Neurología Vascular

SmartRehab: Enhancing Stroke Recovery through Automated Telerehabilitation (P7-14.011)

Mon, 07 Apr 2025 00:00:00 GMT

SmartRehab: Enhancing Stroke Recovery through Automated Telerehabilitation (P7-14.011) Velez, Faddi Saleh; Yeung, Elton; Bonin Pinto, Camila; Ling, Tsei Mei; Alet, Matías Javier; Carbonera, Leonardo; Ciopleias, Bogdan; khan, Abdul; Law, Zhe Kang; Lotlikar, Radhika; Liu, Roxanna; So, Adrian; Chan, Yin; Poon, Gloria; Boada Robayo, Laura; Rudyk, Demian; Kiper, Pawel; Yabluchanskiy, Andriy; Savitz, Sean; Luo, Louis Objective: We tested the SmartRehab efficacy, usability, and feasibility for stroke rehabilitation across seven countries. Background: Stroke is a major cause of disability worldwide. Timely and personalized rehabilitation is critical for recovery, yet current methods are limited by medical shortages, overwhelmed healthcare systems, and insurance constraints. Telerehabilitation has emerged as a promising solution to address these gaps. The SmartRehab app, developed to tackle these issues, uses an Artificial Intelligence powered, computer vision-based pose estimation algorithm to track patient movements, providing precise performance assessment, immediate feedback, and tailored adjustments. The app operates autonomously, allowing patients to complete sessions without a physical therapist (PT) being present, while a single PT can remotely track progress and monitor dozens of patients offline at their convenience. Design/Methods: This ongoing prospective single-arm international multicenter study spans four continents, testing SmartRehab's feasibility and efficacy for post-stroke motor disability. Participants enrolled receive a 4-week automated telerehabilitation program, prescribed by PTs using the SmartRehab platform. Motor improvements are assessed with the Fugl-Meyer Assessment (FMA) for upper and lower extremities. Usability and satisfaction are measured using the Telehealth Usability Questionnaire (TUQ). Results: This ongoing multicenter study has enrolled 30 subjects to date, with 15 stroke survivors completing telerehabilitation (mean age 57.6±16.97; 75% male). Preliminary analysis of patients with complete FMA (n=11) revealed a statistically significant improvement in upper extremity motor function (mean change [Baseline-Follow-up: −10.8±6.8; p<0.001]) and a trend toward improvement in lower extremities (mean change: −4.571±4.9; p=0.052). Usability feedback showed high ratings on TUQ (1-poor,7-great, mean 5.87±1.1). Therapists reported high satisfaction, ease of use, and benefits for patients, while adherence rates varied across countries (19%–95%, average 48%), with lower compliance linked to technology challenges Conclusions: SmartRehab is a feasible and effective telerehabilitation platform for stroke recovery, with high user satisfaction. Significant motor function improvements were observed. Addressing technological barriers may enhance adherence and outcome

Latin America Multidisciplinary Consensus Panel on Management of Severe Bleeding in the Anticoagulated Patient

Mon, 05 May 2025 00:00:00 GMT

Latin America Multidisciplinary Consensus Panel on Management of Severe Bleeding in the Anticoagulated Patient Pontes-Neto, Octávio M.; Noble-Lugo, Alejandra; Montenegro Arenas, Ana Cristina; de Campos Guerra, Joao Carlos; Ceresetto, Jose Manuel; Rosales, Julieta Soledad; Colunga-Lozano, Luis Enrique; Meillon-Garcia, Luis Antonio; Vargas Tellez, Luis Eduardo; Dos Reis Rodrigues, Roseny; Gibler, W. Brian; Kreitzer, Natalie P. Background: Bleeding is the most important complication associated with anticoagulants. Patients experiencing bleeding while on an anticoagulation require proper risk stratification, which involves careful assessment of multiple factors, including hemodynamic stability, the origin of bleeding, and the extent of blood loss. Over the last several decades, important advances have been made in the field of anticoagulant therapy and reversal. Objectives: This manuscript provides a review of anticoagulant related hemorrhages, with particular emphasis on topics most relevant to Latin America. It offers an updated assessment of evidence-based strategies for managing major bleeding related to anticoagulation. We will also explore what happens to patients in real-life situations, where there are not specific reversal agents available. Discussion: While minor bleeding can usually be managed simply by discontinuing the anticoagulant, major bleeding is a medical emergency that may threaten life and require the administration of blood products and the utilization of specific antidotes. Fresh frozen plasma (FFP) or prothrombin complex concentrates (PCCs) can be administrated for major bleeding incidents linked to warfarin. Protamine sulfate is administrated for unfractionated heparin and partially for low-molecular-weight heparin (LMWH). Idarucizumab is the reversal agent for dabigatran, while andexanet alfa is approved for the reversal of oral factor Xa inhibitors. Conclusions: This review highlights the significance of appropriate risk stratification and management strategies for bleeding complications associated with anticoagulants. The manuscript emphasizes the need for adaptable management strategies in regions like Latin America, where resource limitations may impact the availability of specific reversal agents.

Initial Experience of Transarterial Embolization for Shoulder Musculoskeletal Pain Using an Ethiodized Oil-Based Emulsion: A Multicenter Study

Wed, 27 Aug 2025 00:00:00 GMT

Initial Experience of Transarterial Embolization for Shoulder Musculoskeletal Pain Using an Ethiodized Oil-Based Emulsion: A Multicenter Study Sapoval, Marc; Stacoffe, Nicolas; Bertoni, Hernán Gabriel; Déan, Carole; Ghelfi, Julien; Jehanno, Pascal; Gremen, Emeric; Boeken, Tom Purpose: The study reports the initial experience in transarterial embolization (TAE) using an ethiodized oil-based emulsion for patients with refractory shoulder pain, focusing on safety, pain reduction, and functional improvement. Methods: This is a retrospective, multicenter study including 23 patients treated with TAE using an ethiodized oil-based emulsion between April 2021 and May 2024. Clinical outcomes were assessed using visual analog scale (VAS) scores for pain (0-100 mm) and QuickDASH (0-100) scores (Disability of the Arm, Shoulder and Hand) for functionality. Adverse events were recorded and classified. Results: The primary etiology of shoulder pain was adhesive capsulitis (61%), followed by bursitis (39%). Median follow-up was 87 days (range: 27-1088 days). Mean VAS score decreased from 65 mm (± 22) at rest, and 82 mm (± 13) during mobilization to 30 mm (± 27) at rest, and 36 mm (± 24) during mobilization at the last follow-up (p < 0.05). Mean QuickDASH score improved from 67 (± 17) pre-procedure to 43 (± 25) post-procedure (p < 0.05). No major complications occurred, and minor adverse events included one radial artery thrombosis (4%) and one puncture site hematoma (4%). Conclusion: TAE of the shoulder using an ethiodized oil-based emulsion is safe and effective, warranting further investigation in larger studies.

EE277 Cost of Stroke in Latin America: A Multicentric Time-Driven Activity-Based Costing Study

Sun, 01 Dec 2024 00:00:00 GMT

EE277 Cost of Stroke in Latin America: A Multicentric Time-Driven Activity-Based Costing Study Dittrich, L.; Etges, A.P.; Souza, J.S.; Marcolino, M.A.Z.; Rocha, E.; Amaya, P.; Barboza, M.; Saavedra, A.G.; Hornos, G.P.; Abanto, C.; Castillo-Soto, A.L.; Llanos-Leyton, N.; Pujol Lereis, Virginia Andrea; Rodríguez Pérez, María Soledad; Alet, Matías Javier; Navia, V.; Lopez, S.; Arauz, A.; Serrano, F.; Chwal, B. Objectives Given the significant global health challenge posed by stroke, this study aims to measure stroke costs in Latin American countries by analyzing the precise costs of acute ischemic stroke and their regional variabilities using accurate microcosting techniques. Methods A comprehensive international multicenter study evaluated the direct costs of patients admitted with acute ischemic stroke from December 2021 to December 2022. Data were collected from stroke centers in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru, and Uruguay. Direct costs were assessed using a microcosting method. Factors considered included favorable outcomes (modified Rankin Scale (mRS) 0-2), clinical risk levels (age and stroke severity), and treatment interventions (medical treatment alone, intravenous thrombolysis, and mechanical thrombectomy). Purchasing power parity adjustments and international dollar conversions facilitated cross-country comparisons. Descriptive analyses were performed stratified by country and Generalized Estimating Equation models assessed the relationship between clinical variables and total cost per patient. Results The study included 1,106 patients. Among them, 74% received medical treatment alone, 18% received IVT, 4% underwent MT, and 3% received combined IVT and MT. Costs increased with patients clinical risk, outcomes, and treatment options. MT incurred costs 3.1 times higher than medical treatment alone, with an incremental cost of I$20,418 per patient (p < 0.001). Treating high-risk patients incurred substantial cost increases of I$7,512 compared to medium-risk patients (p < 0.0001) and I$7,866 compared to low-risk patients (p < 0.0001). Patients in the mRS 5-6 categories had costs twice as high as those in the mRS 0-2 categories. Conclusions The study reveals disparities in stroke costs across Latin America, offering a comprehensive understanding into the economic landscape and cost variations factors, particularly in under-researched regions. Continued investment in evidence-based research and value-based care models is essential to ensure equitable access and reduce disabilities and deaths.