Temporal Trends of Intravenous Thrombolysis Utilization in Acute Ischemic Stroke in a Prospective Cohort From 1998 to 2019: Modeling Based on Joinpoint Regression.

Introduction: The frequency of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) is lower than it should be in several regions of the world. It is unclear what interventions can produce significant improvements in IVT utilization. We aimed to investigate the temporal trends in IVT in AIS and identify changes in time that could be associated with specific interventions.

Fighting Against Stroke in Latin America: A Joint Effort of Medical Professional Societies and Governments.

Stroke is one of the leading causes of death in Latin America, a region with countless gaps to be addressed to decrease its burden. In 2018, at the first Latin American Stroke Ministerial Meeting, stroke physician and healthcare manager representatives from 13 countries signed the Declaration of Gramado with the priorities to improve the region, with the commitment to implement all evidence-based strategies for stroke care. The second meeting in March 2020 reviewed the achievements in 2 years and discussed new objectives.

Incidence, risk factors, prognosis, and health-related quality of life after stroke in a low-resource community in Chile (ÑANDU): a prospective population-based study.

Background: Stroke is a leading cause of disability and death worldwide. The best estimates of local, national, and global burden of stroke are derived from prospective population-based studies. We aimed to investigate the incidence, risk factors, long-term prognosis, care, and quality of life after stroke in the Ñuble region of Chile.

[Determinants of door to needle time for intravenous thrombolysis in acute ischemic stroke].

Background: Intravenous thrombolysis (IT) in acute ischemic stroke (AIS) is time dependent. The time elapsed from hospital admission to the thrombolytic bolus is named door to needle time (DNT) and is recommend to be of less than 60 min.

Aim: To describe the DNT in our center and determine those factors associated with a DNT longer than 60 min.

Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project.

Importance: There are inconsistencies in concept, criteria, practice, and documentation of brain death/death by neurologic criteria (BD/DNC) both internationally and within countries.

Objective: To formulate a consensus statement of recommendations on determination of BD/DNC based on review of the literature and expert opinion of a large multidisciplinary, international panel.

Process: Relevant international professional societies were recruited to develop recommendations regarding determination of BD/DNC.

Stroke Care and Application of Thrombolysis in Ibero-America: Report From the SITS-SIECV Ibero-American Stroke Register.

Background And Purpose: Standardized registries may provide valuable data to further improve stroke care. Our aim was to obtain updated information about characteristics of stroke patients and management of stroke across the Ibero-American countries, using a common in-hospital registry (Safe Implementation of Treatments in Stroke–Sociedad Iberoamericana de Enfermedades Cerebrovasculares) as a basis for further quality improvement.

Methods: Data for this study were entered into the Safe Implementation of Treatments in Stroke registry from September 2009 to December 2013 by 58 centers in 14 countries.

[Telestroke in Chile: 1 year experience at 7 hospitals].

Background: Acute ischemic stroke (AIS) is one of the leading causes of death in Chile. Intravenous thrombolysis (IVT) is an effective treatment. Geographical barriers and lack of specialists limit its application.

Diffusion-weighted imaging determinants for acute ischemic stroke diagnosis in the emergency room.

Purpose: The aim of this study was to investigate the clinical-radiological determinants of diffusion-weighted image (DWI) abnormalities in patients with suspected acute ischemic stroke (AIS) seen at the emergency room (ER).

Methods: During the study period, 882 consecutive patients were screened at Clínica Alemana de Santiago, Chile; 786 had AIS and 711 (90.4%) were included.

[Thrombolysis in stroke mimics: Experience in 10 cases].

Background: The effectiveness of intravenous thrombolysis (IVT) in cerebral ischemia is time dependent. Stroke mimics (SM) are frequent in emergency rooms. The effort to reduce door to needle time, can lead to administer thrombolytics to SM.

Transcranial Doppler as a Predictor of Ischemic Events in Carotid Artery Dissection.

Background: We aim to evaluate clinical features and transcranial Doppler (TCD) elements, as predictors of the development of ischemic events (IEs) in patients suffering from spontaneous carotid arterial dissection without stroke (CCADW).

Methods: Consecutive patients with CCADW, seen in Clínica Alemana de Santiago between April 2004 and January 2015, were evaluated clinically, and with TCD, microembolic signals (MES) monitoring and breath hold Index (BHI) test were performed.

Results: Forty-one patients with 45 CCADW were included.

The Role of TCD in the Evaluation of Acute Stroke.

Background: The additional information that transcranial Doppler (TCD) can provide as part of a multimodal imaging stroke protocol in the setting of hyper acute strokes has not been evaluated.

Methods: Consecutive patients admitted between December 2012 and January 2015 with ischemic stroke of less than 4.5 hours of onset were studied as soon as possible with a protocol consisting of noncontrast brain computed tomography, computed tomography angiography of supra-aortic vessels, diffusion-weighted magnetic resonance imaging, and TCD.

[Sonothrombolysis for acute ischemic stroke].

Background: Sonothrombolysis (ST) is an emerging modality for the treatment of stroke.

Aim: To assess the feasibility to perform ST in a Chilean hospital.

Material And Methods: Patients attended at a private clinic with an acute ischemic stroke, between September 2002 and May 2013 and eligible for endovenous thrombolysis, were studied with a transcranial Doppler (Spencer PMD 100 or 150®).

Accuracy of diffusion-weighted imaging in the diagnosis of stroke in patients with suspected cerebral infarct.

Background And Purpose: The accuracy of diffusion-weighted imaging (DWI) for the diagnosis of acute cerebral ischemia among patients with suspected ischemic stroke arriving to an emergency room has not been studied in depth.

Methods: DWI was performed in 712 patients with acute or subacute focal symptoms that suggested an acute ischemic stroke (AIS), 609 of them with AIS.

Results: DWI demonstrated a sensitivity of 90% and specificity of 97%, a positive likelihood ratio of 31 and a negative likelihood ratio of 0.

Exclusion criteria for intravenous thrombolysis in stroke mimics: an observational study.

Background: Stroke mimics (SMs) are frequent in emergency departments (EDs), but are treated infrequently with intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis. We aimed at identifying the factors that lead to the exclusion of SMs from thrombolytic therapy.

Methods: Consecutive patients presenting to the ED between December 2004 and March 2011 with symptoms that suggested acute ischemic stroke were included.

Transcranial Doppler in a Hispanic-Mestizo population with neurological diseases: a study of sonographic window and its determinants.

Between 5% and 37% of patients are not suitable for transtemporal insonation with transcranial Doppler (TCD). This unsuitability is particularly frequent in elderly females and non-Caucasians. We aim to evaluate TCD efficiency in a mixed Hispanic population in Santiago, Chile and to determine whether factors associated with the presence of optimal windows depend exclusively on patient-related elements.

[Validation of transcranial Doppler in the diagnosis of brain death].

Background: The clinical diagnosis of brain death is complex.

Aim: To evaluate the diagnostic accuracy of transcranial Doppler (TCD) for brain death.

Patients And Methods: Patients seen on the intensive care unit of a private hospital between January 2004 to December 2008, were included if they were in structural coma, had no craniectomy and had a blind evaluation by a neurologist and TCD done in less than three hours.

Additional information given to a multimodal imaging stroke protocol by transcranial Doppler ultrasound in the emergency room: a prospective observational study.

Background: Transcranial Doppler (TCD) ultrasound can demonstrate dynamic information. We aimed to evaluate whether TCD generates useful additional information in the emergency room after a multimodal stroke imaging protocol and also whether this modified the management of patients with cerebral infarction.

Methods: Patients admitted between April 2006 and June 2007 with ischemic stroke of less than 24 h were subjected to a protocol consisting of non-contrast brain CT, computed tomography angiography, diffusion-weighted magnetic resonance imaging and then TCD within the following 6 h by an observer blinded to the results of imaging studies.

Pandemic influenza A (H1N1) 2009 with neurological manifestations, a case series.

Objectives: Describe a series of atypical presentations of pandemic influenza A (H1N1) 2009.

Methods: Description of case series using hospital records.

Results: Six patients aged 1 to 65 years with confirmed pandemic influenza A (H1N1) 2009 infection presented with neurological complications within 2 to 5 days after the first signs of influenza-like illness.

Nasolaryngoscopic validation of a set of clinical predictors of aspiration in a critical care setting.

Background: Aspiration is frequent in patients with acute neurologic disorders and swallowing dysfunction. Its incidence in stroke, as high as 51%, increases mortality by up to 3 times. Pneumonia, its main complication, further increases morbidity, mortality, and patient care costs.

Accuracy of transcranial Doppler compared with CT angiography in diagnosing arterial obstructions in acute ischemic strokes.

Background And Purpose: Patients with acute ischemic stroke and intracranial arterial obstructions have a poor prognosis and a high probability of deteriorating at 24 hours. We aimed to evaluate the diagnostic accuracy of power motion mode Doppler (PMD-TCD) compared with CT angiography as standard in diagnosing intracranial arterial obstructions in patients presenting with ischemic stroke of <24 hours.

Methods: Consecutive patients presenting with acute ischemic stroke to the emergency department underwent high-resolution brain CT angiography and PMD-TCD within a 6-hour difference.

Stroke epidemiology, prevention, and management strategies at a regional level: Latin America and the Caribbean.

Stroke is a major health problem in Latin American and Caribbean countries. In this paper, we review the epidemiology, aetiology, and management of stroke in the region based on a systematic search of articles published in Spanish, Portuguese, and English. Stroke mortality is higher than in developed countries but rates are declining.