Person: Brunser, Alejandro
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Brunser
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Alejandro
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Publication Who is in the emergency room matters when we talk about door-to-needle time: a single-center experience [Quien estĆ” en el servicio de emergencia importa al hablar de tiempo puerta-aguja: experiencia de un centro clĆnico](2023) Brunser, Alejandro; NuƱez; Juan; Mansilla, Eloy; Cavada, Gabriel; OlavarrĆa, VerĆ³nica V.; Munoz Venturelli, Paula; Lavados, PabloBackground: The efficacy of intravenous thrombolysis (IVT) is time-dependent. Objective: To compare the door-to-needle (DTN) time of stroke neurologists (SNs) versus non-stroke neurologists (NSNs) and emergency room physicians (EPs). Additionally, we aimed to determine elements associated with DTN ā¤ 20āminutes. Methods: Prospective study of patients with IVT treated at ClĆnica Alemana between June 2016 and September 2021. Results: A total of 301 patients underwent treatment for IVT. The mean DTN time was 43.3āĀ±ā23.6āminutes. One hundred seventy-three (57.4%) patients were evaluated by SNs, 122 (40.5%) by NSNs, and 6 (2.1%) by EPs. The mean DTN times were 40.8āĀ±ā23, 46āĀ±ā24.7, and 58āĀ±ā22.5āminutes, respectively. Door-to-needle time ā¤ 20āminutes occurred more frequently when patients were treated by SNs compared to NSNs and EPs: 15%, 4%, and 0%, respectively (odds ratio [OR]: 4.3, 95% confidence interval [95%CI]: 1.66ā11.5, p ā=ā0.004). In univariate analysis DTN time ā¤ 20āminutes was associated with treatment by a SN ( p ā=ā0.002), coronavirus disease 2019 pandemic period ( p ā=ā0.21), time to emergency room (ER) ( p ā=ā0.21), presence of diabetes ( p ā=ā0.142), hypercholesterolemia ( p ā=ā0.007), atrial fibrillation ( p ā<ā0.09), score on the National Institutes of Health Stroke Scale (NIHSS) ( p ā=ā0.001), lower systolic ( p ā=ā0.143) and diastolic ( p ā=ā0.21) blood pressures, the Alberta Stroke Program Early CT Score (ASPECTS; p ā=ā0.09), vessel occlusion ( p ā=ā0.05), use of tenecteplase ( p ā=ā0.18), thrombectomy ( p ā=ā0.13), and years of experience of the physician ( p ā<ā0.001). After multivariate analysis, being treated by a SN (OR: 3.95; 95%CI: 1.44ā10.8; p ā=ā0.007), NIHSS (OR: 1.07; 95%CI: 1.02ā1.12; p ā<ā0.002) and lower systolic blood pressure (OR: 0.98; 95%CI: 0.96ā0.99; p ā<ā0.003) remained significant. Conclusion: Treatment by a SN resulted in a higher probability of treating the patient in a DTN time within 20āminutes.Publication Who is in the emergency room matters when we talk about door-to-needle time: a single-center experience(2023) Brunser, Alejandro; NuƱez, Juan Cristobal; Mansilla, Eloy; Cavada, Gabriel; OlavarrĆa, VerĆ³nica V.; Munoz Venturelli, Paula; Lavados, PabloBackground: The efficacy of intravenous thrombolysis (IVT) is time-dependent. Objective: To compare the door-to-needle (DTN) time of stroke neurologists (SNs) versus non-stroke neurologists (NSNs) and emergency room physicians (EPs). Additionally, we aimed to determine elements associated with DTN ā¤ 20 minutes. Methods: Prospective study of patients with IVT treated at ClĆnica Alemana between June 2016 and September 2021. Results: A total of 301 patients underwent treatment for IVT. The mean DTN time was 43.3 Ā± 23.6 minutes. One hundred seventy-three (57.4%) patients were evaluated by SNs, 122 (40.5%) by NSNs, and 6 (2.1%) by EPs. The mean DTN times were 40.8 Ā± 23, 46 Ā± 24.7, and 58 Ā± 22.5 minutes, respectively. Door-to-needle time ā¤ 20 minutes occurred more frequently when patients were treated by SNs compared to NSNs and EPs: 15%, 4%, and 0%, respectively (odds ratio [OR]: 4.3, 95% confidence interval [95%CI]: 1.66-11.5, p = 0.004). In univariate analysis DTN time ā¤ 20 minutes was associated with treatment by a SN (p = 0.002), coronavirus disease 2019 pandemic period (p = 0.21), time to emergency room (ER) (p = 0.21), presence of diabetes (p = 0.142), hypercholesterolemia (p = 0.007), atrial fibrillation (p < 0.09), score on the National Institutes of Health Stroke Scale (NIHSS) (p = 0.001), lower systolic (p = 0.143) and diastolic (p = 0.21) blood pressures, the Alberta Stroke Program Early CT Score (ASPECTS; p = 0.09), vessel occlusion (p = 0.05), use of tenecteplase (p = 0.18), thrombectomy (p = 0.13), and years of experience of the physician (p < 0.001). After multivariate analysis, being treated by a SN (OR: 3.95; 95%CI: 1.44-10.8; p = 0.007), NIHSS (OR: 1.07; 95%CI: 1.02-1.12; p < 0.002) and lower systolic blood pressure (OR: 0.98; 95%CI: 0.96-0.99; p < 0.003) remained significant. Conclusion: Treatment by a SN resulted in a higher probability of treating the patient in a DTN time within 20 minutes.Publication Diffusion-weighted imaging as predictor of acute ischemic stroke etiology(2022) Brunser, Alejandro; Mansilla, Eloy; Navia, VĆctor; Mazzon, Enrico; Rojo, Alexis; Cavada, Gabriel; OlavarrĆa, VerĆ³nica 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 ā„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] 2.61ā6.8), MPC (OR 3.52; 95%CI 1.54ā8.03), and subcortical lesions <20 mm (OR 3.47; 95%CI 1.76ā6.85). Cardioembolic strokes correlated with MAP (OR 4.3; 95%CI 1.64ā11.2), cortico-subcortical lesions (OR 3.24; 95%CI 1.9ā5.5) and negative DWI (OR 2.46; 95%CI 1.1ā5.49). Cryptogenic strokes correlated with negative DWI (OR 4.1; 95%CI 1,84ā8.69), cortical strokes (OR 3.3; 95%CI 1.25ā8.8), MAP (OR 3.33; 95%CI 1.25ā8.81) and subcortical lesion ā„20 mm (OR 2.44; 95%CI 1,04ā5.73). Lacunar strokes correlated with subcortical lesions diameter <20 mm (OR 42.9; 95%CI 22.7ā81.1) and negative DWI (OR 8.87; 95%CI 4.03ā19.5). Finally, MBAC (OR 9.25; 95%CI 1.12ā76.2), MAP (OR 5.54; 95%CI 1.94ā15.1), and MPC (OR 3.61; 95%CI 1.5ā8.7) correlated with stroke of other etiologies. Conclusions: A relationship exists between DWI and stroke subtypePublication Stroke and cervical artery dissection and/or aneurysm: 2019-2021 Chilean hospital-based national registry(2025) Allende, Maria; Munoz Venturelli, Paula; Mazzon, Enrico; Brunser, Alejandro; Delgado, Iris; Rebolledo Jaramillo, BorisBackground: Cervical artery dissection is one of the main causes of stroke in young adults, yet the characteristics of patients have been mainly described in Caucasian populations. We aimed to identify patients' characteristics associated with stroke among cervical artery dissection patients in Chile. Methods: We conducted a retrospective analysis of a national hospital-based database in Chile between 2019 and 2021. Patients with cervical artery dissection or aneurysm (CeDA) were identified using ICD-10 codes I72.0 (carotid artery) and I72.6 (vertebral artery); stroke events were classified using codes I60-I64. We performed multivariable logistic regression to evaluate the association between patients' characteristics and stroke occurrence. We further performed Poisson regression to assess the impact of the coronavirus pandemic on CeDA admissions. Results: Of 2,647,398 hospital discharges, we identified 597 CeDA patients (mean [SD] age 57 [15] years; female 384, 64 %). Stroke occurred in 233 (37 %) patients, with ischaemic stroke accounting for 71 % of these events. In the multivariable analysis, stroke occurrence was associated with vertebral artery involvement (OR 2.89; 95 %CI 1.76-4.77), atrial fibrillation (2.25; 1.03-4.90), hypertension (1.85; 1.25-2.74), male sex (1.80; 1.24-2.62) and current smoking (1.78; 1.13-2.80). Hospital admissions for CeDA declined in 2020 (rate ratio [RR] 0.69; 95 %CI 0.57-0.85) and 2021 (0.76; 0.63-0.92), compared with 2019. Conclusions: In this Chilean hospital-based database, stroke occurrence among CeDA patients was linked to male sex, vertebral artery involvement, hypertension, current smoking, and atrial fibrillation. Further research is needed to understand the underlying mechanisms and its association with patient prognosis.