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1.
Interv Neuroradiol ; : 15910199241239094, 2024 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-38515399

RESUMEN

BACKGROUND: The best strategy to achieve optimal reperfusion outcomes during mechanical thrombectomy remains to be defined. The RapidPulseTM Cyclic Aspiration System is a novel technology, delivering high-frequency pulsed vacuum forces to increase the efficiency of aspiration thrombectomy. METHODS: Prospective, multicenter, open-label, core lab-adjudicated, two-arm study comparing safety and efficacy of a feasibility version of the RapidPulseTM system compared with contemporary controls. Primary endpoint was the rate of mTICI ≥ 2c after first-pass effect (FPE). Additional efficacy endpoints were the rates of mTICI ≥ 2b after first pass (modified FPE (mFPE)), last pass with study device defined as frontline technical success, and after all passes including rescue therapy. The primary safety endpoints included symptomatic ICH (sICH) within 24 h post-procedure. RESULTS: Between February 2022 to December 2022, 80 subjects were consented and enrolled in the study (n = 40 treatment arm, n = 40 control arm). In the intent to treat (ITT) population, mean age was 67.8 ± 11.5 years; 19 (47.5%) were male. Median NIHSS score was 16 (IQR: 13-22). Median ASPECTS score was 9 (IQR: 8-10). The rate of mTICI ≥ 2c after first pass was 53.9% in ITT population (60.0% in per-protocol population) versus 38.5% in the corresponding control population. Functional independence (mRS 0-2) at 90 days was achieved in 61.1% (22/36) in the RapidPulseTM arm and 52.8% (19/36) in the control arm. In the RapidPulseTM arm, no sICH within 24 h and no device-related morbidity or mortality occurred. CONCLUSION: Preliminary data suggests RapidPulseTM Aspiration System is highly effective and safe for recanalization of large vessel occlusions.

2.
J Clin Med ; 13(11)2024 May 26.
Artículo en Inglés | MEDLINE | ID: mdl-38892834

RESUMEN

Introduction: Although stentrievers (SRs) have been a mainstay of mechanical thrombectomy (MT), and current guidelines recommend the use of SRs in the treatment of large vessel occlusion stroke (LVO), there is a paucity of studies in the literature comparing SRs directly against each other in terms of mechanical and functional properties. Timely access to endovascular therapy and the ability to restore intracranial flow in a safe, efficient, and efficacious manner have been critical to the success of MT. This study aimed to investigate the impact of contemporary SR characteristics, including model, brand, size, and length, on the first-pass effect (FPE) in patients with acute ischemic stroke. Methods: Consecutive patients with M1 occlusion treated with a single SR+BGC were recruited from the ROSSETTI registry. The primary outcome was the FPE that was defined as modified (mFPE) or true (tFPE) for the achievement of modified thrombolysis in cerebral infarction (mTICI) grades 2b-3 or 3 after a single device pass, respectively. We compared patients who achieved mFPE with those who achieved tFPE according to SR characteristics. Results: We included 610 patients (52.3% female and 47.7% male, mean age 75.1 ± 13.62 years). mFPE was achieved in 357 patients (58.5%), whereas tFPE was achieved in 264 (43.3%). There was no significant association between SR characteristics and mFPE or tFPE. Specifically, the SR size did not show a statistically significant relationship with improvement in FPE. Similarly, the length of the SR did not yield significant differences in the mFPE and tFPE, even when the data were grouped. Conclusions: Our data indicate that contemporary SR-mediated thrombectomy characteristics, including model, brand, size, and length, do not significantly affect the FPE.

3.
Case Rep Womens Health ; 27: e00238, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32642450

RESUMEN

The anti-PP1Pk is a rare antibody associated with recurrent miscarriages, mainly in the first half of pregnancy. There seems to be a direct correlation between the antibody titer and risk of miscarriage. As this is a rare entity, few case reports have been published. The most frequently proposed therapeutic approaches are double-filtration plasmapheresis and plasma exchange therapy. The rationale behind them is to remove the cytotoxic antibodies from maternal circulation. Here, we present the case of a 30-year-old woman with a history of two spontaneous miscarriages and a pre-conception anti-PP1Pk antibody titer of 1:4. As soon as she became pregnant, she was placed on prednisolone and low-molecular-weight heparin (LMWH). Biweekly antibody titers were performed throughout the entire gestation and remained below 1:16. As the titers were considered to be low, plasmapheresis was not performed. The pregnancy was uneventful and she delivered a healthy newborn child at 37 weeks of gestation, with no signs of anaemia.

4.
Acta Med Port ; 30(10): 727-733, 2017 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-29268067

RESUMEN

INTRODUCTION: The benefits of manual versus automated red blood cell exchange have rarely been documented and studies in young sickle cell disease patients are scarce. We aim to describe and compare our experience in these two procedures. MATERIAL AND METHODS: Young patients (≤ 21 years old) who underwent manual- or automated-red blood cell exchange for prevention or treatment of sickle cell disease complications were included. Clinical, technical and hematological data were prospectively recorded and analyzed. RESULTS: Ninety-four red blood cell exchange sessions were performed over a period of 68 months, including 57 manual and 37 automated, 63 for chronic complications prevention, 30 for acute complications and one in the pre-operative setting. Mean decrease in sickle hemoglobin levels was higher in automated-red blood cell exchange (p < 0.001) and permitted a higher sickle hemoglobin level decrease per volume removed (p < 0.001), while hemoglobin and hematocrit remained stable. Ferritin levels on chronic patients decreased 54%. Most frequent concern was catheter outflow obstruction on manual-red blood cell exchange and access alarm on automated-red blood cell exchange. No major complication or alloimunization was recorded. DISCUSSION: Automated-red blood cell exchange decreased sickle hemoglobin levels more efficiently than manual procedure in the setting of acute and chronic complications of sickle cell disease, with minor technical concerns mainly due to vascular access. The threshold of sickle hemoglobin should be individualized for clinical and hematological goals. In our cohort of young patients, the need for an acceptable venous access was a limiting factor, but iron-overload was avoided. CONCLUSION: Automated red blood cell exchange is safe and well tolerated. It permits a higher sickle hemoglobin removal efficacy, better volume status control and iron-overload avoidance.


Introdução: Os benefícios da transfusão permuta parcial manual versus automatizada encontram-se pouco documentados e existem poucos estudos em jovens com doença falciforme. Pretendemos descrever e comparar a nossa experiência com os dois procedimentos. Material e Métodos: Foram incluídos jovens (≤ 21 anos) que realizaram transfusão permuta parcial-manual ou -automatizada para prevenção ou tratamento de complicações da doença falciforme. Dados clínicos, técnicos e valores hematológicos foram recolhidos de forma prospectiva e analisados. Resultados: Realizaram-se 94 transfusões permuta parcial num período de 68 meses, 57 manuais e 37 automatizadas, 63 para prevenção de complicações crónicas, 30 por complicações agudas e uma no contexto pré-operatório. A redução média da hemoglobina S foi superior na transfusão permuta parcial-automatizada (p < 0,001) e permitiu uma redução de hemoglobina S por volume permutado superior (p < 0,001), mantendo valores de hemoglobina e hematócrito estáveis. Os valores de ferritina dos doentes crónicos diminuíram em 54%. A principal preocupação foi a obstrução do lúmen do cateter na transfusão permuta parcial-manual e os alarmes de pressão do acesso na transfusão permuta parcial-automatizada. Não houve complicações major nem aloimunização. Discussão: A transfusão permuta parcial-automatizada reduziu a hemoglobina S de forma mais eficiente que a transfusão permuta parcial-manual em doentes com complicações da doença falciforme, existindo pequenos problemas relacionados com o acesso vascular. O valor alvo de hemoglobina S deve ser individualizado segundo a clínica e os objetivos hematológicos. Na nossa coorte de jovens, a necessidade de um acesso venoso aceitável foi a principal limitação, mas a sobrecarga de ferro foi evitada. Conclusão: A transfusão permuta parcial automatizada é segura e bem tolerada. Permite uma maior eficácia na redução da hemoglobina S, um melhor controlo da volemia e a evicção da sobrecarga de ferro.


Asunto(s)
Anemia de Células Falciformes/terapia , Transfusión de Eritrocitos/métodos , Adolescente , Anemia de Células Falciformes/sangre , Automatización , Niño , Preescolar , Recambio Total de Sangre/métodos , Femenino , Hemoglobina Falciforme , Humanos , Masculino , Estudios Prospectivos , Adulto Joven
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