The Combination of Stent and Antiplatelet Therapy May Be Responsible of Parenchymal Magnetic Susceptibility Artifacts after Endovascular Procedure

The aim was to assess the occurrence of magnetic susceptibility artifacts (MSA) following endovascular treatment of intracranial aneurysm by stent using susceptibility weighted imaging (SWI). Imaging and clinical data of 46 patients who underwent stent placement in the case of intracranial aneurysm endovascular treatment (S-Group) were retrospectively analyzed and compared to a control group (C-Group) in which 46 patients had coiling alone. The mean number of MSA was higher in the S-group than in the C-group on postprocedural SWI sequence (8.76, 95%CI [5.76; 11.76] vs. 0.78 [0.32; 1.25], respectively, p < 0.001) with a higher frequency of the appearance of MSA also in the S-group (78.26% vs. 21.74% in the C-group, p < 0.001). In the S-group, in the vascular territory of the treated artery, there was a higher number of MSA than in other vascular territories (mean of 5.18 [3.43; 6.92] vs. 3.08 [1.79; 4.36], p = 0.001). An odds ratio (OR) of 20.98 [5.24; 83.95] suggested a higher proportion of onset of MSA in the S-group than in the C-group (p < 0.001). The appearance of MSA after a treatment by stenting for intracranial aneurysm in patients under antiplatelet therapy was common, particularly in the treated artery territory.

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Abstract 3086: Safety of Induced Hypertension in Acute Ischemic Stroke Patients with Suboptimal Recanalization after Endovascular Thrombolysis.

Stroke ◽

10.1161/str.43.suppl_1.a3086 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Steve M Cordina ◽

Shahram Majidi ◽

Saqib A Chaudhry ◽

Ameer E Hassan ◽

Gustavo J Rodriguez ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Odds Ratio ◽

Multivariate Logistic Regression Analysis ◽

Norepinephrine Infusion ◽

Induced Hypertension ◽

The Mean ◽

Poor Outcomes ◽

Similar Risk

Background: Induced hypertension is feasible, likely safe and can improve neurologic deficits in patients who are not candidates for thrombolysis. The safety of inducing hypertension in post-thrombolytic patients with suboptimal recanalization after endovascular thrombolysis is not currently known. Objective: To determine the feasibility and safety of inducing hypertension in patients in the acute post thrombolytic phase. Methods: We analyzed retrospectively collected data from a database of patients who presented with acute ischemic stroke and who received endovascular treatment with or without intravenous (IV) r-tPA . Patients with suboptimal recanalization after endovascular thrombolysis underwent induction of hypertension (systolic blood pressure [SBP] target 140-180 mmHg) for a 24 hour period after an immediate post-procedure CT scan did not demonstrate any intracerebral hemorrhage (ICH). We determined the rate of symptomatic ICH (sICH), and outcome based on modified Rankin score (mRS) at the time of discharge and compared these data to those observed in patients with non-induced hypertension and normotension. Multivariate logistic regression analysis was used to identify the odds ratio of neurological worsening and/or death after adjusting for initial National Institute of Health Stroke Scale (NIHSS) score and success of hypertension induction, which was defined as a sustained mean BP of ≥ 30% above the admission BP over the first 24 hours. Results: A total of 16 patients (12%, mean age 66) underwent post-thrombolytic induced hypertension among 138 patients who were treated with endovascular treatment. The mean age (± standard deviation [SD]) of treated patients was 68 (± 15.3) years and 52 (46%) were women. Hypertension was induced using intravenous phenylephrine or norepinephrine infusion in 9 and 7 patients, respectively. The mean (±SD) increase in SBP was 140 (±16.4) mmHg. In multivariate analysis, patients with post-thrombolytic induced hypertension had similar risk of sICH (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.11-8.55) and similar discharge mRS (OR 1.85, 95% CI 0.50-6.84). Conclusion: There was no observed increase in sICH or poor outcomes associated with induced hypertension in patients with suboptimal recanalization after endovascular thrombolysis supporting safety. Further trials directed towards assessing efficacy of this approach are needed.

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Effect of mean ocular perfusion pressure on primary open angle glaucoma

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v11i4.38618 ◽

2018 ◽

Vol 11 (4) ◽

pp. 286-290

Author(s):

Pallab Kumar Sen ◽

Nazneen Khan ◽

Md. Shafiqul Islam

Keyword(s):

Odds Ratio ◽

Primary Open Angle Glaucoma ◽

Perfusion Pressure ◽

Open Angle Glaucoma ◽

Control Group ◽

Open Angle ◽

Ocular Perfusion Pressure ◽

Ocular Perfusion ◽

The Mean ◽

The Right

Primary open angle glaucoma is the most common form of glaucoma and it remains asymptomatic until the late stage of the disease. The purpose of this study is to compare the mean ocular perfusion pressure with the primary open angle glaucoma. A total of 60 study subjects were divided into two following groups: a) newly diagnosed patients with primary open angle glaucoma (case) and b) age and sex-matched healthy volunteers (control). The intraocular pressure and blood pressure were measured 3 hourly from 8:00 am to 11:00 pm. The mean ocular perfusion pressure of the right eyes in untreated primary open angle glaucoma was 39.9 ± 7.5 mm Hg whereas it was 47.7 ± 7.7 mm Hg in the control. The odds ratio was 6.6 (95% CI, 2.1-20.5; p=0.002). The right eyes of untreated primary open angle glaucoma had 6.6 times more risk compared to the control group. The mean ocular perfusion pressure of left eyes in untreated primary open angle glaucoma was 39.9 ± 7.5 mm Hg and 48.6 ± 4.0 mm Hg in the control group. The odds ratio was 5.7 (95% CI, 1.8-17.5; p=0.004). The left eyes of untreated primary open angle glaucoma had 5.7 times more risk compared to control group. The findings revealed the evidence of vascular mechanism in glaucoma pathogenesis: Reduction of mean ocular perfusion pressure ≤48 mm Hg, may lead to daily repetitive ischemic insult to the optic nerve.

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Association between myopia and peripapillary hyperreflective ovoid mass-like structures in children

10.1101/19001180 ◽

2019 ◽

Author(s):

In Jeong Lyu ◽

Kyung-Ah Park ◽

Sei Yeul Oh

Keyword(s):

Risk Factors ◽

Odds Ratio ◽

Depth Image ◽

Control Group ◽

Spherical Equivalent ◽

Regression Analyses ◽

Factors Associated ◽

Myopic Shift ◽

The Mean ◽

Disc Size

ABSTRACTPurposeTo investigate the characteristics of children with peripapillary hyperreflective ovoid mass-like structures (PHOMS) and evaluate the risk factors associated with PHOMS.MethodsThis study included 132 eyes of 66 children with PHOMS and 92 eyes of 46 children without PHOMS (controls) who were assessed by disc enhanced depth image spectral-domain optical coherence tomography (OCT). Univariable and multivariable logistic analyses were performed to evaluate risk factors associated with the presence of PHOMS.ResultsAmong the 66 children with PHOMS, 53 patients (80.3%) had bilateral and 13 patients (19.7%) had unilateral PHOMS. The mean age of the PHOMS group was 11.7 ± 2.6 years and 11.4 ± 3.1 years in the control group. Mean spherical equivalent (SE) by cycloplegic refraction was −3.13 ± 1.87 diopters (D) in the PHOMS group and −0.95 ± 2.65 D in the control group. Mean astigmatism was 0.67 ± 0.89 D and 0.88 ± 1.02 D in the PHOMS group and the control group, respectively. Mean disc size was 1735 ± 153 μm in the PHOMS group and 1741 ± 190 μm in the control group. All eyes in PHOMS group had myopia of −0.50 D or less, except for an eye with +1.00 D. According to the univariable (odds ratio [OR] 1.59, P < 0.001) and multivariable (OR 2.00, P < 0.001) logistic regression analyses, SE decreased by 1 D was significantly associated with PHOMS.ConclusionsPHOMS is associated with myopic shift in children. Optic disc tilt may be a mediator between myopia and PHOMS.

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Ventriculostomy-Related Intracranial Hemorrhage Following Surgical and Endovascular Treatment of Ruptured Aneurysms

10.21203/rs.3.rs-1199743/v1 ◽

2022 ◽

Author(s):

Moritz Lenschow ◽

Niklas von Spreckelsen ◽

Sergej Telentschak ◽

Christoph Kabbasch ◽

Roland Goldbrunner ◽

...

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Confidence Interval ◽

Endovascular Treatment ◽

Antiplatelet Therapy ◽

Intracranial Hemorrhage ◽

Odds Ratio ◽

Treatment Decision ◽

Ruptured Aneurysms ◽

Increased Risk

Abstract Introduction : Endovascular therapy of ruptured aneurysms is regularly accompanied by periprocedural heparinization and requires the use of periprocedural antiplatelets in more complex cases. This raises concerns regarding increased bleeding risks in the case of frequently required ventriculostomy. The aim of this study was to analyze risk factors for ventriculostomy-related intracranial hemorrhages (VS-ICH) in endovascular or surgical treatment of ruptured aneurysms with a focus on antithrombotic therapy. Materials and Methods In this retrospective analysis we included patients admitted to our institution over a 12-year period who had received at least one ventriculostomy due to subarachnoid hemorrhage-related hydrocephalus. Patients were dichotomized into an endovascular and surgical group and rates of VS-ICH were compared. Risk factors for VS-ICH were assessed in uni- and multivariate analyses. Results A total of 606 ventriculostomies were performed in 328 patients. Within the endovascular group, antiplatelet therapy was used in 44.8% of cases. The overall rate of ventriculostomy-related intracranial hemorrhage was 13.1%. Endovascular treatment was associated with a higher rate of VS-ICH compared to surgical treatment (p=0.011), but not in cases without antiplatelet therapy (p=0.166). Application of any antiplatelet therapy (odds ratio, 2.647 [95% confidence interval, 1.141-6.143]) and number of ventriculostomies (odds ratio, 2.513 [95% confidence interval, 1.859-3.395]) were independent predictors of ventriculostomy-related hemorrhages. Discussion Our findings indicate an increased risk of VS-ICH in the endovascular group if administration of antiplatelets was required. While this aspect has to be included into treatment decision making, it must be weighed against the benefits of endovascular techniques.

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Not Using a Tourniquet May Reduce the Incidence of Asymptomatic Deep Venous Thrombosis After ACL Reconstruction: An Observational Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211056677 ◽

2021 ◽

Vol 9 (12) ◽

pp. 232596712110566

Author(s):

Masaki Nagashima ◽

Kenichiro Takeshima ◽

Nobuto Origuchi ◽

Ryo Sasaki ◽

Yoshifumi Okada ◽

...

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Odds Ratio ◽

Cruciate Ligament ◽

Control Group ◽

Level Of Evidence ◽

Surgical Field ◽

The Mean ◽

Anterior Cruciate ◽

Without Tourniquet

Background: Deep venous thrombosis (DVT) and pulmonary embolism are serious potential complications after anterior cruciate ligament reconstruction (ACLR). Little is known about the influence of tourniquet use on the incidence of DVT after ACLR. Purpose: To compare the incidence of DVT after ACLR with and without the use of a tourniquet. Study Design: Cohort study; Level of evidence, 3. Methods: Between November 2018 and May 2020, a total of 60 consecutive ACLRs in 60 patients, including 7 revision surgeries, were performed without tourniquet use at our hospital and were enrolled in this study (T– group). In addition, 55 consecutive ACLRs in 55 patients, including 10 revision surgeries, were performed with tourniquet use between April 2017 and September 2018 and were enrolled as the control group (T+ group). DVT was diagnosed using ultrasonography of both legs performed preoperatively and at postoperative week 1. The incidence of postoperative DVT was compared between the T– and T+ groups. Logistic regression analysis was performed to evaluate the effect of older age (≥40 vs <40 years) and tourniquet use on the occurrence of DVT. Results: No DVTs were detected preoperatively. The incidence of postoperative DVT was significantly lower in the T– group compared with the T+ group (1 patient [1.7%] vs 9 patients [16.4%]; P = .005). All patients with DVT were asymptomatic. Although the mean operative time was not significantly different (80.8 minutes in the T+ group vs 78.5 minutes in the T– group; P = .461), the mean blood loss from the drain was significantly lower in the T– group than in the T+ group (149.9 vs 201.9 mL; P < .001). Age ≥40 years and tourniquet use were significantly related to the occurrence of DVT (odds ratio, 8.3 [95% CI, 1.9-36.8]; P = .005; and odds ratio, 8.8 [95% CI, 1.0-75.3]; P = .047, respectively). Conclusion: ACLRs performed without tourniquet resulted in a significantly lower incidence of DVT after ACLR and significantly less bleeding from drains. If adequate visibility of the surgical field is obtained, ACLR without tourniquet use may reduce the incidence of DVT.

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Prior antiplatelet therapy in patients undergoing endovascular treatment for acute ischemic stroke: Results from the MR CLEAN Registry

International Journal of Stroke ◽

10.1177/1747493020946975 ◽

2020 ◽

pp. 174749302094697

Author(s):

Rob A van de Graaf ◽

Sanne M Zinkstok ◽

Vicky Chalos ◽

Robert-Jan B Goldhoorn ◽

Charles BLM Majoie ◽

...

Keyword(s):

Ischemic Stroke ◽

Confidence Interval ◽

Endovascular Treatment ◽

Functional Outcome ◽

Antiplatelet Therapy ◽

Intracranial Hemorrhage ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Symptomatic Intracranial Hemorrhage ◽

Mr Clean

Background Antiplatelet therapy may increase the risk of symptomatic intracranial hemorrhage after endovascular treatment for ischemic stroke but may also have a beneficial effect on functional outcome. The aim of this study is to compare safety and efficacy outcomes after endovascular treatment in patients with and without prior antiplatelet therapy. Methods We analyzed patients registered in the MR CLEAN Registry between March 2014 and November 2017, for whom data on antiplatelet therapy were available. We used propensity score nearest-neighbor matching with replacement to balance the probability of receiving prior antiplatelet therapy between the prior antiplatelet therapy and no prior antiplatelet therapy group and adjusted for baseline prognostic factors to compare these groups. Primary outcome was symptomatic intracranial hemorrhage. Secondary outcomes were 90-day functional outcome (modified Rankin Scale), successful reperfusion (extended thrombolysis in cerebral infarction score ≥2B) and 90-day mortality. Results Thirty percent ( n = 937) of the 3154 patients were on prior antiplatelet therapy, who were matched to 477 patients not on prior antiplatelet therapy. Symptomatic intracranial hemorrhage occurred in 74/937 (7.9%) patients on prior antiplatelet therapy and in 27/477 (5.6%) patients without prior antiplatelet therapy adjusted odds ratio 1.47, 95% confidence interval 0.86–2.49. No associations were found between prior antiplatelet therapy and functional outcome (adjusted common odds ratio 0.87, 95% confidence interval 0.65–1.16), successful reperfusion (adjusted odds ratio 1.23, 95% confidence interval 0.77–1.97), or 90-day mortality (adjusted odds ratio 1.15, 95% confidence interval 0.86–1.54). Conclusion We found no evidence of an association of prior antiplatelet therapy with the risk of symptomatic intracranial hemorrhage after endovascular treatment, nor on functional outcome, reperfusion, or mortality. A substantial beneficial or detrimental effect of antiplatelet therapy on clinical outcome cannot be excluded. A randomized clinical trial comparing antiplatelet therapy versus no antiplatelet therapy is needed.

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Angiographic Analysis of Intravascular Thrombus Volume in Patients with Acute Ischemic Stroke

Journal of Endovascular Therapy ◽

10.1177/152660280701400407 ◽

2007 ◽

Vol 14 (4) ◽

pp. 475-482 ◽

Cited By ~ 2

Author(s):

Adnan I. Qureshi ◽

Ammar Alkawi ◽

Haitham M. Hussein ◽

Afshin A. Divani

Keyword(s):

Multivariate Analysis ◽

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Symptom Onset ◽

Odds Ratio ◽

Mechanical Thrombectomy ◽

Injection Technique ◽

Study Group ◽

The Mean

Purpose: To investigate the role that intravascular thrombus volume plays in mechanical thrombectomy and dose-titrated algorithms using pharmaceutical thrombolytic therapies. Methods: The angiographic studies of 33 consecutive patients (19 women; mean age 66±11 years) who underwent endovascular treatment for acute ischemic stroke were reviewed. A double-injection technique was utilized that involved 2 catheters for simultaneous injection of contrast proximal and distal to the thrombus to delineate its boundaries. The thrombus volume was calculated using the formula for cylindrical objects after measuring its length and diameter. Results: The volume of the 36 thrombi measured in the study group was 46±59 mm3. The mean length and diameter were 10±6 and 2±1 mm, respectively. The time between symptom onset and acquisition of angiographic images ranged from 167 to 589 minutes (mean 336±109). In a multivariate analysis, thrombus volume was not associated with any recanalization (odds ratio 2.4, 95% CI 0.02–191) after adjusting for initial occlusion grade, time between symptom onset and angiography, and previous intravenous use of thrombolytic agents. Volume capacities for retrieval devices to retain 50% and 75% of the thrombi were estimated as 29.2 mm3 and 55.3 mm3, respectively. Conclusion: The large variation in thrombi volume must be considered in designing retrieval devices to optimize their performance.

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Vitamin D Treatment in Patients with Hashimoto’s Thyroiditis may Decrease the Development of Hypothyroidism

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000269 ◽

2016 ◽

Vol 86 (1-2) ◽

pp. 9-17 ◽

Cited By ~ 3

Author(s):

Bekir Ucan ◽

Mustafa Sahin ◽

Muyesser Sayki Arslan ◽

Nujen Colak Bozkurt ◽

Muhammed Kizilgul ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Hashimoto’S Thyroiditis ◽

Healthy Control Group ◽

Hashimoto's Thyroiditis ◽

Control Group ◽

Endocrine Society ◽

Thyroid Autoantibody ◽

Healthy Control ◽

The Mean

Abstract.The relationship between Hashimoto’s thyroiditis and vitamin D has been demonstrated in several studies. The aim of the present study was to evaluate vitamin D concentrations in patients with Hashimoto’s thyroiditis, the effect of vitamin D therapy on the course of disease, and to determine changes in thyroid autoantibody status and cardiovascular risk after vitamin D therapy. We included 75 patients with Hashimoto’s thyroiditis and 43 healthy individuals. Vitamin D deficiency is defined as a 25-hydroxy vitamin D (25(OH)D3) concentration less than 20ng/mL. Vitamin D deficient patients were given 50.000 units of 25(OH)D3 weekly for eight weeks in accordance with the Endocrine Society guidelines. All evaluations were repeated after 2 months of treatment. Patients with Hashimoto’s thyroiditis had significantly lower vitamin D concentrations compared with the controls (9.37±0.69 ng/mL vs 11.95±1.01 ng/mL, p < 0.05, respectively). Thyroid autoantibodies were significantly decreased by vitamin D replacement treatment in patients with euthyroid Hashimoto’s thyroiditis. Also, HDL cholesterol concentrations improved in the euthyroid Hashimoto group after treatment. The mean free thyroxine (fT4) concentrations were 0.89±0.02 ng/dL in patients with Hashimoto’s thyroiditis and 1.07±0.03 ng/dL in the healthy control group (p < 0.001). The mean thyroid volumes were 7.71±0.44 mL in patients with Hashimoto’s thyroiditis and 5.46±0.63 mL in the healthy control group (p < 0.01). Vitamin D deficiency is frequent in Hashimoto’s thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.

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Anticoagulation in addition to dual antiplatelet therapy has no impact on long-term follow-up after endovascular treatment of (sub)acute lower limb ischemia

VASA ◽

10.1024/0301-1526/a000786 ◽

2019 ◽

Vol 48 (4) ◽

pp. 321-329

Author(s):

Mariya Kronlage ◽

Erwin Blessing ◽

Oliver J. Müller ◽

Britta Heilmeier ◽

Hugo A. Katus ◽

...

Keyword(s):

Endovascular Treatment ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Limb Ischemia ◽

Bleeding Complications ◽

Severe Bleeding ◽

Short Term ◽

Long Term Follow Up

Summary. Background: To assess the impact of short- vs. long-term anticoagulation in addition to standard dual antiplatelet therapy (DAPT) upon endovascular treatment of (sub)acute thrombembolic occlusions of the lower extremity. Patient and methods: Retrospective analysis was conducted on 202 patients with a thrombembolic occlusion of lower extremities, followed by crirical limb ischemia that received endovascular treatment including thrombolysis, mechanical thrombectomy, or a combination of both between 2006 and 2015 at a single center. Following antithrombotic regimes were compared: 1) dual antiplatelet therapy, DAPT for 4 weeks (aspirin 100 mg/d and clopidogrel 75 mg/d) upon intervention, followed by a lifelong single antiplatelet therapy; 2) DAPT plus short term anticoagulation for 4 weeks, followed by a lifelong single antiplatelet therapy; 3) DAPT plus long term anticoagulation for > 4 weeks, followed by a lifelong anticoagulation. Results: Endovascular treatment was associated with high immediate revascularization (> 98 %), as well as overall and amputation-free survival rates (> 85 %), independent from the chosen anticoagulation regime in a two-year follow up, p > 0.05. Anticoagulation in addition to standard antiplatelet therapy had no significant effect on patency or freedom from target lesion revascularization (TLR) 24 months upon index procedure for both thrombotic and embolic occlusions. Severe bleeding complications occurred more often in the long-term anticoagulation group (9.3 % vs. 5.6 % (short-term group) and 6.5 % (DAPT group), p > 0.05). Conclusions: Our observational study demonstrates that the choice of an antithrombotic regime had no impact on the long-term follow-up after endovascular treatment of acute thrombembolic limb ischemia whereas prolonged anticoagulation was associated with a nominal increase in severe bleeding complications.

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Mental Health Among Adolescents from Returned Portuguese Immigrant Families

Swiss Journal of Psychology ◽

10.1024/1421-0185/a000015 ◽

2010 ◽

Vol 69 (3) ◽

pp. 131-139 ◽

Cited By ~ 5

Author(s):

Félix Neto

Keyword(s):

Mental Health ◽

Health Outcomes ◽

Mental Health Problems ◽

Immigrant Families ◽

Health Problems ◽

Mental Health Outcomes ◽

Control Group ◽

Older Adolescents ◽

The Mean ◽

Portuguese Adolescents

This study investigated mental health problems and their predictors among adolescents from returned immigrant families. The sample consisted of 360 returned adolescents (mean age = 16.8 years; SD = 1.9). The mean duration of a sojourn in Portugal for the sample was 8.2 years (SD = 4.5). A control group of 217 Portuguese youths were also included in the study. Adolescents from immigrant families reported mental health levels similar to those of Portuguese adolescents who have never migrated. Girls showed more mental health problems than boys. Younger adolescents showed fewer mental health problems than older adolescents. Adaptation variables contributed to mental health outcomes even after acculturation variables were accounted for. Implications of the study for counselors are discussed.

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