Fiabilidad del diagnóstico de ictus en urgencias

Introduction

According to the Spanish Stroke Health Care Plan and the Spanish Health National Service Stroke Strategy, thrombolysis should only be performed in hospitals with Stroke Units. However, the Andalusian Stroke Health Care Plan includes, within the list of services of the Stroke Team, the need to have a neurologist present for the performing of thrombolysis in local hospitals. The objective of this study is to evaluate whether emergency doctors are able to achieve a reliable diagnosis of stroke in order to safely perform thrombolysis.

Methods

The diagnoses on hospital admission and discharge of all patients admitted for neurological reasons in 2006 in the community Hospital Infanta Elena (Huelva, Andalusia) were collected. The reliability of diagnosis performed by emergency doctors was analysed.

Results

A total of 655 patients were admitted to the hospital for neurological reasons, and 76% of them were diagnosed as strokes. The sensitivity of stroke diagnosis made by emergency doctors was very high (97%), but specificity and positive predictive value of that diagnosis was low (52% and 75%, respectively).

Conclusions

To apply thrombolysis based of the diagnosis of a stroke by emergency doctors may subject a significant number of erroneously diagnosed patients to an unnecessary risk of brain haemorrhage. This risk makes performing thrombolysis in community hospitals ethically questionable in these circumstances. Although it is important to have thrombolytic treatment available to everyone, this treatment must be performed safely by neurologists Stroke Units.     

Clasificación etiológica del ictus isquémico: comparación entre la nueva clasificación A-S-C-O y la clasificación del Grupo de Estudio de Enfermedades Cerebrovasculares de la Sociedad Española de Neurología

Introduction

The A-S-C-O classification may be better than other methods for classifying ischaemic stroke by aetiology. Our aims are to describe A-S-C-O phenotype distribution (A: atherosclerosis, S: small vessel disease, C: cardiac source, O: other causes; 1: potential cause, 2: causality uncertain, 3: unlikely to be a direct cause although disease is present) and compare them to the Spanish Society of Neurology‘s Cerebrovascular Disease Study Group (GEECV/SEN) classification. We will also find the degree of concordance between these classification methods and determine whether using the A-S-C-O classification delivers a smaller percentage of strokes of undetermined cause.

Methods

We analysed those patients with ischaemic stroke admitted to our stroke unit in 2010 with strokes that were classified according to GEECV/SEN and A-S-C-O criteria.

Results

The study included 496 patients. The percentages of strokes caused by atherosclerosis and small vessel disease according to GEECV/SEN criteria were higher than the percentages for potential atherosclerotic stroke (A1) (14.1 vs. 11.9%; P=.16) and potential small vessel stroke (S1) (14.3 vs. 3%; P<.001). Cardioembolic stroke (C1) was more frequent (22.2 vs. 31%; P<.001). No differences between unusual cause of stroke and other potential causes (O1) were observed. Some degree of atherosclerosis was present in 53.5% of patients (A1, A2, or A3); 65.5% showed markers of small vessel disease (S1, S2, or S3), and 74.9% showed signs of cardioembolism (C1, C2, or C3). Fewer patients in the group without scores of 1 or 2 for any of the A-S-C-O phenotypes were identified as having a stroke of undetermined cause (46.6 vs. 29.2%; P<.001).The agreement between the 2 classifications ranged from κ<0.2 (small vessel and S1) to κ>0.8 (unusual causes and O1).

Conclusion

Our results show that GEECV/SEN and A-S-C-O classifications are neither fully comparable nor consistent. Using the A-S-C-O classification provided additional information on co-morbidities and delivered a smaller percentage of strokes classified as having an undetermined cause.     

Capacidad de conducción tras un ictus: evaluación y recuperación

Introduction

The ability to drive after a stroke has been recognised by many authors as a sign of independence and it is closely associated with proper social reintegration. However, it remains unclear how the driving ability of an individual who has suffered a stroke should be evaluated, and by whom. Neurorehabilitation can produce improvements in patients who have suffered a stroke, and patients may therefore be able to resume driving at the end of an appropriate neurorehabilitation programme.The aim of this article is to present a literature review in order to highlight current evidence regarding methods for assessing driving ability and therapeutic methods applied in order to recover a patient's ability to drive.

Development

A literature search was performed in different databases for the period between 1993 and 2011. Studies were analysed individually based on methods for assessing driving ability and neurorehabilitation measures.

Conclusions

If there are any doubts regarding stroke patients’ ability to drive, patients should be assessed appropriately. The proper way to assess these patients according to the literature is by employing a multidisciplinary evaluation to determine who is able to take a road test. Neurorehabilitation exercises currently in use may be able to improve driving ability in stroke patients.     

Los ictus y su relación con el sueño y los trastornos del sueño

Introduction

In the current population, strokes are one of the most important causes of morbidity and mortality, to which new risk factors are increasingly being attributed. Of late, there is increased interest in the relationship between sleep disorders and strokes as regards risk and prognosis.

Development

This article presents the changes in sleep architecture and brain activity in stroke patients, as well as the interaction between stroke and sleep disorders, including those which may also influence the outcome and recovery from strokes. The different treatments discussed in the literature are also reviewed, as correct treatment of such sleep disorders may not only improve quality of life and reduce after-effects, but can also increase life expectancy.

Conclusions

Sleep disorders are becoming increasingly associated with stroke. In addition to being a risk factor, they can also interfere in the outcome and recovery of stroke patients.This article aims to present an exhaustive and current review on strokes and their relationship with sleep alterations and sleep disorders.     

The prognostic impact of the stroke unit concept after transient ischemic attack

Background and purpose

Transient ischemic attack (TIA) is associated with high short-term risk of stroke, especially in the early phase following the event. Data about the impact of the early hospitalization in a stroke unit on patients with TIA are sparse. This study compares the prognostic impact of the stroke unit concept with conventional care on patients with TIA.

Methods

During a 30-month period (beginning April 2005), 878 patients (mean age, 70 ± 12 years; 44.3% female) with TIA admitted within 24 h of symptom onset were prospectively evaluated. The adjusted logistic regression analyses were used to estimate the odds ratio for the stroke risk during hospitalization and the 90-day mortality.

Results

Of 878 patients, 591 (67.3%) were treated in the stroke unit, and 287 (32.7%) underwent conventional care. Patients receiving stroke-unit care had significantly higher rates of cranial computed tomography (96.3% vs. 88.1%; P < .001) and brain-supplying artery ultrasound (97.1% vs. 91.3%; P < .001) investigations. The stroke risk during hospitalization was 1.7% in patients treated in stroke unit and 2.4% in patients received a conventional care. A relevant difference between the groups was not found (1.7% vs. 2.4%; P = .45). The 90-day mortality rate was 1.7% in the stroke unit group compared to 2.2% in the conventional care group (1.7% vs. 2.2%; P = .66). The adjusted logistic regression analyses revealed no difference in stroke rates (odds ratio, 0.68; 95% confidence interval, 0.24–1.9) and in the 90-day mortality (odds ratio, 0.63; 95% confidence interval, 0.2–1.96) between the stroke unit concept and conventional care.

Conclusion

The prognostic impact of the stroke unit care for patients with transient ischemic attack appears to be similar to that of the conventional care. Further randomized studies are needed to investigate the impact of stroke-unit care on patients with transient ischemic attack.     

Repercusión de la introducción de neurología en un hospital comarcal de Andalucía

Introduction

The stroke mortality rate in Andalusia is twice that of other autonomous communities. This could be associated with the absence of neurologists in most local hospitals in this community, unlike in the rest of Spain. The objective of this study was to evaluate the impact of incorporating a neurologist to evaluate and monitor stroke patients in a local hospital in Andalusia.

Methods

An observational study was conducted on stroke cases admitted in the first quarter of 2006. Quality indicators, mortality rates, and incapacity rates at follow-up were analysed, comparing groups with and without neurological care.

Results

A total of 116 stroke patients were admitted. There were significant differences in tests performed to diagnose patients (Doppler and echocardiography). The mean hospital stay was significantly lower with neurology care. There was a 39.1% absolute decrease in mortality and a 35.7% absolute increase in capacity for daily life activities was also observed. Neurological care and a lower incapacity level at admission were the only two factors independently associated with a decrease in length of hospital stay and mortality

Conclusion

Specialised care by a neurologist is effective in reducing length of hospital stay, mortality and incapacity. The incorporation of neurologists in local hospitals in Andalusia should be a priority to guarantee equal care in all autonomous communities in Spain. This objective should be included in the Plan Andaluz de Atención al Ictus as a first step in forming a network of stroke units and teams.     

CT perfusion-guided versus time-guided mechanical recanalization in acute ischemic stroke patients

Objective

Perfusion studies are increasingly used to triage acute stroke patients for endovascular recanalization therapies. We compare the safety and efficacy of CT perfusion (CTP)-guided to time-guided mechanical recanalization in acute ischemic stroke (AIS) patients.

Methods

A review was conducted on 132 patients, 94 undergoing CTP-guided and 38 undergoing time-guided (maximum 8 h from symptom onset) mechanical recanalization at our institution.

Results

The rate of partial-to-complete recanalization did not differ between the CTP and the non-CTP group (78.7% vs. 81.6%, respectively, p = 0.71). ICH occurred respectively in 18.1% in the CTP group versus 31.6% in the non-CTP group (p = 0.06). The overall in-hospital mortality rate was significantly lower in the CTP group (15.9% vs. 36.8%, p = 0.04). In multivariable analysis, CTP-guided patient selection was an independent negative predictor of in-hospital mortality (OR = 3.2; p = 0.01). CTP-guided patient selection, however, was not a predictor of favorable outcome (Modified Rankin Scale 0–2 or 0–3).

Conclusions

CTP-based patient selection was associated with lower ICH and mortality rates. Favorable outcomes, however, did not differ between the 2 groups. These results may suggest a possible benefit in terms of in-hospital mortality with CTP-guided triage of AIS patients for endovascular treatment.     

Oclusión arterial de gran vaso diagnosticada por angiografía por tomografía computarizada en el ictus isquémico agudo: frecuencia,factores predictores y seguridad

Introduction

Demonstrating artery occlusion in ischaemic stroke has gained importance due to the increasing availability of endovascular therapies. This study evaluates the frequency of artery occlusion, its associated factors, and complications following the use of CT-angiography in acute stroke.

Methods

We retrospectively analysed a cohort of patients who suffered acute ischaemic stroke between July and-December 2011.

Results

We included 157 patients (mean age, 74 ± 11; mean NIHSS score, 5 [2-13]). Of that total, 56.7% of the patients were admitted to hospital during the first 8 hours. CT-angiography was performed in 71 cases (45.2%); arterial large-vessel occlusion was detected in 37 (52.1%) of these cases, and the most frequent site was M1 (40%). Univariate analysis showed that the NIHSS score (17 vs 7, P < .001) and atrial fibrillation (64% vs 32%, P = .006) were associated with artery occlusion. A logistic regression analysis was performed subsequently, confirming these associations. There were no cases of contrast-induced nephropathy. Door-to-needle time for intravenous thrombolysis was 61.2 ± 24.5 minutes in patients who underwent CT-angiography, and 53.5 ± 34.3 minutes in those who did not (P = .495).

Conclusions

Arterial occlusions are seen in 23.6% of patients, especially in those who are admitted during the first few hours. NIHSS score serves as a useful predictive factor.     

Manifestaciones neurológicas de los mixomas cardiacos. Experiencia en un centro de referencia

Introduction

Cardiac myxoma is an important but uncommon cause of stroke in younger patients. Few published case series analyse the frequency and clinical presentation of neurological complications in patients with myxoma.

Objective

To list all neurological complications from cardiac myxoma recorded in our hospital in the past 28 years.

Patients and methods

We retrospectively reviewed the neurological manifestations of cardiac myxoma in patients treated in our hospital between December 1983 and March 2012.

Results

Of the 36 patients with cardiac myxoma, 8 (22%) presented neurological manifestations. Half were women and mean age of patients was 52.4 ± 11.6 years. Sudden-onset hemiparesis was the most frequent neurological symptom (63%). Established ischaemic stroke was the most common clinical manifestation (75%), followed by transient ischemic attack. The most commonly affected territory corresponded to the middle cerebral artery. Myxoma was diagnosed by echocardiography in all cases. Mean myxoma size was 4.1 cm and most of the tumours (63%) had a polypoid surface. All tumours were successfully removed by surgery. There were no in-hospital deaths.

Conclusions

Cardiac myxomas frequently present with neurological symptoms, especially ischaemic events (established stroke or transient ischaemic attack), in younger patients with no cardiovascular risk factors. The anterior circulation is more frequently affected, especially the middle cerebral artery. Echocardiography can facilitate prompt diagnosis and early treatment of the lesion.     

Intravenous rt-PA in patients with ischaemic stroke and renal dysfunction

Objective

Renal dysfunction (RD) increases risk for ischaemic stroke (IS). The impact of RD on the effects of iv-thrombolysis in the Caucasian population has not been fully determined.

Aims

To evaluate the associations between RD and the outcome of iv-thrombolysis in Caucasian patients with IS.

Methods

The observational, multicentre study included 404 patients with IS who were treated with iv-thrombolysis. RD was defined as estimated glomerular filtration rate ≤60 ml/min/1.73 m². Outcome was assessed with modified Rankin Score at 3 months after the stroke onset.

Results

Medians baseline NIHSS score did not differ between groups of patients with and without RD (12.0 vs. 11.0 pts, p = 0.33). Unfavourable outcome was found in 52.1% of patients with and in 41.2% of patients without RD (p = 0.05), mortality was higher in patients with RD (29.9% vs. 14.3%, p < 0.001), and the presence of haemorrhagic transformation (HT) did not differ between the groups (17.1% vs. 17.1% respectively, p = 0.996). A multivariate analysis showed no impact of RD on the unfavourable outcome (OR 0.98; 95%CI 0.88–1.10), mortality (OR 0.92; 95%CI 0.81–1.05) or presence of HT (OR 1.03; 95%CI 0.90–1.18).

Conclusions

We found no impact of RD on the safety and efficacy of iv-thrombolysis in Caucasian patients with IS.     

Manejo terapéutico con rivastigmina en pacientes con enfermedad de Alzheimer de leve a moderadamente grave en condiciones de práctica clínica habitual. Estudio ENTERPRISE

Introduction

Alzheimer disease (AD) causes progressive cognitive decline leading to loss of independence for activities of daily living; rivastigmine is one of the drugs used for symptomatic management.

Objective

To assess the therapeutic use of different pharmaceutical forms of rivastigmine in patients with AD in normal clinical practice.

Patients and methods

Cross-sectional, observational, multi-centre study conducted on patients with mild to moderate AD treated with rivastigmine in Spanish outpatient clinics specialising in Geriatrics, Psychiatry, and Neurology. Data regarding use of oral (OR) and transdermal (TDR) rivastigmine, compliance (degree of adherence), and caregiver satisfaction with treatment were evaluated.

Results

In total, 2252 patients with a mean age of 77.2 years were included; 60.2% were women. AD was moderate to moderately severe in 58.4%. Rivastigmine treatment was started orally in 54.4% of the patients and transdermally in 45.6%; 35.6% of those who started treatment by the OR route switched to TDR. A single dose adjustment was sufficient for 77.5% of patients on TDR treatment vs 11.8% of patients receiving OR treatment. More patients on TDR treatment (80.8% vs. 57.1% on OR treatment) reached the maximum therapeutic dose of rivastigmine and did so in a shorter period of time (51.6 vs 205.8 days). Compliance rates (60.5% vs 47.2%) and caregivers’ satisfaction with treatment (89.4% vs 81.9%) were also higher for TDR.

Conclusions

In normal clinical practice, using the TDR route of administration improves dose titration and drug compliance, allowing more patients to reach the maximum recommended dose of rivastigmine in a shorter time period.     

Outcome of Chlamydia pneumoniae associated acute ischemic stroke in elderly patients: a case-control study

Background

Limited data exists about the role of Chlamydia pneumoniae elderly patients with acute ischemic stroke.

Objective

To study the role of C. pneumoniae in elderly patients (age more than 65 years) with acute ischemic stroke and its impact on stroke out come.

Methods

We recruited 100 elderly patients with acute ischemic stroke and 100 age and sex matched controls over a period of 2 years. IgG and IgA anti C. pneumoniae antibodies were measured by microimmunofluorescence technique in patients and controls. Good outcome was defined as a Modified Rankin score (mRS) of ≤2.

Results

We found C. pneumoniae antibodies in 35% stroke patients and in 18% control subjects (p = 0.01). Good out come at 90 days follow up was found in 20/35(57.1%) seropositive stroke patients compared to 37/65(56.9%) seronegative stroke patients (p = 0.9).

Conclusions

C. pneumoniae antibody positivity was independently associated with ischemic stroke in elderly patients and its presence does not alter the stroke outcome.     

Labor asistencial del equipo de guardia de neurología en un hospital terciario de Madrid: análisis prospectivo durante un año

Introduction

Population ageing, the rising demand for healthcare, and the establishment of acute stroke treatment programs have given rise to increases in the number and complexity of neurological emergency cases. Nevertheless, many centres in Spain still lack on-call emergency neurologists.

Methods

We conducted a retrospective study to describe the role of on-call neurologists at Hospital General Universitario Gregorio Marañón, a tertiary care centre in Madrid, Spain. Sociodemographic characteristics, most common pathologies, diagnostic tests, and destination of the patients attended were recorded daily using a computer database. Results were compared with the general care data from the emergency department.

Results

The team attended 3234 patients (3.48% of the emergency department total). The mean number of patients seen per day was 11.15. The most frequent pathologies were stroke (34%), epilepsy (16%) and headache (8%). The mean stay in the emergency department was 7.17 hours. Hospital admission rate was 40% (7.38% of emergency hospital admissions). The main destinations for admitted patients were the stroke unit (39.5%) and the neurology department (33%). Endovascular or thrombolytic therapies were performed on 76 occasions. Doctors attended 70% of the patients during on-call hours.

Conclusions

Emergency neurological care is varied, complex, and frequently necessary. Neurological cases account for a sizeable percentage of both patient visits to the emergency room and the total number of emergency admissions. The current data confirm that on-call neurologists available on a 24-hour basis are needed in emergency departments.     

Prehospital transfer medicalization increases thrombolysis rate in acute ischemic stroke. A French stroke unit experience

Objectives

Narrow therapeutic window is a major cause of thrombolysis exclusion in acute ischemic stroke. Whether prehospital medicalization increases t-PA treatment rate is investigated in the present study.

Patients and methods

Intrahospital processing times and t-PA treatment were analyzed in stroke patients calling within 6 h and admitted in our stoke unit. Patients transferred by our mobile medical team (SAMU) and by Fire Department (FD) paramedics were compared.

Results

193 (61.6%) SAMU patients and 120 (38.4%) FD patients were included within 30 months. Clinical characteristics and onset-to-call intervals were similar in the two groups. Mean door-to-imaging delay was deeply reduced in the SAMU group (52 vs. 159 min, p < 0.0001) and was <25 min in 50% of SAMU patients and 14% of FD patients (p < 0.0001). SAMU management was the only independent factor of early imaging (p = 0.0006). t-PA administration rate was higher in SAMU group than in FD group (42% vs. 28%, p = 0.04). Proportion of patients with delayed therapeutic window was higher in FD group than in SAMU group (38% vs. 26%, p < 0.0001).

Conclusion

Prehospital transfer medicalization promotes emergency room bypass, direct radiology room admission and high thrombolysis rate in acute ischemic stroke.     

Insertion sociale et professionnelle des jeunes adultes IMC. Intérêt de facteurs prédictifs dès l’enfance pour ajuster leur projet de vie

Introduction

The aim of this study was to compare the real vocational and social outcome of a young adult CP population that was treated for 2 years at the Kerpape rehabilitation unit, with a retrospective insertion prognosis, taken from the analysis of their clinic record.

Material and method

Investigators first evaluated functional independence, social autonomy, years of education, and vocational status through a phone survey. A second group of investigators (independent from the first one), studied the medical clinic record assessment in order to determine the clinical type of cerebral palsy (CP). The prediction was based on their clinical judgment, using information about the diagnosis, type of involvement, functional status. Out of 120 selected patients, 43 were eventually included in this study.

Results

Type of CP: 36; 4% quadriplegia; 24.2, diplegia, 9.1% hemiplegia, 30.3% dyskinesia. Walking ability: 45.5 walking, 54.5% wheelchair. Complete independence: 36.4% for personal care, 18.2% for domestic life. Vocational assessment: 6.1% competitive employment, 6.1% sheltered, 78.8% unemployed, 3% studying. Social autonomy and vocational prediction was right in 72.7% of the cases.

Discussion

The Intellectual Quotient is the most reliable predictive factor for social and vocational outcomes. On the other hand, the functional independence and walking ability are less predictive for social autonomy prediction. Thus, a greater number of CP adults who are dependent in their everyday life could reach social autonomy. A shortfall in social ability darkens social insertion prognostic, and reduces their quality of life. For CP children, it should be useful to develop specific programs to improve their social ability, in addition to motor rehabilitation, and specific education.     

Atrial fibrillation predicts good functional outcome following intravenous tissue plasminogen activator in patients with severe stroke

Objective

Atrial fibrillation (AF) is associated with poor outcome after intravenous thrombolysis probably due to greater pretreatment stroke severity. We conducted this retrospective study to determine whether AF is an independent predictor for clinical outcome in patients stratified by initial stroke severity.

Methods

A total of 143 acute ischemic stroke patients who received intravenous thrombolysis within 3 h after onset were enrolled. The patients were categorized according to the baseline stroke severity by National Institute of Health Stroke Scale (NIHSS) score (≤10 vs. >10) and the presence of AF or not. Favorable 90-day outcome was defined as a modified Rankin Scale (mRS) score < 2.

Results

Among the 100 patients with severe stroke (NIHSS > 10), those with AF (n = 52) had a higher proportion of favorable 90-day outcome than those without AF (31% vs. 8%, P = 0.005). After adjustment for age, baseline glucose level, and onset to treatment time, the difference remained significant (odds ratio 5.80, 95% confidence interval 1.63–20.68). In patients with mild stroke (NIHSS ≤ 10), no difference in clinical outcome was found between AF (n = 20) and non-AF (n = 23) groups.

Conclusion

Presence of AF was associated with favorable 90-day outcome following intravenous thrombolysis in patients with severe stroke at baseline, while the association did not exist in patients with mild stroke.     

Cefaleas en la persona mayor: características de una serie de 262 pacientes

Introduction

Although headache prevalence decreases in patients older than 65, headaches are a common complaint and their different clinical and therapeutic features must be understood. This article analyses the clinical characteristics of elderly patients treated in an outpatient headache unit.

Methods

We collected demographic and clinical data from patients treated in a tertiary hospital headache unit between January 2008 and May 2013. Headaches were codified according to the International Classification of Headache Disorders, 2nd edition (ICHD-2).

Results

Of a total of 1868 patients treated, 262 patients (14%, 189 women and 73 men) were older than 65 years. Ninety-nine (68 women, 31 men, 5.3% of the total) were over 75. Headaches began after the age of 65 in only 136 patients (51.9%). The 362 headaches were codified as follows: 23.8% as Group 1 (Migraine) and 28.7% as Group 2 (Tension-type headache). We diagnosed 58 (16%) secondary headaches; 26 (7.2%) were classified as Group 13 (Cranial neuralgias) and 23 (6.4%) in Group 14 (Other headaches). Symptomatic medication overuse was detected in 38 patients (14.5%). We also identified headaches considered typical in the elderly, including chronic migraine (41 cases), hypnic headache (6), occipital neuralgia (4), SUNCT (2), cervicogenic headache (1), primary cough headache (1), and giant cell arteritis (2).

Conclusions

Elderly patients were frequently treated in our outpatient headache unit. Tension-type headache was the most common diagnosis in this population. Geriatric headache syndromes such as hypnic headache or occipital neuralgia were also represented in our series.     

Revascularización carotídea con stent: implicaciones clínicas y para el procedimiento de la presencia de una lesión suboclusiva

Introduction and objectives

The advisability of implanting a stent in carotid near-occlusion stenosis is a controversial topic. We have assessed procedural and clinical implications of stent implantation for carotid artery disease with near occlusion.

Methods

We included 205 patients who underwent carotid artery revascularisation with a stent. The group of patients with near-occlusion stenosis (n=54)was compared to the rest of the population (n=151).

Results

No differences were found between groups for age, sex, and the percentage of symptomatic patients (three-quarters of the population). Carotid stent revascularisation for near-occlusion stenosis presented a high procedural success rate (96%) similar to that of revascularisation processes for other lesions (98%). Stenting in cases of near-occlusion stenosis required increased use of proximal protection (54% vs. 20.5%, P<.001) and predilation (33% vs. 17%, P=.01). The process to repair near-occlusion stenosis cause increased detachment of plaque, as shown by higher percentages of macroscopic plaque captured by protection devices (18.5% vs. 7%, P=.01) and of perioperative ischaemic brain lesions (47% vs 31%, P = .07). At 30 days of follow-up, the tendency toward adverse neurological events (death, major and minor stroke) was higher in the near-occlusion group (9.2% vs. 3.2%, P=.08).

Conclusions

Stent revascularisation for near-occlusion carotid stenosis has a high procedural success rate; however, its higher plaque load was responsible for the increased rate of ischaemic brain lesions and adverse neurovascular events at 30 days post-procedure.     

Los costes del ictus en España según su etiología. El protocolo del estudio CONOCES

Introduction

Patients with stroke associated with non-valvular atrial fibrillation (NVAF) are a specific group, and their disease has a considerable social and economic impact. The primary objective of the CONOCES study, the protocol of which is presented here, is to compare the costs of stroke in NVAF patients to those of patients without NVAF in Spanish stroke units from a societal perspective.

Materials and methods

CONOCES is an epidemiological, observational, naturalistic, prospective, multicentre study of the cost of the illness in a sample of patients who have suffered a stroke and were admitted to a Spanish stroke unit. During a 12-month follow-up period, we record sociodemographic and clinical variables, score on the NIH stroke scale, level of disability, degree of functional dependency according to the modified Rankin scale, and use of healthcare resources (hospitalisation at the time of the first episode, readmissions, outpatient rehabilitation, orthotic and/or prosthetic material, medication for secondary prevention, medical check-ups, nursing care and formal social care services). Estimated monthly income, lost work productivity and health-related quality of life measured with the generic EQ-5D questionnaire are also recorded. We also administer a direct interview to the caregiver to determine loss of productivity, informal care, and caregiver burden.

Results and conclusions

The CONOCES study will provide more in-depth information about the economic and clinical impact of stroke according to whether or not it is associated with NVAF.