Publications by authors named "Joao Sargento Freitas"

Introduction: Evidence regarding the benefit of endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (c-ICA-O) is lacking. We assessed the outcomes and safety of EVT in patients with isolated c-ICA-O.

Methods: Retrospective multicenter cohort study of patients with an AIS due to isolated c-ICA-O, within 24-h since last-seen-well.

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The optimal endovascular management of cervical carotid dissection causing tandem occlusion remains uncertain. We investigated the impact of emergent carotid stenting during endovascular treatment (EVT) for acute ischemic stroke (AIS) in patients with tandem occlusion secondary to cervical carotid artery dissection. This was a secondary analysis of patients treated with EVT for AIS due to occlusive carotid artery dissection and tandem occlusion included in the retrospective international Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection (STOP-CAD) study.

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Background: Microembolic signals (MES) can be detected using transcranial Doppler (TCD) ultrasound in several clinical scenarios, including acute ischemic stroke (AIS). This narrative review aims to provide insights into their role in AIS patient management and outcomes.

Methods: The present narrative review consolidates current observational and randomized evidence on the prevalence and clinical relevance of MES in different AIS subtypes and settings.

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Article Synopsis
  • Cervical artery dissection (CeAD) is a leading cause of ischemic strokes in young adults, and this study explored the effects of intravenous thrombolysis (IVT) on patients with CeAD and stroke symptoms.
  • Analyzed data from the STOP-CAD study, it found that IVT significantly improved functional independence after 90 days in patients without increasing the risk of symptomatic intracranial hemorrhage.
  • The results suggest that IVT is a beneficial treatment for eligible patients with CeAD, aligning with current medical guidelines on its use.
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Background: Vascular risk factors seem to contribute to disease progression in Multiple Sclerosis (MS), but the mechanistic connection between vascular risk and MS is unknown. Understanding cerebrovascular hemodynamics (CVH) in MS may help advance our understanding of the link between vascular risk and MS.

Objectives: Examine the relationship between CVH [dynamic cerebral autoregulation (dCA) and vasoreactivity (VR)] and brain structure (MRI) and function (cognition, and gait) in individuals with MS.

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Article Synopsis
  • The study investigates the effectiveness of endovascular treatment (EVT) for cerebral venous thrombosis (CVT) amidst ongoing uncertainty in the medical community.
  • A retrospective analysis of 61 CVT patients showed that EVT was performed in 20% of cases, leading to significant improvements in neurological function, as measured by the NIHSS score, from baseline to discharge.
  • The results suggest that EVT combined with anticoagulation is safe and may benefit select patients, although further research is needed to confirm its overall effectiveness.
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Introduction: Stroke is considered one of the greatest public health challenges worldwide, with the ischemic subtype being the most prevalent. Various acute stroke clinical guidelines recommend early rehabilitation interventions, including very early mobilization. However, despite the studies conducted in recent years regarding when to initiate mobilization after an acute stroke, there are few systematic and personalized protocols based on the factors for which patient mobilization should ideally be performed.

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 To provide an overview on education, training, practice requirements, and fields of application of neurosonology in Europe and beyond.  National representatives and experts in neurosonology were surveyed regarding neurosonology requirements and practice in their countries. Descriptive statistics were used to report the data.

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Background: Small, randomized trials of patients with cervical artery dissection showed conflicting results regarding optimal stroke prevention strategies. We aimed to compare outcomes in patients with cervical artery dissection treated with antiplatelets versus anticoagulation.

Methods: This is a multicenter observational retrospective international study (16 countries, 63 sites) that included patients with cervical artery dissection without major trauma.

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Background: The optimal imaging method for detecting distal medium vessel occlusions (DMVOs) remains undefined.

Purpose: The objective of this study is to compare the diagnostic performance of CTA with CTP in detecting DMVOs.

Data Sources: We searched PubMed, EMBASE, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials up to March 31, 2023 (PROSPERO: CRD42022344006).

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Herein, we investigate the bioactivity of small extracellular vesicles (sEVs), focusing on their local effect in the brain. sEVs from mononuclear cells (MNCs) showed superior effects to sEVs from mesenchymal stem cells (MSCs) and were able to promote neuroprotection and decrease microglia reactivity in a stroke mouse model.

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Purpose: Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) are often complicated by vasospasm and ischemia. Monitoring with transcranial color-coded Doppler (TCCD) could be useful, but its role is not established. We studied the incidence of ultrasonographic vasospasm (uVSP) in PRES/RCVS and its relationship with ischemic lesions and clinical outcome.

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Article Synopsis
  • - Distal medium vessel occlusions (DMVOs) account for 25-40% of acute ischemic strokes, often leading to significant disability due to their impact on critical brain areas; current treatments like intravenous fibrinolysis are only partially effective.
  • - The study aims to evaluate the diagnostic performance of two imaging methods—computed tomography angiography (CTA) and computed tomography perfusion (CTP)—for detecting DMVOs, as the best imaging approach is still unclear.
  • - A systematic review will be conducted using various medical databases to gather studies on the accuracy of CTA and CTP, ultimately comparing their effectiveness in diagnosing DMVOs to guide optimal treatment strategies.
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Background: Blood-brain barrier permeability (BBBp) is a key process involved in ischemic stroke pathophysiology. However, there is a lack of consensus on how BBBp evolves after the ischemia injury, and its clinical relevance at different timepoints post stroke.

Aims: The main objective of this study is to assess BBBp evolution through stroke phases and its implications on patient outcomes.

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The existence of a selective blood-brain barrier (BBB) and neurovascular coupling are two unique central nervous system vasculature features that result in an intimate relationship between neurons, glia, and blood vessels. This leads to a significant pathophysiological overlap between neurodegenerative and cerebrovascular diseases. Alzheimer's disease (AD) is the most prevalent neurodegenerative disease whose pathogenesis is still to be unveiled but has mostly been explored under the light of the amyloid-cascade hypothesis.

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Background And Objectives: COVID-19-related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19.

Methods: This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection.

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Background: Twitter is a social media platform popularly used by health practitioners, a trend that has been followed by medical journals. The impact of Twitter in bibliometrics of stroke-related literature is yet to be determined.

Aims: We aimed to qualitatively assess the usage of Twitter by stroke journals and study the relationship between Twitter activity and citation rates of stroke articles.

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Objetives: Time is relative in large-vessel occlusion acute ischemic stroke (LVO-AIS). We aimed to evaluate the rate of inter-hospital ASPECTS decay in patients transferred from a primary (PSC) to a comprehensive stroke center (CSC); and to identify patients that should repeat computed tomography (CT) before thrombectomy.

Materials And Methods: This was a retrospective cohort study of consecutive anterior circulation LVO-AIS transferred patients.

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Ischemic stroke is becoming one of the most common causes of death and disability in developed countries. Since current therapeutic options are quite limited, focused on acute reperfusion therapies that are hampered by a very narrow therapeutic time window, it is essential to discover novel treatments that not only stop the progression of the ischemic cascade during the acute phase, but also improve the recovery of stroke patients during the sub-acute or chronic phase. In this regard, several studies have shown that endothelial progenitor cells (EPCs) can repair damaged vessels as well as generate new ones following cerebrovascular damage.

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Introduction: Oculopalatal tremor (OPT) is a late manifestation of a Guillain-Mollaret triangle lesion. Memantine has been shown to improve nystagmus in OPT, but its long-term efficacy and putative distinct effects on each plane of nystagmus and on associated phenomena (e.g.

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Introduction: To design more effective interventions, such as neurostimulation, for stroke rehabilitation, there is a need to understand early physiological changes that take place that may be relevant for clinical monitoring. We aimed to study changes in neurophysiology following ischemic stroke, both at rest and with motor planning and execution.

Materials And Methods: We included 10 poststroke patients, between 7 and 10 days after stroke, and 20 age-matched controls to assess changes in cortical motor output via transcranial magnetic stimulation and in dynamics of oscillations, as recorded using electroencephalography (EEG).

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Article Synopsis
  • * Intravenous thrombolysis (IV-rtPA) for acute ischemic stroke (AIS) may lead to myocardial infarction (MI), with studies indicating a higher incidence of cardiac events among those treated with thrombolysis. * A review of AIS patients revealed that only 0.5% experienced MI within 24 hours post-IV-rtPA, with 54% of cases attributed to atherosclerosis and 46% to embolism; significant associations were found between the type of MI and characteristics of the stroke. * While MI after IV-rtPA is rare, the rate of embolic MI was higher than in the general population, suggesting a possible link between the underlying causes of AIS and MI, though the small
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