Outcome and recanalization rate of tandem basilar artery occlusion treated by mechanical thrombectomy

BackgroundTandem basilar artery occlusions (tBAO) are defined as concomitant basilar artery and extracranial dominant vertebral artery occlusions. The prognosis of such tBAO treated by mechanical thrombectomy (MT) has been scantly reported.The purpose of our study was to compare the safety and effectiveness of MT for patients with tBAO compared to those with non-tandem basilar artery occlusions (ntBAO).Patients and methodsRetrospective analysis of a database of patients who underwent MT at two academic centres. All patients treated for BAO were retrieved. Patients with tBAO, defined as a concomitant BAO and extracranial vertebral artery (VA) occlusion or severe stenosis ≥70% (V1 or proximal V2 segment) were compared with patients with ntBAO.ResultsA total of 15 patients with tBAO and 74 patients with ntBAO were enrolled. Successful reperfusion (modified thrombolysis in cerebral infarction score ≥2b) was obtained in 73.3% versus 90.5% (OR = 0.29, 95%CI: 0.07–1.15), good clinical outcome (3-months modified Rankin scale ≤2) was reached by 26.7% versus 32.4% (OR = 0.76; 95% CI: 0.24–2.63) and mortality at 3-months was 46.7% versus 31% (OR = 1.94; 95%CI: 0.63–6) of patients with tBAO versus ntBAO, respectively. Two patients (13.3%) with tBAO and three (4%) with ntBAO had symptomatic intracranial haemorrhage (OR = 3.64; 95% CI: 0.55–24).ConclusionMechanical thrombectomy for patients with tandem basilar artery occlusion tends to be associated with lower rates of successful reperfusion and good clinical outcome, and higher rate of mortality. Larger multicentre studies are warranted to better precise the proper selection and management of such patients.     

Nonsurgical treatment of childhood hypertension: Embolization of an intrarenal aneurysm

Renal artery aneurysms are an unusual cause of renovascular hypertension in children. When present in an intrarenal location, they pose a difficult surgical problem and transcatheter embolization may represent an effective alternative treatment.     

泪道扩张引流管联合中药治疗鼻泪管阻塞40例观察

目的:探讨泪道扩张引流管置入联合中药汤剂治疗鼻泪管阻塞的临床效果。方法:将符合标准40例48眼鼻泪管阻塞患者随机分为观察组和对照组,2组患者均行泪道扩张引流管逆行植入,术后均予妥布霉素地塞米松滴眼液、氧氟沙星眼用凝胶滴眼,观察组加用中药汤剂口服4周,术后2个月拔管。患者益泪症状消失,泪道冲洗通畅为治愈,益泪症状消失,泪道冲洗部分返流为有效,益泪症状同前,泪道冲洗不通,症状同前为无效。结果:分别于泪道拔管后第1、2、3个月,观察组20例25眼中,分别是:治愈24、21、19眼;对照组20例23眼中,治愈20、16、11眼。P值分别是P>0.05,P<0.01,P<0.01,2组从术后2个月开始有显著差异。结论:泪道扩张引流管置入联合中药治疗鼻泪管阻塞远期疗效优于单纯鼻泪管置入术。     

自制同轴导管在输卵管再通术中的临床应用

目的:探讨自制同轴导管在输卵管再通术中的临床应用效果和价值。方法:56例继发不孕患者的86条阻塞的输卵管用自制同轴导管造影后利用导丝行机械再通并给予疏通液。对再通术成功率和术后随访12~36月的妊娠率进行分析。结果:56例中,除7例9条输卵管导丝无法进入外,再通术后疏通输卵管77条,再通率89.53%(77/86),无输卵管穿孔、出血及盆腔感染等严重并发症发生;再通术后19例成功妊娠并顺利生产,受孕率33.93%(19/56)。结论:用自制同轴导管治疗输卵管梗阻安全而有效。     

不同溶栓方法治疗AMI对再通和PLT的影响

目的研究不同静脉溶栓方法在AMI（急性心肌梗死）溶栓再通及PLT（血小板）变化。方法将95例AMI随机分为两组,观察组48例,UK（尿激酶）30万U静推,120万U静滴溶栓治疗AMI;对照组47例,UK静滴溶栓治疗AMI,研究两组治疗后再通率和PLT变化。结果观察组溶栓再通率和PLT聚集率明显优于对照组,观察组溶栓再通率为64．58％,对照组为51．06％,差异有显著性（P〈0．05）。结论观察组比对照组溶栓再通率高且PLT聚集显著。     

Concentrating stroke care provision in the Czech Republic: The establishment of Stroke Centres in 2011 has led to improved outcomes

This article describes policy processes that have led to the re-organisation of stroke care in the Czech Republic since 2011, which has been part of a broader process of care concentration in several medical fields. Currently, stroke care is provided by 13 Comprehensive and 32 Primary Stroke Centres. The paper explains factors that supported the reform implementation, reviews implications, and discusses future challenges.Mandatory reporting of quality indicators, the introduction of a benchmarking system, integration with pre-hospital emergency care, and the introduction of countrywide patient triage have supported more timely treatment for stroke patients and better quality of care. Data from the Stroke Care Quality Indicators of the Czech Stroke Society show positive trends in many areas: the number of patients treated with intravenous thrombolysis quadrupled in eight years, with 26.4 % of all acute stroke patients receiving thrombolysis in 2018. Czech Republic now ranks third in Europe in the number of thrombolysis per population and second in the number of mechanical thrombectomies per population. The Czech experience provides an example of positive outcomes of concentrated stroke care, while highlighting the importance of proper implementation processes. In particular, it is essential to involve stakeholders and to provide reputational incentives through continuous benchmarking.     

Recanalization after endovascular occlusion of a dissecting aneurysm of the posterior cerebral artery--A case report and review of the literature

Endovascular occlusion has been accepted as a safe, minimally invasive, and reliable treatment for ruptured dissecting aneurysms. Occlusion of the entire affected area is ideally the most complete treatment for such lesions. However, it is difficult to occlude the entire dissected lesion when it involves side branches due to the short-term risk of side branch occlusion, emboli dislodgement, and the long-term risk of parent artery recanalization. We herein present an extremely rare case where recanalization occurred after endovascular occlusion of a ruptured dissecting aneurysm of the posterior cerebral artery, and discuss its clinical implications. There are three mechanisms of recanalization: coil compaction due to loose or short segment packing, secondary dissection and occlusion of the false lumen. In endovascular occlusion of dissecting aneurysms that involve side branches, it is important to consider the risk of both recanalization and ischemic complications. We should attempt to insert the microcatheter into the true lumen and maintain dense packing as long as possible, unless the coils occlude the side branches following the procedure. Careful follow-up is necessary in all patients that received endovascular treatment.     

Impact of anticoagulation status on recanalization and outcome of cerebral venous thrombosis

Effective anticoagulation status may determine the recanalization and outcome of cerebral venous thrombosis (CVT). We report impact of anticoagulation status on recanalization and outcome of CVT. This is a retrospective study on 126 patients with CVT diagnosed on magnetic resonance venography (MRV). Their clinical features and risk factors were noted. The data were retrieved from a prospectively maintained registry, and international normalized ratio (INR) was noted after discharge till 3 months. All the patients were on acenocoumarol. Based on INR value, patients were categorized as Group A (effective anticoagulation INR within the therapeutic range or above) and Group B (ineffective anticoagulation INR > 50% below the therapeutic range). A repeat MRV at 3 months was done for recanalization. Outcome at 3 months was evaluated using modified Rankin Scale (mRS), and categorized as good (mRS ≤ 2) and poor (mRS 2 or more) 101(80.2%) patients were in group A and 25(19.8%) in group B. Their demographic, risk factors, magnetic resonance imaging (MRI) and MRV findings were comparable. On repeat MRV, recanalization occurred in 22/24(91.7%); 15(88%) in group A and 7(100%) in group B. Recanalization was independent of coagulation status. Seven (5.6%) patients died and 107(84.9%) had good outcome; 85(84.2%) in group A and 22(88%) in group B. Kaplan Meier analysis also did not reveal survival or good outcome benefits between the groups. In CVT, outcome and recanalization at 3 months are not dependent on coagulation status. Further prospective studies are needed regarding duration of anticoagulant and its impact on recanalization and outcome.     

Endovascular Therapy for Acute Ischemic Stroke: A Systematic Review and Meta-analysis

ObjectiveTo consolidate the evidence from randomized trials for the use of endovascular therapy (ET) in patients with acute ischemic stroke.MethodsWe searched major databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus) from their inception to February 12, 2013, for randomized trials evaluating the efficacy of ET compared with standard of care for acute ischemic stroke. Pooled absolute and relative risk estimates were synthesized by using a random-effects model. Heterogeneity was assessed by using Q statistic and I² statistic. Subset analysis was performed for patients with severe stroke (National Institutes of Health Stroke Scale score ≥20). The study was conducted from January 15, 2013 to April 30, 2013.ResultsOf the 1252 retrieved articles, 5 randomized trials enrolling 1197 patients with acute ischemic stroke were included. Seven hundred eleven patients received ET, and 486 received intravenous (IV) tissue plasminogen activator. There was no significant improvement in any of the outcomes in patients receiving ET compared with those receiving IV thrombolysis. On subgroup analysis, ET was found to have better outcomes in patients with severe stroke (National Institutes of Health Stroke Scale score ≥20), showing a dose-response gradient and improving excellent, good, and fair outcomes by an additional 4%, 7%, and 13%, respectively, compared with IV thrombolysis.ConclusionOverall, ET is not superior to IV thrombolysis for acute ischemic strokes (level B recommendation). However, ET showed promise and improved outcomes in patients with severe strokes, but the evidence is limited due to sample size. There is a need for further trials evaluating the role of ET in this high-risk group.