A regional strategy to decrease the time to thrombectomy in patients with low probability of treatment by thrombolysis

Where and what we attend to is not only determined by what we are currently looking for but also by what we have encountered in the past. Recent studies suggest that biasing the probability by which distractors appear at locations in visual space may lead to attentional suppression of high probability distractor locations which effectively reduces capture by a distractor but also impairs target selection at this location. However, in many of these studies introducing a high probability distractor location was tantamount to increasing the probability of the target appearing in any of the other locations (i.e. the low probability distractor locations). Here, we investigate an alternative interpretation of previous findings according to which attentional selection at high probability distractor locations is not suppressed. Instead, selection at low probability distractor locations is facilitated. In two visual search tasks, we found no evidence for this hypothesis: neither when there was only a bias in target presentation but no bias in distractor presentation (Experiment 1), nor when there was only a bias in distractor presentation but no bias in target presentation (Experiment 2). We conclude that recurrent presentation of a distractor in a specific location leads to attentional suppression of that location through a mechanism that is unaffected by any regularities regarding the target location.

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Is 3 years adequate for tracking completely occluded coiled aneurysms?

Journal of Neurosurgery ◽

10.3171/2019.5.jns183651 ◽

2020 ◽

Vol 133 (3) ◽

pp. 758-764

Author(s):

Eung Koo Yeon ◽

Young Dae Cho ◽

Dong Hyun Yoo ◽

Su Hwan Lee ◽

Hyun-Seung Kang ◽

...

Keyword(s):

De Novo ◽

Careful Monitoring ◽

Surveillance Period ◽

Radiological Data ◽

De Novo Aneurysm ◽

Low Probability ◽

Almost All ◽

Annual Risk

OBJECTIVEThe authors conducted a study to ascertain the long-term durability of coiled aneurysms completely occluded at 36 months’ follow-up given the potential for delayed recanalization.METHODSIn this retrospective review, the authors examined 299 patients with 339 aneurysms, all shown to be completely occluded at 36 months on follow-up images obtained between 2011 and 2013. Medical records and radiological data acquired during the extended monitoring period (mean 74.3 ± 22.5 months) were retrieved, and the authors analyzed the incidence of (including mean annual risk) and risk factors for delayed recanalization.RESULTSA total of 5 coiled aneurysms (1.5%) occluded completely at 36 months showed recanalization (0.46% per aneurysm-year) during the long-term surveillance period (1081.9 aneurysm-years), 2 surfacing within 60 months and 3 developing thereafter. Four showed minor recanalization, with only one instance of major recanalization. The latter involved the posterior communicating artery as an apparent de novo lesion, arising at the neck of a firmly coiled sac, and was unrelated to coil compaction or growth. Additional embolization was undertaken. In a multivariate analysis, a second embolization for a recurrent aneurysm (HR = 22.088, p = 0.003) independently correlated with delayed recanalization.CONCLUSIONSAlmost all coiled aneurysms (98.5%) showing complete occlusion at 36 months postembolization proved to be stable during extended observation. However, recurrent aneurysms were predisposed to delayed recanalization. Given the low probability yet seriousness of delayed recanalization and the possibility of de novo aneurysm formation, careful monitoring may be still considered in this setting but at less frequent intervals beyond 36 months.

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