Person: Navia, Víctor
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Navia
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Víctor
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Publication Diffusion-weighted imaging as predictor of acute ischemic stroke etiology(2022) Brunser, Alejandro; Mansilla, Eloy; Navia, Víctor; Mazzon, Enrico; Rojo, Alexis; Cavada, Gabriel; Olavarría, Verónica V.; Munoz Venturelli, Paula; Lavados, PabloBackground: 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 subtypePublication Availability and barriers to access post-stroke rehabilitation in Latin America(2024) Gonzalez, Alejandro; Rosales, Julieta; De Souza, Ana; Corredor, Angel; Barboza, Miguel; Navia, Víctor; Brunet, Florencia; Lagos, Javier; Novarro, Nelson; Ortega, Diego; Villarroel, Victor; Abanto, Carlos; Barrientos, Jose; Saltos, Filadelfo; Papavasileiou, Vasileios; Todd, Oliver; Gongora, Fernando; ALATAC collaboratorsObjectives: To describe the availability and barriers to access post-stroke rehabilitation services in Latin America. Materials and methods: We conducted a multi-national survey in Latin American countries. The survey consisted of three sections: (1) the national state of post-stroke rehabilitation; (2) the local state of post-stroke rehabilitation; and (3) the coverage and financing of post-stroke services. Stroke leaders from the surveyed countries were involved in developing and disseminating the survey. Results: 261 responses were collected from 17 countries. The mean age of respondents was 42.4 ± 10.1 years, and 139 (54.5 %) of the respondents were male. National clinical guidelines for post-stroke rehabilitation were reported by 67 (25.7 %) of the respondents. However, there were discrepancies between respondents within the same country. Stroke units, physiotherapy, occupational therapy, speech therapy, and neuropsychological therapy services were less common in public than private settings. The main barriers for inpatient and outpatient services included limited rehabilitation facilities, coverage, and rehabilitation personnel. The main source of financing for the inpatient and outpatient services was the national health insurance, followed by out-of-pocket payments. Private and out-of-pocket costs were more frequently reported in outpatient services. Conclusions: Post-stroke rehabilitation services in Latin American countries are restricted due to a lack of coverage by the public health system and private insurers, human resources, and financial aid. Public settings offer fewer post-stroke rehabilitation services compared to private settings. Developing consensus guidelines, increasing coverage, and using innovative approaches to deliver post-stroke rehabilitation is paramount to increase access without posing a financial burden.Publication Risk and impact of stroke across 38 countries and territories of the Americas from 1990 to 2021: a population-based trends analysis from the Global Burden of Disease Study 2021(2025) Martinez, Ramón; Munoz Venturelli, Paula; Ordunez, Pero; Fregni, Felipe; Abanto, Carlos; Alet, Matias; Alvarez, Tony; Amaya, Pablo; Ameriso, Sebastian; Arauz, Antonio; Barboza, Miguel; Bayona, Hernán; Ortiz, Antonio; Calleja, Juan; Cano, Vanessa; Carbonera, Leonardo; Carrillo, Rodrigo; Corredor, Angel; De Souza, Ana; Jimenez, Claudio; Lanas, Fernando; Martins, Sheila; Navia, Víctor; Novarro, Nelson; Olavarría, Verónica V.; Ovbiagele, Bruce; Pachecho, Kevin; Pontes, Octavio; Pujol, Virginia; Rabinstein, Alejandro; Rosales, Julieta; Rosende, Andrés; Sampaio, Gisele; Saposnik, Gustavo; Sen, Souvik; Testai, Fernando; Urrutia, Victor; Anderson, Craig; Lavados, PabloBackground: Despite substantial declines in burden over time, stroke remains a public health threat in the Americas. This study aimed to assess the current magnitude, trends, and disparities in the estimates of stroke burden by sex and age in the Americas from 1990 to 2021. Methods: Estimates from the Global Burden of Disease, Injuries and Risk Factors Study 2021 were used to analyze incidence, prevalence, mortality, years of life lost due to premature death, years lived with disabilities, and disability-adjusted life years (DALYs) caused by stroke and its major subtypes stratified by age, and sex in the Americas from 1990 to 2021. We used Joinpoint regression analysis to estimate the average annual percent change (AAPC) of stroke mortality and disease burden outcomes and assessed trends. Findings: In 2021, there were 1.1 million (95% uncertainty interval: 1.0-1.2) new cases, 12.9 million (12.3-13.7) prevalent cases, 0.5 million (0.5-0.6) deaths, and 11.4 million (10.6-12.1) DALYs due to stroke in the Americas. The absolute number of stroke burden outcomes increased from 1990 to 2021, but their corresponding age-standardized rates significantly declined. A deceleration in reduction rates of burden outcomes for all strokes and most stroke subtypes occurred over the last decade, with pronounced difference between sexes mainly in incidence among younger groups. From 2015 to 2021, trends in incidence rates from all stroke and stroke subtypes reversed to increase in most age groups, and strikingly, trends in mortality and DALY rates from ischemic stroke among younger populations reversed to upward with AAPC over 1.4%. A substantial number of countries contributed to these increasing trends. Interpretation: Regionally, the annual number of stroke cases and deaths significantly increased from 1990 to 2021, despite reductions in age-standardized rates. The declining pace in age-standardized stroke rates has decelerated in recent years, while trends in incidence, and ischemic stroke mortality and DALY among middle-aged adults and adults, reversed towards upward in the period 2015-2021. Further studies are needed to understand the determinants of this recent pattern and identify the most cost-effective interventions to stem this alarming trend. Funding: There was no funding source for this study.Publication Barreras para acceder a rehabilitación posterior a un ataque cerebrovascular en Chile: Sub-análisisde una encuesta internacional a neurólogos y profesionales de rehabilitación en Latinoamérica(2025) Gonzalez, Alejandro; Navia, Víctor; Casanova, MichelleEn Chile, más de la mitad de las personas que sobreviven a un ataque cerebrovascular (ACV) presentan limitaciones para realizar actividades de la vida diaria. Aunque existen servicios de rehabilitación disponibles para esta condición, el acceso efectivo a ellos continúa siendo un desafío para muchos pacientes. En este contexto, el objetivo de este estudio fue identificar las principales barreras para ofrecer servicios de rehabilitación en los sectores públicos y privados del país. Se aplicó una encuesta en 2023, la cual exploró los servicios de rehabilitación ofrecidos en Chile. Un total de 14 profesionales respondieron la encuesta, representando a 21 hospitales. La edad media de los participantes fue de 43,29 años (DE = 8,86), con una media de 13,93 años (DE = 7,24) de experiencia profesional. Los resultados mostraron que las principales barreras para la rehabilitación intrahospitalaria fueron la falta de infraestructura en el sector público y la falta de cobertura en el sector privado. En cuanto a la rehabilitación ambulatoria, las principales barreras reportadas fueron la distancia a los centros de rehabilitación en el sector público y la falta de cobertura en el sector privado. Se concluye que las principales dificultades para ofrecer servicios de rehabilitación post-ACV están relacionadas con deficiencias en infraestructura y financiamiento. El uso de innovaciones en salud, como la telemedicina, podría ser una estrategia útil para mejorar el acceso. Asimismo, se destaca la necesidad de profundizar en las barreras asociadas a la falta de cobertura, e incorporar las perspectivas de pacientes y cuidadores en investigaciones futuras. More than half of stroke survivors in Chile experience limitations in their activities of daily living. Although rehabilitation services are available for this condition, access remains a challenge for many patients. This study aimed to identify the main barriers to providing rehabilitation services in the country's public and private health sectors. A survey was conducted in 2023 to explore the rehabilitation services offered in Chile, with a total of 14 respondents from 21 hospitals. The mean age of the participants was 43.29 years (SD = 8.86), with a mean professional experience of 13.93 years (SD = 7.24). The results showed that the primary barriers to inpatient rehabilitation were the inadequate infrastructure in the public sector and the limited health coverage in the private sector. Regarding outpatient rehabilitation, the main barriers were the commuting distance to rehabilitation centers in the public sector and restricted health coverage in the private sector. In conclusion, the primary challenges in providing post-stroke rehabilitation services are linked to infrastructure and funding deficiencies. Health innovations, such as telemedicine, could be a valuable strategy to improve access. Furthermore, this research underscores the importance of exploring the barriers associated with inadequate health coverage and incorporating the perspectives of patients and caregivers into future studies.