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Incidencia, pronóstico y predicción de la transformación hemorrágica tras el tratamiento revascularizador del ictus
Incidence, prognosis, and prediction of haemorrhagic transformation after revascularisation for stroke
P.B. García Jurado
Autor para correspondencia
pedroblasgj@gmail.com

Autor para correspondencia.
, E. Roldán Romero, M.E. Pérez Montilla, R. Valverde Moyano, I.M. Bravo Rey, F. Delgado Acosta, F.A. Bravo-Rodríguez
Sección de Neurorradiología Diagnóstica y Terapéutica, UGC Radiodiagnóstico, Servicio de Neurología, Hospital Universitario Reina Sofía, Córdoba, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Los accidentes cerebrovasculares &#40;ACV&#41; son la segunda causa de muerte en todo el mundo&#59; en 2015 supusieron 6&#44;24 millones de muertes<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a>&#46; La European Stroke Organization y la American Heart Association&#47;American Stroke Association recomienda actualmente el tratamiento de los ictus isqu&#233;micos con tromb&#243;lisis intravenosa &#40;TIV&#41; en las 3 primeras horas con un nivel de evidencia m&#225;ximo<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">2&#44;3</span></a>&#44; y hasta 4&#44;5 h en pacientes seleccionados<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a>&#46; En cuanto al tratamiento endovascular&#44; se postula que la trombectom&#237;a mec&#225;nica&#44; sumada a un esquema de TIV bien indicado y que se haya iniciado en las primeras 4&#44;5 h es recomendable en aquellos pacientes con ictus de circulaci&#243;n anterior secundario a oclusi&#243;n de gran arteria hasta 6 h despu&#233;s del comienzo de la cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a>&#46; Igualmente&#44; la trombectom&#237;a mec&#225;nica logra altas tasas de recanalizaci&#243;n y de independencia funcional en pacientes con ictus de circulaci&#243;n posterior&#46; La hemorragia intracraneal &#40;HIC&#41; es de las complicaciones hiperagudas m&#225;s temidas tras el tratamiento revascularizador<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a> y el temor al desarrollo de la misma es una de las principales razones para denegar la terapia&#44; lo que puede empeorar el pron&#243;stico de los pacientes<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a>&#46; Las tasas de HIC oscilan considerablemente entre estudios &#40;del 2 al 30&#37;&#41;&#44; lo que se debe a la variabilidad de criterios para definirla en los distintos estudios<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">8&#44;9</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Teniendo presente el cambio tan importante que supone en el pron&#243;stico la transformaci&#243;n hemorr&#225;gica y la inconsistencia existente en la actualidad para definirla&#44; los objetivos de este trabajo son analizar la incidencia y el pron&#243;stico de las HIC en pacientes con ACV isqu&#233;mico agudo tratados mediante TIV o TE mec&#225;nico o farmacol&#243;gico en nuestro centro&#44; as&#237; como estudiar si con las variables disponibles en el momento de realizar el tratamiento revascularizador se puede predecir qu&#233; pacientes que tendr&#225;n transformaci&#243;n hemorr&#225;gica posteriormente&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes y m&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pacientes&#58;</span> se ha realizado un estudio observacional retrospectivo&#46; Se llev&#243; a cabo un muestreo consecutivo entre el 1 de enero del 2014 y el 30 de septiembre del 2016&#44; reclutando a 235 pacientes&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Fueron incluidos en el estudio aquellos pacientes mayores de 18 a&#241;os que tuvieron un ictus isqu&#233;mico agudo y fueron tratados mediante tratamiento revascularizador seg&#250;n el <span class="elsevierStyleItalic">Manual de actuaci&#243;n en la fase aguda del infarto cerebral</span> del Hospital Universitario Reina Sof&#237;a de C&#243;rdoba<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a>&#46; Se excluy&#243; a pacientes con ictus de circulaci&#243;n posterior &#40;34&#41;&#44; disecciones &#40;17&#41; o ictus secundario a &#233;mbolos s&#233;pticos &#40;1&#41;&#46; Se han excluido a estos pacientes con el objetivo de homogeneizar la muestra y poder compararla con la literatura existente&#46; En el caso particular de los ictus de circulaci&#243;n posterior&#44; est&#225; ampliamente aceptado que el manejo difiere de los ictus carot&#237;deos o de arteria cerebral media &#40;ACM&#41;&#44; de ah&#237; que no se hayan incluido en este trabajo&#46; A todos los pacientes se les realiz&#243; una TC de cr&#225;neo de control entre las primeras 22 y 36 h tras el tratamiento o antes en caso de deterioro neurol&#243;gico<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a>&#46; La muestra final analizada fue de 183 pacientes&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Registro de datos&#58;</span> se han recogido variables demogr&#225;ficas &#40;edad y sexo&#41; y factores de riesgo cerebrovasculares &#40;diabetes mellitus&#44; hipertensi&#243;n arterial&#44; fibrilaci&#243;n auricular&#44; hiperlipidemia&#44; coronariopat&#237;a previa&#44; ictus previo&#44; enfermedad vascular perif&#233;rica&#44; consumo de f&#225;rmacos anticoagulantes o antiagregantes&#44; h&#225;bito en&#243;lico y h&#225;bito tab&#225;quico&#41;&#46; Se determin&#243; el deterioro neurol&#243;gico a la llegada a Urgencias mediante la escala National Institutes of Health Stroke Scale &#40;NIHSS&#41; por parte de un facultativo especialista en neurolog&#237;a o en urgencias<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">4</span></a>&#46; Un radi&#243;logo con m&#225;s de 15 a&#241;os de experiencia en neurorradiolog&#237;a determin&#243; la escala Alberta Stroke Program Early CT Score &#40;ASPECTS&#41; en la TC de cr&#225;neo sin contraste basal<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a> y la localizaci&#243;n del trombo mediante la angio-TC de troncos supraa&#243;rticos y arterias intracraneales &#40;pudiendo ser el estudio normal&#44; estar localizado en la arteria car&#243;tida interna &#40;ACI&#41; extracraneal&#44; en la ACI terminal&#44; en el segmento M1 de la ACM&#44; en el segmento M2 de la ACM&#44; en el segmento M3 de la ACM o ser una oclusi&#243;n en t&#225;ndem&#41;&#46; Tambi&#233;n se ha recogido el tiempo transcurrido desde el comienzo de los s&#237;ntomas hasta el inicio del tratamiento&#46; En cuanto al tratamiento&#47;procedimiento efectuado&#44; se ha clasificado en TIV &#40;rt-PA&#44; 0&#44;9<span class="elsevierStyleHsp" style=""></span>mg&#47;kg hasta un m&#225;ximo de 90<span class="elsevierStyleHsp" style=""></span>mg&#41;&#44; TE mec&#225;nico&#44; TE farmacol&#243;gico &#40;urocinasa intraarterial&#44; bolo inicial de 250&#46;000 UI en 10 min y a partir de ah&#237; 1&#46;000 UI&#47;min&#44; con un m&#225;ximo de 1&#46;000&#46;000 de UI de urocinasa&#41;&#44; TE mec&#225;nico y farmacol&#243;gico conjuntamente&#44; TIV y TE mec&#225;nico conjuntamente&#44; TIV y TE farmacol&#243;gico conjuntamente&#44; TIV junto a TE mec&#225;nico y farmacol&#243;gico &#40;en las 2<span class="elsevierStyleHsp" style=""></span>&#250;ltimas combinaciones de tratamientos el l&#237;mite de urocinasa utilizado fue de 500&#46;000 UI&#41;&#44; TIV y arteriograf&#237;a sin tratamiento o arteriograf&#237;a diagn&#243;stica sin tratamiento&#46; Tambi&#233;n se evalu&#243; el grado de discapacidad al alta mediante la modified Rankin Scale &#40;escala mRS&#41; por un neur&#243;logo&#44; consider&#225;ndose invalidante si es igual o mayor a 3 puntos<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">4&#44;12</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Para definir las transformaciones hemorr&#225;gicas se consideraron aquellos casos encuadrables en cualquiera de los 6 tipos de HIC propuestos por Fiorelli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#44; considerando hemorragia parenquimatosa &#40;HP&#41; las hemorragias parenquimatosas tipo 1 &#40;PH1&#41;&#44; las hemorragias parenquimatosas tipo 2 &#40;PH2&#41;&#44; las hemorragias parenquimatosas tipo 1 &#40;PH1&#41;&#44; las hemorragias parenquimatosas a distancia tipo 1 &#40;RPH1&#41; y las hemorragias parenquimatosas a distancia tipo 2 &#40;RPH2&#41;&#46; Se han considerado tambi&#233;n casos aquellos pacientes con hemorragia subaracnoidea &#40;HSA&#41; y se han tenido en cuenta a los pacientes que han presentado extravasaci&#243;n de contraste&#44; definida como una hiperdensidad mayor de 90 Unidades Hounsfield en la TC de control<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a>&#44; ya que es el principal diagn&#243;stico diferencial de las HIC despu&#233;s de trombectom&#237;a mec&#225;nica<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a>&#46; En algunos casos se observaron varios tipos de hemorragia&#44; consider&#225;ndose ambos tipos para catalogarlos&#44; por lo que un paciente puede tener diferentes tipos de hemorragia&#46; Las im&#225;genes de TC de control han sido analizadas por 2<span class="elsevierStyleHsp" style=""></span>radi&#243;logos de 5 y 3 a&#241;os de experiencia de forma independiente y en caso de discrepancias se han revisado junto a un tercer radi&#243;logo con m&#225;s de 15 a&#241;os de experiencia en neurorradiolog&#237;a&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">M&#233;todo estad&#237;stico&#58;</span> para identificar los predictores de HIC y de HP se ha realizado un an&#225;lisis univariante utilizando el test de la chi al cuadrado y el test exacto de Fisher para las variables cualitativas y el test de la t de Student para variables cuantitativas&#46; Junto con este primer an&#225;lisis se han modelado las 2<span class="elsevierStyleHsp" style=""></span>variables dependientes &#40;HIC y HP&#41; mediante una recta de regresi&#243;n log&#237;stica binaria&#46; Para llegar a esta recta de regresi&#243;n se han analizado las variables independientes que forman parte de la recta&#44; para que formasen parte deb&#237;an tener relaci&#243;n con las variables dependientes&#46; Esto se ha estudiado mediante tablas de contingencia junto con el test de la chi al cuadrado&#44; tomando como nivel cr&#237;tico 0&#44;1&#46; Una vez obtenido el conjunto de variables independientes que est&#225;n relacionadas con las variables dependientes&#44; se ha realizado el an&#225;lisis de regresi&#243;n log&#237;stica binaria con el m&#233;todo introductivo&#44; del cual hemos obtenido la recta de regresi&#243;n&#59; para validar esta recta de regresi&#243;n hemos realizado los coeficientes de R2 de Cox y Snell y R2 de Nagelkerke&#44; junto con el porcentaje de acierto del modelo&#44; siendo este &#250;ltimo el valor m&#225;s importante para validar el modelo&#44; teniendo presente que se desaconseja tomar aquellas rectas que tenga un porcentaje menor del 50&#37;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Del mismo modo que se ha descrito&#44; se han dise&#241;ado otros modelos de regresi&#243;n log&#237;stica binaria para determinar el pron&#243;stico y la mortalidad de la HIC y de la HP&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Para efectuar este an&#225;lisis se ha utilizado el paquete SPSS 23 para Windows&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">Un total de 183 pacientes cumplieron los criterios de inclusi&#243;n de este estudio&#46; La edad media de la muestra fue de 67 &#177; 12 a&#241;os&#44; siendo el 63&#37; hombres&#46; La media de la escala NIHSS a su llegada fue de 14 &#177; 5 puntos y la media de la escala ASPECTS fue de 8&#44;4 &#177; 1&#44;4 puntos&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Respecto a la angio-TC de troncos supraa&#243;rticos y arterias intracraneales&#44; el 22&#37; de los estudios fueron normales&#44; en el 12&#37; el trombo estaba localizado en la ACI extracraneal&#44; en el 12&#37; en la ACI terminal&#44; en el 31&#37; en el segmento M1 de la ACM&#44; en el 8&#37; en el segmento M2 de la ACM&#44; en el 2&#37; en el segmento M3 de la ACM y en el 14&#37; puso de manifiesto una oclusi&#243;n en t&#225;ndem&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En cuanto al tratamiento&#47;procedimiento efectuado&#44; al 35&#37; se le realiz&#243; TIV&#44; al 23&#37; TE mec&#225;nico&#44; al 1&#37; TE farmacol&#243;gico&#44; al 3&#37; TE mec&#225;nico y farmacol&#243;gico conjunto&#44; al 27&#37; TIV y TE mec&#225;nico conjuntamente&#44; al 3&#37; TIV y TE farmacol&#243;gico conjuntamente&#44; al 4&#37; TIV junto con TE mec&#225;nico y farmacol&#243;gico&#44; al 4&#37; se le administr&#243; TIV y se le realiz&#243; arteriograf&#237;a sin ning&#250;n procedimiento terap&#233;utico endovascular&#44; y al 1&#37; se le realiz&#243; &#250;nicamente arteriograf&#237;a sin ning&#250;n procedimiento endovascular&#46; El tiempo medio transcurrido desde el comienzo de la sintomatolog&#237;a hasta la aplicaci&#243;n del tratamiento fue de 174&#44;2 &#177; 81&#44;8 min&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">El 31&#44;1&#37; de los pacientes sufrieron transformaci&#243;n hemorr&#225;gica&#44; siendo el 16&#44;4&#37; HP y el 14&#44;2&#37; PH2&#46; En cuanto a los infartos hemorr&#225;gicos predominaron los infartos hemorr&#225;gicos tipo 2&#44; suponiendo el 8&#44;7&#37;&#46; Si utilizamos el concepto de HIC sintom&#225;tica&#44; entendiendo por tal la HIC que se acompa&#241;a de deterioro neurol&#243;gico &#40;al menos 4 puntos en la escala NIHSS&#41;&#44; la tasa es del 10&#44;9&#37;&#44; siendo el 80&#37; de estos casos PH2&#46; En cuanto al tratamiento&#44; el 14&#37; de los pacientes que recibieron TIV&#44; tuvieron HIC &#40;6&#37; HIC sintom&#225;tica&#41;&#59; y el 41&#37; de los que recibieron TE con&#47;sin TIV tambi&#233;n presentaron HIC &#40;13&#37; HIC sintom&#225;tica&#41;&#46; La presencia de HSA se dio en el 3&#44;2&#37; y siempre asociada a un infarto hemorr&#225;gico&#46; En el 1&#44;6&#37; de los pacientes se observ&#243; extravasaci&#243;n de contraste&#44; tambi&#233;n asociada en todos los casos a infartos hemorr&#225;gicos&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El 45&#44;9&#37; de los pacientes fueron dados de alta con un valor de la escala mRS invalidante&#46; De los pacientes que recibieron TIV&#44; 16 &#40;25&#37;&#41; fueron dados de alta con un valor de mRS invalidante&#44; habiendo tenido HIC 4 &#40;6&#37;&#41;&#46; De los pacientes tratados mediante TE con&#47;sin TIV&#44; 68 &#40;58&#37;&#41; fueron dados de alta con un valor de la escala mRS invalidante&#44; habiendo tenido HIC 33 &#40;28&#37;&#41;&#46; La tasa de mortalidad global ha sido del 16&#44;9&#37;&#46; De los pacientes que recibieron TIV&#44; 4 &#40;6&#37;&#41; fallecieron&#44; 2 &#40;3&#37;&#41; tuvieron HIC&#46; De los pacientes tratados mediante TE con&#47;sin TIV&#44; 27 &#40;23&#37;&#41; fallecieron y 16 &#40;14&#37;&#41; tuvieron HIC&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> resume el an&#225;lisis univariante de los factores predictores de cualquier HIC&#46; En el modelo de regresi&#243;n log&#237;stica binaria &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#44; el TE mec&#225;nico &#40;OR 3&#44;3 &#91;1&#44;42-7&#44;63&#93;&#44; p &#61; 0&#44;005&#41; y la TIV junto con TE mec&#225;nico &#40;OR 3&#44;39 &#91;1&#44;52-7&#44;56&#93;&#44; p &#61; 0&#44;003&#41; han sido factores predictores independientes de HIC&#44; mientras que la escala ASPECTS &#40;OR 0&#44;71 &#91;0&#44;55-0&#44;91&#93;&#44; p &#61; 0&#44;007&#41; se ha asociado independientemente con menor riesgo de HIC&#46; El modelo creado para predecir HIC tiene un porcentaje de acierto del 72&#44;4&#37;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> se muestran los resultados del an&#225;lisis univariante de los factores predictores de las HP&#46; En el modelo de regresi&#243;n log&#237;stica binaria &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#44; la edad &#40;OR 1&#44;07 &#91;1&#44;02-1&#44;13&#93;&#44; p &#61; 0&#44;006&#41; y la localizaci&#243;n del trombo en la ACI terminal &#40;OR 4&#44;03 &#91;1&#44;35-11&#44;99&#93;&#44; p &#61; 0&#44;012&#41; han sido factores predictores independientes de HP&#44; mientras que haber recibido TIV &#40;OR 0&#44;24 &#91;0&#44;08-0&#44;68&#93;&#44; p &#61; 0&#44;008&#41; se ha asociado independientemente con menor riesgo de HP en nuestro modelo&#46; El modelo creado para predecir HP tiene un porcentaje de acierto del 80&#44;1&#37;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Tras controlar por todas las variables recogidas&#44; las HIC no se han asociado con valores invalidantes de la escala mRS al alta ni a mayor mortalidad&#46; Tras ajustar por todas las variables recogidas&#44; las HP s&#237; se han asociado con valores invalidantes de la escala mRS &#40;OR 3&#44;2 &#91;1&#44;17-8&#44;76&#93;&#44; p &#61; 0&#44;02&#41; y a mayor mortalidad &#40;OR 5&#44;06 &#91;1&#44;65-15&#44;5&#93;&#44; p &#61; 0&#44;005&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0090" class="elsevierStylePara elsevierViewall">La diferente metodolog&#237;a de los trabajos publicados tanto al definir la transformaci&#243;n hemorr&#225;gica como al seleccionar los pacientes dificulta el an&#225;lisis y extrapolaci&#243;n de los resultados obtenidos&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Tasa de transformaci&#243;n hemorr&#225;gica</span><p id="par0095" class="elsevierStylePara elsevierViewall">La definici&#243;n de HIC posreperfusi&#243;n a&#250;n no ha sido estandarizada y ninguna de las diferentes definiciones existentes permite predecir con certeza la mortalidad y el resultado<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a>&#46; Adem&#225;s&#44; muchos pacientes con ACV severos&#44; y en particular los que se someten a TE&#44; pueden requerir sedaci&#243;n&#44; lo que dificulta la correcta valoraci&#243;n neurol&#243;gica<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a>&#46; Estos 2<span class="elsevierStyleHsp" style=""></span>argumentos han motivado que se haya utilizado un concepto de transformaci&#243;n hemorr&#225;gica puramente radiol&#243;gico&#44; al igual que en el estudio ECASS I<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a>&#44; en lugar de una definici&#243;n cl&#237;nico-radiol&#243;gica&#44; con pleno conocimiento de que ello implica tasas de HIC mayores aunque no necesariamente peor pron&#243;stico&#46; La tasa de transformaci&#243;n hemorr&#225;gica de la muestra ha sido del 31&#44;1&#37;&#44; en caso de que se considere el deterioro neurol&#243;gico la tasa es del 10&#44;9&#37;&#59; esto coincide con lo referido por Seet y Rabinstein<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a> cuando concluyen que la variaci&#243;n existente en la literatura sobre las tasas de transformaci&#243;n hemorr&#225;gica podr&#237;a estar justificada por los distintos criterios utilizados para definirla&#46; Atendiendo al tipo de tratamiento&#44; el 14&#37; de los pacientes que recibieron TIV tuvieron cualquier tipo de HIC y el 41&#37; de los pacientes que recibieron TE con&#47;sin TIV presentaron HIC&#46; Estas tasas son similares a las publicadas recientemente en un metaan&#225;lisis en el que se compar&#243; a 1&#46;320 pacientes que recibieron tratamiento m&#233;dico &#40;tasa de HIC 19&#37;&#41; y 1&#46;499 pacientes tratados mediante TE &#40;tasa de HIC 35&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Factores asociados con la transformaci&#243;n hemorr&#225;gica</span><p id="par0100" class="elsevierStylePara elsevierViewall">Identificar pacientes con alto riesgo de HIC podr&#237;a permitir adoptar medidas precoces para prevenirla<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a>&#44; habi&#233;ndose propuesto algunas estrategias&#44; como controlar estrechamente la presi&#243;n arterial<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a>&#46; En este sentido&#44; el principal objetivo de este trabajo ha sido tratar de determinar factores predictores de HIC y HP&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En nuestro trabajo&#44; el TE mec&#225;nico y la TIV previa al TE mec&#225;nico han sido factores predictores independientes de HIC&#44; mientras que la escala ASPECTS se ha asociado independientemente a menor riesgo de HIC&#46; Nogueira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a> encontraron como predictores independientes de HIC en 1&#46;122 pacientes tratados mediante TE la diabetes mellitus&#44; el TE mec&#225;nico y la escala NIHSS&#46; Existen diferencias entre las distintas investigaciones publicadas que han tratado de determinar factores predictores de HIC sintom&#225;tica tras TIV<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">19&#44;20</span></a> y nuestro estudio&#44; fundamentalmente por la potencia estad&#237;stica y porque nosotros hemos incluido a pacientes tratados mediante tratamiento m&#233;dico y TE&#46; Un valor elevado en la escala ASPECTS se ha asociado a menor probabilidad de transformaci&#243;n hemorr&#225;gica&#44; lo cual es razonable&#44; ya que a mayor ASPECTS se presupone menor probabilidad de complicaciones<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a>&#46; Dada la controversia existente en la actualidad sobre si la TIV previa al TE mec&#225;nico incrementa o no la probabilidad de HIC<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a>&#44; es interesante rese&#241;ar que ha resultado ser el factor independiente predictor de HIC m&#225;s importante del modelo&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Factores asociados a las hemorragias parenquimatosas</span><p id="par0110" class="elsevierStylePara elsevierViewall">Algunos autores consideran la transformaci&#243;n hemorr&#225;gica tan solo si la hemorragia documentada por TC es una HP<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a>&#44; de ah&#237; la relevancia de analizar individualmente a los pacientes con HP&#46; Al analizar las HP&#44; la edad y la localizaci&#243;n del trombo en la ACI terminal han sido factores predictores independientes de HP&#59; mientras que haber recibido TIV exclusivamente se ha asociado independientemente con menor riesgo de HP&#46; Existe una fuerte evidencia sobre las variables que implican mayor riesgo de HP tras TIV &#40;mayor edad&#44; valores altos en la escala NIHSS&#44; cifras de presi&#243;n arterial sist&#243;lica elevada&#44; g&#233;nero masculino&#44; largo per&#237;odo transcurrido entre el comienzo de los s&#237;ntomas y la implementaci&#243;n del tratamiento&#44; y el consumo de aspirina&#41;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">20&#44;23</span></a>&#46; Sin embargo&#44; a&#250;n no hay suficiente evidencia sobre la HP tras TE<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">12&#44;22</span></a>&#46; Para Nogueira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a> son factores predictores independientes de HP tras TE&#58; el TE farmacol&#243;gico&#44; la FA y la escala NIHSS&#44; mientras que para Kaesmacher et al&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a> son el tiempo transcurrido desde que comienza la sintomatolog&#237;a hasta que se aplica el tratamiento&#44; la escala ASPECTS y el ictus del despertar&#46; Es evidente la variabilidad existente&#44; por lo que ser&#237;an &#250;tiles nuevos trabajos prospectivos que analicen factores asociados y predictores de HIC tras TE&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Pron&#243;stico y mortalidad</span><p id="par0115" class="elsevierStylePara elsevierViewall">Tras controlar por todas las variables recogidas&#44; las HIC en general no se han asociado a valores invalidantes de la escala mRS al alta ni a mayores tasas de mortalidad&#44; lo cual s&#237; ha ocurrido con las HP&#46; Estos resultados ponen de manifiesto la relevancia cl&#237;nica de las HP&#44; en concordancia con lo referido anteriormente&#44; y hacen que nos decantemos por una definici&#243;n de HIC con criterios m&#225;s restrictivos&#46; No obstante&#44; hay trabajos que cuestionan la naturaleza &#171;benigna&#187; de los infartos hemorr&#225;gicos tanto tras TIV<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">24</span></a> como tras TE<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">12&#44;22</span></a>&#46; Futuros trabajos en esta l&#237;nea podr&#237;an permitir estandarizar el concepto de HIC&#44; ya que en la actualidad no est&#225; claro si se debe utilizar una definici&#243;n conservadora que incluya los infartos hemorr&#225;gicos y las HIC asintom&#225;ticas o si&#44; por el contrario&#44; se deben utilizar criterios m&#225;s restrictivos&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Limitaciones</span><p id="par0120" class="elsevierStylePara elsevierViewall">Este trabajo es un estudio observacional retrospectivo y presenta limitaciones&#46; En primer lugar&#44; hemos incluido a pacientes tratados mediante tratamiento m&#233;dico&#44; TE y tratamiento combinado&#44; mientras que numerosos trabajos se centran exclusivamente en un tipo de tratamiento en concreto&#46; En segundo lugar&#44; el hecho de incluir a pacientes tratados mediante tratamiento m&#233;dico no ha permitido valorar la revascularizaci&#243;n&#44; por ejemplo&#44; mediante la escala modified Thrombolysis In Cerebral Infarction &#40;mTICI&#41;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a>&#46; En tercer lugar&#44; puede existir un sesgo de selecci&#243;n&#44; ya que algunos pacientes tratados mediante TE o tratamiento combinado fueron pacientes que o estaban fuera del per&#237;odo recomendado para recibir TIV o que tras la TIV no mostraron mejor&#237;a&#44; por lo que a priori podr&#237;an ser considerados ictus m&#225;s severos y con peor pron&#243;stico&#46; No obstante&#44; consideramos que&#44; a pesar de estas limitaciones&#44; la muestra es lo suficientemente representativa y amplia como para responder a los objetivos planteados&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusiones</span><p id="par0125" class="elsevierStylePara elsevierViewall">Conocer los factores predictores y las consecuencias de las HIC tras el tratamiento revascularizador en el ictus isqu&#233;mico agudo es esencial para identificar precozmente a los pacientes que las pueden presentar e implementar estrategias de prevenci&#243;n&#46; Los datos de este trabajo indican que las HIC en general no se asocian a peor pron&#243;stico ni a mayor mortalidad&#44; lo que s&#237; ocurre con las HP&#46; Por otro lado&#44; el TE mec&#225;nico y la TIV previa al TE mec&#225;nico han sido factores predictores independientes de HIC&#44; mientras que valores altos de la escala ASPECTS se han asociado independientemente con menor riesgo de HIC&#46; En el caso de las HP&#44; la edad y la localizaci&#243;n del trombo en la ACI terminal han sido factores predictores independientes de HP&#44; mientras que haber recibido TIV exclusivamente se ha asociado independientemente a menor riesgo de presentarla&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0130" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Tasa de transformaci&#243;n hemorr&#225;gica"
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              "titulo" => "Factores asociados con la transformaci&#243;n hemorr&#225;gica"
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              "titulo" => "Factores asociados a las hemorragias parenquimatosas"
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    "fechaRecibido" => "2017-11-09"
    "fechaAceptado" => "2018-04-15"
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          "palabras" => array:6 [
            0 => "Hemorragia intracraneal"
            1 => "Ictus isqu&#233;mico agudo"
            2 => "Pron&#243;stico"
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            0 => "Intracranial haemorrhage"
            1 => "Acute ischaemic stroke"
            2 => "Prognosis"
            3 => "Haemorrhagic transformation"
            4 => "Endovascular treatment"
            5 => "Intravenous thrombolysis"
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    "resumen" => array:2 [
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La transformaci&#243;n hemorr&#225;gica es una complicaci&#243;n importante del ictus isqu&#233;mico agudo &#40;IIA&#41;&#46; El prop&#243;sito del trabajo es analizar el impacto cl&#237;nico y los factores predictores de las hemorragias intracraneales &#40;HIC&#41; tras terapia revascularizadora&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis retrospectivo monoc&#233;ntrico de 235 pacientes con IIA tratados mediante tromb&#243;lisis intravenosa &#40;TIV&#41; o tratamiento endovascular &#40;TE&#41;&#46; Se ha realizado un modelo de regresi&#243;n log&#237;stica binaria para determinar los factores asociados con las HIC&#44; las hemorragias parenquimatosas &#40;HP&#41;&#44; la escala mRS y la mortalidad&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De los 183 pacientes incluidos&#44; 57 tuvieron HIC &#40;30 HP&#41;&#46; El TE mec&#225;nico &#40;OR 3&#44;3 &#91;1&#44;42-7&#44;63&#93;&#44; p &#61; 0&#44;005&#41; y la TIV junto con TE mec&#225;nico &#40;OR 3&#44;39 &#91;1&#44;52-7&#44;56&#93;&#44; p &#61; 0&#44;003&#41; se han asociado a mayor riesgo de HIC&#44; mientras que valores altos de ASPECTS &#40;OR 0&#44;71 &#91;0&#44;55-0&#44;91&#93;&#44; p &#61; 0&#44;007&#41; se han asociado a menor riesgo&#46; Mayor edad &#40;OR 1&#44;07 &#91;1&#44;02-1&#44;13&#93;&#44; p &#61; 0&#44;006&#41; y la oclusi&#243;n de la car&#243;tida interna terminal &#40;OR 4&#44;03 &#91;1&#44;35-11&#44;99&#93;&#44; p &#61; 0&#44;012&#41; han sido factores predictores de HP&#44; mientras que haber recibido TIV exclusivamente &#40;OR 0&#44;24 &#91;0&#44;08-0&#44;68&#93;&#44; p &#61; 0&#44;008&#41; se ha asociado con menor riesgo&#46; Solo las HP se han asociado a valores invalidantes de mRS &#40;OR &#61; 3&#44;2 &#91;1&#44;17-8&#44;76&#93;&#44; p &#61; 0&#44;02&#41; y mayor mortalidad &#40;OR 5&#44;06 &#91;1&#44;65-15&#44;5&#93;&#44; p &#61; 0&#44;005&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Una mejor comprensi&#243;n de los factores predictores de HIC&#44; mRS y mortalidad puede permitir una mejor selecci&#243;n de pacientes y tratamientos&#46;</p></span>"
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          0 => array:2 [
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            "titulo" => "M&#233;todos"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Haemorrhagic transformation is a major complication of acute ischaemic stroke &#40;AIS&#41;&#46; We sought to determine the predictors and clinical impact of intracranial haemorrhage &#40;ICH&#41; after revascularisation therapy&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We conducted a retrospective&#44; single-centre study including 235 patients with AIS who underwent intravenous recombinant tissue plasminogen activator &#40;IV-rtPA&#41; therapy and&#47;or endovascular treatment&#46; A binary logistic regression model was used to determine the variables associated with ICH&#44; parenchymal haematomas &#40;PH&#41;&#44; modified Rankin Scale &#40;mRS&#41; scores&#44; and mortality&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">ICH was detected in 57 &#40;30 with PH&#41; of 183 patients included&#46; Mechanical thrombectomy&#44; either alone &#40;OR 3&#46;3 &#91;1&#46;42-7&#46;63&#93;&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;005&#41; or in combination with IV-rtPA &#40;OR 3&#46;39 &#91;1&#44;52-7&#46;56&#93;&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;003&#41;&#44; was associated with higher risk of ICH&#44; while higher Alberta Stroke Program Early CT scores &#40;OR 0&#46;71 &#91;0&#46;55-0&#46;91&#93;&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;007&#41; were associated with lower risk&#46; Patients with older age &#40;OR 1&#46;07 &#91;1&#46;02-1&#46;13&#93;&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;006&#41; and occlusion of the terminal branch of the internal carotid artery &#40;OR 4&#46;03 &#91;1&#46;35-11&#46;99&#93;&#44; <span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;012&#41; had a higher risk of PH&#44; while the use of IV-rtPA alone &#40;OR 0&#46;24 &#91;0&#46;08-0&#46;68&#93;&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;008&#41; was associated with lower risk of PH&#46; Only PH was associated with disability as measured by the mRS &#40;OR 3&#46;2 &#91;1&#46;17-8&#46;76&#93;&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;02&#41; and higher mortality &#40;OR 5&#46;06 &#91;1&#46;65-15&#46;5&#93;&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;005&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Greater understanding about the predictors of ICH&#44; mRS scores&#44; and mortality could enable better selection of patients and treatments&#46;</p></span>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Im&#225;genes de TC de cr&#225;neo basales realizadas en las primeras 36 h tras tratamiento revascularizador&#46; a&#41; Infarto hemorr&#225;gico tipo 1&#58; peque&#241;as petequias en la periferia del infarto&#46; b&#41; Infarto hemorr&#225;gico tipo 2&#58; petequias confluentes en el &#225;rea del infarto que no ejercen efecto masa&#46; c&#41; Hemorragia parenquimatosa tipo 1&#58; sangre en &#60; 30&#37; del &#225;rea de infarto&#44; que no ejerce efecto masa&#46; d&#41; Hemorragia parenquimatosa tipo 2&#58; hemorragia parenquimatosa abierta al sistema ventricular con sangre en m&#225;s del 30&#37; del &#225;rea infartada y evidente efecto masa&#46; e&#41; Hemorragia parenquimatosa a distancia tipo 1&#58; hemorragia de volumen peque&#241;o sin relaci&#243;n con el &#225;rea infartada &#40;territorio arteria cerebral media izquierda&#41;&#46; f&#41; Infarto hemorr&#225;gico tipo 1 &#43; hemorragia subaracnoidea &#43; contraste&#58; peque&#241;as petequias en la periferia del infarto&#44; sangre en espacios subaracnoideos y contraste&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">HI1&#58; peque&#241;as petequias en la periferia del infarto&#46; HI2&#58; petequias confluentes en el &#225;rea del infarto sin efecto masa&#46; PH1&#58; sangre en menos del 30&#37; del &#225;rea de infarto y puede tener ligero efecto masa&#46; PH2&#58; sangre en m&#225;s del 30&#37; del &#225;rea infartada con efecto masa evidente&#46; RPH1&#58; hemorragia de volumen peque&#241;o-mediano sin relaci&#243;n con el infarto y puede tener ligero efecto masa&#46; RPH2&#58; hemorragia extensa confluente sin relaci&#243;n con el infarto y con efecto masa evidente&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">HI1&#58; infarto hemorr&#225;gico tipo 1&#59; HI2&#58; infarto hemorr&#225;gico tipo 2&#59; PH1&#58; hemorragia parenquimatosa tipo 1&#59; PH2&#58; hemorragia parenquimatosa tipo 2&#59; RPH1&#58; hemorragia parenquimatosa a distancia tipo 1&#59; RPH2&#58; hemorragia parenquimatosa a distancia tipo 2&#46;</p>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">En &#225;rea infartada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peque&#241;asHI1ConfluentesHI2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 30&#37; &#8595; masaPH1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#37; &#8593; masaPH2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fuera del &#225;rea infartada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peque&#241;a o mediana&#8595; masaRPH1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grande&#8593; masaRPH2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cualquier hemorragia intracraneal &#40;n &#61; 57&#41;n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No hemorragia&#40;n &#61; 126&#41;n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor de p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Demogr&#225;ficas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Edad &#40;a&#241;os&#41; &#40;media &#177; DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#177; 11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#177; 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujeres&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NIHSS &#40;media &#177; DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#177; 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#177; 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ASPECTS &#40;media &#177; DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;8 &#177; 1&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;6 &#177; 1&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tiempo hasta tratamiento &#40;min&#41; &#40;media &#177; DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">175 &#177; 90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">174 &#177; 78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Factores de riesgo cerebrovasculares</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipertensi&#243;n arterial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81 &#40;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fibrilaci&#243;n auricular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hiperlipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Coronariopat&#237;a previa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;07<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ictus previo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;75<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad vascular perif&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anticoagulantes orales&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antiagregantes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alcohol&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tabaco&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Localizaci&#243;n trombo</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACI extracraneal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACI terminal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACM M1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACM M2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACM M3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;23<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T&#225;ndem&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TIV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TE mec&#225;nico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TE farmacol&#243;gico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TE mec&#225;nico y TE farmacol&#243;gico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TIV y TE mec&#225;nico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TIV y TE mec&#225;nico y TE farmacol&#243;gico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66 &#177; 12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;06&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujeres&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NIHSS &#40;media &#177; DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#177; 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#177; 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#44;9 &#177; 1&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;6 &#177; 1&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">176 &#177; 99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">174 &#177; 78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Factores de riesgo cerebrovasculares</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipertensi&#243;n arterial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20 &#40;67&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">81 &#40;64&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fibrilaci&#243;n auricular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hiperlipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">55 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Coronariopat&#237;a previa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;02<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ictus previo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;69<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad vascular perif&#233;rica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anticoagulantes orales&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;31<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antiagregantes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;21&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alcohol&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;53<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tabaco&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;32&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Localizaci&#243;n trombo</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;008&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACI extracraneal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACI terminal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;08<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACM M1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;83&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACM M2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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ISSN: 02134853
Idioma original: Español
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