Immediate and 90-Day Clinical Outcome of Patients with Acute Stroke Treated with the NeVa-Vesalio Mechanical Thrombectomy Device: A Retrospective Case Series.

OBJECTIVE: The NeVa stent retriever is a newly designed mechanical thrombectomy device for the treatment of acute ischemic stroke caused by large vessel occlusion. We investigate the procedural characteristics and patients' clinical outcomes at discharge and at 90 days of follow-up. METHODS: We retrospectively reviewed a cohort of 75 patients (median age, 74 years) treated with the NeVa device for acute large vessel occlusion stroke. Per pass modified Treatment in Cerebral Infarction (mTICI) scores, procedural complications, and clinical outcome parameters including the National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS) score, and mortality were analyzed, based on patients' electronic medical records. RESULTS: Complete first pass effect was observed in 24 patients (32%). Vasospasm, repeated re-thrombosis, failure to advance the NeVa device through the microcatheter, and symptomatic intracranial hemorrhage were observed in 2, 1, 1, and 2 patient(s) respectively. The rate of complete (mTICI 2c-3) reperfusion was achieved in 61 patients (81.33%), with a median number of 2 passes (1-3). Median NIHSS score on admission, after 24 hours, and after 5-10 days or at discharge was 19 (15-23), 11 (4-19), and 3 (2-13.5), respectively. The number of patients with a functional mRS score (0-2) at 90 days follow-up was 29 (39%). CONCLUSIONS: Endovascular stroke management with use of the NeVa-Vesalio stent retriever may be associated with a 90-day functional mRS score in nearly 40% of treated patients.

Comparison of Clinical Performance Between Two Types of Symmetric-Tip Hemodialysis Catheters: A Single-Centre, Randomized Trial.

PURPOSE: To compare the clinical performance of a newly designed, symmetric-tip Arrow-Clark™ VectorFlow® tunnelled haemodialysis catheter, with a Glidepath™, symmetric-tip tunnelled haemodialysis catheter. MATERIAL AND METHODS: From November 2018 to October 2020, patients with End-Stage Renal Disease requiring a de novo tunnelled catheter for hemodialysis, were randomized to Vectorflow® (n = 50) or to Glidepath™ catheter (n = 48). The primary outcome was catheter patency at one year following catheter insertion. Catheter failure was defined as the removal of the catheter due to infectious complications, or low blood flow rate by intraluminal thrombosis or fibrin sheath occlusion. Secondary outcomes were blood flow rate, fractional urea clearance and urea reduction ratio during dialysis. RESULTS: Demographic characteristics were not different between the two groups. At three months and on the one-year endpoint the patency rates with the Vectorflow® catheter were 95.83% and 83.33% respectively, compared to 93.02% at both endpoints with the Glidepath™ catheter (P = 0.27). Catheter failure to infectious complications or low blood flow rate was similar in both groups. Catheter blood flow rate reached the threshold of 300 ml/min at all time points for both catheters. All patients had a high mean fractional urea clearance (1.6-1.7). CONCLUSIONS: The catheter patency rate was not significantly different in patients with a VectorFlow® or a Glidepath™ catheter. Both catheters presented satisfactory dialysis adequacy over one year.

Embolization therapy for type 2 endoleaks after endovascular aortic aneurysm repair: imaging-based predictive factors and clinical outcomes on long-term follow-up

PURPOSE: To evaluate the technical, radiological, and clinical outcomes after type 2 endoleak (T2EL) embolization in patients with a growing aneurysm sac after endovascular aortic aneurysm repair (EVAR). Additionally, to determine clinical and imaging-based factors for outcome prediction after embolization of a T2EL. METHODS: A single-institution, retrospective analysis was performed of 60 patients who underwent a T2EL embolization procedure between September 2005 and August 2016 to treat a growing aneurysm sac diameter following EVAR. The patients' electronic medical records and all available pre- and post-embolization imaging were reviewed. Statistical analysis methods included logistic regression models for binary outcomes, proportional odds models for ordinal outcomes, and linear regression models for continuous outcomes. The Kaplan-Meier method was used to estimate the overall survival probability. RESULTS: Technical, radiological, and clinical success rates after T2EL embolization were 95% (n = 57), 26.7% (n = 16), and 76.7% (n = 46), respectively. Persistent aneurysm sac expansion was found in 31 patients (51.7%). Unsharp or blurred T2EL delineation on pre-interventional computed tomography (CT) was a predictive factor for a post-embolization persistent visible endoleak and persistent growth of the aneurysm sac (P = 0.025). Median survival after T2EL embolization was 5.35 years, with no difference observed between patients with persistent sac expansion compared with patients with stable or decreased sac diameter. CONCLUSION: Progression of the aneurysm sac diameter was observed in half the study patients, despite technically successful T2EL embolization. Unsharp or blurred T2EL delineation on pre-interventional CT seemed to be an imaging-based predictor for a persistent T2EL and progressive aneurysm sac growth after embolization.

Upper gastrointestinal bleeding related to an eroded gastrosplenic collateral lately after splenic artery embolization.

BACKGROUND: Upper gastrointestinal, non-variceal haemorrhage can be related to various etiologies, including peptic ulcer, neoplasm, gastritis, Dieulafoy lesions and other, rare underlying diseases. Here, we describe another, yet unreported etiology of gastric bleeding. CASE PRESENTATION: A 49-year-old man presented with melena; gastroscopy revealed blood in the stomach without active bleeding source. Computed tomography angiography demonstrated a cluster of enlarged gastrosplenic arterial collaterals in the gastric wall and coils in the splenic artery, related to an embolization procedure 30-years ago for splenic trauma. Definitive treatment included catheter-directed glue embolization of the left gastric artery and the enlarged gastrosplenic collaterals. The postinterventional course was uneventful and no recurrence of upper gastrointestinal bleeding was noted after 6 months of follow-up. CONCLUSIONS: Upper gastrointestinal bleeding associated with eroded gastrosplenic collaterals, related to previous splenic artery embolization, can be successfully treated with glue-embolization.

Enhanced removal of refractory humic- and fulvic-like organics from biotreated landfill leachate by ozonation in packed bubble columns.

Biotreated landfill leachate contains much refractory organics such as humic and fulvic acids, which can be degraded by O3. However, the low O3 mass transfer and high energy cost limit its wide application in landfill leachate treatment. Previous studies proved that packed bubble columns could enhance the O3 mass transfer and increase the synthetic humic acids wastewater degradation, but the performance of packed bubble columns in real wastewater treatment has not been investigated. Therefore, this study aims to evaluate the feasibility of application of packed bubble column in the real biotreated landfill leachates treatment and provide insights into the transformation of organic matters in leachates during ozonation. Packed bubble columns with lava rocks or metal pall rings (LBC or MBC) were applied and compared with a non-packed bubble column (BC). At an applied O3 dose of 8.35 mg/(Lwater sample min), the initial COD (400 mg/L) was only removed for 26% in BC and 32% in MBC while this was 46% in LBC, indicating LBC has the best performance. GC-MS analysis shows that raw biotreated leachate contains potential endocrine disruptors such as di(2-ethylhexyl) phthalate (DEHP). 61% of DEHP was removed in LBC and the least intermediate oxidation products from humic- and fulvic-like organics was detected in LBC. The highest O3 utilization efficiency (89%) and hydroxyl radical (OH) exposure rate (3.0 × 10-10 M s) were observed in LBC with lowest energy consumption (EEO) for COD removal of 18 kWh/m3. The enhanced ozonation efficiency in LBC and MBC was attributed to the improved O3 mass transfer. Besides, LBC had additional adsorptive and catalytic activity that promoted the decomposition of O3 to generate OH. This study demonstrates that a packed bubble column increases removal and decreases energy use when treating landfill leachate, thus promoting the application of ozonation.

Roof runoff contamination: Establishing material-pollutant relationships and material benchmarking based on laboratory leaching tests.

Because roofs represent a major part of the urban impervious surface, it is hypothesized that roof runoff is an important source of urban stormwater contamination. However, the contribution of different roofing materials to this contamination has only been examined to a limited extent. In this study, a resource and time efficient methodology, which uses some of the principles of a standardized leaching test (CEN/TS16637-2), was developed to identify material-pollutant relationships for sixteen commonly used roofing materials (EPDM, PVC, TPO, EVA, PU and bitumen membranes). Metals were detected in concentrations ranging from several µg/L in the leachate of synthetic materials up to 2.5 mg/L for Zn in the leachate of EPDM materials. Cd and Cr were not detected in any of the leachates. Furthermore, polycyclic aromatic hydrocarbons were detected in most leachates, with phenanthrene and naphthalene being most frequently detected in concentrations up to 4.5 µg/L for naphthalene. Further insights on organic pollutants' leaching from the tested materials were obtained by a non-target GC-MS screening of the leachates. Several commonly used additives such as flame retardants and light stabilizers were detected. Although no information on long-term leaching and material behavior under outdoor conditions could be obtained by the developed methodology, the laboratory test results could be used to benchmark the materials for their potential impact on roof runoff quality by the calculation of material indexes (which summarize the material-pollutant relationships). EPDM and PU roofing materials were identified as the materials having the highest potential to affect roof runoff quality.

Factors influencing the long-term outcome of tunneled hemodialysis catheters.

PURPOSE: To review the incidence and type of tunneled hemodialysis catheter (THC) complications in a large cohort of patients with end-stage renal disease. Additionally, the longevity of the THC and factors predicting high risk for catheter complications were assessed. MATERIAL AND METHODS: Between August 2009 and December 2016, a cohort of 538 patients underwent primary THC insertion; in 119 patients, THC was inserted after failed arteriovenous fistula or graft. Patients without available clinical follow-up data (n = 67) were excluded for further analysis. The Charlson comorbidity index (CCI) was calculated for each patient. The cumulative incidence function (CIF) was used for THC overall longevity, while Cox proportional hazards models were used for risk factor analysis. RESULTS: In 352 patients, THC was inserted in a virgin neck. THC-related complications were observed in n = 104 (29.55%) of the patients. Infection occurred in n = 38 (10.80%) and malfunction, related to thrombosis or mechanical damage, in n = 45 (12.78%). Removal of the THC for the purpose of switching to alternative dialysis methods was planned in n = 135 (38.4%). The remaining patients were still alive with a functioning THC (n = 18; 5.11%) or died (n = 95; 27%) with a functioning THC. The THC survival rate was 82.67%, 78.13%, 74.15%, 72.96%, 71.02%, and 70.63% on follow-up after 6 months, and after 1-5 years, respectively. Gender, CCI, age, and site of placement of the catheter were found not to affect the life of the catheter. CONCLUSION: The overall complication rate in primary inserted THC was nearly 30% and mainly related to infection and malfunction. THC survival was more than 70% after 5 years, which supports its use for permanent dialysis access, irrespective of gender, CCI, age, and jugular side of THC placement.

Diagnostic accuracy of noncontrast CT imaging markers in cerebral venous thrombosis.

OBJECTIVE: To assess the added diagnostic value of semiquantitative imaging markers on noncontrast CT scans in cerebral venous thrombosis (CVT). METHODS: In a retrospective, multicenter, blinded, case-control study of patients with recent onset (<2 weeks) CVT, 3 readers assessed (1) the accuracy of the visual impression of CVT based on a combination of direct and indirect signs, (2) the accuracy of attenuation values of the venous sinuses in Hounsfield units (with adjustment for hematocrit levels), and (3) the accuracy of attenuation ratios of affected vs unaffected sinuses in comparison with reference standard MRI or CT angiography. Controls were age-matched patients with (sub)acute neurologic presentations. RESULTS: We enrolled 285 patients with CVT and 303 controls from 10 international centers. Sensitivity of visual impression of thrombosis ranged from 41% to 73% and specificity ranged from 97% to 100%. Attenuation measurement had an area under the curve (AUC) of 0.78 (95% confidence interval [CI] 0.74-0.81). After adjustment for hematocrit, the AUC remained 0.78 (95% CI 0.74-0.81). The analysis of attenuation ratios of affected vs unaffected sinuses had AUC of 0.83 (95% CI 0.8-0.86). Adding this imaging marker significantly improved discrimination, but sensitivity when tolerating a false-positive rate of 20% was not higher than 76% (95% CI 0.70-0.81). CONCLUSION: Semiquantitative analysis of attenuation values for diagnosis of CVT increased sensitivity but still failed to identify 1 out of 4 CVT. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that visual analysis of plain CT with or without attenuation measurements has high specificity but only moderate sensitivity for CVT.