Benefits of First Pass Recanalization in Basilar Strokes Based on Initial Clinical Severity.

PURPOSE: Randomized trials demonstrating the benefits of thrombectomy for basilar artery occlusions have enrolled an insufficient number of patients with a National Institutes for Health Stroke Scale (NIHSS) score < 10 and shown discrepant results for patients with an NIHSS > 20. Achieving a first pass recanalization (FPR) improves clinical outcomes in stroke. We aimed to evaluate the effect of the FPR on outcomes among basilar artery occlusion patients, characterized by prethrombectomy initial NIHSS score. METHODS: We retrospectively analyzed the Endovascular Treatment in Ischemic Stroke (ETIS) registry of 279 basilar artery occlusion patients treated with thrombectomy from 6 participating centers. We compared the 90-day clinical outcomes of achieving a FPR versus no FPR, categorized by initial clinical severity: mild (NIHSS < 10), moderate (NIHSS 10-20) and severe (NIHSS > 20). We used Poisson regression with robust error variance to determine the effect of the NIHSS score on the association between FPR and outcomes. RESULTS: The FPR patients with NIHSS < 10 or NIHSS 10-20 were more likely to have a favorable clinical outcome (modified Rankin scale, mRS 0-3) than non-FPR patients (relative risk, RR = 1.32, 95% confidence interval, CI: 1.04, 1.66, p-value = 0.0213, and RR = 1.79, 95% CI: 1.26, 2.53, p-value = 0.0011, respectively). A similar benefit was not found in patients with severe symptoms. We found a significantly lower risk of poor clinical outcome (mRS 4-6) in FPR patients with NIHSS 10-20, but not among patients with an NIHSS > 20. CONCLUSION: Achieving a FPR in basilar artery occlusion patients with mild (NIHSS < 10) or moderate (NIHSS 10-20) symptoms is associated with better clinical outcomes, but not in patients with severe symptoms. These results support the importance of further clinical trials on the benefits of thrombectomy in severe strokes.

A potential protective role of congenital peritoneal encapsulation coexisting with metastatic colon cancer: a rare case report.

Introduction and importance: Congenital peritoneal encapsulation (CPE) is a rare condition in which the small intestine is encased within a mesothelial-lined sac. The following case is an extremely rare description of the co-existence of both colon cancer and peritoneal encapsulation, highlighting the potential role of this co-existence in preventing the spread of metastases and tumor implantation. Case-presentation: A 60-year-old female was diagnosed with metastatic colon cancer. During the operation, a thin fibrous membrane was found covering the small intestine, which suggested CPE. The tumor was removed, and the additional membrane was totally excised. The patient is currently receiving chemotherapy for metastatic treatment and is in good health. Clinical discussion: CPE is a medical condition that results from abnormal peritoneal development, and it is often confused with other differential diagnoses resulting from inflammatory causes. It can occur at different ages and remains asymptomatic for the majority of cases. However, it can be a potential cause of bowel obstruction. An intraoperative diagnosis can easily differentiate the case. The co-existence with colon cancer has been described only once in the literature. Conclusion: Peritoneal encapsulation is a rare, mostly asymptomatic condition. However, it may play a protective role in preventing metastatic colon cancer from affecting the small intestine, thus potentially opening up new avenues for the treatment of cancer metastases.