Dissection Of Vessels Research Articles

S0935 Peroral Traction-Assisted Transanal NOTES Rectosigmoidectomy Followed by Intracorporeal Colorectal Anastomosis in a Live Porcine Model

INTRODUCTION: To introduce one novel technique of peroral external traction-assisted transanal NOTES sigmoidectomy followed by intracorporeal colorectal anastomosis by using only currently available and flexible endoscopic instrumentation in a live swine model. METHODS: Three female swine weighing 25–30 kg underwent NOTES rectosigmoid resection. After preoperative work-up and bowel preparation, general anesthesia combined with endotracheal intubation was achieved. One dual-channel therapeutic endoscope was used. Carbon dioxide insufflation was performed during operation. The procedure of trans-anal NOTES rectosigmoidectomy included 8 steps as follows: (1) rectosigmoid colon tattooed with India ink by submucosal injection; (2) creation of gastrostomy by directed submucosal tunneling; (3) peroral external traction using endoloop ligation; (4) creation of rectostomy on the anterior rectal wall by directed 3 cm submucosal tunneling; (5) peroral external traction-assisted left side of the colon dissection; (6) trans-anal rectosigmoid specimen transection, an anvil was inserted into the proximal segment after a purse-string suture; (7) intracorporeal colorectal end-to-end anastomosis using a circular stapler with a single stapling technique; (8) closure of gastrostomy using endoscopic clips. All animals were euthanized immediately after the procedure, abdominal exploration was performed and the air-under-water leak test was done. RESULTS: The procedure was completed in all three animals, with the operation time ranging from 193 to 259 minutes. Neither intraoperative major complications nor hemodynamic instability occurred during operation. The length of the resected specimen ranged from 7cm to 13cm. With the assistance of a trans-umbilical rigid grasper, intracorporeal colorectal, tension-free, end-to-end anastomosis was achieved in the three animals. CONCLUSION: Peroral traction-assisted transanal NOTES sigmoidectomy followed by intracorporeal colorectal anastomosis is technically feasible and reproducible in an animal model, worthy of further improvement.Figure 1.: a The anterior wall of rectosigmoid colon tattooed with India ink by submucosal injection b An endoloop was placed over the anti-mesenteric side of one colonic segment for traction c Dissection of the inferior mesenteric vessels d The mobilized rectosigmoid colon was exteriorized and transected trans-anally.Figure 2.: a A purse-string suture was placed around the top of the open proximal colonic segment after an stapler anvil was inserted b An endoloop was used to ligate the lateral rectostomy by endoscopy c The anvil was approached to the stapler with the assistance of rigid grasper d Endoscopic observation of colorectal anastomotic tissue ring e. View via laparotomy of the lower abdomen and pelvis showing colorectal end-to-end anastomosis f The resected sigmoid colon specimen.

PEO-CYTOP Fluoropolymer Nanosheets as a Novel Open-Skull Window for Imaging of the Living Mouse Brain.

SummaryIn vivo two-photon deep imaging with a broad field of view has revealed functional connectivity among brain regions. Here, we developed a novel observation method that utilizes a polyethylene-oxide-coated CYTOP (PEO-CYTOP) nanosheet with a thickness of ∼130 nm that exhibited a water retention effect and a hydrophilized adhesive surface. PEO-CYTOP nanosheets firmly adhered to brain surfaces, which suppressed bleeding from superficial veins. By taking advantage of the excellent optical properties of PEO-CYTOP nanosheets, we performed in vivo deep imaging in mouse brains at high resolution. Moreover, PEO-CYTOP nanosheets enabled to prepare large cranial windows, achieving in vivo imaging of neural structure and Ca2+ elevation in a large field of view. Furthermore, the PEO-CYTOP nanosheets functioned as a sealing material, even after the removal of the dura. These results indicate that this method would be suitable for the investigation of neural functions that are composed of interactions among multiple regions.

A Retrospective study of the unique Clinical and Imaging profile of Spontaneous Intra-cranial dissections in the Cerebral vasculature

Aim: This study was designed to look at the unique clinical profile, neuro-imaging features and functional outcomes, of Intra-cranial dissections in the cerebral vasculature, seen at two tertiary stroke care centers in Southern India. Materials and Methods: In this retrospectivce study spanning five years (Dec 13 to Dec 18), a total of 496 patients underwent CT Brain with Angiography for evaluation of an Acute stroke syndrome/ Transient ischemic attack (TIA), at our two study centers. 21/496 (4.2%) of these patients had imaging evidence of intra-cranial dissections which was further confirmed by Contrst MR angiograpgy. The clinical and imaging data of these cases was recorded on a predesigned stroke proforma. The pattern of vessel involved and morphology of vessel dissection was analyzed as per standard radiology criteria. All cases had follow up data ranging from 1 to 3 years, which was used to classify the functional outcomes based on the modified Rankin Scale (mRS). Results: There were 15 males and 6 females in the study, and the mean age was 44.1 years (range 23 to 73 years). Focal neurological deficits, with or without raised intra cranial pressure symptoms occurred in all these patients. 10/21 (48%) dissections were in the anterior circulation, whereas 11/21 (52%) were in the posterior circulation. Subarachnoid or parenchymal hemorrhage at presentation was seen in 11/21 (52%). The Internal Carotid artery (C2-C4 segments) was the commonest vessel involved in the anterior circulation in 64% cases (7/11), while in the posterior circulation, Vertebral artery (V4 segment) was most frequently involved in 60% (6/10) cases. In the entire study cohort, a good functional outcome (mRS 1-2) was seen in 13/21 (62%) cases, and death (mRS-5) was seen in 2/21 (9.5%). Digital Subtraction Angiography (DSA) and stenting/coiling procedures were undertaken in 3/21 (14%) cases. Conclusion: This hospital based study brings out the unique clinical spectrum of intra-c

The anterior-to-psoas approach for interbody fusion at the L5-S1 segment: clinical and radiological outcomes.

Over the last few decades, many surgical techniques for lumbar interbody fusion have been reported. The anterior-to-psoas (ATP) approach is theoretically supposed to benefit from the advantages of both anterior and lateral approaches with similar complication rates, even in L5-S1. At this segment, the anterior lumbar interbody fusion (ALIF) requires retroperitoneal dissection and retraction of major vessels, whereas the iliac crest does not allow the lateral transpsoas approach. This study aimed to investigate clinical-radiological outcomes and complications of the ATP approach at the L5-S1 segment in a single cohort of patients. This is a prospective single-center study, conducted from 2016 to 2019. Consecutive patients who underwent ATP at the L5-S1 segment for degenerative disc disease or revision surgery after previous posterior procedures were considered for eligibility. Complete clinical-radiological documentation and a minimum follow-up of 12 months were set as inclusion criteria. Clinical patient-reported outcomes, such as the visual analog scale for low-back pain, Oswestry Disability Index, and 36-Item Short Form Health Survey (SF-36) scores, as well as spinopelvic parameters, were collected preoperatively, 6 weeks after surgery, and at the last follow-up visit. Intraoperative and perioperative complications were recorded. The fusion rate was evaluated on CT scans obtained at 12 months postoperatively. Thirty-two patients met the inclusion criteria. The mean age at the time of surgery was 57.6 years (range 44-75 years). The mean follow-up was 33.1 months (range 13-48 months). The mean pre- and postoperative visual analog scale (7.9 ± 1.3 vs 2.4 ± 0.8, p < 0.05), Oswestry Disability Index (52.8 ± 14.4 vs 22.9 ± 6.0, p < 0.05), and SF-36 (37.3 ± 5.8 vs 69.8 ± 6.1, p < 0.05) scores significantly improved. The mean lumbar lordosis and L5-S1 segmental lordosis significantly increased after surgery. The mean pelvic incidence-lumbar lordosis mismatch and pelvic tilt significantly decreased. No intraoperative complications and a postoperative complication rate of 9.4% were recorded. The fusion rate was 96.9%. One patient needed a second posterior revision surgery for residual foraminal stenosis. In the present case series, ATP fusion for the L5-S1 segment has resulted in valuable clinical-radiological outcomes and a relatively low complication rate. Properly designed clinical and comparative trials are needed to further investigate the role of ATP for different L5-S1 conditions.

Surgical outcomes of hybrid hand-assisted laparoscopic pelvic exenteration for locally advanced rectal cancer: Initial experience.

Hybrid hand-assisted laparoscopic surgery (HALS) combines better visualization of laparoscopic surgery with the advantages of open surgery. The aim of this study was to describe important technical considerations of HALS and to assess the feasibility of hybrid HALS pelvic exenteration (PE) for primary advanced rectal cancer. From May 2012 to August 2018, we retrospectively analyzed 11 patients who underwent PE for primary advanced rectal cancer (< 10 cm from the anal verge). Patients were divided into the open PE group (n = 5) and the hybrid HALS PE group (n = 6). There was no significant difference in patient characteristics between the two groups, and all included patients were male. Tumor invasion to adjacent organs was mostly anterior invasion. In addition, four patients (66%) in the hybrid HALS PE group and two (40%) in the open PE group received neoadjuvant therapy (P = .3). Compared to open surgery, hybrid HALS has the advantages of less bleeding and less invasion, and can achieve the same results in the short-term. It was a reasonable procedure which was easy and safe dissection of internal iliac vessels and dorsal vein complex. Thus, hybrid HALS may become a useful approach for PE.

Reconstruction of the esophagus of patients with middle thoracic esophageal carcinoma using the remnant stomach following Billroth II gastrectomy.

It seems impossible to reconstruct the esophagus of patients with middle thoracic esophageal carcinoma with a history of distal gastrectomy using the remnant stomach. Although surgeons have made multiple efforts to reconstruct the esophagus using the remnant stomach, it can only be successfully used in cases of lower thoracic esophageal cancer. Additionally, the surgery is more complex than traditional esophagogastrostomy due to challenges including mobilization of the remnant stomach with the spleen and transposition of the pancreatic tail into the left hemithorax. Our operation proved that the remnant stomach, which we named as the completely mobilized remnant stomach after dissection of the feeding vessels, remained viable. We successfully integrated the completely mobilized remnant stomach in the reconstruction of the lower thoracic esophageal tract and then integrated it in Ivor Lewis esophagogastrostomy. We describe this new alternative surgical technique for the treatment of middle thoracic esophageal carcinoma in patients with a history of distal gastrectomy in this study. Clinical data of 23 patients from 2008 to 2019 were retrospectively analyzed. All patients underwent the Ivor Lewis procedure. All remaining vessels of the remnant stomach were dissected at their origins, and Roux-en-Y reconstruction or Braun anastomosis was performed. After esophagectomy during right thoracotomy, anastomosis of the remnant stomach and esophagus was performed. Two-field lymph node dissections were performed. There was no case of necrosis of the remnant stomach or of perioperative death. Serious complications included anastomotic leak in three cases, afferent-efferent loop syndrome in one, and anastomotic stricture in two. Application of the completely mobilized remnant stomach in Ivor Lewis esophagogastrostomy is feasible, and the surgical procedure is similar to that of normal esophagogastrostomy.

DARTS Trial

DARTS Trial

Posterior circulation tandem occlusions: Classification and techniques

BackgroundPosterior circulation tandem occlusions are poorly characterized in current literature. Data regarding endovascular approaches and outcomes in this patient subgroup is extremely limited. MethodsWe conducted a retrospective analysis of a prospectively maintained database and identified 17 patients with posterior circulation tandem occlusions who underwent mechanical thrombectomy between 2014 and 2019. ResultsOf 17 patients with posterior circulation tandem occlusion, the mean age was 55.76 ± 11.8 with 35.3% female. The mean NIHSS score on presentation was 17.2 ± 9.2. Tissue plasminogen activator was administered in 7 (41.2%) patients, stent-retrievers alone were used in 2 (11.8%), aspiration catheters alone were used in 2 (11.8%), a combination was used 12 (70.6%), and a self-expandable stent in 5 (29.4%). The mean number of device passes was 2.24 ± 2.02, recanalization failure occurred in 4 (23.5%) patients, the mean time from stroke onset to puncture was 6.9 ± 2.4 h, and the mean time from puncture to recanalization was 59.3 ± 26.6 min. Postprocedural symptomatic ICH occurred in 1 (5.9 %) patient, periprocedural ICH/SAH occurred in 2 (11.8%), periprocedural distal emboli occurred in 0 (0%), periprocedural vessel dissection occurred in 1 (5.9%), and periprocedural vessel perforation occurred in 1 (5.9%) patient. TICI score>2b was achieved in 13 (76.5%) patients. An improvement in NIHSS>3 at discharge occurred in 10 (58.8%) patients, and good outcomes (mRS score < 2) occurred in 7 (41.2%). The mean length of stay was 11.6 ± 12.2 days, and the mortality rate was 41.2%. ConclusionEndovascular intervention with mechanical thrombectomy is safe and feasible in patients with posterior circulation tandem occlusions.

Feasibility and Safety of Paclitaxel-Coated Balloon Angioplasty for the Treatment of Intracranial Symptomatic In-Stent Restenosis.

Objective: Symptomatic in-stent restenosis (sISR) is the major cause of medium- or long-term cerebral infarctions in patients who underwent percutaneous transluminal angioplasty and stenting for severe intracranial atherosclerotic stenosis. This study aims to evaluate the feasibility and safety of paclitaxel-coated balloon (PCB) angioplasty for the treatment of intracranial sISR.Methods: We report 11 cases of PCB angioplasty for intracranial sISR. Lesion locations and number were as follows: intracranial internal carotid artery (n = 4), M1 segment of middle cerebral artery (MCA) (n = 1), V4 segment of vertebral artery (n = 6). The technical success rate, periprocedural complications, and short-term outcome were retrospectively analyzed.Results: All procedures were successfully performed without periprocedural complication. Asymptomatic vessel dissection after PCB inflation occurred in one case. Postprocedural diffusion-weighted imaging (DWI) showed new asymptomatic ipsilateral infarction in one case. All 11 cases did not experience ipsilateral stroke or death within 30 days or ischemic stroke in the territory of the target artery between 31 and 90 days after procedure.Conclusion: This preliminary study indicates that PCB angioplasty is feasible and safe for the treatment of intracranial sISR. Further studies are needed to clarify its efficiency and long-term outcome.

New technique of dissection of internal mammary vessels for breast reconstruction.

Although internal mammary vessels are considered the best recipients for free flap breast reconstruction, they present the notable drawback of limited accessibility. The aim of this study was to develop a minimally invasive surgical technique for the dissection of internal mammary vessels as recipients for breast reconstruction. From 2008 to 2018, we performed 32 unilateral microsurgical breast reconstructions (mean patient age: 40.1±8.7 years; range, 23-58 years). As internal mammary vessels were exclusively used as recipients, they were dissected using a technique of minimally invasive video-assisted thoracoscopic surgery (VATS) developed in our hospital. The mean surgery time was 5.4±0.55 hours (range, 4.5-6.5 hours), and the mean duration of VATS dissection of internal mammary vessels was 20.6±2.9 minutes (range, 16-27 minutes). Of the specific complications associated with VATS, we only observed reductions in forced expiratory volume in the first second of >15% in 3 patients (9.4%), 10-15% in 8 patients (25%), and <10% in 21 patients (65.63%). We did not have any cases of significant bleeding or postoperative infection in this series of patients. With regard to aesthetic complications, we observed 1 and 2 cases of total necrosis and partial necrosis of the deep inferior epigastric perforator (DIEP) flap, respectively and 2 cases of partial necrosis of supercharged transverse rectus abdominis muscle flap. Endoscopic dissection of internal mammary vessels is a simple and feasible technique. When performed by experienced surgeons, it is a fast procedure that is associated with low rate of complications.

Noninvasive assessment of bowel blood perfusion using intraoperative laser speckle flowgraphy.

Laser speckle flowgraphy (LSFG) is a noninvasive method for quantitative evaluation of blood flow using the mean blur rate (MBR) as the blood flow index. We investigated whether LSFG can intraoperatively detect the demarcation line after vessel dissection and reduce the incidence of anastomotic leakage (AL). This study included 36 patients who underwent left-sided colorectal surgery. First, we compared the demarcation line (determined by LSFG) with the transection line (TL) at which the marginal vessels were divided. We then measured the MBR on both sides of the TL to determine where the MBR changed significantly. We investigated the presence or absence of significant differences between the MBR on the proximal side and that on the distal side of the TL. Finally, we retrospectively compared the patient characteristics and AL rates in the LSFG group (n = 36) and control group (n = 87). In total, 58.3% (21/36) of the demarcation lines determined by LSFG matched the TL. The median distance between the demarcation line determined by LSFG and the TL was 0.0mm (0.0-12.1mm). The MBR sharply decreased at the TL in 80.6% (29/36) of cases. The median MBR was significantly lower on the distal than proximal side. The AL rate was not significantly lower in the LSFG group than in the control group. LSFG accurately detected the demarcation line during surgery. However, LSFG did not reduce the incidence of AL.

Modification of Dargent’s radical vaginal trachelectomy to facilitate ureteral dissection: description of technique

ObjectiveRadical vaginal trachelectomy is the fertility-preserving surgery for patients with early stage cervical cancer. However, it has not gained widespread approval by gynecologic oncologists because of difficulties in the dissection...

Efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm-A systematic review and meta-analysis.

PulseRider is a novel self-expanding nickel-titanium (nitinol) stent for treatment of wide-necked aneurysms, which is commonly located at the arterial branches in the brain. This systematic review and meta-analysis aims to assess the efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm. We performed a systematic literature search on articles that evaluate the efficacy and safety of PulseRider-assisted coiling of the wide-necked aneurysm from several electronic databases. The primary endpoint was adequate occlusion, defined as Raymond-Roy Class I + Raymond-Roy Class II upon immediate angiography and at six-month follow-up. There were a total of 157 subjects from six studies. The rate of adequate occlusion on immediate angiography was 90% (95% CI, 85%-94%) and 91% (95% CI, 85%-96%) at six-month follow-up. Of these, Raymond-Roy Class I can be observed in 48% (95% CI, 41%-56%) of aneurysms immediately after coiling, and 64% (95% CI, 55%-72%) of aneurysms on six-month follow-up. Raymond-Roy Class II was found in 30% (95% CI, 23%-37%) of aneurysms immediately after coiling, and 25% (17-33) after six-month follow-up. Complications occur in 5% (95% CI, 1%-8%) of the patients. There were three intraoperative aneurysm rupture, three thrombus formation, three procedure-related posterior cerebral artery strokes, one vessel dissection, and one delayed device thrombosis. There was no procedure/device-related death. PulseRider-assisted coiling for treatment of patients with wide-necked aneurysm reached 90% adequate occlusion rate that rises up to 91% at sixth month with 5% complication rate.

Non invasive assessment of fractional flow reserve using computational fluid dynamics modeling from coronary angiography images

Fractional flow reserve (FFR invasive) is measured by measuring pressure differences across a coronary artery stenosis by coronary catheterisation technique. This is a gold standard method of determining the extent of stenosis. This method has some potential complications such as coronary vessel dissection, embolism, and renal failure. This paper presents a method for an assessment of FFR noninvasively, with coronary CT angiography imaging and fluid dynamics modelling. FFR is calculated as the ratio between pressure distal to stenosis and pressure proximal to stenosis of the coronary artery region segmented from CT angiography image using MIMICS software. ANSYS software is used to determine the FFR (0.73 ± 0.14). FFR can also be computed non-invasively by this technique for other cardiovascular conditions related to peripheral, cerebrovascular and renovascular disease.

The clinical value of head-neck joint high-resolution vessel wall imaging in ischemic stroke

Background and PurposeTo study the feasibility and clinical utility of head-neck joint high-resolution vessel wall imaging (HNJ-VWI) in the assessment of ischemic stroke. MethodsWe reviewed our institutional HNJ-VWI database. Patients with transient ischemic attack (TIA) or ischemic stroke were included. Abnormal findings of intracranial and/or extracranial artery were assessed on three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) and HNJ-VWI modified from high-resolution 3D T1 sequence and classified into three groups including intracranial, extracranial and coexisting based on the locations. Etiologies of stroke were recorded according to Trial of Org 10172 in Acute Stroke Treatment criteria. ResultsOne hundred and ten consecutive patients were studied. 3D TOF MRA displayed 71.8% (79/110, based on patients) abnormal arteries (stenosis or occlusion) , while HNJ-VWI displayed 96.3% (106/110) abnormal arteries (plaque,wall thickness and occlusion) including four isolated extracranial lesions and ten coexisting lesions. The etiologies of TIA/ischemic stroke included large artery atherosclerosis (80 cases), cerebral small vessel disease (6 cases), cardiogenic (2 cases), dissection (6 cases), vasculitis (4 cases), moyamoya disease (6 cases), others (2 cases) and undetermined (4 cases). For patients with atherosclerosis stroke, re-infarctions were more common in coexisting group than intracranial group (extracranial vs. intracranial vs coexisting: 0% vs. 9.1% vs. 43.7%, p = 0.001). ConclusionsHNJ-VWI is a feasible and valuable technique in assessment of ischemic stroke by detecting extracranial and intracranial artery abnormalities with one-step scan.

Use of Single-recipient Vessels for Cross-chest Abdominal Flap-based Breast Augmentation as an Outpatient.

Background:Breast reconstruction with autologous tissue following mastectomy for breast cancer has become the standard of care. Microvascular breast augmentation is an alternative for patients with failed breast prostheses, including painful capsular contractures or poor cosmetic outcomes. We present a series of 4 patients who underwent microvascular breast augmentation with cross-chest flap recipient vessels.Methods:We perform a bilateral DIEP flap reconstruction in an outpatient setting following a modified recovery protocol, focused on decreasing postoperative pain and narcotic requirements, allowing early ambulation and discharge. This includes harvest of the flap via abdominal microfascial incisions and rib-sparing vessel dissection. Cosmetic microvascular augmentation of the contralateral breast was performed via cross-chest flap recipient vessel anastomoses, where the pedicle was tunneled across the chest and anastomosed to the primary flap.Results:Four patients underwent flap-based breast augmentation with cross-chest recipient vessels. Two patients underwent immediate DIEP flap breast reconstruction of the affected side and contralateral flap-based augmentation, while 2 patients underwent bilateral breast augmentation with DIEP flaps for cosmetic purposes due to undesired cosmetic results following implant-based augmentations. No intraoperative complications were reported, and all patients were discharged within 23 hours without signs of flap compromise or need for operative take-backs. Mean follow-up was 23 weeks.Conclusions:The DIEP flap is recognized as an option for breast augmentation, although its limitations are several, including the pain and recovery associated with autologous tissue-based breast reconstruction. Enhanced recovery protocols help reduce this burden, making it more acceptable and feasible.

Outcomes of Open Versus Percutaneous Access for Patients Enrolled in the GREAT Registry

Arterial access and device delivery in endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) have evolved from open femoral or iliac artery exposure to selective percutaneous arterial access. Although regional application of percutaneous access for these 2 procedures varies widely, the use of this technique continues to increase. Currently, differences in the use of percutaneous access between EVAR and TEVAR have not been well explored. The Gore Global Registry for Endovascular Aortic Treatment (GREAT) registry collected relevant data for evaluation of these issues and the comparative results between open and percutaneous approaches in regard to complication rates and length of stay (LOS). This study was performed via a retrospective review of patients from the GREAT registry (Clinicaltrials.gov no. NCT01658787). The primary variable of this study was access site complications including postoperative hematoma, vessel dissection, and pseudoaneurysm. Patients were categorized by abdominal (EVAR) and thoracic (TEVAR) aortic procedures using percutaneous-only, cutdown-only, and combined vascular access techniques for a total of 6 groups. Standard statistical methodology was used to perform single-variable and multivariable analysis of a variety of covariates including LOS, geographical location of procedure, procedural success rate, and access sheath size. Of 4,781 patients from the GREAT registry, 3,837 (80.3%) underwent EVAR and 944 (19.7%) underwent TEVAR with percutaneous-only access techniques being used in 2,017 (42.2%) and cutdown-only in 2,446 (51.2%). There was variable application of percutaneous access by geographic region with Australia and New Zealand using this technique more frequently and Brazil using percutaneous access the least. No significant difference in the rate of access site complications was detected between the 6 groups of patients in the study; however, significantly lower rates of access site complications were associated with percutaneous-only compared with both cutdown-only and combined techniques (P=0.03). In addition, associated with significantly higher rates of access site complications was longer LOS (P<0.01). Average LOS was 5.2days and was higher in the TEVAR group (10.1days) than that in EVAR (4.0days, P<0.05). Increased sheath size does not appear to increase the risk of access site complication. There was no significant difference found in the complication rate between percutaneous and cutdown access techniques. This analysis demonstrates that percutaneous-only access is safe, has low complication rates, and has lower LOS compared with open access or combined access techniques.

Feasibility and safety of thrombectomy for isolated occlusions of the posterior cerebral artery: a multicenter experience and systematic literature review

BackgroundSubstantial clinical evidence supporting the benefit of mechanical thrombectomy (MT) for distal occlusions within the posterior circulation is still missing. This study aims to investigate the procedural feasibility and safety...

Safety and Efficacy of a Direct Aspiration First-Pass Technique with Large-Bore Catheters for Acute Ischemic Stroke in Vietnam: Experience of a Single Center.

Purpose:The purpose of this study was to evaluate the safety and efficacy of mechanical thrombectomy with a direct aspiration first-pass technique (ADAPT) using large-bore catheters in patients with acute ischemic stroke due to large vessel occlusion (LVO) in a hospital in Vietnam.Methods:This was a retrospective review of patients with acute ischemic stroke due to LVO who were diagnosed and underwent mechanical thrombectomy using ADAPT with large-bore catheters at Bach Mai Hospital from January 2017 to June 2018.Results:Seventy-three patients (47.9% female; age: 61.29 ± 14.49 years) met study criteria. The average procedure duration was 45.09 ± 38.26 min. Successful recanalization post-ADAPT (thrombolysis in cerebral infarction 2b-3) was achieved in 72.6% (53/73) of patients. Good functional outcome (Modified Rankin Scale 0–2) at 3 months was achieved in 50.7% (37/73), with poor functional outcome in 24.7% (18/73). The 90-day mortality rate was 24.7% (18/73). The hemorrhagic transformation rate was 31.6%, in which 19.2% were symptomatic. Vessel perforation occurred in 5.5% (4/73) of patients but in all cases was associated with the guidewire and not the reperfusion catheter. Vessel dissection occurred in 1.4% (1/73) and vasospasm in 5.5% (4/73) of patients.Conclusion:Mechanical thrombectomy using ADAPT with large-bore catheters for acute ischemic stroke due to LVO is a method that yielded good results in recanalization and clinical recovery in a Vietnamese patient population.

Commentary: Keep working: Current endovascular arch-repair technology still has a way to go

Commentary: Keep working: Current endovascular arch-repair technology still has a way to go