RESUMEN
AIM: To evaluate the safety and efficacy of multimodal endovascular treatment (EVT) of acute basilar artery occlusion (BAO), including bridging therapy [intravenous thrombolysis (IVT) with subsequent EVT], to compare particular EVT techniques and identify predictors of clinical outcome. MATERIALS AND METHODS: This retrospective, multi-centre study comprised 72 acute ischaemic stroke patients (51 males; mean age 59.1 ± 13.3 years) with radiologically confirmed BAO. The following data were collected: baseline characteristics, risk factors, pre-event antithrombotic treatment, neurological deficit at time of treatment, localization of occlusion, time to therapy, recanalization rate, post-treatment imaging findings. Thirty- and 90-day outcomes were evaluated using the modified Rankin scale with a good clinical outcome defined as 0-3 points. RESULTS: Successful recanalization was achieved in 94.4% patients. Stepwise binary logistic regression analysis identified the presence of arterial hypertension (OR = 0.073 and OR = 0.067, respectively), National Institutes of Health Stroke Scale (NIHSS) at the time of treatment (OR = 0,829 and OR = 0.864, respectively), and time to treatment (OR = 0.556 and OR = 0.502, respectively) as significant independent predictors of 30- and 90-day clinical outcomes. CONCLUSION: Data from this multicentre study showed that multimodal EVT was an effective recanalization method in acute BAO. Bridging therapy shortens the time to treatment, which was identified as the only modifiable outcome predictor.
Asunto(s)
Arteriopatías Oclusivas/terapia , Arteria Basilar , Procedimientos Endovasculares , Arteriopatías Oclusivas/diagnóstico , Terapia Combinada , Diagnóstico por Imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: Intravenous thrombolysis (IVT) is considered an effective treatment for acute ischemic stroke (IS). However, not all treated patients may achieve good outcome. The aim was to evaluate whether the initial NIHSS and DWI infarct volume could be the predictors for good outcome after IVT. PATIENTS AND METHODS: The set of 125 patients with consecutive hemispheric IS (78 men; mean age 66.0 ± 12.1 years) treated with IVT within 3 h was analyzed. DWI volume was measured on admission. Good outcome was defined as a score 0-2 in modified Rankin Scale. RESULTS: Multivariate logistic regression analysis showed initial NIHSS as an independent predictor of good outcome (P = 0.001). ROC curves showed baseline NIHSS ≤13.5 points and DWI volume ≤13.7 ml as cut-offs related to good outcome. CONCLUSIONS: The initial NIHSS and DWI volume might be the predictors for good clinical outcome in acute stroke patients treated with IVT. The initial NIHSS score seems to be more accurate.
Asunto(s)
Isquemia Encefálica/tratamiento farmacológico , Fibrinolíticos/uso terapéutico , Accidente Cerebrovascular/tratamiento farmacológico , Activador de Tejido Plasminógeno/uso terapéutico , Anciano , Imagen de Difusión por Resonancia Magnética , Femenino , Fibrinolíticos/administración & dosificación , Humanos , Inyecciones Intravenosas , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pronóstico , Curva ROC , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Terapia Trombolítica , Activador de Tejido Plasminógeno/administración & dosificación , Resultado del TratamientoRESUMEN
BACKGROUND: The study prospectively assesses deadspace [(arterial CO2 - end-tidal CO2)/arterial CO2] and the D-dimer assay as a rapid, noninvasive alternative for evaluating pulmonary embolism in critically ill patients. METHODS: Group I patients had nonemergency baseline arterial blood gas and end-tidal CO2 recorded. If patients experienced respiratory distress, D-dimer with repeat arterial blood gas and end-tidal CO2 were obtained. Patients emergently intubated without baseline laboratory studies (group II) had arterial blood gas, end-tidal CO2, and D-dimer obtained. RESULTS: A significant increase (P <0.001) in deadspace was noted with pulmonary embolism (0.43 [0.08], range 0.30 to 0.51, n = 7) versus without (0.21 [0.15], range 0.00 to 0.43, n = 14). Patients in group 1 with pulmonary embolism demonstrated increased deadspace (P <0.026, 0.28 [0.01] to 0.39 [0.13], n = 2) from baseline compared with decreased deadspace (P <0.001, 0.20 [0.09] to 15 [0.16], n = 9) without pulmonary embolism. D-dimer levels >1,000 ng/mL were present in all patients with pulmonary embolism. CONCLUSIONS: The study demonstrates the ability of deadspace and D-dimer to exclude and potentially diagnose pulmonary embolism.
Asunto(s)
Dióxido de Carbono/análisis , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Embolia Pulmonar/diagnóstico , Volumen de Ventilación Pulmonar/fisiología , Angiografía , Antifibrinolíticos/análisis , Dióxido de Carbono/sangre , Distribución de Chi-Cuadrado , Cuidados Críticos , Estudios de Evaluación como Asunto , Femenino , Humanos , Intubación Intratraqueal , Masculino , Oxígeno/sangre , Estudios Prospectivos , Embolia Pulmonar/sangre , Embolia Pulmonar/diagnóstico por imagen , Intercambio Gaseoso Pulmonar/fisiología , Respiración , Espacio Muerto Respiratorio/fisiología , Ultrasonografía Doppler , Relación Ventilacion-PerfusiónRESUMEN
General anesthesia in premature babies is associated with a significant risk of life-threatening apnea. Spinal anesthesia in the high-risk infant is simple, safe, and effective, but the incidence of apnea with its use has not been previously determined. The total absence of apnea in 84 high-risk infants suggests that surgery below the umbilicus under spinal anesthesia can safely be performed on an outpatient basis in preterm infants or babies with a history of apnea. Ketamine as an adjunctive agent adds no apparent risk. The technique is relatively easy, surgery is not compromised, and parental acceptance is high.