Objective
Spain’s so-called Stroke Belt is an area with high prevalence of vascular disease. We aimed to determine the prevalence of undetected obstructive sleep apnea–hypopnea syndrome (OSAHS) among ...patients with acute ischemic stroke (AIS) in southern Spain.
Methods
We conducted a cross-sectional study at the Virgen Macarena University Hospital Stroke Unit during 2018 to 2019. We included patients <72 hours after AIS with a neuroimaging lesion and performed sleep tests.
Results
Seventy-two patients were included. The median participant age was 72 years. Mean body mass index was 27.07 kg/m2, and 40.28% were daily alcohol drinkers. Hypertension, atrial fibrillation, ischemic cardiomyopathy, and previous stroke were detected in 63.9%, 11.1%, 15.3%, and 17.6% of patients, respectively. Polygraphy was feasible in 91.38% of patients. The prevalence of OSAHS was 84.72% (apnea–hypopnea index ≥5). Patients with moderate and severe OSAHS were more likely to be obese and to have a larger neck circumference and facial palsy. The diagnostic criteria of central sleep apnea syndrome were met in only 1.38% of patients.
Conclusions
The high prevalence of OSAHS found in the Spanish Stroke Belt justifies further investigation and development of a screening program as a strategy to identify patients with undetected OSAHS.
Objectives
The detection of cervical arterial dissection (CAD) has been rising in recent years owing to advanced imaging techniques. The aim of this study was to explore whether wide implementation ...of endovascular treatment for ischemic stroke has an impact on the diagnosis of CAD.
Methods
We included all patients with CAD diagnosed at two university hospitals in Seville, Spain from January 2015 to December 2017. We collected clinical variables and information on imaging techniques used for the diagnosis. Implementation of 24 hour/365 day mechanical thrombectomy began in Seville on 15 August 2016. We compared diagnosis rates of CAD performed before and after this date.
Results
We identified 41 patients with CAD. We found 13 patients diagnosed before (1.1% of all ischemic strokes) and 28 (2.2%) after implementation of neurointerventional therapy. In 17 patients, diagnosis was made in the acute phase. Dissection was not suspected according to computed tomography angiography in 11 patients owing to small dissections (n = 2) or total occlusion (n = 9).
Conclusions
CAD diagnoses have been rising in recent years, essentially owing to continuous improvement in imaging techniques. Rapid access to arteriography for thrombectomy is increasing the diagnoses of CAD, even in patients with a low suspicion of dissection.
In 2006, the American Heart Association recommended that for preference carotid endarterectomy (CEA) or, alternatively, carotid angioplasty and stenting (CAS) for symptomatic carotid artery stenosis ...should ideally occur within 14 days of an ischaemic event. The aim was to determine the safety of CAS according to those recommendations in daily practice.
A retrospective analysis was performed of all consecutive patients (2000–16), with ipsilateral carotid symptoms who underwent CAS for extracranial carotid stenosis ≥70%, who were previously included in a prospective database. Thirty day morbidity was assessed (any stroke without transient ischaemic attack TIA/amaurosis fugax), along with mortality of the procedure in the early (≤14 days after stroke onset) and delayed phases (15–180 days after stroke onset). Patients who received CAS and/or mechanical thrombectomy for acute ischaemic stroke treatment were not included.
In total, 1227 patients with symptomatic carotid stenosis who underwent CAS were identified. Early and delayed CAS was performed in 291 and 936 patients, respectively. Morbidity (any stroke) and mortality was 2.2% (n = 27) in the whole cohort (n = 8 2.7% in early vs. n = 19 2% in delayed CAS; p = .47). There were no differences in morbidity between early and delayed CAS regarding TIA (n = 15 vs. 36 5.2% vs. 3.9%; p = .33), minor stroke (n = 4 vs. 5 1.4% vs. 0.5%; p = .14), or major stroke (n = 2 vs. 6 0.7% vs. 0.6%; p = .59). Two patients (0.7%) died after early CAS and eight (0.9%) after delayed CAS (p = .56).
CAS may be safely performed in the early phase after an ischaemic stroke with low clinical complication rates. Further studies are needed to validate CAS safety conducted even earlier in the acute phase of ischaemic stroke.
Acenocoumarol is an oral anticoagulant with significant interindividual dose variations. Variants in CYP2C9 and VKORC1 have been associated with acenocoumarol maintenance dose. We analysed whether ...any of the 49 polymorphisms in CYP2C9 and VKORC1 previously associated with acenocoumarol maintenance dose in a Genome-Wide Association study (GWAs) in Dutch population are associated with stroke recurrence, intracranial haemorrhage (ICH) and acenocoumarol maintenance dose in a Spanish population. We performed a GWAs using Human Core Exome-chip (Illumina) in 78 patients stroke patients treated with acenocoumarol for secondary prevention enrolled as part of the prospective investigator-initiated study (IIS) SEDMAN Study. Patients were followed-up a median of 12.8 months. Three and eight patients had recurrent stroke and ICH events, respectively. We found 14 of the 49 published variants associated with acenocoumarol maintenance dose (p < 0.05). Six polymorphisms were associated with stroke recurrence and four variants with ICH (p < 0.05). In conclusion, variants in VKORC1 and CYP2C9 are associated with acenocoumarol maintenance dose, stroke recurrence and ICH in a Spanish cohort. These results highlight the relevance of studying pharmacogenetics associated with efficacy and safety of anticoagulant drugs and justify studies with larger sample size and different ethnic populations.
The benefits of the PCSK9 inhibitors, alirocumab and evolocumab, in lowering LDL-cholesterol and preventing major adverse cardiac events (MACE) have been demonstrated in pivotal clinical trials. ...However, few studies of routine clinical practice have been conducted to analyse and compare the efficacy and safety of the two drugs.
Retrospective observational study of patients treated with a PCSK9 inhibitor in five hospitals in Andalusia (southern Spain). Baseline demographic and clinical data, LDL-cholesterol levels and the occurrence of MACEs during the follow-up period were recorded.
A total of 141 patients were included in the study: 90 were treated with alirocumab and 51 with evolocumab. The patients’ mean age (IQR) was 58 (11) years and 58 (41%) were women. The most frequent concomitant medications were statins, 94 (66.7%), followed by antiplatelet therapy (66%) and ezetimibe (65.2%). The median (IQR) follow-up period was 18 (18) months, with 18 (24) for alirocumab and 11 (18) for evolocumab. At the six-month follow-up visit, LDL-cholesterol values had decreased to pre-treatment levels and remained significantly decreased (p < 0.05) over time, for both drugs, and a greater reduction was achieved in patients with established cardiovascular disease and concomitant treatment with statins. With respect to adverse effects, there were nine MACEs (6.4%), of which seven were with alirocumab (7.8%) and two with evolocumab (3.9%) (p NS). Other adverse effects (9.2%) included local erythema (3.5%), muscle cramps (2.1%), respiratory symptoms (2.1%) and asthaenia (1.4%).
The efficacy and safety of alirocumab and evolocumab in routine clinical practice are consistent with the findings of the pivotal clinical trials.
•PCSK9i are useful when statins are not enough to reduce LDL-cholesterol or in statin-intolerant patients.•The safety and efficacy profile of PCSK9i was comparable to the pivotal trials in this real-world study.•The mean reduction of LDL-cholesterol was greater for patients with stablished cardiovascular disease and concomitant treatment with statins.
Minor strokes are considered to be those that present with few symptoms, although up to 40% of them entail long-term disability. The rate of thrombolysis in these patients is also lower than in other ...strokes. The aim of this study is to explore whether there are any differences in intravenous thrombolysis care times in minor strokes.
We conducted a retrospective review of strokes treated with intravenous thrombolysis at our centre and a comparative analysis of the care times in minor strokes and in the other types.
Longer times were found in minor strokes in terms of door-to-CT scan and door-to-needle time. This was not the case, however, for the time from the onset of symptoms to arrival at the hospital.
The presence of few symptoms in minor strokes can make them difficult to recognise and could be a reason for delaying treatment. Training among staff caring for these patients is essential to improve this aspect.
Para determinar si existe relación entre Livedo Reticularis (LR) y anticuerpos anticardiolipina (ACA) en pacientes con Lupus Eritematoso Sistémico (LES), se realizó un estudio clínico, prospectivo y ...descriptivo en 17 pacientes con diagnóstico de LES y LR presente, con edades comprendidas entre 15 y 46 años, todas del sexo femenino, procedentes de las consultas de Inmunología y Dermatología de la Ciudad Hospitalaria Enrique Tejera (CHET), Valencia, Venezuela, durante el año 1998. A cada una de las pacientes se le practicó una historia clínica completa y fueron clasificadas de acuerdo con la severidad de las lesiones de LR en LR leve, moderado o severo (criterios de Weinstein y col.). Se determinaron los ACA IgG e IgM por técnicas inmunoenzimáticas. El estudio se realizó de acuerdo con las normas de Buenas Prácticas Médicas en Investigación Clínica y se obtuvo el consentimiento firmado de cada una de las pacientes. La edad promedio de las pacientes estudiadas fue de 28,5 ± 10,9 años. El 52,9% de ellas presentó niveles séricos de ACA IgG por encima de lo normal. Los ACA IgM se encontraron en todos los casos dentro de límites normales (4,41 ± 2,63 U/mL. Rango: 0,51-9,53). Todas las pacientes con LR leve presentaron niveles normales de ACA IgG, y dentro de las categorías Moderado-Severo, el 83,3% y el 80% respectivamente tuvieron niveles elevados ( > o = 10 U/mL), con una asociación estadísticamente significativa (p < 0,05) entre las tres categorías y los niveles de ACA. El 82,4% de las pacientes presentaron manifestaciones severas de la enfermedad dentro de las cuales se encontraron: afectación del sistema nervioso central, vasculitis de miembros inferiores, enfermedad renal, pericarditis, trombocitopenia y abortos recurrentes. No se encontró asociacion estadísticamente significativa entre cada una de estas manifestaciones y la severidad del LR, probablemente debido al reducido número de pacientes estudiadas en cada grupo (p > 0,05). Tampoco se encontró entre los niveles séricos medios de ACA IgG y cada una de dichas manifestaciones (p > 0,05), excepto para la vasculitis de miembros inferiores al utilizar la clasificación de los valores de IgG con relación a su presencia o ausencia (Fisher p = 0,01). Sin embargo, al relacionar el número de manifestaciones severas de la enfermedad presentadas por cada paciente con los niveles de ACA IgG y con la severidad del LR, la asociación fue estadísticamente significativa (p < 0,05).
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