Longer Procedure Time Research Articles

Effect of needle size on outcomes of vacuum-assisted excision of breast lesions. A randomized controlled trial.

Utilizing a larger needle-size instead of a smaller one in vacuum-assisted excision of breast lesions might enhance the effectiveness of the method. We conducted a clinical trial to investigate the effects of needle size 7G compared to 10G regarding excision completeness and procedural efficiency. In this prospective, single-blinded, randomized clinical trial, the patients were enrolled between November 2019 and August 2022. Follow-up examinations were performed at 6 and 24months after the procedure. In total, 208 patients were screened and enrolled, and following withdrawal of consent, the trial population comprised 194 patients. All patients with ultrasound-visible lesions of <30mm in size and biopsy confirmation corresponding to a B2 or B3 lesion were included in the study. Additionally, patients with BI-RADS 3 and 4a microcalcifications measuring <15mm were also eligible. Eighty-five percent of the patients attended the 6-month follow-up, and 65% attended the 24-month follow-up. There were no significant difference between the two randomization arms in terms of age, and lesion size. The mean procedure time was 7.7min and 8.5min for 7G and 10G needle size, respectively (=0.126). Of the 164 patients who attended the 6-month follow-up, no remaining lesions were found in 90% and 81.5% (p=0.109) patients for 7G and 10G needle size respectively. Thirty percent (6/20) of the patients with microcalcifications excised stereotactically, guided by mammography, had a residual lesion compared to 2.5% (1/42) of the patients with intraductal lesions excised under ultrasound guidance. Using a 10G compared to a 7G needle size resulted in no difference in procedure time or excision completeness. Among the analyzed parameters, only a larger lesion size was consistently associated with a longer procedure time and a higher risk of incomplete excision.

P0521 Accuracy of a non-invasive approach in monitoring pediatric inflammatory bowel disease: interim-analysis of a prospective multicenter italian study

Abstract Background Ileocolonoscopy is the gold standard for diagnosing and monitoring pediatric IBD. However, it has limitations, including high costs, invasiveness, and the inability to visualize the small bowel (SB) and assess transmural involvement. Magnetic resonance enterography (MRE), while not the gold standard, is recognized as a key tool for evaluating the SB. Its limitations include high costs, the requirement for oral contrast—which reduces patient tolerance—and longer procedure times. To provide less invasive monitoring, especially in children, non-invasive methods such as capsule endoscopy (CE) and ultrasound (US) have been developed. We aimed to evaluate the accuracy of these non-invasive techniques (US and CE) in monitoring pediatric IBD. Methods This study represents an interim analysis of the prospective multicenter protocol GR-2019-12370621. Consecutive children with IBD were enrolled. At baseline, 6 and 12 months, UC children underwent ileocolonoscopy (IC), CE and US, while CD children underwent IC and EGD, MRE, CE and US. For the terminal ileum in CD and the colon in UC and CD, IC was the gold- standard. For the SB (jejunum, proximal and mid-ileum) MRE was the comparator to assess the presence of active disease. EGD served as the gold standard for duodenum. Sensitivity (Se), specificity (Sp), negative and positive predictive value (NPV and PPV) and accuracy of CE and US were determined for CD and UC in an ITT analysis. Results Thirty-one patients (16 CD and 15 UC) were enrolled as of the retrieval date (04/10/2024). For UC, 31 IC, 31 CE and 30 US procedures were performed. In CD, a total of 40 endoscopies, 30 CEs, 12 US procedures, and 36 MREs were available. In UC, CE showed a Se of 85%, Sp 100%, NPV of 87%, PPV of 100%, and an accuracy of 92.8%. The Se, SP, NPV, PPV and accuracy of US were 63%, 100%, 70%, 100% and 80%, respectively. The combination of CE and US increased accuracy up to 93.1% (Table 1).For CD: the combined accuracy of CE and US was 100% for the terminal ileum, 80% for the jejunum, 69% for the proximal ileum, and 75% for the mid ileum. The accuracy of CE for the colon in CD was 82.1% (Table 2). Conclusion Non-invasive monitoring achieves an accuracy of 93% compared to endoscopy in UC. For CD, it demonstrates excellent accuracy for the terminal ileum (100%) and fair accuracy for the colon (82.1%) compared to the invasive counterpart. However, reduced accuracy in the small intestine, ranging from 69% to 80%, may be influenced by the lack of a definitive gold standard for this segment. The low PPV of the CE, particularly for jejunum and proximal ileum, could be explained by the detection of mucosal lesion not visible by the comparator (MRE).

Echocardiography evaluation of iatrogenic atrial septal defect after combined procedure of catheter ablation and left atrial appendage closure for atrial fibrillation

Using transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) to investigate the occurrence and related causes of iatrogenic atrial septal defect (iASD) after catheter ablation combined with left atrial appendage closure (LAAC) for atrial fibrillation (AF) and its impact on the right heart system. We retrospectively analyzed 330 patients that underwent combined procedure of catheter ablation for AF and LAAC at General Hospital of Northern Theater Command from January 2018 to March 2022. These patients were divided into iASD group and non-iASD group according to whether there was persistent iASD shown on TEE at 3 months after procedure. There were 96 (29.1%) patients with iASD and 234 patients without in the TEE follow up at 3 months post-operation. Patients with iASD had larger left atrial volumes (76.5 ± 35.2 ml vs. 61.1 ± 21.9 ml, p = 0.036) as well as higher occurrence of mitral regurgitation (MR) (32.3% vs. 12.8%, p = 0.018) and tricuspid regurgitation (TR) (27.1% vs. 7.3%, p = 0.002). Procedural features showed that patients with persistent iASD had longer procedure time (92.1 ± 36.3 vs. 69.1 ± 17.8 min, p = 0.003) and larger sheath sizes (4.1 ± 1.2 mm vs. 3.3 ± 1.2 mm, p = 0.022). The preoperative and postoperative right heart parameters of patients in the persistent iASD group were compared, and there were no significant differences on right atrial/ventricular diameter, right heart systolic/diastolic function and pulmonary artery pressure (P > 0.05). The occurrence of iASD 3 months after combined atrial fibrillation ablation and LAAC was 29.1%. The size of left atrium, the pressure of left atrium, the manipulation time within left atrium, the size of sheath, and the use of ICE during operation was related to the closure of iASD.

The Therapeutic Potential of Different Surgical Approaches in the Management of Cardiac Myxoma: A Systematic Review.

Background: Cardiac myxomas are benign tumors of the heart. They occur mostly in the left atrium. The preferred treatment is surgical resection, which can be performed via conventional median sternotomy, minimally invasive, or robotic-assisted approaches. This study aimed to evaluate the outcomes, advantages, and limitations of these surgical methods, with a focus on their safety, efficacy, and impact on patient recovery. Methods: This systemic review was conducted according to PRISMA guidelines. The chosen databases were systematically searched using the keywords "cardiac myxoma", "resection", "approach", "minimally invasive", and "robotic surgery". The comparison between the surgical strategies was based on thirteen articles, which met the inclusion criteria. Results: Median sternotomy remains the standard technique, providing excellent surgical access but is associated with longer hospital stays, higher blood loss, and increased risk of complications such as stroke. Minimally invasive approaches demonstrated comparable safety with shorter ICU stays, reduced blood loss, and lower postoperative pain but presented challenges, including limited exposure and longer procedure times. Robotic-assisted surgery showed potential as a safe alternative but was limited by high costs and technical demands. However, the data on minimally invasive and robotic methods are limited due to the rarity of cardiac myxomas. Conclusions: The choice of surgical technique should be individualised by considering the tumour size, location, patient condition, and surgeon expertise. Routine postoperative echocardiographic monitoring is essential to detect residual or recurrent tumours. Further studies are needed to validate the long-term efficacy of minimally invasive and robotic approaches.

Association of Reperfusion and Procedural Characteristics with Endovascular Thrombectomy Outcomes in Large Core Stroke: Sub-Analysis from the SELECT2 Trial.

From the SELECT2 trial, we evaluated the association between reperfusion status, first-pass effect (near-complete or complete reperfusion [extended thrombolysis in cerebral infarction (eTICI) 2c-3] in 1 pass), procedure time and primary technique (aspiration vs stent-retriever) with functional outcomes in patients receiving EVT across ASPECTS (3 vs 4 vs 5) and core estimate strata (<70 vs ≥70ml, <100 vs ≥100ml, and <150 vs ≥150ml). Of 180 patients who received thrombectomy, 144 (80%) achieved successful reperfusion (eTICI 2b-3) and demonstrated better clinical outcomes (adjusted generalized odds ratios [aGenOR]: 1.48, 95% confidence interval [CI]: 1.01-2.15), compared with unsuccessful reperfusion. Results were consistent across ASPECTS and core estimate strata. Additionally, complete or near-complete reperfusion (eTICI 2c-3) was associated with better functional outcome (aGenOR: 1.99, 95% CI: 1.33-2.97) in patients achieving successful reperfusion. Functional outcome point estimates favored those with first-pass-effect (42 of 167 (25%), aGenOR: 1.46, 95% CI: 0.96-2.24). Longer procedure time was associated with worse modified Rankin scale (mRS) distribution (aGenOR: 0.92, 95% CI: 0.87-0.96, p-value = 0.001 for 10 minutes increment). Aspiration-first technique was used in 43 of 154 (25%) patients and was not associated with higher reperfusion (88% vs 78%, p = 0.18) or better functional outcome (aGenOR: 0.74, 95% CI: 0.50-1.10) as compared with stent-retriever first. Successful reperfusion resulted in improved clinical outcomes in large core patients across baseline ischemic core strata. Near complete or complete reperfusion was further associated with better outcomes, whereas prolonged procedures were associated with worse outcomes. Results were consistent regardless of the technique used. ANN NEUROL 2024.

Safety and efficacy of endoscopic submucosal dissection with gel immersion technique for superficial esophageal neoplasms.

Gel immersion (GI) endoscopy provides a good visual field in endoscopic submucosal dissection (ESD); however, its clinical outcomes are poorly understood. This study aimed to compare the treatment outcomes between esophageal gel immersion endoscopic submucosal dissection (GI-ESD) and conventional ESD (C-ESD) to determine the safety and efficacy of GI-ESD. The data of 71 consecutive patients who underwent esophageal ESD between April 2021 and March 2023 at a Japanese tertiary center were retrospectively reviewed. GI was achieved using an additional irrigation tube. The treatment outcomes between the GI-ESD and C-ESD groups were compared using inverse probability of treatment weighting (IPTW) to control for confounding factors. A total of 75 superficial esophageal epithelial neoplasms (41 in the C-ESD and 34 in the GI-ESD groups) were treated using ESD. The mean procedure time in the GI-ESD group was significantly shorter than that in the C-ESD group (59.2±36.2 vs 85.3±45.7min, P=0.008). After IPTW adjustment, the mean procedural times were 62.6±36.6 and 82.9±41.7min in the GI-ESD and C-ESD groups, respectively (P=0.037), and the incidence rate of muscle layer damage was 4.2% in the GI-ESD group and 30.6% in the C-ESD group (P=0.001). In the multivariate analysis, specimen size ≥30mm (odds ratio [OR]: 9.44, 95% confidence interval [CI]: 2.46-36.30, P=0.001) was positively correlated with longer procedural time (≥90min), whereas GI-ESD (OR: 0.19, 95%CI: 0.05-0.68, P=0.011) showed a negative association. Esophageal GI-ESD may be useful in terms of safety and time efficiency. The GI technique could be an option for esophageal ESD.

Abstract 026: Initial Experience with the Walrus BGC results from 300 cases

Background Until recently only the Flowgate2 (Stryker Neurovascular) was available clinically despite multiple advances in aspiration catheter and stent‐retriever technology. The Walrus BGC (Q'Apel Medical Inc, Fremont, California, USA) is a next generation BGC with improved flexibility and compatibility with large bore aspiration catheters. We report our experience with the Walrus BGC in anterior circulation LVO MT with a focus on procedural aspects related to the vascular anatomy, recanalization efficacy and complications. Materials and Methods A retrospective review at two high volume MT centres in the United Kingdom (&gt;300 cases annually) was performed to identify all patients where the Walrus BGC was used between July 2023 and January 2024. The inclusion criteria included: •Age ≥18• NIHSS score ≥6•ASPECT score ≥3•mRS 0‐2•Life expectancy of &gt;6months•The Walrus BGC was used 1 st line during the MT. All patients underwent plain CT + CTA prior to the MT procedure. Patients received IV tPA if they met the appropriate criteria. The anatomical configuration was recorded as per the ASMET score (Assessment for Mechanical Thrombectomy Score) which assesses and scores the:•Presence of a Bovine arch (0‐1)•The aortic arch confirguration (0‐2)•The degree of dolichoarteriopathy affecting the supra‐aortic vessels (0‐2)•Presence of ICA dolichoarteriopathy (0‐1)The ASMET score gives a range of 0‐6 and higher scores have been previously been shown to be associated with longer procedural times. Positioning of the BGC was divided into either proximal ICA and distal ICA and standard times such as puncture time, time to first angiogram, first pass effect and final eTICI score were recorded. Results 300 patients that met the inclusion criteria with average age 69.5±15yrs, and 168 (56%) male. The average NIHSS score was 15.8±6.5 and average ASPECT score 7.6±1.9. 51.5% of patients received IV tPA. The vast majority of LVo were located in M1 (60%), ICA 21.5% and M2 17.8%. Tandem lesions were present in 18.1%. Arch configuration was as follows: I.34.7%II.21.7%III.43.6% The average ASMET score was 2.6±1.6. Kinked or coiled ICA was seen in 18.1%, tortuous in 53.8% and straight in 28.1%. A distal location of the BGC was achieved in 77.9% and proximal location in 22.1%. FPE was seen in 49% with mFPE in 65.9%. Final eTICI≥2c was 75.9% and ≥2b 92.7%. There was one major complication – a CCF caused by the BGC. Minor non‐flow limiting dissections were seen in 4.3% of cases. With regards to arch configuration and ASMET score there was no statistical significant difference between the puncture to first run time, first pass time, or final angiogram between different arch types. Conclusion The Walrus BGC is highly navigable and there is no statistically significant difference between the time taken to navigate the Walrus in patients with minimal tortuosity compared to very tortuous anatomy. The use of Walrus is associated with a high degree of first pass success and low complication rates.

Abstract 049: Predictors of Hemorrhagic Transformation Following Mechanical Thrombectomy with Emergent Carotid Artery Angioplasty and Stenting for Tandem Occlusions of the Anterior Circulation

Introduction Hemorrhagic transformation of the ischemic core following mechanical thrombectomy (MT) for acute ischemic strokes can negate the benefits of the procedure. Previous regressions have identified variables suggesting larger strokes and longer procedural times as significant predictors of hemorrhagic transformation. Tandem occlusions add another layer of complexity, as the proximal carotid occlusion and the emergent carotid artery angioplasty and stenting (eCAS) introduces additional factors that can influence hemorrhagic transformation by altering the dynamics of reperfusion. We investigated predictors of hemorrhagic transformations following MT+eCAS performed for anterior circulation tandem occlusion in patients with baseline mRS 0‐2.; Methods Retrospective analysis of institutional thrombectomy database for patient characteristics, thrombectomy details, in‐hospital course, and follow‐up outcomes to shortlist significant univariate predictors to conduct multivariate binomial logistic regression and assess for significant predictors of hemorrhagic transformations following MT+eCAS during in‐hospital stay.; Results Multivariate binomial backwards logistic regression identified hypertension (p=0.042) and use of balloon guide catheters as opposed to conventional guide catheters (p=0.035) to significantly increase the risk of hemorrhagic transformation. Middle cerebral artery occlusions as opposed to internal carotid terminus occlusions (p=0.025), conscious sedation as opposed to general anesthesia (p=0.002), primary aspiration passes as opposed to primary stent retriever passes (p=0.007), retrograde as opposed to anterograde eCAS (p=0.004), intracranial slow flow following MT+eCAS (p=0.049) and oral aspirin/ticagrelor as opposed to intravenous eptifibatide load prior to eCAS (p=0.021) suggested reduced risk of hemorrhagic transformation, symptomatic or not.; Conclusion The study identified procedural predictors of hemorrhagic transformation specific to tandem occlusions. Patients undergoing mechanical thrombectomy with carotid artery stenting (MT+eCAS) under general anesthesia, using primary stent retriever passes, anterograde eCAS, and receiving an intravenous eptifibatide load before eCAS were particularly vulnerable to hemorrhagic transformation. Gradual reperfusion, shown to be protective against hemorrhagic transformation, was supported by the significance of intracranial slow flow.

Comprehensive Surgical Management of Thoracic Schwannomas: A Retrospective Multicenter Study on 98 Lesions.

The optimal surgical management of thoracic schwannomas (TSs) remains contentious, with various approaches proposed. Video-assisted thoracoscopic surgery (VATS) and combined VATS with neurosurgical procedures have shown promise, particularly for Eden type IV and III lesions. However, unanimous consent on the most effective surgical intervention and understanding of prognostic factors for tumor recurrence needs to be improved. The aim of this study was to elucidate the optimal surgical approach according to the Eden type and investigate predictive factors for TS recurrence. This retrospective, multicentric, observational study analyzed 98 surgically treated patients with TS from 2011 to 2023, assessing preoperative and 6-month follow-up clinical (recurrences, pain, and myelopathy recovery) and surgical parameters (operative time, intraoperative blood loss, extent of resection). Surgical procedures included thoracic laminectomy or hemilaminectomy for type I, laminectomy or thoracic transpedicular (TPD) approach for type II, laminectomy alone or combined laminectomy with VATS for type III, and VATS or thoracotomy (open thoracotomy [OT]) for type IV. Descriptive and deductive analyses were conducted between and within the 4 cohorts, with multivariate analysis assessing the contribution of predictor variables. No significant differences were found between hemilaminectomy and laminectomy for all analyzed parameters for type I. Type II lesions treated with TPD exhibited similar outcomes to laminectomy, albeit with longer procedure times. Type III lesions benefited from combined approaches compared with neurosurgical-only approaches. Video-assisted thoracoscopic surgery emerged as more favorable than OT for type IV lesions. Multivariate analysis revealed that patient sex, tumor location, extent of resection, and pathology significantly influenced recurrence rates. For Eden type III TSs, neurosurgical and VATS combined surgery achieved better outcomes than neurosurgery alone; for Eden type IV TSs, VATS achieved better results than OT. For Eden types I and II, hemilaminectomy and bilateral laminectomy and laminectomy and TPD achieved similar outcomes, respectively.

Comparison of vessel-Fractional Flow Reserve (vFFR) and Quantitative Flow Ratio (QFR) using instantaneous wave-Free Ratio (iFR) or Resting Full-cycle Ratio (RFR) as reference

Abstract Background Angiography-based functional assessment remains the state of the art to assess the hemodynamic relevance of intermediate coronary stenoses. In addition to fractional flow reserve (FFR), adenosin free indices like instantaneous wave-free ratio (iFR) or resting full-cycle ratio (RFR) are widely used for the invasive evaluation. Although these methods are widely accepted, they are underused in clinical routine due to costs, their invasive nature, longer procedural times, and lack of availability. Vessel-fractional flow reserve (vFFR) and quantitative flow ratio (QFR) are new software-based methods for the evaluation of coronary-physiology. The aim of this study is to compare vFFR and QFR with the established invasive methods iFR or RFR. Methods We prospectively analyzed 95 Patients in our QFR-Registry vFFR- and QFR-computation was performed three-times by two certified, blinded, and independent experts using the QAngio XA 3D 3.2- and CAAS-software, respectively. Results: 101 main epicardial coronary arteries (52 LAD; 19 LCx; 30 RCA) were analyzed using vFFR, QFR and iFR or RFR. vFFR showed a good correlation with adenosine-free indices in all 3 measurements (AUC 0.883 with r=0.672, p&amp;lt;0.001; AUC 0.841 with r=0.618 p&amp;lt;0.001; AUC 0.840 with r=0.592, p&amp;lt;0.001 respectively). The diagnostic accuracy between the three vFFR-measurements and iFR/RFR was 83%; 81% and 79% respectively. QFR-computations showed a similar correlation with iFR/RFR (AUC 0.899 with r=0.720, p&amp;lt;0.001; AUC 0.919 with r=0.649, p&amp;lt;0.001; AUC 0.930 with r=0.703, p&amp;lt;0.001 respectively) with a diagnostic accuracy 88%, 89% and 88% respectively. The intra- and inter-observer reliability for vFFR (intra: mean difference 0.002±0.0568; inter: 0.024±0.054) and QFR (intra: mean difference 0.018±0.071; inter: 0.016±0.075) analyzed in a Bland-Altman Blot showed a good correlation between virtual assessments and invasive measurements with iFR/RFR. Conclusion The data show a good diagnostic agreement between vFFR and QFR and adenosine free invasive assessments. vFFR and QFR appear reasonable alternative approaches for the evaluation of intermediate stenoses. These data provide the rational to prospectively test for a clinical noninferiority of the non-invasive flow measurements.Diagnostic performance of vFFR/cQFR

The effect of the age at the time of targeting a lead implantation on the difficulty with the transvenous lead extraction technique

Abstract Background In transvenous lead removal procedures, the number of years since the lead implantation is an indicator of procedural difficulty and complications. However, even with the same number of years since the lead implantation, we considered the possibility that a younger age at the time of the implantation (AoI) would increase the difficulty of the procedure. Objective To elucidate the procedural difficulty in the transvenous lead extraction procedure according to the age at the time of targeting the lead implantation. Method A total of 471 consecutive transvenous lead extraction cases were analyzed. The patient AoI of the oldest lead in extraction procedure cases was divided into two groups: those younger than 60 years (implant age &amp;lt;60 yrs old: AoI&amp;lt;60) and those older than 60 years (implant age ≧60 yrs old: AoI≧60). The analysis was conducted by the number of years since the lead implantation (&amp;lt;10 years: group A, 10 to 20 years: group B, and &amp;gt;20 years: group C). Results The number of AoI&amp;lt;60 and AoI≧60 patients were 60 and 254 (Group A), 51 and 56 (Group B), and 41 and 9 (Group C). The patient age significantly differed among the groups between an AoI&amp;lt;60 and AoI≧60 (group A: 51.7 vs. 77.1; P&amp;lt;0.001, group B: 61.6 vs. 83.1; P&amp;lt;0.001, group C: 71.2 vs. 88; P&amp;lt;0.001). But the oldest dwell time (years) was similar for all groups (group A: 4.6 vs. 4.2; P=0.324, group B: 14.2 vs. 13.5; P=0.148, and group C: 25.7 vs. 22.6; P=0.097). The complete removal rate (group A: 97.7% vs. 98.4%; P=0.722, group B: 90.4% vs. 93.3%; P=0.567, and group C: 78.05 vs. 90.95; P=0.337) and major complication-free rate (group A: 98.8% vs. 100%; P=0.391, group B: 96.2% vs. 100%; P=0.125, and group C: 90.2% vs. 100%; P=0.281) were not statistically significant in all groups but were higher for an AoI≧60. An AoI&amp;lt;60 resulted in a longer procedure time (group A: 78.4 min. vs. 65.3 min.; P=0.006, group B: 96.0 min. vs. 72.3 min.; P=0.002, and group C: 100.9 min. vs. 94.8 min.; P=0.709), longer fluoroscopy time (group A: 12.0 min. vs. 10.2 min.; P=0.247, group B: 19.2 min. vs. 11.6 min.; P=0.017, and group C: 22.2 min. vs. 16.0 min.; P=0.008), and higher number of laser pulses (group A: 779.6 vs. 433.7; P=0.002, group B: 2089.6 vs. 1032.9; P=0.017, and group C: 1509.3 vs. 831.5; P=0.201) in all groups. Conclusion This study suggested that the difficulty of transvenous lead extraction procedures may increase with a younger AoI, even if the lead dwelling time is the same.

Clinical Impact of Reperfusion Techniques and Occlusion Sites in Thrombectomy: Insights from the ASSIST Stroke Registry

Background Mechanical thrombectomy has changed the landscape of acute ischemic stroke treatment, offering improved outcomes for patients with large vessel occlusions. The interplay between reperfusion techniques and occlusion sites remains a critical consideration in treatment decisions. This study investigates the impact of primary reperfusion techniques—stent retriever classic, stent retriever combination with aspiration, and direct aspiration—on procedural and clinical outcomes at different occlusion sites. Methods Using data from the ASSIST registry, a prospective multinational initiative, patients with anterior circulation acute ischemic stroke with large vessel occlusions (n = 1477) were included. Three primary occlusion sites—M1 segment of the middle cerebral artery, M2 segment of the middle cerebral artery, and the internal carotid artery—were studied. Univariate tests and multivariable logistic regression models were used to assess associations between reperfusion techniques and procedural and clinical outcomes, including the expanded thrombolysis in cerebral infarction score and the modified Rankin Scale, stratified by occlusion site. Results Achieving expanded thrombolysis in cerebral infarction ≥2c after first pass was lower in internal carotid artery occlusions (18.2%, P &lt;0.0001) with direct aspiration alone compared with stent retriever classic (38.2%) or stent retriever combination with aspiration (43.3%), while no differences were seen for M1 segment of the middle cerebral artery ( P = 0.77) and M2 segment of the middle cerebral artery ( P = 0.29) occlusions. Bailout maneuvers, which were more frequent in the direct aspiration group for all occlusion sites, did not result in longer procedure times or different final recanalization outcomes in direct aspiration compared with stent retriever classic or stent retriever combination with aspiration. Overall, there were no differences in the rate of patients with modified Rankin Scale scores of 0–2 at 90 days. No differences in safety outcomes were observed. Conclusions This study provides insight into the complex relationship between reperfusion techniques and occlusion sites in patients with acute ischemic stroke and shows that certain techniques have advantages in certain occlusion sites. As the field evolves, further research is warranted to refine our understanding of these dynamics and inform clinical practice.

Combined left atrial appendage occlusion and catheter ablation procedure for left atrial arrhythmias: A real-world, propensity-matched analysis.

Real-world studies comparing safety and efficacy of combined percutaneous left atrial appendage occlusion (LAAO) and catheter ablation (CA) to LAAO alone are limited. Patients from a large US hospital system undergoing combined LAAO and left-atrial CA from 8/2020 to 2/2024 were retrospectively analyzed and compared to a control group undergoing LAAO alone. Controls were identified using a 1:2 propensity score match based on LAAO device type (Watchman FLX vs. Amulet), CHA2D2-VASc and Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio [INR], Elderly, Drugs/alcohol (HAS-BLED) scores and compared for safety, sealing performance and clinical outcomes at 6 months. Patients were younger in the combined (n = 72) than in the control group (n = 144, 70.2 ± 7.3 vs. 76.7 ± 6.9 years, p < 0.001) but otherwise comparable with a mean CHA2D2-VASc score of 4.2 ± 1.1 and 4.4 ± 1.2 (p = 0.26) and HAS-BLED score of 2.2 ± 0.8 and 2.3 ± 0.7 (p = 0.34). Successful LAAO implantation rates were the same (95.8% vs. 95.8%, p = 0.99) with longer procedure times seen in the combined group (156.5 ± 53 vs. 56 ± 26 min, p < 0.001). Both major (1.4% vs. 2.1%, p = 0.72) and minor (27.8% vs. 19.4%, p = 0.17) in-hospital complications were similar between the combined and control group, respectively. At 45 days, presence of peri-device leak (18.3% vs. 30.4%, p = 0.07) and device related thrombosis (4.5% vs. 4.5%, p = 0.96) on transesophageal echocardiogram did not differ. Finally, all-cause mortality (0% vs. 1.4%, p = 0.99), thromboembolic (0% vs. 0%, p = 0.99) and bleeding (6.1% vs. 4.4%, p = 0.73) events during follow-up were comparable. This large, real-world analysis indicates comparable safety and efficiency of combined LAAO and CA when compared with LAAO alone.

Helicobacter pylori infection increases risk of bleeding during endoscopic submucosal dissection for early gastric cancer.

Endoscopic submucosal dissection (ESD) is commonly used to treat early gastric cancer (EGC). The effects of Helicobacter pylori (HP) infection on ESD and the potential benefits of preoperative eradication of HP remain unclear. The study aims to evaluate the impact of HP infection on bleeding and lesion detection during ESD in patients with EGC. We retrospectively analyzed 634 consecutive patients who underwent ESD for EGC at our center between January 2018 and January 2023. Logistic regression was used to assess the impact of HP infection status on intraoperative bleeding and lesion detection rates. We developed a predictive model based on selected indicators and evaluated its performance using the ROC curve. HP-positive patients experienced a higher rate of intraoperative bleeding (28.8%) compared with HP-negative patients (8.9%) (P < 0.001). HP-positive patients also had longer procedure time (median: 58.5 vs. 50.0min, P < 0.001) and postoperative hospital stays (median: 4.35 vs. 4.07days, P = 0.036). Multivariate analysis identified HP-positive (OR = 4.84), multiple lesions (OR = 1.81), specimen size > 40mm (OR = 3.67), and submucosal invasion (OR = 2.27) as independent risk factors for intraoperative bleeding. The predictive model achieved an AUC of 0.807 (95%CI 0.761-0.852), with a sensitivity of 72.1% and specificity of 75.9%. Preoperative HP eradication was associated with an increased rate of lesion detection (OR = 2.82). Eradicating HP before ESD in patients with EGC reduces intraoperative bleeding and improves lesion detection. Preoperative HP eradication is therefore recommended in patients with EGC.

Endoscopic ultrasound-guided gastroenterostomy versus duodenal stenting for gastric outlet obstruction: A systematic review, meta-analysis, and meta-regression.

Gastric outlet obstruction (GOO) refers to mechanical obstruction at the level of the gastric outlet and is associated with significantly impacted quality of life and mortality. Duodenal stenting (DS) offers a minimally invasive approach to managing GOO but is associated with a high risk of stent obstruction. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel intervention that uses lumen-apposing metal stents to open the restricted lumen. The current evidence comparing EUS-GE to DS is limited and inconsistent. We conducted a systematic literature search on PubMed, Embase, Cochrane, Scopus, and clinicaltrials.gov to retrieve studies comparing EUS-GE to DS for GOO. Odds ratios (OR) and mean differences (MD) with their 95% confidence intervals (CI) were pooled using the DerSimonian-Laird inverse variance random-effects model. Statistical significance was set at P < .05. Ten studies with a total of 1275 GOO patients (585: EUS-GE and 690: DS) were included. EUS-GE was associated with statistically significant higher clinical success [OR: 2.52; 95% CI: 1.64, 3.86; P < .001], lower re-intervention rate [OR: 0.12; 95% CI: 0.06, 0.22; P < .00001], longer procedural time [MD: 20.91; 95% CI: 15.48, 26.35; P < .00001], and lower risk of adverse events [OR: 0.49; 95% CI: 0.29, 0.82; P = .007] than DS. Technical success [OR: 0.62; 95% CI: 0.31, 1.25] and the length of hospital stay [MD: -2.12; 95% CI: -5.23, 0.98] were comparable between the 2 groups. EUS-GE is associated with higher clinical success, longer total procedural time, lower re-intervention rate, and lower risk of adverse events than DS. Technical success and the length of hospital stay were comparable between the 2 groups. EUS-GE appears to be a safe and effective procedure for managing GOO. Further large, multicentric randomized controlled trials are warranted to investigate the safety and outcomes of EUS-GE in patients with malignant GOO.

Intraoperative marking of pulmonary nodules in a hybrid operating room: electromagnetic navigation bronchoscopy versus percutaneous marking.

Intraoperative identification of subsolid or small pulmonary nodules during minimally invasive procedures is challenging. Recent localization techniques show varying success and complications. Hybrid operating rooms (HORs), equipped with radiological tools, facilitate intraoperative imaging. This study compares the accuracy and safety of marking pulmonary nodules using electromagnetic navigation bronchoscopy (ENB) combined with Cone Beam Computed Tomography (CBCT) vs. CBCT-guided percutaneous marking (PM). This retrospective cohort study included patients with pulmonary nodules scheduled for minimally invasive resection in a HOR. Marking techniques included ENB assisted by CBCT and PM guided by CBCT. The study compared the success rate, procedure time, intraoperative complications and radiation dose of both techniques. A total of 104 patients with 114 nodules were included (October 2021-July 2024). Thirty nodules were marked using ENB, and 84 with PM. One case used both techniques due to ENB failure. No differences among groups were found in nodule characteristics. Success rates were similar (93.3% in ENB group vs. 91.7% in PM group, p = 1). Marking took significantly longer time in the ENB group (median 40 min) compared to PM group (25 min, p = 0.007). Five (6%) patients in the PM group experienced intraoperative complications compared to none in the ENB (p = 0.323). Radiation dose was significantly higher in the ENB group (p = 0.002). ENB assisted by CBCT is a safe and effective technique, with success rates comparable to CBCT-guided PM, though it may result in longer procedural times and higher radiation doses.

Intracranial atherosclerotic disease mechanism indicates poor outcomes of thrombectomy in acute cerebral infarction with large vessel occlusion: A matched cohort study

BackgroundThrombectomy is a standard treatment for acute large vessel occlusion (LVO); however, its effectiveness in treating LVO related to intracranial atherosclerosis disease (ICAD) remains uncertain. This study aimed to compare thrombectomy outcomes in ICAD-related and embolic LVO, focusing on patients with similar symptom severities upon hospital admission. MethodsThis retrospective study was conducted at Jikei University Hospital and Jikei University Kashiwa Hospital between October 2017 and March 2023. Ischemic stroke patients with LVO who underwent thrombectomy were categorized into ICAD and embolism groups based on the occlusion mechanism. Groups were matched using National Institutes of Health Stroke Scale scores at the time of admission. A modified Rankin Scale score of 5 or 6 at 90 days after symptom onset was defined as a devastating outcome. The procedural outcomes and frequency of devastating outcomes were compared between the ICAD and embolism groups. ResultsThe study included 33 matched pairs were included. The ICAD group showed lower rates of successful reperfusion (43 % vs. 82 %, p = 0.001), and longer procedural times (median 88 min vs. 50 min, p < 0.001) than the embolism group. The ICAD group had a significantly higher frequency of devastating outcomes than the non-ICAD group (39 % vs. 15 %, p = 0.027). Multivariate analysis identified ICAD as an independent factor associated with devastating outcomes (OR, 3.804; 95 % confidence interval (95 %CI), 1.148–12.603; p = 0.029). ConclusionIn thrombectomy therapy, reperfusion rates and outcomes are significantly worse in patients with ICAD-LVO than in patients with embolic LVO.

Evaluation of silent brain injury in patients undergoing aorto-ostial coronary stent implantation

Background Aorto-ostial (AO) coronary interventions may be associated with multiple problems, including the potential embolization of atherothrombotic debris into the aorta and systemic circulation. Such embolization could theoretically lead to stroke or silent brain injury (SBI). In this study, we aimed to investigate whether there is an increased risk of SBI in patients undergoing AO stent implantation. Methods Fifty-five consecutive patients undergoing AO stenting and 55 consecutive patients undergoing non-AO stenting were included. Venous blood samples were obtained before and 12 h after the procedure to measure neuron-specific enolase (NSE), which is a sensitive marker of brain injury. Newly developed NSE elevation after the procedure in an asymptomatic patient was defined as SBI. Results SBI was detected in 24 (43.6%) patients in the AO stenting group and 17 (30.9%) patients in the non-AO stenting group (p = .167). Although the SBI rates were statistically comparable between the groups, the presence of significant (≥50%) AO stenosis was found to be an independent predictor of SBI in multivariate logistic regression analysis [odds ratio (OR) 2.856; 95% confidence interval (CI) 1.057-7.716; p = .038]. A longer procedure time was another independent predictor for the development of SBI (OR 1.037; 95% CI 1.005-1.069; p = .023). Conclusion This study suggests that AO stenting may be associated with an increased risk of SBI if the lesion in the ostium is significant.

Long-term comparison of rotational and directional atherectomy outcomes in patients with femoropopliteal lesions.

Objective: This study aims to elucidate the differences in vessel patency rates, procedural complications, and the need for repeat interventions between these two techniques, thereby providing insights into the optimal atherectomy strategy for managing peripheral arterial disease in the femoropopliteal segment. Material and Methods: This retrospective study investigated the long-term effectiveness of two atherectomy techniques, rotational atherectomy (RA) and directional atherectomy (DA), in treating lower extremity peripheral artery disease (LE-PAD) affecting the superficial femoral artery (SFA) and popliteal arteries. A total of 134 patients with symptomatic LE-PAD and significant stenosis (70%-99%) were included and divided into two groups based on the atherectomy method used. Both groups underwent similar pre- and post-atherectomy procedures, including drug-coated balloon angioplasty. The primary outcome measure was clinical success, defined as procedural success and an improvement in Rutherford classification at 1year. Results: Baseline characteristics were similar between the two groups, with no significant differences in demographics or lesion characteristics, except for a higher proportion of right-sided lesions in the DA group. While both RA and DA effectively improved ankle-brachial index (ABI) and Rutherford classification at 12 months, RA demonstrated superior long-term benefits, with significantly higher ABI at 24 months and a greater proportion of asymptomatic patients. Although RA had a longer procedural duration and a higher incidence of dissection, it resulted in lower residual stenosis and fewer cases of treated segment thrombosis than DA. Both RA and DA are effective treatment options for femoropopliteal lesions, but RA may offer advantages in long-term symptom management and vessel patency. Conclusion: Both rotational and directional atherectomy effectively treat femoropopliteal lesions, with rotational atherectomy demonstrating superior long-term outcomes in terms of symptom management and vessel patency. Despite longer procedural times and a slightly higher risk of dissection, rotational atherectomy resulted in lower residual stenosis and fewer cases of treated segment thrombosis than directional atherectomy.

The influence of the interventionalist's sex on the outcome and complications of transbronchial lung cryobiopsy

BackgroundTo date there are no data on sex aspects evaluating outcomes of interventional pneumology (IP). Our aim was to investigate sex differences in transbronchial lung cryobiopsy (TBLC) outcomes in the diagnosis of interstitial lung disease (ILD). MethodsAll consecutive (TBLC)s performed for ILD evaluation between Nov 17 and Dec 21 at a tertiary referral center for ILDs and IP were analyzed. The indication for the procedure was determined by a multidisciplinary discussion (MDD). Final results including bronchoalveolar lavage (BAL) and histology were discussed in a 2nd MDD and outcomes and procedure related complications were assessed. ResultsTBLC was performed in 406 patients (38.4 % female/67.8 years/FVC 76.8 %). Among 32 interventionalists, 16 females performed 53 % of interventions. Females had longer procedure times (29.9 vs. 26.6 min, p = 0.046), used fluoroscopy more often (76.7 vs. 50.3 %, p < 0.001) and obtained more samples (3.6 vs. 3.2, p = 0.021) than their male counterparts. No difference was found for major bleeding or pneumothorax. MDD was able to conclude on a diagnosis in 88.4 % of interventions performed by women and in 78.5 % performed by men (p = 0.010). In a multivariate analysis, female gender (OR 1.93) and lower FVC% values (OR 0.98) were significantly associated with diagnostic yield, whereas the number of biopsies, professional experience, use of fluoroscopy or antiplatelet drugs were not relevant. ConclusionThe results of this study strengthen the role of women in endoscopy and may help to motivate women to pursue a career in IP.