Whether nonalcoholic fatty liver disease (NAFLD) can predict atherosclerosis in obese patients re... more Whether nonalcoholic fatty liver disease (NAFLD) can predict atherosclerosis in obese patients remains unclear. The aim of our study was to investigate the usefulness of NAFLD and other cardiometabolic parameters in predicting subclinical atherosclerosis in obese patients. We studied 314 consecutive obese subjects (223 women; mean age, 45.04±9.34 years; body mass index 44.3±5 Kg/m(2) ) and 47 healthy lean individuals. Hepatic steatosis and atherosclerosis (carotid intima-media thickness [cIMT]>0.8 mm and/or presence of plaques) were evaluated ultrasonographically. Liver biopsies were obtained in 51 patients. In obese patients, mean c-IMT was greater in those with NAFLD (P<0.001). Hepatic steatosis and age were independent predictors of atherosclerosis: the NAFLD-associated OR for atherosclerosis was 5.96 (95%CI, 1.60-22.25;p=0.008) in men and 8.26 (95%CI, 4.02-16.99;p<0.001) in women, and the age-associated OR for atherosclerosis was 1.14 (95%CI, 1.07-1.22; p<0.001) in m...
The purpose of this study is to evaluate the best endovascular approach (aspiration or stent-retr... more The purpose of this study is to evaluate the best endovascular approach (aspiration or stent-retriever) and the impact of stent retriever size and length on clinical and angiographic outcomes in patients with acute intracranial ICA occlusion. We conducted a retrospective analysis of a prospective database of consecutive patients with acute intracranial ICA occlusion undergoing endovascular treatment in four Comprehensive Stroke Center between June-2019 and December-2020. We include 121 patients; Stent-retriever (SR) was used as first technical approach in 107 patients (88.4%) and aspiration was used in 14 patients (11.6%). SR group had higher rate of FPE compared to aspiration group (29 vs. 0%, p = 0.02). In SR subgroup, treatment highlighted higher FPE in the 6 × 50 SR (37.7%), than in the rest of the SR which are 21.2% (4–5 mm size and 20–50 mm length SR) and 19% (6 mm size and 25–40 mm length SR), but it was not found to be statistically significant. There were no other significa...
Importance It is estimated that only 27% of patients with acute ischemic stroke and large vessel ... more Importance It is estimated that only 27% of patients with acute ischemic stroke and large vessel occlusion who undergo successful reperfusion after mechanical thrombectomy are disability free at 90 days. An incomplete microcirculatory reperfusion might contribute to these suboptimal clinical benefits. Objective To investigate whether treatment with adjunct intra-arterial alteplase after thrombectomy improves outcomes following reperfusion. Design, Setting, and Participants Phase 2b randomized, double-blind, placebo-controlled trial performed from December 2018 through May 2021 in 7 stroke centers in Catalonia, Spain. The study included 121 patients with large vessel occlusion acute ischemic stroke treated with thrombectomy within 24 hours after stroke onset and with an expanded Treatment in Cerebral Ischemia angiographic score of 2b50 to 3. Interventions Participants were randomized to receive intra-arterial alteplase (0.225 mg/kg; maximum dose, 22.5 mg) infused over 15 to 30 minutes (n = 61) or placebo (n = 52). Main Outcomes and Measures The primary outcome was the difference in proportion of patients achieving a score of 0 or 1 on the 90-day modified Rankin Scale (range, 0 [no symptoms] to 6 [death]) in all patients treated as randomized. Safety outcomes included rate of symptomatic intracranial hemorrhage and death. Results The study was terminated early for inability to maintain placebo availability and enrollment rate because of the COVID-19 pandemic. Of 1825 patients with acute ischemic stroke treated with thrombectomy at the 7 study sites, 748 (41%) patients fulfilled the angiographic criteria, 121 (7%) patients were randomized (mean age, 70.6 [SD, 13.7] years; 57 women [47%]), and 113 (6%) were treated as randomized. The proportion of participants with a modified Rankin Scale score of 0 or 1 at 90 days was 59.0% (36/61) with alteplase and 40.4% (21/52) with placebo (adjusted risk difference, 18.4%; 95% CI, 0.3%-36.4%; P = .047). The proportion of patients with symptomatic intracranial hemorrhage within 24 hours was 0% with alteplase and 3.8% with placebo (risk difference, -3.8%; 95% CI, -13.2% to 2.5%). Ninety-day mortality was 8% with alteplase and 15% with placebo (risk difference, -7.2%; 95% CI, -19.2% to 4.8%). Conclusions and Relevance Among patients with large vessel occlusion acute ischemic stroke and successful reperfusion following thrombectomy, the use of adjunct intra-arterial alteplase compared with placebo resulted in a greater likelihood of excellent neurological outcome at 90 days. However, because of study limitations, these findings should be interpreted as preliminary and require replication. Trial Registration ClinicalTrials.gov Identifier: NCT03876119; EudraCT Number: 2018-002195-40.
BACKGROUND Patients with acute ischemic stroke due to large vessel occlusion may present with con... more BACKGROUND Patients with acute ischemic stroke due to large vessel occlusion may present with concomitant carotid dissections that make the technical approach for their treatment challenging. The purpose of this study was to determine the safety and feasibility of flow diverter (FD) stents to treat carotid artery dissections in tandem lesions of acute ischemic stroke patients during mechanical thrombectomy. METHODS A retrospective review of all patients in which a carotid artery dissection was treated with an FD during endovascular treatment of acute ischemic stroke between 2018 and 2020 was conducted in 5 high‐volume Comprehensive Stroke Centers. Patient clinical and angiographical characteristics, postoperative outcome, and follow‐up were recorded. RESULTS A total of 12 patients (mean age: 54.18±14.74 years, median Alberta Stroke Program Early CT Score: 10 [interquartile range 9–10]) were included. Successful FD stenting with immediate patency of the dissected segments and success...
Poster: "SERAM 2014 / S-0880 / Analisis de la angioarquitectura de las Malformaciones Arter... more Poster: "SERAM 2014 / S-0880 / Analisis de la angioarquitectura de las Malformaciones Arteriovenosas cerebrales y su implicacion clinico-terapeutica. " by: " J. Moreno Negrete , A. Lopez Rueda, O. Chirife, J. Blasco Andaluz, L. San Roman Manzanera, J. Macho Fernandez; Barcelona/ES"
The distal transradial approach (dTRA) is progressively gaining more clinical use in the fields o... more The distal transradial approach (dTRA) is progressively gaining more clinical use in the fields of cardiology and other vascular interventions, as it offers a number of advantages compared to conventional radial approach (TRA). These include lower rates of vascular occlusion which permits preservation of the proximal radial artery for future procedures in the event of a distal occlusion. To share the experience in the use of dTRA for neurointerventions, showing its advantages, pitfalls as well as sharing our optimized puncture and hemostatic ultrarapid compression protocols to improve the use of this vascular access. A retrospective analysis of our experience of diagnostic and interventional procedures performed via dTRA using an optimized protocol for puncture and postpuncture compression of the dTRA was performed. The rate of complications (hematoma and arterial dissection at puncture site) femoral crossover, and assessment of postprocedural stenosis/occlusion with the ultrarapid ...
Poster: "ECR 2013 / C-0968 / Application of the PI-RADS score system by radiologists in trai... more Poster: "ECR 2013 / C-0968 / Application of the PI-RADS score system by radiologists in training on the multiparametric MRI studies performed to patients under biochemical suspicion of prostatic cancer and previous negative biopsies before a new targeted biopsy. " by: " D. Gutierrez , O. Chirife, C. Pineda; Barcelona/ES"
II Joint Meeting of the Portuguese Society of Neuroradiology (SPNR) and of the Spanish Society of... more II Joint Meeting of the Portuguese Society of Neuroradiology (SPNR) and of the Spanish Society of Neuroradiology (SENR) (IX National Congress of the SPNR and XLII Annual Meeting of the SENR) 17–19 October 2013, Lisbon, Portugal Meeting president Pedro Vilela, MD (Portugal) SPNR president Pedro Vilela, MD (Portugal) SENR president Àlex Rovira, MD (Spain) Scientific committee Presidents: Pedro de Melo-Freitas, MD (Portugal); Nuria Bargalló, MD (Spain) Cristina Moura, MD (Portugal) João Paulo Fernandes, MD (Portugal) Pedro Pinto, MD (Portugal) Juan Guzman, MD (Spain) Pilar Piñero, MD (Spain) Organizing committee President: Teresa Palma, MD (Portugal) Júlia Duarte Inês Carreiro Tiago Baptista Tiago Parreira Cláudia Pereira Isabel Cravo Margarida Ayres Basto Carlos Casimiro Ricardo Morais (Neuroradiology Residents Commission) Bruno Gomes (Neuroradiology Residents Commission) Honour committee President: Augusto Goulão, PhD (Portugal) Eduardo Medina, MD (Portugal) Costa Reis, MD (Portugal)...
Poster: "ECR 2013 / C-0735 / Computer tomography Imaging findings, clinical spectrum and fol... more Poster: "ECR 2013 / C-0735 / Computer tomography Imaging findings, clinical spectrum and follow up of patients with right colonic diverticulitis" by: "D. Gutierrez, O. Chirife, M. pages, J. R. Ayuso, C. Ayuso; Barcelona/ES"
Background and Purpose: Mechanical thrombectomy (MT) in ischemic stroke patients with poor prestr... more Background and Purpose: Mechanical thrombectomy (MT) in ischemic stroke patients with poor prestroke conditions remains controversial. We aimed to analyze the frequency of previously disabled patients treated with MT in clinical practice, the safety and clinical response to MT of patients with preexisting disability, and the disabled patient characteristics associated with a better response to MT. Methods: We studied all consecutive patients with anterior circulation occlusion treated with MT from January 2017 to December 2019 included in the Codi Ictus Catalunya registry—a government-mandated, prospective, hospital-based data set. Prestroke disability was defined as modified Rankin Scale score 2 or 3. Functional outcome at 90 days was centrally assessed by a blinded evaluator of the Catalan Stroke Program. Favorable outcome (to return at least to prestroke modified Rankin Scale at 90 days) and safety and secondary outcomes were compared with patients without previous disability. Lo...
Purpose The objective of this study was to assess the efficacy and safety of transradial access f... more Purpose The objective of this study was to assess the efficacy and safety of transradial access for diagnostic angiography and interventional neuroradiology procedures. Methods This was a retrospective analysis of a single-center experience based on 225 patients attended between August 2015 and October 2019, in which transradial access was used for diagnostic angiography and endovascular interventions. Ultrasound-guided access was done at the level of the forearm or anatomical or snuffbox (distal transradial access). Conventional forearm transradial access was done in 179 procedures (right, left and bilateral in 169, 5 and 5, respectively), while distal transradial access was done in 46 cases (41 right and 5 left). Primary outcome measures included successful catheterization, need to change access, or technical complications. Results In the group of 131 diagnostic angiographies, the technique success rate was 100% to target the right vertebral artery, 97% for the right internal caro...
Hypoperfusion is the typical perfusion pattern associated with recent small subcortical infarcts ... more Hypoperfusion is the typical perfusion pattern associated with recent small subcortical infarcts of the brain, but other perfusion patterns may be present in patients with these infarcts. Using CT perfusion, we studied 67 consecutive patients who had a small subcortical infarct at a follow-up MRI study to investigate the correlation between the perfusion pattern and the clinical and radiological course. On CT perfusion map analysis, 51 patients (76%) had focal hypoperfusion, 4 patients (6%) had hyperperfusion and the remaining 12 patients (18%) showed no abnormalities. On dynamic sequential imaging analysis obtained from the source perfusion images, 32 patients (48%) had a sustained hypoperfusion pattern, 11 patients (16%) had a reperfusion pattern, and 18 patients (27%) had a delayed compensation pattern. Systolic blood pressure was higher in patients with sustained hypoperfusion although the perfusion pattern was independent of the final volume of infarction. These results reinfor...
Whether nonalcoholic fatty liver disease (NAFLD) can predict atherosclerosis in obese patients re... more Whether nonalcoholic fatty liver disease (NAFLD) can predict atherosclerosis in obese patients remains unclear. The aim of our study was to investigate the usefulness of NAFLD and other cardiometabolic parameters in predicting subclinical atherosclerosis in obese patients. We studied 314 consecutive obese subjects (223 women; mean age, 45.04±9.34 years; body mass index 44.3±5 Kg/m(2) ) and 47 healthy lean individuals. Hepatic steatosis and atherosclerosis (carotid intima-media thickness [cIMT]>0.8 mm and/or presence of plaques) were evaluated ultrasonographically. Liver biopsies were obtained in 51 patients. In obese patients, mean c-IMT was greater in those with NAFLD (P<0.001). Hepatic steatosis and age were independent predictors of atherosclerosis: the NAFLD-associated OR for atherosclerosis was 5.96 (95%CI, 1.60-22.25;p=0.008) in men and 8.26 (95%CI, 4.02-16.99;p<0.001) in women, and the age-associated OR for atherosclerosis was 1.14 (95%CI, 1.07-1.22; p<0.001) in m...
The purpose of this study is to evaluate the best endovascular approach (aspiration or stent-retr... more The purpose of this study is to evaluate the best endovascular approach (aspiration or stent-retriever) and the impact of stent retriever size and length on clinical and angiographic outcomes in patients with acute intracranial ICA occlusion. We conducted a retrospective analysis of a prospective database of consecutive patients with acute intracranial ICA occlusion undergoing endovascular treatment in four Comprehensive Stroke Center between June-2019 and December-2020. We include 121 patients; Stent-retriever (SR) was used as first technical approach in 107 patients (88.4%) and aspiration was used in 14 patients (11.6%). SR group had higher rate of FPE compared to aspiration group (29 vs. 0%, p = 0.02). In SR subgroup, treatment highlighted higher FPE in the 6 × 50 SR (37.7%), than in the rest of the SR which are 21.2% (4–5 mm size and 20–50 mm length SR) and 19% (6 mm size and 25–40 mm length SR), but it was not found to be statistically significant. There were no other significa...
Importance It is estimated that only 27% of patients with acute ischemic stroke and large vessel ... more Importance It is estimated that only 27% of patients with acute ischemic stroke and large vessel occlusion who undergo successful reperfusion after mechanical thrombectomy are disability free at 90 days. An incomplete microcirculatory reperfusion might contribute to these suboptimal clinical benefits. Objective To investigate whether treatment with adjunct intra-arterial alteplase after thrombectomy improves outcomes following reperfusion. Design, Setting, and Participants Phase 2b randomized, double-blind, placebo-controlled trial performed from December 2018 through May 2021 in 7 stroke centers in Catalonia, Spain. The study included 121 patients with large vessel occlusion acute ischemic stroke treated with thrombectomy within 24 hours after stroke onset and with an expanded Treatment in Cerebral Ischemia angiographic score of 2b50 to 3. Interventions Participants were randomized to receive intra-arterial alteplase (0.225 mg/kg; maximum dose, 22.5 mg) infused over 15 to 30 minutes (n = 61) or placebo (n = 52). Main Outcomes and Measures The primary outcome was the difference in proportion of patients achieving a score of 0 or 1 on the 90-day modified Rankin Scale (range, 0 [no symptoms] to 6 [death]) in all patients treated as randomized. Safety outcomes included rate of symptomatic intracranial hemorrhage and death. Results The study was terminated early for inability to maintain placebo availability and enrollment rate because of the COVID-19 pandemic. Of 1825 patients with acute ischemic stroke treated with thrombectomy at the 7 study sites, 748 (41%) patients fulfilled the angiographic criteria, 121 (7%) patients were randomized (mean age, 70.6 [SD, 13.7] years; 57 women [47%]), and 113 (6%) were treated as randomized. The proportion of participants with a modified Rankin Scale score of 0 or 1 at 90 days was 59.0% (36/61) with alteplase and 40.4% (21/52) with placebo (adjusted risk difference, 18.4%; 95% CI, 0.3%-36.4%; P = .047). The proportion of patients with symptomatic intracranial hemorrhage within 24 hours was 0% with alteplase and 3.8% with placebo (risk difference, -3.8%; 95% CI, -13.2% to 2.5%). Ninety-day mortality was 8% with alteplase and 15% with placebo (risk difference, -7.2%; 95% CI, -19.2% to 4.8%). Conclusions and Relevance Among patients with large vessel occlusion acute ischemic stroke and successful reperfusion following thrombectomy, the use of adjunct intra-arterial alteplase compared with placebo resulted in a greater likelihood of excellent neurological outcome at 90 days. However, because of study limitations, these findings should be interpreted as preliminary and require replication. Trial Registration ClinicalTrials.gov Identifier: NCT03876119; EudraCT Number: 2018-002195-40.
BACKGROUND Patients with acute ischemic stroke due to large vessel occlusion may present with con... more BACKGROUND Patients with acute ischemic stroke due to large vessel occlusion may present with concomitant carotid dissections that make the technical approach for their treatment challenging. The purpose of this study was to determine the safety and feasibility of flow diverter (FD) stents to treat carotid artery dissections in tandem lesions of acute ischemic stroke patients during mechanical thrombectomy. METHODS A retrospective review of all patients in which a carotid artery dissection was treated with an FD during endovascular treatment of acute ischemic stroke between 2018 and 2020 was conducted in 5 high‐volume Comprehensive Stroke Centers. Patient clinical and angiographical characteristics, postoperative outcome, and follow‐up were recorded. RESULTS A total of 12 patients (mean age: 54.18±14.74 years, median Alberta Stroke Program Early CT Score: 10 [interquartile range 9–10]) were included. Successful FD stenting with immediate patency of the dissected segments and success...
Poster: "SERAM 2014 / S-0880 / Analisis de la angioarquitectura de las Malformaciones Arter... more Poster: "SERAM 2014 / S-0880 / Analisis de la angioarquitectura de las Malformaciones Arteriovenosas cerebrales y su implicacion clinico-terapeutica. " by: " J. Moreno Negrete , A. Lopez Rueda, O. Chirife, J. Blasco Andaluz, L. San Roman Manzanera, J. Macho Fernandez; Barcelona/ES"
The distal transradial approach (dTRA) is progressively gaining more clinical use in the fields o... more The distal transradial approach (dTRA) is progressively gaining more clinical use in the fields of cardiology and other vascular interventions, as it offers a number of advantages compared to conventional radial approach (TRA). These include lower rates of vascular occlusion which permits preservation of the proximal radial artery for future procedures in the event of a distal occlusion. To share the experience in the use of dTRA for neurointerventions, showing its advantages, pitfalls as well as sharing our optimized puncture and hemostatic ultrarapid compression protocols to improve the use of this vascular access. A retrospective analysis of our experience of diagnostic and interventional procedures performed via dTRA using an optimized protocol for puncture and postpuncture compression of the dTRA was performed. The rate of complications (hematoma and arterial dissection at puncture site) femoral crossover, and assessment of postprocedural stenosis/occlusion with the ultrarapid ...
Poster: "ECR 2013 / C-0968 / Application of the PI-RADS score system by radiologists in trai... more Poster: "ECR 2013 / C-0968 / Application of the PI-RADS score system by radiologists in training on the multiparametric MRI studies performed to patients under biochemical suspicion of prostatic cancer and previous negative biopsies before a new targeted biopsy. " by: " D. Gutierrez , O. Chirife, C. Pineda; Barcelona/ES"
II Joint Meeting of the Portuguese Society of Neuroradiology (SPNR) and of the Spanish Society of... more II Joint Meeting of the Portuguese Society of Neuroradiology (SPNR) and of the Spanish Society of Neuroradiology (SENR) (IX National Congress of the SPNR and XLII Annual Meeting of the SENR) 17–19 October 2013, Lisbon, Portugal Meeting president Pedro Vilela, MD (Portugal) SPNR president Pedro Vilela, MD (Portugal) SENR president Àlex Rovira, MD (Spain) Scientific committee Presidents: Pedro de Melo-Freitas, MD (Portugal); Nuria Bargalló, MD (Spain) Cristina Moura, MD (Portugal) João Paulo Fernandes, MD (Portugal) Pedro Pinto, MD (Portugal) Juan Guzman, MD (Spain) Pilar Piñero, MD (Spain) Organizing committee President: Teresa Palma, MD (Portugal) Júlia Duarte Inês Carreiro Tiago Baptista Tiago Parreira Cláudia Pereira Isabel Cravo Margarida Ayres Basto Carlos Casimiro Ricardo Morais (Neuroradiology Residents Commission) Bruno Gomes (Neuroradiology Residents Commission) Honour committee President: Augusto Goulão, PhD (Portugal) Eduardo Medina, MD (Portugal) Costa Reis, MD (Portugal)...
Poster: "ECR 2013 / C-0735 / Computer tomography Imaging findings, clinical spectrum and fol... more Poster: "ECR 2013 / C-0735 / Computer tomography Imaging findings, clinical spectrum and follow up of patients with right colonic diverticulitis" by: "D. Gutierrez, O. Chirife, M. pages, J. R. Ayuso, C. Ayuso; Barcelona/ES"
Background and Purpose: Mechanical thrombectomy (MT) in ischemic stroke patients with poor prestr... more Background and Purpose: Mechanical thrombectomy (MT) in ischemic stroke patients with poor prestroke conditions remains controversial. We aimed to analyze the frequency of previously disabled patients treated with MT in clinical practice, the safety and clinical response to MT of patients with preexisting disability, and the disabled patient characteristics associated with a better response to MT. Methods: We studied all consecutive patients with anterior circulation occlusion treated with MT from January 2017 to December 2019 included in the Codi Ictus Catalunya registry—a government-mandated, prospective, hospital-based data set. Prestroke disability was defined as modified Rankin Scale score 2 or 3. Functional outcome at 90 days was centrally assessed by a blinded evaluator of the Catalan Stroke Program. Favorable outcome (to return at least to prestroke modified Rankin Scale at 90 days) and safety and secondary outcomes were compared with patients without previous disability. Lo...
Purpose The objective of this study was to assess the efficacy and safety of transradial access f... more Purpose The objective of this study was to assess the efficacy and safety of transradial access for diagnostic angiography and interventional neuroradiology procedures. Methods This was a retrospective analysis of a single-center experience based on 225 patients attended between August 2015 and October 2019, in which transradial access was used for diagnostic angiography and endovascular interventions. Ultrasound-guided access was done at the level of the forearm or anatomical or snuffbox (distal transradial access). Conventional forearm transradial access was done in 179 procedures (right, left and bilateral in 169, 5 and 5, respectively), while distal transradial access was done in 46 cases (41 right and 5 left). Primary outcome measures included successful catheterization, need to change access, or technical complications. Results In the group of 131 diagnostic angiographies, the technique success rate was 100% to target the right vertebral artery, 97% for the right internal caro...
Hypoperfusion is the typical perfusion pattern associated with recent small subcortical infarcts ... more Hypoperfusion is the typical perfusion pattern associated with recent small subcortical infarcts of the brain, but other perfusion patterns may be present in patients with these infarcts. Using CT perfusion, we studied 67 consecutive patients who had a small subcortical infarct at a follow-up MRI study to investigate the correlation between the perfusion pattern and the clinical and radiological course. On CT perfusion map analysis, 51 patients (76%) had focal hypoperfusion, 4 patients (6%) had hyperperfusion and the remaining 12 patients (18%) showed no abnormalities. On dynamic sequential imaging analysis obtained from the source perfusion images, 32 patients (48%) had a sustained hypoperfusion pattern, 11 patients (16%) had a reperfusion pattern, and 18 patients (27%) had a delayed compensation pattern. Systolic blood pressure was higher in patients with sustained hypoperfusion although the perfusion pattern was independent of the final volume of infarction. These results reinfor...
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