Browsing by Author "Echeverria, Daniel"
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Item Breaking the breach in Latin America: A pilot study of mechanical thrombectomy in the public healthcare system in Chile(2021) Rivera, Rodrigo; Amudio, Cristian; Brunetti, Enzo; Catalan, Pascual; Sordo, Juan Gabriel; Badilla, Lautaro; Echeverria, Daniel; Cruz, Juan Pablo; Ojeda, Hector; Bravo, Loreto; Bravo, Fabian; González, Walter; Orellana, Maria Luisa; Pinto, Camila; Merino, Catalina; Oportus, Monica; Salazar, AlejandroBackground: Mechanical Thrombectomy (MT) is the standard of care for treatment of large vessel occlusion stroke. Until the beginning of 2020 MT was not funded nor widely implemented at the public healthcare level in Chile. Objective: To describe the results of a pilot program created to provide access to public MT in Santiago - Chile. Methods: Analysis from a prospectively collected database of MT cases performed between September 2017 and September 2019 in one center. A stroke network was developed with a single MT capable stroke center and five primary stroke centers. The primary efficacy endpoint was the rate of functional independence (mRS 0-2) at 90 days. Successful reperfusion was defined as 2 b-3 according to the thrombolysis in cerebral infarction scale. Safety outcomes include the rates of symptomatic intracranial hemorrhage and 90-day mortality. Results: A total of 100 patients were treated over the study period. Their mean age was 62.8 11.8 years and median baseline National Institute of Health Stroke Scale (NIHSS) measurement was 17. Seventy-seven percent of the patients received intra venous thrombolysis. Successful reperfusion was achieved in 95% of the cases. NIHSS at 24 hours showed a median drop of 7 points from baseline (p < 0.00001) and 50% of the follow-up patients were functionally independent at 90 days. Symptomatic Intracerebral hemorrhage occurred in 5% of the patients and 90-day all case mortality was 11%. Conclusions: We demonstrated the feasibility of a publicly funded MT program in Chile, with similar results as other international randomized control trials.Item Quantitative evaluation of arteriovenous malformation hemodynamic changes after endovascular treatment using parametric color coding: A case series study.(Sage Publications, 2017) Rivera, Rodrigo; Sordo, Juan; Echeverria, Daniel; Badilla, Lautaro; Pinto, Camila; Merino, CatalinaBackground Brain arteriovenous malformations (AVMs) are complex vascular lesions. Endovascular treatment results are usually measured by calculating the volume reduction of the lesions. Nevertheless, vascular flow quantification seems a more physiologically accurate way of measuring endovascular results. We evaluated the use of parametric color coding (PCC) with digital subtraction angiography (DSA), in order to determine the feasibility of PCC to detect and measure the impact of AVM endovascular treatment-induced changes using real-time hemodynamic parameters. Methods and results Supratentorial brain AVM treatment was evaluated in 29 patients over the course of 38 sessions. Using regions of interest (ROIs) at the carotid siphon, arterial feeder, drainage vein and venous sinus, we found significant increase in time to peak (TTP) values at the arterial feeder, drainage vein and venous sinus. We compared TTP in four different embolization volume groups: I (0-25%), II (26-50%), III (51-75%) and IV (76-100%). We found significant differences between groups and a moderate correlation between embolization percentages, as well as an increase in TTP at the main vein ROI; but not in the arterial side or sinus. Conclusions Brain AVM endovascular treatment results can be quantified in vivo with PCC. PCC is capable of detecting hemodynamic changes after brain AVM endovascular treatment, that may reflect flow drop, and it is correlated with volume embolization.