Biomarkers of Technical Success After Embolectomy for Acute Stroke

Purpose of the ReviewStent retrievers and large-bore aspiration catheters have doubled substantial reperfusion rates compared to first-generation devices. This has been accompanied by a 3-fold reduction in procedural time to revascularization. To measure future thrombectomy improvements, new benchmarks for technical efficacy are needed. This review summarizes the recent literature concerning biomarkers of procedural success and harm and highlights future directions.Recent FindingsExpanded Treatment in Cerebral Ischemia (eTICI), which incorporates scores for greater levels of reperfusion, improves outcome prediction. Core laboratory–adjudicated studies show that outcomes following eTICI 2c (90%–99% reperfusion) are superior to eTICI 2b50 and nearly equivalent to eTICI 3. Moreover, eTICI 2c improves scale reliability. Studies also confirm the importance of rapid revascularization, whether measured as first pass effect or procedural duration under 30 minutes. Distal embolization is a complication that impedes the extent and speed of revascularization, but few studies have reported its per-pass occurrence. Distal embolization and emboli to new territory should be measured after each thrombectomy maneuver. Collaterals have been shown to be an important modifier of thrombectomy benefit. A drawback of the currently accepted collateral grading scale is that it does not discriminate among the broad spectrum of partial collateralization. Important questions that require investigation include reasons for failed revascularization, the utility of a global Treatment in Cerebral Ischemia scale, and the optimal grading system for vertebrobasilar occlusions.SummaryEmerging data support a lead technical efficacy endpoint that combines the extent and speed of reperfusion. Efforts are needed to better characterize angiographic measures of treatment harm and of collateralization.

Inhaled Budesonide vis-à-vis Inhaled Mometasone in Chinese Children with Mild Persistent Asthma: A Single-Center, Retrospective Study

<b><i>Introduction:</i></b> A very limited option of inhaled corticosteroids (ICSs) is approved for pediatric use in China because in children the use of ICSs for long periods is associated with dose-dependent growth reduction. Due to the lack of consensus on which is the best ICS-based treatment option to manage mild persistent asthma in children, the present study was performed to evaluate the efficacy and safety of budesonide (BUD)-based therapy vis-à-vis mometasone-based therapy in children with mild persistent asthma. <b><i>Methods:</i></b> A single-center, retrospective study was conducted in asthmatic children aged between 6 and 11 years. BUD and mometasone furoate (MF) were administered as per the approved dosing regimen using pressurized metered-dose inhalers via oral inhalation route for a period of 12 weeks. The study outcome was assessed in terms of the forced expiratory volume in 1 s (FEV₁), symptom scores, and nonoccurrence of side effects. <b><i>Results:</i></b> Among the 77 asthmatic children, 71 completed the study treatment and were used in carrying out the analysis. The improvement of spirometric parameters like FEV₁, Tiffeneau-Pinelli index (FEV1/forced vital capacity [FVC]), and peak expiratory flow (PEF) values observed in the MF cohort was significantly greater than those of the BUD cohort (<i>p</i> &#x3c; 0.05 for all). An increase of approximately 12%/child was observed for FEV₁/FVC ratios for the BUD cohort and MF cohorts. After the 12-week study, the PEF_m and PEF_e values increased to about 50 L/min/child for the BUD cohort and about 98 L/min/child for the MF cohort. During the study, no asthma exacerbation event was observed in the MF cohort, whereas 1 child in the BUD cohort had asthma exacerbation in week 4. The use of rescue medication during the study was required for 16.2 and 6% of children, respectively, for BUD and MF cohorts. Owing to low dosing frequency, MF could provide a better treatment approach than BUD due to improved patient compliance. <b><i>Conclusions:</i></b> Although both drugs showed improvement in the quality of life of asthmatic children with manageable treatment-emergent adverse effects, the improvement was augmented in MF-treated children. <b><i>Level of Evidence:</i></b> The level of evidence was III. <b><i>Technical Efficacy Stage:</i></b> The technical efficacy stage was 4.

Efficacy and safety of percutaneous microwave ablation for hepatocellular carcinomas <4 cm in difficult location

Objective: Tumor location is a critical factor for determining technical success and local recurrence following percutaneous ablation of hepatocellular carcinomas (HCC). The purpose of this retrospective study was to evaluate the safety and outcome measures of percutaneous microwave ablation (pMWA) for HCCs <4 cm in difficult locations. Methods: Retrospective review included 81 patients who underwent pMWA for HCCs <4 cm. Fourty-three patients (30 males and 13 females; mean age, 61 years) with 53 HCCs located near the diaphragm, heart, gallbladder, kidney, gastrointestinal tract, large vessel and exophytic location were included under difficult location group. Thirty-eight patients (29 males and nine females; mean age, 60 years) with 48 HCCs in other locations were included under control group. Baseline demographics were recorded. Technical efficacy, local tumor progression (LTP), and complication rates were evaluated. Results: Mean follow-up period was 3.4 months (range 1–7). There was no major complication in both the groups; two patients had a mild perihepatic hemorrhage in the difficult location group which was managed conservatively. There was no difference between the groups in the overall technical efficacy rate (84.9% vs 91.7%, p = 0.294), LTP rate (4.4% vs 2.2%. p = 0.57) or complication rate (4.6% vs 0%, p = 0.177). Conclusion: Our data suggest that there is no significant difference in technical efficacy, LTP or complication rates for MWA in both difficult and normal locations. Advances in knowledge: With proper patient selection, pre-procedural planning and appropriate technique, pMWA is feasible, safe, and effective for small HCCs in difficult location with an acceptable range of complications.

Value of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery

Background To evaluate the feasibility and effectiveness of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery. Methods Thirty-nine patients with a total of 40 liver malignant tumors were enrolled between January 2016 and June 2019. All had histories of hepatectomy, splenectomy, cholecystectomy, and intestinal surgery. The distance between the tumor and the gastrointestinal tract was < 5 mm. Normal saline was used as artificial ascites to protect the gastrointestinal tract during thermal ablation. The success rate of the procedure, incidence of major complications, and the technical efficacy of ablation were recorded. Patients were followed for local tumor progression (LTP), and overall survival (OS). Results The use of artificial ascites was successful in 38 of the 40 procedures (95%). Major complications occurred in two of the 39 patients (5.1%) following the procedure. One was an intestinal fistula that occurred in a failed case and was associated with an infection. The other was a liver abscess that occurred in a successful case. The technical efficacy of ablation was 100% (40/40 procedures). The median follow-up was 16 months. The 1-, 2-, and 3-year LTP rates were 2.9%, 5.7% and 5.7%. The 1-, 2-, and 3-year OS rates were 97.1%, 86.8% and 69.5%. Conclusion In patients with previous abdominal surgery, artificial ascites is feasible and effective for assisting thermal ablation of liver cancer adjacent to the gastrointestinal tract.

Value of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery

Background To evaluate the feasibility and effectiveness of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery. Methods Thirty-nine patients with a total of 40 liver malignant tumors were enrolled between January 2016 and June 2019. All had histories of hepatectomy, splenectomy, cholecystectomy, and intestinal surgery. The distance between the tumor and the gastrointestinal tract was < 5 mm. Normal saline was used as artificial ascites to protect the gastrointestinal tract during thermal ablation. The success rate of the procedure, incidence of major complications, and the technical efficacy of ablation were recorded. Patients were followed for local tumor progression (LTP), and overall survival (OS). Results The use of artificial ascites was successful in 38 of the 40 procedures (95%). Major complications occurred in two of the 39 patients (5.1%) following the procedure. One was an intestinal fistula that occurred in a failed case and was associated with an infection. The other was a liver abscess that occurred in a successful case. The technical efficacy of ablation was 100% (40/40 procedures). The median follow-up was 20 months. The 1-, 2-, and 3-year LTP rates were 2.9%, 5.7% and 5.7%. The 1-, 2-, and 3-year OS rates were 97.1%, 86.8% and 69.5%. Conclusion In patients with previous abdominal surgery, artificial ascites is feasible and effective for assisting thermal ablation of liver cancer adjacent to the gastrointestinal tract.

Value of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery

BackgroundTo evaluate the feasibility and effectiveness of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery.MethodsThirty-nine patients with a total of 40 liver malignant tumors were enrolled between January 2016 and June 2019. All had histories of hepatectomy, splenectomy, cholecystectomy, and intestinal surgery. The distance between the tumor and the gastrointestinal tract was < 5 mm. Normal saline was used as artificial ascites to protect the gastrointestinal tract during thermal ablation. The success rate of the procedure, incidence of major complications, and the technical efficacy of ablation were recorded. Patients were followed for local tumor progression (LTP), and overall survival (OS).ResultsThe use of artificial ascites was successful in 38 of the 40 procedures (95%). Major complications occurred in two of the 39 patients (5.1%) following the procedure. One was an intestinal fistula that occurred in a failed case and was associated with an infection. The other was a liver abscess that occurred in a successful case. The technical efficacy of ablation was 100% (40/40 procedures). The median follow-up was 20 months. The 1-, 2-, and 3-year LTP rates were 2.9%, 5.7% and 5.7%. The 1-, 2-, and 3-year OS rates were 97.1%, 86.8% and 69.5%.ConclusionIn patients with previous abdominal surgery, artificial ascites is feasible and effective for assisting thermal ablation of liver cancer adjacent to the gastrointestinal tract.Co-first authors: Qiannan Huang #, Jianguo Li # contributed equally to this article and should be considered co-first authors.Co-corresponding authors: Xuqi He *, Kai Li * contributed equally to this article and should be considered co-corresponding authors.