Atrial fibrillation is associated with higher first pass effect following thrombectomy for large vessel occlusion.

BACKGROUND: First pass effect (FPE), defined as single-pass complete or near complete reperfusion during endovascular thrombectomy (EVT) for large vessel occlusion (LVO) strokes, is a critical performance metric. Atrial fibrillation (AF)-related strokes have different clot composition compared with non-AF strokes, which may impact thrombectomy reperfusion results. We compared FPE rates in AF and non-AF stroke patients to evaluate if AF-related strokes had higher FPE rates. METHODS: We conducted a post-hoc analysis of the DIRECT-SAFE trial data, including patients with retrievable clots on the initial angiographic run. Patients were categorized into AF and non-AF groups. The primary outcome was the presence or absence of FPE (single-pass, single-device resulting in complete/near complete reperfusion) in AF and non-AF groups. We used multivariable logistic regression to examine the association between FPE and AF, adjusting for thrombolysis pre-thrombectomy and clot location. RESULTS: We included 253 patients (67 with AF, 186 without AF). AF patients were older (mean age: 74 years vs 67.5 years, p=0.001), had a higher proportion of females (55% vs 40%, p=0.044), and experienced more severe strokes (median National Institutes of Health Stroke Scale (NIHSS) score: 17 vs 14, p=0.009) than non-AF patients. No differences were observed in thrombolytic agent usage, time metrics, or clot location. AF patients achieved a higher proportion of FPE compared with non-AF patients (55.22% vs 37.3%, adjusted odds ratio 2.00 (95% CI 1.13 to 3.55), p=0.017). CONCLUSIONS: AF-related strokes in LVO patients treated with EVT were associated with FPE. This highlights the need for preparedness for multiple passes and potential adjuvant/rescue therapy in non-AF-related strokes.

Imaging of cryptococcus neoformans infection in breasts: A case report.

There have been few reports on the imaging characteristics of cryptococcus neoformans (C. neoformans) infection of the breast. Herein, we reported the imaging features of C. neoformans infection of the breast in a 41-year-old woman with immune thrombocytopenic purpura. Bilateral, diffuse, hyperechoic, and well-defined margin lesions were observed on breast ultrasounds. In addition, a global asymmetry in the left breast, and a focal asymmetry in the right breast were observed on mammograms. Breast fine needle aspiration and biopsy results revealed a C. neoformans infection. After 5 months of treatment with oral fluconazole and amphotericin B, the lesion on the right breast disappeared on repeated-breast ultrasounds.

Cecum perforation due to a fish bone.

Foreign body (FB) ingestion is a common condition encountered in clinical practice, especially among the pediatric age group; however, this occurrence is rare among adults. Some FBs can induce the perforation of the gastrointestinal tract, including fish bones, chicken bones and toothpicks. The ingestion of FBs is rarely associated with bowel perforation, and most FBs are passed spontaneously. The ingestion of sharp and pointed objects typically produces adverse events related to the upper gastrointestinal system, and FBs are rarely retained in the colon. Bowel perforation caused by the ingestion of FBs should be diagnosed and treated in a timely manner. Here, we present the unusual case of a 51-year-old male who presented to the emergency room with complaints of acute abdominal pain secondary to fish bone ingestion, which triggered cecum perforation.

A rare case of lipomatous pseudohypertrophy of the pancreas.

Lipomatous pseudohypertrophy of the pancreas is a rare disease with unknown etiology, and the pancreas parenchyma is replaced by pancreatic parenchyma by fat tissue. In this article, we aimed to report the case of a 26-year-old male patient admitted to hospital with loss of appetite for 6 months. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) scans showed diffuse enlargement and fatty replacement over the whole pancreas, with scattered remnants of pancreatic parenchyma. Histologic results defined lipomatous pseudohypertrophy of the pancreas. To summarize, this case report is to put forward this extremely rare presentation and to sensitize clinicians that this entity can be a cause of exocrine pancreatic insufficiency, which requires patient follow-up for the appropriate treatment.

The clinical and subclinical features of spinal cord injury on magnetic resonance imaging of patients with N2O intoxication.

Nitrous oxide (N2O) is a weak anesthetic gas that was first used in 1844 in the field of dental anesthesia. However, currently, N2O is being abused for entertainment purposes in the form of N2O-filled balloons, called funky balls, which can cause many adverse effects, especially nervous system injury. This study aimed to investigate the detailed clinical and subclinical features associated with N2O intoxication. We retrospectively reviewed 47 patients diagnosed with N2O intoxication, from May 2018 to July 2019, and collected demographic data, clinical and laboratory tests, and spinal cord magnetic resonance imaging (MRI) findings. The mean time of funky ball use was 8.8 months, with a mean use of 36.3 balls per day. All patients presented with superficial sensory disorders. Reductions in muscle strength, decreased vibration sensation, and decreased or lost tendon reflexes were the most common clinical signs of N2O intoxication. Romberg sign and Lhermitte sign were observed in 39 patients (83%) and 21 patients (44.7%), respectively. Spinal cord lesions on MRI were observed in 32 patients (68.1%), which mostly presented with an inverted V sign. The total duration of N2O use, the number of days of using N2O per week, and the presence of Lhermitte sign (P<0.05) were significantly different between patients with and without spinal cord lesions on MRI. Serum levels of homocysteine and vitamin B12 were significantly different between the time of admission and discharge (P<0.05). Our study indicated that the days of using N2O per week was significantly associated with Spinal Cord Injuries (SCI) on MRI. According to the Receiver Operating Characteristic (ROC) curve analysis, a cutoff days of using per week value of 2.5 days could predict SCI with a sensitivity of 81.3%, a specificity of 73.3%, and an area under the ROC curve (AUC) of 0.813. Changes in the serum levels of homocysteine and vitamin B12 were effective markers for the evaluation of treatment response.

Safety and Efficacy of a Direct Aspiration First-Pass Technique with Large-Bore Catheters for Acute Ischemic Stroke in Vietnam: Experience of a Single Center.

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of mechanical thrombectomy with a direct aspiration first-pass technique (ADAPT) using large-bore catheters in patients with acute ischemic stroke due to large vessel occlusion (LVO) in a hospital in Vietnam. METHODS: This was a retrospective review of patients with acute ischemic stroke due to LVO who were diagnosed and underwent mechanical thrombectomy using ADAPT with large-bore catheters at Bach Mai Hospital from January 2017 to June 2018. RESULTS: Seventy-three patients (47.9% female; age: 61.29 ± 14.49 years) met study criteria. The average procedure duration was 45.09 ± 38.26 min. Successful recanalization post-ADAPT (thrombolysis in cerebral infarction 2b-3) was achieved in 72.6% (53/73) of patients. Good functional outcome (Modified Rankin Scale 0-2) at 3 months was achieved in 50.7% (37/73), with poor functional outcome in 24.7% (18/73). The 90-day mortality rate was 24.7% (18/73). The hemorrhagic transformation rate was 31.6%, in which 19.2% were symptomatic. Vessel perforation occurred in 5.5% (4/73) of patients but in all cases was associated with the guidewire and not the reperfusion catheter. Vessel dissection occurred in 1.4% (1/73) and vasospasm in 5.5% (4/73) of patients. CONCLUSION: Mechanical thrombectomy using ADAPT with large-bore catheters for acute ischemic stroke due to LVO is a method that yielded good results in recanalization and clinical recovery in a Vietnamese patient population.

Comparing the Efficacy of Radiofrequency Ablation Versus Laser Ablation for Chronic Venous Insufficiency in the Lower Extremities: a Vietnamese Report.

INTRODUCTION: Chronic venous insufficiency (CVI) is a chronic condition, triggered by reflux through the saphenous vein network. AIM: To determine the efficacy of endovenous laser ablation (LA) and radiofrequency ablation (RFA) for CVI treatment in the lower extremities, at the Bach Mai Radiology Center. METHODS: This retrospective study was approved by the institutional review board of Bach Mai Hospital. The study recruited 49 people, from August 2016 to April 2018, with recurrent venous insufficiency in the lower extremities and measured 56 ablated veins. RESULTS: In this study, 8 patients (10 veins, with a mean diameter of 5.83 ± 0.96 mm) were treated with RFA, and 41 patients (46 veins, with a mean diameter of 7.96 ± 3.47 mm) were treated with LA. The occlusion rates for LA- and RFA-treated veins were very effective, at 95.7% and 90%, respectively. No significant differences in occlusion rates or clinical improvements were observed between the two ablation methods. On the first day post-treatment, the visual analog score (VAS) value for the LA group was significantly higher than that for the RFA group. Furthermore, ecchymosis, 1 day after treatment, and hyperpigmentation, paresthesia, and numbness, 1 month after treatment, were only observed in the LA group. CONCLUSION: Both LA and RFA were minimally-invasive and safe therapies. No serious complications requiring further interventions were reported and the treatment effectively improved the clinical symptoms of patients. Based on our study, we recommend that RFA should be considered for moderate dilated saphenous vein cases, whereas LA should be indicated for large dilated saphenous vein cases, with or without aneurysm.

Massive Dissecting Aneurysm in the Basilar Tip Artery Treated with Intra-aneurysm and Basilar Artery Coiling.

INTRODUCTION: Deconstructive versus reconstructive technique remains controversial on the management of acute basilar tip artery dissection. AIM: We introduced a case report of massive dissecting aneurysm in the basilar tip artery treated with intra-aneurysm and basilar artery coiling. RESULTS: A 30-year-old male presented with sudden headache and severe vomiting. Radiographic study showed a large unruptured dissecting aneurysm in the basilar tip artery involving bilateral P1 segment. This aneurysm was treated with intra-aneurysm and basilar artery coiling. Patient was discharge after 7 days without any neurological deficits. Post-operatively, the patient received 75 mg aspirin and 75 mg clopidogrel PO per day for 3 months - then 75 mg aspirin per day for up to 1 year. Angiographic follow-up at 3 months showed a complete occlusion of aneurysmal sac and basilar tip artery without any deficits (mRS 0). Cerebral arteriography at 6 months follow-up confirmed a stable occlusion of aneurysmal sac with a minor recurrence of aneurysm in left P1 segment. CONCLUSION: Intra-aneurysm and basilar artery coiling is valuable alternative technique to treat complex basilar tip dissecting aneurysm in case of infeasible reconstructive technique. Clinical presentation, aneurysm characteristics and collateral circulation have to be investigated on each case to adopt this technique.

Flow diverter stent for treatment of cerebral aneurysms: A report of 130 patients with 134 aneurysms.

BACKGROUND: This study aims to report our experience with cerebral aneurysms, which may improve in the treatment with the flow-diverter stent and follow up. METHODS: This study was conducted in a consecutive series of 130 patients. 134 procedures were performed for treating these patients in Hanoi Medical University Hospital and Bach Mai Hospital from January 2012 to April 2017. 143 flow diverter stents (Pipeline, FRED and SILK) were used. Aneurysm morphology, stent patency and cerebral parenchyma before and after intervention were analyzed on images of digital subtraction angiography (DSA), computed tomography (CT) and magnetic resonance (MR). The follow-up data after 3-6 months and 12 months were recorded. RESULTS: In 130 patients (31 men, 99 women), aneurysms of internal carotid artery were mostly common (92.6%), especially in cavernous (35.1%) and in para-ophthalmic (40.3%) segments. 83 cases (61.9%) had wide-neck aneurysms, and 16 cases (11.9%) had multiple aneurysms, and only 5 cases (3.7%) had blister-liked aneurysms. Endovascular treatment was successfully performed at rate of 94.8%. In 3 patients, the stent could not be delivered. Mortality and morbidity rates were 1.5% and 3.7%, respectively. MRI and MSCT follow-up at 3 months showed complete or incomplete occlusions of aneurysms was 7.4% or 17.5%, respectively. 3 patients experienced a thromboembolic event (4.3%). CONCLUSIONS: Intracranial aneurysms of cavernous and para-ophthalmic segments of internal carotid artery are mostly common with wide-neck and multi aneurysms. Deployment of flow diverter stent is safe and effective with high rate of successful and low procedural complications.

Interventional Treatment of Lymphatic Leakage Post Appendectomy: Case Report.

BACKGROUND: Postoperative lymphatic complications are not common, and lymphatic leakage complication post appendectomy (LLCPC) is even rarer. However, the number of this operation is high so LLCPC can occur. CASE REPORT: Here, we report a female patient post appendectomy with severe chylous ascites. This patient underwent six operations. A leakage point at the right iliac-fossa, which was embolized successfully after two sessions, was spotted during intranodal lymphangiography. After 6 months, the ascites were significantly reduced while some lymphatic aneurysms still existed in the lumbar-retroperitoneal region. CONCLUSIONS: Basing the knowledge of this clinical case and literature, we have concluded that lymphatic leakage can be diagnosed and embolized by percutaneous intervention.

Conventional digital subtractional vs non-invasive MR angiography in the assessment of brain arteriovenous malformation.

OBJECTIVES: Digital subtractional angiography (DSA) is the standard method for diagnosis, assessment and management of arteriovenous malformation in the brain. Conventional DSA (cDSA) is an invasive imaging modality that is often indicated before interventional treatments (embolization, open surgery, gamma knife). Here, we aimed to compare this technique with a non-invasive MR angiography (MRI DSA) for brain arteriovenous malformation (bAVM). PATIENTS AND METHODS: Fourteen patients with ruptured brain AVM underwent embolization treatment pre-operation. Imaging was performed for all patients using MRI (1.5 T). After injecting contrast Gadolinium, dynamic MRI was performed with 40 phases, each phase of a duration of 1.2 s and having 70 images. The MRI results were independently assessed by experienced radiologist blinded to the cDSA. RESULTS: The AVM nidus was depicted in all patients using cDSA and MRI DSA; there was an excellent correlation between these techniques in terms of the maximum diameter and Spetzler Martin grading. Of the fourteen patients, the drainage vein was depicted in 13 by both cDSA and MRI DSA showing excellent correlation between the techniques used. CONCLUSION: MRI DSA is a non-invasive imaging modality that can give the images in dynamic view. It can be considered as an adjunctive method with cDSA to plan the strategy treatment for bAVM.