Mechanical Thrombectomy for Minor and Mild Stroke Patients Harboring Large Vessel Occlusion in the Anterior Circulation: A Multicenter Cohort Study.

BACKGROUND AND PURPOSE: Proximal large vessel occlusion (LVO) is present in up to 30% of minor strokes. The effectiveness of mechanical thrombectomy (MT) in the subgroup of minor stroke with LVO in the anterior circulation is still open to debate. Data about MT in this subgroup of patients are sparse, and their optimal management has not yet been defined. The purpose of this multicenter cohort study was to evaluate the effectiveness of MT in patients experiencing acute ischemic stroke (AIS) because of LVO in the anterior circulation, presenting with minor-to-mild stroke symptoms (National Institutes of Health Stroke Scale score of <8). METHODS: Multicenter cohort study involving 4 comprehensive stroke centers having 2 therapeutic approaches (urgent thrombectomy associated with best medical treatment [BMT] versus BMT first and MT if worsening occurs) about management of patients with minor and mild acute ischemic stroke harboring LVO in the anterior circulation. An intention-to-treat analysis was conducted. The primary end point was the rate of excellent outcome defined as the achievement of a modified Rankin Scale score of 0 to 1 at 3 months. RESULTS: Three hundred one patients were included, 170 with urgent MT associated with BMT, and 131 with BMT alone as first-line treatment. Patients treated with MT were younger, more often received intravenous thrombolysis, and had shorter time to imaging. Twenty-four patients (18.0%) in the medical group had rescue MT because of neurological worsening. Overall, excellent outcome was achieved in 64.5% of patients, with no difference between the 2 groups. Stratified analysis according to key subgroups did not find heterogeneity in the treatment effect size. CONCLUSIONS: Minor-to-mild stroke patients with LVO achieved excellent and favorable functional outcomes at 3 months in similar proportions between urgent MT versus delayed MT associated with BMT. There is thus an urgent need for randomized trials to define the effectiveness of MT in this patient subgroup.

Diffusion weighted imaging and time in acute ischemic stroke, is there any relation?

BACKGROUND AND PURPOSE: Diffusion-weighted MRI (DWI) is useful for patient selection during the first 6hours after stroke onset. The main aim of this study was to investigate the relationship between the time from stroke symptom onset and stroke volume assessed using DWI. MATERIALS AND METHODS: We evaluated 203 patients with anterior circulation stroke who were admitted to Montpellier's Stroke Unit and for whom a DWI ASPECT score (DWI-ASPECTS) was obtained during the first 6hours from symptom onset. Patients were classified according to the number of hours after the onset of symptoms that DWI was performed. Two experienced neuroradiologists independently calculated the DWI-ASPECTS, which was classified by the size of the stroke volume in three groups: 0-3, 4-6 and 7-10. RESULTS: No relationship was found between temporal groups and the DWI-ASPECTS. The number of patients who reached each of the 3 classified stroke volumes was not different between the temporal groups. CONCLUSION: There is no correlation in our findings between the time of stroke symptom onset and the DWI-ASPECT score during the first 6hours from stroke onset.

Maternal undernutrition and cardiometabolic disease: a Latin American perspective.

The current epidemic of obesity and cardiometabolic diseases in developing countries is described as being driven by socioeconomic inequalities. These populations have a greater vulnerability to cardiometabolic diseases due to the discrepancy between the maternal undernutrition and its consequence, low-birth weight progeny, and the subsequent modern lifestyles which are associated with socioeconomic and environmental changes that modify dietary habits, discourage physical activity and encourage sedentary behaviors. Maternal undernutrition can generate epigenetic modifications, with potential long-term consequences. Throughout life, people are faced with the challenge of adapting to changes in their environment, such as excessive intake of high energy density foods and sedentary behavior. However, a mismatch between conditions experienced during fetal programming and current environmental conditions will make adaptation difficult for them, and will increase their susceptibility to obesity and cardiovascular diseases. It is important to conduct research in the Latin American context, in order to define the best strategies to prevent the epidemic of cardiometabolic diseases in the region.

A Study on the Efficacy and Safety of Pipeline Shield Stents and Nonmodified Surface Flow-Diverting Stents in Patients with Intracranial Aneurysms.

BACKGROUND: Few studies have compared the Pipeline Shield stents with previous generations of flow-diverting stents (FDSs) for the treatment of unruptured intracranial aneurysms. This study aimed to evaluate the efficacy and safety of Pipeline Shield stents and FDSs without modified surfaces. METHODS: The present evaluation is a retrospective cohort study of patients endovascularly treated with Pipeline Shield stents or FDSs without modified surfaces for unruptured intracranial aneurysms between January 2014 and June 2022. The data analyzed were obtained from the anonymized database of our institution's interventional radiology service. RESULTS: A total of 147 patients with 155 unruptured intracranial aneurysms were included. Of the 155 aneurysms, 96 were treated with Pipeline Shield stents and 59 with FDSs without modified surfaces. The aneurysms treated with Pipeline Shield stents had higher 6-month (O'Kelly-Marotta [OKM] D; 87.5% vs. 71.4%; P = 0.025) and 1-year (OKM D; 82.5% vs. 63.0%; P = 0.047) occlusion rates than the aneurysms treated using FDSs without modified surfaces. No differences between the devices were found at the 1-year follow-up in the incidence of ischemic stroke (P = 0.939) or hemorrhagic complications (P = 0.559). CONCLUSIONS: Pipeline Shield stents demonstrated superior complete occlusion rates (OKM D) at both the 6-month and the 1-year follow-up assessments compared with nonmodified surface FDSs. No significant differences were found in the safety profiles between the 2 types of stents with regard to thromboembolic complications and ischemic events. Further research with larger study populations is necessary to validate these findings.

Angiographic outcomes of embolization in patients with intracranial aneurysms with coil- assisted Laser cut stent versus braided stents.

INTRODUCTION: Intracranial aneurysms (IA) are a focal dilatation of the vessel wall, the rupture of these, causes subarachnoid hemorrhage. Until now, endovascular management is the ideal treatment, providing the interventionist a range of options among which the stent and coils embolization stands out because of its occlusion rate. This study presents the results of a retrospective cohort comparing the effectiveness, morbidity, and mortality of IA treatment with laser-cut stent-assisted coils versus braided stents. METHODOLOGY: Retrospective cohort of patients diagnosed with unruptured intracranial aneurysms treated with coil-assisted laser-cut stents or braided stents between January 2014 and December 2021. RESULTS: In total, 138 patients with 147 intracranial aneurysms were analyzed, 91 of them were treated with laser-cut stent and 56 with braided stents. The main antecedent was arterial hypertension (48.55%). In the immediate angiographic control, a Raymond Roy scale (RRO) I was obtained in 86.81% of the patients with laser-cut stents and 87.50% of the patients with braided stents. In the angiographic follow-up at 12 months, an RRO I occlusion rate of 85.19% was reported in both groups. Perioperative complications occur in 16 patients treated with laser-cut stents and 12 patients treated with braided stents. Three patients presented bleeding complications during the 12-month follow-up, of which two correspond to patients treated with braided stents and one with a laser-cut stent. CONCLUSION: Treatment of patients with intracranial aneurysms with laser-cut stents or braided stents and coils is just as safe and effective.

Comparison of Clopidogrel and Ticagrelor for Dual Antiplatelet Therapy of Patients with Unruptured Cerebral Aneurysms Undergoing Endovascular Treatment.

BACKGROUND: Thromboembolic events are critical complications in neuroendovascular procedures, and dual antiplatelet therapy (DAPT) can reduce them. The effects of using aspirin and clopidogrel in DAPT are well characterized, but use of aspirin and ticagrelor has been less studied. METHODS: This retrospective cohort study, conducted between April 1, 2015, and December 30, 2020, included patients with endovascular treatment with flow-diverting and non-flow-diverting stents for unruptured cerebral aneurysms who received DAPT with aspirin and clopidogrel or with aspirin and ticagrelor. RESULTS: Of 148 patients with unruptured intracranial aneurysms with flow-diverting and non-flow-diverting stents started on DAPT with aspirin (100 mg/day) and clopidogrel (75 mg/day), 24 had a poor response to clopidogrel according to the VerifyNow test and had DAPT changed to aspirin (100 mg/day) and ticagrelor (90 mg every 12 hours). One thrombotic complication (0.81%) and 1 bleeding complication (0.81%) occurred in patients receiving DAPT with clopidogrel and aspirin during the procedure. These complications did not occur (0.00%) in patients receiving DAPT with ticagrelor and aspirin. At the 6-month follow-up, 4 patients (3.15%) in the clopidogrel group presented with thrombotic complications, whereas no patients (0.00%) in the ticagrelor group experienced this complication. At 6-month follow-up, 4 patients (3.23%) in the clopidogrel group presented with hemorrhagic complications, whereas only 1 patient (4.17%) in the ticagrelor group experienced this complication. CONCLUSIONS: Our study showed that DAPT with ticagrelor (90 mg every 12 hours) and aspirin (100 mg/day) is a safe and effective alternative to DAPT with clopidogrel (75 mg/day) and aspirin (100 mg/day) for patients with an inadequate response to clopidogrel.

Incidencia de endofugas en pacientes con aneurismas de aorta abdominal infrarrenal intervenidos con técnica endovascular / Incidence of endoleaks in patients with infrarenal abdominal aortic aneurysms treated on with the endovascular technique

Introducción: Las endofugas son la complicación más frecuente de los tratamientos endovasculares de aneurismas de aorta abdominal y torácica. El objetivo de este estudio es describir la frecuencia de endofugas en pacientes con aneurismas de aorta infrarrenal tratados con técnicas endovasculares. Metodología: Estudio de cohorte retrospectivo en el que se incluyeron pacientes con aneurismas infrarrenales tratados con terapia endovascular en dos instituciones de alta complejidad entre el 1 de septiembre de 2013 y el 1 de marzo de 2021. Se incluyeron datos demográficos, antecedentes, características morfológicas del cuello y saco del aneurisma, tipo de prótesis utilizada, presencia y tipo de endofuga. Se realizó un análisis descriptivo univariado. Los intervalos de confianza se describieron con un 95%. Resultados: Se incluyeron 99 pacientes, la media de edad fue 74,37 años, la media de la longitud del cuello fue de 29,47 mm, el 90,24% tuvieron una longitud favorable (>15mm). La media del ángulo fue de 44,57°, el 67,86% tenía un ángulo favorable (<60°). El 28,28% de los pacientes presentaron endofugas, la frecuencia de las endofugas tipo Ia fue de 7,07%, las de tipo Ib 8,08%, las de tipo II 18,37%, las de tipo IIIa y IIIb 1,01%. No se presentaron endofugas tipo IV ni V. Conclusiones: La frecuencia de presentación de endofugas fue del 28,28%; la endofuga más frecuente es la de tipo II 18,37%, ligeramente inferior a lo descrito en la literatura.

Introduction: Endoleaks are the most common complication of endovascular treatment of abdominal and thoracic aortic aneurysms.. The objective of this study is to describe the frequency of endoleaks in patients with infrarenal aortic aneurysms treated with endovascular techniques. Methodology: Retrospective cohort study that included patients from September 1, 2013, to March 1, 2021, with infrarenal aneurysms treated with endovascular therapy at the FOSCAL and FOSCAL international clinics. Demographic data, history, morphological characteristics of the aneurysm neck and sac, type of prosthesis used, presence, and type of endoleak were included. A univariate descriptive analysis was performed. Confidence intervals were reported at 95%. Results: 99 patients were included, the mean age was 74.37 years, the mean neck length was 29.47 mm, 90.24% had a favorable length (>15 mm); The mean angle was 44.57, 67.86% had a favorable angle (<60º). 28.28% of the patients presented endoleaks, the frequency of type Ia endoleaks was 7.07%, type Ib endoleaks 8.08%, type II 18.37%, type IIIa, and IIIb endoleaks 1, 01%. There were no type IV or type V endoleaks. Conclusions: The frequency of presentation of endoleaks was 28.28%; the most frequent endoleak is type II 18.37%. slightly lower than that reported in the literature

Angioplastia de salvamento de extremidad con isquemia crítica infrapoplítea / Percutaneous Transluminal Angioplasty of Critical Limb Ischemia

Objetivo: Evaluar y describir los resultados clínicos de la técnica Angioplastia de rescate en pacientes con isquemia crítica de miembros inferiores con enfermedad arterial infrapoplítea en un centro de atención nivel IV. Materiales y métodos: Estudio de cohorte ambispectivo analítico observacional. Resultados: Se realizaron angioplastias infrapoplíteas en el Servicio de Radiología de FOSCAL y FOSCAL Internacional entre septiembre de 2013 y abril de 2016, a 65 pacientes. Previo al procedimiento, en el 89 % de los pacientes se observó claudicación y dolor; en el 88 %, frialdad de la extremidad; en el 81 %, úlcera y en el 64 %, infección. En el 63 % de la población se encontraron tres síntomas asociados. Se dividieron los pacientes en dos grupos: el primero, aquellos a quienes se les había realizado angioplastia en un solo vaso y el segundo, a quienes se les había realizado angioplastia en dos o más vasos. Se encontró que el tiempo libre de amputación fue mayor en el grupo uno, comparado con el dos, con valor de P estadísticamente significativo. Conclusión: La angioplastia de vasos infrapoplíteos en pacientes con enfermedad arterial periférica (EAP) e isquemia crítica de miembros inferiores disminuye el dolor, la claudicación y la infección en los pacientes. Favorece una tasa baja de amputaciones mayores posteriores a la terapia como medida de salvamento de la extremidad. La probabilidad de supervivencia de la extremidad a los 573 días es del 50 %.

Objective: To evaluate and describe the clinical results of percutaneous transluminal angioplasty of critical limb ischemia in a level IV care center. Materials and methods: Observational analytical ambispective cohort study. Results: An infra-popliteal angioplasty was performed in the Radiology service of FOSCAL and FOSCAL International between the months of September 2013 and April 2016 to 65 patients. Prior to the procedure, 89% of the patients presented claudication and pain, 88% coldness of the limb, 81% of the patients presented ulceration and 64% infection, noting that 63% of the population had 3 associated symptoms. The patients were divided into two groups; the first, those who had undergone angioplasty in a single vessel and the second group who had undergone angioplasty in two or more vessels. We found that the amputation-free time was greater in the group one compared to group two, with a statistically significant P value. Conclusion: Angioplasty of infrapopliteal vessels in patients with peripheral arterial disease (PAD) and critical lower limb ischemia reduces pain, claudication and infection in patients. There is a low rate of major amputations after therapy as a measure of salvage of the limb. The probability of survival of the limb at 573 days is 50%.

Oclusión Endovascular De Arteria Carótida Interna Aberrante Como Causa De Tinnitus Pulsátil / Endovascular Occlusion Of Aberrant Internal Carotid Artery Causing Tinnitus

RESUMEN Presentamos el caso de un paciente de 43 años con historia de tinnitus crónico intratable y pulsátil debido al curso aberrante de la arteria carótida interna derecha. En los estudios complementarios, la arteriografía mostró un polígono arterial de Willis preservado y un test de oclusión permeable sin síntomas neurológicos a la oclusión de la arteria carótida derecha. Se realizó oclusión endovascular de la arteria carótida interna derecha en las porciones petrosa y lacerum, con alivio inmediato de los síntomas.

ABSTRACT We present a case of a 43-years old male patient with a history of chronic and intractable pulsatile tinnitus due to an aberrant course of the right internal carotid artery. In complementary studies, the angiography showed a preserved Willis' arterial polygon and a balloon-occlusion test with adequate patency and no neurological symptoms. We performed the endovascular occlusion of the right internal carotid artery in the petrous and lacerum portions with the relief of symptoms.