Aspiration Failure Research Articles

Performance and learning curve of a surgical care practitioner in completing hip aspirations

INTRODUCTION The roles of non-medically trained practitioners within the NHS are expanding; they are now being employed by many specialties, including surgery, to relieve pressures on healthcare teams. AIMS To investigate the learning curve and competence of an orthopaedic surgical care practitioner (SCP) in performing hip aspirations. METHODS Data were retrospectively collected on 510 orthopaedic hip aspirations, of which 360 were completed by a single SCP and 150 were completed by surgeons before the SCP took over routine aspiration. The 360 aspirations completed by an SCP were separated into groups of 30 by date, so any trend in failure rate could be analysed. Ordinal χ2 analysis was used to analyse this trend and Pearson χ2 analysis was used to analyse differences in failure rates between professionals. RESULTS The hip aspiration failure rate for the SCP was significantly lower than for the surgeons; 8.6% vs 20.7% (P<0.001). With the experience gained in completing the first 210 procedures, the failure rate of the SCP dropped to 3.3% for the remaining 150 procedures. This downward trend in hip aspiration failure rate, with advancing experience of the SCP, was shown to be statistically significant (P=0.006). DISCUSSION SCPs who complete hip aspirations on a regular basis have significantly lower failure rates than surgeons, probably as a result of the learning curve, which this study demonstrated. Other trusts should consider delegating routine hip aspiration work to a designated SCP to lower failure rates.

Aspirations and Income, Food Security and Subjective Well-Being in Rural Ethiopia

Despite some improvements in recent years, poverty and food insecurity remain widespread and the main challenges in Ethiopia. Using individual and household level data collected in rural Ethiopia, we examine if aspirations are strongly associated with well-being outcomes, as posited in the aspirations failure framework articulated by Ray (2006) and others. We employ both bivariate and multivariate analyses. We find that aspirations (particularly that of the household head) are indeed strongly associated with the household per-capita income and expenditure and with various triangulating measures of household food (in)security including per-capita calorie consumption, the food consumption score (FCS), the household dietary diversity score (HDDS), and the household food insecurity access scale (HFIAS). Contrary to a few other studies, we also find strong evidence that, in rural Ethiopia, aspirations are positively associated with satisfaction in life and/or happiness. Findings in this study provide suggestive evidence that policies aimed at improving well-being outcomes might benefit from multiple effects (both direct and indirect) if they incorporate aspirations raising strategies.

Presenting hydrothorax predicts failure of needle aspiration in primary spontaneous pneumothorax

ObjectiveThe objective was to evaluate if existence of hydrothorax in initial chest radiograph predicts treatment outcome in patients with primary spontaneous pneumothorax who received needle thoracostomy. MethodsThis is a retrospective cohort study carried out from January 2011 to August 2014 in 1 public hospital in Hong Kong. All consecutive adult patients aged 18years or above who attended the emergency department with the diagnosis of primary spontaneous pneumothorax with needle aspiration performed as primary treatment were included. Age, smoking status, size of pneumothorax, previous history of pneumothorax, aspirated gas volume and presence of hydropneumothorax in initial radiograph were included in the analysis. The outcome was success or failure of the needle aspiration. Logistic regression was used to identify the predicting factors of failure of needle aspiration. ResultThere were a total of 127 patients included. Seventy-three patients (57.5%) were successfully treated with no recurrence upon discharge. Among 54 failure cases, 13 patients (10.2%) failed immediately after procedure as evident by chest radiograph and required second treatment. Forty-one patients (32.3%) failed upon subsequent chest radiographs. Multivariate logistic regression showed factors independently associated with the failure of needle aspiration, which included hydropneumothorax in the initial radiograph (odds ratio [OR]=4.47 [1.56i12.83], P=.005), previous history of pneumothorax (OR=3.92 [1.57-9.79], P=.003), and large size of pneumothorax defined as apex-to-cupola distance ≥5cm (OR=2.75 [1.21-6.26], P=.016). ConclusionsHydropneumothorax, previous history of pneumothorax, and large size were independent predictors of failure of needle aspiration in treatment of primary spontaneous pneumothorax.

Poverty and Aspirations Failure

We develop a theoretical framework to study the psychology of poverty and ‘aspirations failure’, defined as the failure to aspire to one's own potential. In our framework, rich and the poor persons share the same preferences and same behavioural bias in setting aspirations. We show that poverty can exacerbate the effects of this behavioural bias leading to aspirations failure and hence, a behavioural poverty trap. Aspirations failure is a consequence of poverty, rather than a cause. We specify the conditions under which raising aspirations alone is sufficient to help escape from a poverty trap, even without relaxing material constraints.

Weight loss in a patient with polycystic kidney disease: when liver cysts are no longer innocent bystanders

Objective and importance:Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent inherited kidney disorder, and liver involvement represents one of its major extra-renal manifestations. Although asymptomatic in most patients, polycystic liver disease (PLD) can lead to organ compression, severe disability and even become life-threatening, thereby warranting early recognition and appropriate management.Clinical presentation:We report the case of a 56-year-old woman with ADPKD and severe weight loss secondary to a giant hepatic cyst compressing the pylorus. Partial hepatectomy was required after failure of cyst aspiration and sclerotherapy, and patient's condition improved rapidly.Discussion and conclusions:We discuss the presentation and classification of compressing liver cysts, and the available therapeutic alternatives for this potentially severe complication of ADPKD.

Aspiration Failure: A Poverty Trap for Indigenous Children in Peru?

This paper aims to contribute to understand the mechanisms underlying the complex exclusion process of indigenous people in Peru, by analysing the role played by aspirations in the investment in education of indigenous children. To address these issues, the paper relies on a very rich data set, the Young Lives data, and use an original instrument that allow to cast light on the causal relation between aspiration and educational outcomes. We find that aspiration failure is a channel of inequality persistence between indigenous and non-indigenous people, but that aspiration failure do not takes the form of a lack of aspiration. Indigenous children do not have internalized racial schemas about occupation or about their opportunities. However, the gap between their aspiration and their current socio-economic status is too large, in so far as it has a disincentive effect on forward-looking behaviour.

Bone marrow trephine biopsy in Haematological diseases: a study of 53 cases

Bone marrow aspiration (BMA) and biopsy (BMTB) are important investigations for diagnosis of haematolgical malignancies and non-malignant diseases both in adults and children. BMA and BMTB are complementary and if both are done a comprehensive analysis of bone marrow involvement is possible. 53 cases of BMTB were studied in order to underscore the indications and importance of BMTB. BMTB was done to determine cellularity in aplastic anaemia (AA) (33.96%, n=18) and in cases of failure of aspiration (32.08%, n=17). Failure of aspiration was attributable to bone marrow (BM) fibrosis (76%, n=13) due to acute leukaemia (35.30%, n=6) and myelofibrosis (43.17%, n=7). BMTB upstaged non Hodgkin’s lymphoma (NHL) from IIIB to IVB in 22.22% cases. 1 case of AA showed focal lymphoid aggregate which later evolved into acute lymphoblastic leukaemia (ALL). BMTB is a safe procedure and increased bleeding was noted only in a case of polycythaemia vera. DOI: http://dx.doi.org/10.3329/jdmc.v22i2.21544 J Dhaka Medical College, Vol. 22, No.2, October, 2013, Page 207-210

P173 Ambulatory Management Of Spontaneous Pneumothorax

Introduction There is no clear consensus on the management of Spontaneous pneumothorax. BTS recommends insertion of chest drain following failure of initial aspiration in large primary spontaneous pneumothorax (PSP) and in all patients with symptomatic/ large secondary spontaneous pneumothorax (SSP). These patients are usually admitted to hospital following chest drain insertion. Objective To study the feasibility and safety of early discharge of spontaneous pneumothorax patients requiring chest drain on the ambulatory pathway with a Heimlich valve (pneumostat device). Methods Patients were initially managed as per BTS guidelines. Patients who had a chest drain inserted were admitted until review by the respiratory team. All PSP patients and some SSP patients with good performance status (WHO scale 0–1) were eligible for the ambulatory pathway. Those with continuing air leak are fitted with a Heimlich valve and discharged home. They were reassessed every two days with a CXR on arrival in the ambulatory care unit. The chest drain was removed once the air leak stopped for at least 24 h. Results 21 episodes of spontaneous pneumothorax in 18 patients (10 PSP and 8 SSP) were treated on the ambulatory pathway between May’13 and June’14. The healthcare usage of patients on ambulatory pathway is listed in the table. The pneumothorax resolved successfully in 82% (17 episodes). There were three recurrences requiring repeat management on the ambulatory pathway. A total of 10 patients were referred to the surgeon including four with continuing air leak and six due to recurrence. Patients with continuing air leak remained in the community until admission for thoracic surgery. Complications included pain in two patients and allergic reaction to the dressing used in one patient. The patient with allergic reaction had accidental dislodgement of chest drain during dressing change necessitating reinsertion of chest drain. Conclusion It is feasible for most patients with large PSP and many patients with SSP to be managed on an ambulatory care pathway with a Heimlich valve until their pneumothorax heals or is definitively treated. Reference Fanny Voisin et al . Ambulatory management of spontaneous pneumothorax with pigtail catheters. http://dx.doi.org.10.1016/j.annemergmed.2013.12.017

RT-06 * GAMMA KNIFE SURGERY AFTER NAVIGATION-GUIDED ASPIRATION FOR CYSTIC METASTATIC BRAIN TUMORS

Metastatic brain tumors over 3 cm in diameter (volume of 14.1ml) are generally considered poor candidates for Gamma Knife surgery (GKS). We retrospectively assessed the method and efficacy of GKS for large cystic metastatic brain tumors after navigation-guided aspiration under local anesthesia. From September 2007 to April 2014, 38 cystic metastatic brain tumors in 32 patients (12 males, 20 females; mean age, 63.2 years) were treated at Kansai Rosai Hospital. The patients were performed navigation-guided cyst aspiration under local anesthesia, then at the day or the next day, were performed GKS and usually discharged on the day. The methods for preventing of leptomeningeal dissemination are following: 1) puncture from the place whose cerebral thickness is 1 cm or more; 2) avoidance of Ommaya reservoir implantation; and 3) placement of absorbable gelatin sponge to the tap tract. Tumor volume, including the cystic component, decreased from 25.4 ml (range 8.7-84.7 ml) to 11.4 ml (range 2.9-36.7 ml) following aspiration; the volume reduction was approximately 51.6%. Follow-up periods in the study population ranged from 0 to 24 months (median 3.5 months). The overall median survival was 6.7 months. There was no leptomeningeal dissemination related to the aspiration. One patient experienced radiation necrosis after GKS, one patient experienced re-aspiration by failure of aspiration, and two patients experienced surgical resections and one patient experienced re-aspiration by cyst regrowth after GKS. Long-term hospitalization is not desirable for the patients with brain metastases. In japan, Long-term hospitalization is required for surgical resection or whole brain radiation therapy, but only two days hospitalization is required for GKS after navigation-guided aspiration at our hospital. This GKS after navigation-guided aspiration is more effective and less invasive than surgical resection or whole brain radiation therapy.

The Mayo Clinic experience with Morel-Lavallée lesions

Although uncommon, Morel-Lavallée lesions (also called closed degloving injuries) are associated with considerable morbidity in trauma patients. There is lack of consensus regarding proper management of these lesions. Management options include nonoperative therapies, along with percutaneous and operative techniques. We sought to define the factors associated with failure of percutaneous aspiration to better identify patients requiring immediate operative management. We retrospectively searched our prospectively collected database for patient records containing the terms Morel-Lavallée, closed degloving injury, or posttraumatic seroma from February 2, 2004, through December 23, 2011. Treatment methods included compression wraps or observation (nonoperative management), percutaneous aspiration, or operative management with incision/drainage or formal debridement of skin and soft tissues that resulted in wound vacuum-assisted closure placement and/or split-thickness skin graft (operative management). The treatment groups were compared using univariate analysis and χ testing. We identified 79 patients with 87 Morel-Lavallée lesions in the setting of trauma. Most were caused by motor vehicle collisions (25%). No difference was observed between the treatment groups in sex, body mass index, anticoagulation treatment, diabetes mellitus, smoking history, or alcohol use. The percutaneous aspiration group had higher rates of recurrence (56% vs. 19% and 15% in nonoperative and operative groups, respectively). The percentage of patients who had aspiration of more than 50 mL of fluid was higher for lesions that recurred than for lesions that resolved (83% vs. 33%, p = 0.02). Aspiration of more than 50 mL of fluid from Morel-Lavallée lesions was much more common among lesions that recurred (83%) than among those that resolved (33%). We therefore recommend that aspiration of more than 50 mL of fluid from a Morel-Lavallée lesion prompts operative intervention. We have now adopted this as a practice management guideline. Therapeutic/care management study, level III.

Shorter Symptoms Onset to Emergency Department Presentation Time Predicts Failure of Needle Aspiration in Primary Spontaneous Pneumothorax

Objective To evaluate factors in predicting the failure of needle aspiration in primary spontaneous pneumothorax, in particular the interval between symptom onset and emergency department presentation. Methods This is a retrospective cohort study carried out from January 2010 to October 2012 in two public hospitals in Hong Kong. All consecutive adult patients aged 18 or more who attended the emergency departments in the study period with the diagnosis of primary spontaneous pneumothorax, where needle aspiration was performed as the primary treatment were recruited. Age, smoking status, previous pneumothorax, symptom interval, size of pneumothorax and aspirated gas volume were included in the analysis. The outcome was successful or failed needle aspiration. Logistic regression was used to identify independent predictors of failed needle aspiration. Results A total of 196 patients were included. Overall, 105 patients (53.6%) were treated successfully with no recurrence upon discharge. Among those failure patient, 30 patients (15.3%) failed as evidence by the chest X-ray taken immediately after the procedure while 61 patients (31.1%) failed upon subsequent chest X-ray. Multivariate logistic regression showed factors independently associated with failure of needle aspiration included size of pneumothorax (apex to cupola distance) (odds ratio [OR]=1.022, 95% confidence interval [CI]=1.009-1.039, p=0.001) and symptoms onset to emergency department presentation time (OR=0.987, 95% CI=0.976-0.999, p=0.028). Conclusions Large pneumothorax and shorter symptoms onset to emergency department presentation time were associated with higher failure rate of needle aspiration for primary spontaneous pneumothorax. (Hong Kong j.emerg. med. 2014;21:16-22)

The Complicity of Consumption: Hedonism and Politics in Thomas Pynchon'sAgainst the Dayand John Dos Passos'sUSA

This article is a comparative study of two epic works that share a historical setting and a broad political outlook, but diverge significantly in at least one respect. Frequent and heavy alcohol consumption is a feature of both Thomas Pynchon'sAgainst the Dayand John Dos Passos'sUSAtrilogy, but the way in which these authors describe heavy drinking – and hedonistic behaviour in general – indicates fundamental differences between the modernism of Dos Passos and Pynchon's postmodernist strategies. The article contends that this aspect of Pynchon's novel represents a critique of attitudes within the twentieth-century American left towards sensuality, patriarchy and the failure of leftist aspiration within a contemporary context that invokes such subjects as the complicity of consumption, terrorism and the ethics of political assassination.

Ipsilateral Opposite-Side Aspiration in Resistant Pneumothorax After CT Image Guided Lung Biopsy: Complementary Role After Simple Needle Aspiration

<h3>Background</h3> The goal of this study was to evaluate the efficacy of ipsilateral opposite-side aspiration, a new method to overcome resistant pneumothorax after failure of a simple aspiration. The patient position is reversed (from prone to supine or vice versa) and the aspiration repeated. <h3>Methods</h3> Between January 1, 2010, and April 3, 2012, 129 consecutive, CT image-guided, percutaneous needle biopsies of lung nodules were performed in 127 patients (75 men, 52 women; mean age, 67.8 years; range, 26-88 years). Two patients underwent repeated biopsies. The mean lesion diameter was 38 mm (range, 8-110 mm). Core biopsy and fine-needle aspiration (FNA) were performed in 126 procedures; in three cases, only FNA was performed. In the cases with symptomatic minimal pneumothorax and in all patients with pneumothorax > 10 mm, immediate, simple, manual aspiration was performed. Ipsilateral opposite-side aspiration was performed when simple aspiration failed. <h3>Results</h3> Among 129 CT image-guided biopsies, pneumothorax was detected by CT scan in 54 (42%); 51 (39%) were detected during the biopsy. Delayed pneumothorax occurred in two patients (1.55%). Manual aspiration to treat pneumothorax was performed in 27 of 129 procedures (21%). Simple aspiration was successful in 20 of these 27 cases (74%). Ipsilateral opposite-side aspiration was accomplished in the remaining seven cases (26%) and was successful in six cases (86%). Two of 129 procedures (1.55%) required chest tube placement. <h3>Conclusions</h3> Immediate, simple, percutaneous aspiration of iatrogenic pneumothorax was successful in 74% of patients needing treatment. Our proposed new method of ipsilateral opposite-side aspiration offers a solution for patients who remain with resistant pneumothorax after simple aspiration.

Predictors of Failed Thrombus Aspiration in Patients Undergoing Primary Percutaneous Coronary Intervention

ABSTRACT Background: Aspiration thrombectomy is recommended as an adjunctive method in patients undergoing primary percutaneous coronary intervention (PCI), however, thrombus aspiration failure is relatively frequent. The objective of this study was to evaluate the rate and identify predictors of failed thrombus aspiration in a contemporaneous series of patients. Methods Prospective cohort study including consecutive patients with acute ST-segment elevation myocardial infarction undergoing primary PCI with thrombus aspiration from December 2009 to December 2011. Aspiration thrombectomy was performed at the operator’s discretion and success was defined as effective thrombus aspiration by a dedicated catheter with the achievement of a final TIMI flow > 0. Results 1,055 primary PCIs were performed and aspiration thrombectomy was used in 37% of cases with a success rate of 70%. Aspiration thrombectomy success was observed in 254 patients whereas failure was observed in 107 patients. Aspiration thrombectomy failure was associated with age, hypertension, diabetes mellitus , dyslipidemia, previous PCI, TIMI risk score, Killip IV, leukocyte count, serum fibrinogen, target vessel reference diameter and preprocedural TIMI 3 flow. Patients with failed thrombus aspiration had a trend towards higher mortality (11.6% vs. 5.9%; P = 0.09). Conclusions Aspiration thrombectomy failure during primary PCI was observed in 30% of the cases and was associated with a trend towards higher mortality. The identification of clinical, laboratory and angiographic predictors may help improve these devices and the technique and enable better patient selection.

Preditores de insucesso de tromboaspiração em pacientes submetidos à intervenção coronária percutânea primária

INTRODUÇÃO: A tromboaspiração é recomendada como método adjunto à intervenção coronária percutânea (ICP) primária, mas o insucesso em recuperar trombos é relativamente frequente. O objetivo deste estudo foi avaliar as taxas de insucesso de tromboaspiração e identificar seus preditores, em uma série contemporânea de pacientes. MÉTODOS: Estudo de coorte prospectivo que incluiu pacientes consecutivos atendidos com infarto agudo do miocárdio com elevação do segmento ST e submetidos à ICP primária com tromboaspiração no período de dezembro de 2009 a dezembro de 2011. Os procedimentos de tromboaspiração foram realizados por decisão do operador, e o sucesso foi definido como aspiração efetiva de trombo pelo cateter dedicado, com recuperação do fluxo coronário (fluxo TIMI > 0). RESULTADOS: Foram realizadas 1.055 ICPs primárias, sendo que a tromboaspiração foi utilizada em 37% dos casos, com taxa de sucesso de 70%. Foram identificados 254 pacientes com sucesso e 107 com insucesso da tromboaspiração. Insucesso de tromboaspiração foi associado a: idade, hipertensão, diabetes mellitus, dislipidemia, ICP prévia, escore de risco TIMI, Killip IV, contagem de leucócitos, fibrinogênio sérico, diâmetro de referência do vaso-alvo e TIMI 3 pré-procedimento. Pacientes com insucesso da tromboaspiração apresentaram tendência a maior mortalidade (11,6% vs. 5,9%; P = 0,09). CONCLUSÕES: Insucesso de tromboaspiração durante ICP primária ocorreu em 30% dos casos e esteve associado a tendência de maior mortalidade. A identificação de preditores clínicos, laboratoriais e angiográficos pode auxiliar no aprimoramento desses dispositivos e em sua técnica, além da escolha de pacientes mais adequados para seu emprego.

Excimer laser coronary angioplasty with manual thrombus aspiration for a case of very late stent thrombosis of sirolimus-eluting stent

Very late stent thrombosis occurring after drug-eluting stent implantation is a rare complication. However, it is often associated with poor outcome. Manual thrombectomy has been shown to lower the rate of distal embolization in the case of ST-elevation myocardial infarction of native coronary arteries. However, the presence of abundant thrombus material may lead to manual thrombus aspiration failure. Here, we describe the case of a patient with acute myocardial infarction due to stent thrombosis of a sirolimus-eluting stent occurring 50 months after stent deployment showing abundant thrombus material, which led to manual thrombus aspiration failure and was then successfully treated by excimer laser coronary angioplasty. In these cases, excimer laser coronary angioplasty may be useful due to its ability to dissolve thrombus.

P2-144 - How Should we Manage the Central Vein Access Port System in Outpatient Cancer Chemotherapy when the Port System Can be Flushed, but no Blood Aspirated?

ABSTRACT Background There are no reported data on the management of the central vein access port (CV-port) system when the CV-port system can be flushed, but no blood aspirated, mainly because a small thrombus occludes the catheter tip (catheter tip thrombosis). Moreover, it remains unclear whether catheter tip thrombosis needs to be treated. Methods From April 2008 to January 2012, 199 patients who were treated with outpatient chemotherapy via a CV-port in the Center for Clinical Oncology, Okayama University Hospital, were analyzed retrospectively. Results Of the patients, no blood could be aspirated in 21 (17.6 %) when treated via a CV-port. The median time between CV-port placement and the failure of blood aspiration was 273 (range 7–1641) days. Among the patients with no blood aspiration from their CV-port, thirteen cases (61.9 %) had no complications other than failure of blood aspiration, and anticancer agents have been successfully administered. However, the other eight patients had their CV-port system replaced due to complications, including three catheter ruptures, two thrombotic events around the catheter, two infections, and one occlusion due to catheter bending. Conclusions Approximately 60% of patients might not require any treatment or intervention for the failure of blood aspiration from their CV-port. Medical staffs, however, should be aware that approximately one-third of the cases with no blood aspiration potentially have troubles with their CV-ports that need to be replaced.

The Mammotome biopsy system is an effective treatment strategy for breast abscess

BackgroundAlthough most breast abscesses can be treated with the current first-line treatment of antibiotics by needle aspiration, the therapeutic duration is lengthy and recurrences often occur. Therefore, we aimed to investigate the clinical efficacy of the Mammotome biopsy system (Johnson & Johnson Corp., New Brunswick, NJ) in a cohort of patients with breast abscesses. MethodsForty lactating and 30 nonlactating breast abscess patients with unfavorable outcomes with antibiotic treatment and/or needle aspiration failure were recruited and treated with the Mammotome biopsy system. ResultsSkin inflammation of all patients disappeared within 6 days with no recurrence. The clinical outcomes in patients with an abscess size ≤3.5 cm was significantly better than those with an abscess size >3.5 cm (P = .025). ConclusionsThe Mammotome biopsy system, an effective treatment strategy that is minimally invasive and less damaging, in combination with appropriate antibiotic therapy can be used safely as the first-line approach to breast abscess management.

Gastrostomy Tube Placement by Endoscopy Versus Radiologic Methods in Patients with ALS: A Retrospective Review of Complications and Outcome (P01.101)

Objective: To better define the best method of gastrostomy (G) tube placement for patients with amyotrophic lateral sclerosis (ALS). Background Weight loss and nutritional status are prognostic factors for survival during the course of ALS. Ultimately, a G-tube is often needed to deliver nutrition. G-tube placement can be performed by percutaneous endoscopic gastrostomy (PEG) or radiologically inserted gastrostomy (RIG) procedures. Further, RIG can be performed as internal-external pull-type (pull-type-RIG) or external-internal (push-type-RIG) methods. Safe G-tube placement must overcome specific challenges in the ALS population. Most ALS patients in need of G-tubes have concomitant respiratory failure. Aspiration, post-operative pneumonia, and peri-procedure respiratory failure are important concerns for ALS patients that undergo surgical procedures that necessitate sedative medications and anesthetic agents. The best method for G-tube placement has not been well defined in this population. Design/Methods: Retrospective cohort study of ALS patients that underwent G-tube placement by PEG or RIG. Results: Statistical analysis was performed on consecutive ALS patients that underwent G-tube placement by PEG and RIG. 50 patients were analyzed in each group. The two methods were compared with respect to peri-interventional aspects and clinical results. Parameters assessed included procedure success rate, peri- and post-procedural complications, length of hospital stay, 6-month mortality, and pain. Age, FVC, and ALSFRS were assessed in separate analysis to determine their impact on the success and complication rate of both procedure types. Subgroup analysis was performed to compare these parameters in the pull-type-RIG and push-type-RIG groups. Conclusions: Procedural related complications, including aspiration and post-operative pneumonia, are more common in ALS patients that undergo G-tube placement by the PEG method. RIG is a safer and more efficacious alternative in patients with ALS. We speculate that the limited use of general anesthesia and sedation during the RIG procedure accounts for the superior outcome in the RIG population. Disclosure: Dr. Allen has nothing to disclose. Dr. Hall has nothing to disclose. Dr. Wallery has nothing to disclose. Dr. Ajroud-Driss has nothing to disclose. Dr. Armstrong has nothing to disclose. Dr. McManus has nothing to disclose. Dr. Cook has nothing to disclose. Dr. Sufit has nothing to disclose. Dr. Chrisman has nothing to disclose. Dr. Wolfe has nothing to disclose. Dr. Siddique has nothing to disclose.

Clinical and Angiographic Predictors and Prognostic Value of Failed Thrombus Aspiration in Primary Percutaneous Coronary Intervention

This study sought to investigate which factors are associated with failure of thrombus aspiration (TA) and if this has prognostic implications. The pathophysiological mechanism and clinical benefit of TA during primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction is still in debate. Between August 2001 and October 2007, TA was attempted in 1,399 patients. Failure of TA was defined as the inability to reach and/or cross the occlusion with the aspiration catheter for effective thrombus removal. In addition, we analyzed patients in which no material could be obtained. We examined baseline clinical and angiographic variables related to failure of TA or to the lack of aspirate. Follow-up on vital status was obtained at 1 year. In 144 (10.3%) patients, the aspiration catheter failed to cross the lesion. After multivariable adjustment, marked proximal tortuosity (odds ratio [OR]: 2.88, 95% confidence interval [CI]: 1.92 to 4.31, p < 0.001), the presence of a calcified lesion (OR: 2.70, 95% CI: 1.77 to 4.13, p < 0.001), and a bifurcation lesion (OR: 1.97, 95% CI: 1.15 to 3.37, p = 0.013) were independent predictors of failed TA. Age over 60 years and the circumflex as infarct-related artery were associated with the lack of aspirate. Mortality rates at 1 year were 6.2% in patients with failed TA and 6.4% with successful TA (hazard ratio: 0.98, 95% CI: 0.49 to 1.95, p = 0.95). The presence of marked proximal tortuosity of the infarct-related artery, a calcified lesion, and a bifurcation lesion are independent predictors of failure of thrombus aspiration. We found that unsuccessful TA did not affect 1-year mortality.