The administration of rtPA before mechanical thrombectomy in acute ischemic stroke patients is associated with a significant reduction of the retrieved clot area but it does not influence revascularization outcome.

Both intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are evidence-based treatments for acute ischemic stroke (AIS) in selected cases. Recanalization may occur following IVT without the necessity of further interventions or requiring a subsequent MT procedure. IVT prior to MT (bridging-therapy) may be associated with benefits or hazards. We studied the retrieved clot area and degree of recanalization in patients undergoing MT or bridging-therapy for whom it was possible to collect thrombus material. We collected mechanically extracted thrombi from 550 AIS patients from four International stroke centers. Patients were grouped according to the administration (or not) of IVT before thrombectomy and the mechanical thrombectomy approach used. We assessed the number of passes for clot removal and the mTICI (modified Treatment In Cerebral Ischemia) score to define revascularization outcome. Gross photos of each clot were taken and the clot area was measured with ImageJ software. The non-parametric Kruskal-Wallis test was used for statistical analysis. 255 patients (46.4%) were treated with bridging-therapy while 295 (53.6%) underwent MT alone. By analysing retrieved clot area, we found that clots from patients treated with bridging-therapy were significantly smaller compared to those from patients that underwent MT alone (H1 = 10.155 p = 0.001*). There was no difference between bridging-therapy and MT alone in terms of number of passes or final mTICI score. Bridging-therapy was associated with significantly smaller retrieved clot area compared to MT alone but it did not influence revascularization outcome.

Assessment of renal vascular anatomy on multi-detector computed tomography in living renal donors.

BACKGROUND: Prospective renal donors are a select population of healthy individuals who have been thoroughly screened for significant comorbidities before they undergo multi-detector computed tomography angiography and urography (MDCT). PURPOSE: The aim of this study is to describe the anatomy of potential living renal donor subjects using MDCT over a 2-year period. The primary objective is to identify the renal arterial anatomy variations, with a secondary objective of identifying venous and collecting system/ureteric variations. MATERIALS AND METHODS: A prospective study was performed of prospective living kidney transplant donors at a national kidney transplant centre. Study inclusion criteria were all potential kidney donors who underwent MDCT during the living-donor assessment process over a 2-year period. RESULTS: Our cohort included 160 potential living donors who had MDCT; mean age was 45.6 years (range, 21-71). Two renal arteries were identified on the left in 40 subjects (25%) and on the right in 42 subjects (26.3%). A total of 3 or more renal arteries were identified on the left in 7 subjects (4.4%) and on the right in 7 subjects (4.4%). On the left, the distances between multiple arteries ranged from 1 mm to 43 mm, and on the right, they were 1 mm to 84 mm. CONCLUSIONS: Conventionally described anatomy was only seen on the left side in 70.6% and 69.4% on the right side of subjects. Single renal arteries are seen in 54.4% showing that conventional anatomy has a relatively low incidence.

Direct Common Carotid Artery Puncture for Endovascular Treatment of Acute Large Vessel Ischemic Stroke in a Patient with Aortic Coarctation.

Coarctation of the aorta is a condition that typically presents in childhood as a congenital malformation. This report describes a case of acute right middle cerebral artery ischemic stroke, which occurred in a patient with aortic coarctation that remained undiagnosed until her eighth decade. Complex anatomical variant presented a significant technical challenge in establishing endovascular access for mechanical thrombectomy using standard femoral, brachial, or radial artery approaches. Direct right common carotid puncture was performed successfully with subsequent reperfusion and full neurological recovery. Direct carotid artery puncture represents an alternative to standard transfemoral access in the event of stroke in a patient with difficult anatomy.

Prevalence and clinical significance of extravascular incidental findings in patients undergoing CT cervico-cerebral angiography.

INTRODUCTION: CT cervico-cerebral angiography (CTCCA) is now the first line diagnostic imaging modality for the majority of vascular pathologies of the head and neck with diagnostic value comparable to or better than traditional angiographic techniques. The aim of this study was to assess the prevalence, clinical significance and management of extravascular incidental findings detected on CTCCA. MATERIALS AND METHODS: A retrospective review of the CTCCA reports of 302 consecutive patients from 2009 to 2013 was undertaken. Extravascular incidental findings were classified, according to an adaptation of the CT colonography data and reporting system (CRADS), as EV1-EV4. EV1=no incidental findings, EV2=clinically insignificant incidental finding, EV3=incidental finding of intermediate clinical significance, EV4=highly clinically significant finding. Follow up of the electronic medical records of patients with EV3 or EV4 findings was undertaken to determine subsequent management. RESULTS: Potentially clinically significant findings were demonstrated in 14.2% of patients with 8.6% of patients having a highly clinically significant finding. 4 incidental findings were confirmed to be malignant lesions and 5 required acute intervention. In addition 19% of patients with highly clinically significant incidental findings did not receive appropriate follow up. DISCUSSION: This study has demonstrated the presence of clinically important incidental findings in a significant proportion of patients undergoing CTCCA with a significant minority of these patients not receiving follow up. A standardised method of reporting incidental findings, such as that used in this paper, would aid radiologists and referring physicians in recording and communicating these findings.