Large Clot Research Articles

Sudden death due to aortic rupture in New Zealand sheep

ABSTRACT Case history Over a period of 2 months in the spring and early summer of 2021, 13 cases of sudden death in cull ewes due to aortic rupture were diagnosed at a small number of New Zealand abattoirs. Clinical findings In 12/13 (92%) cases, a large blood clot was present in the thorax, and in one case the blood clot was seen in the tissues dorsal to the heart. There were no obvious signs of external trauma. The pluck (heart and lungs) or fixed aorta was submitted for histological examination in seven cases and in all of these, a tear in the aorta was found. Comparing the microscopic appearance of the proximal aorta in these seven cases to three clinically normal ewes from unaffected farms, the aortic wall thickness appeared thinner in the case ewes than the unaffected ewes. Subjectively, there was increased collagen in the tunica media in 3/7 and decreased elastin fibres in 5/7 case ewes compared to the control ewes. Further investigations on the index farm (where the first cases originated), found that the mean liver and serum Cu concentrations in 10 similarly aged, clinically normal ewes were within the normal reference range for New Zealand sheep. Similarly, the liver Cu concentrations of the seven case ewes were within the normal reference range. Diagnosis Aortic rupture due to an unknown aetiology. Clinical relevance Clinicians should be aware of this condition as a differential diagnosis for sudden death in older sheep and to assist the Ministry for Primary Industries in establishing the extent of this problem in New Zealand.

Usefulness of net retrieval devices for central airway obstruction caused by blood clots during extracorporeal membrane oxygenation: Case series.

Extracorporeal membrane oxygenation (ECMO) is the last trump card for severe respiratory failure. The main complications of ECMO are bleeding and thrombosis, both of which can be life-threatening. Large blood clots can cause central airway obstruction (CAO) during ECMO, and CAO should be removed as soon as possible because of asphyxiation. However, there is no comprehensive reports on its frequency and management. The purpose of this study is to share therapeutic experiences for rare and serious conditions and provide valuable insights. We report 3 patients placed on ECMO for severe respiratory failure. CAO due to large blood clots occurred during ECMO in all 3 patients. Large blood clots were removed using flexible bronchoscopy, grasping forceps, and net retrieval devices in all 3 patients. In all 3 patients, large blood clots were removed multiple times during ECMO. The patients' respiratory conditions improved and they were eventually weaned off the ECMO. CAO due to large blood clots during ECMO is rare. The frequency of CAO requiring bronchoscopic removal was estimated to be approximately 1,5%. When this occurs, clots should be removed as soon as possible. Net retrieval devices are useful tools for the collection of large blood clots.

Development of toluidine red particle agglutination-based turbidimetric immunoassay for anticardiolipin antibody detection in syphilis

IntroductionSerological tests of non-treponemal and treponemal types are the most frequently used for syphilis diagnosis. Nontreponemal tests are used to monitor disease activity. Toluidine red unheated serum test (TRUST), as one of nontreponemal tests, is generally applicable to hospitals at different levels. However, accurate judgment of TRUST results is inseparable from an experienced and accurate operator. To reduce current shortcomings of manual TRUST method, we attempted to convert the manual TRUST test into automatic TRUST test, that is, to determine the degree of aggregation of toluidine red particles by detecting the absorbance value of serum after reaction with toluidine red particles. Methods50 μL of serum sample and 80 μL toluidine red particles were added to 96-well plate. Then, the 96-well plate was placed on a microplate reader at medium grade for 8 min to mix. Then, plasma reagin reacted with toluidine red particles and promoted the aggregation of toluidine red particles to form a large clot, which eventually caused a decrease in the absorbance at 540 nm. ResultsThe results showed that the specificity of the automatic TRUST test was 100%, the sensitivity was 87%. And this method showed 93.5% correlation with manual TRUST test. The developed method is simple and involves less subjectivity in reading results, opening new avenues for syphilis diagnostic testing. ConclusionTurbidimetric immunoassay can avoid the shortcomings of subjective interpretation, time-consuming and manual operation of manual TRUST method, and is more suitable for large-scale screening in health examination.

Abstract WP189: TIGER Study: Effectiveness and Safety of Tigertriever Are Maintained When Treating Large Clot Size

Introduction: Larger volume thrombi are associated with a lower probability of functional independence defined as a modified Rankin Score (mRS) ≤2 and a higher number of retrieval attempts. A subanalysis of the TIGER study data was performed in order to assess the effectiveness and safety of Tigertriever in small and large clot sizes. Methods: The TIGER study was a single arm, prospective, multi-center trial assessing the efficacy and safety of the Tigertriever, a radially-adjustable stent retriever, for LVO-related stroke. The trial enrolled 160 subjects, of which 150 had successful mTICI 2b-3 revascularization (94%) at end of all procedures. The interventionalists evaluated the clot length angiographically prior to the treatment, and analysis was performed to compare the Tigertriever performance in short clots with long clots. Results: Data is available from 135 (78 males) out of the 160 subjects enrolled in the study.The median clot length was 9mm with a range of 1-50mm. Subjects were divided into two subgroups: Group A; subjects with small clot length, ≤9mm (n=69) and group B, subjects with large clot length, >9mm (n=66). Baseline NIHSS was significantly smaller in group A compared to group B (16.9 vs.19, respectively, P=0.02). Median clot size in group A was 6.1mm and 16.5mm in group B. The mean number of passes with Tigertriever to achieve successful revascularization (mTICI 2b-3) was slightly higher in group B, but not statistically different (1.7 in group A vs. 2 in group B, P=0.07). First pass effect (63% vs. 50% NS), good clinical outcome (62% vs. 53% NS), sICH (1.4% vs. 3% NS) and ENT (Embolization to new territory 2.9% vs. 1.5% NS) were comparable in group A and group B, respectively. Conclusions: Despite the impaired neurological functioning as indicated by significantly higher baseline NIHSS in subjects admitted with larger clot length, Tigertriever efficacy and safety were maintained when treating these large clots compared to small clots.

Perioperative challenges in a pregnant patient having large left atrial clot: A case report.

Perioperative challenges in a pregnant patient having large left atrial clot: A case report.

Combined Use of Copernic RC Venous Remodeling Balloon and Aspiration Thrombectomy for Cerebral Venous Sinus Thrombosis.

Cerebral venous sinus thrombosis is a potentially fatal condition. The current first line of treatment for sinus thrombosis is anticoagulation. Endovascular treatment is an alternative for patients whose symptoms progress despite adequate medical management. Mechanical thrombectomy is required in the setting of a large clot burden. Unfortunately, the conventional technique of intraarterial thrombectomy with the use of a stent retriever and/or aspiration is not very effective in sinus thrombosis because of a larger clot burden compared to an intracranial artery. Herein we describe our endovascular approach of mechanical thrombectomy in sinus thrombosis using Copernic 8 × 80 RC (Rene Chapot) balloon and aspiration catheter.

Investigation of the Effects of an Inferior Vena Cava Filter and Captured Clot Size on the Hemodynamic Parameters in Non-Newtonian Turbulent Pulsatile Blood Flow

In this computational fluid dynamics (CFD)-based study, the effects of inferior vena cava (IVC) filter implantation on the risk of IVC thrombosis have been investigated using different hemodynamic parameters, including time-averaged wall shear stress (TAWSS), the oscillating shear index (OSI), and the relative residence time (RRT). The boundary conditions in this study have been based on physiological pulses. Additionally, the k–ω model and the Carreau model have been chosen to represent the turbulent flow regime and non-Newtonian blood, respectively. For this purpose, three blood clots with the largest cross-sectional diameters of 30%, 50%, and 70% of the filter diameter have been used. Capturing a small clot in the filter has the minimum effect on the hemodynamic parameters, while by increasing the size of the captured clot, OSI and RRT parameters increase in areas downstream of the filter on the wall. The presence of a filter and clot increases the risk of thrombosis. In the case of capturing large clots, there is the possibility of damage to endothelial cells or platelet activation. Captured clots lead to the formation of plaque and thrombus on the IVC wall. However, the possibility of thrombus growth on its surface is not negligible, particularly if larger clots are trapped in the filter.

THU377 Arterio-enteric Fistula, A Rare Complication After Pancreatic Transplant

Abstract Disclosure: A.M. Herrera Chancay: None. A. Calderon: None. A. Manavalan: None. Introduction: Areterio-enteric (AE) fistula is a rare but life-threatening complication of a failed pancreas transplant and most often presents with a gastrointestinal (GI) herald bleed. This case illustrates the importance of the prompt recognition and appropriate evaluation of GI bleeding in patients with a failed pancreas transplant and highlights the challenges associated with the management of an AE fistula. Case Description: A 53-year-old man with history of T1D complicated by retinopathy, neuropathy, nephropathy, end-stage renal disease (ESRD) and failed combined pancreas-renal transplant, presented to our hospital with diabetic ketoacidosis secondary to insulin pump malfunction. His course was complicated by a GI bleed. He was initiated on proton pump inhibitors but endoscopy was deferred due to resolution of bleeding. The patient was discharged from the hospital with plans for outpatient endoscopy however, he returned to the emergency room with hematemesis, malena and hemorrhagic shock complicated by cardiac arrest. Emergent endoscopy was performed but the source of bleeding could not be visualized due to large clots and fresh blood. A CT angiogram revealed brisk bleeding from the right common iliac pancreatic transplant graft. Coil embolization was attempted but unsuccessful and the patient was ultimately treated with two stents to the right iliac artery with subsequent resolution of bleeding. The patient was ultimately discharged home in stable condition. Conclusion: During pancreas transplant, the donor pancreas and duodenum are connected by a Roux en Y anastomosis to the small bowel of the recipient. The donor pancreas is placed in the right iliac fossa followed by anastomosis of the recipient right common iliac artery with the donor Y graft (Consisting of the iliac artery, its bifurcation, and the splenic and superior mesenteric arteries). AE fistula is an extremely rare complication of pancreatic transplant with only about 30 reported cases. This occurs in the setting of transplant failure, possibly due to the increased local inflammation. Endoscopy is often unsuccessful in locating the bleeding source. Angiography and stenting of the bleeding vessel seem to offer the most success and should be considered in patients with failed pancreas transplant presenting with GI bleeding. Presentation: Thursday, June 15, 2023

Primary Brainstem Hemorrhage—An Institutional Series From a Stroke Register and Evaluation of Outcome Determinants

Objective Primary brainstem hemorrhage (PBH) carries poor prognosis and the need for aggressive management is a matter of debate especially in developing countries with limited resources. The aim of this study was to analyze the prognostic factors in mortality prediction following PBH in a series of 59 consecutive patients. Methods A single institutional, retrospective, cohort study with a study period of 6 years (2016-2021). All patients with computerized tomography-proven intracerebral hematoma in the midbrain, pons, or medulla, alone or in combination were included in the study. Outcome was analyzed using a modified Rankin score (mRS) and was categorized into good (mRS 0, 1, 2, and 3), poor (mRS 4 and 5), and death. Statistical analysis was done using univariate regression analysis followed by multivariate regression analysis and a P value < .05 was considered significant. Results A total of 59 patients diagnosed with primary brainstem hematoma were included in the study. Of the 59 patients, 40 (67.79%) were males and 19 (32.2%) were females, with a mean age of 55.51 ± 13.46 (range of 29-93 years). The median admission GCS score on admission was 6. No definite history of hypertension could be elicited in 18 patients (30.50%). The most common site for a brain stem hematoma was the pons 47 (79.9%) followed by pons-midbrain combination (06 10.2%). The average clot volume was 7.78 ± 6.5 mL. Fourth ventricular extension was seen in 18 patients (28.8%%) of whom 15 (27.2%) developed hydrocephalus. All patients were managed conservatively. At 3 months, 34 patients (57.62%) succumbed to the illness while 25 survived (42.37%) of whom only 12 had a good outcome (mRS 0-3). In addition to GCS score < 8, ( P < .001) large clot volume (>10 mL) ( P < .001), high systolic blood pressure on admission, and intraventricular extension, a high admission neutrophil-to-lymphocyte ratio (NLR) ( P < .03) was found to have significant correlation with mortality. Conclusion Brainstem hemorrhage has a high mortality and few patients have good clinical outcome. Admission GCS, clot volume, hypertensive in etiology, and a high NLR are poor prognostic factors. Low GCS on admission is the most important and independent predictor of mortality and poor outcome.

The Effect of Blood Clots on the Quality of RNA Extracted from PAXgene Blood RNA Tubes.

Background: PAXgene® Blood RNA tubes are routinely used in clinical research and molecular biology applications to preserve the stability of RNA in whole blood. However, in practice, blood clots are occasionally observed after blood collection and are often ignored. Currently, there are few studies on whether blood clots affect the quality of RNA extracted from these tubes. Materials and Methods: Fifteen pairs of non-clot and clot PAXgene Blood RNA tube samples (n = 30) were collected to form two matched groups from 15 patients. According to the maximum diameter (d) of the blood clot observed visually at the time of sample reception, the clot groups were divided into a small-clot group (0 cm < d < 0.5 cm) and a large-clot group (d ≥ 0.5 cm). RNA was extracted by the PAXgene Blood RNA Kit. To analyze the quality of RNA, its yield and purity were assessed by spectrophotometry, and integrity was measured by microfluidic electrophoresis. An A260/280 ratio between 1.8 and 2.2 indicated purified RNA, and RNA integrity number (RIN) values ≥7.0 were considered to represent qualified integrity. Results: The median yields of RNA from the non-clot and clot groups were 3.84 (2.80-6.38) μg and 4.87 (2.77-8.30) μg, respectively. The median A260/280 ratios were 2.08 (2.06-2.09) and 2.09 (2.07-2.11), whereas the median A260/230 ratios were 1.77 (1.31-1.91) and 1.67 (1.21-1.94) in the two groups. In addition, the median RINs were 8.20 (8.00-8.40) and 7.20 (6.60-7.70), respectively. There were no significant differences in RNA yields, A260/280, or A260/230 between the two groups. However, the RIN value of the clot group was significantly lower compared with the non-clot group (p < 0.05), with RIN ≥7.0 found in all non-clot samples and 60% of clot samples (p < 0.05). Furthermore, in the clot groups, the small-clot samples had higher RIN values than large-clot samples (8.25 [7.75-8.75] vs. 6.90 [6.60-7.30], p < 0.001). Conclusions: The formation of large blood clots in PAXgene Blood RNA tubes will reduce the integrity of extracted RNA.

Term Delivery Complicated by Uterine Rupture with No Prior History of Cesarean Section or Uterine Curettage Following Oxytocin Use and Arrest in Second Stage of Labor: A Case Report.

BACKGROUND Uterine rupture during delivery in an unscarred uterus may be associated with oxytocin dose during second stage arrest and with underlying maternal factors. This report is of a 34-year-old woman, gravida 5, para 3, with no previous history of cesarean section (CS), who had a uterine rupture at term delivery following the use of oxytocin for second-stage arrest. CASE REPORT A 34-year-old Afghani woman, gravida 5, para 3 was admitted at term for delivery. The current pregnancy had been normal and the estimated birth weight was approximately 4000 g. There was no history of steroid treatment or any underlying connective tissue disease, and no history of dilation and curettage. Oxytocin was given as per protocol, starting at 20 ml/h of a dilution of 10 IU/1 L natrium chloride (NaCl). Subsequent labor progress was complicated by arrest of descent in the second stage of labor, necessitating cesarean section delivery. After opening the abdominal wall, a uterine rupture with several large blood clots was discovered, freely floating in the peritoneal space, about 500 ml in volume. The rupture stretched from the left side of the uterine body and down into the thin lower segment. The tissue in this area had diffuse hematoma. CONCLUSIONS Although uterine rupture mostly occurs in women with previous CS, this report has shown that uterine rupture can occur in pregnancy complicated by arrest in the second stage of labor.

Urethral Sheath to Evacuate Blood Clots through Mitrofanoff Appendicovesicostomy

Background: the Mitrofanoff appendicovesicostomy provides a catheterizable submucosal tunnel between umbilicus and bladder (or neobladder). In patients with a closed bladder neck, the Mitrofanoff channel is the only way to access the bladder. We describe our case of a 17 year-old girl with a Mitrofanoff appendicovesicostomy and a previous surgical closure of the bladder neck and who developed a large bladder clot due to hematuria after a surgical cystolithotomy in an augmented bladder; Methods: after an unsuccessful trans-appendicovesicostomy bladder washing, the endoscopic evaluation was performed using a 14 Ch rigid cystoscope and surrounded by its own urethral sheath. The clot was progressively fragmented through the cystoscope under direct vision. Clot fragments were aspirated to obtain a complete evacuation; Results: the urethral sheath prevented damages to the appendicovesicostomy, allowing at the same time repeated accesses of the cystoscope into the neobladder and ensuring the procedural success. The postoperative period was uneventful, and the neobladder catheter was removed after two days. Neither channel stenosis nor anastomosis dehiscence nor incontinence were reported after five months; Conclusions: the use of urethral sheath 14 Ch through an appendicovesicostomy preserves both the stoma and the channel, making possible endoscopic procedures such as blood clot evacuation into the neobladder.

P68: Atypical Presentation of Pump Thrombosis in HVAD: Usefulness of HVAD Waveforms in Diagnosing Pump Thrombosis

Background: Pump thrombosis is a life-threatening complication from left ventricular assist device (LVAD). Early recognition and diagnosis is essential to prevent adverse outcomes. This case study illustrates an atypical presentation of pump thrombosis. Method: A 62-year-old male with ischemic cardiomyopathy s/p HVAD implant suffered an intercranial hemorrhage in the setting of MDR pseudomonas bacteremia. Patient’s anticoagulation was reversed and an emergent craniotomy was successfully performed. Hemolysis markers were unremarkable (LDH < 300 U/L, plasma free hemoglobin <10mg/dL). On POD 4, an intermittent loss of pulse variability was noted on the HVAD waveform and on the radial arterial line waveform (Figure 1). This loss lasted 10 seconds, self-resolved and reoccurred every few minutes. It was not associated with hemolysis, decrease in powers, arrythmia, hypovolemia or postural changes. The patient was hemodynamically stable and discharged to an acute rehabilitation center without resolution of this intermittent loss of pvar. Result The patient subsequently underwent an orthotopic heart transplant. Upon inspection of the explanted heart, a large mobile clot was noted at the inflow cannula (Picture 1). The clot partial intermittent obstruction of the inflow cannula likely caused the intermittent loss of pulsatility. Conclusion: Inflow pump thrombosis does not always present with classic hallmark sign such as loss of power and flow, hemolysis markers elevation and worsening heart failure and can be difficult to diagnose. This case illustrates the usefulness of HVAD waveform assessment to identify early signs of pump thrombosis.Figure 1. Progressive loss of pulsatilityFigure 2. Progressive loss of pulsatilityFigure 3. A view of the left ventricle with inflow cannula with mobile clot

CARD31: Novel Tubing Connectors Reduce ECMO Circuit Thrombosis

Background: Extracorporeal Membrane Oxygenator (ECMO) circuit thrombosis is a common complication that plagues the clinical management of patients receiving mechanical circulatory support. High doses of anticoagulation required to reduce circuit thrombus burden can increase hemorrhagic complication risk, yet concomitantly persistent circuit clots result in frequent circuit replacement. Prior studies have identified the tubing-connector junction as contributing over 80% of circuit clots. Analysis and alteration of this junction can optimize mechanical flow properties to reduce the overall clot burden. We have designed a novel connector to reduce or eliminate the primary source of ECMO circuit clots. Methods: Our study utilized a combination of ex vivo and in vivo evaluation of our novel tubing connectors in comparison to current connectors. Our novel connectors were designed for use with 3/8” tubing and created using injection molding (Fig 1). For ex vivo simulation, we created a flow loop with 3/8” tubing and alternated current and novel connectors. Heparinized porcine blood was perfused for 96 hours. For in vivo assessment, we cannulated four goats with arterial and venous large-bore catheters and created an ECMO circuit with an oxygenator per standard clinical practice. These circuits were run for varying time periods, ranging from 12h to 48h. After completion of blood perfusion in both experimental setups, connectors were excised from the circuits and inspected. Clots were quantified for presence and radial protrusion into the connector lumen, and compared across connector type. Results: In both ex vivo and in vivo configurations, the current connectors formed large clots. In contrast, novel connectors formed almost no clots (p<0.01). Ex vivo flow loops showed more than one clot per current connector (upstream and downstream), while novel connectors contained only a single clot amongst 9 connectors with no luminal protrusion (Fig 2). In vivo connectors (Fig 3) were analyzed using a grading system involving clot presence and luminal protrusion. Current connectors had a significantly higher clot presence score (p<0.01) and lumen protrusion score (p<0.01) than novel connectors. Summary: Novel ECMO tubing connectors significantly reduce clot burden and can be easily integrated into current clinical practice, suggesting they may make significant impact in clinical ECMO circuits. Substantial reduction in thrombogenicity has the potential to reduce the need for anticoagulation, thereby also reducing adverse hemorrhagic events.

Use of Cultured Epithelial Autograft in Conjunction with Biodegradable Temporizing Matrix in Massive Burns: A Case Series.

Intensive care for massively burn patients has increased survival and highlights the need for a solution to the problem of insufficient donor sites for autologous skin coverage. In this case series we present ten patients with average burn size of 81% TBSA and mean age of 24 years old, who underwent burn excision followed by either immediate or delayed biodegradable temporizing matrix (BTM) placement. After an integration period, the BTM was delaminated either the day before or immediately prior to placement of cultured epithelial autografts (CEA) over a widely meshed (4:1 or 6:1) split thickness skin graft (STSG). One patient had CEA alone, without STSG, placed on integrated BTM and had successful take. Seven patients survived to discharge and had average 95% wound closure at 135±35 days. The patients had on average 10.4 total operations and 8.7 excision and grafting operations. Five patients had complications related to the BTM requiring removal or replacement including three fungal infections, one bacterial infection and one with bleeding and a large clot burden. In conclusion, this surgical strategy is a viable option for patients with massive burns and insufficient donor for autologous skin grafting.

Impact of stent-retriever tip design on distal embolization during mechanical thrombectomy: a randomized in vitro evaluation

BackgroundRepeated number of passes, clot fragmentation, and distal embolization during mechanical thrombectomy (MT) lead to worse clinical outcomes in acute ischemic stroke. This study aimed to assess the recanalization and...

Homoeopathic Treatment of Chocolate Cyst: A Case Report

AbstractChocolate cysts of the ovary come under the subgroup of endometriosis. The prevalence of chocolate cyst in the reproductive age group is 8% and in the postmenopausal age group it is 18%. Its defining symptoms include dyspareunia, pelvic pain, irregular periods and menstrual pain. A cyst size of more than 4 cm indicates the need for surgical treatment. The typical therapies for this condition include hormone therapy and operations like hysterectomy. In this case report, we have shown a positive curative role of homeopathic medicine in the management of chocolate cyst of the ovary.A 31-year-old woman complaining of weakness came to the OPD, painful irregular menses with large clots and stitching pain in the right inguinal region. She was diagnosed with a case of chocolate cyst of the ovary. She had been on hormonal therapy for a year without any relief, and the report showed that the cyst has grown bigger. The patient was treated successfully with individualised homoeopathic medicine Lachesis in centesimal potency, which showed significant improvement in patient – and post-treatment outcome was corroborated with follow-up and laboratory investigation which showed complete regression of cyst.Causal attribution for changes in the condition of patients after homoeopathic medication was assessed by modified Naranjo criteria. However, this is a single case in which chocolate cyst of the ovary associated with variable and unpredictable remission was found.

The “reverse vessel sign” mandating endoscopic hemostasis after cold snare removal of a large adherent clot in lower GI bleeding

The “reverse vessel sign” mandating endoscopic hemostasis after cold snare removal of a large adherent clot in lower GI bleeding

Abstract Number ‐ 151: Impact of Stent‐Retriever Tip Design on Distal Embolization during Mechanical Thrombectomy

Introduction Mechanical thrombectomy (MT) is a widely performed procedure for acute ischemic stroke (AIS) due to large vessel occlusion. Repeated number of passes, clot fragmentation, and distal embolization during MT lead to worse clinical outcomes. We aim to evaluate the impact of different stent‐retriever (SR) distal tip designs on distal emboli generation during MT. Methods Fragment‐prone clot analogs (diameter = 3.53±0.14mm; length = 6.74±0.61mm) were used to create proximal middle cerebral artery (MCA‐M1) occlusions in an in vitro neurovascular model featuring a complete circle of Willis. The anatomical replica was connected to a flow loop with circulating saline at physiological flow rate and temperature; 100‐µm filters were placed at the neurovascular outflow points of the model to collect generated distal emboli. After initial embolization, experiments were randomized into one of the three treatment arms based on SR tip design: open‐end (Open‐SR: Solitaire 6.0×40mm), closed‐end (Closed‐SR: Embotrap II 5.0×33mm), and filter‐end (Filter‐SR: NeVa NET 5.5×37mm). A balloon guide catheter was inflated at the internal carotid artery C1 level immediately after SR deployment, and the SR was pulled out under continuous proximal pump aspiration. A total of 90 cases were performed (30 cases/treatment arm). A single attempt was performed per case and after each pass, distal emboli collected in the outflow filters were analyzed by an image processing algorithm. Successful first pass recanalization (FPR) was confirmed if no residual clot was observed at the initial location or in a distal branch of the model. Primary study endpoints were: FPR rate (%FPR), the size of the largest embolus (largest‐E), the total emboli count (total‐E), the total count of emboli larger than 1mm (total&gt;1mm‐E), and the total area of the filter covered by emboli (area‐E). Results FPR was achieved in 57.8% of cases (52/90): Filter‐SR achieved a non‐significantly higher %FPR (70%) than closed‐SR (50%) and open‐SR (53.3%) (p = 0.244). In comparison to open‐ and closed‐SR, filter‐SR significantly reduced the largest‐E (open‐SR = 1.66±0.68mm vs. closed‐SR = 1.77±0.90mm vs. filter‐SR = 1.22±0.77mm; p = 0.013) as well as the total&gt;1mm‐E (open‐SR = 2.27±2.33 vs. closed‐SR = 3.97±5.68 vs. filter‐SR = 0.93±1.28; p = 0.002), and the area‐E (open‐SR = 18.22±14.47mm2 vs. closed‐SR = 23.98±22.39mm2 vs. filter‐SR = 10.14±8.81mm2; p = 0.013). The differences between distal tip designs were not clearly evidenced in the total‐E (open‐SR = 22.7±10.75 vs. closed‐SR = 23.13±13.16 vs. filter‐SR = 20.63±12.77; p = 0.464). No significant differences were found between open‐ and closed‐SR (p&gt;0.05 in all metrics). Conclusions When facing fragment‐prone clots with low SR engagement, the filter‐SR significantly reduces the number of large clot fragments (&gt;1mm), the size of the largest embolus, and the overall surface area of clot fragments that embolize distally during an MT procedure.

Features of the prognosis and outcomes of pregnancy with massive subchorionic thrombosis. A literature review

Massive subchorionic thrombohematoma, also termed in the literature as Breus mole, is a rare condition in which a large maternal blood clot separates the chorionic plate from the chorionic villi. The etiology and pathogenesis of this condition are yet unclear, and the very concept of massive subchorionic thrombohematoma remains vague due to the singularity of clinical cases and the necessity to distinguish it from other types of hematomas. The lack of a unified view on the pathology and clear-cut clinical, laboratory and ultrasound criteria can lead to insufficient attention of doctors and untimely or even incorrect establishing diagnosis, which significantly worsens the prognosis of pregnancy and increases the risk of potential complications. Patients with massive subchorionic thrombohematoma require increased attention due to the high rate of such manifestations as antenatal death, fetal growth retardation, late miscarriage, and preeclampsia. Each case should be carefully analyzed in order to find predictors of thrombohematomas and methods of their prevention.