Browsing by Author "Rivera, Rodrigo"
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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 Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic(2021) Nguyen, Thanh N.; Haussen, Diogo C.; Qureshi, Muhammad M.; Yamagami, Hiroshi; Fujinaka, Toshiyuki; Mansour, Ossama Y.; Abdalkader, Mohamad; Frankel, Michael; Qiu, Zhongming; Taylor, Allan; Lylyk, Pedro; Eker, Omer F.; Mechtouff, Laura; Piotin, Michel; Oliveira Lima, Fabricio; Mont'Alverne, Francisco; Izzath, Wazim; Sakai, Nobuyuki; Mohammaden, Mahmoud; Al-Bayati, Alhamza R.; Renieri, Leonardo; Mangiafico, Salvatore; Ozretic, David; Chalumeau, Vanessa; Ahmad, Saima; Rashid, Umair; Irteza Hussain, Syed; John, Seby; Griffin, Emma; Thornton, John; Fiorot, Jose Antonio; Rivera, Rodrigo; Hammami, Nadia; Cervantes-Arslanian, Anna M.; Hammami, Nadia; Cervantes-Arslanian, Anna M.; Dasenbrock, Anna M.; Le Vu, Huynh; Nguyen, Viet Quy; Hetts, Steven; Bourcier, Romain; Guile, Romain; Walker, Melanie; Sharma, Malveeka; Frei, Don; Jabbour, Pascal; Herial, Nabeel; Al-Mufti, Fawaz; Ozdemir, Atilla Ozcan; Aykac, Ozlem; Gandhi, Dheeraj; Chugh, Chandril; Matouk, CharlesBackground: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study's objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines. Methods: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation. Findings: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p<0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p<0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. Interpretation: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.Item Descripción de los cambios en la velocidad media de flujo sanguíneo cerebral en posición supino y sedente, en pacientes con hemorragia subaracnoidea aneurismática con vasoespasmo asintomático o sin vasoespasmo. Serie de casos(Sociedad Médica de Santiago, 2014) Merino, Catalina; Heap, Pía; Vergara, Valentina; Yáñez, Alonso; Rivera, RodrigoEarly mobilization in intensive care units (ICU) provides respiratory, neurological and cardiovascular benefits in hospitalized patients. However, the orthostatic effects of changing from a supine to a sitting position may interfere with cerebral hemodynamics of patients with aneurysmal subarachnoid hemorrhage (aSAH). Aim: To describe the changes in mean cerebral blood flow velocity (MCBFV) in supine and sitting position, in adult patients with aSAH, with asymptomatic vasospasm (AVS) or without vasospasm (VS) at a neurosurgical ICU. Material and Methods: Descriptive case series study in 21 patients with aSAH, both with and without VS. They were positioned in a supine 30° position and then seated at the edge of bed for six minutes. MCBFV was measured by transcranial Doppler (TCD), and hemodynamic variables in both positions were registered. After this basal assessment and for 21 days after the episode of SAH, patients were seated once a day and signs of VS were recorded. Results: No significant changes in MCBFV or hemodynamic variables were detected during position changes, except for an increase in heart rate in the sitting position. No patient with AVS at the onset, had symptomatic VS during the 21 days of follow up when patients were seated. Among patients with a normal MCBFV at baseline, five patients (24%) had VS at a mean of three days after the first time that they were seated on the edge of bed. Conclusions: Sitting patients at the edge of the bed is a safe mobilization alternative for patients who suffered aSAH who did not have VS or had AVS.Item GERO Cohort Protocol, Chile, 2017-2022: Community-based Cohort of Functional Decline in Subjective Cognitive Complaint elderly(2020) Slachevsky, Andrea; Zitko, Pedro; Martínez-Pernía, David; Forno, Gonzalo; Court, Felipe A; Lillo, Patricia; Villagra, Roque; Duran-Aniotz, Claudia; Parrao, Teresa; Assar, Rodrigo; Orellana, Paulina; Toledo, Carolina; Rivera, Rodrigo; Ibañez, Agustín; Parra, Mario A; Christian González-Billault, Christian; Amieva, Helena; Thumala, DanielaBackground: With the global population aging and life expectancy increasing, dementia has turned a priority in the health care system. In Chile, dementia is one of the most important causes of disability in the elderly and the most rapidly growing cause of death in the last 20 years. Cognitive complaint is considered a predictor for cognitive and functional decline, incident mild cognitive impairment, and incident dementia. The GERO cohort is the Chilean core clinical project of the Geroscience Center for Brain Health and Metabolism (GERO). The objective of the GERO cohort is to analyze the rate of functional decline and progression to clinical dementia and their associated risk factors in a community-dwelling elderly with subjective cognitive complaint, through a population-based study. We also aim to undertake clinical research on brain ageing and dementia disorders, to create data and biobanks with the appropriate infrastructure to conduct other studies and facilitate to the national and international scientific community access to the data and samples for research. Methods: The GERO cohort aims the recruitment of 300 elderly subjects (> 70 years) from Santiago (Chile), following them up for at least 3 years. Eligible people are adults not diagnosed with dementia with subjective cognitive complaint, which are reported either by the participant, a proxy or both. Participants are identified through a household census. The protocol for evaluation is based on a multidimensional approach including socio-demographic, biomedical, psychosocial, neuropsychological, neuropsychiatric and motor assessments. Neuroimaging, blood and stool samples are also obtained. This multidimensional evaluation is carried out in a baseline and 2 follow-ups assessments, at 18 and 36 months. In addition, in months 6, 12, 24, and 30, a telephone interview is performed in order to keep contact with the participants and to assess general well-being. Discussion: Our work will allow us to determine multidimensional risks factors associated with functional decline and conversion to dementia in elderly with subjective cognitive complain. The aim of our GERO group is to establish the capacity to foster cutting edge and multidisciplinary research on aging in Chile including basic and clinical research.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.