Abstract P14: Per Pass Clot Retrieval Technique: Interim Analysis of the Excellent Registry

Background: EXCELLENT (NCT03685578) is a large, prospective, single-arm, multicenter, international registry of mechanical thrombectomy (MT) with EmboTrap as the first attempted device in routine clinical practice. The study collects per pass data on procedural and technical details that are based on interventionalists’ preference, providing an opportunity to assess current practices in MT across multiple international high-volume stroke centers. Methods: Subjects treated according to standard of care were eligible for inclusion in the study if EmboTrap was used in the first MT pass. Interim analysis focusing on procedural details and per pass clot retrieval technique was performed based on 689 subjects enrolled by 79 physicians across 26 international sites (US, Belgium, Germany, France) between Sept 2018 and Jul 2020. Results: Mean #passes was 2.1 (median=1, max=10), 50.3% subjects had only 1 pass and 84.8% had 3 or fewer. Per pass use of stent retriever, aspiration, balloon guide, intermediate catheter and long sheath catheter, along with technique details (e.g. incubation time, device positioning, co-aspiration) are summarized in Table 1. Rates and reasons for device changes are also given. Conclusion: Interim analysis of the ongoing EXCELLENT registry informs on current practice patterns in MT. This is the first report of detailed per pass clot retrieval strategies in a large international multicenter cohort.

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Endovascular Embolectomy for Emergent Large Vessel Occlusion: A Historical Perspective

American Journal of Interventional Radiology ◽

10.25259/ajir-3-2017 ◽

2017 ◽

Vol 1 ◽

pp. 2

Author(s):

Simone Montoya ◽

Emily Walters ◽

Nguyen Mai ◽

Tarun Bhalla

Keyword(s):

Historical Perspective ◽

Current Practice ◽

Mechanical Thrombectomy ◽

Standard Of Care ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Short Period ◽

Significant Disability

Acute ischemic stroke is one of the leading causes of morbidity and mortality in America and the leading cause of adult long-term disability. Strokes due to emergent large vessel occlusion (ELVO) often lead to significant disability; however, they also can be amenable to treatment with the potential for good functional outcome. Over a short period, the standard of treatment has evolved considerably, from supportive care to systemic therapy and now to targeted therapy. The role for mechanical thrombectomy had been debated for years, but in light of five back-to-back publications demonstrating its superiority, it is now considered standard of care in those patients who meet criteria. This article aims to introduce the reader to the progression of events leading to the current practice of endovascular embolectomy in ELVO.

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A multicenter study of the safety and effectiveness of mechanical thrombectomy for patients with acute ischemic stroke not meeting top-tier evidence criteria

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012905 ◽

2017 ◽

Vol 10 (1) ◽

pp. 10-16 ◽

Cited By ~ 24

Author(s):

Nitin Goyal ◽

Georgios Tsivgoulis ◽

Donald Frei ◽

Aquilla Turk ◽

Blaise Baxter ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Standard Of Care ◽

High Volume ◽

Functional Independence ◽

Functional Improvement ◽

Complication Rates ◽

Logistic Regression Models ◽

Symptomatic Intracerebral Hemorrhage

BackgroundWhile mechanical thrombectomy (MT) has become the standard of care for patients with acute ischemic stroke (AIS) with emergent large-vessel occlusions (ELVO), recently published guidelines appropriately award top-tier evidence to the same selective criteria that were employed in completed clinical trials. We sought to evaluate the safety and effectiveness of MT in patients with AIS with ELVO who do not meet top-tier evidence criteria (TTEC).MethodsWe conducted an observational study on consecutive patients with AIS with ELVO who underwent MT at six high-volume endovascular centers. Standard safety outcomes (3-month mortality, symptomatic intracranial hemorrhage) and effectiveness outcomes (3-month functional independence: modified Rankin Scale scores of 0–2) were compared between patients meeting and failing TTEC.ResultsThe sample consisted of 349 (60%) controls fulfilling TTEC and 234 (40%) non-TTEC patients. Control patients meeting TTEC for MT tended to have higher functional independence rates at 3 months (47% vs 39%; p=0.055), while the rates of symptomatic intracerebral hemorrhage (sICH) were similar (9%) in both groups (p=0.983). In multivariable logistic regression models, adherence to TTEC for MT was not independently related to any safety outcome (sICH: OR 0.71, 95% CI 0.30 to 1.68, p=0.434; 3-month mortality: OR 1.27, 95% CI 0.69 to 2.33, p=0.448) or effectiveness outcome (3-month functional independence: OR 0.81, 95% CI 0.48 to 1.37, p=0.434; 3-month functional improvement: OR 0.73, 95% CI 0.48 to 1.11, p=0.138) after adjusting for potential confounders.ConclusionsApproximately 40% of patients with AIS with ELVO offered MT do not fulfill TTEC for MT. Patients who did not meet TTEC had high rates of good clinical outcome and low complication rates.

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Interim analysis of a prospective randomized international multicenter investigator driven study comparing tacrolimus and cyclosporin A, both in combination with MMF and steroids after lung transplantation

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2004-816840 ◽

2004 ◽

Vol 52 (S 1) ◽

Author(s):

H Treede ◽

A Glanville ◽

W Klepetko ◽

R Lama ◽

G Verleden ◽

...

Keyword(s):

Lung Transplantation ◽

Cyclosporin A ◽

Interim Analysis ◽

International Multicenter

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Surgical interval after neo-adjuvant therapy in rectal cancer, current practice patterns in Canada

10.26226/morressier.596648e4d462b80290b520a5 ◽

2017 ◽

Author(s):

Antonio Caycedo

Keyword(s):

Rectal Cancer ◽

Adjuvant Therapy ◽

Current Practice ◽

Practice Patterns

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Revascularization and functional outcomes after mechanical thrombectomy for acute ischemic stroke in elderly patients

Journal of Neurosurgery ◽

10.3171/2018.12.jns182399 ◽

2020 ◽

Vol 132 (4) ◽

pp. 1182-1187 ◽

Cited By ~ 1

Author(s):

Carrie E. Andrews ◽

Nikolaos Mouchtouris ◽

Evan M. Fitchett ◽

Fadi Al Saiegh ◽

Michael J. Lang ◽

...

Keyword(s):

Ischemic Stroke ◽

Elderly Patients ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Multivariate Logistic Regression Analysis ◽

Standard Of Care ◽

Stroke Severity ◽

Vessel Occlusion ◽

Younger Patients ◽

Success Of Treatment

OBJECTIVEMechanical thrombectomy (MT) is now the standard of care for acute ischemic stroke (AIS) secondary to large-vessel occlusion, but there remains a question of whether elderly patients benefit from this procedure to the same degree as the younger populations enrolled in the seminal trials on MT. The authors compared outcomes after MT of patients 80–89 and ≥ 90 years old with AIS to those of younger patients.METHODSThe authors retrospectively analyzed records of patients undergoing MT at their institution to examine stroke severity, comorbid conditions, medical management, recanalization results, and clinical outcomes. Univariate and multivariate logistic regression analysis were used to compare patients < 80 years, 80–89 years, and ≥ 90 years old.RESULTSAll groups had similar rates of comorbid disease and tissue plasminogen activator (tPA) administration, and stroke severity did not differ significantly between groups. Elderly patients had equivalent recanalization outcomes, with similar rates of readmission, 30-day mortality, and hospital-associated complications. These patients were more likely to have poor clinical outcome on discharge, as defined by a modified Rankin Scale (mRS) score of 3–6, but this difference was not significant when controlled for stroke severity, tPA administration, and recanalization results.CONCLUSIONSOctogenarians, nonagenarians, and centenarians with AIS have similar rates of mortality, hospital readmission, and hospital-associated complications as younger patients after MT. Elderly patients also have the capacity to achieve good functional outcome after MT, but this potential is moderated by stroke severity and success of treatment.

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Current practice patterns of society of urologic oncology members in performing inguinal lymph node staging/therapy for penile cancer: A survey study

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2021.03.007 ◽

2021 ◽

Author(s):

Nicholson Marilin ◽

Viraj A. Master ◽

Curtis A. Pettaway ◽

Philippe E. Spiess

Keyword(s):

Lymph Node ◽

Penile Cancer ◽

Current Practice ◽

Practice Patterns ◽

Inguinal Lymph Node ◽

Survey Study ◽

Lymph Node Staging ◽

Urologic Oncology

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Beyond guidelines: analysis of current practice patterns of AANS/CNS tumor neurosurgeons

Journal of Neuro-Oncology ◽

10.1007/s11060-020-03389-9 ◽

2021 ◽

Vol 151 (3) ◽

pp. 361-366

Author(s):

Evan D. Bander ◽

Jonathan H. Sherman ◽

Chetan Bettegowda ◽

Manish K. Aghi ◽

Jason Sheehan ◽

...

Keyword(s):

Current Practice ◽

Practice Patterns ◽

Cns Tumor

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Current practice and perceptions of safety protocols for the use of intraperitoneal chemotherapy in the operating room: results of the IP-OR international survey

Pleura and Peritoneum ◽

10.1515/pp-2020-0148 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Daniel Clerc ◽

Martin Hübner ◽

K.R. Ashwin ◽

S.P. Somashekhar ◽

Beate Rau ◽

...

Keyword(s):

Operating Room ◽

Intraperitoneal Chemotherapy ◽

Current Practice ◽

High Volume ◽

International Survey ◽

Protection Measures ◽

Team Members ◽

Cleaning Staff ◽

The Individual ◽

Or Team

Abstract Objectives To assess the risk perception and the uptake of measures preventing environment-related risks in the operating room (OR) during hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC). Methods A multicentric, international survey among OR teams in high-volume HIPEC and PIPAC centers: Surgeons (Surg), Scrub nurses (ScrubN), Anesthesiologists (Anest), Anesthesiology nurses (AnesthN), and OR Cleaning staff (CleanS). Scores extended from 0–10 (maximum). Results Ten centers in six countries participated in the study (response rate 100%). Two hundred and eleven responses from 68 Surg (32%), 49 ScrubN (23%), 45 Anest (21%), 31 AnesthN (15%), and 18 CleanS (9%) were gathered. Individual uptake of protection measures was 51.4%, similar among professions and between HIPEC and PIPAC. Perceived levels of protection were 7.57 vs. 7.17 for PIPAC and HIPEC, respectively (p<0.05), with Anesth scoring the lowest (6.81). Perceived contamination risk was 4.19 for HIPEC vs. 3.5 for PIPAC (p<0.01). Information level was lower for CleanS and Anesth for HIPEC and PIPAC procedures compared to all other responders (6.48 vs. 4.86, and 6.48 vs. 5.67, p<0.01). Willingness to obtain more information was 86%, the highest among CleanS (94%). Conclusions Experience with the current practice of safety protocols was similar during HIPEC and PIPAC. The individual uptake of protection measures was rather low. The safety perception was better for PIPAC, but the perceived level of protection remained relatively low. The willingness to obtain more information was high. Intensified, standardized training of all OR team members involved in HIPEC and PIPAC is meaningful.

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