Therapeutic workflow processes have been implemented and improved over the years to enable rapid response for acute ischemic stroke patients. Optimization of mechanical thrombectomy devices and techniques overcame some of the initial technical constraints; nonetheless, the implication of vessel tortuosity in procedure time and outcomes is still uncertain. We aimed to evaluate the predictors and the impact of difficult catheter access to the target occluded vessel.
Methods
This is a retrospective, single-center study. Baseline characteristics were retrieved, and adjudication of the aortic arch and cervical vasculature tortuosity was performed. The primary outcome of interest was to evaluate the factors associated with an increased puncture to clot time. Secondary outcomes included first pass, successful recanalization, and good clinical outcome.
Results
A total of 183 patients met inclusion criteria (mean age 72.0±14.5, 54.1% were women). Fifty-two patients (28.4%) had an aortic arch type 1, 58 (31.7%) type 2, and 73 (39.9%) type 3. Tortuosity was considered significant in 68 (37.1%), and 103 (57.9%) of brachiocephalic/common carotids and internal carotid arteries, respectively, and 38 (20.8%) patients had a bovine aortic arch. The mean time from puncture-to-clot access was 15.8±8.7 min, and puncture-to-recanalization was 34.5±18.5. Age, hyperlipidemia, aortic arch type III, ICA tortuosity, BC/CCA tortuosity, and BAD score demonstrated a positive correlation (p<0.05) with increased time from puncture-to-clot access. The likelihood of achieving FPE was inversely correlated to the presence of tortuosity in the ICA (p=0.02). None of the investigated anatomical factors demonstrated a correlation with functional outcomes.
Conclusion
Unfavorable vascular anatomy is associated with prolonged clot access in patients undergoing endovascular thrombectomy. The factors associated with prolonged access time included age, hyperlipidemia, type III aortic arch, and the presence of tortuosity at the cervical vasculature (BC/CCA and ICA). Non-invasive imaging evaluation may allow prompt selection of the best approach and culminate in procedure optimization.
Disclosures
G. M. Cortez: None. A. Monteiro: None. A. Nguyen: None. A. Aghaebrahim: None. E. Sauvageau: None. R. Hanel: None.
Cerebral venous and sinus thrombosis is an uncommon but potentially lethal event. Although thrombosis accounts for only 1% of all strokes, if it is left untreated patients suffer from continuing headaches, vague neurological complaints, and may even progress to coma and death. New endovascular techniques and technology allow the possibility of more aggressive thrombolysis and thrombectomy in the setting of acute thrombosis. The authors present a case of recanalization of an extensive cerebral thrombosis using a new endovascular retrieval device.
The authors describe here a unique case of contiguous, synchronous meningioma and lymphoma in the spinal column. Both tumors were present at the same vertebral level, one intradural and the other extradural. A patient presented with bilateral leg pain, acute weakness, and sensory loss in the lower extremities. Magnetic resonance imaging revealed an intradural mass at T6-7 with ambiguous boundaries relative to the thecal sac and compressing the spinal cord. The patient underwent resection of the epidural and intradural mass at T6-7. Histopathology revealed the epidural specimen to be a double-hit B-cell lymphoma and the intradural mass to be a transitional meningioma. Postoperatively, the patient did well, with an immediate return of strength and sensation. A postoperative MR image showed complete resection of the intradural mass. The authors suggest that biopsy may be prudent in patients with known systemic lymphoma presenting with a spinal lesion that has unclear boundaries relative to the thecal sac prior to commencing radiation and chemotherapy.
Recently some series have been published about the use of Onyx for the treatment of DAFVs with satisfactory results. Our aim was to describe the treatment of different types of intracranial DAVFs with transcatheter injection of Onyx through an arterial approach.
MATERIALS AND METHODS:
At the Department of Interventional Neuroradiology, Hospital Lariboisière Paris, between January 2005 and January 2010, we treated 44 DAVFs in 42 patients. All patients were initially treated by arterial injection of Onyx. The average patient age was 56 years (range, 27–86 years), and there were 17 women and 25 men treated.
RESULTS:
A total of 58 arterial pedicles were catheterized, with the middle meningeal artery representing the most common site (n = 38). The average time of injection was 30 minutes (range, 15–60 minutes), and the average amount of Onyx was 2.5 mL (range, 0.6–6.5 mL). Of the 20 fistulas with direct venous drainage into a dural sinus (types I and II), we achieved the preservation of the sinus in 7 patients. Of the 44 fistulas embolized, 8 required a second embolization treatment and 1 fistula required a third treatment. In 9 cases, a complementary treatment was performed via transvenous embolization with coils and/or open surgery. Early complications were observed in 6 patients: Four had nerve injury (facial palsy, n = 2, and neuralgia, n = 2), and 2 had complications related to extension of venous thrombosis postembolization. All 6 patients had partial or complete resolution of these symptoms.
CONCLUSIONs:
The treatment of DAVFs by intracranial arterial injection of Onyx is safe, and, in most cases, results in the occlusion of the arterial venous shunt. In DAVFs with direct sinus drainage, sinus preservation was only possible in 7 of 20 patients (35%).
The project studied the photon diffusion through turbid media with mobile phone camera. The student experiments in transmission profile imaging and pulse broadening measurement were calibrated with the same samples used in published research papers. Light sources employing HeNe laser and consumer product keychain LED were included in the project. Application to mHealth monitoring was demonstrated in the measurements of an index finger diffusion mean free path and the embedded blood vessel absorption effect. Extension to an iris response measurement was also demonstrated. The interdisciplinary project has been popular among engineering students and engineering technology students and will be a good model project for future students. Keywords— Photon diffusion; turbid media; mHealth monitoring; mobile phone camera; iris response; index finger diffusion property; blood vessel absorption effect
Socioeconomic status (SES) is a dynamic determinant factor that could predict the population's wellness in many aspects. However, there is little existing literature on how socioeconomic conditions influence ischemic stroke outcomes. This study aims to determine whether SES has any correlation with the functional outcome of ischemic stroke patients undergoing mechanical thrombectomy.
Methods
Data was retrospectively collected using the Lyerly neurosurgery center's prospectively maintained thrombectomy database. Patient-level data collected include stroke risk factors such as age, race, gender, comorbidities, infarct core volume, history of stroke, and tobacco usage. We measured the outcome of ischemic stroke using the modified Rankin Score (mRS) at 90-day post-procedure. SES was defined by a combination of the zip code median income data we collected from the 2019 U.S. Census Bureau's American Community Survey (ACS) 5-year Projection and patients' health insurance coverage. We used several multivariate analyses to plot the correlation between the outcomes and SES.
Results
Among 508 patients collected, 234 (46%) had preferred outcome (mRS ≤ 2) and 274 (54%) had poor outcome (mRS > 2). Baseline risk factors that presented a significant correlation with poor outcome included age (p < 0.001), infarct core volume (p = 0.007), hypertension (p = 0.006), atrial fibrillation (p = 0.001), and existing history of stroke (p = 0.012). After adjusting for nuisance variables, unfavorable functional outcome (p < 0.001) was more likely to occur in patients with lower median income based on zip code. There was no association between health insurance and functional outcome (p = 0.58).
Conclusions
Median income based on zip code is a SES indicator that is potentially associated with functional outcomes of ischemic stroke patients undergoing mechanical thrombectomy. Further studies addressing this relationship are needed.
Disclosures
A. Nguyen: None. G. M. Cortez: None. M. Baretta: None. A. Aghaebrahim: None. E. Sauvageau: None. R. Hanel: None.
( Obstet Gynecol . 2021;137:72–81) Progress has occurred recently to predict and diagnose preeclampsia in pregnant women. Angiogenic and antiangiogenic biomarkers such as placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were recently examined. In addition these factors have been implemented clinically as predictive measurements of preeclampsia. This study aims to review and analyze sFlt-1, PlGF, and the sFLt-1/PlGF ratio and their ability to predict time to delivery and adverse outcomes in patients with preeclampsia.
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