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Girona, Spain

Castano C.,Autonomous University of Barcelona | Dorado L.,Autonomous University of Barcelona | Guerrero C.,Autonomous University of Barcelona | Millan M.,Autonomous University of Barcelona | And 6 more authors.
Stroke | Year: 2010

Background and Purpose-: To describe the safety and effectiveness of a self-expanding and fully retrievable stent (Solitaire AB; ev3 Inc, Plymouth, MN) in revascularization of patients with acute ischemic stroke. Methods-: Prospective, single-center study of 20 patients with an acute ischemic stroke attributable to a large artery occlusion of the anterior circulation within the first 8 hours from symptoms onset (median National Institutes of Health Stroke Scale, 19 [interquartile range, 15-23]). The occlusion site was middle cerebral artery in 12 patients, proximal internal carotid artery/middle cerebral artery tandem occlusion in 3 patients, and terminus internal carotid artery in 5 patients. Thrombectomy was used as rescue therapy in 2 patients who were refractory to intra-arterial plasminogen activator, and in 3 patients in whom successful recanalization with the MERCI retriever was not achieved. Results-: Successful revascularization defined as thrombosis in cerebral ischemia grade 2b or 3 was achieved in 18 of 20 (90%) treated vessels, and 16 patients showed immediate restoration of flow after stent deployment. The mean number of passes for maximal recanalization was 1.4, and the median (quartiles) time from groin puncture to recanalization was 50 (38-71) minutes. No case required adjuvant therapy after deployment of the embolectomy device. No significant procedural events occurred. Symptomatic intracranial hemorrhage was found in 2 (10%) patients, 4 (20%) patients died during the 90-day follow-up period, and 45% of patients showed good functional outcome at 3 months (modified Rankin Scale score ≤2). Conclusions-: These results suggest that the Solitaire AB device can rapidly, safely, and effectively retrieve clots from the middle cerebral artery and terminus internal carotid artery within 8 hours from symptoms onset. © 2010 American Heart Association, Inc.

Faul J.,Asthma Research Center | Schoors D.,Universitair Ziekenhuis Brussel | Brouwers S.,Universitair Ziekenhuis Brussel | Scott B.,ZNA Middelheim Hospital | And 4 more authors.
Journal of Vascular Surgery | Year: 2014

Objective Vasodilators are used with caution in patients with chronic obstructive pulmonary disease (COPD). We have developed a device for percutaneous arteriovenous shunt creation in the iliac region to increase cardiac output and oxygen delivery for patients with COPD. Although this device does not cause significant blood pressure changes in normotensive patients with COPD, we hypothesized that arteriovenous shunt creation might cause vasodilator effects in hypertensive patients because of a reduction in vascular resistance. Methods Twenty-four patients with COPD and hypertension enrolled in an open label study of arteriovenous shunt creation for COPD. We performed cardiac catheterization at baseline and again 3 to 6 months after the procedure. As a safety measure we also recorded office blood pressure at baseline and again after 3, 6, 9, and 12 months. Results The procedure increased oxygen delivery (1.1-1.4 L.min-1) and cardiac output (6-8.2 L.min-1) (P <.001) and lowered both the systemic vascular resistance (P <.001) and the pulmonary vascular resistance (P <.01). After 12 months, however, the average systolic blood pressure was reduced from 145 to 132 mm Hg (P <.0001), and the average diastolic blood pressure was reduced from 86 to 67 mm Hg (P <.0001). Conclusions Percutaneous iliac arteriovenous fistula creation for COPD causes a significant and persistent lowering of blood pressure in patients with co-existing hypertension. © 2014 by the Society for Vascular Surgery.

Ntaios G.,University of Lausanne | Ntaios G.,University of Thessaly | Faouzi M.,University of Lausanne | Ferrari J.,St. Johns of God Hospital | And 3 more authors.
Neurology | Year: 2012

Objective: To develop and validate a simple, integer-based score to predict functional outcome in acute ischemic stroke (AIS) using variables readily available after emergency room admission. Methods: Logistic regression was performed in the derivation cohort of previously independent patients with AIS (Acute Stroke Registry and Analysis of Lausanne [ASTRAL]) to identify predictors of unfavorable outcome (3-month modified Rankin Scale score >2). An integer-based pointscoring system for each covariate of the fitted multivariate model was generated by their β-coefficients; the overall score was calculated as the sum of the weighted scores. The model was validated internally using a 2-fold cross-validation technique and externally in 2 independent cohorts (Athens and Vienna Stroke Registries). Results: Age (A), severity of stroke (S) measured by admission NIH Stroke Scale score, stroke onset to admission time (T), range of visual fields (R), acute glucose (A), and level of consciousness (L) were identified as independent predictors of unfavorable outcome in 1,645 patients in ASTRAL. Their β-coefficients were multiplied by 4 and rounded to the closest integer to generate the score. The area under the receiver operating characteristic curve (AUC) of the score in the ASTRAL cohort was 0.850. The score was well calibrated in the derivation (p = 0.43) and validation cohorts (0.22 [Athens, n = 1,659] and 0.49 [Vienna, n = 653]). AUCs were 0.937 (Athens), 0.771 (Vienna), and 0.902 (when pooled). An ASTRAL score of 31 indicates a 50% likelihood of unfavorable outcome. Conclusions: The ASTRAL score is a simple integer-based score to predict functional outcome using 6 readily available items at hospital admission. It performed well in double external validation and may be a useful tool for clinical practice and stroke research. Copyright © 2012 by AAN Enterprises, Inc.

Nair J.,Acute Stroke Unit | Chatterjee K.,Acute Stroke Unit
Journal of Medical Case Reports | Year: 2010

Introduction. Stroke mimics are usually non-vascular disease processes. These raise the possibility of a stroke and are common in clinical practice. It is necessary to distinguish these mimics in order to provide early and appropriate management, as well as reduce possible harm on our patient. Case presentation. We report the case of a 50-year-old Caucasian man who developed symptoms suggestive of posterior circulation stroke after he was exposed to methyl iodide at his workplace. Results of stroke investigations of our patient were negative, and a detailed occupational history clinched the diagnosis. Acute presentation with a stroke-like picture is rare in cases of methyl iodide poisoning. We have attempted to discuss the differential diagnosis of stroke mimics through a review of literature. Conclusion. Stroke mimics are difficult to diagnose in an emergency room situation and may be initially treated as stroke. This case report underlines the importance of history taking, especially occupational history, in the differential diagnosis of stroke. We also stress the need to recognize mimics at presentation in order to arrive at an early and appropriate management of patients. © 2010 Nair and Chatterjee; licensee BioMed Central Ltd.

Finnigan S.,University of Queensland | Finnigan S.,Center for Allied Health Research | Wong A.,University of Queensland | Wong A.,Acute Stroke Unit | And 2 more authors.
Clinical Neurophysiology | Year: 2016

Objective: Quantitative electroencephalographic (QEEG) indices sensitive to abnormal slow (relative to faster) activity power seem uniquely informative for clinical management of ischaemic stroke (IS), including around acute reperfusion therapies. However these have not been compared between IS and control samples. The primary objective was to identify the QEEG slowing index and threshold value which can most accurately discriminate between IS patients and controls. Methods: The samples comprised 28 controls (mean age: 70.4; range: 56-84) and 18 patients (mean age: 69.3; range: 51-86). Seven indices were analysed: relative bandpower (delta, theta, alpha, beta), delta/alpha power ratio (DAR), (delta + theta)/(alpha + beta) ratio (DTABR) and QSLOWING. The accuracies of each index for classifying participants (IS or control) were analysed using receiver operating characteristic (ROC) techniques. Results: All indices differed significantly between the samples (< .001). DAR alone exhibited optimal classifier accuracy, with a threshold of 3.7 demonstrating 100% sensitivity and 100% specificity for discriminating between radiologically-confirmed, acute IS or control. DTABR and relative delta were the next most accurate classifiers. Conclusions: DAR of 3.7 demonstrated maximal accuracy for classifying all 46 participants as acute IS or control. Significance: DAR assessment may inform clinical management of IS and perhaps other neurocritical patients. © 2015 International Federation of Clinical Neurophysiology.

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