Publications by authors named "Camilo R. Gomez"
Article Synopsis
- * Researchers used a combination of enteral cilostazol and intravenous high-dose albumin to treat three aSAH patients, leading to a notable improvement in their condition.
- * Post-treatment evaluations showed significant resolution of perfusion issues, vasospasm, and neurological deficits, suggesting that this combination therapy may be effective for severe cases resistant to standard treatments.
Article Synopsis
- The study investigates how the number of mechanical thrombectomy (MT) procedures performed annually at hospitals affects patient outcomes for acute ischemic stroke in the U.S. from 2016 to 2020.
- It found that as MT procedural volume increases, patients had lower rates of being discharged home/self-cared and higher odds of in-hospital mortality and post-treatment intracranial hemorrhage (ICH).
- The results suggest a paradox where higher procedural volume at hospitals correlates with worse outcomes, likely due to treating more severe cases at these high-volume centers.
Background And Purpose: Intraarterial thrombolysis as an adjunct to mechanical thrombectomy is increasingly being considered to enhance reperfusion in acute ischemic stroke patients. Intraarterial thrombolysis may increase the risk of post-thrombectomy intracerebral hemorrhage (ICH) in certain patient subgroups.
Methods: We analyzed acute ischemic stroke patients treated with mechanical thrombectomy in a multicenter registry.
Background And Purpose: Post thrombolytic intracerebral hemorrhage (ICH) is associated with higher rate of death or disability in acute ischemic stroke patients. We investigated the relationship between post thrombolytic ICH volume and change in volume and death or disability at 90 days in acute ischemic stroke patients.
Methods: We analyzed 110 patents recruited in the Safety Evaluation of 3K3A-APC in Ischemic Stroke (RHAPSODY) trial who received intravenous tissue plasminogen activator (tPA) followed by mechanical thrombectomy (if indicated) and 3K3A-APC or placebo.
Objectives: The value of thrombectomy in patients with acute ischemic stroke cannot be understated. As such, whether these patients get access to this treatment can significantly impact their disease outcomes. We analyzed the trends in thrombectomy adoption between teaching and non-teaching hospitals in the United States, and their impact on overall patient care.
View Article and Find Full Text PDFNeuroendovascular rescue of patients with acute ischemic stroke caused by a large arterial occlusion has evolved throughout the first quarter of the present century, and continues to do so. Starting with the intra-arterial instillation of thrombolytic agents via microcatheters to dissolve occluding thromboembolic material, the current status is one that includes a variety of different techniques such as direct aspiration of thrombus, removal by stent retriever, adjuvant techniques such as balloon angioplasty, stenting, and tactical intra-arterial instillation of thrombolytic agents in smaller branches to treat no-reflow phenomenon. The results have been consistently shown to benefit these patients, irrespective of whether they had already received intravenous tissue-type plasminogen activator or not.
View Article and Find Full Text PDFArticle Synopsis
- The study reviews predictors of delayed cerebral infarction (DCI) and early cerebral infarction (ECI) in patients with aneurysmal subarachnoid hemorrhage (aSAH) through a systematic literature analysis.
- It analyzed 12 cohort studies with 4527 patients, finding that higher severity scores, elevated Fisher scores, female sex, and vasospasm significantly increase the risk of DCI, while factors like pre-existing hypertension and aneurysm location did not show consistent predictive value.
- Conversely, for ECI, no significant predictors were identified related to sex, pre-existing hypertension, severity, or aneurysm location, highlighting areas for further research in understanding ECI risk.
Article Synopsis
- Physician transfer can be a faster alternative to patient transfer for performing mechanical thrombectomy in acute ischemic stroke patients, leading to quicker treatment.
- A systematic review of 12 studies (involving 1,894 patients) showed that physician transfer significantly reduced the time from stroke onset to recanalization by approximately 62 minutes and increased the chances of functional independence after 90 days.
- However, physician transfer did not show a significant increase in the odds of achieving complete or near-complete recanalization compared to patient transfer.
Background: We performed an analysis of a large intensive care unit electronic database to provide preliminary estimates of various blood pressure parameters in patients with acute stroke receiving intravenous (IV) antihypertensive medication and determine the relationship with in-hospital outcomes.
Methods: We identified the relationship between pre-treatment and post-treatment systolic blood pressure (SBP) and heart rate (HR)-related variables and in-hospital mortality and acute kidney injury in patients with acute stroke receiving IV clevidipine, nicardipine, or nitroprusside using data provided in the Medical Information Mart for Intensive Care (MIMIC) IV database.
Results: A total of 1830 patients were treated with IV clevidipine (n = 64), nicardipine (n = 1623), or nitroprusside (n = 143).
Background And Aims: There is no clear consensus on ideal systolic blood pressure (SBP) target post-endovascular thrombectomy (EVT) in patients with acute ischemic stroke. This study intends to investigate the relationship between reducing SBP and clinical outcomes and to determine the therapeutic efficacy of moderate and intensive SBP reduction post EVT.
Methods: A comprehensive search was conducted across five electronic databases to identify studies relevant to our analysis.
Objectives: Current guidelines recommend transthoracic echocardiography (TTE) following an ischemic stroke as the primary technique to identify cardiac abnormalities associated with an increased risk of cerebral embolism. It is unclear whether cardiac magnetic resonance imaging (cMRI), a technique shown to provide increased imaging resolution, may also enhance the cardiac assessment of ischemic stroke patients. We compared cMRI with TTE in the evaluation of Left Atrial (LA) size and pump function in a cohort of 44 patients with ischemic stroke.
View Article and Find Full Text PDFBackground: The optimal target post-procedure stenosis after percutaneous angioplasty and stent placement (PTAS) for intracranial stenosis is unknown. We determined the effect of post-procedure stenosis after intracranial PTAS on subsequent clinical events in patients with severe symptomatic intracranial stenosis.
Methods: We categorized the severity of post-procedure stenosis as '<30%', '30-49%', and '≥50%' among 207 patients who underwent PTAS in a multicenter randomized clinical trial.
Background And Purpose: There are limited data regarding the comparison of balloon expandable stents (BES) and self-expanding stents (SES) for the treatment of intracranial arterial stenosis.
Methods: We conducted a systematic review to identify studies that compared SES and BES in patients with symptomatic intracranial arterial stenosis. Data were extracted from relevant studies found through a search of PubMed, Scopus, and Web of Science until from January 1, 2010 to September 28, 2023.
Introduction: Urgent endovascular intervention is currently accepted as the primary and critical therapeutic approach to patients whose acute ischemic stroke results from a large arterial occlusion (LAO). In this context, one of the quality metrics most widely applied to the assessment of emergency systems performance is the "door-to-puncture" (D-P) time. We undertook a project to identify the subinterval of the D-P metric causing the most impact on workflow delays and created a narrowly focused project on improving such subinterval.
View Article and Find Full Text PDFBackground: In recent years, there have anecdotal reports of intra-arterial thrombolysis (IAT) for the treatment of spinal cord ischemia (SCI) with encouraging results. We describe a patient with acute cervical SCI who underwent IAT with Tenecteplase at our institution.
Case Presentation: A 20-year-old man presented to the emergency department with a 12-hour history of progressive onset upper and lower extremity numbness, weakness, and urinary incontinence after sustaining a fall.
Article Synopsis
- The study examined how mechanical thrombectomy (MT) impacts acute ischemic stroke patients in U.S. hospitals that also perform coronary interventions like PCI for heart attacks.
- Data from 2017 to 2020 showed that over a million stroke patients were treated at different hospital types, and patients at hospitals performing both PCI and MT had lower in-hospital mortality rates compared to those that only performed PCI or neither procedure.
- The findings suggest that nearly 37% of stroke patients are admitted to hospitals that only perform PCI, highlighting the need to increase MT access in these facilities to improve patient outcomes.
Article Synopsis
- * Researchers analyzed data from 131 patients over 45 months, finding a low incidence (6.9%) of new ischemic events during the waiting period, with a calculated risk of 2.5 new events per 1000 patient days.
- * The findings aim to inform the timing of CAS procedures for patients with ICA stenosis, especially those with stenosis severity of 50% or greater.
Introduction: Several reports have identified that clinical outcomes such as death or disability in acute ischemic stroke (AIS) patients following intravenous (IV) tissue plasminogen activator (tPA) treatment can vary according to race and ethnicities. We determined the effect of race/ethnicity on rates of arterial recanalization in AIS patients with large vessel occlusion (LVO) after IV tPA.
Methods: We analyzed 234 patients with LVO detected on computed tomographic angiography (CTA) who received IV tPA and subsequently underwent angiography for potential thrombectomy.
Background: In 2018, the time window for mechanical thrombectomy eligibility in patients with acute ischemic stroke increased from within 6 hours to within 24 hours of symptom onset. The purpose of this study was to evaluate the effect of window expansion on procedural and hospital volumes and patient outcomes at a national level.
Methods: We conducted a retrospective cohort study of patients with acute ischemic stroke undergoing mechanical thrombectomy using data from the National Inpatient Sample.
We describe a very young child who developed an acute ischemic stroke from a LAO, while affected by COVID-19 and MIS-C, and whom we treated successfully with thrombectomy. We compare his clinical and imaging findings with those of the existing case reports, and we explore the multifactorial nature of such a neurovascular complication, particularly in the context of the most recent publications regarding the multifactorial endothelial derangements produced by the illness.
View Article and Find Full Text PDFBackground: Although observational studies have reported favorable clinical outcomes associated with intra-arterial thrombolysis as adjunct to mechanical thrombectomy, the cost and length of hospitalization associated with this intervention has not been studied.
Methods: We analyzed the nationally representative data of the United States data from Nationwide Inpatient Sample (NIS) to compare hospitalization cost and duration in addition to other outcomes in patients receiving (n = 1990) with those not receiving intra-arterial thrombolysis (n = 1990) in acute ischemic stroke patients undergoing mechanical thrombectomy using a case control design matched for age, gender, and presence of aphasia, hemiplegia, neglect, coma/stupor, hemianopsia and dysphagia.
Results: There was no difference in the median hospitalization cost in patients treated with intra-arterial thrombolysis compared with those not treated with intra-arterial thrombolysis: $36,992 [28,361 to 54,336] versus $35,440 [24,383 to 50,438], (regression coefficient 2,485 [-1,947 to 6,917], p = 0.
Background: Acute ischemic stroke from tandem occlusion of internal carotid artery (ICA) poses a technical challenge to neurointerventionalists.
Objective: To present a novel balloon-assisted catheterization of occluded carotid artery (BOCA) technique used for rapid and effective catheterization of occluded/critically stenosed ICA in tandem occlusion.
Methods: A retrospective review of 10 patients with tandem carotid occlusion, treated with BOCA technique for revascularization between July 2020 and June 2021, was performed.
Unlabelled: To investigate the effect of the occurrence of early hyperchloremia on death or severe disability at 180 days in patients with severe traumatic brain injury (TBI).
Design: Post hoc analysis of Resuscitation Outcomes Consortium Hypertonic Saline (ROC HS)-TBI trial.
Setting: A total of 114 North American emergency medical services agencies in the ROC.
Background And Purpose: Although many stroke centers in United States are using intravenous (IV) tenecteplase (TNK) for acute ischemic stroke patients, there is paucity of comparative data between IV TNK and IV alteplase from real-world settings.
Materials And Methods: We analyzed the data from 122 healthcare facilities in Cerner Real World Data and included patients admitted between February 2016 to April 2022 to determine the effect of IV TNK (compared with IV alteplase) on occurrence of two outcomes in acute ischemic stroke patients stratified by use of thrombectomy: non-routine discharge or death, and intracranial hemorrhage after adjusting for potential confounders.
Results: Among 30,643 acute ischemic stroke patients analyzed, 29,480 (96.