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1. Predicting Recanalization Failure With Conventional Devices During Endovascular Treatment Related to Vessel Occlusion

Author: Alan Flores, Marcos Elizalde, Laia Seró, Xavier Ustrell, Ylenia Avivar, Anna Pellisé, Paula Rodriguez, Angela Monterde, Lidia Lara, Jose Maria Gonzalez‐de‐Echavarri, Victor Cuba, Marc Rodrigo Gisbert, Manuel Requena, Carlos A. Molina, Angel Chamorro, Natalia Perez de la Ossa, Pedro Cardona, David Cánovas, Francisco Purroy, Yolanda Silva, Ana Camzpello, Joan Marti‐Fabregas, Sonia Abilleira, and Marc Ribó
Subjects: acute stroke, endovascular procedure, prognosis, recanalization, Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background Among patients with stroke eligible for endovascular treatment, preprocedure identification of those with low chances of successful recanalization with conventional devices (stent‐retrievers and/or direct aspiration) may allow anticipating procedural rescue strategies. We aimed to develop a preprocedural algorithm able to predict recanalization failure with conventional devices (RFCD). Methods Observational study. Data from consecutive patients with stroke who received endovascular treatment between 2019 and 2022 in 10 centers were collected from the Catalan Stroke Registry (Codi Ictus Catalunya Registry, CICAT). RFCD was defined as final thrombolysis in cerebral infarction ≤2a or the use of rescue therapy defined as balloon angioplasty±stent deployment. Univariate and multivariate analysis to identify variables associated with RFCD were performed. A gradient boosted decision tree machine learning model to predict RFCD was developed utilizing preprocedure variables previously selected. Clinical improvement at 24 hours was defined as a drop of ≥4 points from baseline National Institutes of Health Stroke Scale score or 0–1 at 24 hours. Results In total, 984 patients were included; RFCD was observed in 14.3% (n:141) of the cases. Of these, 47.5% (n = 67) received balloon angioplasty±stent deployment as rescue therapy. Among patients receiving balloon angioplasty±stent deployment, clinical improvement was associated with lower number of attempts with conventional devices (median number of passes 2 versus 3; P = 0.045). In logistic regression, the absence of atrial fibrillation (odds ratio [OR]: 2.730, 95%CI: 1.541–4.836; P = 0.007) and no‐thrombolytic treatment (OR: 1.826, 95%CI: 1.230–2.711; P = 0.003) emerged as independent predictors of RFCD. A predictive model for RFCD, based on age, sex, hypertension, wake‐up stroke, baseline National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT [Computed Tomography] Score, occlusion site, thrombolysis, and atrial fibrillation showed an acceptable discrimination (area under the curve: 0.72±0.024 SD) and accuracy (0.75±0.015 SD). Overall performance was moderate (weighted F1‐score: 0.77±0.041 SD). Conclusion In RFCD patients, early balloon angioplasty±stent deployment rescue was associated with improved outcomes. A predictive model using affordable preprocedure clinical variables could be useful to identify these patients before intervention.
Published: 2024
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2. 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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3. Door‐In–Door‐Out Time Effect on Clinical Outcome According to Reperfusion Time in Endovascular Treatment

Author: Alan Flores, Laia SeróMD, Xavier Ustrell, Anna Pellisé, Jaume Viñas, Paula Rodriguez, Angela Monterde, Gislaine Castilho de Oliveira, Carlos A. Molina, Pedro Cardona, Adrian Valls, Joan Marti‐Fabregas, Eva Giralt‐Steinhauer, Joaquín Serena, Francisco Purroy, José Zaragoza‐Brunet, Oriol Barrachina, Manuel Gomez‐Choco, Ernest Palomeras, Dolores Cocho, Josep Maria Aragonés, Claudia Pedroza, Gloria Díaz, Xavier Jimenez, Alvaro Garcia‐Tornel, Marc Ribó, and Natalia Perez de la Ossa
Subjects: door‐in door‐out time, drip and ship, endovascular treatment, onset to reperfusion time, Neurology. Diseases of the nervous system, RC346-429, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background Door‐in–door‐out time (DIDO) in nonthrombectomy stroke centers is a key performance indicator in acute stroke care. Nonetheless, the relative importance of DIDO on outcome in patients transferred for endovascular treatment (EVT) is not widely known. Therefore, we aim to explore the association between DIDO and clinical outcome according to onset to reperfusion time in patients undergoing EVT. Methods Observational multicenter study including patients transferred to a thrombectomy‐capable center from a local stroke center who underwent thrombectomy. The primary outcome was favorable clinical outcome, as evaluated by a modified Rankin Scale score of 0 to 2 at 3 months. We evaluated the association between DIDO and clinical outcome according to onset to reperfusion time and factors related to shorter DIDO time. Results Among 2710 patients transferred for thrombectomy evaluation, 970 (43.8%) patients received EVT. Median baseline National Institutes of Health Stroke Scale and DIDO time were 12 (interquartile range [IQR], 6–19) and 83 minutes (IQR, 66–108), respectively. Among patients undergoing EVT, no association was found between DIDO and clinical outcome. Considering only patients treated in the early time window (onset to reperfusion time ≤240 minutes), patients with favorable outcome had a shorter DIDO (60 [IQR, 52–68] versus 73 [IQR, 61–83] minutes; P=0.013). A receiver operating characteristic curve identified a cutoff of 67 minutes of DIDO time that better predicted favorable outcome (sensitivity, 70%; specificity, 73%; area under the curve, 0.741). A multivariate analysis showed that DIDO ≤67 minutes emerged as an independent factor associated with favorable outcome (odds ratio [OR], 5.29 [95% CI, 1.38–20.27]; P=0.015). Door to computed tomography time was the only factor associated with DIDO ≤67 minutes (OR, 1.113 [95% CI, 1.018–1.261]; P=0.022) in a multivariate analysis in this time frame. Conclusions In transferred patients undergoing EVT, DIDO has a significant impact on clinical outcome, mainly in the first hours from stroke onset. A benchmark of 67 minutes in DIDO time is proposed. Shorter door to computed tomography time appears to be an independent factor associated to achieve DIDO time ≤67 minutes. Measures to optimize workflow into referral centers are warranted.
Published: 2022
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4. Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry

Author: Salvatore Rudilosso, José Ríos, Alejandro Rodríguez, Meritxell Gomis, Víctor Vera, Manuel Gómez-Choco, Arturo Renú, Núria Matos, Laura Llull, Francisco Purroy, Sergio Amaro, Mikel Terceño, Víctor Obach, Joaquim Serena, Joan Martí-Fàbregas, Pedro Cardona, Carlos Molina, Ana Rodríguez-Campello, David Cánovas, Jerzy Krupinski, Xavier Ustrell, Ferran Torres, Luis San Román, Mercè Salvat-Plana, Francesc Xavier Jiménez-Fàbrega, Ernest Palomeras, Esther Catena, Carla Colom, Dolores Cocho, Juanjo Baiges, Josep Maria Aragones, Gloria Diaz, Xavier Costa, María Cruz Almendros, Maria Rybyeba, Miquel Barceló, Dolors Carrión, Matilde Núria Lòpez, Eduard Sanjurjo, Natalia Pérez de la Ossa, Xabier Urra, Ángel Chamorro, and for the Catalan Stroke Code and Reperfusion (Cat-SCR) Consortium
Subjects: thrombectomy, stroke, prognosis, outcome, registries, propensity score, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background and Purpose In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score ≤2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score 3), good (if NIHSS
Published: 2021
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5. Accuracy of a Smartwatch to Assess Heart Rate Monitoring and Atrial Fibrillation in Stroke Patients

Author: Claudia Meza, Jesus Juega, Jaume Francisco, Alba Santos, Laura Duran, Maite Rodriguez, Jose Alvarez-Sabin, Laia Sero, Xavier Ustrell, Saima Bashir, Joaquín Serena, Yolanda Silva, Carlos Molina, and Jorge Pagola
Subjects: atrial fibrillation, stroke, wearable, smartwatch, screening, accuracy, Chemical technology, TP1-1185
Abstract: (1) Background: Consumer smartwatches may be a helpful tool to screen for atrial fibrillation (AF). However, validation studies on older stroke patients remain scarce. The aim of this pilot study from RCT NCT05565781 was to validate the resting heart rate (HR) measurement and the irregular rhythm notification (IRN) feature in stroke patients in sinus rhythm (SR) and AF. (2) Methods: Resting clinical HR measurements (every 5 min) were assessed using continuous bedside ECG monitoring (CEM) and the Fitbit Charge 5 (FC5). IRNs were gathered after at least 4 h of CEM. Lin’s concordance correlation coefficient (CCC), Bland-Altman analysis, and mean absolute percentage error (MAPE) were used for agreement and accuracy assessment. (3) Results: In all, 526 individual pairs of measurements were obtained from 70 stroke patients—age 79.4 years (SD ± 10.2), 63% females, BMI 26.3 (IQ 22.2–30.5), and NIHSS score 8 (IQR 1.5–20). The agreement between the FC5 and CEM was good (CCC 0.791) when evaluating paired HR measurements in SR. Meanwhile, the FC5 provided weak agreement (CCC 0.211) and low accuracy (MAPE 16.48%) when compared to CEM recordings in AF. Regarding the accuracy of the IRN feature, analysis found a low sensitivity (34%) and high specificity (100%) for detecting AF. (4) Conclusion: The FC5 was accurate at assessing the HR during SR, but the accuracy during AF was poor. In contrast, the IRN feature was acceptable for guiding decisions regarding AF screening in stroke patients.
Published: 2023
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6. Blood Biomarkers to Predict Long-Term Mortality after Ischemic Stroke

Author: Laura Ramiro, Laura Abraira, Manuel Quintana, Paula García-Rodríguez, Estevo Santamarina, Jose Álvarez-Sabín, Josep Zaragoza, María Hernández-Pérez, Xavier Ustrell, Blanca Lara, Mikel Terceño, Alejandro Bustamante, and Joan Montaner
Subjects: ischemic stroke, biomarker, mortality, endostatin, IL-6, TNF-R1, Science
Abstract: Stroke is a major cause of disability and death globally, and prediction of mortality represents a crucial challenge. We aimed to identify blood biomarkers measured during acute ischemic stroke that could predict long-term mortality. Nine hundred and forty-one ischemic stroke patients were prospectively recruited in the Stroke-Chip study. Post-stroke mortality was evaluated during a median 4.8-year follow-up. A 14-biomarker panel was analyzed by immunoassays in blood samples obtained at hospital admission. Biomarkers were normalized and standardized using Z-scores. Multiple Cox regression models were used to identify clinical variables and biomarkers independently associated with long-term mortality and mortality due to stroke. In the multivariate analysis, the independent predictors of long-term mortality were age, female sex, hypertension, glycemia, and baseline National Institutes of Health Stroke Scale (NIHSS) score. Independent blood biomarkers predictive of long-term mortality were endostatin > quartile 2, tumor necrosis factor receptor-1 (TNF-R1) > quartile 2, and interleukin (IL)-6 > quartile 2. The risk of mortality when these three biomarkers were combined increased up to 69%. The addition of the biomarkers to clinical predictors improved the discrimination (integrative discriminative improvement (IDI) 0.022 (0.007–0.048), p < 0.001). Moreover, endostatin > quartile 3 was an independent predictor of mortality due to stroke. Altogether, endostatin, TNF-R1, and IL-6 circulating levels may aid in long-term mortality prediction after stroke.
Published: 2021
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7. 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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8. 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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9. 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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10. 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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11. Abstract WP4: Intravenous Thrombolysis And Outcomes In Patients With Large-vessel Stroke Directly Admitted Or Transferred To A Thrombectomy-capable Center

Author: Alvaro Garcia-Tornel Garcia-Camba, Prudencio Lozano, Manuel Requena, David Rodriguez-Luna, Noelia Rodriguez-Villatoro, Marta Rubiera, Marian Muchada, Marta Olive-Gadea, Federica Rizzo, sandra boned, Marc Ribo, Carlos A Molina, Jorge Pagola, Jesús Juega, Laura Dorado, Xavier Jimenez-Fabrega, Pedro Cardona, Xabier Urra, Francisco Purroy, Mikel Terceño, Alan F Flores, Angel Chamorro, Yolanda Silva, Xavier Ustrell, Jose Zaragoza, Jaime Roquer, Jerzy Krupinski, Dolores Cocho, Ernest Palomeras, Manuel J Gomez-Choco, David Canovas, Joan Martí-Fàbregas, Natalia Mas, Olga Fagundez, Sonia Abilleira, and Natalia Perez de la Ossa
Subjects: Advanced and Specialized Nursing, Neurology (clinical), Cardiology and Cardiovascular Medicine
Abstract: Objective: To assess whether the effect of intravenous thrombolysis in patients with large-vessel occlusion differed between patients directly admitted to thrombectomy-capable centers and patients transferred from local stroke centers without thrombectomy capabilities. Methods: We included 3206 patients with an acute ischemic large-vessel stroke with first imaging within 7 hours after onset that were directly admitted to thrombectomy-capable centers and treated with thrombectomy, or transferred from local stroke centers for thrombectomy evaluation, between 2017 and 2021 in Catalonia, Spain. Primary outcome was the degree of disability at 90 days, as evaluated by the shift analysis on the mRs score. Secondary outcomes included mortality 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 (975[49%] treated with thrombolysis) directly admitted to thrombectomy-capable centers and 938 patients (580[66%] treated with thrombolysis and 616[67%] treated with thrombectomy) transferred from local stroke centers (mean age 72±13 years, median NIHSS score 17[IQR 12-21], 1363 female[48%]). Patients treated with intravenous thrombolysis were younger, had shorter time from onset to first image acquisition, and higher rates of wake-up stroke, atrial fibrillation and anticoagulation intake. The effect of intravenous thrombolysis on the primary outcome was similar in patients directly admitted to thrombectomy-capable centers (acOR 1.50, 95% CI 1.24-1.81) and patients transferred from local stroke centers (acOR 1.44, 95% CI 1.04 to 2.01)(p interaction =0.68). Patients treated with intravenous thrombolysis had lower mortality rate, higher rate of parenchymal hematoma and similar rate of successful reperfusion, with no difference according to type of center (p interaction >0.1). Conclusion: Administration of intravenous thrombolysis in patients with a large-vessel stroke with intention to thrombectomy was associated with higher odds of good functional outcome and higher rates of parenchymal hematoma, independently of the type of stroke center were it was administered.
Published: 2023
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12. Determinants and Trends of the Use of Intravenous Thrombolysis for Minor Stroke: A Population-Based Study, 2016 to 2020

Author: Maria Àngels, Font, Sonia María, García-Sánchez, Juan José, Mengual, Luis, Mena, Carla, Avellaneda, Joaquín, Serena, Adrián, Valls-Carbó, Ángel, Chamorro, Xavier, Ustrell, Carlos, Molina, Pere, Cardona, Marina, Guasch-Jiménez, Francisco, Purroy, Ana, Rodríguez-Campello, Ernest, Palomeras, Dolores, Cocho, Jerzy, Krupinski, David, Cánovas, Jessica, García-Alhama, José, Zaragoza, Elsa, Puiggròs, Nuria, Matos, Josep Maria, Aragonès, Xavier, Costa, Eduard, Sanjurjo, Claudia, Pedroza, Jordi, Monedero, M Cruz, Almendros, Maria, Rybyeva, Dolors, Carrión, Glòria, Díaz, Miquel, Barceló, Xavier, Jiménez-Fàbrega, Mercè, Salvat-Plana, Roberto, Elosúa, Natalia, Pérez de la Ossa, and Manuel, Gómez-Choco
Subjects: Advanced and Specialized Nursing, Stroke, Treatment Outcome, Fibrinolytic Agents, Humans, Female, Thrombolytic Therapy, Neurology (clinical), Prospective Studies, Cardiology and Cardiovascular Medicine, Brain Ischemia, Ischemic Stroke, Thrombectomy
Abstract: Background: We analyzed the main factors associated with intravenous thrombolysis (IVT) in patients with minor ischemic stroke. Methods: Data were obtained from a prospective, government-mandated, population-based registry of stroke code patients in Catalonia (6 Comprehensive Stroke Centers, 8 Primary Stroke Centers, and 14 TeleStroke Centers). We selected patients diagnosed with ischemic stroke and National Institutes of Health Stroke Scale (NIHSS) ≤5 at hospital admission from January 2016 to December 2020. We excluded patients with a baseline modified Rankin Scale score of ≥3, absolute contraindication for IVT, unknown stroke onset, or admitted to hospital beyond 4.5 after stroke onset. The main outcome was treatment with IVT. We performed univariable and binary logistic regression analyses to identify the most important factors associated with IVT. Results: We included 2975 code strokes; 1433 (48.2%) received IVT of which 30 (2.1%) had a symptomatic hemorrhagic transformation. Patients treated with IVT as compared to patients who did not receive IVT were more frequently women, had higher NIHSS, arrived earlier to hospital, were admitted to a Comprehensive Stroke Centers, and had large vessel occlusion. After binary logistic regression, NIHSS score 4 to 5 (odds ratio, 40.62 [95% CI, 31.73–57.22]; P P Conclusions: Minor stroke female patients, with higher NIHSS, arriving earlier to the hospital, presenting with large vessel occlusion and admitted to a Comprehensive Stroke Centers were more likely to receive intravenous thrombolysis.
Published: 2022

13. Influence of vascular imaging acquisition at local stroke centers on workflows in the drip-n-ship model: a RACECAT post hoc analysis

Author: Alan Flores, Alvaro Garcia-Tornel, Laia Seró, Xavier Ustrell, Manuel Requena, Anna Pellisé, Paula Rodriguez, Angela Monterde, Lidia Lara, Jose María Gonzalez-de-Echavarri, Carlos A Molina, Antonio Doncel-Moriano, Laura Dorado, Pedro Cardona, David Cánovas, Jerzy Krupinski, Natalia Más, Francisco Purroy, Jose Zaragoza-Brunet, Ernesto Palomeras, Dolores Cocho, Jessica Garcia, Carla Colom, Yolanda Silva, Manuel Gomez-Cocho, Xavier Jiménez, Josep Ros-Roig, Sonia Abilleira, Natalia Pérez de la Ossa, and Marc Ribo
Subjects: Surgery, Neurology (clinical), General Medicine
Abstract: BackgroundThe influence of vascular imaging acquisition on workflows at local stroke centers (LSCs) not capable of performing thrombectomy in patients with a suspected large vessel occlusion (LVO) stroke remains uncertain. We analyzed the impact of performing vascular imaging (VI+) or not (VI− at LSC arrival on variables related to workflows using data from the RACECAT Trial.ObjectiveTo compare workflows at the LSC among patients enrolled in the RACECAT Trial with or without VI acquisition.MethodsWe included patients with a diagnosis of ischemic stroke who were enrolled in the RACECAT Trial, a cluster-randomized trial that compared drip-n-ship versus mothership triage paradigms in patients with suspected acute LVO stroke allocated at the LSC. Outcome measures included time metrics related to workflows and the rate of interhospital transfers and thrombectomy among transferred patients.ResultsAmong 467 patients allocated to a LSC, vascular imaging was acquired in 277 patients (59%), of whom 198 (71%) had a LVO. As compared with patients without vascular imaging, patients in the VI+ group were transferred less frequently as thrombectomy candidates to a thrombectomy-capable center (58% vs 74%, P=0.004), without significant differences in door-indoor-out time at the LSC (median minutes, VI+ 78 (IQR 69–96) vs VI− 76 (IQR 59–98), P=0.6). Among transferred patients, the VI+ group had higher rate of thrombectomy (69% vs 55%, P=0.016) and shorter door to puncture time (median minutes, VI+ 41 (IQR 26–53) vs VI− 54 (IQR 40–70), PConclusionAmong patients with a suspected LVO stroke initially evaluated at a LSC, vascular imaging acquisition might improve workflow times at thrombectomy-capable centers and reduce the rate of futile interhospital transfers. These results deserve further evaluation and should be replicated in other settings and geographies.
Published: 2023
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14. D-Dimer as Predictor of Large Vessel Occlusion in Acute Ischemic Stroke

Author: Alejandro Bustamante, Mikel Terceño, Joaquín Serena, Mónica Millán, Natalia Pérez de la Ossa, María Hernández-Pérez, Xavier Ustrell, Teresa García-Berrocoso, Joan Montaner, Antoni Dávalos, Marta Rubiera, Anna Ramos-Pachón, Elena López-Cancio, Moisés Garcés, and Pere Cardona
Subjects: Male, medicine.medical_specialty, patients, Brain Ischemia, Fibrin Fibrinogen Degradation Products, Predictive Value of Tests, Internal medicine, Atrial Fibrillation, D-dimer, medicine, Humans, Prospective Studies, cardiovascular diseases, Prehospital triage, Stroke, Acute ischemic stroke, Aged, Ischemic Stroke, Retrospective Studies, Thrombectomy, Advanced and Specialized Nursing, business.industry, Endovascular Procedures, biomarkers, Middle Aged, medicine.disease, stroke, reperfusion, thrombectomy, Reperfusion, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Biomarkers, Large vessel occlusion
Abstract: Background and Purpose: Improving prehospital triage of large vessel occlusion (LVO) would reduce time to reperfusion therapies. We aimed to study early predictors of LVO in acute ischemic stroke to identify candidates for endovascular treatment. Methods: The Stroke-Chip was a prospective observational study conducted at 6 Stroke Centers in Catalonia. Blood samples were obtained in the first 6 hours from symptom onset of consecutive patients. Stroke severity was evaluated with National Institutes of Health Stroke Scale (NIHSS) and LVO was assessed. Independent association of multiple blood biomarkers with LVO was evaluated using logistic regression models adjusted by covariates. Sensitivity, specificity, and predictive values were assessed for NIHSS and the combination of NIHSS and selected serum biomarkers levels. Results: One thousand three hundred eight suspected strokes were enrolled for a 17-month period. LVO was not assessed in 131 patients. One thousand one hundred seventy-seven patients were selected for analysis (mean age 69.3 years, 56% men, median baseline NIHSS of 6, and median time to blood collection 2.5 hours). LVO was detected in 262 patients. LVO patients were older, had higher baseline NIHSS, history of atrial fibrillation, and lower time from stroke onset to admission. After logistic regression analysis, D-dimer remained an independent predictor of LVO (odds ratio, 1.59 [1.31–1.92]). Specificity and positive predictive value to exclude or detect LVO were higher when using combined D-dimer levels and NIHSS score assessment rather than NIHSS alone. Conclusions: Early D-dimer levels are an independent predictor of LVO and may be useful to better optimize prehospital patient transport to the appropriate stroke center.
Published: 2021
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15. Abstract 148: Impact Of Performing Vascular Imaging At Local Stroke Centers On Functional Outcome In The Drip And Ship Model. A Racecat Sub-study

Author: Alan Flores, Alvaro García-Tornel, Laia Seró, Xavier Ustrell, Anna Pellise, Gislaine Castilho, Sonia Abilleira, Natalia Perez De La Ossa, and Marc Ribo
Subjects: Advanced and Specialized Nursing, Neurology (clinical), Cardiology and Cardiovascular Medicine
Abstract: Background: Although recommended, impact of vascular imaging performed to determine a large vessel occlusion (LVO) at local stroke centers on functional outcome in the drip and ship model is uncertain. Our aim was to compare functional outcomes in patients with (VI+) and without (VI-) vascular imaging at local stroke center using data from the RACECAT trial. Methods: RACECAT study was a multicenter, cluster-randomized trial that compared drip-n-ship vs. mother-ship models in acute stroke patients with LVO suspicion based on the prehospital RACE scale, performed in the period of March 2017 to Juny 2020. Patients allocated to Local-center arm, were included in this substudy to evaluate the impact of performing VI (CT-Angiography) at Local-center on functional outcome at 3 months assessed by modified Rankin scale (mRS) Results: From 690 patients, ischemic stroke or transient ischemic attack was diagnosed in 467. Among these, a vascular imaging was performed at the Local-center in 55.6% (n:260), of which an LVO was confirmed in 76.1% (n:198). No differences in baseline characteristics were observed between VI+ and VI- groups. The rate iv-tPA treatment at Local-centers was higher in VI+ (67.8% vs. 54.2%; p=0.004) with shorter door-to-needle times time (VI+: 31 (24-44) Vs VI-: 39 (27-56) minutes, p=0.003). The rate of patients receiving endovascular treatment at the comprehensive center was similar (VI+: 41.9% Vs VI-:39.4%; p=0.602), however VI+ patients presented shorter time from EVT-center arrival to groin-puncture (VI+: 37 (26-48) Vs VI-:52 (42-70) minutes; p Conclusion: Initial evaluation in a local stroke center capable to efficiently perform vascular imaging might be associated with better long term functional outcome in stroke patients with high suspicion of LVO. Whether this association is related to vascular imaging acquisition or a better performance of centers in which it is acquired should be further evaluated.
Published: 2022
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16. The Role of Vascular Imaging atReferral Centers in the Drip and Ship Paradigm

Author: Sergi Amaro, María Hernández-Pérez, José Zaragoza-Brunet, Marta Rubiera, Joan Martí-Fàbregas, Laia Seró, Joaquín Serena, Anna Pellisé, Jordi Monedero, Dolores Cocho, Francesc Xavier Jiménez-Fàbrega, Carlos A. Molina, Xavier Costa, Maria Angels Font Padrós, Jaume Viñas, Paula Rodriguez, Gislaine Castilho, Pedro Cardona, Natalia Pérez de la Ossa, Eduard Sanjurjo, Alan Flores, Marc Ribó, Francisco Purroy, Esther Catena, Xavier Ustrell, Maria Rybyeba, Gloria Diaz, E. Palomeras, Catalan Stroke Code, Dolors Carrión, Angela Monterde, Jurek Kuprinski, Manuel Gómez-Choco, Miquel Barceló, and Natalia Más
Subjects: Male, Patient Transfer, medicine.medical_specialty, Multivariate analysis, Thrombolytic treatment, Population, Referral centers, Drip and ship paradigm, Severe stroke, Brain Ischemia, Internal medicine, medicine, Humans, Organized stroke care, Endovascular treatment, Prospective Studies, education, Stroke, Aged, Aged, 80 and over, education.field_of_study, Vascular imaging, business.industry, Endovascular Procedures, Rehabilitation, Middle Aged, medicine.disease, Outcome and Process Assessment, Health Care, Treatment Outcome, Multicenter study, Cardiology, Female, Surgery, Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Abstract: Background: In drip-and-ship protocols, non-invasive vascular imaging (NIVI) at Referral Centers (RC), although recommended, is not consistently performed and its value is uncertain. We evaluated the role of NIVI at RC, comparing patients with (VI+) and without (VI-) vascular imaging in several outcomes. Methods: Observational, multicenter study from a prospective government-mandated population-based registry of code stroke patients. We selected acute ischemic stroke patients, initially assessed at RC from January-2016 to June-2020. We compared and analyzed the rates of patients transferred to a Comprehensive Stroke Center (CSC) for Endovascular Treatment (EVT), rates of EVT and workflow times between VI+ and VI-patients. Results: From 5128 ischemic code stroke patients admitted at RC; 3067 (59.8%) were VI+, 1822 (35.5%) were secondarily transferred to a CSC and 600 (11.7%) received EVT. Among all patients with severe stroke (NIHSS >16) at RC, a multivariate analysis showed that lower age, thrombolytic treatment, and VI+ (OR:1.479, CI95%: 1.117-1.960, p=0.006) were independent factors associated to EVT. The rate of secondary transfer to a CSC was lower in VI+ group (24.6% vs. 51.6%, p
Published: 2022

17. Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data

Author: Götz Thomalla, Florent Boutitie, Henry Ma, Masatoshi Koga, Peter Ringleb, Lee H Schwamm, Ona Wu, Martin Bendszus, Christopher F Bladin, Bruce C V Campbell, Bastian Cheng, Leonid Churilov, Martin Ebinger, Matthias Endres, Jochen B Fiebach, Mayumi Fukuda-Doi, Manabu Inoue, Timothy J Kleinig, Lawrence L Latour, Robin Lemmens, Christopher R Levi, Didier Leys, Kaori Miwa, Carlos A Molina, Keith W Muir, Norbert Nighoghossian, Mark W Parsons, Salvador Pedraza, Peter D Schellinger, Stefan Schwab, Claus Z Simonsen, Shlee S Song, Vincent Thijs, Danilo Toni, Chung Y Hsu, Nils Wahlgren, Haruko Yamamoto, Nawaf Yassi, Sohei Yoshimura, Steven Warach, Werner Hacke, Kazunori Toyoda, Geoffrey A Donnan, Stephen M Davis, Christian Gerloff, Boris Raul Acosta, Karen Aegidius, Christian Albiker, Anna Alegiani, Miriam Almendrote, Angelika Alonso, Katharina Althaus, Pierre Amarenco, Hemasse Amiri, Bettina Anders, Adriana Aniculaesei, Jason Appleton, Juan Arenillas, Christina Back, Christian Bähr, Jürgen Bardutzky, Flore Baronnet-Chauvet, Rouven Bathe-Peters, Anna Bayer-Karpinska, Juan L. Becerra, Christoph Beck, Olga Belchí Guillamon, Amandine Benoit, Nadia Berhoune, Daniela Bindila, Julia Birchenall, Karine Blanc-Lasserre, Miguel Blanco Gonzales, Tobias Bobinger, Ulf Bodechtel, Eric Bodiguel, Urszula Bojaryn, Louise Bonnet, Benjamin Bouamra, Paul Bourgeois, Lorenz Breuer, Ludovic Breynaert, David Broughton, Raf Brouns, Sébastian Brugirard, Bart Bruneel, Florian Buggle, Serkan Cakmak, Ana Calleja, David Calvet, David Carrera, Hsin-Chieh Chen, Bharath Cheripelli, Tae-Hee Cho, Chi-un Choe, Lillian Choy, Hanne Christensen, Mareva Ciatipis, Geoffrey Cloud, Julien Cogez, Elisa Cortijo, Sophie Crozier, Dorte Damgaard, Krishna Dani, Beatrijs De Coene, Isabel De Hollander, Jacques De Keyser, Nina De Klippel, Charlotte De Maeseneire, Ann De Smedt, Maria del Mar Castellanos Rodrigo, Sandrine Deltour, Jelle Demeestere, Laurent Derex, Philippe Desfontaines, Ralf Dittrich, Anand Dixit, Laurens Dobbels, Valérie Domigo, Laura Dorado, Charlotte Druart, Kristina Hougaard Dupont, Anne Dusart, Rainer Dziewas, Matthias Ebner, Myriam Edjali-Goujon, Philipp Eisele, Salwa El Tawil, Ahmed Elhfnawy, Ana Etexberria, Nicholas Evans, Simon Fandler, Franz Fazekas, Sandra Felix, Jochen B. Fiebach, Jens Fiehler, Alexandra Filipov, Katharina Filipski, Robert Fleischmann, Christian Foerch, Ian Ford, Alexandra Gaenslen, Ivana Galinovic, Elena Meseguer Gancedo, Ramanan Ganeshan, Carlos García Esperón, Alicia Garrido, Thomas Gattringer, Olivia Geraghty, Rohat Geran, Stefan Gerner, Sylvie Godon-Hardy, Jos Göhler, Amir Golsari, Meritxell Gomis, David Gorriz, Verena Gramse, Laia Grau, Martin Griebe, Cristina Guerrero, Damla Guerzoglu, Sophie Guettier, Vincent Guiraud, Christoph Gumbinger, Ignaz Gunreben, Florian Haertig, Christian Hametner, Bernard Hanseeuw, Andreas Hansen, Jakob Hansen, Thomas Harbo, Andreas Harloff, Peter Harmel, Karl Georg Häusler, Florian Heinen, Valentin Held, Simon Hellwig, Dimitri Hemelsoet, Michael Hennerici, Juliane Herm, Sylvia Hermans, María Hernández, Jose Hervas Vicente, Niels Hjort, Cristina Hobeanu, Carsten Hobohm, Elmar Höfner, Katharina Hohenbichler, Marc Hommel, Julia Hoppe, Eva Hornberger, Carolin Hoyer, Xuya Huang, Nils Ipsen, Irina Isern, Lourdes Ispierto, Helle Iversen, Lise Jeppesen, Marta Jimenez, Jan Jungehülsing, Eric Jüttler, Dheeraj Kalladka, Bernd Kallmünzer, Arindam Kar, Lars Kellert, André Kemmling, Tobias Kessler, Usman Khan, Matthias Klein, Christoph Kleinschnitz, Matti Klockziem, Michael Knops, Luzie Koehler, Martin Koehrmann, Heinz Kohlfürst, Rainer Kollmar, Peter Kraft, Thomas Krause, Bo Kristensen, Jan M. Kröber, Natalia Kurka, Alexandre Ladoux, Patrice Laloux, Catherine Lamy, Emmanuelle Landrault, Arne Lauer, Claire Lebely, Jonathan Leempoel, Kennedy Lees, Anne Leger, Laurence Legrand, Lin Li, Anna-Mareike Löbbe, Frederic London, Elena Lopez-cancio, Matthias Lorenz, Stephen Louw, Caroline Lovelock, Manuel Lozano Sánchez, Giuseppe Lucente, Janos Lückl, Alain Luna, Kosmas Macha, Alexandre Machet, Daniel Mackenrodt, Dominik Madzar, Charles Majoie, Anika Männer, Vicky Maqueda, Jacob Marstrand, Alicia Martinez, Annika Marzina, Laura Mechthouff, Per Meden, Guy Meersman, Julia Meier, Charles Mellerio, Oliver Menn, Nadja Meyer, Dominik Michalski, Peter Michels, Lene Michelsen, Monica Millán Torne, Jens Minnerup, Boris Modrau, Sebastian Moeller, Anette Møller, Nathalie Morel, Fiona Moreton, Ludovic Morin, Thierry Moulin, Barry Moynihan, Anne K. Mueller, Keith W. Muir, Patricia Mulero, Sibu Mundiyanapurath, Johannes Mutzenbach, Simon Nagel, Oliver Naggara, Arumugam Nallasivan, Irene Navalpotro, Alexander H. Nave, Paul Nederkoorn, Lars Neeb, Hermann Neugebauer, Tobias Neumann-Haefelin, Stefan Oberndorfer, Christian Opherk, Lorenz Oppel, Catherine Oppenheim, Johannes Orthgieß, Leif Ostergaard, Perrine Paindeville, Ernest Palomeras, Verena Panitz, Bhavni Patel, Andre Peeters, Dirk Peeters, Anna Pellisé, Johann Pelz, Anthony Pereira, Natalia Pérez de la Ossa, Richard Perry, Salvador Petraza, Stéphane Peysson, Waltraud Pfeilschifter, Alexander Pichler, Alexandra Pierskalla, Hans-Werner Pledl, Sven Poli, Katrin Pomrehn, Marika Poulsen, Luis Prats, Silvia Presas, Elisabeth Prohaska, Volker Puetz, Josep Puig, Josep Puig Alcántara, Jan Purrucker, Veronique Quenardelle, Sankaranarayanan Ramachandran, Soulliard Raphaelle, Nicolas Raposo, Tilman Reiff, Michel Remmers, Pauline Renou, Martin Ribitsch, Hardy Richter, Martin Ritter, Thomas Ritzenthaler, Gilles Rodier, Christine Rodriguez-Regent, Manuel Rodríguez-Yáñez, Maria Roennefarth, Christine Roffe, Sverre Rosenbaum, Charlotte Rosso, Joachim Röther, Michal Rozanski, Noelia Ruiz de Morales, Francesca Russo, Matthieu Rutgers, Sharmilla Sagnier, Yves Samson, Josep Sánchez, Tamara Sauer, Jan H. Schäfer, Simon Schieber, Josef Schill, Dennis Schlak, Ludwig Schlemm, Sein Schmidt, Wouter Schonewille, Julian Schröder, Andreas Schulz, Johannes Schurig, Sönke Schwarting, Alexander Schwarz, Christopher Schwarzbach, Matthias Seidel, Alexander Seiler, Jochen Sembill, Joaquin Serena Leal, Ashit Shetty, Igor Sibon, Claus Z. Simonsen, Oliver Singer, Aravinth Sivagnanaratham, Ide Smets, Craig Smith, Peter Soors, Nikola Sprigg, Maximilian Spruegel, David Stark, Susanne Steinert, Sebastian Stösser, Markus Stuermlinger, Bart Swinnen, Ruben Tamazyan, Jose Tembl, Mikel Terceno Izaga, Emmanuel Touze, Thomas Truelsen, Guillaume Turc, Gaetane Turine, Serdar Tütüncü, Pippa Tyrell, Xavier Ustrell, Wilfried Vadot, Anne-Evelyne Vallet, Pauline Vallet, Lucie van den Berg, Sophie van den Berg, Cecile van Eendenburg, Robbert-Jan Van Hooff, Isabelle van Sloten, Peter Vanacker, Evelien Vancaester, Patrick Vanderdonckt, Yves Vandermeeren, Frederik Vanhee, Roland Veltkamp, Karsten Vestergaard, Alain Viguier, Dolores Vilas, Kersten Villringer, Dieke Voget, Jörg von Schrader, Paul von Weitzel, Elisabeth Warburton, Claudia Weber, Jörg Weber, Karl Wegscheider, Mirko Wegscheider, Christian Weimar, Karin Weinstich, Christopher Weise, Gesa Weise, Chris Willems, Klemens Winder, Matthias Wittayer, Marc Wolf, Martin Wolf, Valerie Wolff, Christian Wollboldt, Frank Wollenweber, Anke Wouters, Bertrand Yalo, Marion Yger, Nadia Younan, Laetita Yperzeele, Vesna Zegarac, Pia Zeiner, Ulf Ziemann, Thomas Zonneveld, Mathieu Zuber, Tsugio Akutsu, Junya Aoki, Shuji Arakawa, Ryosuke Doijiri, Yusuke Egashira, Yukiko Enomoto, Eisuke Furui, Konosuke Furuta, Seiji Gotoh, Toshimitsu Hamasaki, Yasuhiro Hasegawa, Teryuki Hirano, Kazunari Homma, Masahiko Ichijyo, Toshihiro Ide, Shuichi Igarashi, Yasuyuki Iguchi, Masafumi Ihara, Hajime Ikenouchi, Tsuyoshi Inoue, Ryo Itabashi, Yasuhiro Ito, Toru Iwama, Kenji Kamiyama, Shoko Kamiyoshi, Haruka Kanai, Yasuhisa Kanematsu, Takao Kanzawa, Kazumi Kimura, Jiro Kitayama, Takanari Kitazono, Rei Kondo, Kohsuke Kudo, Masayoshi Kusumi, Ken Kuwahara, Shoji Matsumoto, Hideki Matsuoka, Ban Mihara, Kazuo Minematsu, Ken Miura, Naomi Morita, Wataru Mouri, Kayo Murata, Yoshinari Nagakane, Taizen Nakase, Hiromi Ohara, Nobuyuki Ohara, Hideyuki Ohnishi, Hajime Ohta, Masafumi Ohtaki, Ryo Ohtani, Toshiho Ohtsuki, Hideo Ohyama, Takashi Okada, Yasushi Okada, Masato Osaki, Nobuyuki Sakai, Yoshiki Sanbongi, Naoshi Sasaki, Makoto Sasaki, Shoichiro Sato, Kenta Seki, Wataru Shimizu, Yoshiaki Shiokawa, Takashi Sozu, Junichiro Suzuki, Rieko Suzuki, Yasushi Takagi, Shunya Takizawa, Norio Tanahashi, Eijiro Tanaka, Ryota Tanaka, Yohei Tateishi, Tomoaki Terada, Tadashi Terasaki, Kenichi Todo, Azusa Tokunaga, Akira Tsujino, Toshihiro Ueda, Yoshikazu Uesaka, Mihoko Uotani, Takao Urabe, Masao Watanabe, Yoshiki Yagita, Yusuke Yakushiji, Keizo Yasui, Toshiro Yonehara, Shinichi Yoshimura, K. Aarnio, F. Alemseged, C. Anderson, T. Ang, M.L. Archer, J. Attia, P. Bailey, A. Balabanski, A. Barber, P.A. Barber, J. Bernhardt, A. Bivard, D. Blacker, C.F. Bladin, A. Brodtmann, D. Cadilhac, B.C.V. Campbell, L. Carey, S. Celestino, L. Chan, W.H. Chang, A. ChangI, C.H. Chen, C.-I. Chen, H.F. Chen, T.C. Chen, W.H. Chen, Y.Y. Chen, C.A. Cheng, E. Cheong, Y.W. Chiou, P.M. Choi, H.J. Chu, C.S. Chuang, T.C. Chung, L. Churilov, B. Clissold, A. Connelly, S. Coote, B. Coulton, E. Cowley, J. Cranefield, S. Curtze, C. D'Este, S.M. Davis, S. Day, P.M. Desmond, H.M. Dewey, C. Ding, G.A. Donnan, R. Drew, S. Eirola, D. Field, T. Frost, C. Garcia-Esperon, K. George, R. Gerraty, R. Grimley, Y.C. Guo, G. Hankey, J. Harvey, S.C. Ho, K. Hogan, D. Howells, P.M. Hsiao, C.H. Hsu, C.T. Hsu, C.-S. Hsu, J.P. Hsu, Y.D. Hsu, Y.T. Hsu, C.J. Hu, C.C. Huang, H.Y. Huang, M.Y. Huang, S.C. Huang, W.S. Huang, D. Jackson, J.S. Jeng, S.K. Jiang, L. Kaauwai, O. Kasari, J. King, T.J. Kleinig, M. Koivu, J. Kolbe, M. Krause, C.W. Kuan, W.L. Kung, C. Kyndt, C.L. Lau, A. Lee, C.Y. Lee, J.T. Lee, Y. Lee, Y.C. Lee, C. Levi, C.R. Levi, L.M. Lien, J.C. Lim, C.C. Lin, C.H. Lin, C.M. Lin, D. Lin, C.H. Liu, J. Liu, Y.C. Lo, P.S. Loh, E. Low, C.H. Lu, C.J. Lu, M.K. Lu, J. Ly, H. Ma, L. Macaulay, R. Macdonnell, E. Mackey, M. Macleod, J. Mahadevan, V. Maxwell, R. McCoy, A. McDonald, S. McModie, A. Meretoja, S. Mishra, P.J. Mitchell, F. Miteff, A. Moore, C. Muller, F. Ng, F.C. Ng, J-L. Ng, W. O'Brian, V. O'Collins, T.J. Oxley, M.W. Parsons, S. Patel, G.S. Peng, L. Pesavento, T. Phan, E. Rodrigues, Z. Ross, A. Sabet, M. Sallaberger, P. Salvaris, D. Shah, G. Sharma, G. Sibolt, M. Simpson, S. Singhal, B. Snow, N. Spratt, R. Stark, J. Sturm, M.C. Sun, Y. Sun, P.S. Sung, Y.F. Sung, M. Suzuki, M. Tan, S.C. Tang, T. Tatlisumak, V. Thijs, M. Tiainen, C.H. Tsai, C.K. Tsai, C.L. Tsai, H.T. Tsai, L.K. Tsai, C.H. Tseng, L.T. Tseng, J. Tsoleridis, H. Tu, H.T-H. Tu, W. Vallat, J. Virta, W.C. Wang, Y.T. Wang, M. Waters, L. Weir, T. Wijeratne, C. Williams, W. Wilson, A.A. Wong, K. Wong, T.Y. Wu, Y.H. Wu, B. Yan, F.C. Yang, Y.W. Yang, N. Yassi, H.L. Yeh, J.H. Yeh, S.J. Yeh, C.H. Yen, D. Young, C.L. Ysai, W.W. Zhang, H. Zhao, L. Zhao, Katharina Althaus-Knaurer, Jörg Berrouschot, Erich Bluhmki, Paolo Bovi, Gilles Chatellier, Lynda Cove, Stephen Davis, A. Dixit, Geoffrey Donnan, Christina Ehrenkrona, Christoph Eschenfelder, Marc Fatar, Juan Francisco Arenillas, Franz Gruber, Lalit Kala, Peter Kapeller, Markku Kaste, Christof Kessler, Martin Köhrmann, Rico Laage, Kennedy R. Lees, Alain Luna Rodriguez, Jean-Louis Mas, Robert Mikulik, Carlos Molina, Girish Muddegowda, Keith Muir, Kurt Niederkorn, Xavier Nuñez, Peter Schellinger, Joaquin Serena, Jan Sobesky, Thorsten Steiner, Ann-Sofie Svenson, Rüdiger von Kummer, Joanna Wardlaw, Rebecca A. Betensky, Gregoire Boulouis, Raphael A. Carandang, William A. Copen, Pedro Cougo, Shawna Cutting, Kendra Drake, Andria L. Ford, John Hallenbeck, Gordon J. Harris, Robert Hoesch, Amie Hsia, Carlos Kase, Lawrence Latour, Michael H. Lev, Alona Muzikansky, Nandakumar Nagaraja, Lee H. Schwamm, Eric Searls, Shlee S. Song, Sidney Starkman, Albert J. Yoo, Ramin Zand, Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), Hospices Civils de Lyon (HCL), Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon, Monash University [Melbourne], National Cerebral and Cardiovascular Center (NCCC - OSAKA), Osaka University [Osaka], University of Heidelberg, Medical Faculty, Massachusetts General Hospital [Boston], University of Melbourne, Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Royal Adelaide Hospital [Adelaide Australia], National Institute of Neurological Disorders and Stroke [Bethesda] (NINDS), National Institutes of Health [Bethesda] (NIH), University Hospitals Leuven [Leuven], Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Flanders Make [Leuven], Flanders Make, University of Newcastle [Australia] (UoN), Troubles cognitifs dégénératifs et vasculaires - U 1171 (TCDV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Vall d'Hebron University Hospital [Barcelona], University of Glasgow, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Girona Biomedical Research Institute [Girona, Spain] (IDIBGI), Ruhr-Universität Bochum [Bochum], Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Aarhus University Hospital, Cedars-Sinai Medical Center, Florey Institute of Neuroscience and Mental Health [Melbourne, Victoria, Australia], Austin Health, Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome], China Medical University Hospital [Taichung], Karolinska Institutet [Stockholm], The Walter and Eliza Hall Institute of Medical Research (WEHI), University of Texas at Austin [Austin], Collaborators Evaluation of unknown Onset Stroke thrombolysis trials (EOS) investigators: Boris Raul Acosta, Karen Aegidius, Christian Albiker, Anna Alegiani, Miriam Almendrote, Angelika Alonso, Katharina Althaus, Pierre Amarenco, Hemasse Amiri, Bettina Anders, Adriana Aniculaesei, Jason Appleton, Juan Arenillas, Christina Back, Christian Bähr, Jürgen Bardutzky, Flore Baronnet-Chauvet, Rouven Bathe-Peters, Anna Bayer-Karpinska, Juan L Becerra, Christoph Beck, Olga Belchí Guillamon, Amandine Benoit, Nadia Berhoune, Daniela Bindila, Julia Birchenall, Karine Blanc-Lasserre, Miguel Blanco Gonzales, Tobias Bobinger, Ulf Bodechtel, Eric Bodiguel, Urszula Bojaryn, Louise Bonnet, Benjamin Bouamra, Paul Bourgeois, Florent Boutitie, Lorenz Breuer, Ludovic Breynaert, David Broughton, Raf Brouns, Sébastian Brugirard, Bart Bruneel, Florian Buggle, Serkan Cakmak, Ana Calleja, David Calvet, David Carrera, Hsin-Chieh Chen, Bastian Cheng, Bharath Cheripelli, Tae-Hee Cho, Chi-Un Choe, Lillian Choy, Hanne Christensen, Mareva Ciatipis, Geoffrey Cloud, Julien Cogez, Elisa Cortijo, Sophie Crozier, Dorte Damgaard, Krishna Dani, Beatrijs De Coene, Isabel De Hollander, Jacques De Keyser, Nina De Klippel, Charlotte De Maeseneire, Ann De Smedt, Maria Del Mar Castellanos Rodrigo, Sandrine Deltour, Jelle Demeestere, Laurent Derex, Philippe Desfontaines, Ralf Dittrich, Anand Dixit, Laurens Dobbels, Valérie Domigo, Laura Dorado, Charlotte Druart, Kristina Hougaard Dupont, Anne Dusart, Rainer Dziewas, Martin Ebinger, Matthias Ebner, Myriam Edjali-Goujon, Philipp Eisele, Salwa El Tawil, Ahmed Elhfnawy, Matthias Endres, Ana Etexberria, Nicholas Evans, Simon Fandler, Franz Fazekas, Sandra Felix, Jochen B Fiebach, Jens Fiehler, Alexandra Filipov, Katharina Filipski, Robert Fleischmann, Christian Foerch, Ian Ford, Alexandra Gaenslen, Ivana Galinovic, Elena Meseguer Gancedo, Ramanan Ganeshan, Carlos García Esperón, Alicia Garrido, Thomas Gattringer, Olivia Geraghty, Rohat Geran, Christian Gerloff, Stefan Gerner, Sylvie Godon-Hardy, Jos Göhler, Amir Golsari, Meritxell Gomis, David Gorriz, Verena Gramse, Laia Grau, Martin Griebe, Cristina Guerrero, Damla Guerzoglu, Sophie Guettier, Vincent Guiraud, Christoph Gumbinger, Ignaz Gunreben, Florian Haertig, Christian Hametner, Bernard Hanseeuw, Andreas Hansen, Jakob Hansen, Thomas Harbo, Andreas Harloff, Peter Harmel, Karl Georg Häusler, Florian Heinen, Valentin Held, Simon Hellwig, Dimitri Hemelsoet, Michael Hennerici, Juliane Herm, Sylvia Hermans, María Hernández, Jose Hervas Vicente, Niels Hjort, Cristina Hobeanu, Carsten Hobohm, Elmar Höfner, Katharina Hohenbichler, Marc Hommel, Julia Hoppe, Eva Hornberger, Carolin Hoyer, Xuya Huang, Nils Ipsen, Irina Isern, Lourdes Ispierto, Helle Iversen, Lise Jeppesen, Marta Jimenez, Jan Jungehülsing, Eric Jüttler, Dheeraj Kalladka, Bernd Kallmünzer, Arindam Kar, Lars Kellert, André Kemmling, Tobias Kessler, Usman Khan, Matthias Klein, Christoph Kleinschnitz, Matti Klockziem, Michael Knops, Luzie Koehler, Martin Koehrmann, Heinz Kohlfürst, Rainer Kollmar, Peter Kraft, Thomas Krause, Bo Kristensen, Jan M Kröber, Natalia Kurka, Alexandre Ladoux, Patrice Laloux, Catherine Lamy, Emmanuelle Landrault, Arne Lauer, Claire Lebely, Jonathan Leempoel, Kennedy Lees, Anne Leger, Laurence Legrand, Robin Lemmens, Lin Li, Anna-Mareike Löbbe, Frederic London, Elena Lopez-Cancio, Matthias Lorenz, Stephen Louw, Caroline Lovelock, Manuel Lozano Sánchez, Giuseppe Lucente, Janos Lückl, Alain Luna, Kosmas Macha, Alexandre Machet, Daniel Mackenrodt, Dominik Madzar, Charles Majoie, Anika Männer, Vicky Maqueda, Jacob Marstrand, Alicia Martinez, Annika Marzina, Laura Mechthouff, Per Meden, Guy Meersman, Julia Meier, Charles Mellerio, Oliver Menn, Nadja Meyer, Dominik Michalski, Peter Michels, Lene Michelsen, Monica Millán Torne, Jens Minnerup, Boris Modrau, Sebastian Moeller, Anette Møller, Nathalie Morel, Fiona Moreton, Ludovic Morin, Thierry Moulin, Barry Moynihan, Anne K Mueller, Keith W Muir, Patricia Mulero, Sibu Mundiyanapurath, Johannes Mutzenbach, Simon Nagel, Oliver Naggara, Arumugam Nallasivan, Irene Navalpotro, Alexander H Nave, Paul Nederkoorn, Lars Neeb, Hermann Neugebauer, Tobias Neumann-Haefelin, Norbert Nighoghossian, Stefan Oberndorfer, Christian Opherk, Lorenz Oppel, Catherine Oppenheim, Johannes Orthgieß, Leif Ostergaard, Perrine Paindeville, Ernest Palomeras, Verena Panitz, Bhavni Patel, Andre Peeters, Dirk Peeters, Anna Pellisé, Johann Pelz, Anthony Pereira, Natalia Pérez de la Ossa, Richard Perry, Salvador Petraza, Stéphane Peysson, Waltraud Pfeilschifter, Alexander Pichler, Alexandra Pierskalla, Hans-Werner Pledl, Sven Poli, Katrin Pomrehn, Marika Poulsen, Luis Prats, Silvia Presas, Elisabeth Prohaska, Volker Puetz, Josep Puig, Josep Puig Alcántara, Jan Purrucker, Veronique Quenardelle, Sankaranarayanan Ramachandran, Soulliard Raphaelle, Nicolas Raposo, Tilman Reiff, Michel Remmers, Pauline Renou, Martin Ribitsch, Hardy Richter, Peter Ringleb, Martin Ritter, Thomas Ritzenthaler, Gilles Rodier, Christine Rodriguez-Regent, Manuel Rodríguez-Yáñez, Maria Roennefarth, Christine Roffe, Sverre Rosenbaum, Charlotte Rosso, Joachim Röther, Michal Rozanski, Noelia Ruiz de Morales, Francesca Russo, Matthieu Rutgers, Sharmilla Sagnier, Yves Samson, Josep Sánchez, Tamara Sauer, Jan H Schäfer, Simon Schieber, Josef Schill, Dennis Schlak, Ludwig Schlemm, Sein Schmidt, Wouter Schonewille, Julian Schröder, Andreas Schulz, Johannes Schurig, Sönke Schwarting, Alexander Schwarz, Christopher Schwarzbach, Matthias Seidel, Alexander Seiler, Jochen Sembill, Joaquin Serena Leal, Ashit Shetty, Igor Sibon, Claus Z Simonsen, Oliver Singer, Aravinth Sivagnanaratham, Ide Smets, Craig Smith, Peter Soors, Nikola Sprigg, Maximilian Spruegel, David Stark, Susanne Steinert, Sebastian Stösser, Markus Stuermlinger, Bart Swinnen, Ruben Tamazyan, Jose Tembl, Mikel Terceno Izaga, Vincent Thijs, Götz Thomalla, Emmanuel Touze, Thomas Truelsen, Guillaume Turc, Gaetane Turine, Serdar Tütüncü, Pippa Tyrell, Xavier Ustrell, Wilfried Vadot, Anne-Evelyne Vallet, Pauline Vallet, Lucie van den Berg, Sophie van den Berg, Cecile van Eendenburg, Robbert-Jan Van Hooff, Isabelle van Sloten, Peter Vanacker, Evelien Vancaester, Patrick Vanderdonckt, Yves Vandermeeren, Frederik Vanhee, Roland Veltkamp, Karsten Vestergaard, Alain Viguier, Dolores Vilas, Kersten Villringer, Dieke Voget, Jörg von Schrader, Paul von Weitzel, Elisabeth Warburton, Claudia Weber, Jörg Weber, Karl Wegscheider, Mirko Wegscheider, Christian Weimar, Karin Weinstich, Christopher Weise, Gesa Weise, Chris Willems, Klemens Winder, Matthias Wittayer, Marc Wolf, Martin Wolf, Valerie Wolff, Christian Wollboldt, Frank Wollenweber, Anke Wouters, Bertrand Yalo, Marion Yger, Nadia Younan, Laetita Yperzeele, Vesna Zegarac, Pia Zeiner, Ulf Ziemann, Thomas Zonneveld, Mathieu Zuber, Tsugio Akutsu, Junya Aoki, Junya Aoki, Shuji Arakawa, Ryosuke Doijiri, Yusuke Egashira, Yukiko Enomoto, Mayumi Fukuda-Doi, Eisuke Furui, Konosuke Furuta, Seiji Gotoh, Toshimitsu Hamasaki, Yasuhiro Hasegawa, Teryuki Hirano, Kazunari Homma, Masahiko Ichijyo, Toshihiro Ide, Shuichi Igarashi, Yasuyuki Iguchi, Masafumi Ihara, Hajime Ikenouchi, Manabu Inoue, Tsuyoshi Inoue, Ryo Itabashi, Yasuhiro Ito, Toru Iwama, Kenji Kamiyama, Shoko Kamiyoshi, Haruka Kanai, Yasuhisa Kanematsu, Takao Kanzawa, Kazumi Kimura, Jiro Kitayama, Takanari Kitazono, Masatoshi Koga, Rei Kondo, Kohsuke Kudo, Masayoshi Kusumi, Ken Kuwahara, Shoji Matsumoto, Hideki Matsuoka, Ban Mihara, Kazuo Minematsu, Ken Miura, Kaori Miwa, Naomi Morita, Wataru Mouri, Kayo Murata, Yoshinari Nagakane, Taizen Nakase, Hiromi Ohara, Nobuyuki Ohara, Hideyuki Ohnishi, Hajime Ohta, Masafumi Ohtaki, Ryo Ohtani, Toshiho Ohtsuki, Hideo Ohyama, Takashi Okada, Yasushi Okada, Masato Osaki, Nobuyuki Sakai, Yoshiki Sanbongi, Naoshi Sasaki, Makoto Sasaki, Shoichiro Sato, Kenta Seki, Wataru Shimizu, Yoshiaki Shiokawa, Takashi Sozu, Junichiro Suzuki, Rieko Suzuki, Yasushi Takagi, Shunya Takizawa, Norio Tanahashi, Eijiro Tanaka, Ryota Tanaka, Yohei Tateishi, Tomoaki Terada, Tadashi Terasaki, Kenichi Todo, Azusa Tokunaga, Kazunori Toyoda, Akira Tsujino, Toshihiro Ueda, Yoshikazu Uesaka, Mihoko Uotani, Takao Urabe, Masao Watanabe, Yoshiki Yagita, Yusuke Yakushiji, Haruko Yamamoto, Keizo Yasui, Toshiro Yonehara, Sohei Yoshimura, Shinichi Yoshimura, K Aarnio, F Alemseged, C Anderson, T Ang, M L Archer, J Attia, P Bailey, A Balabanski, A Barber, P A Barber, J Bernhardt, A Bivard, D Blacker, C F Bladin, A Brodtmann, D Cadilhac, B C V Campbell, L Carey, S Celestino, L Chan, W H Chang, A ChangI, C H Chen, C-I Chen, H F Chen, T C Chen, W H Chen, Y Y Chen, C A Cheng, E Cheong, Y W Chiou, P M Choi, H J Chu, C S Chuang, T C Chung, L Churilov, B Clissold, A Connelly, S Coote, B Coulton, E Cowley, J Cranefield, S Curtze, C D'Este, S M Davis, S Day, P M Desmond, H M Dewey, C Ding, G A Donnan, R Drew, S Eirola, D Field, T Frost, C Garcia-Esperon, K George, R Gerraty, R Grimley, Y C Guo, G Hankey, J Harvey, S C Ho, K Hogan, D Howells, P M Hsiao, C H Hsu, C T Hsu, C-S Hsu, J P Hsu, Y D Hsu, Y T Hsu, C J Hu, C C Huang, H Y Huang, M Y Huang, S C Huang, W S Huang, D Jackson, J S Jeng, S K Jiang, L Kaauwai, O Kasari, J King, T J Kleinig, M Koivu, J Kolbe, M Krause, C W Kuan, W L Kung, C Kyndt, C L Lau, A Lee, C Y Lee, J T Lee, Y Lee, Y C Lee, C Levi, C R Levi, L M Lien, J C Lim, C C Lin, C H Lin, C M Lin, D Lin, C H Liu, J Liu, Y C Lo, P S Loh, E Low, C H Lu, C J Lu, M K Lu, J Ly, H Ma, L Macaulay, R Macdonnell, E Mackey, M Macleod, J Mahadevan, V Maxwell, R McCoy, A McDonald, S McModie, A Meretoja, S Mishra, P J Mitchell, F Miteff, A Moore, C Muller, F Ng, F C Ng, J-L Ng, W O'Brian, V O'Collins, T J Oxley, M W Parsons, S Patel, G S Peng, L Pesavento, T Phan, E Rodrigues, Z Ross, A Sabet, M Sallaberger, P Salvaris, D Shah, G Sharma, G Sibolt, M Simpson, S Singhal, B Snow, N Spratt, R Stark, J Sturm, M C Sun, Y Sun, P S Sung, Y F Sung, M Suzuki, M Tan, S C Tang, T Tatlisumak, V Thijs, M Tiainen, C H Tsai, C K Tsai, C L Tsai, H T Tsai, L K Tsai, C H Tseng, L T Tseng, J Tsoleridis, H Tu, H T-H Tu, W Vallat, J Virta, W C Wang, Y T Wang, M Waters, L Weir, T Wijeratne, C Williams, W Wilson, A A Wong, K Wong, T Y Wu, Y H Wu, B Yan, F C Yang, Y W Yang, N Yassi, H L Yeh, J H Yeh, S J Yeh, C H Yen, D Young, C L Ysai, W W Zhang, H Zhao, L Zhao, Katharina Althaus-Knaurer, Martin Bendszus, Jörg Berrouschot, Erich Bluhmki, Paolo Bovi, Gilles Chatellier, Lynda Cove, Stephen Davis, A Dixit, Geoffrey Donnan, Rainer Dziewas, Christina Ehrenkrona, Christoph Eschenfelder, Marc Fatar, Juan Francisco Arenillas, Franz Gruber, Werner Hacke, Lalit Kala, Peter Kapeller, Markku Kaste, Christof Kessler, Martin Köhrmann, Rico Laage, Kennedy R Lees, Didier Leys, Alain Luna Rodriguez, Jean-Louis Mas, Robert Mikulik, Carlos Molina, Girish Muddegowda, Keith Muir, Kurt Niederkorn, Xavier Nuñez, Catherine Oppenheim, Sven Poli, Peter Ringleb, Peter Schellinger, Stefan Schwab, Joaquin Serena, Jan Sobesky, Thorsten Steiner, Ann-Sofie Svenson, Danilo Toni, Roland Veltkamp, Rüdiger von Kummer, Nils Wahlgren, Joanna Wardlaw, Rebecca A Betensky, Gregoire Boulouis, Raphael A Carandang, William A Copen, Pedro Cougo, Shawna Cutting, Kendra Drake, Andria L Ford, John Hallenbeck, Gordon J Harris, Robert Hoesch, Amie Hsia, Carlos Kase, Lawrence Latour, Arne Lauer, Michael H Lev, Alona Muzikansky, Nandakumar Nagaraja, Lee H Schwamm, Eric Searls, Shlee S Song, Sidney Starkman, Steven Warach, Ona Wu, Albert J Yoo, Ramin Zand, University of Newcastle [Callaghan, Australia] (UoN), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome] (UNIROMA), Troubles cognitifs dégénératifs et vasculaires - U 1171 - EA 1046 (TCDV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CarMeN, laboratoire, Yperzeele, Laetitia, Evaluation of Unknown Onset Stroke Thrombolysis trials (EOS) investigators, UCL - SSS/IONS - Institute of NeuroScience, UCL - (MGD) Service de neurologie, Supporting clinical sciences, UZB Other, Physical Medicine and Rehabilitation, Clinical sciences, Neuroprotection & Neuromodulation, Radiology and Nuclear Medicine, ANS - Neurovascular Disorders, Neurology, ACS - Atherosclerosis & ischemic syndromes, Graduate School, Center of Experimental and Molecular Medicine, ACS - Pulmonary hypertension & thrombosis, and ACS - Microcirculation
Subjects: medicine.medical_treatment, [SDV]Life Sciences [q-bio], Ischemic Stroke/*diagnostic imaging/*drug therapy, Tomography, X-Ray Computed/methods, Fibrinolytic Agents/adverse effects/*therapeutic use, 030204 cardiovascular system & hematology, Ischemic Stroke/diagnostic imaging, surgery, 0302 clinical medicine, Modified Rankin Scale, 030212 general & internal medicine, 10. No inequality, Infusions, Intravenous, Stroke, Tomography, Time-to-Treatment, General Medicine, Thrombolysis, X-Ray Computed/methods, Tissue Plasminogen Activator/adverse effects, 3. Good health, [SDV] Life Sciences [q-bio], Diffusion Magnetic Resonance Imaging/methods, Treatment Outcome, Meta-analysis, Tissue Plasminogen Activator, Intravenous, medicine.medical_specialty, Infusions, Intravenous thrombolysis, Neuroimaging, Neuroscience(all), Placebo, Tissue Plasminogen Activator/adverse effects/*therapeutic use, 03 medical and health sciences, Fibrinolytic Agents, Internal medicine, medicine, Humans, ddc:610, Ischemic Stroke, business.industry, neurology, Fibrinolytic Agents/adverse effects, Odds ratio, Recovery of Function, medicine.disease, Clinical research, Diffusion Magnetic Resonance Imaging, Human medicine, business, Tomography, X-Ray Computed, Fibrinolytic agent
Abstract: International audience; BACKGROUND: Patients who have had a stroke with unknown time of onset have been previously excluded from thrombolysis. We aimed to establish whether intravenous alteplase is safe and effective in such patients when salvageable tissue has been identified with imaging biomarkers. METHODS: We did a systematic review and meta-analysis of individual patient data for trials published before Sept 21, 2020. Randomised trials of intravenous alteplase versus standard of care or placebo in adults with stroke with unknown time of onset with perfusion-diffusion MRI, perfusion CT, or MRI with diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch were eligible. The primary outcome was favourable functional outcome (score of 0-1 on the modified Rankin Scale [mRS]) at 90 days indicating no disability using an unconditional mixed-effect logistic-regression model fitted to estimate the treatment effect. Secondary outcomes were mRS shift towards a better functional outcome and independent outcome (mRS 0-2) at 90 days. Safety outcomes included death, severe disability or death (mRS score 4-6), and symptomatic intracranial haemorrhage. This study is registered with PROSPERO, CRD42020166903. FINDINGS: Of 249 identified abstracts, four trials met our eligibility criteria for inclusion: WAKE-UP, EXTEND, THAWS, and ECASS-4. The four trials provided individual patient data for 843 individuals, of whom 429 (51%) were assigned to alteplase and 414 (49%) to placebo or standard care. A favourable outcome occurred in 199 (47%) of 420 patients with alteplase and in 160 (39%) of 409 patients among controls (adjusted odds ratio [OR] 1·49 [95% CI 1·10-2·03]; p=0·011), with low heterogeneity across studies (I(2)=27%). Alteplase was associated with a significant shift towards better functional outcome (adjusted common OR 1·38 [95% CI 1·05-1·80]; p=0·019), and a higher odds of independent outcome (adjusted OR 1·50 [1·06-2·12]; p=0·022). In the alteplase group, 90 (21%) patients were severely disabled or died (mRS score 4-6), compared with 102 (25%) patients in the control group (adjusted OR 0·76 [0·52-1·11]; p=0·15). 27 (6%) patients died in the alteplase group and 14 (3%) patients died among controls (adjusted OR 2·06 [1·03-4·09]; p=0·040). The prevalence of symptomatic intracranial haemorrhage was higher in the alteplase group than among controls (11 [3%] vs two [\textless1%], adjusted OR 5·58 [1·22-25·50]; p=0·024). INTERPRETATION: In patients who have had a stroke with unknown time of onset with a DWI-FLAIR or perfusion mismatch, intravenous alteplase resulted in better functional outcome at 90 days than placebo or standard care. A net benefit was observed for all functional outcomes despite an increased risk of symptomatic intracranial haemorrhage. Although there were more deaths with alteplase than placebo, there were fewer cases of severe disability or death. FUNDING: None.
Published: 2020
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18. Reasons for Not Performing Mechanical Thrombectomy: A Population-Based Study of Stroke Codes

Author: Daniel Guisado-Alonso, Alejandro Martínez-Domeño, Luis Prats-Sánchez, Raquel Delgado-Mederos, Pol Camps-Renom, Sònia Abilleira, Natalia Pérez de la Ossa, Anna Ramos-Pachón, Pere Cardona, Ana Rodríguez-Campello, Carlos A. Molina, Salvatore Rudilosso, Joan Martí-Fàbregas, Rebeca Marín, Francisco Purroy, Joaquín Serena, David Canovas, Manuel Gómez- Choco, Xavier Ustrell, Josep Zaragoza, Jerzy Krupinski, Natalia Mas Sala, Ernest Palomeras, Dolors Cocho, Josep Maria Aragonés, Núria López, Eduard Sanjurjo, Dolors Carrión Duch, Mercè López, M.Cruz Almendros Rivas, Jordi Monedero Boado, Esther Catena, Maria Rybyeba, and Gloria Diaz
Subjects: Male, medicine.medical_specialty, Intracranial Hemorrhages, Population, 030204 cardiovascular system & hematology, Brain Ischemia, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Modified Rankin Scale, Internal medicine, Occlusion, Medicine, Humans, Prospective Studies, Registries, education, Stroke, Aged, Thrombectomy, Advanced and Specialized Nursing, Aged, 80 and over, education.field_of_study, business.industry, Intracranial Artery, Middle Aged, medicine.disease, Mechanical thrombectomy, Population based study, Tissue Plasminogen Activator, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract: Background and Purpose: Mechanical thrombectomy (MT) is effective for acute ischemic stroke (AIS) in selected patients with large intracranial vessel occlusion. A minority of patients with AIS receive MT. We aimed to describe the reasons for excluding patients with AIS for MT. Methods: We evaluated patients with AIS in a prospective population-based multicenter registry (Codi Ictus Catalunya registry) that includes all stroke code activations from January to June 2018 in Catalonia, Spain. We analyzed the major reasons for not treating with MT. Results: Stroke code was activated in 3060 patients. Excluding 355 intracranial hemorrhages and 502 stroke mimics, resulted in 2203 patients with AIS (mean age 72.8±13.8 years; 44.6% were women). Of the patients with AIS, 405 (18.4%) were treated with MT. We analyzed the reasons for not treating with MT. The following reasons were considered not modifiable: absence of large intracranial vessel occlusion (922, 41.9%), transient ischemic attack (206, 9.4%), and more than one cause (124, 5.6%). The potentially modifiable reasons for not performing MT by changing selection criteria were as follows: an intracranial artery occlusion that was considered inaccessible or not indicated (48, 2.2%); clinical presentation that was considered too mild to be treated (222, 10.1%); neuroimaging criteria (129, 5.9%), age/prior modified Rankin Scale score/medical comorbidities (129, 5.9%), and therapeutic time window >8 hours (16, 0.7%). Conclusions: In our area, considering all potentially modifiable causes for not performing MT, the percentage of patients with AIS eligible for MT could increase from 18.4% to a maximum of 43.1%. The clinical benefit of this increase is still uncertain and should be confirmed in future trials. Criteria for stroke code activation must be considered for the generalizability of these results.
Published: 2021

19. Age- and Sex-Specific Risk Profiles and In-Hospital Mortality in 13,932 Spanish Stroke Patients

Author: Carles Forné, E. Palomeras, Juan F. Arenillas, Jaime Masjuan, Xavier Ustrell, Ikram Benabdelhak, Manuel Gómez-Choco, Francisco Purroy, Blanca Fuentes, Joan Martí-Fàbregas, Antonio Dávalos, José Castillo, Moisés Garcés, Jerzy Krupinski, Ana María De Arce, Ana Vena, J. Tejada, and Joaquín Serena
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, Adolescent, Stroke patient, Specific risk, 030204 cardiovascular system & hematology, Risk Assessment, Young Adult, 03 medical and health sciences, Sex Factors, 0302 clinical medicine, Risk Factors, Modified Rankin Scale, Internal medicine, Sex differences, medicine, Humans, Hospital Mortality, Registries, cardiovascular diseases, Mortality, Stroke, Aged, Aged, 80 and over, Ischemic stroke, business.industry, Mortality rate, Confounding, Age Factors, Middle Aged, Prognosis, medicine.disease, Hospitalization, Neurology, Spain, Age differences, Cohort, Etiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract: Background: In-hospital stroke death rate is an important sanitary issue. Despite advances in the acute phase management of stroke patients, mortality and disability rates remain high. In aging populations and with different mortality between the sexes in general, the study of sex- and age-related differences becomes increasingly relevant for optimization of post-acute clinical care of stroke patients. Methods: We designed a cohort follow-up study with 13,932 consecutive ischemic stroke (IS) patients from 19 Spanish hospitals. Data was obtained from the Spanish Stroke Registry; transient ischemic attacks and ages Results: The median (percentiles 2.5 and 97.5%) age was 78 (41–92) years old for women and 71 (41–92) for men. IS women were more likely to be older, to exhibit cardio-embolic aetiology, and less likely to have been admitted to a stroke unit or to have had a stroke code activated. Both pre-stroke modified Rankin Scale and National Institute of Health Stroke Scale (NIHSS) scores at admission increased significantly with age and were higher in women than those in men. Differences in distributions of common risk factors for IS and of in-hospital outcomes between women and men actually changed with patient’s age. It is to be noted here that although there were no statistically significant differences (p > 0.05) between the sexes within any age group, in-hospital mortality appeared significantly higher in women than that in men when analysed overall, due to confounding. Death was more closely related to stroke in women than in men and occurred earlier. Although there were some age-specific sex differences between the predictors for in-hospital mortality, stroke severity measured by NIHSS was the main predictor of in-hospital mortality for both sexes. Topographic classifications – partial anterior circulatory infarct and total anterior circulatory infarct – were significant prognostic factors for men aged Conclusion: Although most of our findings were consistent with previous studies, it is important to take into account and highlight differences in in-hospital mortality between the sex and age group. Not to account for age-related differences between the sexes can give false results that may mislead management decisions. As most deaths in women were related to stroke, it is important to improve their early management, stroke code activation, access to stroke units and/or revascularisation therapies, especially in the older age groups.
Published: 2019
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20. Abstract 18: The Role of Vascular Imaging at Primary Stroke Centers in the Drip and Ship Paradigm

Author: Marc Ribó, Jurek Krupinski, Victor Obach, Jaume Viñas, Pedro Cardona, Alan Flores, Joaquín Serena, Manuel Gomez Choco, Natalia Pérez de la Ossa, Marta Rubiera, José Zaragoza-Brunet, E. Palomeras, Xavier Ustrell, Natalia Más, Laia Seró, Anna Pellisé, Francisco Purroy, and Dolores Cocho
Subjects: Advanced and Specialized Nursing, medicine.medical_specialty, Vascular imaging, business.industry, medicine.disease, Endovascular therapy, Internal medicine, Ischemic stroke, medicine, Cardiology, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Stroke
Abstract: Background: In drip-and-ship protocols, vascular imaging at Primary Stroke Centers (PSC), although recommended, is not usually performed in many PSC, and its value is uncertain. Our aim was to evaluate the role of performing vascular imaging at PSC, comparing patients with vascular imaging at PSC (VI+) Vs. those without vascular imaging (VI-) in several outcomes. Methods: Observational, multicenter study from a prospective, government-mandated, population-based registry of ischemic stroke code patients firstly evaluated at a PSC from January-2016 to June-2020. We determined and compared rates of Mechanical Thrombectomy (MT) candidates transferred to CSC from all ischemic stroke codes at PSC, MT treated at CSC patients from all MT candidates transferred, and metrics related to drip-and-ship paradigm between VI + and VI- groups. A multivariate analysis to determine PSC related factors associated with receiving EVT at CSC was performed. Results: From 5792 ischemic stroke code patients at PSC, 3384 (58.4%) received a vascular imaging at PSC (VI+). Among all, 32.6% were transferred to CSC as MT candidates, and finally, 10.6% were treated with MT at CSC. The rate of transferred MT candidates was lower in the VI+ than VI- group (n: 783, 23.1% Vs. n: 1109, 46 %, p< 0.001). Among the transferred MT candidates, MT treatment at CSC was more common in the VI+ than VI- (n: 377, 48.1% Vs: n: 239, 21.5%, p Conclusion: In the present study, performing vascular imaging at PSC diminishes unnecessary transfers to CSC and is associated with a higher probability of receiving MT at CSC in transferred patients. In mild strokes, performing a vascular imaging at PSC increases the probability of receiving MT at CSC. Metrics related to drip-and-ship model were not affected by performing a vascular imaging at PSC.
Published: 2021
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21. Impact of COVID-19 Infection on the Outcome of Patients With Ischemic Stroke

Author: Alejandro Bustamante, Ana Rodríguez-Campello, Mikel Vicente, Antia Moreira, Meritxell Gomis, Mercè Salvat, Joan Martí-Fàbregas, Luis Mena, Ana Núñez-Guillén, Luis Prats-Sánchez, Josep Zaragoza, María Del Carmen García-Carreira, Marta Rubiera, Pol Camps-Renom, Angel Ois, Saima Bashir Viturro, Francisco Purroy, Manuel Gómez-Choco, Marta Olivé, Patricia Esteve, Xavier Ustrell, Marta Almeria, Laura Llull, Cecile van Eendenburg, Oriol Barrachina, Raquel Delgado-Mederos, Natalia Pérez de la Ossa, Pere Cardona, Dolores Cocho, Javier Codas, Esther Catena, Marina Guasch-Jiménez, Laia Seró, Manuel Requena, Joaquín Serena, E. Palomeras, Alejandro Martínez-Domeño, Gislaine Castilho de Oliveira, Daniel Guisado-Alonso, Sergio Amaro, and Jerzky Krupinski
Subjects: Male, Original Contributions, Stroke severity, coronavirus, medicine.disease_cause, Severity of Illness Index, Thrombolytic Therapy, Prospective Studies, Stroke, Thrombectomy, Coronavirus, Aged, 80 and over, Age Factors, Middle Aged, Prognosis, stroke, cerebrovascular disease, reperfusion, thrombectomy, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), pandemics, Clinical and Population Sciences, Internal medicine, medicine, Humans, In patient, Mortality, Aged, Ischemic Stroke, Advanced and Specialized Nursing, SARS-CoV-2, business.industry, Anticoagulants, COVID-19, medicine.disease, Functional Status, Logistic Models, Case-Control Studies, Multivariate Analysis, Ischemic stroke, Neurology (clinical), prognosis, business
Abstract: Supplemental Digital Content is available in the text., Background and Purpose: We evaluated whether stroke severity, functional outcome, and mortality are different in patients with ischemic stroke with or without coronavirus disease 2019 (COVID-19) infection. Methods: A prospective, observational, multicentre cohort study in Catalonia, Spain. Recruitment was consecutive from mid-March to mid-May 2020. Patients had an acute ischemic stroke within 48 hours and a previous modified Rankin Scale (mRS) score of 0 to 3. We collected demographic data, vascular risk factors, prior mRS score, National Institutes of Health Stroke Scale score, rate of reperfusion therapies, logistics, and metrics. Primary end point was functional outcome at 3 months. Favourable outcome was defined depending on the previous mRS score. Secondary outcome was mortality at 3 months. We performed mRS shift and multivariable analyses. Results: We evaluated 701 patients (mean age 72.3±13.3 years, 60.5% men) and 91 (13%) had COVID-19 infection. Median baseline National Institutes of Health Stroke Scale score was higher in patients with COVID-19 compared with patients without COVID-19 (8 [3–18] versus 6 [2–14], P=0.049). Proportion of patients with a favourable functional outcome was 33.7% in the COVID-19 and 47% in the non-COVID-19 group. However, after a multivariable logistic regression analysis, COVID-19 infection did not increase the probability of unfavourable functional outcome. Mortality rate was 39.3% among patients with COVID-19 and 16.1% in the non-COVID-19 group. In the multivariable logistic regression analysis, COVID-19 infection was a risk factor for mortality (hazard ratio, 3.14 [95% CI, 2.10–4.71]; P
Published: 2021

22. Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia

Author: Pere Cardona, Mercè López, Eduardo Sanjurjo, Jordi Monedero, Dolors Carrión, Carmen Repullo, David Cánovas, Natalia Pérez de la Ossa, Sergi Amaro, Esther Catena, Joan Martí-Fàbregas, Gloria Diaz, Mónica Millán, Maria Rybyeba, Xabier Urra, Manuel Gómez-Choco, E. Palomeras, Xavier Ustrell, Laura Redondo, M Cruz Almendros, Miquel Barceló, Álvaro García-Tornel, José Zaragoza-Brunet, Maria Jesus Pueyo, Jaume Roquer, Yolanda Silva, Catalan Stroke Code, Anna Ramos-Pachón, Marc Ribo, Natalia Mas Sala, Xavier Jiménez-Fàbrega, Francisco Purroy, Verónica Hidalgo, Jurek Krupinski, Silvia Solà, Dolores Cocho, [Ramos-Pachón A, Millán M ] Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Spain. [García-Tornel A] Unitat d’Ictus, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. [Ribó M] Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. [Amaro S] Stroke Unit, Hospital Clínic, Barcelona, Spain. [Cardona P] Stroke Unit, Hospital Universitari Bellvitge, Hospitalet de Llobregat, Spain. [Cocho D] Hospital General de Granollers, Granollers, Spain, and Hospital General de Granollers
Subjects: medicine.medical_specialty, Health Care Facilities, Manpower, and Services::Health Facilities::Health Facility Administration::Hospital Administration::Hospital Departments::Emergency Service, Hospital [HEALTH CARE], Coronavirus disease 2019 (COVID-19), enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::accidente cerebrovascular [ENFERMEDADES], COVID-19 (Malaltia), vigilancia sanitaria de los servicios de salud::centros sanitarios::hospitales::unidades hospitalarias::servicios médicos de urgencia [VIGILANCIA SANITARIA], Time-to-Treatment, Odds, Fibrinolytic Agents, Health care, Pandemic, virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES], medicine, Emergency medical services, Humans, Thrombolytic Therapy, Prospective Studies, Clinical Research in Stroke, Stroke, Acute stroke, Coronavirus disease 2019, SARS-CoV-2, business.industry, Incidence (epidemiology), Urgències mèdiques, Serveis d', Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES], medicine.disease, Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Stroke [DISEASES], Neurology, Spain, Emergency medicine, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Organization, Malalties cerebrovasculars
Abstract: Accident cerebrovascular; Serveis mèdics d'emergència; Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV Accidente cerebrovascular; Servicios médicos de emergencia; Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV Stroke; Emergency medical services; Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV Introduction: The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system's bottlenecks from a territorial point of view. Methods: Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15-May 2, 2020) and an immediate prepandemic period (January 26-March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. Results: Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = -0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05-2.4], p 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4-0.9], p 0.015) during the pandemic period. Conclusion: During the COVID-19 pandemic, Catalonia's stroke system's weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system's analysis is crucial to allocate resources appropriately.
Published: 2021

23. Abstract TMP5: Vessel Status Findings in Patient Candidates Transferred for Endovascular Treatment. Data From Catalonia’s Code Stroke Registry

Author: Natalia Pérez de la Ossa, Marc Ribó, Laia Seró, Anna Pellisé, Ernesto Palomeras, Jose Zaragoza, Carlos A. Molina, Sonia García, Alan Flores, Xavier Ustrell, Dolores Cocho, David Cánovas, Victor Obach, Sònia Abilleira, Catalan Stroke Code, Francisco Purroy, Natalia Más, Cardona Pere, Marta Rubiera, J. Serena, Rodriguez Paula, Jaume Viñas, and Jurek Krupinski
Subjects: Advanced and Specialized Nursing, Stroke registry, medicine.medical_specialty, business.industry, Occlusion, Emergency medicine, Code (cryptography), Medicine, Observational study, In patient, Neurology (clinical), Endovascular treatment, Cardiology and Cardiovascular Medicine, business, Fibrinolytic agent
Abstract: The aim of this study was to determine changes in vessel status between PSC and CSC according to site and occlusion level, rtPA-treatment, and pre-specified time intervals. Methods: Observational, multicenter study, from a prospective, government-mandated, population-based registry. We selected data from candidates to EVT with documented LVO at PSC who were transferred to CSC from January 2017 to June 2019. We used clinical variables and time intervals as the Symptom-Onset to Vascular-Imaging at CSC (SOTVI2). The primary endpoint was defined as no-occlusion/distal occlusion ineligible for EVT at CSC arrival (NOEVTatCSC) as was utilized. Results: From 589 patients, 37% received rtPA. Rate of NOEVTatCSC was 10.5% (n: 62) and 87% were treated with rtPA, being 35.8% of causes to exclude EVT at CSC arrival. In univariate analysis, lower baseline-NIHSS (median 12 vs. 16 p Conclusion: In patient candidates for EVT transferred from PSC to CSC, NOEVTatCSC is infrequent making the need of a second vascular study before the angiogram at CSC arguable. Despite of its modest effect, tPA-treatment at PSC is the only factor associated with NOEVTatCSC. This could be most relevant in basilar occlusions and in the first 4-hours. Changes in the vessel status according to initial occlusion in PSC occur in anterior circulation. Future studies addressed to determine factors related to these changes are warranted.
Published: 2020
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24. Blood biomarkers predictive of epilepsy after an acute stroke event

Author: Elena Fonseca, Marta Rubiera, Laia Grau-López, Juan Luis Becerra, Alejandro Bustamante, Josep Zaragoza, Laura Abraira, Teresa Gasull, Pere Cardona, Sonia Cazorla, Xavier Ustrell, Manuel Toledo, Mar Castellanos, José Alvarez-Sabín, Marta Jiménez, David Cánovas, Estevo Santamarina, Jordi Ciurans, Mónica Millán, Mikel Terceño, Joan Montaner, María Hernández-Pérez, and Manuel Quintana
Subjects: Male, 0301 basic medicine, medicine.medical_specialty, S100 Calcium Binding Protein beta Subunit, Epileptogenesis, Cohort Studies, 03 medical and health sciences, Epilepsy, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Interquartile range, Internal medicine, Humans, Medicine, Longitudinal Studies, Prospective Studies, Stroke, Aged, Aged, 80 and over, business.industry, Proportional hazards model, HSC70 Heat-Shock Proteins, Middle Aged, medicine.disease, epileptogenesis, poststroke epilepsy, seizures, stroke, Endostatins, 030104 developmental biology, Neurology, Blood biomarkers, Shock (circulatory), Cohort, Female, Neurology (clinical), medicine.symptom, business, Biomarkers, 030217 neurology & neurosurgery
Abstract: Blood biomarkers have not been widely investigated in poststroke epilepsy. In this study, we aimed to describe clinical factors and biomarkers present during acute stroke and analyze their association with the development of epilepsy at long term.A panel of 14 blood biomarkers was evaluated in patients with ischemic and hemorrhagic stroke. Biomarkers were normalized and standardized using Z-scores. Stroke and epilepsy-related variables were also assessed: stroke severity, determined by National Institutes of Health Stroke Scale (NIHSS) score, stroke type and cause, time from stroke to onset of late seizures, and type of seizure. Multiple Cox regression models were used to identify clinical variables and biomarkers independently associated with epilepsy.From a cohort of 1115 patients, 895 patients were included. Mean ± standard deviation (SD) age was 72.0 ± 13.1 years, and 57.8% of patients were men. Fifty-one patients (5.7%) developed late seizures, with a median time to onset of 232 days (interquartile range [IQR] 86-491). NIHSS score ≥8 (P .001, hazard ratio [HR] 4.013, 95% confidence interval [CI] 2.123-7.586) and a history of early onset seizures (P .001, HR 4.038, 95% CI 1.802-9.045) were factors independently associated with a risk of developing epilepsy. Independent blood biomarkers predictive of epilepsy were high endostatin levels 1.203 (P = .046, HR 4.300, 95% CI 1.028-17.996) and low levels of heat shock 70 kDa protein-8 (Hsc70) 2.496 (P = .006, HR 3.795, 95% CI 1.476-9.760) and S100B1.364 (P = .001, HR 2.955, 95% CI 1.534-5.491). The risk of epilepsy when these biomarkers were combined increased to 17%. The area under the receiver-operating characteristic (ROC) curve of the predictive model was stronger when clinical variables were combined with blood biomarkers (74.3%, 95% CI 65.2%-83.3%) than when they were used alone (68.9%, 95% CI 60.3%-77.6%).Downregulated S100B and Hsc70 and upregulated endostatin may assist in prediction of poststroke epilepsy and may provide additional information to clinical risk factors. In addition, these data are hypothesis-generating for the epileptogenic process.
Published: 2020

25. Tratamiento de reperfusión en el ictus isquémico agudo por disección arterial cervicocerebral: descripción de los resultados de un estudio nacional multicéntrico

Author: S. Cajaraville, E. Palomeras, A. de Arce, M. Paré-Curell, M. de Lera Alfonso, Francisco Purroy, P. de la Riva, Xavier Ustrell, Pablo Iruzubieta, J. Tembl, Moisés Garcés, Jon Rodríguez-Antigüedad, Manuel Rodríguez-Yáñez, A. de Felipe Mimbrera, J. Serena, J.J. Mengual Chirife, Maite Martínez-Zabaleta, J. Ekiza, Jurek Krupinski, David Campo-Caballero, Daniel Guisado-Alonso, Blanca Fuentes, and J. Tejada García
Subjects: Gynecology, Disección, medicine.medical_specialty, business.industry, Ictus, 03 medical and health sciences, Fibrinólisis, 0302 clinical medicine, Reperfusión, Trombectomía, Medicine, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract: Introducción El ictus isquémico (II) por disección arterial cervicocerebral (DAC) es una entidad infrecuente y existen pocos datos sobre el uso de terapias de reperfusión como la fibrinólisis intravenosa y la trombectomía mecánica. Se analizó el uso de dichas terapias en pacientes con II por DAC y se comparó con aquellos pacientes reperfundidos con II por otras causas. Método Estudio observacional retrospectivo multicéntrico de pacientes con II por DAC basado en el Registro Nacional de Ictus de la Sociedad Española de Neurología durante el periodo 2011-2019. Se realizaron análisis comparativos entre: a) pacientes con DAC tratados y no tratados con terapias de reperfusión y b) pacientes reperfundidos con II por DAC y pacientes reperfundidos con II por otras causas. Se incluyeron variables epidemiológicas, del ictus y resultados al alta y a los 3 meses. Resultados Un total de 21.037 pacientes con II fueron incluidos; 223 (1%) fueron por DAC y 68 (30%) recibieron tratamiento de reperfusión. El uso de tratamientos de reperfusión fue menor en los casos de DAC de arteria vertebral y mayor en los casos de oclusión carotídea. Los pacientes con II por DAC reperfundidos respecto a aquellos con II reperfundidos por otras causas fueron más jóvenes, la trombectomía mecánica se utilizó más y la fibrinólisis intravenosa menos. Las complicaciones hemorrágicas, la mortalidad y la autonomía a los 3 meses fueron similares. Conclusiones Las terapias de reperfusión se usan con frecuencia en los pacientes con II por DAC. Los resultados demuestran eficacia y seguridad y son equiparables a los pacientes tratados con terapias de reperfusión por II de otras causas. Introduction Ischaemic stroke (IS) due to cervical and cerebral artery dissection (CAD) is a rare entity, and few data are available on the use of such reperfusion therapies as intravenous fibrinolysis and mechanical thrombectomy in these patients. We analysed the use of these treatments in patients with IS due to CAD and compared them against patients receiving reperfusion treatment for IS of other aetiologies. Method We conducted an observational, retrospective, multicentre study of patients with IS due to CAD recorded in the National Stroke Registry of the Spanish Society of Neurology during the period 2011-2019. Comparative analyses were performed between: a) patients with CAD treated and not treated with reperfusion therapies and b) patients treated with reperfusion for IS due to CAD and patients treated with reperfusion for IS due to other causes. Epidemiological data, stroke variables, and outcomes at discharge and at 3 months were included in the analysis. Results The study included 21, 037 patients with IS: 223 (1%) had IS due to CAD, of whom 68 (30%) received reperfusion treatment. Reperfusion treatments were used less frequently in cases of vertebral artery dissection and more frequently in patients with carotid artery occlusion. Compared to patients with IS due to other causes, patients with CAD were younger, more frequently underwent mechanical thrombectomy, and less frequently received intravenous fibrinolysis. Rates of haemorrhagic complications, mortality, and independence at 3 months were similar in both groups. Conclusions Reperfusion therapy is frequently used in patients with IS due to CAD. The outcomes of these patients demonstrate the efficacy and safety of reperfusion treatments, and are comparable to the outcomes of patients with IS due to other aetiologies.
Published: 2020
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26. Factors associated with poor anticoagulation control with vitamin K antagonists among outpatients attended in Internal Medicine and Neurology. The ALADIN study

Author: Cristina Barbagelata, Francisco Cabrera, María Herrera, Pedro Cardona, Radka Ivanova Georgieva, José Miguel Pons, Maite Martínez, Jesús Saiz, Tomás Pérez, José Ángel Satué, Cristina Tejera Pérez, Joan Rosal, Javier Fernández, M. José Gómez, Jordi Sanahuja, Patricia Ibáñez, Ana Rodríguez, José M. Errea, Alejandro Martínez-Domeño, Antonio Manquillo, Ana Latorre, Luis Beltrán, Juli Font, Cecile van Eedenburg, Xavier Ustrell, Elena Bello, Raquel González, M. Carmen Gil, José Antonio Díaz, Francisco Purroy, Elena Calzado, José Carlos Gómez, Susana Arias, Clara Sainz, Óscar Fabre, Francisco Javier Barrero, José Ferreiro, José M. Ramírez-Moreno, Mariano Aguayo, Lamberto Landete, Manuel Rodríguez, Ramón Villaverde, Eduardo Agüera-Morales, C. Suárez Fernández, José Ramírez, Gemma Reig, Covadonga Fernández, Carmen Jiménez, Ana M Roa, Alejandro Ponz, Joaquín Carnedo, Rafael Fernández de la Puerta, Jerzy Kuprinski, Raquel Chamarro, Enrique Cabrerizo, Rafael López, M. Ángeles Revilla, Xavier Nogués, Marta Serrano, Roberto Muñoz, José M. Trejo, Jaume Roquer, Beatriz Zandio, María Pérez de la Blanca, Santiago Montull, Helena Quesada, Juan Carlos Anglada, Ana de Arce, Ana Pampliega, Juan Carlos Belinchón, Jaime Gállego, Francisco Moniche, Inmaculada Villegas, Nuria Aymerich, Juan José Mengual, Ana Calleja, Antonio Gil-Núñez, Antonio Medina, Fernando Salgado, Antonio Pose, Blanca Batalla, Sandra Boned-Riera, Juan José Cara, José M. Terrero, Juan Luengo, Román Cerro, José Tembl, Laia Seró, Christian Homedes, Manuel Payan, Imma Cañas, Blanca Fuentes, Fernando Díaz, Laura Ballester, Francisco Lozano, Ignacio Casado, M. Pilar Moreno, Luis López, Antonio Arjona, Miguel Yebra, Jorge Romero, Marco Antonio Budiño, Francesc Puchades, Jacinto Hernández, Javier García, María Concepción Prados Sánchez, Joan Martí-Fàbregas, José Castro, M. Ángeles Fidalgo, Javier Marta, Alicia de Felipe, David Esteva, María Bestué, Vicente Oliver, Marta Guillan, David Vinuesa García, Esther Aragón, Natividad Raña, José Maciñeiras, José Luis Vázquez, Juan Carlos Martínez-Acitores, Dolores Fernández, Félix González, Demetrio Sánchez, Rafael Bustamante, María Ángeles Ortega, Nuria Navarrete, Jesús M. Juega, Emilio Barroso, Pedro Luis Muñoz, Leticia Álvarez, Mónica Arias, Carlos Sánchez, Juan Antonio Arroyo, Juan José Timiraos, Ana Jurado, José Carlos Pontes, Sonia M. García, Iluminada García Polo, Daniel Irigoyen, Arturo Artero, Maria Àngels Font, Miguel Ángel Rico, Laura Imaz, Salvadora Martínez, José Carlos Fernández, Ikram Benabdelhak, Ana María González, Patricia Martínez, Sonia Huertas, Francisco Javier Martínez, Yolanda Bravo, Alfonso Aguirre, Luis Mérida, Carlos Tejero, Jordi Espinosa, Montserrat González, Consuelo Matute, José M. de Lis, Marian Muchada, José Bernardo Escribano, M. Dolores Moragues, Miguel Ángel Corrales, Mar Freijo, Juan F. Arenillas, J. Manuel Cerqueiro, Aida Lago, Manuel Montero, Enrique Mostacero, Javier de la Torre, Jesús Foronda, David Gorriz, Óscar Fernández, Elisa Rodríguez, Alex Culla, José M. Rivera, Juan Carlos Portilla, Roberto Pérez, Marta Pena, Bárbara Vives, Julián Fernández, Jose Antonio Egido, Ana Castellano, Mónica Zamora, Agustín Pijierro, Eva Calvo, Elisa Cortijo, Fernando Aguilar, David Cánovas, José Vivancos, Pablo Irimia, Enrique Calderón, Carlos Molina, Pedro Jesús Serrano, Esther Fernández, J. Tejada, Carmen Morata, María Paz Martínez, Gerardo Ruiz, César Lucas, Purificación Durán, Ángel Ois, Noemí Díez, José Antonio Tamayo, Jordi Casanova, Igor Molina, Jaime Díaz, Carmen Caro, Susana Mederer, Fernando Jaén, Jordi Estela, Dionisio Carrillo, Irene Navalpotro, José Luis Beato Pérez, Alain Luna, Jorge Artal, Jesús Cantero, Enrique Palacio, Elisa Cuadrado, Javier Reyes, Pilar Meler, Miguel Alberto de Zarraga, Gema Sanz, M. Ángeles López, Ricardo Gómez, Joaquín Sánchez, Miguel Ángel García, Raúl Quirós, Rosario Gil, Héctor Guerrero, Jorge Marrero, Eduardo Carmona, José Carlos Morán, José Antonio Trujillo, Alan Flores, Juan Manuel García, Manuel Gómez-Choco, Amparo Romero, Carlos Vilar, Santiago Freire, M. del Mar Castellanos, Silvia Tur, Cristina Borrachero, Jesús Vega, Sonia Gonzalo, Alberto Morán, Laura Ramos, Antonio Cayon, Manuel Seijo, Raquel Delgado-Mederos, M. José Fonseca, Juan Girón, Aida Rodríguez, Yesica Miranda, Jaime Masjuan, Álvaro González, Iván Moreno, Fernando Sierra, Jordi Jiménez, M. del Carmen Riveira, Davinia Larrosa, Rosa Díaz, Daniel Peña, M.M. Contreras Muruaga, Joaquín Antón, Irene Escudero, Borja Enrique Sanz, and Antoni German
Subjects: medicine.medical_specialty, Acenocoumarol, Neurology, business.industry, Warfarin, Atrial fibrillation, General Medicine, 030204 cardiovascular system & hematology, Vitamin k, medicine.disease, Thromboembolic risk, 03 medical and health sciences, 0302 clinical medicine, Multicenter study, Diabetes mellitus, Internal medicine, medicine, 030212 general & internal medicine, business, medicine.drug
Abstract: Objective To identify factors associated with poor anticoagulation control with vitamin K antagonists (VKA) among outpatients with nonvalvular atrial fibrillation (NVAF) attended in Neurology and Internal Medicine in Spain. Methods Cross-sectional and multicenter study, from the ALADIN database, of outpatients with NVAF treated with VKA and attended in Internal Medicine and Neurology in Spain. Rates of anticoagulation control were determined with the direct and Rosendaal methods, considering data from the 6 months before the inclusion. Results Out of 1337 patients included in the ALADIN study, 750 were taking VKA, and complete information about INR values in the last 6 months was available in 383 patients. Mean scores of Charlson Index, CHADS2, CHA2DS2-VASc and HAS-BLED were 1.94 ± 1.54; 3.10 ± 1.26; 4.63 ± 1.54, and 2.20 ± 0.90, respectively. 46.2% and 47.0% of patients had an adequate anticoagulation control according to the direct and Rosendaal methods, respectively. Inadequate anticoagulation control according to the direct method was associated with diabetes (OR: 2.511; 95% CI: 1.144–5.659), prior labile INR (OR: 35.371; 95% CI: 15.058–83.083) and the determination of >6 INR controls in the last 6 months (OR: 4.747; 95% CI: 2.094–10.759), and according to the Rosendaal method, with prior labile INR (p Conclusions Despite the high thromboembolic risk, only a little more than a half of patients were well controlled. Factors associated with poor anticoagulation control were diabetes, labile INR, >6 INR controls and HAS-BLED.
Published: 2018
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27. Factores asociados al mal control de la anticoagulación con antivitamina K en pacientes con fibrilación auricular no valvular atendidos en consultas de Medicina Interna y Neurología. Estudio ALADIN

Author: M.M. Contreras Muruaga, G. Reig, J. Vivancos, A. González, P. Cardona, J.M. Ramírez-Moreno, J. Martí-Fábregas, C. Suárez Fernández, Antonio Pose, José Antonio Díaz, Manuel Rodríguez, Marta Pena, Susana Arias, Davinia Larrosa, Álvaro González, Elisa Rodríguez, Montserrat González, Dolores Fernández, Cristina Barbagelata, Natividad Raña, Santiago Freire, J. Manuel Cerqueiro, Héctor Guerrero, Laura Ramos, Leticia Álvarez, José M. de Lis, Carmen Caro, Manuel Seijo, Susana Mederer, Miguel Alberto de Zarraga, José Ferreiro, José M. Terrero, Mónica Arias, Roberto Pérez, Joaquín Sánchez, José Maciñeiras, Julián Fernández, Fernando Jaén, David Esteva, Mónica Zamora, Nuria Navarrete, Javier García, Luis Mérida, Miguel Ángel Corrales, Raúl Quirós, Jesús Cantero, Francisco Javier Barrero, Inmaculada Villegas, José Castro, Jesús Foronda, Dionisio Carrillo, Jesús Vega, José Antonio Trujillo, Manuel Montero, Ana Jurado, Carlos Sánchez, Eduardo Agüera-Morales, María Sánchez, Purificación Durán, Rafael Fernández de la Puerta, María Pérez de la Blanca, María Paz Martínez, Óscar Fernández, José Antonio Tamayo, Rafael Bustamante, Pedro Jesús Serrano, Antonio Arjona, Javier Fernández, Manuel Payan, Ricardo Gómez, Daniel Peña, Enrique Cabrerizo, Fernando Salgado, Radka Ivanova Georgieva, Antonio Gil-Núñez, Elena Bello, Fernando Díaz, Antonio Medina, Ana Castellano, Yesica Miranda, Óscar Fabre, Iluminada García Polo, Patricia Ibáñez, Clara Sainz, Fernando Sierra, Esther Aragón, Jaime Díaz, Fernando Aguilar, María Ángeles Ortega, José Antonio Egido, José Carlos Pontes, Miguel Ángel García, Francisco Cabrera, Blanca Batalla, Alex Culla, Carlos Molina, Alan Flores, Laia Seró, Marian Muchada, Pilar Meler, Sandra Boned-Riera, David Cánovas, Jordi Estela, Juli Font, Francisco Purroy, Ikram Benabdelhak, Jordi Sanahuja, Jaume Roquer, Ana Rodríguez, Ángel Ois, Elisa Cuadrado, Jordi Jiménez, Xavier Nogués, Jerzy Kuprinski, Antoni German, Daniel Irigoyen, Juan José Cara, Maria Àngels Font, Sonia Huertas, Alejandro Martínez-Domeño, Juan Antonio Arroyo, Raquel Delgado-Mederos, Manuel Jesús Gómez-Choco, Juan José Mengual, Sonia M. García, M. del Mar Castellanos, Cecile van Eedenburg, Imma Cañas, Jordi Espinosa, Santiago Montull, Helena Quesada, Xavier Ustrell, Christian Homedes, Irene Navalpotro, Jordi Casanova, Aida Pilar Lago, Carmen Morata, David Gorriz, Iván Moreno, José Tembl, Alejandro Ponz, M. José Fonseca, Raquel Chamarro, Rosario Gil, Vicente Oliver, Ana Pampliega, Arturo Artero, Francesc Puchades, Lamberto Landete, Carlos Vilar, Carmen Jiménez, Bárbara Vives, M. Dolores Moragues, Rosa Díaz, Silvia Tur, José Bernardo Escribano, César Lucas, Francisco Martínez, José Miguel Pons, Amparo Romero, David García, José Pérez, Ramón Villaverde, Salvadora Martínez, Aida Rodríguez, Carlos Tejero, Cristina Pérez, Enrique Mostacero, Covadonga Fernández, Alain Luna, Tomás Pérez, Félix González, Ana de Arce, Maite Martínez, Noemí Díez, Jaime Gállego, Beatriz Zandio, María Herrera, Nuria Aymerich, Roberto Muñoz, Javier Marta, Jorge Artal, José M. Errea, Juan José Timiraos, M. Pilar Moreno, Mar Freijo, Juan Manuel García, M. Carmen Gil, M. Ángeles Revilla, Enrique Palacio, José Luis Vázquez, María Bestué, Ana Latorre, Eva Calvo, Laura Ballester, Marta Serrano, Jesús M. Juega, M. Ángeles López, Pablo Irimia, Laura Imaz, Blanca Fuentes, Borja Enrique Sanz, Luis Beltrán, Gerardo Ruiz, Patricia Martínez, Demetrio Sánchez, Emilio Barroso, Igor Molina, Marco Antonio Budiño, Jaime Masjuan, Alicia de Felipe, Consuelo Matute, Javier Tejada, Alberto Morán, Esther Fernández, M. del Carmen Riveira, Joaquín Carnedo, Antonio Manquillo, Raquel González, José Carlos Fernández, Marta Guillan, Miguel Yebra, José M. Trejo, Jesús Saiz, Juan Carlos Martínez-Acitores, Yolanda Bravo, Juan Francisco Arenillas, Ana Calleja, Elisa Cortijo, Javier Reyes, Luis López, Pedro Luis Muñoz, M. Ángeles Fidalgo, Jacinto Hernández, José Carlos Gómez, José Carlos Morán, Sonia Gonzalo, Jorge Marrero, José Ángel Satué, Juan Carlos Belinchón, Francisco Moniche, Enrique Calderón, Irene Escudero, Javier de la Torre, Ignacio Casado, Joaquín Antón, Juan Carlos Portilla, Juan Luengo, Joan Rosal, Elena Calzado, Juan Carlos Anglada, Juan Girón, José M. Ramírez, Agustín Pijierro, Ana Roa, Jorge Romero, Mariano Aguayo, Cristina Borrachero, Gema Sanz, M. José Gómez, Miguel Ángel Rico, Antonio Cayon, Eduardo Carmona, Román Cerro, Rafael López, Alfonso Aguirre, Francisco Lozano, and José M. Rivera.
Subjects: 03 medical and health sciences, 0302 clinical medicine, business.industry, Medicine, 030212 general & internal medicine, General Medicine, 030204 cardiovascular system & hematology, business, Humanities
Abstract: Resumen Objetivo Identificar los factores asociados con el mal control de la anticoagulacion con antagonistas de la vitamina K (AVK) en pacientes con fibrilacion auricular no valvular (FANV) atendidos en consultas de Neurologia y Medicina Interna de Espana. Metodos Estudio transversal, multicentrico, anidado en el estudio ALADIN, de sujetos con FANV, tratados con AVK, atendidos en consultas de Medicina Interna o Neurologia de Espana. El grado de control de la anticoagulacion se estudio mediante el metodo directo y el de Rosendaal, considerando los 6 meses previos a la inclusion. Resultados De los 1.337 pacientes incluidos en ALADIN, 750 estaban tratados con AVK, con informacion completa sobre el INR de los ultimos 6 meses en 383 pacientes. Las puntuaciones medias del indice de Charlson, CHADS2, CHA2DS2-VASc y HAS-BLED fueron 1,94 ± 1,54; 3,10 ± 1,26; 4,63 ± 1,54 y 2,20 ± 0,90, respectivamente. El 46,2% y el 47,0% de los pacientes presentaban un control adecuado de la anticoagulacion por los metodos directo y Rosendaal, respectivamente. El control inadecuado de la anticoagulacion se asocio por el metodo directo con diabetes (OR: 2,511; IC 95%: 1,144-5,659), antecedentes de INR inestable (OR: 35,371; IC 95%: 15,058-83,083) y la realizacion de > 6 controles en los ultimos 6 meses (OR: 4,747; IC 95%: 2,094-10,759), y por el metodo de Rosendaal, con los antecedentes de INR inestable (p Conclusiones Pese al alto riesgo tromboembolico, solo estaban bien controlados algo mas de la mitad. Los factores asociados al mal control de la anticoagulacion fueron la diabetes, INR inestable, > 6 controles de INR y el HAS-BLED.
Published: 2018
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28. Workflows and Outcomes in Patients With Suspected Large Vessel Occlusion Stroke Triaged in Urban and Nonurban Areas

Author: Garcia-Tornel, Alvaro, Millan, Monica, Rubiera, Marta, Bustamante, Alejandro, Requena, Manuel, Dorado, Laura, Olivé-Gadea, Marta, Jiménez, Xavier, Soto, Angels, Querol, Marisol, Hernández-Pérez, Maria, Gomis, Meritxell, Cardona, Pere, Urra, Xabier, Purroy, Francesc, Silva, Yolanda, Ustrell, Xavier, Esteve, Patricia, Salvat-Plana, Mercè, Gallofré, Miquel, Molina, Carlos, Dávalos, Antoni, Jovin, Tudor, Abilleira, Sonia, Ribo, Marc, Pérez de la Ossa, Natalia, Jacobi, Marc Ribó, Sanjuan, Estela, Santana, Katherine, Rodríguez, Noelia, Pagola, Jorge, Rodriguez-Luna, David, Maisterra, Olga, Santamarina, Estevo, Muchada, Marian, Juega, Jesús, Boned, Sandra, Franco, Antonio Palasi, García -Tornel, Álvaro, Deck, Matías, Sala, Victoria, Muñoz, Lucía, Millán, Mónica, López-Cancio, Elena, 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, Sara, Guerra, Rubio, Bragado, Irene, Arbex, Andrea, Rodríguez, Luis, 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, Vérez Santamaria, Patricia Valentina, 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, Amaro, Sergio, 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, Vera Monge, Victor Augusto, Ramos, Oscar, Rodríguez, Alejandro, Campello, Ana Rodríguez, Ballester, Gemma Romeral, Trujillano, Mireia Llop, Steinhauer, Eva Giralt, Godia, Elisa Cuadrado, Ois Santiago, Angel Javier, 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, Krupinski, Jerzy, Folch, 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 (intensivista), Sebastian, Gómez-Choco, Manuel, 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, Izarra, Mikel Terceño, Trigo, Irene Bragado, Viturro, Saima Bashir, Albiñana, Laura Pardo, Garrido, Montserrat Reina, Cazcarra, Carla Marco, Uscamaita, Karol Enrique, Márquez, Fabian, Coll, Cristina, Lloret Villlas, Mar Irida, Vila, Berta Solano, Alemany Perna, Berta, Domínguezl, Daniel López, de Lera, Mercedes, Cots Foraster, Anna, Vera Monge, Victor Augusto, Bojaryn, Urszula, Benabdelhak, Ikram, Capdevila, Gerard Mauri, Sanahuja Montesinos, Jordi, Vázquez, Daniel, Vicente Hervás, José, González, Cristina, Quílez, Alejandro, Pascual, Mikel Vicente, Ruiz, María, Riba, Yolanda, Gil Villar, M. Pilar, García, Cristina, Roig, Xavier Ustrell, Mora, Mònica Baldrich, Guinjoan, Anna Pellisé, Borras, Judit, Mañé Martínez, Alba, Marés, Rafael, Viñas i Gaya, Jaume, Seró, Laia, Flores, Alan, Rodríguez, Paula, Castilho, Gislaine, Ortega, Angela Monterde, Reverté, Silvia, Zaragoza, Josep, Baiges, Joan Josep, Zaragoza, Josep, Ozaeta, Gisela Martín, Escalante, Sonia, Payo, Iago, Salvado, Júlia Saura, Sala, Natalia Mas, Soler Insa, Josep M, Vilamala, Ester Tio, Navarro, Josep Abos, Tabuenca, Héctor Cruz, Canento Sánchez, Tamara, Ros, Marta, Matos, Nuria, Roldán, Elisabet, Rubiol, Elsa Puiggrós, Franquet, Elisabet, Fuentes, Lidia, Donaire, Javier, Martí, Elena, Giménez, Laura, Vázquez, Junior Gil, Clara Gris Ambrós, Eloisa Nieto, Rodríguez, Puri, Oletta, José Félix, Mellado, Pilar Pons, Catena, Gómez, Bárbara, Raileau, Vergilin, Ruíz, Esther Catena, Pardina, Oscar, Mercadal, Jordi, López-Diéguez, María, Pérez, Pilar, Gabarró, Lourdes, Orriols, María, Canet, Joan Josep, Roca, Mireia, Álvaro, Muriel, Boneu, Francesc, Giménez, Georgina, Albà, Jaume, Gibert, Francesc, Garcia, Jéssica, Barragan, Patricia, Jurado, Gustavo, Ortega, Josep Sabaté, Martínez Solano, Joan Amaurys, Fernández, Víctor, Torres, Mónica, Belén Montero Alvaredo, Ana, Redondo Parejo, Laura, Maria Aragonés, Josep, Bullón, Anna, Loste, Cora, González, Paula, Bejarano, Neker, Sanchez, Francisco, Lucchetti, Gianni, Pla, Xavier, Gimeno, Javier, Reynaga, Esteban, Barcons, Montse, Celedón, Gabriel, Ortiz, Juan, Anastasovski, Goran, Mascaró, Oscar, de los Ríos, Javier Diez, Feliu, Meritxell, Ribera, Anna, Ruiz, Cristhian, Corominas, Gerard, Nunes, Daniella, Roca, Claudia, Latorre, Nadina, Yataco, Lizbeth, Cruz, Maricelys, Blanco, Nerea, Castejón, Santiago, Calderón, Dolores Cocho, Sunyer, Claustre Pont, Garcia, Jordi Espinosa, Martin, Rodrigo Paz, de Luis Sanchez, Albert, Vivas, Dolores Espinosa, Molina, Juan Valencia, Gemma, Palome, Planels, Chaume, Laia Tomas, Vilella, Ares Villagrasa, Bustamante, Marco, Boltes, 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Puig Pastalle, Montserrat, 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, Uku, Florenc, 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, Amill Vallve, Genis, 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, Mari, Alba, Barrameda, Penela, Ajenjo, Prieto, Benavente, Rebollar, Pareja, Rodriguez, Piñar, Rodríguez, Francisco, Javier, 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, Edurne Judith, Fernandez Toledo, 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, Viñuales Muñoz, Ana Maria, Roig, Josep, and Hidalgo., Verònica
Published: 2022
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29. Influence of Hospital Type on Outcomes of Individuals Aged 80 and Older with Stroke Treated Using Intravenous Thrombolysis

Author: David Cánovas, Francisco Purroy, E. Palomeras, Martha Vargas, Ana Vena, Jordi Sanahuja, Pere Cardona, Jaume Roquer, Miquel Gallofré, Moisés Garcés, Elisa Cuadrado-Godia, Dolores Cocho, Ángel Chamorro, Ikram Benabdelhak, Jerzy Krupinski, Sònia Abilleira, Joaquín Serena, Marc Ribó, Meritxell Gomis, Xavier Ustrell, Júlia Saura, Marta Rubiera, and Antonio Dávalos
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Stroke severity, Population, 030204 cardiovascular system & hematology, elderly, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Risk Factors, Modified Rankin Scale, Internal medicine, medicine, Humans, Thrombolytic Therapy, Prospective Studies, Registries, hospital characteristics, Favorable outcome, Infusions, Intravenous, education, Stroke, Aged, Aged, 80 and over, Nihss score, education.field_of_study, business.industry, Thrombolysis, medicine.disease, stroke, Hospitals, Treatment Outcome, Hospital treatment, Spain, Tissue Plasminogen Activator, Physical therapy, Female, fibrinolysis, Geriatrics and Gerontology, business, 030217 neurology & neurosurgery
Abstract: ObjectivesThe aim of the study was to confirm the safety and effectiveness of using intravenous thrombolysis (IVT) with individuals aged 80 and older in routine practice in different hospital settings. DesignObservasional registry. SettingProspective multicenter population-based registry of acute stroke patients treated with reperfusion therapies in Catalonia, Spain (Sistema Online d'Informacio de l'Ictus Agut). ParticipantsIndividuals treated only with IVT (N = 3,231; 1,189 (36.8%) aged 80). MeasurementsSymptomatic intracranial hemorrhage, mortality, and favorable outcome (modified Rankin Scale (mRS) score = 0-2) at 3 months were evaluated according to hospital characteristics. Treating hospitals were classified in three categories: comprehensive stroke centers (CSCs), primary stroke centers (PSCs), and community hospitals operating a telestroke system (TS). First individuals aged 80 and older were compared with those younger than 80, and then participants aged 80 and older were focused on. ResultsParticipants aged 80 and older had significantly higher baseline National Institute of Health Stroke Scale (NIHSS) scores, longer onset to treatment times, and worse outcomes than younger participants. For participants aged 80 and older, 90-day mortality was 23.2%, with 38.7% having favorable outcomes at 3 months. Symptomatic intracranial hemorrhage (SICH; Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy definition) was observed in 4.7% of subjects. None of the risk factors differed significantly between participants treated in different types of hospitals. Basal stroke severity measured according to NIHSS score was not significantly different either. The three different types of hospitals achieved similar outcomes, although the TS and PSC hospitals had significantly higher proportions of SICH (6.3% and 6.3%, respectively) than the CSC (3.2%). ConclusionOlder adults with acute stroke treated with IVT had similar outcomes regardless of hospital characteristics.
Published: 2017
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30. Geographic dissemination of endovascular stroke thrombectomy in Catalonia within the 2011–2015 period

Author: Sònia Abilleira, Dolores Cocho, MOISES GARCES REDONDO, Angel Ois, POL CAMPS-RENOM, Paloma Mora, Sandra Boned Riera, Manuel Gomez-Choco, Antonio Martínez Yélamos, Cristian Tebé, Sebastian Remollo Friedemann, Marc Ribo, Alejandro Tomasello, Natalia Pérez de la Ossa, and Xavier Ustrell
Subjects: medicine.medical_specialty, education.field_of_study, business.industry, Public health insurance, Population, Primary care, 030204 cardiovascular system & hematology, medicine.disease, Confidence interval, Surgery, 03 medical and health sciences, 0302 clinical medicine, Original Research Articles, Emergency medicine, Medicine, Area of residence, Registry data, cardiovascular diseases, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, education, Stroke, 030217 neurology & neurosurgery, Health statistics
Abstract: Introduction Endovascular thrombectomy was recently established as a new standard of care in acute ischemic stroke patients with large artery occlusions. Using small area health statistics, we sought to assess dissemination of endovascular thrombectomy in Catalonia throughout the period 2011–2015. Patients and methods We used registry data to identify all endovascular thrombectomies for acute ischemic stroke performed in Catalonia within the study period. The SONIIA registry is a government-mandated, population-based and externally audited data base that includes all reperfusion therapies for acute ischemic stroke. We linked endovascular thrombectomy cases identified in the registry with the Central Registry of the Catalan Public Health Insurance to obtain the primary care service area of residence for each treated patient, age and sex. We calculated age-sex standardized endovascular thrombectomy rates over time according to different territorial segmentation patterns (metropolitan/provincial rings and primary care service areas). Results Region-wide age-sex standardized endovascular thrombectomy rates increased significantly from 3.9 × 100,000 (95% confidence interval: 3.4–4.4) in 2011 to 6.8 × 100,000 (95% confidence interval: 6.2–7.6) in 2015. Such increase occurred in inner and outer metropolitan rings as well as provinces although highest endovascular thrombectomy rates were persistently seen in the inner metropolitan area. Changes in endovascular thrombectomy access across primary care service areas over time were more subtle, but there was a rather generalized increase of standardized endovascular thrombectomy rates. Discussion This study demonstrates temporal and territorial dissemination of access to endovascular thrombectomy in Catalonia over a 5-year period although variation remains at the completion of the study. Conclusion Mapping of endovascular thrombectomy is essential to assess equity and propose actions for access dissemination.
Published: 2017
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31. Clinical and neuroimaging criteria to improve the workflow in transfers for endovascular treatment evaluation

Author: Marta Rubiera, Francisco Purroy, Natalia Pérez de la Ossa, Alejandro Tomasello, Marc Ribó, Carlos A. Molina, Xabier Urra, Sònia Abilleira, Yolanda Silva, Joaquín Serena, Xavier Ustrell, Catalan Stroke Code, Sandra Boned, Marta Olivé-Gadea, Manuel Requena, Pere Cardona, and Anna Ramos
Subjects: Patient Transfer, medicine.medical_specialty, Time Factors, medicine.diagnostic_test, business.industry, Endovascular Procedures, Computed tomography, Neuroimaging, medicine.disease, Workflow, Stroke, Treatment Outcome, Neurology, medicine, Humans, Medical physics, cardiovascular diseases, Endovascular treatment, business, Retrospective Studies
Abstract: Background Transfer protocols from primary to comprehensive stroke centers are crucial for endovascular treatment success. Aim To evaluate clinical and neuroimaging data of transferred patients and their likelihood of presenting a large infarct core at comprehensive stroke center arrival. Methods Retrospective analysis of population-based mandatory prospective registry of acute stroke patients evaluated for endovascular treatment. Consecutive patients evaluated at primary stroke center with suspected large vessel occlusion and PSC-ASPECTS ≥ 6 transferred to a comprehensive stroke center were included. PSC and CSC-ASPECTS, time-metrics, and clinical data were analyzed. Results During 28 months, 1185 endovascular treatment candidates were transferred from PC to comprehensive stroke center in our public stroke network, 477 had an anterior circulation syndrome and available neuroimaging information and were included. Median baseline NIHSS was 13 (8–19). On arrival to comprehensive stroke center, large vessel occlusion was confirmed in 60.2% patients, and 41.2% received endovascular treatment. Median interfacility ASPECTS decay was 1 (0–2) after a median of 150.7 (SD 101) min between both CT-acquisitions. A logistic regression analysis adjusted by age, time from symptoms to PC-CT, and time from PC-CT to CSC-CT showed that only a baseline NIHSS and PSC-ASPECTS independently predicted a CSC-ASPECTS Conclusion After a median transfer time >2 h, only 11.9% showed ASPECTS
Published: 2019

32. Correlation of blood biomarkers with early-onset seizures after an acute stroke event

Author: Teresa Gasull, Laura Abraira, Alejandro Bustamante, Juan Luis Becerra, Josep Zaragoza, Marta Rubiera, Mikel Terceño, José Alvarez-Sabín, Antoni Dávalos, Nicola Giannini, Estevo Santamarina, Sonia Cazorla, David Cánovas, Manuel Quintana, Xavier Ustrell, Laia Grau-López, Manuel Toledo, Marta Jiménez, Mónica Millán, Mar Castellanos, Joan Montaner, Jordi Ciurans, and Pere Cardona
Subjects: Male, medicine.medical_specialty, Standard score, Logistic regression, Epileptogenesis, 03 medical and health sciences, Behavioral Neuroscience, Epilepsy, 0302 clinical medicine, Interquartile range, Risk Factors, Seizures, Internal medicine, medicine, Humans, 030212 general & internal medicine, Longitudinal Studies, Prospective Studies, Age of Onset, Stroke, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Odds ratio, Middle Aged, medicine.disease, Confidence interval, Neurology, Female, Neurology (clinical), business, 030217 neurology & neurosurgery, Biomarkers
Abstract: Introduction: Blood biomarkers have not been widely studied in stroke-related seizures. In this study, we aimed to describe clinical factors and biomarkers present during acute stroke and to analyze their association with early-onset seizures. Methods: We retrospectively evaluated a panel of 14 blood biomarkers in 1115 patients with ischemic and hemorrhagic stroke. Biomarkers were normalized and standardized using Z scores. We also recorded stroke and epilepsy-related variables, including stroke severity (National Institute of Health Stroke Scale [NIHSS] scores), type, and causes, timefromonset of stroke to occurrence of early seizures, and type of seizure. Adjusted logistic regression modelswere built to identify clinical variables and biomarkers independently associated with early seizures. Results: Mean +/- standard deviation (SD) age was 72.3 +/- 13.2 years, and 56.8% of the patients were men. Thirtyeight patients (3.9%) developed early seizureswith a median time to onset of 1 day (interquartile range (IQR), 04). A higher NIHSS score (odds ratio [OR] = 1.046; 95% confidence interval (CI): 1.001-1.094; p = 0.044) and hemorrhagic stroke (OR= 2.133; 95% CI: 1.010-4.504; p= 0.047) were independently associatedwith a greater risk of early seizures. Independent blood biomarkers predictive of early seizures were lower levels of tumor necrosis factor receptor 1 (TNF-R1) (0.326) (p= 0.009; OR = 2.625; 95% CI: 1.271-5.420). The predictive power of the regression model was greater when clinical variables were combined with blood biomarkers (73.5%; 95% CI: 65.1%-81.9%) than when used alone (64%; 95% CI: 55%-72.9%). Conclusion: Higher NCAM and lower TNF-R1 levels may help predict the occurrence of early seizures. The combined use of these biomarkers and clinical variables could be useful for identifying patients at risk of seizures. (C) 2019 Elsevier Inc. All rights reserved.
Published: 2019

33. Revalidation of the RACE scale after its regional implementation in Catalonia: a triage tool for large vessel occlusion

Author: David, Carrera, Montse, Gorchs, Marisol, Querol, Sònia, Abilleira, Marc, Ribó, Mònica, Millán, Anna, Ramos, Pedro, Cardona, Xabier, Urra, Ana, Rodríguez-Campello, Luis, Prats-Sánchez, Francisco, Purroy, Joaquín, Serena, David, Cánovas, Josep, Zaragoza-Brunet, Jerzy A, Krupinski, Xavier, Ustrell, Júlia, Saura, Sonia, García, Maria Àngela, Mora, Xavier, Jiménez, Antoni, Dávalos, Natalia, Pérez de la Ossa, and Tudor, Jovin
Subjects: Male, Emergency Medical Services, medicine.medical_specialty, thrombolysis, Referral, medicine.medical_treatment, Revascularization, Severity of Illness Index, Brain Ischemia, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Revalidation, 0302 clinical medicine, medicine, Emergency medical services, Humans, Prospective Studies, Registries, Stroke, Aged, Thrombectomy, Aged, 80 and over, business.industry, Reproducibility of Results, General Medicine, Thrombolysis, Middle Aged, medicine.disease, Triage, stroke, Cerebrovascular Disorders, Spain, thrombectomy, Area Under Curve, Scale (social sciences), Emergency medicine, Female, Surgery, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract: Background and purposeOur aim was to revalidate the RACE scale, a prehospital tool that aims to identify patients with large vessel occlusion (LVO), after its region-wide implementation in Catalonia, and to analyze geographical differences in access to endovascular treatment (EVT).MethodsWe used data from the prospective CICAT registry (Stroke Code Catalan registry) that includes all stroke code activations. The RACE score evaluated by emergency medical services, time metrics, final diagnosis, presence of LVO, and type of revascularization treatment were registered. Sensitivity, specificity, and area under the curve (AUC) for the RACE cut-off value ≥5 for identification of both LVO and eligibility for EVT were calculated. We compared the rate of EVT and time to EVT of patients transferred from referral centers compared with those directly presenting to comprehensive stroke centers (CSC).ResultsThe RACE scale was evaluated in the field in 1822 patients, showing a strong correlation with the subsequent in-hospital evaluation of the National Institute of Health Stroke Scale evaluated at hospital (r=0.74, PConclusionsThis large validation study confirms RACE accuracy to identify stroke patients eligible for EVT, and provides evidence of geographical imbalances in the access to EVT to the detriment of patients located in remote areas.
Published: 2019

34. Pre-Existing Cerebral Small Vessel Disease Limits Early Recovery in Patients with Acute Lacunar Infarct

Author: Jon Rodríguez-Antigüedad, Joan Martí-Fàbregas, Xavier Ustrell, José Tembl, Joaquín Serena, Martí Paré-Curell, Francisco Purroy, Juan José Mengual, Blanca Fuentes, E. Palomeras, Manuel Gómez-Choco, Manuel Rodríguez-Yáñez, and Mar Castellanos
Subjects: Male, TOAST Classification, medicine.medical_specialty, Time Factors, Lacunar stroke, medicine.medical_treatment, stroke recovery, Disease, lacune, Disability Evaluation, 03 medical and health sciences, microbleed, 0302 clinical medicine, Neuroimaging, Risk Factors, Modified Rankin Scale, Internal medicine, Humans, Medicine, Registries, cardiovascular diseases, Stroke, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Rehabilitation, white matter hyperintensity, Stroke Rehabilitation, lacunar stroke, Recovery of Function, Middle Aged, medicine.disease, Small vessel disease, lacunar stroke, lacune, microbleed, stroke recovery, white matter hyperintensity, Small vessel disease, Treatment Outcome, Cerebral Small Vessel Diseases, Stroke, Lacunar, Cardiology, Etiology, Female, Surgery, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Stroke recovery, 030217 neurology & neurosurgery
Abstract: Background and Purpose: To assess whether neuroimaging markers of chronic cerebral small vessel disease (cSVDm) influence early recovery after acute ischemic stroke (AIS). Methods: Retrospective analysis of patients diagnosed with AIS and included in the Spanish Neurological Society Stroke Database. Inclusion criteria: (1) Brain MRI performed after acute stroke and (2) Premorbid modified Rankin scale (mRS) = 0. Exclusion criteria: (1) Uncommon stroke etiologies, (2) AIS not confirmed on neuroimaging, or (3) Old territorial infarcts on neuroimaging. Patients scored from 0 to 2 according to the amount of cSVDm. Patients were divided into lacunar ischemic stroke (LIS) and nonlacunar ischemic stroke (NLIS) groups according to TOAST classification. Primary outcome: Distribution of mRS at discharge. Secondary outcomes: NIHSS improvement more than or equal to 3 at 24 hours and at discharge, NIHSS worsening more than or equal to 3 points at 24 hours. Results: We studied 4424 patients (3457 NLIS, 967 LIS). The presence of cSVDm increased the risk of worsening 1 category on the mRS at discharge in the LIS group ([1] cSVDm: OR 1.89 CI 95% 1.29-2.75, P = .001. [2] cSVDm: OR 1.87, CI 95% 1.37-2.56 P = .001) and was an independent factor for not achieving an improvement more than or equal to 3 points on the NIHSS at discharge for all the patients and the LIS group (all stroke patients: [1] cSVDm: OR 0.81 CI 95% .68-.97 P = .022. [2] cSVD: OR 0.58 CI95% .45-.77, P = .001./LIS: [1] cSVDm: OR 0.64, CI 95% .41-.98, P = .038. [2] cSVDm: OR 0.43, CI 95% .24-.75 P = .003). Conclusions: Pre-existing SVD limits early functional and neurological recovery after AIS, especially in LIS patients.
Published: 2019

35. Access to Endovascular Treatment in Remote Areas

Author: Sergi Amaro, Xabier Urra, Alejandro Tomasello, Joaquín Serena, Joan Martí-Fàbregas, A. Chamorro, MA de Miquel, Joan Perendreu, Joan Josep Baiges, Yolanda Silva, Anna Pellisé, Antoni Dávalos, Xavier Ustrell, Jordi Jiménez-Conde, Pilar Otermin, Jordi Sanahuja, Pilar Coscojuela, Sònia Abilleira, Carlos Castaño, Rafael Marés, R Delgado Mederos, Josep Maria Aragonés, Elisa Cuadrado-Godia, A Martínez Domeño, Marc Ribó, Francisco Purroy, Marta Rubiera, C van Eendenburg, N Cayuela, Juan Macho, Jurek Krupinski, L San Roman Manzanera, Ana Rodríguez-Campello, J Estela, Angel Ois, Meritxell Gomis, MC Nicolás, Mar Castellanos, Carlos A. Molina, JM Soler Insa, Eva Giralt, S Huertas, M Del Carmen Garcia, Moisés Garcés, Helena Quesada, Natalia Pérez de la Ossa, Manuel Gómez-Choco, J. Pagola, Sebastian Remollo, David Rodriguez-Luna, Paloma Mora, R Marín Bueno, Jordi Blasco, Sonia García, Victor Obach, L Cocho Calderón, Antonio M. López, Laura Dorado, David Cánovas, Jaume Roquer, Lucia Aja, Mónica Millán, Júlia Saura, R Martínez, Blanca Lara, E. López-Cancio, Miquel Gallofré, Leopoldo Guimaraens, Antonio Martínez-Yélamos, E. Palomeras, Pere Cardona, and Marian Muchada
Subjects: Male, medicine.medical_specialty, Population, 030204 cardiovascular system & hematology, Stroke care, Hospitals, Special, Stroke onset, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Thrombolytic Therapy, Registries, Symptom onset, Endovascular treatment, education, Stroke, Aged, Aged, 80 and over, Advanced and Specialized Nursing, education.field_of_study, Groin, business.industry, Endovascular Procedures, Middle Aged, medicine.disease, Surgery, medicine.anatomical_structure, Spain, Baseline characteristics, Reperfusion, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Delivery of Health Care, 030217 neurology & neurosurgery
Abstract: Background and Purpose— Since demonstration of the benefit of endovascular treatment (EVT) in acute ischemic stroke patients with proximal arterial occlusion, stroke care systems need to be reorganized to deliver EVT in a timely and equitable way. We analyzed differences in the access to EVT by geographical areas in Catalonia, a territory with a highly decentralized stroke model. Methods— We studied 965 patients treated with EVT from a prospective multicenter population-based registry of stroke patients treated with reperfusion therapies in Catalonia, Spain (SONIIA). Three different areas were defined: (A) health areas primarily covered by Comprehensive Stroke Centers, (B) areas primarily covered by local stroke centers located less than hour away from a Comprehensive Stroke Center, and (C) areas primarily covered by local stroke centers located more than hour away from a Comprehensive Stroke Center. We compared the number of EVT×100 000 inhabitants/year and time from stroke onset to groin puncture between groups. Results— Baseline characteristics were similar between groups. Throughout the study period, there were significant differences in the population rates of EVT across geographical areas. EVT rates by 100 000 in 2015 were 10.5 in A area, 3.7 in B, and 2.7 in C. Time from symptom onset to groin puncture was 82 minutes longer in group B (312 minutes [245–435]) and 120 minutes longer in group C (350 minutes [284–408]) compared with group A (230 minutes [160–407]; P Conclusions— Accessibility to EVT from remote areas is hampered by lower rate and longer time to treatment compared with areas covered directly by Comprehensive Stroke Centers.
Published: 2016
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36. Corrigendum to 'Correlation of blood biomarkers with early-onset seizures after an acute stroke event' [Epilepsy Behav 104(Pt B) (2020 Mar)]

Author: Manuel Quintana, Mikel Terceño, Joan Montaner, Alejandro Bustamante, Antoni Dávalos, Marta Rubiera, Pere Cardona, Juan Luis Becerra, José Alvarez-Sabín, Jordi Ciurans, Teresa Gasull, Josep Zaragoza, Estevo Santamarina, Xavier Ustrell, Mónica Millán, David Canovas, Sonia Cazorla, Nicola Giannini, Laura Abraira, Laia Grau-López, Mar Castellanos, Manuel Toledo, and Marta Jiménez
Subjects: medicine.medical_specialty, business.industry, Event (relativity), medicine.disease, Behavioral Neuroscience, Epilepsy, Neurology, Blood biomarkers, Internal medicine, medicine, Cardiology, Neurology (clinical), business, Early onset, Acute stroke
Published: 2020
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37. Some light in the shadows of atrial fibrillation and stroke: To look or not to look

Author: Xavier Ustrell and Minoru Tagawa
Subjects: medicine.medical_specialty, Stroke patient, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Atrial Fibrillation, medicine, Humans, cardiovascular diseases, Risk factor, Stroke, Aspirin, Preventive strategy, business.industry, Atrial fibrillation, medicine.disease, Cryptogenic stroke, Ischemic stroke, Cardiology, Neurology (clinical), business, 030217 neurology & neurosurgery, medicine.drug
Abstract: In ischemic stroke, the diagnostic workup determines the best preventive strategy. However, cryptogenic stroke accounts for about 20%–40% of all strokes.1 For these patients, the best preventive treatment remains unknown, and most guidelines recommend risk factor modification and antiplatelet therapy. Given the substantial recurrence rate for cryptogenic stroke, this is not a comfortable situation: just try to tell your stroke patients, “After all these tests, I do not have any clue why you had a stroke”; and about the treatment, “Just take an aspirin and cross fingers you do not have another one.”
Published: 2017

38. Blood Biomarkers for the Early Diagnosis of Stroke: The Stroke-Chip Study

Author: María Hernández-Pérez, Joaquín Serena, Sara Pich, Alejandro Bustamante, Rafael Marés, Luis Cano, Mar Castellanos, Dolors Giralt, Mikel Terceño, Teresa García-Berrocoso, Yolanda Silva, Marta Rubiera, Joan Montaner, Anna Penalba, Elena López-Cancio, Teresa Gasull, Carles Ferrer-Costa, Francisco Rubio, Mónica Millán, Joan Josep Baiges, Helena Quesada, Xavier Ustrell, Antoni Dávalos, Silvia Reverté, Eduardo Salas, Pedro Cardona, and Moisés Garcés
Subjects: Male, diagnosis, Chemokine CXCL1, 030204 cardiovascular system & hematology, Logistic regression, Brain Ischemia, 0302 clinical medicine, Natriuretic Peptide, Brain, Nerve Growth Factor, Odds Ratio, Prospective Studies, Stroke, Neural Cell Adhesion Molecules, Aged, 80 and over, Caspase 3, Interleukin-17, Atrial fibrillation, Middle Aged, stroke, Endostatins, Matrix Metalloproteinase 9, Receptors, Tumor Necrosis Factor, Type I, Cardiology, Biomarker (medicine), Female, Amine Oxidase (Copper-Containing), Cardiology and Cardiovascular Medicine, Interleukin Receptor Common gamma Subunit, medicine.medical_specialty, hypertension, Fas Ligand Protein, S100 Calcium Binding Protein beta Subunit, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, Internal medicine, von Willebrand Factor, medicine, Humans, cardiovascular diseases, Aged, Cerebral Hemorrhage, Advanced and Specialized Nursing, cerebral hemorrhage, Apolipoprotein C-III, Receiver operating characteristic, business.industry, Interleukin-6, HSC70 Heat-Shock Proteins, biomarkers, Odds ratio, medicine.disease, Confidence interval, Peptide Fragments, Surgery, Fibronectins, Blood pressure, Insulin-Like Growth Factor Binding Protein 3, Logistic Models, ROC Curve, Case-Control Studies, Phosphopyruvate Hydratase, Neurology (clinical), business, Cell Adhesion Molecules, 030217 neurology & neurosurgery, Biomarkers
Abstract: Background and Purpose— Stroke diagnosis could be challenging in the acute phase. We aimed to develop a blood-based diagnostic tool to differentiate between real strokes and stroke mimics and between ischemic and hemorrhagic strokes in the hyperacute phase. Methods— The Stroke-Chip was a prospective, observational, multicenter study, conducted at 6 Stroke Centers in Catalonia. Consecutive patients with suspected stroke were enrolled within the first 6 hours after symptom onset, and blood samples were drawn immediately after admission. A 21-biomarker panel selected among previous results and from the literature was measured by immunoassays. Outcomes were differentiation between real strokes and stroke mimics and between ischemic and hemorrhagic strokes. Predictive models were developed by combining biomarkers and clinical variables in logistic regression models. Accuracy was evaluated with receiver operating characteristic curves. Results— From August 2012 to December 2013, 1308 patients were included (71.9% ischemic, 14.8% stroke mimics, and 13.3% hemorrhagic). For stroke versus stroke mimics comparison, no biomarker resulted included in the logistic regression model, but it was only integrated by clinical variables, with a predictive accuracy of 80.8%. For ischemic versus hemorrhagic strokes comparison, NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) >4.9 (odds ratio, 2.40; 95% confidence interval, 1.55–3.71; P 4.7 (odds ratio, 2.02; 95% confidence interval, 1.19–3.45; P =0.010), together with age, sex, blood pressure, stroke severity, atrial fibrillation, and hypertension, were included in the model. Predictive accuracy was 80.6%. Conclusions— The studied biomarkers were not sufficient for an accurate differential diagnosis of stroke in the hyperacute setting. Additional discovery of new biomarkers and improvement on laboratory techniques seem necessary for achieving a molecular diagnosis of stroke.
Published: 2017

39. Abstract 18: External Validation of the RACE Scale After Its Implementation in the Stroke Code Protocol in Catalonia

Author: Antoni Dávalos, Joan Martí-Fàbregas, Moisés Garcés, Natalia Pérez de la Ossa, Pere Cardona, Sònia Abilleira, Ana Rodríguez-Campello, David Cánovas, David Carrera, Xabier Urra, Francisco Purroy, Joaquín Serena, Xavier Ustrell, Jurek Krupinski, Júlia Saura, Millan Monica, Marc Ribó, Montse Gorchs, and Xavier Jiménez
Subjects: Advanced and Specialized Nursing, CODE protocol, Scale (ratio), business.industry, External validation, 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Medicine, Neurology (clinical), Medical emergency, Endovascular treatment, Cardiology and Cardiovascular Medicine, business, Stroke, 030217 neurology & neurosurgery, Large vessel occlusion
Abstract: Introduction: We aimed to revalidate the RACE scale as a pre-hospital tool to identify patients with large vessel occlusion (LVO) and patients receiving endovascular treatment (EVT) after its implementation in the Stroke Code protocol of Catalonia (7.5 M inhabitants). Methods: We used data from the CICAT registry (Feb to Jun 2016), a government-mandated, prospective, hospital-based dataset that includes all Stroke Code activations. CICAT is linked to the EMS database to capture information about the pre-hospital care. RACE score, pre-hospital and in-hospital delays, final diagnostic, presence of LVO (TICA, MCA M1 or M2, tandem or basilar occlusion) and revascularization treatment were registered. Sensitivity, specificity and area under the curve (AUC) to identify LVO and patients receiving EVT were calculated for the pre-established cut off RACE≥5. Results: From the 1600 stroke code activations we included in the study the 962 patients in which the RACE scale was available (60%). The RACE scale showed a strong correlation with the NIHSS evaluated at hospital arrival (r=0.74, p Conclusion: This large validation study performed after implementation of the RACE scale in the real clinical practice in the region of Catalonia confirms RACE accuracy to identify candidates to EVT. A RACE score ≥5 detected 77% of patients that finally underwent EVT confirming the scale as a valuable tool at the prehospital level.
Published: 2017
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40. Abstract WP244: Review Criteria For Transfer Elderly Patient From Community Hospital To Comprehensive Stroke Center

Author: Teresa Usabiaga Bernal, Xavier Ustrell, Pedro Cardona, Nuria Cayuela, Paloma Mora, Lucia Aja, Helena Quesada, Elsa Puiggros, Blanca Lara, Francisco Rubio, Moisés Garcés, and Ester Catena
Subjects: Advanced and Specialized Nursing, medicine.medical_specialty, business.industry, medicine.disease, Vascular occlusion, Community hospital, medicine.anatomical_structure, Radiological weapon, Epidemiology, Emergency medicine, medicine, Neurology (clinical), medicine.symptom, Endovascular treatment, Cardiology and Cardiovascular Medicine, Elderly patient, business, Stroke, Artery
Abstract: Background: Recent guidelines recommend thrombectomy to treat stroke due to large vessel occlusions within first six hours after onset stroke time. There is no age limit, however elderly patients (>=80 years old) transferred from community hospital (CH) to comprehensive stroke center (CSC) possibly present different radiological findings in comparison with younger patients, that finally exclude them of endovascular treatment and could avoid unnecessary transfers to CSC. Method: We reviewed consecutive patients transferred from five CH to our CSC from January 2012 to July 2016. We analyzed radiological findings in ASPECTS (Alberta Stroke Program Early CT Scale) and segment of occluded artery in NonContrastCT (NCCT) and CT-angiography, both realized in CH (pre-transfer) and CSC. We evaluated the changes in NCCT between both centers related to onset stroke time, time of transfer, vascular occlusion segment and other epidemiological variables. Results: A total of 3825 patients were evaluated in our CSC as stroke code (24% elderly and increasing annually); 21% were transferred from CH to CSC with large vessel occlusion diagnosis and NIHSS>8. Subgroup of elderly patients presented worse score in ASPECTS-NCCT evaluated at CSC previous to endovascular treatment than younger patients (mean 6.8 vs 8.4;p: 0.001). An ASPECT score 6) in NCCT at CSC (AUC: 0.69; S: 61%, E: 85%). Conclusions: Patients over 83 years old and low score in ASPECT (score
Published: 2017
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41. Abstract TP63: Lacunarization After Endovascular Treatment: a Surrogate Marker of Good Functional Outcome

Author: Pedro Cardona, Helena Quesada, Blanca Lara, Nuria Cayuela, Xavier Ustrell, Moises Garces, Paloma Mora, Roger Barranco, M Angeles De Miquel, Ana Maria Escrig, and Francisco Rubio
Subjects: Advanced and Specialized Nursing, cardiovascular diseases, Neurology (clinical), Cardiology and Cardiovascular Medicine
Abstract: Introduction: Multiple randomized trials have demonstrated that endovascular treatment (EVT) in selected stroke patients is associated with good clinical outcome (90 days mRankin 0-2: 44-60%). However the percentage of good functional outcome could be improved if we consider patients without cortical clinical impairment with presentation of classical lacunar syndrome despite non-lacunar radiological infarct. Methods: Consecutive patients with ischemic stroke who received endovascular reperfusion were retrospectively analyzed between May 2010 and April 2015. On admission NCCT (non-contrast CT) and CTASI (CT Angiography Source Image) were performed in stroke patients according to our hospital guidelines. We independently applied the ASPECT score in all baselines NCCT, CTASI and follow-up NCCT 24H, and magnetic resonance (MR) during hospitalization. Five pure clinical lacunar syndromes (CLS) were recorded within 24h exam after EVT in our stroke unit and 90 days follow-up Results: We review 428 thrombectomies of patients with acute ischemic stroke. Ninety-five percent of occlusions were located in middle cerebral artery or terminal internal carotid, (49% women, mean age 65+/-13 years; NIHSS at admission: 17; baseline mRS 0-1:96%). Successful recanalization (TICI 2b-3) was achieved in 81%. At 3 months good functional outcome (mRS 0-2) was seen in 51% and death occurred in 13%. CLS were indentified in 42% patients within 24h after EVT. This clinical syndromes were associated to ASPECT score in 24 NCCT and CTASI in patients with recanalization 2b-3 (p:0.003), but only 4% had a defined radiological lacunar stroke on MR. CLS turned out to be one of independence predictors of good outcomes (Rankin 0-2 at 90d) after adjustment for ages, sex and baseline NIHSS scores (OR 1.85; CI:1.4-3.1; p:0.001). Also CLS were still present in 34% of patients with Rankin>2 at 90d (Rankin 3:26%; Rankin 4:7%) Conclusions: These results suggest that a neurological exam 24h after EVT with identification of pure lacunar syndrome can predict favorable functional outcome at 90days. This group of patients presents radiological findings with an unusual location and size with regard to CLS. We suggest to consider patients with CLS as good outcome after EVT regardless 90d mRankin>2.
Published: 2016
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42. Abstract WP439: Who Benefits From CT-Angiography Previous Intravenous Thrombolysis?

Author: Roger Barranco, Moisés Garcés, Pedro Cardona, Teresa Usabiaga Bernal, De Miquel M. Angeles, Nuria Cayuela, Ester Catena, Paloma Mora, Helena Quesada, Xavier Ustrell, Blanca Lara, Alfons Moral, Anna Escrig, and Francisco Rubio
Subjects: Advanced and Specialized Nursing, medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Significant difference, Thrombolysis, medicine.disease, Arterial occlusion, Dense artery sign, Occlusion, Angiography, medicine, cardiovascular diseases, Neurology (clinical), Radiology, Thrombus, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Stroke
Abstract: Background: Endovascular treatment (EVT) is an effective treatment in strokes with persistent large artery occlusion despite previous intravenous thrombolisis (IVT) as rescue treatment. Performing computer tomography angiography (CTA) before IVT could allow early activation of neurointerventional teams; however routine CTA could delay unnecessary door-to-needle time of IVT and may be infeasible. Methods: We reviewed stroke code activations between May 2011 and June 2015 in our comprehensive stroke center and divided into groups based on NIHSS and patency of arterial occlusion according to non-enhanced CT on admission (dense artery sign or dot sign) and baseline CTA. We assessed patients treated with IVT and selected to EVT according to results in CTA post-IVT. We analyze percentage of recanalization or migration of thrombus after IVT alone and variables associated to successful treatment. Results: Of 2856 stroke codes registered during the study period 1810 were diagnosis of ischemic strokes. We treated 520 patients with IVT, 202 had a radiological evidence of large artery occlusion (55%M1, 32% M2, 5%TICA, 5%ICA, 3% basilar). Thirty-two percent of patients showed changes in CTA carried out after IVT(17% successfully recanalized, 15% distal migration of thrombus) so they were not selected to endovascular treatment. There were significant difference between M1 and M2 occlusion regarding changes in CTA after IVT (23% vs 70%; p Conclusions: We consider defer CTA angiography until after IVT in stroke code patients with moderate clinical impairment (NIH
Published: 2016
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43. Cardiac Workup of Ischemic Stroke

Author: Anna Pellisé and Xavier Ustrell
Subjects: medicine.medical_specialty, cardiac workup, Heart disease, electrocardiography, medicine.medical_treatment, Article, Ambulatory electrocardiography, Internal medicine, medicine, echocardiography, atrial fibrillation, cardiovascular diseases, Stroke, Cardiac imaging, medicine.diagnostic_test, business.industry, stroke, Atrial fibrillation, General Medicine, medicine.disease, Embolism, Angiography, cryptogenic stroke, cardiovascular system, Cardiology, cardioembolic stroke, Cardiac monitoring, Cardiology and Cardiovascular Medicine, business, Electrocardiography
Abstract: Stroke is the leading cause of disability in developed countries and the third cause of mortality. Up to 15-30% of ischemic strokes are caused by cardiac sources of emboli being associated with poor prognosis and high index of fatal recurrence. In order to establish an adequate preventive strategy it is crucial to identify the cause of the embolism. After a complete diagnostic workup up to 30% of strokes remain with an undetermined cause, and most of them are attributed to an embolic mechanism suggesting a cardiac origin. There is no consensus in the extent and optimal approach of cardiac workup of ischemic stroke. Clinical features along with brain imaging and the study of the cerebral vessels with ultrasonography or MRI/CT based angiography can identify other causes or lead to think about a possible cardioembolic origin. Atrial fibrillation is the most common cause of cardioembolic stroke. Identification of occult atrial fibrillation is essential. Baseline ECG, serial ECG(’s), cardiac monitoring during the first 48 hours, and Holter monitoring have detection rates varying from 4 to 8% each separately. Extended cardiac monitoring with event loop recorders has shown higher rates of detection of paroxysmal atrial fibrillation. Cardiac imaging with echocardiography is necessary to identify structural sources of emboli. There is insufficient data to determine which is the optimal approach. Transthoracic echocardiography has an acceptable diagnostic yield in patients with heart disease but transesophageal echocardiography has a higher diagnostic yield and is necessary if no cardiac sources have been identified in patients with cryptogenic stroke with embolic mechanism.
Published: 2010
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44. Ictus. Diagnóstico y tratamiento de las enfermedades cerebrovasculares

Author: Joaquín Serena-Leal and Xavier Ustrell-Roig
Subjects: business.industry, Medicine, Cardiology and Cardiovascular Medicine, business, Humanities
Abstract: En nuestro medio, el ictus es la segunda causa de muerte y la primera de discapacidad, con un gran impacto economico. La trombolisis y las unidades de ictus son la mayor contribucion al tratamiento del ictus de los ultimos anos y han cambiado una actitud nihilista por una actitud activa, ya que el ictus es una emergencia medica. El activador tisular del plasminogeno recombinante es eficaz en las primeras 3 h del inicio del ictus y la Food and Drug Administration y la Agencia Europea del Medicamento han aprobado su uso. La actuacion protocolizada durante la fase aguda para corregir alteraciones fisiologicas es el fundamento de las unidades de ictus, y muestra una reduccion de la mortalidad y la discapacidad. Se estan desarrollando multiples estrategias para tratar a un mayor numero de pacientes, como los farmacos con mayor ventana terapeutica, la trombolisis intravenosa combinada con intraarterial, la identificacion de pacientes con penumbra isquemica mediante nuevas tecnicas de neuroimagen y los tratamientos neuroprotectores para evitar mayor dano cerebral. El tratamiento preventivo tambien ha experimentado un cambio por el mejor conocimiento de la etiopatogenia, el papel de los factores de riesgo vascular y el desarrollo de nuevos farmacos. El conocimiento de la enfermedad cerebrovascular y su adecuado tratamiento es hoy dia imprescindible para el mejor tratamiento de los pacientes con ictus.
Published: 2007
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45. Functional outcome after primary endovascular therapy or IV thrombolysis alone for stroke. An observational, comparative effectiveness study

Author: Carlos A. Molina, Joan Martí-Fàbregas, Joan Perendreu, Jerzy Krupinski, Miquel Gallofré, Aida Ribera, Ángel Chamorro, Carlos Castaño, Mar Castellanos, Xabier Urra, Jordi Blasco, Marc Ribó, Sònia Abilleira, Francisco Purroy, Júlia Saura, Leopoldo Guimaraens, Antonio Martínez-Yélamos, Joan Josep Baiges, Antonio Dávalos, Catalan Stroke Code, Manuel Gómez-Choco, Jaume Roquer, Alejandro Tomasello, David Cánovas, Dolores Cocho, Laura Dorado, Lucia Aja, Pere Cardona, and Xavier Ustrell
Subjects: Adult, Male, medicine.medical_specialty, Iv thrombolysis, Treatment outcome, Large vessel, Endovascular therapy, Brain Ischemia, Fibrinolytic Agents, Medicine, Humans, Thrombolytic Therapy, Prospective Studies, Prospective cohort study, Acute ischemic stroke, Stroke, Aged, Aged, 80 and over, business.industry, Endovascular Procedures, Middle Aged, medicine.disease, Surgery, Treatment Outcome, Neurology, Tissue Plasminogen Activator, Observational study, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Abstract: Background: Among the acute ischemic stroke patients with large vessel occlusions and contraindications for the use of IV thrombolysis, mainly on oral anticoagulation or presenting too late, primary endovascular therapy is often performed as an alternative to the standard therapy even though evidence supporting the use of endovascular reperfusion therapies is not yet established. Using different statistical approaches, we compared the functional independence rates at 3 months among patients undergoing primary endovascular therapy and patients treated only with IV thrombolysis. Methods: We used data from a prospective, government-mandated and externally audited registry of reperfusion therapies for ischemic stroke (January 2011 to November 2012). Patients were selected if treated with either IV thrombolysis alone (n = 1,582) or primary endovascular thrombectomy (n = 250). A series of exclusions were made to homogenize the clinical characteristics among the two groups. We then carried out multivariate logistic regression and propensity score matching analyses on the final study sample (n = 1,179) to compare functional independence at 3 months, as measured by the modified Rankin scale scores 0-2, between the two groups. Results: The unadjusted likelihood of good outcome was poorer among the endovascular group (OR: 0.69; 95% CI: 0.47-1.0). After adjustment, no differences by treatment modality were seen (OR: 1.51; 95% CI: 0.93-2.43 for primary endovascular therapy). Patients undergoing endovascular thrombectomy within 180-270 min (OR: 2.89; 95% CI: 1.17-7.15) and patients with severe strokes (OR: 1.84; 95% CI: 1.02-3.35) did better than their intravenous thrombolysis counterparts. The propensity score-matched analyses with and without adjustment by additional covariates showed that endovascular thrombectomy was as effective as intravenous thrombolysis alone in achieving functional independence (OR for unadjusted propensity score matched: 1.35; 95% CI: 0.9-2.02, OR for adjusted propensity score matched: 1.45; 95% CI: 0.91-2.32). Conclusion: This comparative effectiveness study shows that in ischemic stroke patients with contraindications for IV thrombolysis, primary endovascular treatment might be an alternative therapy at least as effective as IV thrombolysis alone. Randomized controlled trials are urgently needed.
Published: 2014

46. Outcomes of a contemporary cohort of 536 consecutive patients with acute ischemic stroke treated with endovascular therapy

Author: Natalia Pérez de la Ossa, Juan Macho, Dolores Cocho, Josep Maria Soler Insa, Pablo García-Bermejo, Joan Perendreu, Álvaro Cervera, Sonia Huertas-Folch, Meritxell Gomis, David Carrera-Giraldo, Jerzy Krupinski, Alejandro Tomasello, Elisa Cuadrado-Godia, Jordi Blasco-Andaluz, Marc Ribó, Sergio Amaro, Sònia Abilleira, Angel Ois, Mar Castellanos, Lluis Cano, Jordi Sanahuja, Cecile van Eendenburg, Carlos A. Molina, Xabier Urra, Joan Martí-Fàbregas, Jorge Pagola, Ana Rodríguez-Campello, Helena Quesada, Ángel Chamorro, Rafael Marés, Júlia Saura, Paloma Mora, Pilar Coscojuela, Raquel Delgado-Mederos, Anna Pellisé, E. Palomeras, David Cánovas, Joaquín Serena, Moisés Garcés, Aida Ribera, Aitziber Aleu, José Alvarez-Sabín, Francisco Rubio, Francisco Purroy, Laura Dorado, Luis San Roman, Lucia Aja, Mónica Millán, Raul Martínez, Pilar Otermin, Xavier Ustrell, Victor Obach, Jaume Roquer, Elena López-Cancio, Marta Rubiera, Juanjo Baiges, Manuel Gómez-Choco, Lavinia Dinia, Antoni Dávalos, Pere Cardona, Jordi Estela, Miquel Gallofré, Elio Vivas, Maria del Carmen Garcia, Esteban Santamarina, Sonia García, Maria Angeles De Miquel, Josep Maria Aragonés, Yolanda Silva, M. Carme Nicolás-Herrerias, and Carlos Castaño
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Population, Cerebral Revascularization, Revascularization, Brain Ischemia, Fibrinolytic Agents, Modified Rankin Scale, Predictive Value of Tests, Internal medicine, medicine, Humans, Registries, education, Aged, Advanced and Specialized Nursing, education.field_of_study, Cerebral infarction, business.industry, Endovascular Procedures, Atrial fibrillation, Thrombolysis, Recovery of Function, Middle Aged, medicine.disease, Surgery, Stroke, Logistic Models, Treatment Outcome, Tissue Plasminogen Activator, Cardiology, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Fibrinolytic agent
Abstract: Background and Purpose— We sought to assess outcomes after endovascular treatment/therapy of acute ischemic stroke, overall and by subgroups, and looked for predictors of outcome. Methods— We used data from a mandatory, population-based registry that includes external monitoring of completeness, which assesses reperfusion therapies for consecutive patients with acute ischemic stroke since 2011. We described outcomes overall and by subgroups (age ≤ or >80 years; onset-to-groin puncture ≤ or >6 hours; anterior or posterior strokes; previous IV recombinant tissue-type plasminogen activator or isolated endovascular treatment/therapy; revascularization or no revascularization), and determined independent predictors of good outcome (modified Rankin Scale score ≤2) and mortality at 3 months by multivariate modeling. Results— We analyzed 536 patients, of whom 285 received previous IV recombinant tissue-type plasminogen activator. Overall, revascularization (modified Thrombolysis In Cerebral Infarction scores, 2b and 3) occurred in 73.9%, 5.6% developed symptomatic intracerebral hemorrhages, 43.3% achieved good functional outcome, and 22.2% were dead at 90 days. Adjusted comparisons by subgroups systematically favored revascularization (lower proportion of symptomatic intracerebral hemorrhages and death rates and higher proportion of good outcome). Multivariate analyses confirmed the independent protective effect of revascularization. Additionally, age >80 years, stroke severity, hypertension (deleterious), atrial fibrillation, and onset-to-groin puncture ≤6 hours (protective) also predicted good outcome, whereas lack of previous disability and anterior circulation strokes (protective) as well as and hypertension (deleterious) independently predicted mortality. Conclusions— This study reinforces the role of revascularization and time to treatment to achieve enhanced functional outcomes and identifies other clinical features that independently predict good/fatal outcome after endovascular treatment/therapy.
Published: 2014

47. Implantable loop recorder: a new tool in the diagnosis of cryptogenic stroke

Author: Xavier Ustrell, Anna Pellisé, Alfredo Bardají, Miriam Garcia, Jordi Mercé, and Ramón de Castro
Subjects: Aged, 80 and over, Male, medicine.medical_specialty, business.industry, General Medicine, Prostheses and Implants, Brain Ischemia, Cryptogenic stroke, Stroke, Electrocardiography, Intracranial Embolism, Internal medicine, Atrial Fibrillation, medicine, Implantable loop recorder, Cardiology, Humans, Female, business, Aged
Published: 2012

48. [Stroke. Diagnosis and therapeutic management of cerebrovascular disease]

Author: Joaquín Serena-Leal and Xavier Ustrell-Roig
Subjects: Therapeutic window, medicine.medical_specialty, business.industry, medicine.medical_treatment, Stroke units, General Medicine, Thrombolysis, Vascular risk, medicine.disease, Neuroprotection, Stroke treatment, Stroke, Physical therapy, Medicine, Humans, business, Intensive care medicine, Cause of death
Abstract: Stroke is the second cause of death and the first cause of disability with an important economical cost. Thrombolysis and stroke units are the major contribution to stroke treatment of the last years changing a nihilist therapeutic attitude towards an active attitude, stroke is a medical emergency. Treatment with rtPA has shown to be effective in the first 3 hours following stroke and the FDA and the European Medical Agency (EMEA) have approved its use. A protocolised management of the acute phase to treat physiological complications is the mainstone of stroke units showing a reduction in mortality and disability. Multiple strategies are under development in order to treat more patients, drugs with a longer therapeutic window, intravenous thrombolysis followed by intrarterial thrombolysis, selection of patients with mismatch with new neuroimaging techniques and neuroprotective therapies. Preventive treatment has also experienced a change due to a better knowledge of the ethiopathogeny, the role of vascular risk factors and the development of new preventive drugs. Knowledge of cerebrovascular diseases is today's clue for the best treatment of our patients.
Published: 2007

49. Holter implantable subcutáneo: una nueva herramienta en el diagnóstico del ictus criptogénico

Author: Ramón de Castro, Alfredo Bardají, Xavier Ustrell, Anna Pellisé, Miriam Garcia, and Jordi Mercé
Subjects: Gynecology, medicine.medical_specialty, business.industry, medicine, Cardiology and Cardiovascular Medicine, business
Published: 2013
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50. The diagnosis and treatment of a patient with puerperal infection and subdural hygromas

Author: María Diaz Vieito, Antoni Arxer, Josefina Ros, Antonio Villalonga, Xavier Ustrell, and Natàlia Aragonès
Subjects: Adult, medicine.medical_specialty, Dextran 40, Asymptomatic, Spinal Puncture, Pregnancy, medicine, Humans, Puerperal Infection, medicine.diagnostic_test, business.industry, Lumbar puncture, Headache, Magnetic resonance imaging, medicine.disease, Magnetic Resonance Imaging, Subdural Effusion, Surgery, Analgesia, Epidural, Anesthesiology and Pain Medicine, Accidental, Anesthesia, Analgesia, Obstetrical, Female, Postural headache, medicine.symptom, business, Blood Patch, Epidural
Abstract: We describe a patient readmitted after developing a persistent postural headache resulting from an accidental lumbar puncture during labor 10 days earlier. Magnetic resonance imaging demonstrated bifrontal subdural hygromas and diffuse pachymeningeal enhancement. The patient had signs of a puerperal infection, and an epidural patch was performed with dextran 40 instead of blood, after which gradual improvement was noted. The patient was discharged totally asymptomatic 3 days later.
Published: 2004

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