Occlusion Therapy Research Articles

Continuous transcranial ultrasound in large vessel stroke: Image guidance for high-intensity focused sonothrombolysis.

Sonothrombolysis is a potential adjunctive therapy for large vessel occlusion (LVO) stroke. Bedside ultrasound image-guided high-intensity focused ultrasound (HIFU) therapy could deliver higher energy therapeutic ultrasound to the thrombus with higher precision than what was previously accomplished in human trials. The aim is to test the feasibility of diagnostic transcranial contrast-enhanced ultrasound (CEUS) to image the occlusion site and continuously maintain the guidance image on-target for a sufficient exposure time for HIFU to be effective during LVO stroke evaluation and treatment. This prospective, single center, observational cohort study included adult patients, presenting within 6 hours of stroke symptom onset, with LVO identified on computed tomography angiography (CTA). A hand-held CEUS imaging study was initiated following CTA and lasted up to 30 minutes. The primary outcome is the proportion of patients where a guidance CEUS image of the occlusion was achieved. A CEUS image of the occluded artery was obtained in 32/35 of the included patients. The median total imaging time was 23 minutes (interquartile range 15-30). Patients undergoing thrombectomy had a lower total imaging time (17 vs. 29.5 minutes, p=.002). When imaging was successful, on-target image was maintained for only 58% (standard deviation 23.8%) of total imaging time. No complications related to CEUS were observed. This feasibility study explored the use of diagnostic transcranial CEUS for continuous imaging of occlusion sites in LVO strokes. Challenges in maintaining target image during HIFU were identified, highlighting the need for technical advances for clinical application.

Intravenous alteplase before endovascular therapy for acute large vessel occlusion with large ischemic core: subanalysis of a randomized clinical trial

BackgroundThe efficacy of endovascular therapy (EVT) in patients with large ischemic core has been reported, but it remains unclear whether IV alteplase (IVT) has beneficial effects in addition to EVT...

Mediastinal and thoracic hematoma following transradial cerebral angiography: a case report

BackgroundCerebral angiography through the transradial approach (TRA) is associated with a low risk of complications, but in rare cases, these complications can be life-threatening.Case presentationA 56-year-old female patient was admitted for transradial cerebral angiography due to the complaint of right limb weakness and the diagnosis of cerebral infarction and cerebral artery stenosis. During the procedure, the patient coughed with expectoration and complained of throat discomfort, palpitations, and pains in the right shoulder and back. Emergency CT scan indicated hematoma in the middle mediastinum and the right thoracic cavity, and perforation of a branch of the subclavian artery was highly suspected. Subclavian artery angiography was conducted immediately, which revealed a patchy contrast medium overflow in a branch of the right costocervical trunk. Selective endovascular occlusion therapy was performed successfully with gelfoam particles and placement of 2 microcoils. At 12 days after cerebral angiography, the patient recovered well and was discharged from the hospital.ConclusionMediastinal and thoracic hematoma may occur due to vessel perforation during TRA cerebral angiography, in which guidewire advancement must be cautious. Early detection and appropriate countermeasures can reduce the severity of vascular perforation and subsequent hematoma.

Occlusal therapy in patients with temporomandibular joint dysfunction and occlusal and articulatory disorders

the article presents a statistical analysis of the assessment of the impact of various factors that led to occlusal and articulatory disorders and functional disorders of the masticatory apparatus on the choice of occlusal constructions therapy for the treatment of temporomandibular joint dysfunction. For conducting the research, a clinical and laboratory examination was carried out and orthopedic treatment of 150 patients with various occlusal options violations Variants of occlusion therapy are described and given characteristic.

Condylar Remodeling and Skeletal Changes Following Occlusal Splint and Manual Therapy: A Cone Beam Computed Tomography Study in Temporomandibular Disorders.

Background: Temporomandibular disorders (TMD) may be associated with degenerative disease of temporomandibular joint (TMJ), such as condyle erosion and subchondral cysts. Occlusal splint and cranio-mandibular manual therapy, or combined therapy, is recommended as a conservative treatment to alleviate pain-related signs and symptoms in TMD. This study aimed to assess osseous condylar changes and skeletal changes following occlusal splint and cranio-mandibular manual therapy in TMD using cone beam computed tomography (CBCT). Methods: A retrospective cohort study included 24 patients diagnosed with TMD. Combined therapy was performed until pain-related signs and symptoms disappeared. CBCT scans were performed before and after therapy. Osseous structure of condyles and their subsequent modifications were analyzed on CBCT images: flattening, erosion, and subchondral cyst. Sella-Nasion-A point (SNA), Sella-Nasion-B point (SNB), A point-Nasion-B point (ANB), Sella-Articulare-Gonion (Condylar angle), and anterior and posterior facial height (AFH, PFH) were measured on CBCT-generated lateral cephalograms. A paired t-test, Wilcoxon rank-sum test, McNemar test, and Stuart-Maxwell test were used for the statistical analyses. Results: The treatment period with combined therapy was 7.42 ± 3.27 months, and 21 out of 33 TMJ presenting degenerative disease (63.6%) had significant complete remodeling (p < 0.05). Following therapy, SNB significantly decreased from 75.61 ±3.47° to 74.82 ± 3.41° (p = 0.02), ANB significantly increased from 4.05° (3.35-4.9°) to 4.8° (3.3-6.12°) (p < 0.001), AFH significantly increased from 112.85 mm (109.28-118.72) to 115.3 mm (112.58-118.88) (p < 0.001), PFH/AFH significantly decreased from 64.17 (61.39-66.1) to 63 (59.68-64.51) (p = 0.012), and condylar angle significantly increased from 140.84 ± 8.18° to 144.42 ± 8.87° (p = 0.007). Conclusion: Combined therapy promoted significant condylar remodeling in TMJ degenerative disease, along with skeletal changes (mandibular retrusion and increase in facial height). Therapeutic strategies should consider condylar remodeling in TMD. Skeletal and dental parameters should be evaluated prior to occlusal splint therapy.

Combining the deployment of only the distal basket segment of the EMBOTRAP III and an aspiration catheter for M2 occlusions: the ONE-SEG technique.

Endovascular therapy (EVT) for distal medium vessel occlusions requires prioritizing effectiveness and safety. We developed a technique combining the deployment of only the distal basket segment of the EMBOTRAP III and an aspiration catheter (AC) for M2 occlusions, called the "ONE-SEG technique," and evaluated its clinical and technical impacts. This was a retrospective review of 30 consecutive patients with M2 segment middle cerebral artery occlusion treated using the ONE-SEG technique. This method involves deploying the EMBOTRAP III through a microcatheter in only one segment and guiding the AC to the M2 origin or distal M1. The rates of final-pass expanded thrombolysis in cerebral infarction (eTICI) scores of 2c/3 or 2b/2c/3, safety (symptomatic intracranial hemorrhage [sICH]), and clinical outcomes (modified Rankin Scale [mRS] score 0-2, 0-3 at 90 days, and mortality at 90 days) were evaluated. Of the 30 cases, 36.7% were female, and the mean age was 75.6 ± 11.0 years. The ONE-SEG technique was used for 17 cases (56.7%, median NIHSS 10 [5-15.5]) with primary M2 occlusion and 13 cases (43.3%, median NIHSS 20 [14-22.5]) with secondary M2 occlusion after proximal thrombus removal. The successful final reperfusion rate (eTICI 2b/2c/3) was 90% overall (27/30 cases). One case (3.3%) developed sICH with secondary M2 occlusion. At 3 months, mRS scores 0-2 were seen in 64.7% of patients with primary M2 occlusion (11/17 cases) and in 23.1% (3/13 cases) with secondary M2 occlusion. EVT using the ONE-SEG technique appears to be safe and effective for M2 occlusion.

Occlusal splint therapy- myth or fact? -A case report

The term Temporomandibular Joint Disorders (TMD) refers to a group of intricate disorders with a variety of etiologies that frequently call for multimodal therapy strategies. Treatment of TMDs requires careful diagnosis and treatment planning to resolve occlusal and functional problems. In contemporary dental practice, splint therapy can be used as an effective and conservative means of treatment of TMDs. In this case report occlusal splint therapy was used to treat a male patient of 27yrs age who had symptoms of TMD, including pain in the head, neck, and shoulder. After 8 months of splint therapy, a clinical examination and radiographic interpretation showed considerable changes, including decreased pain frequency, better jaw function, and radiographic evidence of altered joint spaces. This case report shows the effectiveness of occlusal splint therapy in treating temporomandibular joint disorders.

Efficacy and safety of hybrid therapy for lower extremity acute arterial occlusion by a vascular team

Efficacy and safety of hybrid therapy for lower extremity acute arterial occlusion by a vascular team

Endovascular therapy for acute intracranial large vessel occlusion due to atherothrombosis: Multicenter historical registry

BackgroundAtherothrombotic stroke-related large vessel occlusion (AT-LVO) is caused by two etiologies, the intracranial artery occlusion due to in situ occlusion (intracranial group) or due to embolism from cervical carotid occlusion...

Single-Centre Experience with Endovascular Therapy in Acute Occlusion of ICAS: Preferred Stent Thrombectomy Versus Preferred Angioplasty.

The preferred endovascular therapy (EVT) for large-vessel occlusion in intracranial atherosclerosis (ICAS) is unknown. We compared the efficacy of preferred stent thrombectomy and preferred angioplasty in patients with acute large-vessel occlusion in ICAS. Data from consecutive EVT patients (May 2020 to September 2023) with acute middle cerebral artery occlusion in ICAS were retrospectively analyzed. Preferred angioplasty was performed if there was a preoperative "microcatheter first-pass effect;" otherwise, preferred stent thrombectomy was performed. Analyses were grouped according to the two EVT treatments. Clinical data of all patients, including the time from puncture to recanalization, rate of successful reperfusion, early neurological improvement, intracranial hemorrhage, and modified Rankin Scale score at 90 days, were recorded and analyzed. Six-two patients were enrolled in this study (mean age was 60.66±13.21y, 22.6% female). The preferred angioplasty group had a higher first-pass recanalization rate than the preferred stent thrombectomy group (61.3% vs. 21.9%, P<0.001) and a higher proportion of patients who were functionally independent (defined as a modified Rankin Scale score of 0 to 3) at 90 days [odds ratio,3.681; 95% confidence interval (CI):1.009 to 13.428; P=0.048]. There was no significant difference between the groups in the time from puncture to recanalization, the frequency of successful reperfusion, and early neurological improvement, or intracranial hemorrhage (P>0.05). This study suggests that for acute middle cerebral artery occlusion in ICAS, preferred angioplasty may be a safe and effective procedure.

Investigation of choroidal structure changes after intravitreal anti-VEGF therapy for retinal vein occlusion.

We aimed to investigate the effect of retinal vein occlusion (RVO) on the posterior segment structures of the eye and its changes with intravitreal anti-Vascular Endothelial Growth Factor (VEGF) treatment. This prospective longitudinal study included 29 eyes of 29 patients with RVO (17 males and 12 females) followed for 6 months. The best corrected visual acuity (BCVA), macula, choroid ticknesses and choroidal vascularity index (CVI) obtained by spectral-domain optical coherence tomography were recorded at baseline and the first, third, and sixth months after the first injection. Results were compared with fellow eyes (non-affected eyes) and age- and sex-matched controls. BCVA increased significantly in the 6th month, more in the first month of injection (p < 0.05 for each). Central macular tickness, subfoveal choroid tickness, stromal and total area of choroid decreased significantly after injection (p < 0.05 for each). CVI values increased significantly, especially in the 1st month after injection (p < 0.05 for each). In eyes with Branch RVO, there was a significant decrease in the macular thickness of the occlusive areas with treatment, while there was no statistically significant change in the non-occlusive macular thickness. Observation of changes in choroidal structure may be useful to assess the activity of RVO and predict the efficacy of anti-VEGF therapy.

A case of bilateral straatsma syndrome

Straatsma syndrome is characterized by a constellation of conditions including amblyopia, nystagmus, and myopia. We present the case of a 10-year-old boy who complained of involuntary back-and-forth eye movements and reduced vision since birth. His visual acuity was measured at 2/60 in both eyes. Examination revealed horizontal pendular nystagmus without ocular misalignment. Fundus examination showed myopic changes, including an anomalous optic disc with extensive myelinated nerve fibers extending from the optic disc along the superior and inferior arcades to the fovea. Axial length measurements were 28.34 mm and 27.96 mm in the right and left eyes, respectively. SD-OCT imaging confirmed thickening of the retinal nerve fiber layer. Treatment included cycloplegic refraction and occlusion therapy, with regular follow-ups every three months utilizing contact lenses with cycloplegic refraction. The etiology of retinal fiber myelination remains unclear; however, it is hypothesized that blurred retinal imaging during critical ocular development stages may lead to axial elongation and subsequent myopia, potentially delaying the development of the lamina cribrosa and facilitating myelination extension.

Visual Outcome of Occlusion Therapy in Anisometropic Amblyopia

Background: Amblyopia is a common visual disorder in children, often treated with occlusion therapy. This study aimed to assess the visual outcomes following occlusion therapy in children with anisometropic amblyopia, focusing on improvements in best-corrected visual acuity (BCVA) over a six-month period. Methods: This cross-sectional study was conducted in Shaheed Monsur Ali Medical College Hospital, Dhaka, Bangladesh during the period from January 2015 to August 2015. Participants underwent occlusion therapy, where the better-seeing eye was covered for varying durations based on initial BCVA. Visual acuity was measured using the Snellen chart and converted to logMAR units at baseline, and after 1, 3, and 6 months of therapy. Statistical analysis was performed using Pearson’s correlation test. Results: The mean BCVA improved significantly from 0.88±0.28 at baseline to 0.55±0.21 after 1 month, 0.42±0.15 after 3 months, and 0.23±0.12 after 6 months (p &lt; 0.001 for all comparisons). Among the participants, 68% had hypermetropia, 22% had astigmatism, and 10% had myopia. The majority of participants (68%) had anisometropic amblyopia in the right eye. The age distribution was 32% aged 5-7 years, 47% aged 8-9 years, and 21% aged 10-11 years, with a mean age of 8.64 years. Gender distribution was 64% male and 36% female. Conclusion: Occlusion therapy significantly improves visual acuity in children with anisometropic amblyopia, with early and consistent treatment yielding the best results. These findings support the continued use of occlusion therapy as an effective treatment modality, even when initiated later in childhood. Future research should explore long-term outcomes and complementary treatment approaches.

The role of nutraceuticals in the management of temporomandibular disorders.

Temporomandibular disorders (TMDs) are usually treated with occlusal appliances and supportive treatments such as physical therapy and drugs. Supplements can be included among potential supportive therapies, with the aim of reducing the use of drugs. To evaluate the efficacy of nutraceuticals' short-term treatment in subjects with temporomandibular disorders. The study started in January 2021 and ended in January 2022. Subjects with temporomandibular disorders and a verbal numeric scale >40 were recruited and randomly assigned to one of the following groups. If waiting to start a therapy, to the nutraceutical group or to the no treatment group, while if already undergoing splint therapy, to nutraceautical+splint group or to splint therapy group. Nutraceutical used was composed by Boswellia Serrata Casperome, Magnesium, Tryptophan and vitamins B2 and D with a posology of one tablet/day before sleep for 40days. Presence of temporomandibular pain, headache, neck pain and sleep/emotional disorders were assessed at T0 and at T1, after 40days. ANOVA was performed to compare treatments with nutraceuticals and theirrespective controls, as for the variables related to painful symptomatology. Chi- Squared was conducted to assess differences in sleep/emotional disorders between groups. The statistical significance was p<0.05. The groups using nutraceuticals showed statistically significant improvements over controls for most of the variables analyzed. The use of nutraceutical seems to be a valuable support for TMD therapy in the short term either alone or combined with occlusal splint therapy.

Comparison of Cambridge vision stimulator (CAM) therapy with passive occlusion therapy in the management of unilateral amblyopia; a randomized clinical trial

ABSTRACT Introduction There are limited studies on the effectiveness of Cambridge vision stimulator (CAM) therapy as a management strategy in amblyopic patients. In addition, all these studies have a low sample size. The main purpose of this study was to compare the effect of CAM therapy with passive occlusion therapy in the management of unilateral amblyopia. Methods In this randomized clinical trial study, 110 cooperative amblyopic children, who had not been managed previously, were randomly divided into two groups of CAM therapy (n = 55) and passive occlusion therapy (n = 55). In the CAM procedure, five discs with different spatial frequencies (SF) (2, 6, 15, 20, 30 cycles/degree) were presented to the patient (30 minutes a day, twice a week). Plates with SF equal to the two lines better than the measured corrected distance visual acuity (CDVA) were chosen. During the training, the non-amblyopic eye was occluded. The standard occlusion therapy protocols were performed in the occlusion therapy group. The CDVA for all patients was measured at baseline and then at one, two, and three months after the treatment. Results The mean age of patients in CAM and occlusion therapy groups was 7.0 ± 2.1 and 6.9 ± 1.9 years, respectively (p = .721). There was no significant difference in the mean CDVA between CAM and occlusion therapy groups after one (0.30 ± 0.16 vs. 0.25 ± 0.14, p = .079), two (0.15 ± 0.10 vs. 0.15 ± 0.11, p = .732) and three months (0.05 ± 0.08 and 0.05 ± 0.06, p = .919) from baseline. However, the mean amount of CDVA increased significantly in each follow-up in both groups (all p < .001). Regarding the amblyopia type and severity, the mean improvement of CDVA from baseline in the anisometropic patients and in moderate amblyopia was significantly higher in the CAM group than the occlusion group after two and three months (p < .05). Discussion CAM and conventional occlusion therapies significantly improved CDVA in children with amblyopia, and the difference was not significant; therefore, they could be used as alternatives. CAM therapy requires cost and time for the amblyopic patient and parents. Thus, it can be considered as a second treatment option in amblyopic patients, especially anisometropic type and moderate amblyopia, with poor compliance to patching.

Effect of Occlusion Therapy on the Deviation Angle in Patients with Partially Accommodative Esotropia and Amblyopia

Purpose: To assess the impact of occlusion therapy on the deviation angle in patients with partially accommodative esotropia (ET) and amblyopia. Study Design: Retrospective chart review. Place and Duration of Study: The medical records of patients attending the pediatric ophthalmology clinic at Elite Hospital, Riyadh, Saudi Arabia between June, 2014 and September, 2021 were reviewed. Methods: We retrospectively analyzed the pre- and post-therapy, angle of deviation of 63 children with partially accommodative ET who underwent occlusion therapy for amblyopia. Results: The mean angle of deviation before and one month after using the full cycloplegic prescription glasses was 31.74 PD (range,12–85 PD) and 16.5 PD(6–45 PD), respectively. After occlusion therapy (6–18 months), the mean angle of deviation decreased to 10.03 PD (0–45 PD). Thirteen patients (20.63%) underwent surgery after completion of occlusion therapy, which was significantly less than the number of patients that would have been scheduled for surgery before proper occlusion therapy (n = 41, 65.07%). Conclusion: Amblyopia therapy should be completed before surgical intervention in patients with hypermetropia, partially accommodative ET, and amblyopia. There was a significant reduction in ET angle following occlusion therapy. Furthermore, it decreased the number of patients requiring surgery and the angle to be corrected.

Optimizing endovascular therapy for large vessel occlusion using CYP2C19 genotype-guided antiplatelet therapy: a case report

Optimizing endovascular therapy for large vessel occlusion using CYP2C19 genotype-guided antiplatelet therapy: a case report

Occlusion therapy for amblyopia, a historical report from 9th century Persian scholar, Ali ibn Sahl ibn Rabban al-Tabari (838–870 CE)

ABSTRACT Introduction This study reevaluates the historical origins of occlusion therapy for amblyopia, focusing on the contributions of the 9th-century Islamic scholar, Ali ibn Sahl ibn Rabban al-Tabari (838–870 CE). Methods The investigation delved into al-Tabari’s writings, particularly ”Firdous al-Hikma,” to extract insights into his approach to addressing reduced vision in one eye.Additionally, the study examined subsequent advancements in occlusion therapy by scholars such as Thabit ibn Qurrah and Rhazes, building upon al-Tabari’sfoundational work. Results Al-Tabari’s reports contain significant insights into occlusion therapy for amblyopia, predating commonly attributed origins of the treatment. Within ”Firdous al-Hikma,” he outlines methods for addressing reduced vision, advocating for the covering of the healthier eye to promote the function of the weaker eye. These findings highlight the pioneering efforts of al-Tabari and his contemporaries in the Islamic civilization and challenge the conventional narrative surrounding the history of occlusion therapy. Subsequent advancements by scholars such as Thabit ibn Qurrah and Rhazes expanded upon al-Tabari’s work, advocating for similar therapeutic approaches within the Islamic civilization. Their contributions further solidified the practice of occlusion therapy, laying the groundwork for its continued evolution and refinement in subsequent centuries. Discussion Al-Tabari’s contributions to occlusion therapy underscore the rich heritage of scientific inquiry in theIslamic civilization during the medieval period. This historical perspective sheds light on the diverse contributions to medical knowledge and practice outside of Western contexts and emphasizes the importance of recognizing and honoring these contributions in the broader history of medicine.

Occlusive therapy in dermatology.

Occlusive therapy in dermatology.

Analysis of choroidal thickness, macular thickness, peripapillary retinal nerve fiber layer thickness, and macular vascular density in children with unilateral amblyopia using swept-source optical coherence tomography and their changes following occlusion therapy

Analysis of choroidal thickness, macular thickness, peripapillary retinal nerve fiber layer thickness, and macular vascular density in children with unilateral amblyopia using swept-source optical coherence tomography and their changes following occlusion therapy