Abstract Background 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 ≤ 20 minutes. Methods Prospective study of patients with IVT treated at Clínica Alemana between June 2016 and September 2021. Results A total of 301 patients underwent treatment for IVT. The mean DTN time was 43.3 ± 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 ± 23, 46 ± 24.7, and 58 ± 22.5 minutes, respectively. Door-to-needle time ≤ 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 ≤ 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. Conclusions Treatment by a SN resulted in a higher probability of treating the patient in a DTN time within 20 minutes. (IVT timedependent. timedependent dependent. dependent time-dependent doortoneedle door needle (DTN (SNs nonstroke non (NSNs EPs . (EPs) Additionally 2 201 2021 30 433 43 3 43. 236 23 23. seventythree seventy three 57.4% 574 57 4 (57.4% 12 40.5% 405 40 5 (40.5% 2.1% 21 1 (2.1% 408 8 40. 247 24 7 24.7 225 22 22. Doortoneedle Door 15 15% 4% 0 0% odds OR [OR] 4.3 95 95%CI 95CI CI [95%CI] 166115 66 11 1.66–11.5 0.004. 0004 0.004 004 0.004) 0.002, 0002 0.002 , 002 0.21, 021 0.21 ER (ER 0.142, 0142 0.142 142 0.142) 0.007, 0007 0.007 007 0.007) 0.09, 009 0.09 09 0.09) (NIHSS 0.001, 0001 0.001 001 0.001) 0.143 0143 143 pressures ASPECTS (ASPECTS 0.05, 005 0.05 05 0.05) 0.18, 018 0.18 18 0.18) 0.13, 013 0.13 13 0.13) 0.001. (OR 3.95 395 1.44–10.8 144108 44 10 1.07 107 07 1.02–1.12 102112 02 0.98 098 98 0.96–0.99 096099 96 99 0.003 0003 003 significant (EPs 202 57.4 (57.4 40.5 (40.5 2.1 (2.1 24. [OR 4. 9 [95%CI 16611 1.66–11. 000 0.00 00 0.2 014 0.14 14 0.0 01 0.1 3.9 39 1.44–10. 14410 1.0 1.02–1.1 10211 0.9 0.96–0.9 09609 57. (57. (40. 2. (2. 1661 1.66–11 0. 3. 1.44–10 1441 1. 1.02–1. 1021 0.96–0. 0960 (57 (40 (2 166 1.66–1 1.44–1 144 1.02–1 102 0.96–0 096 (5 (4 ( 16 1.66– 1.44– 1.02– 0.96– 1.66 1.44 1.02 0.96 1.6 1.4

Resumen Antecedentes La respuesta a la trombólisis intravenosa (TIV) es dependiente del tiempo. Objetivo Comparar los tiempo puerta-aguja (TPAs) de neurólogos vasculares (NVs) contra los de neurólogos no vasculares (NNVs) y médicos emergencistas (MEs), y determinar los elementos asociados a un PTA ≤ 20 minutos. Métodos Análisis observacional prospectivo de pacientes con TIV tratados en Clínica Alemana entre junio de 2016 y septiembre de 2021. Resultados En total, 301 pacientes con TIV fueron tratados. El TPA promedio fue de 43,3 ± 23,6 minutos. Un total de 173 (57,4%) pacientes fueron evaluados por NVs, 122 (40,5%), por NNVs, y 6 (2,1%), por MEs; los TPAs promedios fueron de 40,8 ± 23; 46 ± 24,7 y 58 ± 22,5 minutos, respectivamente. Los TPAs ≤ 20 minutos fueron más frecuentes en pacientes tratados por NVs versus NNVs y MEs: 15%, 4% y 0%, respectivamente (odds ratio [OR]: 4,3; intervalo de confianza del 95% [IC95%]: 1,66–11,5; p = 0,004). El análisis univariado demostró que TPA ≤ 20 minutos se asoció con: tratamiento por NVs (p = 0,002), periodo de la pandemia de enfermedad por coronavirus 2019 (COVID-19; p = 0,21), tiempo a urgencia (p = 0,21), diabetes (p = 0,142), hipercolesterolemia (p = 0,007), fibrilación auricular (p < 0,09), puntaje en la National Institutes of Health Stroke Scale [NIHSS] (p = 0,001), presión arterial sistólica (p = 0,143) y diastólica menores (p = 0,21), Alberta Stroke Program Early CT Score (ASPECTS ; p = 0,09), oclusión de vasos cerebrales (p =0,05), uso de tecneteplase (p = 0,18), trombectomía (p = 0,13) y años de experiencia del médico (p < 0,001). El análisis multivariado demostró que ser tratado por NVs (OR: 3,95; IC95%: 1,44–10,8; p = 0,007), el puntaje en la NIHSS (OR: 1,07; IC95%: 1,02–1,12; p < 0,002) y la presión arterial sistólica (OR: 0,98; IC95%: 0,96–0,99; p < 0,003) se asociaron a TPA ≤ 20 minutos. Conclusões El tratamiento por NVs resultó en un TPA menor y en una mayor probabilidad de tratamiento ≤ 20 minutos. (TIV puertaaguja puerta aguja (TPAs (NVs (NNVs MEs, MEs , (MEs) 2 201 2021 30 433 43 3 43, 236 23 23, 17 57,4% 574 57 4 (57,4% 12 40,5%, 405 40,5% 40 5 (40,5%) 2,1%, 21 2,1% 1 (2,1%) 408 8 40, 247 24 7 24, 225 22 22, 15 15% 0 0% odds OR [OR] 4,3 95 IC95% IC95 IC [IC95%] 1,66–11,5 166115 66 11 0,004. 0004 0,004 . 004 0,004) 0,002, 0002 0,002 002 COVID19 COVID 19 (COVID-19 0,21, 021 0,21 0,21) 0,142, 0142 0,142 142 0,142) 0,007, 0007 0,007 007 0,007) 0,09, 009 0,09 09 0,09) [NIHSS 0,001, 0001 0,001 001 0,001) 0,143 0143 143 ASPECTS =0,05, 005 =0,05 05 =0,05) 0,18, 018 0,18 18 0,18) 0,13 013 13 0,001. (OR 3,95 395 1,44–10,8 144108 44 10 1,07 107 07 1,02–1,12 102112 02 0,98 098 98 0,96–0,99 096099 96 99 0,003 0003 003 (MEs 202 57,4 (57,4 40,5 (40,5% 2,1 (2,1% [OR 4, 9 IC9 [IC95% 1,66–11, 16611 000 0,00 00 COVID1 (COVID-1 0,2 014 0,14 14 0,0 =0,0 01 0,1 3,9 39 1,44–10, 14410 1,0 1,02–1,1 10211 0,9 0,96–0,9 09609 57, (57, (40,5 2, (2,1 [IC95 1,66–11 1661 (COVID- 0, =0, 3, 1,44–10 1441 1, 1,02–1, 1021 0,96–0, 0960 (57 (40, (2, [IC9 1,66–1 166 (COVID =0 1,44–1 144 1,02–1 102 0,96–0 096 (5 (40 (2 [IC 1,66– 16 1,44– 1,02– 0,96– ( (4 1,66 1,44 1,02 0,96 1,6 1,4

Abstract Background Intracerebral hemorrhage (ICH) is a deadly disease and increased intracranial pressure (ICP) is associated with worse outcomes in this context. Objective We evaluated whether dilated optic nerve sheath diameter (ONSD) depicted by optic nerve ultrasound (ONUS) at hospital admission has prognostic value as a predictor of mortality at 90 days. Methods Prospective multicenter study of acute supratentorial primary ICH patients consecutively recruited from two tertiary stroke centers. Optic nerve ultrasound and cranial computed tomography (CT) scans were performed at hospital admission and blindly reviewed. The primary outcome was mortality at 90-days. Multivariate logistic regression, ROC curve, and C-statistics were used to identify independent predictors of mortality. Results Between July 2014 and July 2016, 57 patients were evaluated. Among those, 13 were excluded and 44 were recruited into the trial. Their mean age was 62.3 ± 13.1 years and 12 (27.3%) were female. On univariate analysis, ICH volume on cranial CT scan, ICH ipsilateral ONSD, Glasgow coma scale, National Institute of Health Stroke Scale (NIHSS) and glucose on admission, and also diabetes mellitus and current nonsmoking were predictors of mortality. After multivariate analysis, ipsilateral ONSD (odds ratio [OR]: 6.24; 95% confidence interval [CI]: 1.18–33.01; p = 0.03) was an independent predictor of mortality, even after adjustment for other relevant prognostic factors. The best ipsilateral ONSD cutoff was 5.6mm (sensitivity 72% and specificity 83%) with an AUC of 0.71 (p = 0.02) for predicting mortality at 90 days. Conclusion Optic nerve ultrasound is a noninvasive, bedside, low-cost technique that can be used to identify increased ICP in acute supratentorial primary ICH patients. Among these patients, dilated ONSD is an independent predictor of mortality at 90 days. (ICH (ICP context (ONSD ONUS (ONUS 9 days centers (CT reviewed 90days. 90days 90-days regression curve Cstatistics C statistics 201 2016 5 those 1 4 trial 623 62 3 62. 131 13. 27.3% 273 27 (27.3% female analysis scan scale NIHSS (NIHSS odds OR [OR] 6.24 624 6 24 95 CI [CI] 1.18–33.01 1183301 18 33 01 0.03 003 0 03 factors 56mm mm 6mm sensitivity 72 83% 83 071 71 0.7 0.02 002 02 noninvasive bedside lowcost low cost 20 27.3 2 (27.3 [OR 6.2 [CI 1.18–33.0 118330 0.0 00 7 8 07 0. 27. (27. 6. 1.18–33. 11833 (27 1.18–33 1183 (2 1.18–3 118 ( 1.18– 11 1.18 1.1 1.

Resumo Antecedentes A hemorragia intraparenquimatosa (HIP) aguda apresenta elevada morbimortalidade e a presença de hipertensão intracraniana (HIC) confere um pior prognóstico. Objetivo Avaliamos se a dilatação do diâmetro da bainha do nervo óptico (DBNO) através do ultrassom do nervo óptico (USNO) na admissão hospitalar seria preditora de mortalidade. Métodos Estudo multicêntrico e prospectivo de pacientes consecutivos com HIP supratentorial primária aguda admitidos em dois centros terciários. Ultrassom do nervo óptico e tomografia computadorizada (TC) de crânio foram realizados na admissão e revisados de forma cega. O desfecho primário do estudo foi a mortalidade em 3 meses. Análises de regressão logística, curva de característica de operação do receptor (ROC, na sigla em inglês) e estatística-C foram utilizadas para identificação dos preditores independentes de mortalidade. Resultados Entre julho de 2014 e julho de 2016, 44 pacientes foram incluídos. A idade média foi 62,3 (±13,1) anos e 12 (27,3%) eram mulheres. Na análise univariada, o volume da HIP na TC de crânio, DBNO ipsilateral à HIP, glicemia, escala de coma de Glasgow (ECG) e NIHSS na admissão hospitalar, e também diabetes mellitus e não-tabagista foram preditores de mortalidade. Após análise multivariada, o DBNO ipsilateral à HIP permaneceu como preditor independente de mortalidade (odds ratio [OR]: 6,24; intervalo de confiança [IC] de 95%: 1,18–33,01; p = 0,03). O melhor ponto de corte do DBNO ipsilateral como preditor de mortalidade em 3 meses foi 5,6mm (sensibilidade 72% e especificidade 83%) e área sob a curva (AUC, na sigla em inglês) 0,71 (p = 0,02). Conclusão O USNO é um método não-invasivo, beira-leito, de baixo custo, que pode ser empregado para estimar a presença de HIC em pacientes com HIP supratentorial primária aguda. A presença de DBNO dilatada é um preditor independente de mortalidade em 3 meses nesses pacientes. (HIP (HIC prognóstico (DBNO (USNO terciários (TC cega logística ROC, ROC (ROC inglês estatísticaC estatística C 201 2016 4 incluídos 623 62 62, ±13,1 131 13 1 (±13,1 27,3% 273 27 (27,3% mulheres univariada glicemia ECG (ECG nãotabagista não tabagista multivariada odds OR [OR] 6,24 624 6 24 IC [IC 95% 95 1,18–33,01 1183301 18 33 01 0,03. 003 0,03 . 0 03 0,03) 56mm mm 5 6mm sensibilidade 72 83% 83 AUC, AUC (AUC 071 71 0,7 0,02. 002 0,02 02 0,02) nãoinvasivo, nãoinvasivo invasivo, invasivo não-invasivo beiraleito, beiraleito beira leito, leito beira-leito custo 20 ±13, (±13, 27,3 2 (27,3 [OR 6,2 9 1,18–33,0 118330 00 0,0 7 8 07 0, ±13 (±13 27, (27, 6, 1,18–33, 11833 ±1 (±1 (27 1,18–33 1183 ± (± (2 1,18–3 118 ( 1,18– 11 1,18 1,1 1,

Abstract 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.

RESUMEN Antecedentes: Los patrones topográficos pueden correlacionarse con las causas del accidente cerebrovascular isquémico. Objetivo: Investigar la asociación entre imágenes ponderadas por difusión por resonancia nuclear magnética (dRNM) y el ensayo de Org 10172 en la clasificación de tratamiento agudo de accidentes cerebrovasculares (TOAST). Métodos: Fueron incluidos 1.019 pacientes con accidente cerebrovascular isquémico. Las dRNM fueron clasificadas como: i) negativa; ii) dRNM lesión única (cortico-subcortical, cortical, subcortical ≥20 mm, o subcortical <20 mm); iii) lesiones disgregadas un territorio vascular (pequeñas lesiones dispersas o confluentes con lesiones adicionales); y iv) lesiones múltiples (unilaterales de circulación anterior [MAC], de circulación posterior [MPC], bilaterales de circulación anterior [MBAC] y de circulación anterior y posterior [MAP]). Resultados: Existió relación entre los patrones de dRNM y la clasificación TOAST (p<0,001). La aterosclerosis de las arterias grandes se asoció con lesiones pequeñas y disgregadas en un territorio vascular (Odds Ratio [OR] 4,22, intervalo de confianza del 95% [IC95%] 2,61–6,8), MPC (OR 3,52; IC95% 1,54–8,03), y lesiones subcorticales <20 mm (OR 3,47; IC95% 1,76–6,85). Cardioembolias se relacionaron con MAP (OR 4,3; IC95% 1,64–11,2), lesiones cortico-subcorticales (OR 3,24; IC95% 1,9–5,5) y dRNM negativas (OR 2,46; IC95% 1,1–5,49). Los accidentes cerebrovasculares criptogénicos se relacionaron con dRNM negativas (OR 4,1; IC95% 1,84–8,69), accidentes cerebrovasculares corticales (OR 3,3; IC95% 1,25–8,8), MAP (OR 3,33; IC95% 1,25–8,81) y lesiones subcorticales ≥20 mm (OR 2,44; IC95% 1,04–5,73). Los accidentes cerebrovasculares lacunares se correlacionaron con lesiones subcorticales de diámetro <20 mm (OR 42,9; IC95% 22,7–81,1) y dRNM negativas (OR 8,87; IC95% 4,03–19,5). Finalmente, MBAC (OR 9,25; IC95% 1,12–76,2), MAP (OR 5,54; IC95% 1,94–15,1) y MPC (OR 3,61; IC95% 1,5–8,7) se relacionaron con accidentes cerebrovasculares de otras etiologías. Conclusiones: Existe relación entre dRNM y subtipo de accidente cerebrovascular.

Abstract Background: Deep breathing (DB) and handgrip (HG) exercise -with and without circulatory occlusion (OC) in muscle-, have been shown to have beneficial effects on cardiovascular function; however, the combination of these maneuvers on heart rate (HR) and cardiac sympathovagal balance have not been previously investigated. Therefore, the aim of the present study was to evaluate the effect of simultaneous DB, HG, and OC maneuvers on the sympathovagal balance in healthy women and men subjects. Methods and results: Electrocardiogram and ventilation were measured in 20 healthy subjects (Women: n = 10; age = 27 ± 4 years; weight = 67.1 ± 8.4 kg; and height = 1.6 ± 0.1 m. Men: n = 10; age = 27 ± 3 years; weight = 77.5 ± 10.1 kg; and height = 1.7 ± 0.1 m) at baseline and during DB, DB + HG, or DB + HG + OC protocols. Heart rate (HR) and respiratory rate were continuously recorded, and spectral analysis of heart rate variability (HRV) were calculated to indirectly estimate cardiac autonomic function. Men and women showed similar HR responses to DB, DB + HG and DB + HG + OC. Men exhibited a significant HR decrease following DB + HG + OC protocol which was accompanied by an improvement in cardiac autonomic control evidenced by spectral changes in HRV towards parasympathetic predominance (HRV High frequency: 83.95 ± 1.45 vs. 81.87 ± 1.50 n.u., DB + HG + OC vs. base-line; p < 0.05). In women, there was a marked decrease in HR after completion of both DB + HG and DB + HG + OC tests which was accompanied by a significant increase in cardiac vagal tone (HRV High frequency: 85.29 ± 1.19 vs. 77.93 ± 0.92 n.u., DB + HG vs. baseline; p < 0.05). No adverse effects or discomfort were reported by men or women during experimental procedures. Independent of sex, combination of DB, HG, and OC was tolerable and resulted in decreases in resting HR and elevations in cardiac parasympathetic tone. Conclusions: These data indicate that combined DB, HG and OC are effective in altering cardiac sympathovagal balance and reducing resting HR in healthy men and women.

Abstract 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. Background Lowdose Low dose (LrtPA standarddose standard SrtPA (SrtPA deathdisability death disability death/disability Objective dosage Methods 201 2018 Results 16 50 female 654185 65 4 18 5 65.4±18. years these 30 (30% analysis s p=0.000, p0000 p p=0.000 , 0 000 (mRS p<0.000, p<0.000 (p<0.000) p=0.076, p0076 p=0.076 076 (p=0.076) p=0.021, p0021 p=0.021 021 (p=0.021) p=0.19, p019 p=0.19 19 (p=0.19) p=0.06, p006 p=0.06 06 (p=0.06) p=0.10, p010 p=0.10 10 (p=0.10) RatioINR Ratio INR p=0.18, p018 p=0.18 (p=0.18) p=0.045, p0045 p=0.045 045 (p=0.045) p<0.003, p0003 p<0.003 003 (p<0.003) (p=0.000 p=0.027. p0027 p=0.027 . 027 (p=0.027) p=0.02 p002 02 (p=0.02 OR (OR 2.21 221 2 21 95CI CI 95 1.37‒14.19, 1371419 1.37‒14.19 1 37 14 1.37‒14.19) 11.41 1141 11 41 3.98‒32.70, 3983270 3.98‒32.70 3 98 32 70 3.98‒32.70) 56.10 5610 56 8.81‒357.80, 88135780 8.81‒357.80 8 81 357 80 8.81‒357.80) 4.41 441 1.37‒14.10 1371410 0.22 022 22 0.10‒0.40 010040 40 Conclusions drugs 20 65418 6 65.4±18 (30 p000 p=0.00 00 p<0.00 (p<0.000 p007 p=0.07 07 (p=0.076 (p=0.021 p01 p=0.1 (p=0.19 p00 p=0.0 (p=0.06 (p=0.10 (p=0.18 p004 p=0.04 04 (p=0.045 (p<0.003 (p=0.00 (p=0.027 (p=0.0 2.2 9 137141 1.37‒14.1 11.4 114 398327 3.98‒32.7 7 56.1 561 8813578 8.81‒357.8 35 4.4 44 0.2 0.10‒0.4 01004 6541 65.4±1 (3 p<0.0 (p<0.00 (p=0.07 p0 p=0. (p=0.1 (p=0.04 (p=0. 2. 13714 1.37‒14. 11. 39832 3.98‒32. 56. 881357 8.81‒357. 4. 0. 0.10‒0. 0100 654 65.4± ( p<0. (p<0.0 p=0 (p=0 1371 1.37‒14 3983 3.98‒32 88135 8.81‒357 0.10‒0 010 65.4 p<0 (p<0. p= (p= 137 1.37‒1 398 3.98‒3 8813 8.81‒35 0.10‒ 01 65. p< (p<0 (p 13 1.37‒ 39 3.98‒ 881 8.81‒3 0.10 (p< 1.37 3.98 88 8.81‒ 0.1 1.3 3.9 8.81 1. 3. 8.8 8.

RESUMEN Introducción: Dosis reducidas de trombolitico (LrtPA) podrían no ser inferiores en muerte/discapacidad. Objetivo: Evaluar el porcentaje de pacientes tratados con LrtPA en nuestro centro después del ensayo ENCHANTED, y los factores asociados con el uso de esta dosis. Métodos: Estudio prospectivo de pacientes consecutivos con infarto cerebral ingresados entre junio de 2016 y noviembre de 2018. Resultados: 160 pacientes fueron tratados con trombólisis intravenosa, 50% mujeres; edad media 65,4±18,5 años. 48 casos (30%) recibieron LrtPA. En el análisis univariado, LrtPA se asoció con la edad del paciente (p=0,000), escala de Rankin modificadas (mRS) (p<0,000), hipertensión arterial (p=0,076), diabetes mellitus (p=0,021), hipercolesterolemia (p=0,19), tabaquismo (p=0,06), fibrilación auricular (p=0,10), antecedentes de enfermedad coronaria (p=0,06), tratamiento previo con antiplaquetarios (p<0,000), International Normalized Ratio-INR (p=0,18), recuento de plaquetario (p=0,045), leucoaraiosis en neuroimagen (p<0,003), contraindicaciones para el tratamiento trombolítico (p=0,000) y tratamiento endovascular (p=0,027). Las hemorragias previas relevantes fueron determinantes para el tratamiento con LrtPA. El diagnóstico al alta de imitador de accidente cerebrovascular fue significativo (p=0,02) para el tratamiento con dosis estándar. El análisis multivariado demostró que mRS (OR: 2,21; IC95% 1,37‒14,19), tratamiento antiplaquetario previo (OR: 11,41; IC95% 3,98‒32,7), contraindicaciones para trombólisis (OR: 56,1; IC95% 8,81‒357,8), leucoaraiosis (OR: 4,41; IC95% 1,37‒14,1) y un diagnóstico de imitador de accidente cerebrovascular (OR: 0,22; IC95% 0,1‒0,40) fueron asociados con la dosis recibida. Conclusiones: LrtPA está restringido al 30% de nuestros pacientes. Los criterios para tomar esta decisión se basan en variables que podrían aumentar el riesgo de hemorragia cerebral/sistémica o excluir al paciente del tratamiento con fármacos líticos. Introducción (LrtPA muertediscapacidad muerte discapacidad muerte/discapacidad Objetivo ENCHANTED Métodos 201 2018 Resultados 16 intravenosa 50 mujeres 654185 65 4 18 5 65,4±18, años 30 (30% univariado p=0,000, p0000 p p=0,000 , 0 000 (mRS p<0,000, p<0,000 (p<0,000) p=0,076, p0076 p=0,076 076 (p=0,076) p=0,021, p0021 p=0,021 021 (p=0,021) p=0,19, p019 p=0,19 19 (p=0,19) p=0,06, p006 p=0,06 06 (p=0,06) p=0,10, p010 p=0,10 10 (p=0,10) RatioINR Ratio INR p=0,18, p018 p=0,18 (p=0,18) p=0,045, p0045 p=0,045 045 (p=0,045) p<0,003, p0003 p<0,003 003 (p<0,003) (p=0,000 p=0,027. p0027 p=0,027 . 027 (p=0,027) p=0,02 p002 02 (p=0,02 estándar OR (OR 2,21 221 2 21 IC95 IC 1,37‒14,19, 1371419 1,37‒14,19 1 37 14 1,37‒14,19) 11,41 1141 11 41 3,98‒32,7, 398327 3,98‒32,7 3 98 32 7 3,98‒32,7) 56,1 561 56 8,81‒357,8, 8813578 8,81‒357,8 8 81 357 8,81‒357,8) 4,41 441 1,37‒14,1 137141 0,22 022 22 0,1‒0,40 01040 40 recibida Conclusiones cerebralsistémica sistémica líticos 20 65418 6 65,4±18 (30 p000 p=0,00 00 p<0,00 (p<0,000 p007 p=0,07 07 (p=0,076 (p=0,021 p01 p=0,1 (p=0,19 p00 p=0,0 (p=0,06 (p=0,10 (p=0,18 p004 p=0,04 04 (p=0,045 (p<0,003 (p=0,00 (p=0,027 (p=0,0 2,2 IC9 11,4 114 39832 3,98‒32, 9 56, 881357 8,81‒357, 35 4,4 44 1,37‒14, 13714 0,2 0,1‒0,4 0104 6541 65,4±1 (3 p<0,0 (p<0,00 (p=0,07 p0 p=0, (p=0,1 (p=0,04 (p=0, 2, 11, 3983 3,98‒32 88135 8,81‒357 4, 1,37‒14 1371 0, 0,1‒0, 010 654 65,4± ( p<0, (p<0,0 p=0 (p=0 398 3,98‒3 8813 8,81‒35 1,37‒1 137 0,1‒0 01 65,4 p<0 (p<0, p= (p= 39 3,98‒ 881 8,81‒3 1,37‒ 13 0,1‒ 65, p< (p<0 (p 3,98 88 8,81‒ 1,37 0,1 (p< 3,9 8,81 1,3 3, 8,8 1, 8,