcome, Neurology (clinical), business, Nuclear medicine, Tomography, X-Ray Computed, Perfusion, Comments
Abstract: Key Points Question In patients with proximal anterior circulation occlusion stroke presenting in the extended window, are rates of favorable outcomes at 90 days comparable in the patients selected for thrombectomy with noncontrast computed tomography vs patients selected with computed tomography perfusion or magnetic resonance imaging? Findings In a multicenter cohort of 1604 patients in the extended window with large-vessel occlusion, patients selected by noncontrast computed tomography had comparable clinical and safety outcomes with patients selected by computed tomography perfusion or magnetic resonance imaging. Meaning These findings suggest noncontrast computed tomography alone may be used as an alternative to advanced imaging in selecting patients with late-presenting large-vessel occlusion for mechanical thrombectomy., This cohort study compares the clinical outcomes of patients with stroke who presented 6 to 24 hours after symptom onset and were selected for mechanical thrombectomy by noncontrast computed tomography vs those selected by computed tomography perfusion or magnetic resonance imaging., Importance Advanced imaging for patient selection in mechanical thrombectomy is not widely available. Objective To compare the clinical outcomes of patients selected for mechanical thrombectomy by noncontrast computed tomography (CT) vs those selected by computed tomography perfusion (CTP) or magnetic resonance imaging (MRI) in the extended time window. Design, Setting, and Participants This multinational cohort study included consecutive patients with proximal anterior circulation occlusion stroke presenting within 6 to 24 hours of time last seen well from January 2014 to December 2020. This study was conducted at 15 sites across 5 countries in Europe and North America. The duration of follow-up was 90 days from stroke onset. Exposures Computed tomography with Alberta Stroke Program Early CT Score, CTP, or MRI. Main Outcomes and Measures The primary end point was the distribution of modified Rankin Scale (mRS) scores at 90 days (ordinal shift). Secondary outcomes included the rates of 90-day functional independence (mRS scores of 0-2), symptomatic intracranial hemorrhage, and 90-day mortality. Results Of 2304 patients screened for eligibility, 1604 patients were included, with a median (IQR) age of 70 (59-80) years; 848 (52.9%) were women. A total of 534 patients were selected to undergo mechanical thrombectomy by CT, 752 by CTP, and 318 by MRI. After adjustment of confounders, there was no difference in 90-day ordinal mRS shift between patients selected by CT vs CTP (adjusted odds ratio [aOR], 0.95 [95% CI, 0.77-1.17]; P = .64) or CT vs MRI (aOR, 0.95 [95% CI, 0.8-1.13]; P = .55). The rates of 90-day functional independence (mRS scores 0-2 vs 3-6) were similar between patients selected by CT vs CTP (aOR, 0.90 [95% CI, 0.7-1.16]; P = .42) but lower in patients selected by MRI than CT (aOR, 0.79 [95% CI, 0.64-0.98]; P = .03). Successful reperfusion was more common in the CT and CTP groups compared with the MRI group (474 [88.9%] and 670 [89.5%] vs 250 [78.9%]; P
Published: 2021

43. Endovascular Thrombectomy Versus Intravenous Thrombolysis of Posterior Cerebral Artery Occlusion Stroke

Author: Silja Räty, Thanh N. Nguyen, Simon Nagel, Davide Strambo, Patrik Michel, Christian Herweh, Muhammad M. Qureshi, Mohamad Abdalkader, Pekka Virtanen, Marta Olive-Gadea, Marc Ribo, Marios Psychogios, Anh Nguyen, Joji B. Kuramatsu, David Haupenthal, Martin Köhrmann, Cornelius Deuschl, Jordi Kühne Escolà, Jelle Demeestere, Robin Lemmens, Lieselotte Vandewalle, Shadi Yaghi, Liqi Shu, Volker Puetz, Daniel P.O. Kaiser, Johannes Kaesmacher, Adnan Mujanovic, Dominique Cornelius Marterstoc, Tobias Engelhorn, Anne Berberich, Piers Klein, Diogo C. Haussen, Mahmoud H. Mohammaden, Hend Abdelhamid, Isabel Fragata, Bruno Cunha, Michele Romoli, Wei Hu, Jianlon Song, Johanna T. Fifi, Stavros Matsoukas, Sunil A. Sheth, Sergio A. Salazar-Marioni, João Pedro Marto, João Nuno Ramos, Milena Miszczuk, Christoph Riegler, Sven Poli, Khouloud Poli, Ashutosh P. Jadhav, Shashvat Desai, Volker Maus, Maximilian Kaeder, Adnan H. Siddiqui, Andre Monteiro, Tatu Kokkonen, Francesco Diana, Hesham E. Masoud, Neil Suryadareva, Maxim Mokin, Shail Thanki, Pauli Ylikotila, Kemal Alpay, James E. Siegler, Italo Linfante, Guilherme Dabus, Dileep Yavaghal, Vasu Saini, Christian H. Nolte, Eberhart Siebert, Markus A. Möhlenbruch, Peter A. Ringleb, Raul G. Nogueira, Uta Hanning, Lukas Meyer, Urs Fischer, and Daniel Strbian
Subjects: endovascular thrombectomy, intravenous thrombolysis, posterior cerebral artery, posterior circulation stroke, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background and Purpose Posterior cerebral artery occlusion (PCAo) can cause long-term disability, yet randomized controlled trials to guide optimal reperfusion strategy are lacking. We compared the outcomes of PCAo patients treated with endovascular thrombectomy (EVT) with or without intravenous thrombolysis (IVT) to patients treated with IVT alone. Methods From the multicenter retrospective Posterior cerebraL ArTery Occlusion (PLATO) registry, we included patients with isolated PCAo treated with reperfusion therapy within 24 hours of onset between January 2015 and August 2022. The primary outcome was the distribution of the modified Rankin Scale (mRS) at 3 months. Other outcomes comprised 3-month excellent (mRS 0–1) and independent outcome (mRS 0–2), early neurological improvement (ENI), mortality, and symptomatic intracranial hemorrhage (sICH). The treatments were compared using inverse probability weighted regression adjustment. Results Among 724 patients, 400 received EVT+/-IVT and 324 IVT alone (median age 74 years, 57.7% men). The median National Institutes of Health Stroke Scale score on admission was 7, and the occluded segment was P1 (43.9%), P2 (48.3%), P3–P4 (6.1%), bilateral (1.0%), or fetal posterior cerebral artery (0.7%). Compared to IVT alone, EVT+/-IVT was not associated with improved functional outcome (adjusted common odds ratio [OR] 1.07, 95% confidence interval [CI] 0.79–1.43). EVT increased the odds for ENI (adjusted OR [aOR] 1.49, 95% CI 1.05–2.12), sICH (aOR 2.87, 95% CI 1.23–6.72), and mortality (aOR 1.77, 95% CI 1.07–2.95). Conclusion Despite higher odds for early improvement, EVT+/-IVT did not affect functional outcome compared to IVT alone after PCAo. This may be driven by the increased risk of sICH and mortality after EVT.
Published: 2024
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44. Endovascular Therapy in the Extended Time Window for Large Vessel Occlusion in Patients With Pre-Stroke Disability

Author: Kanta Tanaka, Hiroshi Yamagami, Muhammad M. Qureshi, Kazutaka Uchida, James E. Siegler, Raul G. Nogueira, Shinichi Yoshimura, Nobuyuki Sakai, Nicolas Martinez-Majander, Simon Nagel, Jelle Demeestere, Volker Puetz, Diogo C. Haussen, Mohamad Abdalkader, Marta Olive-Gadea, Mahmoud H. Mohammaden, João Pedro Marto, Anne Dusart, Simon Winzer, Liisa Tomppo, Francois Caparros, Hilde Henon, Flavio Bellante, João Nuno Ramos, Santiago Ortega-Gutierrez, Sunil A. Sheth, Stefania Nannoni, Johannes Kaesmacher, Lieselotte Vandewalle, Sergio Salazar-Marioni, Mudassir Farooqui, Pekka Virtanen, Rita Ventura, Syed Zaidi, Alicia C. Castonguay, Ajit S. Puri, Behzad Farzin, Hesham E. Masoud, Piers Klein, Jessica Jesser, Manuel Requena, Tomas Dobrocky, Daniel P.O. Kaiser, Erno Peltola, Davide Strambo, Markus A. Möhlenbruch, Eugene Lin, Peter A. Ringleb, Osama O. Zaidat, Charlotte Cordonnier, Daniel Roy, Robin Lemmens, Marc Ribo, Daniel Strbian, Urs Fischer, Patrik Michel, Jean Raymond, and Thanh N. Nguyen
Subjects: activities of daily living, ischemic stroke, endovascular therapy, reperfusion, outcome, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background and Purpose We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without pre-stroke disability. Methods In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0–4 and LVO who underwent EVT 6–24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0–2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS score 2–4) and those without (mRS score 0–1). Results A total of 2,231 patients (median age, 72 years; median National Institutes of Health Stroke Scale score, 16) were included in the present analysis. Of these, 564 (25%) had pre-stroke disability. The primary outcome (FI or RoR) was observed in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR, 30.7%) compared to 44.1% of patients without (FI, 44.1%; RoR, 13.0%) (P
Published: 2024
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45. When to Stop

Author: David Rodriguez-Luna, Jorge Pagola, Sandra Boned, Jesus Juega, Marta Olivé-Gadea, Marc Ribó, Carlos A. Molina, Alejandro Tomasello, Marta Rubiera, Matias Deck, Manuel Requena, Álvaro García-Tornel, David Hernández, Marian Muchada, and Noelia Rodriguez-Villatoro
Subjects: Advanced and Specialized Nursing, medicine.medical_specialty, Multivariate analysis, Cerebral infarction, business.industry, medicine.medical_treatment, Thrombolysis, Odds ratio, medicine.disease, 030218 nuclear medicine & medical imaging, Mechanical thrombectomy, 03 medical and health sciences, 0302 clinical medicine, Modified Rankin Scale, Internal medicine, medicine, Cardiology, In patient, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Stroke, 030217 neurology & neurosurgery
Abstract: Background and Purpose— Substantial proportion of patients who achieve successful recanalization of acute ischemic stroke due to large vessel occlusion do not achieve good functional outcome. We aim to analyze the effect of number of thrombectomy device passes and degree of the recanalization (by modified Thrombolysis in Cerebral Infarction) on the clinical and functional outcome. Methods— Five hundred forty-two consecutive patients underwent mechanical thrombectomy for large vessel occlusion in the anterior circulation at a single tertiary stroke center. Baseline characteristics, number of passes, recanalization degree, clinical outcome at 24 hours (measured by National Institutes of Health Scale score), and functional outcome (measured by modified Rankin Scale at 90 days) were registered. Multivariate analysis was performed to determine the association of number of passes and degree of recanalization with dramatical clinical recovery (final National Institutes of Health Scale score ≤2 or decrease in 8 or more National Institutes of Health Scale score points in 24 hours) and good functional outcome (modified Rankin Scale score ≤2 at 90 days). Results— Four hundred fifty-nine patients (84%) achieved successful recanalization (modified Thrombolysis in Cerebral Infarction 2B–3), 213 (39%) of them after first device pass. In the multivariate analysis, first-pass recanalization and modified Thrombolysis in Cerebral Infarction 3 were independent predictors of good functional outcome (odds ratio, 2.5; 95% CI, 1.4–4.5; P =0.002 and odds ratio, 2.6 CI; 1.5–4.7; P =0.001, respectively) and dramatical clinical recovery (odds ratio, 1.8; 95% CI, 1.1–3; P =0.032 and odds ratio, 2.9; 95% CI, 1.7–5.1; P P P Conclusions— High number of device passes and less degree of recanalization are associated with worse outcome in patients with acute ischemic stroke secondary to large vessel occlusion. Future studies should investigate the optimal number of passes that should be attempted in patients without substantial recanalization.
Published: 2019
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46. Breeding Great Tit Parus major Individuals have Moderately Consistent Foraging Niches Across Years

Author: Juan Carlos Senar, Marta Olivé-Muñiz, and Emilio Pagani-Núñez
Subjects: Geography, Animal Science and Zoology, Humanities, Ecology, Evolution, Behavior and Systematics
Abstract: La especializacion de la dieta durante la cria de los descendientes puede tener consecuencias importantes sobre el exito reproductivo de los progenitores y la tasa de reclutamiento de la descendencia. Sin embargo, se tiene muy poco conocimiento sobre la consistencia de los padres en seleccionar las presas para alimentar a sus polluelos. En este articulo, utilizamos carboneros comunes Parus major mediterraneos para comprobar si los padres mantienen de manera consistente su especializacion individual a lo largo de los anos. Para hacer esto, grabamos las presas entregadas a polluelos de 10-14 dias de edad a lo largo de seis anos. Estandarizamos los datos para controlar los factores ambientales y realizamos un Analisis de Componentes Principales (PCA) para caracterizar el comportamiento de provision de alimento de los individuos. Evaluamos la consistencia de la dieta seleccionada utilizando datos de individuos grabados en dos anos distintos mediante un analisis de repetibilidad y tambien realizando un Modelo Lineal Generalizado donde medimos la consistencia de la posicion de los individuos del grupo con relacion a la de los otros individuos (consistencia relativa). Los resultados del PCA muestran que la dieta seleccionada para proveer a las crias varia a traves de dos gradientes: tamano vs. frecuencia de la presas, y orugas vs. aranas. Controlando todos los factores, encontramos que tanto la repetibilidad como la correlacion de la seleccion de la dieta entre anos son significativas pero moderadas. Aunque los carboneros muestran una alta especializacion individual de la dieta en un mismo ano, la dieta fluctua hasta cierto punto en distintos anos. Esos resultados enfatizan la necesidad de tener en cuenta la variacion individual en cuanto a la seleccion de la dieta en distintas etapas vitales y a lo largo de los anos. Esto podria proporcionar cierta plasticidad a los padres que se enfrentan a condiciones ambientales altamente fluctuantes y amortiguar el cambio climatico, y podria deberse a la creciente experiencia adquirida a lo largo su vida.
Published: 2021
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47. EP-367 - SÍNDROME DE RAMSAY HUNT E HERPES ZOSTER LARÍNGEO EM PVHA: UM RELATO DE CASO

Author: Adriane Silva, Paula Leite, Gabryela Couto, Layanne Paz, Raissa Alves, and Marta Oliveira
Subjects: Infectious and parasitic diseases, RC109-216, Microbiology, QR1-502
Abstract: Introdução: A Síndrome de Ramsay Hunt é causada pela reativação do vírus varicela zoster (VVZ) latente no gânglio geniculado, caracterizada pela tríade de otalgia, lesões vesiculares em canal auditivo e paralisia facial ipsilateral. O acometimento laríngeo do VVZ é uma afecção rara. As complicações relacionadas a este vírus são mais comuns em pacientes imunocomprometidos. Objetivo: Relatar um caso de Síndrome de Ramsay Hunt e acometimento laríngeo em uma PVHA. Método: Estudo analítico do tipo relato de caso. Resultados: Homem, 52 anos, PVHA em terapia antirretroviral há 5 meses (CD4: 246 cél/mm³, carga viral indetectável) e Sarcoma de Kaposi aguardando propedêutica oncológica. Procura o Hospital das Clínicas de Pernambuco com queixa de otalgia à direita, odinofagia e episódios de febre (38°C) há 2 dias. Apresenta lesões polimórficas vesiculares, pustulosas e crostosas em pavilhão auditivo e região retroauricular direitas com hiperemia, edema e otorreia e paralisia facial periférica à direita (escala de House-Brackmann grau IV). A videolaringoscopia demonstrou vesículas e ulcerações em região faríngea e supraglótica à direita, incluindo metade da epiglote, seio piriforme e aritenoide à direita. Tomografia de crânio, sem alterações, e Tomografia de mastoides, com material de densidade de partes moles em células da mastoide direita e membrana timpânica ipsilateral espessada. A audiometria indicou perda auditiva mista de grau leve à direita. Obteve o diagnóstico de Síndrome de Ramsay Hunt e Herpes Zoster laríngeo com infecção bacteriana secundária. Realizado aciclovir 10mg/kg 8/8h endovenoso por 14 dias, dexametasona 4mg 8/8h EV por 7 dias, bem como antibióticoterapia de amplo espectro. Evoluiu com melhora significativa com alta para seguimento ambulatorial. Conclusão: O caso apresenta características clássicas da Síndrome de Ramsay Hunt, com manifestações laríngeas, destacando a gravidade potencial em pacientes imunocomprometidos, que podem desenvolver formas mais disseminadas do Herpes Zoster. Ressalta-se a importância do diagnóstico precoce e tratamento adequado para reduzir complicações e melhorar o prognóstico.
Published: 2024
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48. LEITURAS TRANSMEDIA: O PODCAST NA CONSTRUÇÃO DE COMUNIDADES LEITORAS

Author: Catarina Menezes, Maria José Gamboa, and Marta Oliveira
Subjects: leituras transmedia, livros, podcast, comunidades leitoras, educação, Social sciences (General), H1-99
Abstract: A inovação tecnológica e a apropriação da tecnologia pelas pessoas, em contextos profundamente multimediáticos, têm vindo a alterar os modos de ler e de socializar leituras. No quadro de uma nova ecologia comunicacional, a tecnologia digital, em particular o podcast, constrói novas possibilidades de partilha e diálogo, redimensionando a dimensão sociocultural da leitura. Configura-se, assim, como um recurso que problematiza o conceito de leitura e os modos de ligar e formar leitores, desafiando à construção de comunidades informais que partilham as suas experiências de leitura. Neste sentido, apresenta-se o projeto Contrakapa, um podcast sobre livros e leituras, desenvolvido como projeto extracurricular, em contexto de ensino superior. A partir da aplicação de um questionário e da análise de conteúdo dos podcasts já publicados, pretende-se conhecer a forma como os participantes percecionam o seu envolvimento no projeto e o impacto que o mesmo teve/pode ter na sua construção enquanto leitores e elementos de uma comunidade leitora, nos seus modos de ler e de pensar o lugar da leitura e da literatura. Como se envolvem os participantes no projeto? Que motivos orientam o seu envolvimento? Como avaliam essa participação? O que sentem quando produzem e ouvem o podcast? O que pensam sobre o impacto do projeto no seu percurso leitor? Os dados obtidos apontam para um envolvimento positivo com o projeto, salientando-se uma dimensão emocional, fundamental para a construção de itinerários pessoais de leitura e de comunidades de leitores, e, consequentemente, para a exploração das suas possibilidades formativas em dinâmicas transmediáticas.
Published: 2024
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49. Therapeutic effect of botulinum toxin A on folliculitis dissecans of the scalp

Author: Simone Ramos Neri, Marcia Regina Franzolin, Célia Luiza Petersen Vitello Kalil, Vaniky Duarte Marques, Ronaldo Maciel Marques, and Marta Oliveira Domingos
Subjects: botulinum toxins type a, folliculitis, alopecia, staphylococcus aureus, staphylococcus lugdunensis, Dermatology, RL1-803
Abstract: A patient with dissecting folliculitis of the scalp who did not respond to antibiotic therapy received four monthly sessions of intradermal administration of 100 IU of botulinum toxin A. Four months after treatment, a complete recovery of the affected area of the patient's scalp was observed. A biopsy taken from the affected area showed the presence of Staphylococcus lugdunensis and Staphylococcus aureus resistant to erythromycin. Botulinum toxin A had no effect on the viability or biofilm production of the Staphylococcus strains, indicating that the healing effect of the toxin was associated with the host response alone.
Published: 2024
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50. Implicaciones de iniciar fármacos antiepilépticos previo a la realización de EEG en primeras crisis epilépticas

Author: Elena Fonseca, Marta Olivé, D. Campos, A. Llauradó, Manolo Quintana, A. Ballvé, Laura Abraira, Manuel Requena, Estevo Santamarina, Manuel Toledo, and María Sueiras
Subjects: 03 medical and health sciences, 0302 clinical medicine, business.industry, Medicine, Neurology (clinical), business, Humanities, 030217 neurology & neurosurgery
Abstract: Resumen Introduccion Determinar si la administracion de farmacos antiepilepticos (FAE) puede alterar la probabilidad de encontrar anomalias epileptiformes en EEG realizados de forma precoz tras una primera crisis epileptica (CE). Metodo Estudio observacional retrospectivo en el que se incluyo a los pacientes atendidos en urgencias de nuestro centro por una primera CE entre julio del 2014 y noviembre del 2019. Se recogieron los datos clinicos, las caracteristicas tecnicas de adquisicion e interpretacion de los EEG efectuados durante las primeras 72 h tras la CE y los factores relacionados con la recurrencia. Resultados Se recogieron 155 pacientes; edad media 48,6 ±22,5 anos; 61,3% hombres. El 51% presento crisis tonico-clonicas de inicio desconocido y el 12% focales con progresion a tonico-clonica bilateral. El 25,2% (39/155) recibio tratamiento con FAE antes de la realizacion del EEG; en 33 pacientes se administro un FAE no benzodiacepinico y en 6 una benzodiacepina. Se observaron anomalias epileptiformes en 29,7% de los pacientes. La administracion previa de FAE no se asocio de forma significativa ni con la probabilidad de detectar anomalias epileptiformes (p = 0,25) ni con el riesgo de recurrencia a los 6 meses (p = 0,63). Conclusiones La administracion de un FAE previo a la realizacion del EEG precoz tras una primera CE no disminuye la probabilidad de detectar anomalias epileptiformes. Estos hallazgos sugieren que iniciar un FAE de forma inmediata en aquellos pacientes con alto riesgo de recurrencia precoz no implica un menor rendimiento diagnostico de dicha prueba.
Published: 2021
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