ABSTRACT
"State of the Art" Learning Objectives: This manuscript serves to provide the reader with a general overview of the contemporary approaches to peripheral nerve reconstruction as the field has undergone considerable advancement over the last 3 decades. The learning objectives are as follows: To provide the reader with a brief history of peripheral nerve surgery and some of the landmark developments that allow for current peripheral nerve care practices.To outline the considerations and management options for the care of patients with brachial plexopathy, spinal cord injury, and lower extremity peripheral nerve injury.Highlight contemporary surgical techniques to address terminal neuroma and phantom limb pain.Review progressive and future procedures in peripheral nerve care, such as supercharge end-to-side nerve transfers.Discuss rehabilitation techniques for peripheral nerve care.
Le présent manuscrit vise à fournir au lecteur un aperçu général des approches contemporaines de la reconstruction des nerfs périphériques puisque le domaine a beaucoup progressé depuis trois décennies. Les objectifs d'apprentissage s"établissent comme suit : Fournir au lecteur un bref historique de la chirurgie des nerfs périphériques et quelques-unes des avancées historiques qui ont donné lieu aux pratiques de soins actuelles des nerfs périphériques.Décrire les considérations et les possibilités de prise en charge pour les soins des patients ayant une plexopathie brachiale, une lésion médullaire ou une lésion des nerfs périphériques des membres inférieurs.Souligner les techniques chirurgicales contemporaines pour traiter les neurones terminaux et les douleurs des membres fantômes.Examiner les interventions progressives et futures pour les soins des nerfs périphériques, comme l'amplification du transfert du nerf terminal au nerf latéral.Parler des techniques de réadaptation pour les soins des nerfs périphériques.
ABSTRACT
Background and aims: Endovascular thrombectomy (EVT) is the current standard of care for large vessel occlusion (LVO) acute ischemic stroke (AIS); however, up to two-thirds of EVT patients have poor functional outcomes despite successful reperfusion. Many radiological markers have been studied as predictive biomarkers for patient outcomes in AIS. This study seeks to determine which clinico-radiological factors are associated with outcomes of interest to aid selection of patients for EVT for LVO AIS. Methods: A retrospective study of patients who underwent EVT from 2016 to 2020 was performed. Data on various radiological variables, such as anatomical parameters, clot characteristics, collateral status, and infarct size, were collected alongside traditional demographic and clinical variables. Univariate and multivariate analysis was performed for the primary outcomes of functional independence at 3 months post-stroke (modified Rankin Scale 0-2) and secondary outcomes of in-hospital mortality and symptomatic intracranial hemorrhage. Results: The study cohort comprised 325 consecutive patients with anterior circulation LVO AIS (54.5% male) with a median age of 68 years (interquartile range 57-76). The median NIHSS was 19. Age, hypertension, hyperlipidaemia, National Institutes of Health Stroke Scale (NIHSS), Alberta mCTA score, ASPECTS, clot length, thrombus HU and mTICI score and the angle between ICA and CCA were associated with functional outcomes at 3 months on univariate analysis. On multivariate analysis, age, Alberta mCTA collaterals and NIHSS were significantly associated with functional outcomes, while ASPECTS approached significance. Conclusion: Among the many proposed radiological markers for patients in the hyperacute setting undergoing EVT, the existing well-validated clinico-radiological measures remain strongly associated with functional status.