Good Functional Outcome In Patients Research Articles

Anesthetic management for large vessel occlusion acute ischemic stroke with tandem lesions

BackgroundEndovascular therapy (EVT) stands as an established and effective intervention for acute ischemic stroke in patients harboring tandem lesions (TLs). However, the optimal anesthetic strategy for EVT in TL patients...

Early blood pressure lowering therapy is associated with good functional outcome in patients with intracerebral hemorrhage

BackgroundThe implementation of a care bundle might improve functional outcome for patients with intracerebral hemorrhage (ICH). However, the impact of anti-hypertensive treatment on ICH outcomes remains uncertain. Our objective is to examine whether early blood pressure (BP) lowering therapy within first 12 h is associated with good outcome in ICH patients.MethodsWe included acute ICH patients who had baseline computed tomography (CT) scans within 6 h after onset of symptoms between October 2013 and December 2021. Early BP reduction was defined as use of anti-hypertensive agents within 12 h after onset of symptom. The clinical characteristics were compared between patients who received early BP lowering therapy and those without. The associations between early BP lowering and good outcome and functional independence at 3 months were assessed by using multivariable logistic regression analyses.ResultsA total of 377 patients were finally included in this study for outcome analysis. Of those, 212 patients received early BP reduction within 12 h after ICH. A total of 251 (66.6%) patients had good outcome. After adjustment for age, admission systolic BP, admission GCS score, baseline hematoma volume, hematoma expansion, and presence of intraventricular hemorrhage, early BP lowering therapy was associated with functional independence (adjusted odd ratio:1.72, 95% confidence interval:1.03–2.87; P = 0.039) and good outcome (adjusted odd ratio: 2.02, 95% confidence interval:1.08–3.76; P = 0.027).ConclusionsIn ICH patients presenting within 6 h after symptom onset, early BP reduction within first 12 h is associated with good outcome and functional independence when compared to those who do not undergo such early intervention. Implementation of quality measures to ensure early BP reduction is crucial for management of ICH.

Precise single column resection and reconstruction with femoral head plus total hip replacement for primary malignant peri-acetabulum tumors

To evaluate whether single acetabular column can be reserved and the effect of reconstruction with femoral head plus total hip replacement (THR) for primary malignant peri-acetabulum tumors. From 2007 to 2015, nineteen patients with primary malignant peri-acetabulum tumors were enrolled. All cases underwent single column resection with clear surgical margins. Ten of the 19 tumor’s resections were assisted by computer navigation. Femoral heads were applied to reconstruct anterior or posterior column defects; THR was used for joint reconstruction. The surgical safety, oncologic outcome and prosthesis survivorship and function were evaluated by regular follow-up. The average follow-up period was 65.9 months. Surgical margins contained wide resection in 12 cases and marginal resection in 7 cases. One patient with Ewing's sarcoma died 14 months postoperative due to lung metastasis. One case with chondrosarcoma had recurrence. One prosthesis was removed due to infection. The average MusculoSkeletal Tumor Society (MSTS) function score was 83.7%. Due to the relative small number of cases, there was no significant difference in the recurrence rate and prosthesis failure rate between the navigation group and non-navigation group. Single column resection and reconstruction with femoral head autograft plus THR is an effective, safe method with less complication rate and better functional outcome for patients with peri-acetabular tumors.

Choice and Timing of Antithrombotic after Ischemic Stroke, Intracerebral Hemorrhage or Cerebral Venous Thrombosis.

Stroke is a multifactorial vascular disease and remains a leading cause of disability in the United States. Strokes can be ischemic or hemorrhagic in nature and secondary to arterial or venous disease, making determining the etiology and secondary prevention strategy important for preservation of the injured brain, prevention of recurrent strokes, and in the maintenance of good functional outcomes for patients impacted by stroke. In this narrative review, we provide a synopsis of the available medical evidence surround selection, timing, and choice of therapy, including utilization of left atrial appendage closure, in patients with ischemic, hemorrhagic or venous stroke.

Abstract TMP94: Association of Acute Carotid Stenting With Functional Outcome Mediated by Excellent Reperfusion in Tandem Lesions: Analysis of a Multicenter Registry

Introduction: Current evidence suggests that acute carotid artery stenting (CAS) for cervical lesions is associated with better functional outcomes in patients with acute stroke with tandem lesions (TLs) treated with endovascular treatment (EVT). However, a gap in understanding persists regarding the underlying causal pathophysiological mechanism of this relationship when compared to angioplasty alone. We aimed to determine whether, and to what degree, excellent reperfusion (mTICI 2c-3) mediates the relationship between acute CAS and functional outcome in patients with TLs. Methods: This sub-analysis stems from a multicenter cohort study of patients with anterior circulation TLs who underwent EVT across 16 stroke centers spanning from January 2015 to December 2020. Mediation analysis was conducted to examine the potential causal pathway in which the relationship between acute CAS and favorable functional outcome (90-day mRS 0-2) is mediated by excellent reperfusion. Results: A total of 512 patients were included, out of whom 319 (62.3%) underwent acute CAS, and 243 (47.5%) had a favorable functional outcome. Excellent reperfusion was a predictor of favorable functional outcome (adjusted OR [aOR]: 2.27, 95% CI 1.57-3.28, p =<0.001). Excellent reperfusion partially mediated the relationship between acute CAS and functional outcome ( Figure ), as acute CAS was still significantly associated with functional outcome after adjustment for excellent reperfusion (aOR: 1.56, 95% CI 1.07-2.28, p =0.022). Excellent reperfusion explained 53% (95% CI 24-87) of the relationship between acute CAS and functional outcome. Conclusions: In TL patients undergoing EVT, excellent reperfusion predicted favorable functional outcome when CAS was performed as compared to angioplasty alone. A significant proportion (53%) of the treatment effect of acute CAS on functional outcome was found to be mediated through the improvement of excellent reperfusion rates.

Evaluation of early functional outcome of arthroscopic decompression in chronic primary sub-acromial impingement syndrome

<b>Background:</b> Sub-Acromial Impingement Syndrome (SAIS) spectrum ranges from acute inflammation to chronic degeneration of the bursa and of rotator cuff tendons in sub-acromial space. It may lead to a full-thickness tear of rotator cuff tendons and degenerative joint disease of the shoulder girdle leading to functional loss and disability if not treated early and adequately. This study aimed to determine the early functional outcome of arthroscopic sub-acromial decompression in chronic SAIS due to mechanical causes.<br /> <b>Material and methods:</b> This was a prospective cohort study. Patients were operated on arthroscopically for sub-acromial decompression between September 2018 and March 2020. Thirty-five patients with a range of 20 to 65 years of age diagnosed clinically with primary chronic sub-acromial impingement syndrome meeting the inclusion criteria were included in this study. All the patients under study were initially kept for at least four weeks of a course of conservative treatment and persisted in having symptoms were treated surgically with arthroscopic sub-acromial decompression. The UCLA (The University of California at Los Angeles) shoulder rating scale was used to assess shoulder function. The assessment was done in the pre-operative period, four weeks, 12 weeks, and 16 weeks post arthroscopic sub-acromial decompression surgery.<br /> <b>Results:</b> Compared to pre-operative UCLA shoulder function score at the end of non-operative conservative treatment, the patients under study showed a statistically significant improvement at the end of the 16th week of post-arthroscopic subacromial decompression (p<0.0001).<br /> <b>Conclusion:</b> This study concludes that arthroscopic sub-acromial decompression provides a good functional outcome in patients having primary shoulder impingement due to extrinsic mechanical causes such as shape and slope of the acromion in the absence of significant (total or near total) rotator cuff tear after 16 weeks of follow-up.

Mechanical Thrombectomy by Stent Retrievers for Treating Acute Ischemic Stroke due to Large Vessel Occlusion

Background Recently multiple studies have evaluated the role of mechanical thrombectomy in treatment of acute ischemic stroke & demonstrated that it has a favorable impact on the functional outcome in patients with acute ischemic stroke related to proximal arterial occlusion. In addition to that, multiple systematic reviews and meta-analyses analyzed the results of these recent Randomized Control Trials and concluded that endovascular treatment is more likely to result in a better functional outcome for patients compared to IV thrombolysis alone for acute ischemic stroke due to large vessel occlusion, with no differences in mortality and symptomatic intracerebral hemorrhage at 90 days follow-up. Mechanical approaches have shown great potential of replacing locally applied thrombolytic agents as first-line therapy. Objectives The aim of work is to evaluate the safety and efficacy of endovascular treatment (EVT) of acute large vessel occlusion within the first 6 hours of symptoms onset, including bridging therapy [intravenous thrombolysis (IVT) with subsequent EVT]. We also compare our results to other main trials in recent years. Methods A one arm clinical trial was conducted on 25 patients with acute ischemic stroke at Ain Shams University hospitals as well as private centers, from the first of April 2020 to the end of September 2020. All participants subjected to full history taking, radiological assessment and assessment of the stroke severity. Results The median age of the studied patients was 64 years (Interquartile range 58-72.5) and about half (56%) of them were males. On pre-post intervention comparison, there was a highly significant statistical difference regarding NIHSS score, infarct volume, mRS score at 90 days (P < 0.001) and ASPECTS (P < 0.01) of the studied patients. 12% of patients had mortality at 30 days after mechanical thrombectomy with good functional outcome (mRS 0-2) rate of 60%. Conclusion Mechanical thrombectomy is effective and safe in treatment of acute ischemic stroke in patients with large cerebral artery occlusion with the first 6 hours of symptoms onset.

Current Concepts in Diagnostics and Treatment of Patellar Instability: Review

Background. Patellar instability is one of the most common pathologies of the musculoskeletal system, predominantly observed in physically active young individuals. It ranks third in the structure of knee joint injuries after anterior cruciate ligament and meniscal injuries.
 The aim of this review to present modern perspectives on the diagnosis, principles, and surgical treatment techniques for patients with patellar instability based on an analysis of the literature.
 Methods. Publications were searched in the PubMed/MedLine and eLIBRARY databases. A total of 112 foreign articles published between 1984 and 2023 and 12 domestic publications from 2011 to 2022 were found. During the analysis, 68 articles were selected, which had full texts or abstracts containing sufficient information on diagnostic methods, commonly used standard and modified surgical correction methods for patellar instability, and treatment protocols considering patient age structure, instability characteristics, and functional demands.
 Results. A qualitatively new stage in the reconstructive and restorative surgery of patellar instability is the in-depth examination of patients to determine the extent of damage to the medial retinaculum and the presence of dysplastic changes in anatomical structures that provide normal biomechanics of the knee extensor apparatus. A strictly individual approach to the selection of surgical treatment methods considering risk factors contributing to the development of chronic patellar instability becomes of particular importance.
 Conclusion. Precise restoration of the medial patellofemoral ligament, supplemented by the correction of identified dysplastic changes in anatomical formations of the knee joint area, allows for better functional outcomes in patients with acute and chronic patellar instability.

Functional results in children with retinopathy of prematurity treated with intravitreal bevacizumab

Background/aimThe aim of the study is to describe the efficacy and to determine the functional outcome in terms of visual acuity and refractive defect of a single dose of intravitreal bevacizumab in patients with high-risk ROP type 1. MethodsIn this retrospective clinical study patients diagnosed between December 2013 and January 2018 with high-risk pre-threshold ROP type 1 and treated with intravitreal bevacizumab were selected. All patients were treated following the established protocol at our centre. Those patients with less than three-year follow-up were excluded. Visual acuity and cycloplegic refraction in the last visit were registered. Treatment efficacy was defined as the absence of retreatment with intravitreal anti-VEGF or laser during follow-up. ResultsA total of 38 infants (76 eyes) were included in the analysis. Twenty infants (40 eyes) completed visual acuity testing. Mean age was 6 years (IQR: 4–9). Median visual acuity was 0.8 (IQR: 0.5–1). Thirty-four eyes (85%) had good visual acuity (greater than or equal to 0.5). Thirty-seven patients (74 eyes) had cycloplegic refraction measured. Median spherical equivalent at the last visit was +0.94 (IQR: –0.25; 1.88). Treatment success rate was 96.05%. ConclusionIntravitreal bevacizumab treatment showed good functional outcome in patients with high-risk ROP type 1. In our study, good response to treatment was observed with a success rate over 95%.

Lower initial red blood cell count in cerebrospinal fluid predicts good functional outcome in patients with spontaneous subarachnoid haemorrhage.

Red blood cell (RBC) degradation after subarachnoid haemorrhage (SAH) negatively affects functional outcome. Although the detection of RBCs in the cerebrospinal fluid (CSF) is a widely available part of neurological routine diagnostics, the prognostic value as a biomarker remains unclear. This study was undertaken to investigate whether CSF RBC count correlates with established radiological markers of SAH volume and whether the CSF RBC count can predict functional outcome in SAH patients. A total of 121 consecutive spontaneous SAH patients were retrospectively analyzed. CSF was collected from external ventricular drain as part of routine diagnostic procedures. We used multivariable binary logistic regression to investigate associations between CSF RBC counts and functional outcome 3 months after SAH or hospital survival. Good functional outcome was defined as modified Rankin Scale ≤ 2. Patients' age was 60 ± 14 years, and the median admission Hunt & Hess grade (H&H) was 4. CSF samples were collected 2 days after intensive care unit admission. High CSF RBC counts positively correlated with radiological measurements for SAH volume, for example, modified Fisher score (p = 0.002) and Hijdra ventricle score (p = 0.016). Multivariable regression analysis adjusted for age, H&H grade, modified Fisher and Hijdra scores showed that low CSF RBC counts predicted hospital survival (per 100,000 CSF RBCs: adjusted odds ratio [adjOR] = 0.74, 95% confidence interval [CI] = 0.61-0.89, p = 0.001) and good functional outcome after 3 months (per 100,000 CSF RBC: adjOR = 0.76, 95% CI = 0.60-0.96, p = 0.020). CSF RBC counts correlate with radiographic scores quantifying SAH volume and may serve as an early independent biomarker for hospital survival and good functional 3-month outcome in patients requiring ventriculostomy after SAH.

Resultados funcionales de tratamiento con bevacizumab intravítreo en pacientes con retinopatía del prematuro

Background/aimThe aim of the study is to describe the efficacy and to determine the functional outcome in terms of visual acuity and refractive defect of a single dose of intravitreal bevacizumab in patients with high-risk ROP type1. MethodsIn this retrospective clinical study patients diagnosed between December 2013 and January 2018 with high-risk pre-threshold ROP type1 and treated with intravitreal bevacizumab were selected. All patients were treated following the established protocol at our centre. Those patients with less than three-year follow-up were excluded. Visual acuity and cycloplegic refraction in the last visit were registered. Treatment efficacy was defined as the absence of retreatment with intravitreal anti-VEGF or laser during follow-up. ResultsA total of 38 infants (76eyes) were included in the analysis. Twenty infants (40eyes) completed visual acuity testing. Mean age was 6years (IQR: 4-9). Median visual acuity was 0.8 (IQR: 0.5-1). Thirty-four eyes (85%) had good visual acuity (greater than or equal to 0.5). Thirty-seven patients (74eyes) had cycloplegic refraction measured. Median spherical equivalent at the last visit was +0.94 (IQR: −0.25; 1.88). Treatment success rate was 96.05%. ConclusionIntravitreal bevacizumab treatment showed good functional outcome in patients with high-risk ROP type1. In our study, good response to treatment was observed with a success rate over 95%.

Short-Term Global Instability and Genu Recurvatum Outcomes of Revision Total Knee Arthroplasty with Rotating-Hinged Knee Prosthesis

Purpose: Primary revision total knee arthroplasty (TKA) is associated with bone loss and ligamentous insufficiency. After TKA, patients may have global knee instability or genu recurvatum and require revision TKA with a rotating-hinged knee (RHK) prosthesis. However, several studies have reported variable outcomes. This study aimed to: 1) evaluate the outcomes of revision TKA with an RHK prosthesis; and 2) compare the outcomes and satisfaction of patients with global instability and genu recurvatum following revision TKA. Methods: The cases of 18 patients (mean age, 71 ± 8.5 years; mean follow-up time, 24 months (range, 12–38 months) who underwent revision TKA with an RHK prosthesis in 2015–2018 were retrospectively reviewed. Patients were further classified into the global instability group (n=11), those who were diagnosed with periprosthetic joint infection (8 patients), TKA dislocation (2 patients), and periprosthetic fracture with a complete tear of the medial collateral ligament (1 patient); and the genu recurvatum group (n=7). Clinical evaluations were performed preoperatively, at 1 year postoperative, and at the last follow-up. Outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS), pain visual analog scale (VAS), range of motion (ROM), complications, and radiographic data. Patient satisfaction was assessed at the 1-year follow-up using a self-administered scale. Results: Overall, the mean KOOS at the 1-year follow-up was significantly improved versus preoperative (71.39 ± 8.65 vs. 22.56 ± 11.58, p<0.001). The mean 1-year postoperative KOOS (50 vs. 47, p=0.028), surgical satisfaction score (p=0.005), home activity satisfaction score (p=0.0029), and recreational activity satisfaction score (p=0.024) were significantly higher in the global instability versus genu recurvatum group, whereas the mean pain VAS score was significantly higher in the global instability versus genu recurvatum group (6 vs. 4, p=0.037). The mean ROM improved from 30° to 90° in the global instability group and from -20° to 0° in the genu recurvatum group. No surgical complications or signs of prosthesis loosening were observed. Conclusions: Revision TKA with an RHK prosthesis showed better functional outcomes in patients with global instability versus genu recurvatum. Furthermore, patients with global instability showed higher satisfaction with surgery, home, and recreational activities than those with genu recurvatum.

Impact of the body mass index on the retention of the anorectal mucosa after double-stapled ileal pouch-anal anastomosis for ulcerative colitis

BackgroundDouble-stapled ileal pouch-anal anastomosis (DS-IPAA) is easy to construct and has a good functional outcome in patients with ulcerative colitis (UC). However, retention of the anorectal mucosa may lead to a subsequent risk of inflammation and neoplasia. This study aimed to identify factors associated with the retention of a large amount of anorectal mucosa after DS-IPAA.MethodsThe medical records of 163 patients who had undergone one-stage total proctocolectomy and DS-IPAA for UC between 2007 and 2020 were retrospectively reviewed. The patients were divided into two groups according to the length of the retained mucosa. The high anastomosis group was defined as having a retained mucosal length of ≥ 30 mm in the anterior or posterior wall. Clinical factors were compared between the high and low anastomosis groups.ResultsThe high anastomosis group showed a significantly higher body mass index (BMI) (high vs. low: 23.2 vs. 19.0), longer operation time (304 vs. 263) and greater blood loss (357 vs. 240). In the multivariate analysis, high BMI was the only factor significantly associated with high anastomosis (odds ratio 1.32). There was a positive correlation between BMI and the length of the retained mucosa.ConclusionsIn DS-IPAA, BMI showed the strongest association with the retention of a large amount of the anorectal mucosa. In high BMI patients, although the risk of inability of anastomosis is little than that of IPAA with mucosectomy, the possible retention of a large amount of mucosa should be considered.

Ultraearly Hematoma Evacuation (

Early decompressive surgery within 24 hours improves the functional outcome of patients with traumatic spinal cord injury; however, little is known about the effect of early surgery for spontaneous spinal epidural hematoma (SSEH). In this study, we aimed to investigate the effectiveness of ultraearly hematoma evacuation (<12 hours) for SSEH. Patients with SSEH treated with surgical hematoma evacuation at our institution between January 2000 and July 2021 were retrospectively analyzed. Neurologic function was evaluated using the American Spinal Injury Association Impairment Scale (AIS). AIS grades A-C were defined as severe, and grades D and E as mild. AIS grades D and E at the final follow-up were considered favorable outcomes. Preoperative status and postoperative treatment results were compared between patients who had hematoma evacuation within 12 hours of onset and those who underwent surgery after 12 hours. Twenty-five consecutive patients were included in the analysis. Preoperatively, 23 patients (92.0%) had severe AIS. Fourteen (56.0%) patients underwent early surgery. At the final follow-up, 21 patients (84.0%) achieved favorable outcomes. Patients treated with ultraearly surgery had significantly better outcomes (100% vs. 63.6%, P= 0.03). Additionally, the time from onset to surgery was significantly shorter in patients with AIS improvement by 2 or more grades than that in patients with AIS improvement of 1 or less (median 8 hours vs. 14 hours, P= 0.0001). Ultraearly surgery within 12 hours for SSEH was associated with better functional outcomes.

Triple Disruption of the Superior Shoulder Suspensory Complex - Review and Surgical Technique.

The shoulder girdle is composed of two arches, and these two arches are held together by the superior shoulder suspensory complex (SSSC), a ligamentous complex. Goss's 1993 description of the SSSC as a ring includes the glenoid, coracoid process, coracoclavicular ligaments, distal clavicle, acromioclavicular joint, and acromion. Goss also noted in a 1996 study that a rupture of the SSSC in two places can result in an unstable lesion. This case report presents an unusual association of fractures involving the coracoid process, acromion, and distal clavicle, which has rarely been reported in the literature. Indeed, a triple lesion of the SSSC is very uncommon and the treatment is still debated. Therefore, we propose a surgical technique which we believe to have provide good results. A 54-year-old Caucasian male patient presented with Neer I distal third fracture of the clavicle, a displaced fracture of the acromion, and a fracture of the coracoid process following a left shoulder trauma after an epileptic crisis. The patient underwent surgery and has been followed for 1 year with good clinical and functional outcomes. This case report highlights the complexity of lesions of the SSSC and the importance of determining proper surgical technique based on the type of lesion. It demonstrates that surgery combined with active rehabilitation can lead to good functional outcomes for patients with this type of injury. This report will be of interest to clinicians involved in the treatment of this type of lesion and should add a valuable treatment option for the treatment of triple disruption of the SSSC.

Effect of the anastomosis between the posterior inferior cerebellar artery and the superior cerebellar artery on outcomes of acute basilar artery occlusion after endovascular treatment

BackgroundThe effects of secondary collateral compensation on outcomes remain unclear in patients with acute basilar artery occlusion (BAO) after endovascular treatment (EVT). This study aimed to evaluate the benefits of...

Functional outcomes of patients with NORSE and FIRES treated with immunotherapy: A systematic review

ObjectiveTo determine the frequency of good functional outcomes in patients with NORSE and FIRES treated with immunotherapy. MethodsWe performed a systematic search of the MedLine and EMBASE databases to gather studies including at least 5 patients with NORSE or FIRES and at least one patient treated with immunotherapy, and reporting functional outcomes. Good functional outcome was defined as a modified Rankin Scale (mRS) score ≤ 2 (or an equivalent measure) at the last available follow-up assessment. Only patients with known functional outcomes were included in the analysis. ResultsWe analyzed 16 studies including a total of 161 patients with NORSE. Six studies were carried out only with FIRES patients (n = 64). Of the 161 patients with NORSE, 141 (87.5%) received immunotherapy. Outcome data were available for 135, 56 of whom (41.4%) achieved good functional outcomes. Twenty-four of the 58 patients with FIRES treated with immunotherapy and for whom outcome data were available achieved good functional outcomes (41.3%). Mortality rates in patients with NORSE and FIRES treated with immunotherapy were 20/121 (16.5%) and 6/58 (10.3%), respectively. By type of immunotherapy, good functional outcomes were achieved in 36/89 patients receiving glucocorticoids (40.4%), 27/71 patients receiving IV immunoglobulins (38%), 11/37 patients treated with plasma exchange (29.7%), 5/17 patients receiving rituximab (29.4%), and 2/13 patients receiving cyclophosphamide (15.3%). ConclusionDespite the lack of randomised clinical trials, immunotherapy is frequently prescribed to patients with NORSE and FIRES. However, rates of functional dependence and mortality remain high in these patients. Second-line therapies achieved lower rates of good outcomes, probably because they were administered to patients with more severe, refractory disease.

Pronóstico funcional de pacientes con NORSE y FIRES tratados con inmunoterapia: revisión sistemática

ObjectiveTo determine the frequency of good functional outcomes in patients with NORSE and FIRES treated with immunotherapy. MethodsWe performed a systematic search of the MedLine and EMBASE databases to gather studies including at least 5 patients with NORSE or FIRES and at least one patient treated with immunotherapy, and reporting functional outcomes. Good functional outcome was defined as a modified Rankin Scale (mRS) score ≤ 2 (or an equivalent measure) at the last available follow-up assessment. Only patients with known functional outcomes were included in the analysis. ResultsWe analysed 16 studies, including a total of 161 patients with NORSE (10 studies) and 64 patients with FIRES (6 studies). Of the 161 patients with NORSE, 141 (87.5%) received immunotherapy. Outcome data were available for 135, 56 of whom (41.4%) achieved good functional outcomes. Twenty-four of the 58 patients with FIRES treated with immunotherapy and for whom outcome data were available achieved good functional outcomes (41.3%). Mortality rates in patients with NORSE and FIRES treated with immunotherapy were 20/121 (16.5%) and 6/58 (10.3%), respectively. By type of immunotherapy, good functional outcomes were achieved in 36/89 patients receiving glucocorticoids (40.4%), 27/71 patients receiving IV immunoglobulins (38%), 11/37 patients treated with plasma exchange (29.7%), 5/17 patients receiving rituximab (29.4%), and 2/13 patients receiving cyclophosphamide (15.3%). ConclusionDespite the lack of randomised clinical trials, immunotherapy is frequently prescribed to patients with NORSE and FIRES. However, rates of functional dependence and mortality remain high in these patients. Second-line therapies achieved lower rates of good outcomes, probably because they were administered to patients with more severe, refractory disease.

Predictors and Outcomes of Salvaging the Corticospinal Tract After Thrombectomy in Basilar Artery Occlusion Stroke.

BackgroundRegional eloquence of brainstem structures may contribute to neurological status in basilar artery occlusion (BAO) stroke. The corticospinal tract (CST) which is vulnerable to BAO is important for motor activity. This study investigated the impact of CST salvage on outcomes and its associated factors in patients with BAO treated with thrombectomy.MethodsWe retrospectively investigated 88 patients with BAO admitted ≤24 h after onset and presented with motor deficits and who underwent thrombectomy. Patients with a pre-stroke modified Rankin Scale (mRS) score of 4–5 who did not undergo baseline brain computed tomography angiography were excluded. CST salvage was evaluated using follow-up imaging (magnetic resonance imaging [MRI] or computed tomography when MRI was not available) after thrombectomy. A good outcome was defined as a 3-month mRS score of ≤2 or 3 if a patient's pre-stroke mRS score was 3. The associations between CST salvage and outcomes and clinical parameters were analyzed using logistic regression analyses.ResultsThirty-nine (44.3%) patients had CST salvage and the same number of patients had good outcomes. CST salvage was independently associated with a good outcome [adjusted odds ratio (aOR): 18.52, 95% confidence interval (CI): 4.31–79.67, p < 0.001]. After adjusting for confounders, atrial fibrillation (aOR: 3.92, 95% CI: 1.18–13.00, p = 0.026), location of occlusion (mid-BAO; aOR: 0.21, 95% CI: 0.06–0.72, p = 0.013), length of occlusion (involved segment of BAO <2; aOR: 4.77, 95% CI: 1.30–17.59, p = 0.019), and onset-to-puncture-time ≤180 min (aOR: 4.84, 95% CI: 1.13–20.75, p = 0.034) were significantly associated with CST salvage.ConclusionCST salvage was associated with good functional outcomes in patients with BAO treated with thrombectomy. The presence of atrial fibrillation, location and length of BAO may predict CST salvage after thrombectomy, and rapid treatment with thrombectomy may protect this eloquent tract in these patients.

The Impact of Endovascular Rescue Therapy on the Clinical and Radiological Outcome After Aneurysmal Subarachnoid Hemorrhage: A Safe and Effective Treatment Option for Hemodynamically Relevant Vasospasm?

ObjectiveCerebral vasospasm (CVS) represents one of the multiple contributors to delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH). Especially the management of CVS, refractory to medical treatment, is a challenging task during the acute phase after aSAH. Endovascular rescue therapies (ERT), such as medical and mechanical dilation, are possible treatment options on an individual basis. However, data about the influence on the patients' functional outcomes are limited. This study aims to assess the impact of ERT on the long-term functional outcome in aSAH-patients with refractory CVS.MethodsWe performed a retrospective analysis of aSAH patients treated between 2012 and 2018. CVS was considered refractory, if it persisted despite oral/intravenous nimodipine application and induced hypertension. The decision to perform ETR was made on an individual basis, according to the detection of “tissue at risk” on computed tomography perfusion (CTP) scans and CVS on computed tomography angiography (CTA) or digital subtraction angiography (DSA). The functional outcome was assessed according to the modified Rankin scale (mRS) 3 months after the ictus, whereas an mRS ≤ 2 was considered as a good outcome.ResultsA total of 268 patients were included. Out of these, 205 patients (76.5%) were treated without ERT (group 1) and 63 patients (23.5%) with ERT (group 2). In 20 patients (31.8%) balloon dilatation was performed, in 23 patients (36.5%) intra-arterial nimodipine injection alone, and in 20 patients (31.8%) both procedures were combined. Considering only the patient group with DCI, the patients who were treated with ERT had a significantly better outcome compared to the patients without ERT (Mann–Whitney test, p = 0.02).ConclusionEndovascular rescue therapies resulted in a significantly better functional outcome in patients with DCI compared to the patient group treated without ETR. CTP and CTA-based identification of “tissue at risk” might be a reliable tool for patient selection for performing ERT.