Tiempos de llegada de pacientes con ataque cerebrovascular en un hospital regional de alta complejidad / Arrival times of patients with stroke to a public hospital

Background: Stroke is a time-dependent emergency. Most patients with acute ischemic stroke are excluded from reperfusion therapies due to late consultation. Aims: To estimate the arrival times of patients with stroke to the Emergency Room (ER) of a public hospital. To identify factors associated with early consultation. Material and Methods: A convenience sample, 583 patients aged 71 ± 13 years (55% males) consulting for stroke at an emergency room was analyzed in terms of delay between onset of symptoms and arrival to the ER, demographics and etiology of stroke. Results: The admission diagnoses were ischemic stroke in 76%, intracerebral hemorrhage in 12%, transient ischemic attack in 9% and subarachnoid hemorrhage in 3%. The median time of arrival was 8 hours and 11 minutes after the onset of symptoms. Nineteen percent of consultations for ischemic stroke occurred within 3 hours of symptom onset, and 38% within 6 hours. In the logistic regression analysis, having an address near the hospital and the severity of stroke were associated with early consultation with a combined odds ratio of 5.97 (95% confidence intervals 3.23-11.04). Conclusions: There were significant differences in the arrival times of patients with stroke. Only a low proportion of patients with ischemic stroke consulted within the window for reperfusion therapies. Severe strokes and living near the hospital were associated with early consultation.

Covered stent in endovascular treatment of aortoiliac occlusive disease / 中华普通外科杂志

Objective To evaluate the use of covered stent in endovascular treatment for aortoiliac occlusive disease.Method In this study45 cases [8 women,37 men; age range,38-94 years; mean age,(61 ± 12) years] of aortoiliac occlusive disease were reviewed,28 with intermittent claudication,11 with rest pain,6 with toe gangrene,including 22 unilateral iliac artery occlusions,8 unilateral occlusions combined with contralateral stenosis and 15 aorto-bilateral iliac artery occlusions.4 cases received catheter thrombolysis therapy for 3 days before stenting and the others received directly covered stent placement.Result Procedures were successful in all cases completed including 19 cases with one side covered stent and 26 cases with kissing covered stent.Limb ischemia was significantly relieved in all patients,only one case amputated because of infection.The mean follow-up period was (12 ±4) months (6 to 21 months).All stents were patent except one occlusion at 14 months due to bad outflow.The primary patency was 97.8％.Conclusions Covered stent can bring a satisfied results and outcomes in endovascular treatment of aortoiliac occlusive disease.