Effect of combined acetylsalicylic acid and statins treatment on intracranial aneurysm rupture.

BACKGROUND: Acetylsalicylic acid (ASA) and statins have been identified as potentially reducing the risk of intracranial aneurysms (IA) rupture. We aim to determine the effect of this drugs on the risk of rupture of IA. PATIENTS AND METHODS: We performed a retrospective cohort study from a prospective database of patients with IA treated in our institution between January 2013 and December 2018. Demographics, previous oral treatments, presence of multiple aneurysms, size of aneurysm, lobulation, location and morphology of the aneurysms were recorded. Patients were dichotomized as ruptured and unruptured IA. RESULTS: A total of 408 IA were treated, of which 283 (68.6%) were in women. The median age was 53, 194 (47.5%) were ruptured IA. 38 patients (9.3%) were receiving ASA and 84 (20.6%) were receiving statins at the moment of the IA diagnosis. In the multivariable regression analysis, ASA plus statin use and multiple aneurysms were independently associated with unruptured IA (OR 5.01, 95% CI, 1.37-18.33, P = 0.015 and OR 2.72, 95% CI 1.68-4.27, P<0.001, respectively). Whereas, lobulated wall aneurysm and PComA/AComA location were inversely and independently associated with unruptured IA condition (OR 0.34, 95% CI 0.21-0.55, P<0.001 and OR 0.37, 95% CI 0.23-0.60, P<0.001, respectively). However, ASA and statins in monotherapy were not independently associated with unruptured IA condition. CONCLUSIONS: In our study population ASA plus statins treatment is independently associated with unruptured IA. Larger and prospective studies are required to explore this potential protective effect against IA rupture.

Impact of general anesthesia on posterior circulation large vessel occlusions after endovascular thrombectomy.

BACKGROUND: The impact of general anesthesia on functional outcome in patients with large vessel occlusion remains unclear. Most studies have focused on anterior circulation large vessel occlusion; however, little is known about the effect of general anesthesia in patients with posterior circulation-large vessel occlusion. METHODS: We performed a retrospective analysis from the prospective CICAT registry. All patients with posterior circulation-large vessel occlusion-and undergoing endovascular therapy between January 2016 and January 2020 were included. Demographics, baseline characteristics, procedural data, and anesthesia modality (general anesthesia or conscious sedation) were evaluated. The primary outcome was the proportion of patients with good clinical outcome (modified Rankin Scale score of 0-2) at three months. RESULTS: 298 patients underwent endovascular treatment with posterior circulation-large vessel occlusion-were included. Age, diabetes mellitus, renal insufficiency, baseline National Institutes of Health Stroke Scale score, puncture to recanalization length, ≥3 device passes, absent of successful recanalization (defined as treatment in cerebral ischemia of 3), and general anesthesia were statistically associated with poor outcome (mRS: 3-6). In the multivariable regression, general anesthesia and ≥3 device passes were independently associated with poor outcome (aOR: 3.11, (95% CI: 1.34-7.2); P = 0.01 and 3.77, (95% CI: 1.29-11.01); P = 0.02, respectively). Patients treated with general anesthesia were less likely to have a good outcome at three months compared to conscious sedation (19.7% vs. 45.1%, P < 0.001). CONCLUSIONS: In our study population, general anesthesia use is associated with poor clinical outcome in patients with posterior circulation-large vessel occlusion-treated endovascularly.

A Bibliometric Analysis of the Latin American Research on Stroke 2003-2017.

BACKGROUND: Stroke is a leading cause of mortality and disability worldwide. Research activity in Latin American countries might be the key to solving, or at least improving, the understanding of stroke-related issues in the region. Our aim was to describe and analyze the research output on stroke in Latin America. METHODS: We performed a bibliometric analysis of studies on stroke in Latin America reported from 2003 to 2017 in Scopus-indexed journals. We extracted the annual research, countries, journals, authors, institutions, citation frequency, and journal metrics. The data were quantitatively analyzed. Publication activity was adjusted to the countries by population size. Also, the results from an author and country co-occurrence analysis are presented as network visualization maps using VOSviewer. RESULTS: A total of 2298 Latin American stroke-related reports were identified, most were original research reports (72%). The number of reported studies had increased from 2003 to 2017 (P < 0.001). Brazil was the country with the greatest production with 1273 reports (55.4%), followed by Argentina and Mexico. No association was found between stroke prevalence and mortality and the scientific production of the country. Six universities and three hospitals were the most prolific institutions. A collaborative relationship was found between the United States and Brazil, Argentina, and Mexico. The intraregional collaboration of research on stroke was low among Latin American countries. CONCLUSIONS: Despite the continuous increase in research output from Latin American countries, more effort is needed to strengthen the research capacity by developing networks and collaborative research projects, ideally among the Latin American countries themselves.