S1004 ERCP Complexity Score Predicts 90-day Post Procedure Hospital Utilization

BackgroundFlow diversion (FD) is a common treatment modality for complex intracranial aneurysms. A major concern regarding the use of FD is thromboembolic events (TEE). There is debate surrounding the optimal antiplatelet regimen to prevent TEE. We aim to evaluate the safety and efficacy of ticagrelor as a single antiplatelet therapy (SAPT) for the prevention of TEE following FD for complex aneurysm treatment.MethodsA retrospective review of a prospectively maintained neuroendovascular database at three endovascular centers was performed. Patients were included if they had an intracranial aneurysm that was treated with FD between January 2018 and September 2019 and were treated with ticagrelor as SAPT. Primary outcomes included early (within 72 hours post-procedure) and late (within 6 months) ischemic events.ResultsA total of 24 patients (mean age 47.7 years) with 36 aneurysms were eligible for analysis, including 15 (62.5%) females. 14 (58.3%) patients presented with subarachnoid hemorrhage. 35 aneurysms arose from the anterior circulation and 1 from the posterior circulation. 23 aneurysms had a saccular morphology, whereas 7 were fusiform and 6 were blister. For the treatment of all 36 aneurysms, 30 procedures were performed with 32 FD devices. Procedural in-stent thrombosis occurred in 2 cases and was treated with intra-arterial tirofiban without complications. Aneurysm re-bleeding was reported in 1 (4.2%) patient. There were no reported early or late TEE. Three patients discontinued ticagrelor due to systemic side effects.ConclusionTicagrelor is a safe and effective SAPT for the prevention of TEE after FD. Large multicenter prospective studies are warranted to validate our findings.

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Intrauterine lidocaine and naproxen for analgesia during intrauterine device insertion: randomized controlled trial

Contraception and Reproductive Medicine ◽

10.1186/s40834-019-0094-0 ◽

2019 ◽

Vol 4 (1) ◽

Cited By ~ 1

Author(s):

Shana M. Miles ◽

Katerina Shvartsman ◽

Susan Dunlow

Keyword(s):

Pain Assessment ◽

Controlled Trial ◽

Intrauterine Device ◽

Self Medication ◽

Double Blind ◽

Clinical Trial Registration ◽

Treatment Groups ◽

Pain Scores ◽

Post Procedure ◽

Treatment Medication

Abstract Background This study evaluates oral naproxen and intrauterine instillation of lidocaine for analgesia with intrauterine device (IUD) placement as compared to placebo. Methods This was a randomized, double-blind, placebo-controlled trial. Patients desiring levonorgestrel 52 mg IUD or Copper T380A IUD were randomized into treatment groups. Patients received either oral naproxen 375 mg or placebo approximately 1 h prior to procedure in conjunction with 5 mL of 2% lidocaine or 5 mL of intrauterine saline. The primary outcome was pain with IUD insertion measured on a visual analog scale immediately following the procedure. Prespecified secondary outcomes included physician pain assessment, post procedure analgesia, satisfaction with procedure, satisfaction with IUD, and pain assessment related to IUD type. Results From June 4, 2014 to October 28, 2016 a total of 160 women desiring Copper T380A or levonorgestrel 52 mg intrauterine device insertion and meeting study criteria were enrolled and randomized in the study. Of these, 157 (78 in the Copper T380A arm, 79 in the levonorgestrel 52 mg) received study treatment medication. There were 39 in naproxen/lidocaine arm, 39 in placebo/lidocaine arm, 40 in naproxen/placebo arm, and 39 in placebo/placebo arm. There were no differences in the mean pain scores for IUD placement between treatment groups (naproxen/lidocaine 3.38 ± 2.49; lidocaine only 2.87 ± 2.13; naproxen only 3.09 ± 2.18; placebo 3.62 ± 2.45). There was no difference in self-medication post procedure or in satisfaction with the procedure and IUD among women in the treatment arms or by type of IUD. Conclusion Naproxen with or without intrauterine lidocaine does not reduce pain with IUD placement. Clinical trial registration Clinicaltrials.gov, NCT02769247. Registered May 11, 2016, Retrospectively registered

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Predictions of FluSurge 2.0 methodology on hospital utilization during the Covid-19 outbreaks in several countries

International Journal of Engineering Business Management ◽

10.1177/18479790211020530 ◽

2021 ◽

Vol 13 ◽

pp. 184797902110205

Author(s):

Francisco Reyes-Santias ◽

Isabel Barrachina-Martinez ◽

David Vivas-Consuelo

Keyword(s):

Total Population ◽

Age Distribution ◽

Scenario Planning ◽

Hospital Utilization ◽

Hospital Treatment ◽

Health Security ◽

Support Resources ◽

Hospital Beds ◽

The Usa ◽

America South

Application of the Flusurge 2.0 methodology to predict the needs of conventional hospital treatment, intensive care, and respiratory support resources as a consequence of coronavirus disease (COVID-19) in several countries. Different countries of the following continents have been selected: Europe, Asia, Africa, North America, South America, and Oceania. Variables: Total population and age distribution; Number of COVID19 infections; Number of deaths from COVID19; Number of non-ICU hospital beds; Number of ICU beds; Number of ventilators. Method: The proposed possible scenario planning is based on the application of FluSurge 2.0 Software, developed by The Johns Hopkins Center for Health Security (CHS/CDC). Saturation of conventional hospitalization is expected in India, Uganda, Nepal, and Haiti; there is a forecast of saturation for ICU beds in all sample countries except Turkey. Ventilator saturation is expected in all countries of the sample except Argentina, Austria, Brazil, France, United Kingdom, Japan, South Korea, Norway, Poland, Turkey and the USA. The model shows, for a percentage greater than 50% of the countries, difficulties related to the saturation of their ICU units, and the use of ventilators.

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149 Emergency Clot Retrieval and Stenting for Posterior Circulation Stroke

British Journal of Surgery ◽

10.1093/bjs/znab134.234 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

K Daga ◽

M T Ahmad ◽

M Taneja

Keyword(s):

Treatment Option ◽

Current Literature ◽

Basilar Artery ◽

Cerebral Angiography ◽

Posterior Circulation ◽

Anterior Circulation ◽

Acute Setting ◽

Post Procedure ◽

Basilar Artery Stenosis

Abstract The current literature regarding the morphology and presentations of strokes due to basilar artery stenosis/occlusion is limited. This pathology is a rare cause of stroke and its management is not clearly decided in guidelines or published literature. Moreover, posterior circulation strokes are reported to be more devastating than anterior circulation. We present a case of a 68-year-old male who presented in an acute setting with reduced consciousness, myoclonic jerks, weakness and nausea due to a stroke from an occluded mid-segment basilar artery. MRI showed evidence of left cerebellar and right occipital infarcts. Emergent cerebral angiography was performed, and he was immediately treated by thrombectomy and stenting (Stryker Wingspan stent). The patient made a full recovery within one week and remained well at follow-up 3 months post-procedure. Emergency recanalization of basilar artery strokes, by clot retrieval and stenting, should be considered as a treatment option.

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Early vascular responses to ultrathin biodegradable polymer sirolimus-eluting stent for the treatment of st-elevation myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1781 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y Oishi ◽

T Shinke ◽

H Tanaka ◽

K Ogura ◽

K Arai ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Outcomes ◽

Antiplatelet Therapy ◽

St Elevation Myocardial Infarction ◽

Current Generation ◽

Vascular Responses ◽

Post Procedure ◽

St Elevation ◽

Sirolimus Eluting Stent

Abstract Background Recent clinical study suggests newer-generation drug-eluting stents (DES) that combine ultrathin strut and nano-coating with biodegradable polymers sirolimus-eluting stent (BP-SES) could improve long-term clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) over current generation DES. However, safety profiles in very early phase have not been systematically addressed. Objective and method We exploratory investigate early vascular response following BP-SES implantation in patients with STEMI to reveal mechanism of the favorable clinical outcomes in recent studies using frequency domain-optical coherence tomography (FD-OCT). Consecutive twenty patients with STEMI who underwent FD-OCT immediately after primary PCI and were eligible for follow-up FD-OCT at 2 weeks after implantation were enrolled between June 2018 and November 2019. Results Twenty patients (age 62.7±11.3 years, male 85.0%) were enrolled with frequencies of hypertension (45.0%), diabetes mellitus (35.0%), dyslipidemia (55.0%) and smoking (80.0%). Aspiration catheter were used in all patients, and 1.13±0.34 stents were used. Only one patient (5.0%) received chronic antiplatelet therapy with aspirin prior to the onset of STEMI. All patients started to receive prasugrel as thienopyridine from this event and continued dual antiplatelet therapy for 2 weeks. The percentage of uncovered struts significantly decreased from post-procedure to 2W follow-up (69±18% post-procedure versus 30±11% at 2W follow up, p<0.0001). Malapposed struts also decreased (5.6±5.7% post-procedure versus0.9±1.2% at 2W follow up, p<0.0001).The average protrusion area of athero-thrombotic burden numerically decreased (0.37±0.19 at post-procedure versus 0.34±0.14 mm2 at 2W follow up, p=0.19) and its volume showed similar tendency (10.60±6.40 at post-procedure versus 9.36±5.14 mm3 at 2W follow up, p=0.19). Conclusion(s) This study firstly elucidated very early vascular responses following ultrathin strut BP-SES implantation in STEMI patients, showing early progression of strut coverage and resolution of athero-thrombotic materials. This technology may have a potential to overcome the current generation DESs in this clinical setting. Thrombus, uncovered and malapposed struts Funding Acknowledgement Type of funding source: None

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