Mechanical thrombectomy for AIS from large vessel occlusion - current trends and future perspectives.

Stroke is found to be one of the global top causes of mortality and the major factor in years of life with a handicap (DALYs). Ischemic strokes contributed to nearly 70% of all strokes worldwide. For endovascular thrombectomy in acute ischemic stroke with large vessel obstruction (AIS-LVO), using stent retrievers and/or reperfusion catheters has become the gold standard of therapy. The methodology involved keyword-based search in databases like PubMed, Embase, and Google Scholar for recent publications on mechanical thrombectomy (MT), AIS, large vessel occlusion (Large Vessel Occlusion (LVO)), screening relevant articles, retrieving full texts, and synthesizing key findings on procedural advancements, patient selection, COVID-19 (coronavirus disease 2019) impact, delay effects, effectiveness, clinical outcomes, and future perspectives. Only people with substantial cerebral artery obstruction may do well from MT. This includes the distal carotid artery and the proximal middle cerebral artery (segment M1). The size of a blocked vessel and NIHSS (National Institute of Health Stroke Scale) score are directly connected. Both the 2018 and 2019 versions of the AHA/ASA (American Heart Association/American Stroke Association) Guidelines for the Early Management of Patients with Acute Ischemic Stroke contained the recommendations that cases with AIS-LVO get endovascular therapy when administered during the time frame of 0-6 h after onset (Grade IA evidence). It is questionable whether this group of patients can be managed without the need for intravenous tissue plasminogen activator at the onset. When functional independence [modified Rankin Scale (mRS) score 2] was present at long-term follow-up, the endovascular intervention was favored. Tenecteplase, which differs from alteplase in terms of genetic variation, has a greater half-life and a higher level of fibrin selectivity, enabling bolus infusion. Studies have also demonstrated its efficacy and safety, as well as its long-term cost-effectiveness.

Unveiling the power of imaging techniques: comparing high-resolution ultrasound and functional MR neurography in peripheral nervous system pathology: a short communication.

MRI and ultrasonography are used for diagnosing and helping manage peripheral nervous system pathologies. Multiple studies have compared the diagnostic accuracy of these two modalities, but the results can vary depending on the specific conditions being evaluated. In general, high-resolution ultrasound is considered a reliable and accurate tool for evaluating peripheral nerves, with high sensitivity and specificity. High-resolution ultrasound and functional MR neurography are both noninvasive imaging techniques used to evaluate nerve structures in the body. However, they differ in several technical aspects like imaging modality, spatial resolution, field of view, image quality, and accessibility. Establishing consensus on image acquisition techniques, and reporting formats to facilitate effective communication and comparison of results will further enhance the outcomes. The use of advanced ultrasound techniques, such as contrast-enhanced ultrasound, elastography, and ultrasound biomicroscopy, should be promoted for better visualization and characterization of nervous tissues, like transcranial Doppler for cerebrovascular evaluation.

Renal Function Improvement after Aortic Valve Replacement in a Patient with Chronic Kidney Disease - A Case Report.

Inadequate peripheral perfusion due to cardiac diseases can worsen renal function in patients with chronic kidney disease (CKD). Due to the nature of the simultaneous cardiac and renal disease, it is often difficult to determine which is the primary cause, and hence many surgeons hesitate to operate on patients with end-stage kidney disease. However, when the primary cause is cardiac related, renal function can improve after successful cardiac surgery. Here, we describe a 55-year-old female patient with CKD Stage 5 who was on maintenance hemodialysis with severe aortic stenosis (AS) and underwent surgical aortic valve replacement and recovered from dialysis-dependent kidney disease. Drastic improvement in renal function after cardiac surgery can occur even in patients with CKD due to improved renal perfusion, especially in cases of AS. Therefore, diagnosing the primary cause of renal dysfunction is essential.