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: 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,

ABSTRACT Introduction: Changes in ventricular geometry in hypertensive patients are influenced by 24-hour control of blood pressure, as well as its adequate decrease during nighttime. Objective: To describe the left ventricle geometric patterns in patients with or without nocturnal hypertension. Method: An ambulatory blood pressure monitoring (ABPM) and an echocardiogram were performed on 54 patients with high blood pressure, from 2016 to 2017. The following ABPM variables were calculated: average and pressure loads of daytime, nighttime, and 24-hour, as well as circadian pattern. In the echocardiogram, the diameters, the interventricular septum and the left ventricular posterior wall were measured; its mass and mass index were calculated, as well as determined its geometric and diastolic function patterns. Results: The average age was 57.4%±14.1 years old. Females (57.4%) and white skin color (59.3%) predominated. Waking and nocturnal hypertension were found in 38.9% and 51.9% respectively, and the altered dipper phenomenon was found in 68.5% of the patients, significantly associated with increased nocturnal blood pressure (p=0.001). The interventricular septum was considerably higher in patients with nocturnal hypertension when compared to the group without it (11.1±2.2 vs. 9.6±1.4 mm; p=0.006). Altered geometry predominated (53.7%) at the expense of higher concentric remodeling (40.7%), without any association with nocturnal hypertension. Conclusions: Left ventricle geometric patterns behaved similarly in patients with and without nocturnal hypertension.

RESUMEN Introducción: En los cambios de la geometría ventricular en hipertensos influyen el control de la presión arterial durante las 24 horas del día, así como su descenso adecuado en el período nocturno. Objetivo: Describir los patrones geométricos del ventrículo izquierdo en pacientes con y sin hipertensión arterial nocturna. Método: Se realizó monitoreo ambulatorio de la presión arterial (MAPA) y ecocardiograma a 54 pacientes con hipertensión arterial del 2016 al 2017. Se calcularon las variables de MAPA: promedio y cargas de presión diurno, nocturno y 24 horas, y el patrón circadiano. En el ecocardiograma se midieron los diámetros, el tabique interventricular y la pared posterior del ventrículo izquierdo, se calculó su masa e índice de masa, y se determinó su patrón geométrico y de función diastólica. Resultados: La edad promedio fue 55,4±14,1 años y predominaron el sexo femenino (57,4%) y el color de la piel blanco (59,3%). La hipertensión arterial al despertar y nocturna se halló en el 38,9% y 51,9%, respectivamente, y el fenómeno dipper alterado en 68,5% de los pacientes, asociado significativamente al incremento de la presión arterial nocturna (p=0,001). El tabique interventricular fue significativamente mayor en pacientes con hipertensión arterial nocturna en comparación con el grupo que no la presentaba (11,1±2,2 vs. 9,6±1,4 mm; p=0,006). Predominó la geometría alterada (53,7%) a expensas de mayor remodelado concéntrico (40,7%), sin asociación con la hipertensión arterial nocturna. Conclusiones: Los patrones geométricos del ventrículo izquierdo se comportaron de forma similar en pacientes con y sin hipertensión arterial nocturna.

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.