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  • Ovid Technologies (Wolters Kluwer Health)  (4)
  • Cougo-Pinto, Pedro T  (4)
  • 1
    Online Resource
    Online Resource
    Abstract T MP13: Chagas Disease Related Stroke: Safety of Intravenous Thrombolysis and Endovascular Treatment
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. suppl_1 ( 2014-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. suppl_1 ( 2014-02)
    Abstract: Background: AND AIM: Chagas disease (CD) is a common cause of stroke in undeveloped countries and has become more frequent in the US, where it is largely underestimated. CD related strokes are believed to be mainly cardioembolic but some studies have suggested concomitant cerebral vasculitis. Data on the safety of recanalization therapies in patients with acute stroke related to CD is still restricted to single case reports. We aimed to assess the rate of symptomatic intracranial hemorrhage (SIH) in a group of patients with CD-related stroke treated with intravenous tissue plasminogen activator (IV TPA) and/or endovascular therapy. METHODS: We performed a retrospective analysis of a prospective, single-center, hospital-based registry of acute stroke patients treated with IV TPA and/or endovascular therapy and routinely tested for CD. Demographics, medical history and clinical data were obtained from the registry. CT scans at admission and after 24-48 hours were blindly reviewed by two experienced stroke neurologists, who rated the presence of hemorrhage transformation according to the European Cooperative Acute Stroke Study criteria. RESULTS: From 2001 to 2012, 197 patients met the inclusion criteria for this study. CD was diagnosed in 30 patients (15.2%). Patients with CD had higher admission scores on the National Institute of Health Stroke Scale [median: 19; interquartile range (IR): 16-22; no CD: 14; IR: 9-19; P 〈 0.01]. Among patients treated with IV TPA, the rate of SIH was similar among patients with CD (1/24; 4.2%) and patients without CD (8/150; 5.3%; OR: 0.77, 95% CI: 0.09-6.46; P=0.99). Among those treated with rescue endovascular treatment, SIH occurred in 2/6 (33.3%) patients with CD and in 3/17 (17.6%) patients without CD (OR: 2.33, 95%CI: 0.28-19.17, P=0.58). Overall, there was no difference in mortality between groups [CD: 6 (20%); no CD: 24 (14.4%); OR: 1.49; 95% CI: 0.55-4.0; P=0.42] . CONCLUSIONS: In the largest series of patients with acute stroke related to CD treated with recanalization therapies ever reported, we found that IV TPA appears to be safe in these patients. Further studies are necessary to confirm the safety and efficacy of endovascular recanalization strategies in patients with CD.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.45.suppl_1.tmp13
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
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  • 2
    Online Resource
    Online Resource
    Abstract WP214: Transcranial Color Coded Sonography versus Transcranial Doppler for the Detection of Right-to-left Shunt and Patent Foramen Ovale in Young Patients With Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Introduction: Patent Foramen Ovale (PFO) is the most common right-to-left shunt (RLS) and is often found in young patients with stroke related to paradoxical embolism. Contrast-Enhanced Transesophageal Echocardiography (TEE) is considered a gold standard to visualize PFO. Transcranial Doppler (TCD) with bubble test is often used to detect RLS with good correlation to TEE for the diagnostic of PFO. More recently, Transcranial Color Coded Sonography (TCCS) which included B-mode and color coded imaging has overcome TCD in many clinical applications but the accuracy of TCCS for detection of RLS and PFO has not been systematically evaluated. Hypothesis: To determine if the TCCS is an accurate tool to identify both PFO and RLS. Methods: We investigate 106 patients with ischemic stroke under 55 years-old admitted from 2012 to 2014 in a tertiary academic hospital. Patients were evaluated with TEE, TCD and TCCS, and all exams included a saline bubble test. The examiners were blinded for the other tests results. Kappa agreement was calculated inter-examiners for TCCS and TCD. Accuracy of TCCS was calculated in comparison to TEE. Results: We detected a RLS in 54 (50.9%) patients (age mean 43.9 ± 8.2) with kappa agreement 0.92 (95%CI 0.78-1.0) when performed TCCS and TCD. TEE and TCSS were positive in 23/98 (23.4%) and TEE did not reveal contrast in 20/98 (20.4%). In 30 (28.3%) patients only TEE revealed a PFO. TCSS had a sensitivity of 88.4% (95%CI 0.68-0.97), specificity of 72.2% (95%CI 0.60-0.81) and positive likelihood ratio of 3.18 (2.14-4.73) of the diagnosis of PFO. Conclusion: TCCS and TCD had an excellent agreement. TCCS has a good accuracy for the detection of PFO and RLS in young patients with stroke.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wp214
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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  • 3
    Online Resource
    Online Resource
    Abstract TP46: A Score to Detect Proximal Artery Occlusion in Patients With Acute Ischemic Stroke of the Anterior Circulation Based on NIHSS and Non-contrast Brain CT: the PAO Score
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Introduction: After the results of the new endovascular trials that demonstrated a robust effect of endovascular treatment for acute ischemic stroke (AIS), early detection of proximal artery occlusion (PAO) has become a fundamental task during the initial assessment of acute stroke patients at the emergency department. Nevertheless, an accurate identification of PAO may be particularly challenging in smaller hospitals and in developing countries, areas with restricted assess to vascular neuroimaging modalities such as CTA and MRA. Hypothesis: Algorithms based on NIHSS and non-contrasted CT (NCCT) findings can be accurately used to detect PAO in patients with AIS of the anterior circulation. Method: We retrospectively evaluated 194 consecutive patients with AIS of the anterior circulation from a prospective stroke registry of patients admitted to an academic tertiary emergency unit in Brazil during 2014 that had a NCCT and a CTA at admission. NIHSS scores and attenuation of major intracranial arteries of the anterior circulation on NCCT were collected by two experienced investigators that were blind to the CT angiography findings. We used a ratio between two ROIs (rVA) that were drawn on NCCT blinded to CT angiography: (i) on the region of highest vessel attenuation ipsilateral to the involved hemisphere and (ii) mirror ROI on the corresponding vessel segment of the contralateral hemisphere. We used ROC curve analysis and C-statistics to predict CT angiography PAO. Results: NIHSS and vessel attenuation values were highly associated with the PAO with an area under the curve (AUC) of 0.88 (p 〈 0,001) and 0.83 (p 〈 0,001), respectively. An NIHSS of 10 at admission had a sensitivity, and negative predictive value of 97% and 97%, respectively. The rVA ≥ 1.50 had a specificity and positive predictive value 96% and 85%, respectively. The POA score was then built by logistic regression from NIHSS and rVA and showed even higher accuracy for the presence of POA on CTA, with an AUC of 0.93 (p 〈 0,001). Conclusion: The PAO score based on admission NIHSS and proximal vessel attenuation on NCCT can be accurately used to detect PAO in patients with AIS of the anterior circulation. Further studies are necessary to validate this score in a multicenter setting.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.tp46
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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    Online Resource
  • 4
    Online Resource
    Online Resource
    Abstract TP213: Accuracy of Transcranial Color-coded Sonography for the Detection and Measurement of Intracranial Arterial Stenosis When Compared to CT Angiography in Patients With Acute Ischemic Stroke and Transient Ischemic Attack
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Introduction: Transcranial Color-Coded Sonography (TCCS) including B-mode imaging and color-coded Duplex is non-invasive, bedside and inexpensive tool for the assessment of the intracranial circulation. TCCS can be used to assess intracranial stenosis but its accuracy has not been systematically compared to CT angiography in acute stroke patients. Hypothesis: TCCS has high accuracy when compared to CT angiography for the detection and measurement of intracranial arterial stenosis in patients with acute ischemic stroke. Methods: In this prospective study 43 patients (67% male; mean age: 59.8 ± 11 years) with acute ischemic stroke or Transient Ischemic Accident (TIA) underwent examinations of the intracranial arteries by TCCS and CT angiography. Different examiners that were blinded to test results performed the exams. TCCS and CT angiography were performed during the hospital stay. All stenotic segments of intracranial vessels were classified into 4 groups: normal or mild ( 〈 50%), moderate (50%-70%), severe (≥70%) and subocclusion/occlusion. Results: 580 of 645 arterial segments in 43 patients were evaluated. The sensitivity, specificity, positive predictive value, and negative predictive value of TCCD in comparison with CT angiography for the detection of moderate to severe intracranial stenosis (≥50%) were 81.5%, 100%, 100%, and 76% respectively. The Cohen’s kappa between TCCS and CT angiography was 0.76 (p 〈 0.001). Conclusions: TCCS is a bedside non-invasive tool that can be used to evaluate intracranial arteries with high accuracy for moderate to severe stenosis when compared to CT angiography. Moderate agreement was found between TCCS and CT angiography for the evaluation of intracranial stenosis in patients with acute ischemic stroke or TIA.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.tp213
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
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