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Browsing by Author "Mazzon, Enrico"

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A Chilean Experience of Telestroke in a COVID-19 Pandemic Year
(2022) Delfino, Carlos; Mazzon, Enrico; Cavada, Gabriel; Muñoz Venturelli, Paula; Brunser, Alejandro; Jurado, Felipe; Lara, Lorena; Rocha, Diego; Arévalo, Mirya; Rojas, Diego; Mansilla, Eloy
Background and purpose: Telemedicine for stroke patients' care (telestroke [TS]) has grown notably in recent decades and may offer advantages during health crisis. Hospital admissions related to stroke have decreased globally during the COVID-19 pandemic, but scarce information is available regarding the effect of COVID-19 in TS. Using a population-based TS registry, we investigated the impact of the first year of the COVID-19 pandemic throughout our TS network in Santiago, Chile. Methods: Stroke codes evaluated after the onset of COVID-19 restrictions in Chile (defined as March 15, 2020) were compared with those evaluated in 2019. We analyzed differences between number of stroke codes, thrombolysis rate, stroke severity, and time from the stroke onset to hospital admission. Results: We observed that the number of stroke codes and the number of patients undergoing reperfusion therapy did not change significantly (p = 0.669 and 0.415, respectively). No differences were found with respect to the median time from the stroke onset to admission (p = 0.581) or in National Institutes of Health Stroke Scale (NIHSS) scores (p = 0.055). The decision-making-to-needle time was significantly shorter in the COVID-19 period (median 5 min [IQR 3-8], p < 0.016), but no significant changes were found at the other times. Conclusions: This study demonstrates the potential of adapting TS to extreme situations such as the COVID-19 pandemic, as well as the importance of establishing networks that facilitate patient access to quality treatments.
Association between spontaneous internal carotid artery dissection and perivascular adipose tissue attenuation on computed tomography angiography
(2023) Cheng, Kevin; Lin, Andrew; Stecher, Ximena; Bernstein, Tomas; Zuñiga, Paulo; Mazzon, Enrico; Brunse, Alejandro; Diaz, Violeta; Martinez, Gonzalo; Cameron, William; Nicholls, Stephen; Patel, Sanjay; Dey, Damini; Wong, Dennis; Muñoz Venturelli, Paula
Background: Spontaneous cervical artery dissection (sCAD) is a leading cause of ischemic stroke in young patients. Studies using high-resolution magnetic resonance imaging and positron emission tomography have suggested vessel wall inflammation to be a pathogenic factor in sCAD. Computed tomography (CT) attenuation of perivascular adipose tissue (PVAT) is an established non-invasive imaging biomarker of inflammation in coronary arteries, with higher attenuation values reflecting a greater degree of vascular inflammation. Objectives: We evaluate the CT attenuation of PVAT surrounding the internal carotid artery (PVATcarotid) with and without spontaneous dissection. Methods: Single-centre prospective observational study of 56 consecutive patients with CT-verified spontaneous dissection of the internal carotid artery (ICA) admitted between 2011 and 2018. Of these patients, 6 underwent follow-up CTA. 22 patients who underwent CTA for acute neurological symptoms but did not have dissection formed the control group. Using semiautomated research software, PVATcarotid was measured as the mean Hounsfield Unit (HU) attenuation of adipose tissue within a defined volume of interest surrounding the ICA. Results: PVATcarotid was significantly higher around dissected ICA compared with non-dissected contralateral ICA in the same patients (-58.7±10.2 vs. -68.9±8.1 HU, P<0.0001) and ICA of patients without dissection (-58.7±10.2 vs. -69.3±9.3 HU, P<0.0001). After a median follow-up of 89 days, there was a significant reduction in PVATcarotid around dissected ICA (from -57.5±13.4 to -74.3±10.5 HU, P<0.05); while no change was observed around non-dissected contralateral ICA (from -71.0±4.4 to -74.1±4.1 HU, P=0.19). ICA dissection was an independent predictor of PVATcarotid following multivariable adjustment for age and the presence of ICA occlusion.
Breaking Down Barriers: Easter Island's First Telestroke Thrombolysis Experience and Case Report
(2022) Mazzon, Enrico; Arévalo, Mirya; Mirelis, Samuel; Delfino, Carlos; Rojas, Diego; Lara, Luis; Cárcamo, Daniel; Jurado, Felipe; Rocha, Diego; Muñoz, Paula; Mansilla, Eloy
Easter Island (Rapa Nui), Chile, is remote, located in the Polynesian Triangle in Oceania. The closest continental point is Chile, 3,512 km east. It has a population of 7,750 inhabitants, who are Chilean citizens, and receives more than 60,000 tourists a year. For this entire population, there is a medium complexity hospital without a neurology specialist. In 2019, local professionals were trained in a Telestroke program with remote clinical support conducted by neurologists located on mainland Chile. We present a 50-year-old native male, with unknown medical history, who suddenly presented right-half-body weakness and aphasia. He was evaluated via Telestroke consultation, and thrombolysis with tenecteplase was indicated. The patient improved rapidly and 45 min later the NIHSS score was 0 points. To our knowledge, this is the first reported case of Telestroke treatment in such a remote area, highlighting the importance of telemedicine to overcome geographical and technological stroke care barriers and to improve patients' outcome, no matter where they live.
Cervical artery dissection in postpartum women after cesarean and vaginal delivery
(2022) Urrutia, Francisca; Mazzon, Enrico; Brunser, Alejandro; Díaz, Violeta; Calderon, Juan; Stecher, Ximena; Bernstein, Tomas; Zuñiga, Paulo; Schilling, Andrea; Muñoz, Paula
Background and aims: Cervical artery dissection (CAD) is an infrequent but potentially disabling and fatal disease, accounting for up to 25 % of strokes in young adults. Pregnancy-related hormonal changes and increased hemodynamic stress on artery walls during vaginal delivery have been associated to CAD. We aim to describe a series of women presenting CAD during postpartum (PP) after cesarean and vaginal delivery. Methods: CAD women admitted to one hospital in Santiago, Chile, between July 2018 and October 2020 were included in a prospective cohort. Demographic, clinical and imaging data were registered for the PP group. Results: Sixty-seven women were diagnosed with CAD, from which 10 were PP. Seven women had cesarean section and 3 had vaginal delivery. They presented CAD related symptoms after a median of 10.5 (IQR 5-15) days from delivery. All of them had headache as initial symptom, 9 presented cervical pain and 8 had a family history of stroke. Four patients presented preeclampsia during pregnancy. Acute treatment consisted mostly in antiplatelet agents and analgesics. None of these patients had a CAD related stroke. Demographic, clinical and imaging characteristics of these women with CAD during PP are described. Conclusions: This case series underpins the importance of clinical suspicion of CAD after delivery, highlighting the fact that CAD is not limited to women with vaginal delivery, thus alternative causes beyond acute hemodynamic stress could be involved. Further research is required to determine genetic components, along with deeper knowledge of modulating factors related to CAD in this setting.
Cervical Artery Dissections with and without stroke, risk factors and prognosis: a Chilean prospective cohort
(2020) Mazzon, Enrico; Rocha, D.; Brunser, Alejandro; Barra, C. de la; Stecher, Ximena; Bernstein, T.; Zúñiga, P.; Díaz, V.; Martínez, G.; Muñoz Venturelli, Paula
We aimed to characterize spontaneous cervical artery dissection (CeAD) patients with and without stroke and describe risk factors for cerebrovascular complications in a Chilean prospective cohort. Methods: Consecutive CeAD patients admitted to a Chilean center confirmed by neuroimaging. Logistic regression was used. Results: 168 patients were included, median follow-up time was 157 days. Stroke occurred in 49 (29.2%) cases, 4 (2%) patients died, all of whom had a stroke, and 10 (6%) presented CeAD recurrence. In univariate analyses, men (odds ratio [OR] 3.97, 95% confidence interval [CI] 1.97-8.00, P < 0.001), internal carotid artery CeAD (OR 2.82, 95% CI 1.38-5.78, P = 0.005) and vessel occlusion (OR 4.45, 95% CI 1.38-14.38, P = 0.035) increased stroke risk. Conversely, vertebral artery dissection (OR 0.35, 95% CI 0.16-0.74, P = 0.006) and longer symptom onset to admission (O-A) time (OR 0.79, 95% CI 0.70-0.90, P < 0.001) were associated to decreased stroke risk. After multivariate analysis, men (OR 2.88, 95% CI 1.32-6.27, P = 0.008) and O-A time (OR 0.80, 95% CI 0.69-0.92, P = 0.002) remained independently associated with stroke. Conclusion: CeAD presented commonly as a non-stroke entity, with favorable prognosis. Albeit to a higher frequency of CeAD in women, stroke occurred predominantly in men, who were admitted earlier.
Determinantes del tiempo puerta-aguja en trombolisis endovenosa en el infarto cerebral, experiencia de un centro
(2020) Brunser, Alejandro; Mazzon, Enrico; Muñoz, Paula; Hoppe, Arnold; Lavados, Pablo; Rojo, Alexis; Navia, Víctor; Cavada, Gabriel; Olavarría, Verónica; Mansilla, Eloy
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. Material and Methods: Prospective analysis of patients treated with IT at a private hospital between June 2016 and June 2019. The percentage of patients with DNT exceeding 60 min, and the causes for this delay were evaluated. Results: IT was used in 205 patients. DNT was 43.6 ± 23.8 min. Forty patients (19.5% (95% CI, 14.4-25.7), had a DNT longer than 60 min. Uni-varied analysis demonstrated that AIS with infratentorial symptomatology (ITS), was significantly associated with DNTs exceeding 60 min. A history of hypertension, a higher NIH Stroke Scale score, the presence of an hyperdense sign in brain tomography (p = 0.001) and the need for endovascular therapy (p = 0.019), were associated with DNT shorter than 60 min. Multivariate analysis ratified the relationship between ITS and DNT longer than 60 min (Odds ratio: 3.19, 95% confidence intervals 1.26-8). Conclusions: The individual elements that correlated with a DNT longer than 60 min were the failure to detect the AIS during triage and doubts about its diagnosis
Diffusion-weighted imaging as predictor of acute ischemic stroke etiology
(2021) Brunser, Alejandro; Mansilla, Eloy; Navia, Victor; Mazzon, Enrico; Rojo, Alexis; Cavada, Gabriel; Olavarría, Verónica; Muñoz Venturelli, Paula; Manuel, Pablo
Background: Topographic patterns may correlate with causes of ischemic stroke. Objective: To investigate the association between diffusionweighted imaging (DWI) and Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Methods: We included 1019 ischemic stroke patients. DWI were classified as: i) negative; ii) DWI single lesion (cortico-subcortical, cortical, subcortical ≥20 mm, or subcortical <20 mm); iii) scattered lesions in one territory (small scattered lesions or confluent with additional lesions); and iv) multiple lesions (multiple unilateral anterior circulation [MAC], multiple posterior circulation [MPC], multiple bilateral anterior circulation [MBAC], and multiple anterior and posterior circulations [MAP]). Results: There was a relationship between DWI patterns and TOAST classification (p<0.001). Large artery atherosclerosis was associated with small, scattered lesions in one vascular territory (Odds Ratio [OR] 4.22, 95% confidence interval [95%CI] 2.61–6.8), MPC (OR 3.52; 95%CI 1.54–8.03), and subcortical lesions <20 mm (OR 3.47; 95%CI 1.76–6.85). Cardioembolic strokes correlated with MAP (OR 4.3; 95%CI 1.64–11.2), cortico-subcortical lesions (OR 3.24; 95%CI 1.9–5.5) and negative DWI (OR 2.46; 95%CI 1.1–5.49). Cryptogenic strokes correlated with negative DWI (OR 4.1; 95%CI 1,84–8.69), cortical strokes (OR 3.3; 95%CI 1.25–8.8), MAP (OR 3.33; 95%CI 1.25–8.81) and subcortical lesion ≥20 mm (OR 2.44; 95%CI 1,04–5.73). Lacunar strokes correlated with subcortical lesions diameter <20 mm (OR 42.9; 95%CI 22.7–81.1) and negative DWI (OR 8.87; 95%CI 4.03–19.5). Finally, MBAC (OR 9.25; 95%CI 1.12–76.2), MAP(OR 5.54; 95%CI 1.94–15.1), and MPC (OR 3.61; 95%CI 1.5–8.7) correlated with stroke of other etiologies. Conclusions: A relationship exists between DWI and stroke subtype.
Diffusion-weighted imaging as predictor of acute ischemic stroke etiology
(2022) brunser, alejandro; Mansilla, Eloy; NAVIA, VICTOR; Mazzon, Enrico; Rojo, Alexis; Cavada, Gabriel; Olavarría, Verónica V.; Munoz Venturelli, Paula; Lavados, Pablo
Background: Topographic patterns may correlate with causes of ischemic stroke. Objective: To investigate the association between diffusion weighted imaging (DWI) and Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Methods: We included 1019 ischemic stroke patients. DWI were classified as: i) negative; ii) DWI single lesion (cortico-subcortical, cortical, subcortical ≥20 mm, or subcortical <20 mm); iii) scattered lesions in one territory (small scattered lesions or confluent with additional lesions); and iv) multiple lesions (multiple unilateral anterior circulation [MAC], multiple posterior circulation [MPC], multiple bilateral anterior circulation [MBAC], and multiple anterior and posterior circulations [MAP]). Results: There was a relationship between DWI patterns and TOAST classification (p<0.001). Large artery atherosclerosis was associated with small, scattered lesions in one vascular territory (Odds Ratio [OR] 4.22, 95% confidence interval [95%CI] 2.61–6.8), MPC (OR 3.52; 95%CI 1.54–8.03), and subcortical lesions <20 mm (OR 3.47; 95%CI 1.76–6.85). Cardioembolic strokes correlated with MAP (OR 4.3; 95%CI 1.64–11.2), cortico-subcortical lesions (OR 3.24; 95%CI 1.9–5.5) and negative DWI (OR 2.46; 95%CI 1.1–5.49). Cryptogenic strokes correlated with negative DWI (OR 4.1; 95%CI 1,84–8.69), cortical strokes (OR 3.3; 95%CI 1.25–8.8), MAP (OR 3.33; 95%CI 1.25–8.81) and subcortical lesion ≥20 mm (OR 2.44; 95%CI 1,04–5.73). Lacunar strokes correlated with subcortical lesions diameter <20 mm (OR 42.9; 95%CI 22.7–81.1) and negative DWI (OR 8.87; 95%CI 4.03–19.5). Finally, MBAC (OR 9.25; 95%CI 1.12–76.2), MAP (OR 5.54; 95%CI 1.94–15.1), and MPC (OR 3.61; 95%CI 1.5–8.7) correlated with stroke of other etiologies. Conclusions: A relationship exists between DWI and stroke subtype
Effects of an Avocado-based Mediterranean Diet on Serum Lipids for Secondary Prevention after Ischemic Stroke Trial (ADD-SPISE)
(2021) Olavarría, Verónica; Campodónico, Paola; Vollrath, Valeska; Von Geldern, Paula; Velásquez, Carolina; Pávez, Patricia; Valente, Bárbara; Donoso, Pamela; Ginesta, Alexandra; Cavada, Gabriel; Mazzon, Enrico; Navia, Víctor; Guzmán, Matías; Brinck, Pablo; Lavados, Pablo
Background: A poor or unhealthy diet is responsible for an important fraction of ischemic stroke risk. Adherence to dietary patterns, such as the Mediterranean diet, rich in monounsaturated fatty acids mainly from olive oil, is associated with a lower stroke risk. Furthermore, lowering low-density cholesterol (LDL-C) levels decreases stroke recurrence. Interestingly, Avocado-substituted diets, which are also rich in monounsaturated fatty acids, significantly decrease LDL cholesterol levels. This study aims to evaluate whether a Mediterranean diet based on Avocados reduces LDL-C compared to a low-fat high-complex carbohydrate diet after 3 months of the intervention in patients who had a recent acute ischemic stroke. The trial will also assess safety and feasibility. Patients and methods: Prospective, randomized open-label, blinded outcome assessment clinical trial. Participants are patients within a month of being admitted with an ischemic stroke, who consent and fulfil the eligibility criteria. Patients are randomly assigned to either diet intervention in a 1:1 ratio on top of the usual secondary prevention treatment. The intervention diet is: A)Avocado-based Mediterranean diet with intake of 1/2 portion of Avocado per day and B)The control diet is a low-fat high-complex carbohydrate diet. The main efficacy outcome is a reduction in plasma LDL-C levels at 3 months of the dietary intervention. Secondary outcomes include changes in the levels of serum lipid profile and serum inflammation markers, safety, and feasibility. A sample size of 200 patients was estimated to provide 80% power and 5% level of significance (10% loss and 5% crossover) to detect a minimum difference of 4.6 mg/dL in LDL-C after 3 months of intervention. Conclusion: We hypothesize that an Avocado-based Mediterranean diet will further reduce the levels of LDL-cholesterol at 3 months compared to the control diet, and that the intervention is safe and feasible.
In-Hospital Acute Ischemic Stroke is Associated with Worse Outcome: Experience of a Single Center in Santiago Chile
(2021) Brunser, Alejandro; Navia, Víctor; Araneda, Patricia; Mazzon, Enrico; Muñoz Venturelli, Paula; Cavada, Gabriel; Olavarría, Verónica; Lavados, Pablo
Objectives: In-hospital acute ischemic stroke (HIS) accounts for 217% of all acute ischemic strokes (AIS) seen in hospital and they have worse prognosis. In this study we aimed to identify the frequency of HIS and their characteristics in our center. Materials and Methods: Retrospective analysis of a prospective register of patients with AIS seen at Clínica Alemana de Santiago, between January 2017 and January 2019. HIS and community onset ischemic strokes patients (CIS) were compared, univariate analysis was performed, covariates with p < 0.25 were selected for multivariate analysis. Differences between, proportion of strokes treated with thrombolytic therapy, door to needle time were compared between HIS and CIS patients, as also mortality rates at 90 days. Results: During the study period 369 patients with AIS were seen; of these 20 (5.4%, 95 CI%, 3.58.2) corresponded to HIS. In univariate analysis, HIS compared to patients arriving form the community to the emergency room, suffered more frequently from, heart failure (p = 0.04), and active malignancies (p < 0.001). HIS patients had longer times from symptom onset to non-contrast brain tomography (540 §150 minutes); they were also less frequently treated with intravenous thrombolysis compared to community AIS: 15% versus 30% respectively (p = 0.08). Mortality rates at 90 days were higher in HIS: 30 versus 5% (p = 0.001). Conclusions: In this cohort, HIS patients suffered delays in their neuroimaging studies and received less intravenous thrombolysis; this underscores the need for a standardized approach to the recognition and management of inhospital acute ischemic stroke
Low dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experience
(2020) Brunser, Alejandro; Mazzon, Enrico; Cavada, Gabriel; Mansilla, Eloy; Rojo, Alexis; Almeida, Juan; Olavarría, Verónica; Muñoz Venturelli, Paula; Lavados, Pablo
Background: Low-dose alteplase (LrtPA) has been shown not to be inferior to the standard-dose (SrtPA) with respect to death/disability. Objective: We aim to evaluate the percentage of patients treated with LrtPA at our center after the ENCHANTED trial and the factors associated with the use of this dosage. Methods: Prospective study in consecutive patients with an acute stroke admitted between June 2016 and November 2018. Results: 160 patients were treated with intravenous thrombolysis, 50% female; mean age 65.4±18.5 years. Of these, 48 patients (30%) received LrtPA. In univariate analysis, LrtPA was associated with patient’s age (p=0.000), previous modified Rankin scale scores (mRS) (p<0.000), hypertension (p=0.076), diabetes mellitus (p=0.021), hypercholesterolemia (p=0.19), smoking (p=0.06), atrial fibrillation (p=0.10), history of coronary artery disease (p=0.06), previous treatment with antiplatelet agents (p<0.000), admission International Normalized Ratio-INR (p=0.18), platelet count (p=0.045), leukoaraiosis on neuroimaging (p<0.003), contraindications for thrombolytic treatment (p=0.000) and endovascular treatment (p=0.027). Previous relevant bleedings were determinants for treatment with LrtPA. Final diagnosis on discharge of stroke mimic was significant (p=0.02) for treatment with SrtPA. In multivariate analysis, mRS (OR: 2.21; 95%CI 1.37–14.19), previous antiplatelet therapy (OR: 11.41; 95%CI 3.98–32.70), contraindications for thrombolysis (OR: 56.10; 95%CI 8.81–357.80), leukoaraiosis (OR: 4.41; 95%CI 1.37–14.10) and diagnosis of SM (OR: 0.22; 95%CI 0.10–0.40) remained independently associated. Conclusions: Following the ENCHANTED trial, LrtPA was restricted to 30% of our patients. The criteria that clinicians apply are based mostly on clinical variables that may increase the risk of brain or systemic hemorrhage or exclude the patient from treatment with lytic drugs.
Pre-stroke adherence to a Mediterranean diet pattern is associated with lower acute ischemic stroke severity: a cross-sectional analysis of a prospective hospital-register study
(2020) Lavados, Pablo; Mazzon, Enrico; Rojo, Alexis; Brunser, Alejandro; Olavarría, Verónica
Background: High adherence to a Mediterranean Diet is associated with reduced incidence and mortality of acute ischemic stroke (AIS) but may also be associated with severity. Our purpose was to investigate the association of adherence to a Mediterranean diet and severity in a prospective hospital register of AIS patients. Methods: We included AIS patients admitted from February 2017 to July 2019. All were assessed by a neurologist with a standard stroke protocol, including NIHSS. Adherence to Mediterranean diet was prospectively measured by the 14-point Mediterranean Diet Adherence Screener (MEDAS) and defined as low (0–6 points) or high (7–14 points). Demographic and clinical characteristics were compared by group with univariate analysis. A Generalized Linear Model (GLM) was used to investigate the association of admission NIHSS as a continuous ordinal variable and an ordinal logistic regression (OLR) analysis to determine the independent association of the NIHSS quartiles with adherence to Mediterranean diet. Results: Three hundred sixty-eight patients were included, mean age 68.3 (17.7), 158 (42.9%) females. The median NIHSS score was 3 (IQR 1–9) and the median MEDAS score was 6 (IQR 4.5–8). Patients with high MEDAS scores had significantly lower; admission NIHSS scores, sedentary lifestyle, body mass index, total and LDL cholesterol levels, but higher alcohol consumption. After adjustments, high adherence to Mediterranean diet remained independently associated with lower stroke severity both in the GLM (β coefficient = − 0.19, p = 0.01) and in the OLR model (OR for lower NIHSS quartiles 0.6 (95% CI 0.37–0.98, p = 0.04). Conclusions: Higher pre-stroke adherence to a Mediterranean diet is independently associated with lower AIS severity.
Risk Factors and Diet Components Determining Adherence to the Mediterranean Diet in Acute Ischemic Stroke Patients: A Cross-Sectional Analysis of a Prospective Hospital Register Study
(2021) Olavarría, Verónica; Navia, Víctor; Mazzon, Enrico; Rojo, Alexis; Brunser, Alejandro M.; Lavados, Pablo
Objectives: Low adherence to a Mediterranean diet (MeDi) is associated with increased incidence, mortality, and severity of acute ischemic strokes (AIS). Nevertheless, the explanatory factors associated with such results are unclear. Our aim was to investigate stroke risk factors associated with adherence to a MeDi in a prospective cohort of AIS patients. Materials and Methods: Patients admitted from February 2017 to February 2020 were included in this study. Adherence was measured using the 14-point Mediterranean Diet Adherence Screener (MEDAS). Demographic and clinical characteristics were compared with adherence with a univariate analysis. A binomial regression was used to investigate the independent association of premorbid factors and MeDi compo- nents with adherence. Results: There were 413 patients. Mean age was 68.6 (17.4), 176 (42.6%) women. Median MEDAS score was 6 (IQR 47) points. 253 patients (61.2%) had a low adherence (MEDAS 6). In the univariate analysis, a low MEDAS was associated with lower education, diabetes, sedentary life- style, greater body mass index (BMI), lower alcohol consumption, and higher LDLc. In the regression analysis, younger age, lower education, functional dis- ability, hypertension, sedentary lifestyle, and higher BMI were associated with lower MEDAS scores. Six MeDi components had particularly low patient adherence: seafood, legumes, olive oil, nuts, wine, and fruit. Discussion: These data indicate low adherence to MeDi in younger patients who are less educated and have existing cardiovascular risk factors, in particular hypertension, sed- entary lifestyle, and higher BMI. Some components of the diet had a particu- larly low adherence. Conclusions: Tailoring diet prevention interventions to these specific populations, focusing on components with known less adher- ence, could improve adherence to a MeDi and the opportunity for secondary stroke prevention.
Stroke care and collaborative academic research in Latin America
(2022) Muñoz, Paula; González, Francisca; Urrutia, Francisca; Mazzon, Enrico; Navia, Víctor; Brunser, Alejandro; Lavados, Pablo; Olavarría, Verónica; Almeida, Juan; Guerrero, Rodrigo; Rojo, Alexis; Gigoux, Juan; Vallejos, José; Conejan, Nathalie; Esparza, Tomas; Escobar, Arturo; Soto, Álvaro; Pontes, Octavio; Arauz, Antonio; Abanto, Carlos; Carce, Cheryl; Zafra, Jessica; Liu, Hueiming; Song, Lili; Miranda, Jaime; Anderson, Craig
Objective: A narrative overview of regional academic research collaborations to address the increasing burden and gaps in care for patients at risk of, and who suffer from, stroke in Latin America (LA). Materials and methods: A summary of experiences and knowledge of the local situation is presented. No systematic literature review was performed. Results: The rapidly increasing burden of stroke poses immense challenges in LA, where prevention and manage-ment strategies are highly uneven and inadequate. Clinical research is increasing through various academic consortia and networks formed to overcome structural, funding and skill barriers. However, strengthening the ability to generate, analyze and interpret randomized evidence is central to further develop effective therapies and healthcare systems in LA. Conclusions: Regional networks foster the conduct of multicenter studies -particularly randomized controlled trials-, even in resource-poor regions. They also contribute to the external validity of international studies and strengthen systems of care, clinical skills, critical thinking, and international knowledge exchange.
Stroke symptoms, risk factors awareness and personal decision making in Chile. A national survey
(2022) Navia, Víctor; Mazzon, Enrico; Olavarría, Verónica; Almeida, Juan; Brunser, Alejandro; Lavados, Pablo; Hoffmeister, Lorena; Muñoz Venturelli, Paula
Background: Knowledge about stroke symptoms, correct decision in front of a stroke case and recognition of stroke risk factors are crucial to fight against stroke burden. We aimed to assess the stroke awareness among a sample of the Chilean population. Methods: A closed-ended questions structured survey was applied in November 2019 using a computer-assisted telephone interviewing system. Probabilistic sample, random selection and stratification for region was used. Multivariate logistic regression model was used to estimate the association between participants' characteristics and responses. Results: Of 706 participants, only 74.4% (95% CI 70.9-77.5) recognized at least one typical stroke symptom. Most (586, 82.4% 95% CI 75.2-89.7) chose to contact the emergency ambulance or directly go to the emergency department in case of a stroke symptom and recognized at least one risk factor (692, 97.9% CI 96.7-98.8). In multivariable analysis, sociodemographic characteristics associated to a worse recognition of at least one stroke symptom were being men (OR 0.67, 95% CI 0.47-0.96), being 55 years old or older (OR 0.59 95% CI 0.37-0.93) and from the lowest socioeconomic level (SES) (OR 0.33 95% CI 0.16-0.67). Female sex was associated with lower stroke risk factor knowledge (OR 0.64 95% IC 0.47-0.87). Participants who recognized at least one typical stroke symptom and would promptly seek care at an emergency department differed significantly between SES (p=0.001) and age groups (p=0.035). Conclusions: We found insufficient knowledge about stroke symptoms and best decisions making in the Chilean population. We describe gaps that can be targeted in future stroke awareness campaigns. There is a need to strengthen tailored stroke education particularly for underserved populations.
Telestroke in Chile: 1 year experience at 7 hospitals
(2019) Mansilla, Eloy; Mazzon, Enrico; Jurado, Felipe; Lara, Lorena; Arévalo, Mirya; Rojas, Diego; Stephens, Gloria; Hoppe, Arnold; Brunser, Alejandro
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. Telemedicine can overcome some of these pitfalls. Aim: To describe the implementation and results of AIS treatment by telemedicine at the TeleStroke Unit (TeleACV) of the Southern Metropolitan Health Service, connected with seven hospitals in Chile. Material and methods: Descriptive analysis of a prospective tele-thrombolysis data-base that covers from 2016 to 2018, with an emphasis in the last year. Results: During the analyzed period, seven remote telemedicine centers were activated as far as 830 kilometers on a continental level from the reference center and up to 3,700 kilometers on an island level. There were 1,024 telemedicine consultations, 144 (14%) of them resulted in an IVT treatment. During 2018, 597 tele-consultations were made, thrombolysis was done in 115 (19%) patients aged 66+-13 years; 54 (46.6%) being female. The median admission National Institute of Health Stroke Scale was 8 (interquartile range (IQR) 5-14). The median door-to-needle time was 56.5 (IQR 44.8-73.3) minutes; 60% of patients were treated within 60 minutes. Eight patients (7%) were referred for a subsequent mechanical thrombectomy to a center of greater complexity. Symptomatic intra-cranial hemorrhages occurred in four treated patients (4%). One patient had a systemic bleeding. Conclusions: The Telestroke Unit achieved a high rate of IVT and good door-to-needle times. This may help to overcome some of the geographic barriers and the specialist availability gap in our country.

Browsing by Author "Mazzon, Enrico"

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