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Browsing by Author "Nunes, AP"

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  • Acute Treatment of Isolated Posterior Cerebral Artery Occlusion: Single Center Experience
    Publication . Cunha, B; Baptista, M; Pamplona, J; Carvalho, R; Perry da Câmara, C; Alves, M; Papoila, AL; Nunes, AP; Reis, J; Fragata, I
    Background and objectives: Randomized trials for mechanical thrombectomy (MT) excluded patients with ischemic strokes due to isolated posterior cerebral artery occlusion (IPCAO), and there is no evidence for best acute treatment strategy in these patients. We aimed to assess the effectiveness and safety of MT in acute IPCAO. Methods: We retrospectively analyzed consecutive patients with acute stroke due to IPCAO submitted to MT and/or intravenous thrombolysis (IVT), between 2015-2019. Effectiveness outcomes (recanalization rate, first-pass effect, NIHSS 24h improvement and 3-month Modified Ranking Scale - mRS) and safety outcomes (complications, symptomatic intracranial hemorrhage (SICH) and 3-month mortality) were described and compared between groups. Results: A total of 38 patients were included, 25 underwent MT and 13 had IVT alone. Successful and complete recanalization were achieved in 68% and 52% of MT patients, respectively. NIHSS improvement at 24h was found in 56% of MT patients versus 30.8% of patients submitted to IVT alone (OR [95% CI]=2.86 [0.69-11.82]) and excellent functional outcome at 3 months (mRS≤1) was achieved in 54.2% of MT patients versus 38.5% in the IVT group (OR [95% CI]=1.60 [0.41-6.32]). Complications occurred in 3 (12%) procedures and there were no SICH. Mortality at 3 months was 20% in the MT group and 15.4% in patients submitted to IVT alone. Conclusions: Our results reflect a real-world scenario in a single center and seem to support the recently growing literature showing that MT is a feasible and safe treatment in IPCAO, with favorable effectiveness.
    2022Journal article Open access Show more
  • Global Impact of COVID-19 on Stroke Care and IV Thrombolysis
    Publication . Nogueira, RG; Qureshi, MM; Abdalkader, M; Martins, SO; Yamagami, H; Qiu, Z; Mansour, OY; Sathya, A; Czlonkowska, A; Tsivgoulis, G; Aguiar de Sousa, D; Demeestere, J; Mikulik, R; Vanacker, P; Siegler, JE; Kõrv, J; Biller, J; Liang, CW; Sangha, NS; Zha, AM.; Czap, AL; Holmstedt, CA; Turan, TN; Ntaios, G; Malhotra, K; Tayal, A; Loochtan, A; Ranta, A; Mistry, EA; Alexandrov, AW; Huang, DY; Yaghi, S; Raz, E; Sheth, SA; Mohammaden, MH; Frankel, M; Bila Lamou, EG; Aref, HM; Elbassiouny, A; Hassan, F; Menecie, T; Mustafa, W; Shokri, HM; Roushdy, T; Sarfo, FS; Alabi, TO; Arabambi, B; Nwazor, EO; Sunmonu, TA; Wahab, K; Yaria, J; Mohammed, HH; Adebayo, PB; Riahi, AD; Sassi, SB; Gwaunza, L; Ngwende, GW; Sahakyan, D; Rahman, A; Ai, Z; Bai, F; Duan, Z; Hao, Y; Huang, W; Li, G; Li, W; Liu, G; Luo, J; Shang, X; Sui, Y; Tian, L; Wen, H; Wu, B; Yan, Y; Yuan, Z; Zhang, H; Zhang, J; Zhao, W; Zi, W; Leung, TW; Chugh, C; Huded, V; Menon, B; Pandian, JD; Sylaja, PN; Usman, FS; Farhoudi, M; Hokmabadi, ES; Horev, A; Reznik, A; Sivan Hoffmann, R; Ohara, N; Sakai, N; Watanabe, D; Yamamoto, R; Doijiri, R; Tokuda, N; Yamada, T; Terasaki, T; Yazawa, Y; Uwatoko, T; Dembo, T; Shimizu, H; Sugiura, Y; Miyashita, F; Fukuda, H; Miyake, K; Shimbo, J; Sugimura, Y; Yagita, Y; Takenobu, Y; Matsumaru, Y; Yamada, S; Kono, R; Kanamaru, T; Yamazaki, H; Sakaguchi, M; Todo, K; Yamamoto, N; Sonoda, K; Yoshida, T; Hashimoto, H; Nakahara, I; Kondybayeva, A; Faizullina, K; Kamenova, S; Zhanuzakov, M; Baek, JH; Hwang, Y; Lee, JS; Lee, SB; Moon, J; Park, H; Seo, JH; Seo, KD; Sohn, SI; Young, CJ; Ahdab, R; Wan Zaidi, WA; Aziz, ZA; Basri, HB; Chung, LW; Ibrahim, AB; Ibrahim, KA; Looi, I; Tan, WY; Yahya, NW; Groppa, S; Leahu, P; Al Hashmi, AM; Imam, YZ; Akhtar, N; Pineda-Franks, MC; Co, CO; Kandyba, D; Alhazzani, A; Al-Jehani, H; Tham, CH; Mamauag, MJ; Venketasubramanian, N; Chen, CH; Tang, SC; Churojana, A; Akil, E; aykaç, O; Ozdemir, AO; Giray, S; Hussain, SI; John, S; Le Vu, H; Tran, AD; Nguyen, HH; Nhu Pham, T; Nguyen, TH; Nguyen, TQ; Gattringer, T; Enzinger, C; Killer-Oberpfalzer, M; Bellante, F; De Blauwe, S; Vanhooren, G; De Raedt, S; Dusart, A; Lemmens, R; Ligot, N; Pierre Rutgers, M; Yperzeele, L; Alexiev, F; Sakelarova, T; Bedeković, MR; Budincevic, H; Cindric, I; Hucika, Z; Ozretic, D; Saric, MS; Pfeifer, F; Karpowic, I; Cernik, D; Sramek, M; Skoda, M; Hlavacova, H; Klecka, L; Koutny, M; Vaclavik, D; Skoda, O; Fiksa, J; Hanelova, K; Nevsimalova, M; Rezek, R; Prochazka, P; Krejstova, G; Neumann, J; Vachova, M; Brzezanski, H; Hlinovsky, D; Tenora, D; Jura, R; Jurák, L; Novak, J; Novak, A; Topinka, Z; Fibrich, P; Sobolova, H; Volny, O; Krarup Christensen, H; Drenck, N; Klingenberg Iversen, H; Simonsen, CZ; Truelsen, TC; Wienecke, T; Vibo, R; Gross-Paju, K; Toomsoo, T; Antsov, K; Caparros, F; Cordonnier, C; Dan, M; Faucheux, JM; Mechtouff, L; Eker, O; Lesaine, E; Ondze, B; Peres, R; Pico, F; Piotin, M; Pop, R; Rouanet, F; Gubeladze, T; Khinikadze, M; Lobjanidze, N; Tsiskaridze, A; Nagel, S; Ringleb, PA; Rosenkranz, M; Schmidt, H; Sedghi, A; Siepmann, T; Szabo, K; Thomalla, G; Palaiodimou, L; Sagris, D; Kargiotis, O; Klivenyi, P; Szapary, L; Tarkanyi, G; Adami, A; Bandini, P; Calabresi, P; Frisullo, G; Renieri, L; Sangalli, D; Pirson, A; Uyttenboogaart, M; van den Wijngaard, I; Kristoffersen, ES; Brola, W; Fudala, M; Horoch-Lyszczarek, E; Karlinski, M; Kazmierski, R; Kram, P; Rogoziewicz, M; Kaczorowski, R; Luchowski, P; Sienkiewicz-Jarosz, H; Sobolewski, P; Fryze, W; Wisniewska, A; Wiszniewska, M; Ferreira, P; Ferreira, P; Fonseca, L; Marto, JP; Pinho e Melo, T; Nunes, AP; Rodrigues, M; Tedim Cruz, V; Falup-Pecurariu, C; Krastev, G; Mako, M; de Leciñana, MA; Arenillas, JF; Ayo-Martin, O; Cruz Culebras, A; Tejedor, ED; Montaner, J; Pérez-Sánchez, S; Tola Arribas, MA; Rodriguez Vasquez, A; Mayza, M; Bernava, G; Brehm, A; Machi, P; Fischer, U; Gralla, J; Michel, PL; Psychogios, MN; Strambo, D; Banerjee, S; Krishnan, K; Kwan, J; Butt, A; Catanese, L; Demchuk, AM; Field, T; Haynes, J; Hill, MD.; Khosravani, H; Mackey, A; Pikula, A; Saposnik, G; Scott, CA; Shoamanesh, A; Shuaib, A; Yip, S; Barboza, MA; Barrientos, JD; Portillo Rivera, LI; Gongora-Rivera, F; Novarro-Escudero, N; Blanco, A; Abraham, M; Alsbrook, D; Altschul, D; Alvarado-Ortiz, AJ; Bach, I; Badruddin, A; Barazangi, N; Brereton, C; Castonguay, A; Chaturvedi, S; Chaudry, SA; Choe, H; Choi, JA; Dharmadhikari, S; Desai, K; Devlin, TG; Doss, VT; Edgell, R; Etherton, M; Farooqui, M; Frei, D; Gandhi, D; Grigoryan, M; Gupta, R; Hassan, AE; Helenius, J; Kaliaev, A; Kaushal, R; Khandelwal, P; Khawaja, AM; Khoury, NN; Kim, BS; Kleindorfer, DO; Koyfman, F; Lee, VH; Leung, LY; Linares, G; Linfante, I; Lutsep, HL; Macdougall, L; Male, S; Malik, AM; Masoud, H; McDermott, M; Mehta, BP; Min, J; Mittal, M; Morris, JG; Multani, SS; Nahab, F; Nalleballe, K; Nguyen, CB; Novakovic-White, R; Ortega-Gutierrez, S; Rahangdale, RH; Ramakrishnan, P; Romero, JR; Rost, N; Rothstein, A; Ruland, S; Shah, R; Sharma, M; Silver, B; Simmons, M; Singh, A; Starosciak, AK; Strasser, SL; Szeder, V; Teleb, M; Tsai, JP; Voetsch, B; Balaguera, O; Pujol Lereis, VA; Luraschi, A; Almeida, MS; Cardoso, FB; Conforto, A; De Deus Silva, L; Varrone Giacomini, L; Oliveira Lima, F; Longo, AL; Magalhães, PSC; Martins, RT; Mont'alverne, F; Mora Cuervo, DL; Costa Rebello, L; Valler, L; Zetola, VF; Lavados, PM; Navia, V; Olavarría, VV; Almeida Toro, JM; Amaya, PFR; Bayona, H; Corredor, A; Rivera Ordonez, CE; Mantilla Barbosa, DK; Lara, O; Patiño, MR; Diaz Escobar, LF; Dejesus Melgarejo Fariña, DE; Cardozo Villamayor, A; Zelaya Zarza, AJ; Barrientos Iman, DM; Rodriguez Kadota, L; Campbell, B; Hankey, GJ.; Hair, C; Kleinig, T; Ma, A; Tomazini Martins, R; Sahathevan, R; Thijs, V; Salazar, D; Yuan-Hao Wu, T; Haussen, DC; Liebeskind, D; Yavagal, DR; Jovin, TG; Zaidat, OO; Nguyen, TN
    Objective: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.
    2021Journal article Open access Show more
  • Magnitude of Blood Pressure Change and Clinical Outcomes after Thrombectomy in SAtroke Caused by Large Artery Occlusion
    Publication . Anadani, M; Matusevicius, M; Tsivgoulis, G; Peeters, A; Nunes, AP; Mancuso, M; Roffe, C; Havenon, A; Ahmed, N
    Background: Extremes of both high and low systolic blood pressure (SBP) after mechanical thrombectomy (MT) in large artery occlusion stroke are known predictors of unfavorable outcome. However, the effect of SBP change (∆SBP) during the first 24 h on thrombectomy outcomes remains unclear. We aimed to investigate the association between ∆SBP at different time intervals and thrombectomy outcomes. Methods: We analyzed MT-treated patients registered in the SITS International Stroke Thrombectomy Registry from January 1, 2014 to September 3, 2019. Primary outcome was 3-month unfavorable outcome (modified Rankin scale scores 3-6). We defined ∆SBP as the mean SBP of a given time interval after MT (0-2, 2-4, 4-12, 12-24 h) minus admission SBP. Multivariable mixed logistic regression models were used to adjust for known confounders and center as random effect. Subgroup analyses were included to contrast specific subpopulations. Restricted cubic splines were used to model the associations. Results: The study population consisted of 5835 patients (mean age 70 years, 51% male, median NIHSS 16). Mean ∆SBP was -12.3, -15.7, -17.2, and -16.9 mmHg for the time intervals 0-2, 2-4, 4-12 h, and 12-24 h, respectively. Higher ∆SBP was associated with unfavorable outcome at 0-2 h (odds ratio 1.065, 95% confidence interval 1.014-1.118), 2-4 h (1.140, 1.081-1.203), 4-12 h (1.145, 1.087-1.203), and 12-24 h (1.145, 1.089-1.203), for every increase of 10 mmHg. Restricted cubic spline models suggested that increasing ∆SBP was associated with unfavorable outcome, with higher values showing increased risk of unfavorable outcome. Conclusion: SBP increase after thrombectomy in large artery occlusion stroke is associated with poor functional outcome.
    2021Journal article Open access Show more
  • Stroke Etiology and Outcomes after Endovascular Thrombectomy: Results from the SITS Registry and a Meta-Analysis
    Publication . Matusevicius, M; Cooray, C; Rand, VM; Nunes, AP; Moreira, T; Tassi, R; Egido, JA; Ollikainen, J; Bigliardi, G; Holmin, S; Ahmed, N
    Background and purpose: The influence of stroke etiology on outcomes after endovascular thrombectomy (EVT) is not well understood. We aimed to investigate whether stroke etiology subgrouped as large artery atherosclerosis (LAA) and cardiac embolism (CE) influences outcomes in large artery occlusion (LAO) treated by EVT. Methods: We included EVT treated LAO stroke patients registered in the Safe Implementation of Treatment in Stroke (SITS) thrombectomy register between January 1, 2014 and September 3, 2019. Primary outcome was successful reperfusion (modified Treatment in Cerebral Infarction 2b-3). Secondary outcomes were symptomatic intracranial hemorrhage (SICH), 3-month functional independence (modified Ranking Scale 0-2) and death. Multivariable logistic regression models were used for comparisons. In addition, a meta-analysis of aggregate data from the current literature was conducted (PROSPERO, ID 167447). Results: Of 7,543 patients, 1,903 (25.2%) had LAA, 3,214 (42.6%) CE, and 2,426 (32.2%) unknown, other, or multiple etiologies. LAA patients were younger (66 vs. 74, P<0.001) and had lower National Institutes of Health Stroke Scale score at baseline (15 vs. 16, P<0.001) than CE patients. Multivariable analyses showed that LAA patients had lower odds of successful reperfusion (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.57 to 0.86) and functional independence (OR, 0.74; 95% CI, 0.63 to 0.85), higher risk of death (OR, 1.44; 95% CI, 1.21 to 1.71), but no difference in SICH (OR, 1.09; 95% CI, 0.71 to 1.66) compared to CE patients. The systematic review found 25 studies matching the criteria. The meta-analysis did not find any difference between etiologies. Conclusions: From the SITS thrombectomy register, we observed a lower chance of reperfusion and worse outcomes after thrombectomy in patients with LAA compared to CE etiology, despite more favorable baseline characteristics. In contrast, the meta-analysis did not find any difference between etiologies with aggregate data.
    2021Journal article Open access Show more