title: Impact of a comprehensive stroke centre on the care of patients with acute ischaemic stroke due to cervical artery dissection.
abstract: BACKGROUND
  Cervical artery dissection (CAD) is the cause of 2% to 3% of ischaemic strokes and 10% to 25% of the ischaemic strokes in young people. Our objective is to evaluate whether implementation of a comprehensive stroke centre (CSC) improves the diagnosis and modifies the prognosis of patients with acute stroke due to CAD.
  
  
  METHODS
  Retrospective study of a registry of consecutive patients with acute stroke due to CAD. They were classified according to the period of care at our centre: pre-CSC (October 2004-March 2008, 42 months) or post-CSC (April 2008-June 2012, 51 months). We compared baseline characteristics, methods of diagnosis, treatment and outcome of these patients in both periods.
  
  
  RESULTS
  Nine patients were diagnosed with CAD in pre-CSC and 26 in post-CSC, representing 0.8% and 2.1% of all ischaemic strokes treated in each period, respectively. The diagnosis of CAD was made within the first 24 hours in 42.3% of the patients in post-CSC versus 0% in pre-CSC, by using urgent cerebral angiography as a diagnostic test in 46.2% of cases in the second period compared to 0% in the first. Both severity of stroke (median NIHSS score 11 vs. 3, P=.014) and time to neurological care (265 min vs 148, P=.056) were higher in the post-CSC period. Endovascular treatment was performed in 34.3%, and all treatments were post-CSC. The functional outcome was comparable for both periods.
  
  
  CONCLUSIONS
  Implementation of a CSC increases the frequency of the diagnosis of CAD, as well as the treatment options for these patients in the acute phase of stroke.
authors.affiliation: Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España. Electronic address: miriam.almendrote@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Almendrote
authors.affiliation: Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: M
authors.initials: M
authors.lastname: Millán
authors.affiliation: Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: L A
authors.initials: LA
authors.lastname: Prats
authors.affiliation: Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: N
authors.initials: N
authors.lastname: Pérez de la Ossa
authors.affiliation: Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: E
authors.initials: E
authors.lastname: López-Cancio
authors.affiliation: Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: M
authors.initials: M
authors.lastname: Gomis
authors.affiliation: Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: L
authors.initials: L
authors.lastname: Dorado
authors.affiliation: Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: M
authors.initials: M
authors.lastname: Hernández-Pérez
authors.affiliation: Unidad de Neurorradiología Intervencionista, Departamento de Neurociencias, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: C
authors.initials: C
authors.lastname: Hidalgo
authors.affiliation: Unidad de Neurorradiología Intervencionista, Departamento de Neurociencias, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: P
authors.initials: P
authors.lastname: García-Bermejo
authors.affiliation: Unidad de Neurorradiología Intervencionista, Departamento de Neurociencias, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: C
authors.initials: C
authors.lastname: Castaño
authors.affiliation: Institut de Diagnòstic per la Imatge, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: S
authors.initials: S
authors.lastname: Domenech
authors.affiliation: Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Dávalos
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D020215:Carotid Artery, Internal, Dissection / Q000150:complications*; D002533:Cerebral Angiography; D018450:Disease Progression; D004632:Emergency Medical Services; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Angiography; Arteriografía; Centro terciario de ictus; Cervical artery dissection; Comprehensive stroke center; Disección de arterias cervicales; Endovascular treatment; Ictus; Stroke; Systemic thrombolysis; Tratamiento endovascular; Trombólisis sistémica