MAZZON AGURTO, ENRICO
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MAZZON AGURTO, ENRICO
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emazzon@udd.cl
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57214689246

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A Chilean Experience of Telestroke in a COVID-19 Pandemic Year

2022 , Carlos Delfino , MAZZON AGURTO, ENRICO , Felipe Jurado Díaz , MUÑOZ VENTURELLI, PAULA ANDREA , BRUNSER, ALEJANDRO , Gabriel Cavada , Lorena Lara Cisternas , Diego Rocha Jiménez , Mirya Arévalo Valdivia , Diego Rojas Torres , Eloy Mansilla

<b><i>Background and Purpose:</i></b> Telemedicine for stroke patients’ care (telestroke [TS]) has grown notably in recent decades and may offer advantages during health crisis. Hospital admissions related to stroke have decreased globally during the COVID-19 pandemic, but scarce information is available regarding the effect of COVID-19 in TS. Using a population-based TS registry, we investigated the impact of the first year of the COVID-19 pandemic throughout our TS network in Santiago, Chile. <b><i>Methods:</i></b> Stroke codes evaluated after the onset of COVID-19 restrictions in Chile (defined as March 15, 2020) were compared with those evaluated in 2019. We analyzed differences between number of stroke codes, thrombolysis rate, stroke severity, and time from the stroke onset to hospital admission. <b><i>Results:</i></b> We observed that the number of stroke codes and the number of patients undergoing reperfusion therapy did not change significantly (<i>p</i> = 0.669 and 0.415, respectively). No differences were found with respect to the median time from the stroke onset to admission (<i>p</i> = 0.581) or in National Institutes of Health Stroke Scale (NIHSS) scores (<i>p</i> = 0.055). The decision-making-to-needle time was significantly shorter in the COVID-19 period (median 5 min [IQR 3–8], <i>p</i> &#x3c; 0.016), but no significant changes were found at the other times. <b><i>Conclusions:</i></b> This study demonstrates the potential of adapting TS to extreme situations such as the COVID-19 pandemic, as well as the importance of establishing networks that facilitate patient access to quality treatments.

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Effects of an Avocado-based Mediterranean Diet on Serum Lipids for Secondary Prevention after Ischemic Stroke Trial (ADD-SPISE)

2021 , Verónica V. Olavarría , CAMPODONICO GALDAMES, PAOLA ROSSANA , Valeska Vollrath , Paula von Geldern , Carolina Velásquez , Patricia Pavez , Barbara Valente , Pamela Donoso , Alexandra Ginesta , Gabriel Cavada , MAZZON AGURTO, ENRICO , NAVIA GONZALEZ, VICTOR HUGO , Matías Guzmán , Pablo Brinck , Pablo M. Lavados

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Low dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experience

2020 , BRUNSER, ALEJANDRO , MAZZON AGURTO, ENRICO , Gabriel Cavada , Eloy Mansilla , Alexis Rojo , ALMEIDA TORO, JUAN MANUEL , OLAVARRIA IANISZEWSKY, VERONICA VIVIANA , MUÑOZ VENTURELLI, PAULA ANDREA , LAVADOS GERMAIN, PABLO MANUEL

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.

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Seasonal trend of cervical artery dissection in a Chilean cohort

2019 , RECULE GONZALEZ, FRANCISCA , MAZZON AGURTO, ENRICO , DIAZ TAPIA, VIOLETA DEL CARMEN , Rocha, Diego , BRUNSER RABOVICH, ALEJANDRO MICHEL , De La Barra, Camila , Zuniga, Paulo , Dominga Garcia, Maria , Gabriel Cavada , MUÑOZ VENTURELLI, PAULA ANDREA , Zeballos, Shirley , Charaf, Yusef

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Determinantes del tiempo puerta-aguja en trombolisis endovenosa en el infarto cerebral, experiencia de un centro

2020 , BRUNSER, ALEJANDRO , MAZZON AGURTO, ENRICO , MUÑOZ VENTURELLI, PAULA ANDREA , HOPPE WIEGERING, ARNOLD JOHANNES GOTTLIEB , LAVADOS GERMAIN, PABLO MANUEL , Alexis Rojo , NAVIA GONZALEZ, VICTOR HUGO , Gabriel Cavada , OLAVARRIA IANISZEWSKY, VERONICA VIVIANA , Eloy Mansilla

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In-Hospital Acute Ischemic Stroke is Associated with Worse Outcome: Experience of a Single Center in Santiago Chile

2021 , BRUNSER RABOVICH, ALEJANDRO MICHEL , Patricia Araneda , NAVIA GONZALEZ, VICTOR HUGO , MAZZON AGURTO, ENRICO , Gabriel Cavada , MUÑOZ VENTURELLI, PAULA ANDREA , OLAVARRIA IANISZEWSKY, VERONICA VIVIANA , LAVADOS GERMAIN, PABLO MANUEL

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Diffusion-weighted imaging as predictor of acute ischemic stroke etiology

2022 , Alejandro Michel Brunser , Eloy Mansilla , NAVIA GONZALEZ, VICTOR HUGO , MAZZON AGURTO, ENRICO , Alexis Rojo , Gabriel Cavada , OLAVARRIA IANISZEWSKY, VERONICA VIVIANA , LAVADOS GERMAIN, PABLO MANUEL , MUÑOZ VENTURELLI, PAULA ANDREA

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.

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