OLAVARRIA IANISZEWSKY, VERONICA VIVIANA
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OLAVARRIA IANISZEWSKY, VERONICA VIVIANA
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OLAVARRIA IANISZEWSKY, VERONICA VIVIANA
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v.olavarria@udd.cl
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57204794060

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Who is in the emergency room matters when we talk about door-to-needle time: a single-center experience

2023 , BRUNSER RABOVICH, ALEJANDRO MICHEL , Juan-Cristobal Nuñez , Eloy Mansilla , Gabriel Cavada , OLAVARRIA IANISZEWSKY, VERONICA VIVIANA , MUÑOZ VENTURELLI, PAULA ANDREA , LAVADOS GERMAIN, PABLO MANUEL

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. Conclusion Treatment by a SN resulted in a higher probability of treating the patient in a DTN time within 20 minutes.

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Lipid-Lowering Pretreatment and Outcome Following Intravenous Thrombolysis for Acute Ischaemic Stroke: A Post Hoc Analysis of the Enhanced Control of Hypertension and Thrombolysis Stroke Study Trial

2018 , Jatinder S. Minhas , Xia Wang , Hisatomi Arima , Philip M. Bath , Laurent Billot , Joseph P. Broderick , Geoffrey A. Donnan , Jong S. Kim , LAVADOS GERMAIN, PABLO MANUEL , Tsong-Hai Lee , Sheila Cristina Ouriques Martins , Verónica V. Olavarría , Jeyaraj D. Pandian , Octávio Marques Pontes-Neto , Stefano Ricci , Shoichiro Sato , Vijay K. Sharma , Nguyen H. Thang , Ji-Guang Wang , Mark Woodward , John Chalmers , Craig S. Anderson , Thompson G. Robinson

<b><i>Background:</i></b> Debate exists as to whether statin pretreatment confers an increased risk of 90-day mortality and symptomatic intracranial haemorrhage (sICH) in acute ischaemic stroke (AIS) patients treated with intravenous thrombolysis. We assessed the effects of undifferentiated lipid-lowering pretreatment on outcomes and interaction with low-dose versus standard-dose alteplase in a post hoc subgroup ­analysis of the Enhanced Control of Hypertension and Thrombolysis Stroke Study. <b><i>Methods:</i></b> In all, 3,284 thrombolysis-eligible AIS patients (mean age 66.6 years; 38% women), with information on lipid-lowering pretreatment, were randomly assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) intravenous alteplase within 4.5 h of symptom onset. Of the total number of patients, 615 (19%) received statin or other lipid-lowering pretreatment. The primary clinical outcome was combined endpoint of death or disability (modified Rankin Scale scores 2–6) at 90 days. <b><i>Results:</i></b> Compared with patients with no lipid-lowering pretreatment, those with lipid-lowering pretreatment were significantly older, more likely to be non-Asian and more likely to have a medical history including vascular co-morbidity. After propensity analysis assessment and adjustment for important baseline variables at the time of randomisation, as well as imbalances in management during the first 7 days of hospital admission, there were no significant differences in mortality (OR 0.85; 95% CI 0.58–1.25, <i>p</i> = 0.42), or in overall ­90-day death and disability (OR 0.85, 95% CI 0.67–1.09, <i>p</i> = 0.19), despite a significant decrease in sICH among those with ­lipid-lowering pretreatment according to the European Co-operative Acute Stroke Study 2 definition (OR 0.49, 95% CI 0.28–0.83, <i>p</i> = 0.009). No differences in key efficacy or safety outcomes were seen in patients with and without lipid-lowering pretreatment between low- and standard-dose alteplase arms. <b><i>Conclusions:</i></b> Lipid-lowering pretreatment is not associated with adverse outcome in AIS patients treated with intravenous alteplase, whether assessed by 90-day death and disability or death alone.

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Low blood pressure and adverse outcomes in acute stroke: HeadPoST study explanations

2020 , Menglu Ouyang , MUÑOZ VENTURELLI, PAULA ANDREA , Laurent Billot , Xia Wang , Lili Song , Hisatomi Arima , LAVADOS GERMAIN, PABLO MANUEL , Maree L. Hackett , OLAVARRIA IANISZEWSKY, VERONICA VIVIANA , BRUNSER, ALEJANDRO , Sandy Middleton , Octavio M. Pontes-Neto , Tsong-Hai Lee , Caroline L. Watkins , Thompson Robinson , Craig S. Anderson

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Risk Factors and Diet Components Determining Adherence to the Mediterranean Diet in Acute Ischemic Stroke Patients: A Cross-Sectional Analysis of a Prospective Hospital Register Study

2022 , OLAVARRIA IANISZEWSKY, VERONICA VIVIANA , NAVIA GONZALEZ, VICTOR HUGO , MAZZON AGURTO, ENRICO , Alexis Rojo , BRUNSER, ALEJANDRO , LAVADOS GERMAIN, PABLO MANUEL

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No benefit of flat head positioning in early moderate–severe acute ischaemic stroke: a HeadPoST study subgroup analysis

2020 , BRUNSER, ALEJANDRO , Menglu Ouyang , Hisatomi Arima , Pablo M Lavados , Thompson Robinson , MUÑOZ VENTURELLI, PAULA ANDREA , Verónica V Olavarría , Laurent Billot , Marre L Hackett , Lili Song , Sandy Middleton , Octavio Pontes-Neto , Tsong-Hai Lee , Caroline Watkins , Craig S Anderson

BackgroundAlthough the Head Positioning in acute Stroke Trial (HeadPoST) showed no effect of the flat head position (FP; vs sitting up head position (SUP)) on functional outcome, we hypothesised that it could still offer benefits if commenced early in those with acute ischaemic stroke (AIS) of at least moderate severity.MethodsSubgroup analysis of HeadPoST in participants with National Institutes of Health Stroke Scale (NIHSS) scores ≥7, ≥10 and ≥14, randomised to FP or SUP <4.5 hours of AIS onset on functional outcomes defined by a shift in scores on the modified Rankin scale (mRS) and death/disability (mRS scores 3–6), and any cardiovascular serious adverse event. Logistic regression analyses were undertaken adjusted for study design and baseline risk factors.ResultsThere was no significant differential treatment effect in patient subgroups defined by increasing baseline NIHSS scores: adjusted OR and 95% CI for ordinal shift and binary (3–6) mRS scores: for NIHSS ≥7 (n=867) 0.92 (0.67 to 1.25) and 0.74 (0.52 to 1.04); NIHSS ≥ 10 (n=606) 0.80 (0.58 to 1.10) and 0.77 (0.49 to 1.19); NIHSS ≥14 (n=378) 0.82 (0.54 to 1.24) and 1.22 (0.69 to 2.14).ConclusionsEarly FP had no significant effect in patients with moderate–severe AIS.Trial registration numberNCT02162017.

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Regional variation in acute stroke care organisation

2016 , MUÑOZ VENTURELLI, PAULA ANDREA , Thompson Robinson , LAVADOS GERMAIN, PABLO MANUEL , OLAVARRIA IANISZEWSKY, VERONICA VIVIANA , Hisatomi Arima , Laurent Billot , Maree L. Hackett , Joyce Y. Lim , Sandy Middleton , Octavio Pontes-Neto , Bin Peng , Liying Cui , Lily Song , Gillian Mead , Caroline Watkins , Ruey-Tay Lin , Tsong-Hai Lee , Jeyaraj Pandian , H. Asita de Silva , Craig S. Anderson

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Stroke symptoms, risk factors awareness and personal decision making in Chile. A national survey

2022 , NAVIA GONZALEZ, VICTOR HUGO , MAZZON AGURTO, ENRICO , OLAVARRIA IANISZEWSKY, VERONICA VIVIANA , ALMEIDA TORO, JUAN MANUEL , BRUNSER, ALEJANDRO , LAVADOS GERMAIN, PABLO MANUEL , HOFFMEISTER ARCE, LORENA , MUÑOZ VENTURELLI, PAULA ANDREA

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Intravenous Thrombolysis in Patients 90 Years or Older with Moderate to Severe Acute Ischemic Stroke Increases Ambulation at Discharge and Is Safe: A Prospective Cohort Study from a Single Center in Santiago, Chile

2024 , GONZÁLEZ BREVIS, PABLO ENRIQUE , LAVADOS GERMAIN, PABLO MANUEL , André I. Aguirre , BRUNSER RABOVICH, ALEJANDRO MICHEL , OLAVARRIA IANISZEWSKY, VERONICA VIVIANA

<b><i>Introduction:</i></b> The World Health Organization predicts that the global population aged 60 years and older will double by 2050, leading to a significant rise in the public health impact of acute ischemic stroke (AIS). Existing stroke guidelines do not specify an upper age limit for the administration of intravenous thrombolysis (IVT), although some suggest a relative exclusion criterion in patients aged ≥80 in the 3–4.5-h window. Many physicians avoid treating these patients with IVT, argumenting high risk and little benefit. Our aim was to investigate the efficacy and safety of IVT treatment in patients with non-minor AIS aged ≥90, admitted to our institution. The primary efficacy endpoint was the ability to walk at discharge (mRS 0–3), and the primary safety endpoints were death and symptomatic intracranial hemorrhagic transformation (sIHT) at discharge. <b><i>Methods:</i></b> Patients with AIS aged ≥90 admitted to our center from January 2003 to December 2022 were included. They were selected if had an NIHSS ≥5, were previously ambulatory (prestroke mRS score 3 or less), and arrived within 6 h from symptom onset. Those treated or not with IVT were compared with univariate analysis. <b><i>Results:</i></b> The mean age was 93.2 (2.4) years, and 51 (73.9%) were female. The admission mRS and NIHSS were 1 (IQR 0–2) and 14 (IQR 7–22), respectively. Thrombolyzed patients had a shorter time from symptom onset to door and lower glycemia on admission. IVT was associated with a higher proportion of patients achieving mRS 0–3 at discharge (<i>p</i> = 0.03) and at 90 days (<i>p</i> = 0.04). There were no differences between groups in the risk of death (<i>p</i> = 0.55) or sIHT (<i>p</i> = 0.38). <b><i>Conclusion:</i></b> In this small sample, ambulatory patients aged ≥90 with moderate or severe AIS treated with IVT had increased odds of being able to walk independently at discharge than those not treated, without safety concerns.

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EFFECTS OF AN AVOCADO BASED MEDITERRANEAN DIET ON SERUM LIPIDS FOR SECONDARY PREVENTION AFTER ISCHEMIC STROKE TRIAL (ADD-SPISE)

2023 , CAMPODONICO GALDAMES, PAOLA ROSSANA , LAVADOS GERMAIN, PABLO MANUEL , OLAVARRIA IANISZEWSKY, VERONICA VIVIANA

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Socioeconomic and Cardiovascular Variables Explaining Regional Variations in Stroke Mortality in Chile: An Ecological Study

2011 , LAVADOS GERMAIN, PABLO MANUEL , DIAZ TAPIA, VIOLETA DEL CARMEN , Liliana Jadue , OLAVARRIA IANISZEWSKY, VERONICA VIVIANA , Daniel A. Cárcamo , DELGADO BECERRA, OROZIMBA IRIS

<i>Background:</i> Regional differences in stroke mortality rates have been described in Chile. These could be related to the distribution of cardiovascular risk factors, the quality of medical care or socioeconomic status influencing incidence or case fatality rates. Our objective was to investigate variables explaining the variability in stroke mortality rates in the different regions of Chile. <i>Methods:</i> Adjusted stroke mortality rates in different regions were calculated for the year 2003. Variables were added from three sources: the National Death Certificate Database, the National Socioeconomic Characterization Survey and the National Health Survey. A logistic regression model was used to investigate regions, demographic variables and socioeconomic variables associated with the risk of death from stroke. A linear regression model was used to study the association of socioeconomic variables and cardiovascular risk factors with the standardized mortality rate by region and the contribution of these to the variability. <i>Results:</i> A twofold increase was found in adjusted stroke mortality rates among regions. Greater risk was associated with older age, female gender and residence in regions V, VII, VIII and IX. Sixty-two percent of the regional variability rate was explained by the combined prevalence of poverty (34%), diabetes (17%), sedentarism (8%) and overweight (3%). <i>Conclusion:</i> The risk of death from stroke in Chile is associated with age, sex and living in four specific regions of the country. The majority of the increased risk in these regions is explained by the prevalence of poverty, diabetes, a sedentary lifestyle and overweight.

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