ABSTRACT
Although free-floating thrombus (FFT) poses a significant risk of stroke or transient ischemic attack (TIA), optimal management strategies are uncertain. To determine the state-of-the-art of medical interventions for FFT, we conducted a systematic review of the efficacy of various medical interventions and factors influencing FFT resolution and recurrence. A comprehensive search of Embase, PubMed, and ScienceDirect identified 61 studies encompassing 179 patients with FFT-related stroke or TIA treated with anticoagulants, antiplatelets, or their combinations. Primary outcomes assessed were stroke recurrence and thrombus resolution. Statistical analyses (Fisher's exact test, chi-square test, Mann-Whitney test, and Kruskal-Wallis test) utilized significance set at p < 0.05. Over a median follow-up of 7 months, thrombus resolution occurred in 65% of patients, while 11.2% experienced recurrence, primarily as TIAs. Cardioembolism was significantly less common in resolved cases (p = 0.025). Combination therapy (antiplatelets, anticoagulants, and statins) significantly enhanced clot resolution (OR 11.4; 95% CI 1.436-91.91; p = 0.021) compared to monotherapies. Ulcerated plaque was a significant predictor of recurrence (OR 8.2; 95% CI 1.02-66.07; p = 0.048). These findings underscore the superiority of combination therapy in FFT management and highlight the need for targeted interventions in patients with ulcerated plaques to mitigate recurrence risk.
ABSTRACT
Aim To compare the accuracy of shoulder ultrasound (US) in diagnosing rotator cuff tendon tears between junior and experienced musculoskeletal (MSK) radiologists. Also, to compare the overall ultrasound accuracy referenced to MRI. Methods A retrospective data collection for patients with clinically suspected rotator cuff tears who underwent ultrasound from June 2021 - June 2023 was conducted. Patients who also performed MRI for the same shoulder were only included in the study. US and MRI images were evaluated by two MSK radiologists with different experience levels. The diagnosis of rotator cuff tears was done on MRI through consensus. Ultrasound accuracy referenced to MRI was calculated for each radiologist. A second consensus was conducted for US images to calculate the overall US accuracy. The percentage of agreement and Cohen's kappa correlation coefficient were calculated before and after the US consensus. Results Forty-one patients were included in the study, 12 (29.3%) males and 29 (70.7%) females, with a mean age of 49.6 years. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy of US interpreted by junior vs experienced MSK radiologists for supraspinatus full thickness tears (FTTs) were 100% vs 91%, 90% vs 93%, 79% vs 83%, 100% vs 97%, and 93% vs 93%, respectively. After the second consensus, sensitivity, specificity, PPV and NPV, and accuracy were 91%, 90%, 77%, 96%, and 90%, respectively. Conclusion The accuracy of shoulder ultrasound in diagnosing supraspinatus FTTs by junior MSK radiologists compares well to the more experienced ones, but not for partial thickness tears (PTTs).