Outcomes and Predictors of In-hospital Mortality in Nonagenarians with NSTEMI: A Comparison of PCI and Medical Management.

Clinical Outcomes With Mavacamten Use in Patients With Obstructive Hypertrophic Cardiomyopathy Using Real-World Data.

To evaluate the efficacy of thoracic endovascular aortic repair (TEVAR) and the endovascular intervention window in the treatment of patients with Type B aortic intramural hematoma (TBIMH). This retrospective multicenter cohort study recruited 502 patients with TBIMH from four medical centers in China between 2017 and 2024. The patients were categorized into two groups: the medical management (MM) group ( n =167) and the TEVAR group ( n =335). Propensity score matching (PSM) generated 155 matched pairs. Subgroup analysis was conducted within the TEVAR group to compare the survival outcomes associated with three timing windows for TEVAR. The Kaplan-Meier method and log-rank test were employed for survival analysis. Before PSM, the TEVAR group exhibited higher incidences of comorbidities [e.g., pleural effusion, penetrating atherosclerotic ulcer (PAU), and ulcer-like projection (ULP)] and greater anatomical severity (hematoma thickness and extent) than the MM group. After matching, the two groups were well-balanced in all demographic and clinical variables. The adjusted analysis revealed that TEVAR was associated with lower all-cause mortality (9.68% vs 18.71%, P =0.034) and improved survival (Log-rank, P =0.036) compared to MM. A subgroup analysis further indicated that the timing of intervention matters; the hyperacute-phase TEVAR (≤48hours) was associated with the highest mortality rate (18.18%), whereas survival rates were similar for procedures performed during the acute (3-14days) and subacute (>14days) phases. Our study demonstrated that TEVAR was associated with improved survival outcomes compared to MM, including in patients with severe anatomical features. An exploratory analysis suggests that avoiding TEVAR within the hyperacute phase (≤48hours) might improve outcomes in specific high-risk groups. These findings require confirmation through prospective randomized controlled trials before they can inform definitive clinical practice.

OBJECTIVES:Perihematomal edema (PHE) impacts recovery after spontaneous intracerebral hemorrhage (sICH). How minimally invasive surgery (MIS) affects PHE compared with medical management and conventional surgical management (craniotomy or decompressive craniectomy), and whether this relates to functional outcomes remains poorly understood.DESIGN:In this single-center observational study including 40 patients (MIS n = 16, medical management n = 13, conventional surgical evacuation, n = 11), we assessed PHE volumes and functional outcomes after MIS for sICH and compared them with medical management and conventional surgical management. We collected data retrospectively, calculating hematoma and perihematomal volumes using the validated ABC/2 method (A = maximal diameter, B = orthogonal diameter, C = slice count × thickness). We used linear mixed modeling in IBM SPSS (statistical software package) to detect differences in peak PHE, interaction between PHE and days, and differences in functional outcomes across the three treatment groups. ICH score was a covariate in all modeling. The outcomes were peak PHE volume, PHE trajectory comparison across treatment groups, and 90-day functional outcome. Research was institutional review board approved and conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) and with the Helsinki Declaration of 1975.SETTING:Study was conducted in a single tertiary care center with 24-hour neurocritical care and neurosurgical services.INTERVENTIONS:Patients were grouped based on which intervention they underwent. As study was conducted retrospectively, intervention (medical management, surgical evacuation, MIS) were determined based on clinical appropriateness.MEASUREMENTS AND MAIN RESULTS:We collected data retrospectively, calculating hematoma and perihematomal volumes using the validated ABC/2 method. PHE trajectory was compared with 90-day functional outcome and time across all groups. MIS was associated with significantly lower peak PHE burden, compared with medical and conventional surgical treatment groups, after accounting for ICH score (F [2, 118] = 7.26; p = 0.001). PHE evolved over time, across all treatment groups (F [9, 118] = 2.26; p = 0.023). MIS tended to peak earlier, but the shape of the PHE trajectory over time did not differ significantly between groups (F [16, 118] = 1.18; p = 0.295). MIS was associated with better functional outcomes (90-d modified Rankin Scale [mRS]) based on treatment type (p < 0.001) with the MIS group having the lowest average mRS 2.3 ± 1.49, medical management group having an average of 3 ± 2, and the standard evacuation group having average of 4.3 ± 1.4, after accounting for ICH score. Higher baseline ICH score also independently associated with worse outcome (F [1, 143] = 4.37; p = 0.038). While the sample size was small and results are exploratory, together the findings suggest that treatment modality for sICH influences both long-term functional outcomes and PHE burden, independent of baseline ICH severity. These findings suggest the temporal profile of edema resolution, rather than merely its volume, may be a key mechanism underlying MIS benefits in sICH management.CONCLUSIONS:In this observational exploratory study, MIS, compared with both medical therapy and conventional surgery, was associated with reduced peak of PHE and better 90-day functional outcome, independent of baseline sICH severity. The difference in temporal trajectory of edema, while may be clinically meaningful, was not statistically significant between treatment strategies. Larger prospective studies with standardized imaging protocols are needed to validate these observations and explore their implications for optimizing post-ICH care.

Background: Non-culprit coronary lesion management of patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease remains a controversial topic in interventional cardiology. Earlier practice concentrated on the culprit vessel only but emerging evidence indicates that the timing of intervention of non-culprit lesions of immediate, early-staged or delayed demonstrations of intervention determine a decisive position on patient prognosis. Purpose: To compare clinical outcomes of immediate, early-staged, and delayed non-culprit percutaneous coronary intervention (PCI) in STEMI patients with multivessel disease, as per the existing guidelines. Methods: The study is a prospective observational study that was undertaken at the Fellow Interventional Cardiology, Armed Forces Institute of Cardiology (AFIC), Rawalpindi in the duration from 22nd July, 2025 to 22nd October, 2025. One hundred and twenty-five patients with multivessel disease who had angiographically confirmed disease were included in the study of STEMI. After culprit PCI patients were allocated to four groups. Group A: Immediate non-culprit PCI (same sitting). Group B: PCI at an early stage (3-4 days later) in the same admission. Group C: PCI delayed (more than 2 weeks). Group D: Non-significant lesions (&lt;70%): Medical management. The main outcomes were recurrent ischemia, heart failure, arrhythmias, complications during the procedure, and in-hospital mortality. Findings: PCI at the earliest possible stages (Group B) was the most successful in clinical results, as the rate of repeat ischemia was 6.9 and the rate of complications related to the procedure was the lowest (3%). The immediate PCI (Group A) also had a little more risks (13.6% ischemia) and delayed PCI (Group C) obtained stable yet slower recovery. Medical management (Group D) had higher recurrence (18%), whilst no in-hospital death was reported in all the groups. Conclusion: Early-staged non-culprit PCI during the identical hospital stay is the most desirable balance between safety and effectiveness of STEMI patients who are hemodynamically stable. It is recommended to medically treat non-significant lesions in accordance with the existing guidelines.

Abstract Background Patients with a history of coronary artery bypass grafting (CABG) who present with acute coronary syndrome (ACS) have poor outcomes, and the optimal treatment strategy for this population remains unclear. The benefits of routine invasive management in patients with prior CABG presenting with non-ST-elevation myocardial infarction (NSTEMI) are uncertain, as these patients were often excluded from pivotal trials. Purpose We aimed to describe the clinical characteristics and outcomes of patients with NSTEMI and prior CABG, comparing medical vs. invasive treatment strategies. Additionally, the invasive treatment group was categorized into native vs. graft vessels. Methods This was a retrospective, observational, and analytical study. Among 4.400 NSTEMI patients admitted between 2010 and 2023, 191 (4.3%) with previous CABG were selected. The outcomes analyzed included all-cause mortality, recurrent myocardial infarction, and cardiovascular hospitalization at 1-year. Results Of the 191 patients, 94 (49.2%) received medical treatment, and 97 (50.8%) underwent percutaneous coronary intervention (PCI). There were no significant differences in demographic or clinical characteristics between the groups. The mean age was 72.6±9 years, 82.7% were male and 17.3% were female. In the medical management group (MMG), 90.4% underwent angiography without PCI, while 9.6% had no invasive assessment. In revascularized patients, 64.9% underwent PCI on native vessels, and 35.1% on bypass grafts. During follow-up, the 1-year mortality was significantly higher in MMG (24.5%) compared to the PCI group (10.3%) (p=0.010). When comparing PCI in native vessels vs. grafts, no significant outcome differences were found. After adjusting for potential confounders, PCI was associated with a 62.5% reduction in death risk at 1-year compared to MMG (aHR= 0.375, p=0.014). The results persisted after propensity score matching, with higher 1-year mortality rates in the MMG (23.5%) vs. PCI (9.4%) (p=0.019). Hazard ratio was 0.38 (p=0.022), confirming the protective effect associated with the PCI group. Conclusion This retrospective study suggests that patients undergoing PCI achieve better outcomes, including lower mortality, compared to medical treatment. However, selection bias remains a confounding issue, and some contributing factors may not be accounted for in adjusted models. Further research is required to optimize treatment strategies for this population.Medical versus Invasive management

Evidence on the most effective treatment for stroke due to distal and medium vessel occlusions (DMVOs) remains unclear, as existing meta-analyses compare heterogeneous groups. We conducted a network meta-analysis to directly and indirectly compare different treatments for DMVOs: We performed a comprehensive search of databases through April 2025 to identify studies comparing endovascular treatment (EVT) with other therapies in DMVOs. We included 31 studies with EVT, intravenous thrombolysis (IVT), medical management (MM), and conservative management (CM) groups, including 7500 patients. Outcomes assessed included 90-day favorable modified Rankin Scale (mRS0–2), symptomatic intracranial hemorrhage (sICH), and 90-day mortality.: Compared to CM, EVT was associated with a higher rate of mRS 0–2 (RR:2.79, CI:95% 1.28–6.11, p = 0.01), while MM and IVT showed no significant differences. For mRS 3–6, CM (RR:3.05, CI:95% 1.43–6.55, p = 0.004) and thrombolysisIVT (RR:1.34, CI:95% 1.01–1.77, p = 0.04) carried greater risk than EVT. MM (RR: 0.59, CI:95% 0.35–1.00, p = 0.0498), IVT (RR:0.57, CI:95% 0.29–1.10, p = 0.10), and CM (RR:0.14, CI:95% 0.005–4.16, p = 0.26) showed non-significant lower sICH risk compared to EVT. No significant differences were found in 90-day mortality.: EVT consistently showed a favorable profile for mRS 0–2 at 90 days, with a non-significant increase in sICH and in 90-day mortality. These findings support EVT to improve functional recovery in DMVOs.

Background Randomized trials have shown that endovascular thrombectomy (EVT) benefits patients with large vessel occlusion; however, its role in medium vessel occlusion remains unclear. Purpose To compare the efficacy and safety of EVT versus standard medical management in medium vessel occlusion stroke. Materials and Methods This multicenter, retrospective study enrolled patients with acute ischemic stroke from an occlusion of M3 or M4 segments of the middle cerebral artery, anterior cerebral artery, or posterior cerebral artery from 25 stroke centers (September 2019 to September 2024). The primary end point was an ordinal shift in 90-day modified Rankin Scale (mRS) scores. Safety outcomes included 90-day mortality and symptomatic intracranial hemorrhage at 24 hours. Results A total of 1075 patients were included in the study (median age, 69 years; IQR, 59-76 years; 637 men; 529 treated with EVT and 546 treated with standard medical management; median baseline National Institutes of Health Stroke Scale [NIHSS], 10 [IQR, 6-12]). In the primary analysis using inverse probability of treatment weighting, there was an improvement in 90-day mRS distribution (adjusted common odds ratio, 1.38; 95% CI: 1.18, 1.61; P < .001) favoring EVT. Rates of mRS scores of 0-1 (43.7% [231 of 529 patients] vs 36.1% [197 of 546 patients]; adjusted risk ratio [RR], 1.61; 95% CI: 1.33, 1.96; P < .001) and mRS scores of 0-2 (60.9% [322 of 529 patients] vs 53.5% [292 of 546 patients]; adjusted RR, 1.39; 95% CI: 1.14, 1.69; P = .001) were higher with EVT. Between EVT and standard medical management groups, there was no difference in 90-day mortality (8.32% [44 of 529 patients] vs 8.97% [49 of 546 patients]; adjusted RR, 0.74; 95% CI: 0.51, 1.12; P = .17) or symptomatic intracranial hemorrhage (11.5% [61 of 529 patients] vs 10.4% [57 of 546 patients]; adjusted RR, 1.24; 95% CI: 0.92, 1.66; P = .16). Subgroup analyses indicated EVT benefit in patients with an NIHSS score of 6 or higher (adjusted RR, 1.62; 95% CI: 1.37, 1.92), but not in those with an NIHSS score of 1-5 (adjusted RR, 0.79; 95% CI: 0.58, 1.19; P value for interaction < .001). Conclusion Compared with standard medical management, EVT was associated with better outcomes in patients with acute medium vessel occlusion stroke, particularly those with more severe symptoms, without increasing symptomatic intracranial hemorrhage or 90-day mortality. Chinese Clinical Trial Registry no. ChiCTR2500096954 © The Author(s) 2025. Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article.

Introduction The impact of treatment modality on cognitive function is not well established. In this post‐hoc analysis of the SAMMPRIS trial, we compare cognitive outcomes in patients with symptomatic ICAD managed with percutaneous transluminal angiographic stenting to those treated with aggressive medical management. Methods Using the SAMMPRIS trial sample of 451 patients, we included patients who underwent successful symptomatic intracranial atherosclerotic stenosis (i.e. no periprocedural complications or stenting challenges) along with those those treated with aggressive medical management. Cognitive outcomes between the stenting and aggressive medical management arms were then assessed using the Montreal Cognitive Assessment (MoCA) at 30 days, 4 months, 12 months, and final follow‐up. Multivariate linear and logistic regression models were used to adjust for baseline MoCA score, age, sex, and vascular risk factors. Results Following exclusion for non‐successful stenting, we analyzed 270 patients (stenting: 122, aggressive medical management: 152). The stenting group exhibited significantly reduced odds of achieving MoCA ≥ 26 compared to the medical management group (OR 0.54, 95% CI 0.29 to 1.00, p=0.050), representing a 54% higher likelihood of reaching sub‐normal cognitive outcome. Despite higher baseline cognitive function in the stenting group (median MoCA 26 vs 25, p=0.019), no significant difference was observed in continuous MoCA scores between patients receiving stenting and medical management (OR ‐0.63, 95% CI ‐1.60 to 0.34, p=0.205). Conclusion Stenting was associated with decreased long‐term cognitive outcomes relative to symptomatic ICAD treated with aggressive medical therapy. By raising concern about potential cognitive harm from interventional management, these findings highlight the importance of including cognitive outcomes as a factor in treatment selection.

Background & objectives Quality of life (QoL) is a highly underrated yet an extremely crucial measure of the functional outcomes of any therapy. Reduction of intraocular pressure solely cannot determine the success of antiglaucoma therapy. This study was conducted to compare the QoL in patients with moderate to severe glaucoma on medical and surgical therapy, using glaucoma quality of life -15 (GQL-15) questionnaire. Methods A prospective observational study was conducted on 54 eyes of 46 individuals from October 2022 to December 2023. Normative values of the GQL-15 scores were obtained from a control group comprising 30 eyes of 15 age and sex-matched healthy individuals (non-glaucoma). The questionnaire was filled pre-operatively when participants were on medical management and at six months follow up after trabeculectomy i.e., on surgical management. GQL-15 scores were then compared among three groups in the study: controls, medical management and surgical management. Results The study showed poorer quality of life in individuals with glaucoma than in the control group. The GQL-15 scores significantly improved after trabeculectomy (32.1±10.3) compared to the medical management group (36.3±11), (P<0.001). A significant difference was observed for all questionnaire domains, including central and near vision, peripheral vision, dark adaptation and glare, and outdoor mobility (P<0.001) for all. Scores varied by glaucoma severity, with severe cases showing the poorest QoL. Interpretations & conclusions Surgical therapy may improve QoL in patients with moderate to severe glaucoma, suggesting a potential role for trabeculectomy over medical management.

To implement and evaluate a needs-based faculty development programme in a female-only medical college. The mixed methods study was conducted in 2022-23 at the Women Medical and Dental College, Abbottabad, Pakistan. The faculty needs assessment was conducted in February 2022 using an online questionnaire, followed by identification of institutional needs through consultation in various organisational forums. Faculty development activities were planned and implemented in 2022-23 based on the needs assessment. At the end of each faculty development activity, the participants were asked to fill a feedback questionnaire. At the conclusion of the programme, 10 individual semistructured face-to-face interviews were conducted, and the data was thematically analysed to evaluate the programme. Areas including development of multiple choice questions, use of teaching aids, medical education research, curriculum development, leadership in medical education, time management, and small group interactive teaching were identified during the needs assessment phase. The total average feedback score for all activities combined was 4.2 out of 5 (SD=0.17), with positive feedback in open-ended questions. Five core themes emerged from the interview data: teaching skills development, applicable content, needs-based programme, networking opportunities, and learner-centred activities. Faculty development programmes should be needs-based, and should focus on context-specific content, learner-centred activities and networking opportunities. Continuous evaluation of the programme is an important element.

493 Background: The acquisition of general medical oncology practices presents integration challenges that may hinder quality and access to specialized comprehensive cancer care. General medical oncologists—who comprise approximately 34% of the national oncology workforce—often manage a wide range of tumor types in community-based settings. This initiative aimed to promote clinical integration, multidisciplinary collaboration, and consistent care quality across oncology practices acquired by an integrated health system through the creation of a generalist disease management group (DMG) and associated tumor board. Methods: Twenty-seven generalist medical oncology faculty were invited via institutional email to participate in the new DMG. A generalist division director was appointed to oversee the initiative and facilitate a weekly multidisciplinary tumor board. Each session included participation from medical oncology disease-specific experts, radiation oncologists, surgical oncologists, radiologists, clinical trials specialists, and molecular oncologists. Over an 18-week period, 145 patient cases were reviewed. Subsequently, an anonymous survey was distributed to DMG members to evaluate self-reported improvements in care quality, practice integration into the health system, and patient access to clinical trials. Results: The survey achieved an 81% response rate (n=22). Of respondents, 91% agreed that the DMG improved the quality of care they deliver. 82% agree that the DMG has provided insights that changed their treatment plan. 55% agree that the DMG made it more likely for them to retain patients for cancer treatment. In terms of integration, 95% agreed that the tumor board provided insights into unknown cancer-related services and 86% agree that the DMG increased their likelihood to refer patients for cancer-related services within the health system. Lastly, in terms of clinical trial access, 95% agreed that the DMG increased their awareness of available clinical trials and 86% agreed that the tumor board increased their likelihood of referring a patient for trial evaluation. Conclusions: Implementation of a generalist DMG and multidisciplinary tumor board was feasible, enhanced network integration, and improved both provider collaboration and patient access to institutional oncology resources. This model offers a scalable framework for engaging general medical oncologists in system-level care standardization. Future expansion to include additional specialties, such as pathology, and further integration with community oncology practices may amplify its impact.

Most randomized controlled trials (RCTs) of bariatric surgery have a small size, a limited type of surgical procedure, and follow-up duration. Our aim was to compare bariatric surgery with medical management in patients with type 2 diabetes mellitus (T2DM) based on a meta-analysis of RCTs. PubMed/Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies published before February 28, 2025. We included RCTs comparing bariatric surgery with medical management in T2DM patients with follow-up ≥1 year. The outcomes of interest were diabetes remission, diabetic microvascular complications, and diabetic macrovascular complications. The criterion of diabetes remission was prespecified in clinical trials' protocols or defined as HbA1c <6.5% measured at least 3 months after cessation of glucose-lowering pharmacotherapy. At 1 year follow-up, 53.1% of patients in the bariatric surgery group achieved diabetes remission, compared to only 5.4% in the medical management group (risk ratio [RR] = 8.26; 95% confidence intervals [CI], 4.69-14.56; p < 0.001). The superiority of bariatric surgery in diabetes remission remained significant at 2 years (RR = 7.42), 3 years (RR = 16.97), and even ≥5 years (RR = 4.26). Bariatric surgery was associated with a significantly reduced risk of diabetic microvascular events compared to medical management (RR = 0.42, 95% CI 0.18-0.97, p = 0.04), while its association with macrovascular events was not statistically significant (RR = 1.09; 95% CI, 0.70-1.70; p = 0.71). Considering the specific microvascular events, bariatric surgery was significantly associated with the reduced incidence of albuminuria (RR = 0.37, 95% CI 0.16-0.81, p = 0.01), but not with diabetic retinopathy. Bariatric surgery seems to be superior to medical management for diabetes remission and improving diabetic microvascular complications in patients with T2DM. However, bariatric surgery and medical management show similar effects on diabetic macrovascular complications.

Readmission following early thoracic endovascular aortic repair compared to optimal medical treatment for uncomplicated acute type B aortic dissection.

It remains uncertain whether surgical evacuation improves functional outcomes in patients with supratentorial intracerebral hemorrhage (ICH). To compare the safety and efficacy of minimally invasive surgery with the Artemis Neuro Evacuation Device to guideline-based medical management alone for spontaneous supratentorial ICH. The MIND open-label, multicenter randomized clinical trial randomized patients with spontaneous supratentorial ICH in a 2:1 ratio to either minimally invasive surgery or medical management alone. Participants were enrolled at 32 participating global sites between February 6, 2018, and August 28, 2023. This article reports on the primary trial outcome. Of 4066 eligible adult patients (aged 18-80 years) with moderate- to large-volume supratentorial ICH (20-80 mL), baseline National Institutes of Health Stroke Scale score of 6 or higher, and Glasgow Coma Scale score between 5 and 15, 154 were randomized to minimally invasive surgery and 82 to medical management. Data were analyzed from February to September 2024. Minimally invasive surgery (within 72 hours of symptom onset) plus medical management or medical management alone. The primary efficacy outcome was 180-day combined death and disability via ordinal modified Rankin Scale score (range, 0 [no symptoms] to 6 [death]). The primary safety outcome was 30-day mortality. Following an independent feasibility analysis prompted by the publication of positive results of a contemporaneous ICH trial, enrollment was stopped early at 236 participants. Overall median (IQR) participant age was 60 (50-70) years, 87 participants (36.9%) were female, 164 (69.5%) had primarily deep bleeds, and 72 (30.5%) had primarily lobar bleeds. Efficacy results of the primary model analysis suggested lack of evidence for the superiority of minimally invasive surgery over medical management (odds ratio [OR], 1.03; 96% CI, 0.62-1.72; P = .45). The adjusted model's mean OR was also nonsignificantly greater than 1 (OR, 1.10; 96% CI, 0.66-1.85; P = .35). By 30 days, 11 participants (7.2%) in the surgery group and 8 (9.8%) in the medical management group died (difference, -2.5%; 95% CI, -11.7% to 4.8%). In the MIND randomized clinical trial, minimally invasive surgery within 72 hours did not significantly reduce 30-day mortality or improve 180-day disability in patients with supratentorial ICH compared to medical management alone. ClinicalTrials.gov Identifier: NCT03342664.

National guidelines for elective colectomy for uncomplicated diverticulitis have changed to a patient-centered approach. Patient-reported outcome measures, such as the Diverticulitis Quality of Life Instrument, may be helpful to determine who will benefit from elective colectomy for diverticulitis. We performed a prospective observational cohort study to investigate whether greater Diverticulitis Quality of Life Instrument scores (indicating more severe disease burden) would be associated with increased likelihood of electing to undergo colectomy for recurrent diverticulitis. Adult patients ≥18 year old seen in consultation for uncomplicated diverticulitis at a tertiary referral medical center from March 2021 to August 2023 were included for analysis. The primary outcome of interest was the decision to proceed with elective colectomy vs. continued medical management. Of the 70 patients included, 48 (68.6%) elected for medical management and 22 (31.4%) had elective surgery planned or completed during the study period. The mean overall Diverticulitis Quality of Life Instrument scores were 4.6 (standard deviation, 1.8) for the medical management group and 5.3 (standard deviation, 1.2) for the elective colectomy group. An adjusted multivariable analysis showed an odds ratio of 1.39 (confidence interval, 1.03-1.89, P = .04) for electing surgical management with one-unit greater baseline Diverticulitis Quality of Life Instrument overall score and an odds ratio of 1.36 (confidence interval, 1.03-1.78, P = .03) for one-unit greater baseline Diverticulitis Quality of Life Instrument score in the subdomain of behavior. We observed significantly greater baseline overall Diverticulitis Quality of Life Instrument scores and scores in the subdomain of behavior in patients who chose to pursue elective colectomy after consultation for recurrent diverticulitis.

Congenitally corrected transposition of the great arteries is a rare congenital cardiac condition with varied presentations, complicating treatment decisions. This study evaluates the impact of medical management, physiologic repair, and anatomic repair on health-related quality of life. A cross-sectional follow-up was conducted on 50 congenitally corrected transposition of the great arteries patients from a cohort of 240 at Cleveland Clinic (1995-2020). Health-related quality of life was assessed using MacNew and PROMIS-10 questionnaires. Echocardiographic data on systemic atrioventricular valvular regurgitation and systemic ventricular dysfunction were analysed. A time-varying coefficient model evaluated these factors' impact on health-related quality of life. Anatomic repair had significantly higher PROMIS-10 Physical T-scores compared to physiologic repair (median 50.9 vs 41.6, p = 0.04). MacNew Social scores were significantly higher for medical management compared to physiologic repair (median 6.8 vs 6.0, p = 0.02). Echocardiographic analysis revealed that systemic ventricular dysfunction had a stronger immediate impact on health-related quality of life. Systemic atrioventricular valve regurgitation showed a delayed negative effect, significant at 6-10 years after echo, although this effect gradually decreased over time. Anatomic repair patients had better systemic ventricular function (84.6% normal), and less systemic atrioventricular valve regurgitation (69.2% had none) compared to medical management and physiologic repair groups. Anatomic repair improves health-related quality of life in congenitally corrected transposition of the great arteries patients, with physiologic repair showing some gains over time. Health-related quality of life data should provide important guidance regarding treatment decisions, especially in well-balanced congenitally corrected transposition of the great arteries patients.

Endovascular therapy (EVT) is standard treatment for large vessel occlusion in patients with a National Institutes of Health Stroke Scale (NIHSS) score ≥6, but its role in mild stroke (NIHSS score <6) remains uncertain. To explore the association between EVT and clinical outcomes in mild stroke. This study prospectively enrolled consecutive patients with a mild stroke at 35 comprehensive stroke centers in China between January 2020 and December 2023. Patients were categorized into primary EVT (pEVT) or best medical management (BMM) groups. The primary outcome was an excellent outcome (modified Rankin Scale (mRS) score ≤1). Secondary outcomes included a good outcome (mRS score ≤2) and lowering of the mRS score. Safety endpoints were mortality and symptomatic intracranial hemorrhage. Outcomes were compared between groups using multivariable logistic regression and inverse probability of treatment weighting (IPTW). Finally, 307 patients were included: 117 received pEVT, and 190 received BMM. In the IPTW model, pEVT was associated with higher excellent (aOR=3.6, 95% CI 2.5 to 5.2) and good (aOR=4.0, 95% CI 2.5 to 6.6) outcomes, lower mortality (aOR=0.1, 95% CI 0.01 to 0.4), and a lower 90-day mRS (aOR=0.2, 95% CI 0.1 to 0.3), with similar sICH rates. Among the BMM group, 80 patients (42.1%) experienced early neurological deterioration (END), with 55 receiving rescue EVT (rEVT), and were still included in BMM group. In the multivariable model, the rEVT was related with higher excellent (aOR=7.2, 95% CI 1.4 to 37.9) and good (aOR=4.1, 95% CI 1.2 to 14.8) outcomes and a lower mRS (aOR=2.0, 95% CI 0.9 to 4.8). Primary EVT significantly increases the likelihood of achieving an excellent outcome in mild stroke. Over 40% of patients with a mild stroke treated with BMM experienced END, and rEVT effectively improved the prognosis.

Patients with symptomatic intracranial arterial stenosis (sICAS) are at risk of perioperative complications associated with stent placement and medication recurrence. Simple balloon angioplasty (SBA), a less invasive and safer alternative to stent placement, is an effective alternative treatment for sICAS. We conducted a retrospective analysis on patients with sICAS treated at the Jiangxi Provincial People's Hospital between January 2020 and December 2023. Patients with severe stenosis (70-99%) were divided into the medical management (MM) and SBA groups. Demographics, medical histories, National Institutes of Health Stroke Scale (NIHSS) scores, vessel stenosis, postoperative residual stenosis, and 30-day outcomes were also assessed. This study enrolled 176 patients, including 95 (66 males, mean age 57.4 ± 1.07 years) and 81 (55 males, mean age 61.1 ± 0.94 years) in the MM and SBA groups, respectively. Patients in the SBA group were significantly older than those in the MM group (p < 0.05). No significant differences were observed in sex, comorbidities (hypertension, diabetes, hyperlipidemia, smoking/alcohol use, and prior stroke), or baseline NIHSS scores (all p > 0.05). Pre-treatment stenosis rates were similar between groups: 80.90 ± 0.85% vs. 79.60 ± 1.01% (p > 0.05). One patient in the SBA group failed due to vessel tortuosity, while the remaining 80 procedures were successful. Of these, 15 patients (18.5%) required rescue stenting-11 because of elastic recoil and 4 because of flow-limiting dissection. The immediate residual stenosis rate was 24.68 ± 1.41%. Within 30 days, endpoint events occurred in four patients (4.2%) in the medical group (progressive infarction) and seven patients (8.6%) in the angioplasty group, including intracerebral and subarachnoid hemorrhage (n = 2), perforator infarction (n = 3), infarct progression (n = 1), and cortical infarction (n = 1). No deaths occurred in either group. The difference in the event rates was not statistically significant (p > 0.05). Subgroup analysis revealed that arterial dissection was significantly associated with postoperative endpoint events (p < 0.05), while occurrence was correlated with lesion length (p < 0.05), but not with the selected balloon size (p > 0.05). There was no significant difference in endpoint events between submaximal (< 90% of normal vessel diameter) and aggressive (> 90% of normal vessel diameter) angioplasties (p > 0.05). Overall, this study suggests that SBA does not significantly increase the 30-day risk of stroke or death in patients with sICAS compared with medical therapy. Both submaximal and aggressive angioplasty are safe. Further research is warranted to refine patient selection, optimize balloon size, and develop strategies to minimize the need for rescue stenting and reduce the risk of arterial dissection.

Carotid artery web is an underrecognized cause of ischemic stroke and is associated with a high risk of recurrent events. It is uncertain whether medical management or carotid revascularization is beneficial for patients with ischemic stroke and ipsilateral carotid web. In the absence of large randomized clinical trials and observational studies, we performed a systematic review and meta-analysis comparing medical management and carotid revascularization in this population. The systematic review was registered in PROSPERO (CRD42024485069). We searched five databases: Embase, Scopus, MEDLINE, Web of Science, and CINAHL. We included observational studies that studied the association between recurrent stroke in patients with ipsilateral carotid web receiving medical management (antiplatelet and anticoagulation) and carotid revascularization. Random effects modeling was performed, and risk ratio with 95% confidence intervals were reported. We included 17 studies (16 published and 1 institutional study). In the medical management group, 32% (90/281) of patients experienced recurrent ischemic stroke ipsilateral to the carotid web. The meta-analysis revealed a significantly lower risk of recurrent ischemic stroke with carotid revascularization (relative risk 0.11, 95% confidence interval 0.06-0.28, p < 0.001, I2 = 14.5%). Both carotid endarterectomy and carotid artery stenting were equally effective in reducing recurrent stroke risk (relative risk 0.44, 95% confidence interval 0.11-1.76, p = 0.99). Carotid revascularization is associated with reduced recurrence rates, with no difference between revascularization subtypes (carotid endarterectomy vs carotid artery stenting). However, given the small, heterogeneous cohorts and the uncertain natural history of carotid artery web under medical management, these findings should be interpreted with caution until prospective, controlled comparative effectiveness studies are performed. ANN NEUROL 2025;98:625-633.