Postprocedural Research Articles

A comparative study of the effect of capsular repair in the Latarjet procedure.

Long term studies have shown the Latarjet procedure to be successful in preventing re-dislocation in primary and recurrent anterior inferior shoulder instability. It provides stability through the sling effect of the conjoint tendon and the bone block. It is unclear whether augmentation with capsular repair provides an added benefit or leads to restricted range of external rotation. The primary aim of this study is to evaluate the effect of capsular repair in the open Latarjet procedure on rotational range of active external rotation in 90 degrees abduction (RoM-ER90). The secondary aim is to evaluate the effect on clinical outcomes including post-operative apprehension, instability, proprioception and shoulder function scores. This is a multi-national retrospective cohort study including patients with a minimum of 6-months follow-up post Latarjet procedure performed between 2016 and 2020 recruited from 3 units in Australia and France. Range of motion was measured using a Proteck goniometer. Clinical outcomes were assessed using the Western Ontario Shoulder Instability Index (WOSI), Oxford shoulder, Oxford instability, Walch-Duplay and Rowe scores. Shoulder proprioception was assessed by the active relocation test described by Glendon et al. RESULTS: Forty-four patients were included, median age was 29.5years and 91% male. Three groups were assessed, open latarjet with no capsular repair (OL n = 11), open latarjet with capsular repair (OLCR n = 20), and arthroscopic Latarjet without capsular repair (AL n = 13). There was no apparent effect of capsular repair on the ROM-ER 90 in the open groups with a median (interquartile range) of 78° (72°, 90°) for OL and 84° (75°, 90°; P = 0.87) for OLCR groups. Capsular repair and arthroscopic approach did not affect the proportion of patients reporting shoulder apprehension (P = 0.52 and 0.48 respectively). There was no difference in proprioception between operative and non-operative sides for the OL group (P = 0.43). Proprioception was poorer on the operative side for the OLCR group (P = 0.04) but better on the operative side for the AL group (P = 0.08). WOSI scores for the open surgical groups were similar (OL = 78, OLCR = 80, P = 0.91) and when combined (median WOSI = 79) demonstrated greater stability than the AL group (P = 0.009). There was no evidence of an effect of capsular repair or arthroscopic approach on the Walch-Duplay, Oxford Instability, or Rowe scores. There is no significant difference in ROM-ER 90 or WOSI score in patients who undergo the Latarjet procedure with and without capsular repair. The arthroscopic Latarjet may preserve proprioception but did not improve shoulder stability compared to the open Latarjet. III, retrospective cohort study.

Management of Vascular Complications from Button Battery Ingestions.

To propose a gastrointestinal bleeding management algorithm that incorporates an endoscopic and imaging scoring system and specifies management of vascular complication from button battery ingestion. Button batteries (BB) are found in many electronic devices and ingestions are associated with serious complications especially in cases of unwitnessed ingestions, prolonged impaction, and in children less than 5years of age. Gastrointestinal bleeding from BB related vascular injury is rare but often rapidly fatal, with a mortality rate as high as 81%. There are no evidence-based guidelines for managing vascular complications from button battery ingestions. This paper proposes a management algorithm that 1) incorporates both an endoscopic and imaging scoring system to guide initial, post procedure, and discharge care and 2) specifies management of button battery related vascular bleeding. The endoscopic score is a modified Zargar classification with added categories for suspected aneurysm and tracheoesophageal fistula. Surgical and endovascular interventions for vascular injury are also reviewed. Until evidence-based guidelines can be developed, hospitals should have a multidisciplinary protocol based on institutional expertise to rapidly manage BB related vascular injury. Prevention of BB related injury offers the best hope of preventing serious complications and should include increasing public awareness and improving safety standards by working with industry and government.

Predicting Photovoltaic Module Lifespan Based on Combined Stress Tests and Latent Heat Analysis

In this study, long-term reliability tests for high-power-density photovoltaic (PV) modules were introduced and analyzed in accordance with IEC 61215 and light-combined damp heat cycles, such as DIN 75220. The results indicated that post light soaking procedure, light-combined damp heat cycles caused a 3.51% power drop, while IEC standard tests (DH1000 and TC200) caused only 0.87% and 1.32% power drops, respectively. IEC 61215 failed to assess the long-term reliability of the high-power-density PV module, such as the passivated emitter rear cell. Additionally, based on the combined test, the latent heat (Qmod) of the module was introduced to predict its degradation rate and to fit the prediction curve of the product guaranteed by the PV module manufacturers. Qmod facilitates in predicting a PV module’s lifespan according to the environmental factors of the actual installation area. The Qmod values of the PV stations in water environments, such as floating and/or marine PVs, indicated that they would last 7.2 years more than those on a rooftop, assuming that latent heat is the only cause of deterioration. Therefore, extending module life and improving power generation efficiency by determining installation sites to minimize latent heat would be advantageous.

TriHex 2.0-Advancing Skin Health Science and the TriHex Technology.

The original TriHex combination-Tripeptide-1 and Hexapeptide-12 (TriHex) encompasses a peptide combination selected for its ability to modulate the extracellular matrix (ECM) by progressively eliminating clumped collagen and elastin fragments and then stimulating replacement with new collagen and elastin. Incorporation of a proprietary, patent-pending Octapeptide-45 (Octa) to the TriHex original provides potential for added benefit based on the peptide's capacity to stimulate hyaluronic acid (HA) and its anticipated added benefit in wound healing. This is named TriHex 2.0 in the paper. A full-scale validation process was structured to assess Octa synergy with TriHex using an exvivo model, assessing ECM changes histologically in relation to elastin, HA and basement membrane components. In addition, gene expression studies were undertaken, including bulk and single cell sequencing analysis to assess the particular changes that occurred by adding Octa to the TriHex. Following the gene expression analysis, a further round of exvivo studies was conducted to assess protein expression of the defined differentially expressed genes using histological staining. Octa synergized with TriHex as demonstrated by significantly upregulated genes (p < 0.05) affecting the ECM and basement membrane. A histological assessment using the exvivo model demonstrated tropoelastin intensity significantly increasing with TriHex (43%) and 2.0 (42%) (p < 0.05 for both) compared to untreated explants. HA levels (CD44 intensity) significantly increased with TriHex (69%; p < 0.01), while TriHex 2.0 demonstrated HA levels 160% greater (p < 0.001) than the untreated tissue. Single cell sequencing identified a gene expression profile upregulation relating to ECM modulation and wound healing in both TriHex and 2.0, but TriHex 2.0 showed additional activities in basement membrane physiology, stem cell recruitment, and protection of fibroblasts against cellular senescence. The addition of Octapeptide-45 to TriHex technology in the form of TriHex 2.0 is a significant advance to TriHex technology science. Both forms demonstrate ECM remodeling and positive wound healing, but supplementary benefits are evident including increased elastin and hyaluronic acid stimulation, added effects on the basement membrane, additional wound healing capacity in basal keratinocytes and anti-senescent effects in fibroblasts. This is helpful for pre-conditioning of the skin prior to procedures and post procedure related to additional ECM remodeling, wound healing advantages, senescent cell targeting and DEJ strengthening. Clinical studies to follow.

Catheter Ablation of Parahisian Premature Ventricular Complexes From the Right Sinus of Valsalva.

Cather ablation of parahisian premature ventricular complexes (PVCs) often requires ablation in multiple cardiac chambers, including the sinuses of Valsalva (SoV). The safety and efficacy of ablation within the right SoV to target parahisian arrhythmias has not been widely reported. To report on the demographic and procedural characteristics of patients undergoing catheter ablation of PVCs who underwent ablation in the right SoV, and to examine the impact of late-gadolinium enhanced cardiac magnetic resonance (LGE-CMR) on procedural findings. Consecutive patients undergoing ablation of parahisian PVCs and ablation in the right SoV with preprocedural LGE-CMR were included. Eleven patients were included in the study population (11 males (100%), median age: 68 ± 7 years, median ejection fraction: 53% ± 7%, PVC burden 23% ± 13%). Intramural LGE-CMR scar was present in all patients and involved the basal anteroseptum/outflow tract in nine patients. Ablation within the right SoV eliminated (n = 9) or suppressed (n = 2) PVCs in all patients. The successful SoV site displayed the absolute earliest presystolic activation time or matching pacemaps in only 44% and 55% of patients, respectfully. Transient heart block during right SoV ablation occurred in 1/11(9%) patients. The post procedure PVC burden decreased from 23% ± 13% to 7% ± 6%, procedural success was attained in 10/11(91%) of patients. Parahisian PVCs ablated from the right SoV are often intramural, may require ablation in multiple chambers, and colocalize with intramural LGE-CMR scar. Traditional EGM markers of successful ablation sites were less frequently seen at successful site of SoV ablation, long term success was achieved in 91% of patients.

Biliary sphincterotomy resets pancreaticobiliary pain refractory to intrasphincteric Botox injections in functional biliary pain.

The management of Type III sphincter of Oddi dysfunction or functional biliary pain (FBP) is challenging. A strategy of intermittent intrasphincteric botulinum toxin (Botox) injections into the sphincter of Oddi can alleviate pancreaticobiliary pain. In patients who lose response to intermittent Botox injections, endoscopic biliary sphincterotomy (ES) could potentially reset pain facilitating ongoing management of symptoms. A retrospective review of case notes over a seven-year period (2014-2021) was performed. All patients underwent blood tests, gastroscopy, trans-abdominal ultrasonography, cross-sectional imaging withmagnetic resonance cholangiopancreatography (MRCP)/computed tomography (CT) and endoscopic ultrasound (EUS)to rule out alternative causes for their symptoms of pancreaticobiliary pain. A diagnosis of FBP was made in patients with typical post-cholecystectomy pain and normal liver function tests and bile duct size on imaging. Patients with symptomatic FBP underwent intermittent endoscopic Botox injections to the sphincter of Oddi. Patients who lost response to Botox injections underwent ES and were followed up in an outpatient setting to assess response. One hundred and thirty (128 female, 2 male) patients with FBP underwent a mean of four (2-8) Botox injections over the study period. Of 130 (90%) patients, 117 reported a significant improvement in pain on post procedure review with 81% of patients managing to discontinue opioid medication post procedure. Fifty-one out of 130 (39%) lost response to Botox injections after a median of six (range 5-11) sessions (median eightmonths between sessions [range 6-18months]) and continued to have ongoing pancreaticobiliary pain and subsequently underwent biliary ES. Forty-one out of 50 (82%) reported a clinical improvement in their symptoms of pancreaticobiliary pain following ES, with response persisting at follow-up for up to mean of eight (5-15) months and no further hospital attendances due to severe pancreaticobiliary pain. ES can reset pancreaticobiliary pain in FBP once Botox injection therapy to the sphincter of Oddi becomes ineffective and may provide ongoing relief of symptoms.

Intraoperative neuromonitoring and mapping during spinal cord untethering surgery; a single-centre paediatric neurosurgery unit experience.

A review of intraoperative neuromonitoring (IONM) and mapping (IONMa) utility during paediatric tethered cord surgery with particular attention to feasibility, measures to prevent injury, and postoperative outcome. A retrospective analysis of spinal cord untethering surgery between 2015 and 2022 was carried out. Cohort demographics, IONM and IONMa data, and procedural details were summarised and associations between variables explored. Clinical outcome was assessed 3-months post procedure via review of medical records. One hundred and twenty-two patients (median age: 3years old: IQR: 2-9, 61% female) underwent surgery. The most common diagnosis was thickened filum (n = 59, 48%). Urological dysfunction was the most common presenting complaint (62%). Electromyography (EMG), motor evoked potentials (MEP), somatosensory evoked potentials (SSEP), and bulbocavernosus reflexes (BCR) were successfully recorded in 100%, 99%, 90%, and 73% patients. Unsuccessful BCR monitoring only occurred in females (p < 0.001). The Triggered-EMG protocol identified nerve rootlets adhered to the filum or tethering structure in 16% of the cohort. Alert criteria breaches (> 30-50% reduction in SSEP, > 80% reduction in MEP amplitude, absent BCR) occurred in 13 patients (11%). These alert criteria breaches were reversed in 11 (85%) with no permanent neurological deficits. In 2 (15%), alerts were irreversible, and one developed a permanent neurological deficit. Signs and symptoms of tethered cord had either stabilised (≥ 64%), improved (≥ 20%), or worsened (≤ 4%) at 3-month postoperative review. IONM and IONMa are useful and effective tools in monitoring and identifying neural tissue, which can guide safe cord untethering and lipoma resection. Our results validate IONM and IONMa in surgery for cord untethering.

Natural History of Chronic Subdural Hematoma following Middle Meningeal Artery Embolization: A Retrospective Analysis

The efficacy of middle meningeal artery (MMA) embolization in the management of chronic subdural hematoma (cSDH) has been increasingly supported by recent randomized controlled trials. However, long-term data on the natural history of cSDH post-treatment remain limited. This study aims to evaluate the natural history and outcomes of cSDH over a 12-month period following MMA embolization. We conducted a retrospective analysis of 61 MMA embolization for the treatment of cSDH in 49 consecutive patients at a single institution between October 2019 and December 2022. Patients underwent MMA embolization as the primary treatment of cSDH, concurrently with surgical evacuation, or after initial surgical evacuation and subsequent recurrence. Clinical data, including patient demographics, hematoma maximal thickness, midline shift size, procedural details, and outcomes, were collected and analyzed. The primary outcomes assessed were time to resolution of hematoma maximal thickness, midline shift reduction and clinical improvement. Secondary outcomes included occurrence of complications, recurrence rate and the characteristics of the group of patients who needed surgical rescue. Tables and Kaplan-Meier curves were created, broken down by the percentage of reduction in current hematoma maximal thickness. Results for the primary, concurrent and recurrent groups were compared. The mean age of included patients was 73 ± 10.8 years. Among them, 33 patients (67.3%) reported a history of previous trauma, with falls being the main mechanism of injury (65.3%). The majority of patients (77.5%) were male. The most frequent neurological symptom was headache (61.2%). The mean hematoma thickness and midline shift were 15.9±7.1 and 5.6±2.6 mm, respectively. There was a significant improvement in clinical symptoms within 1 month following middle meningeal artery embolization. Kaplan-Meier curves were generated for resolution of hematoma size and midline shift. At one month post procedure, only 25% of patients had at least a 25% reduction in hematoma size. However, by three months, 75% had a decrease in hematoma size by 50%. 85% of patients had complete resolution of hematoma by 7 months and all patients had resolution of hematoma by 12 months. Four patients underwent surgical rescue hematoma evacuation and the mean timeframe between the embolization and the surgical rescue was 2 weeks. Hematoma size and midline shift resolved faster for patients who underwent concurrent or rescue surgical evacuation of the hematoma in addition to embolization. No difference in results between the liquid embolics n-BCA and Onyx-18 was found. This study demonstrated a favorable resolution of subdural hematoma within 7 months in 85% of patients and in all patients by 12 months. By 3 months, 50% of patients had a decrease in hematoma size by 50% or more. A complete resolution of midline shift within 7 months, and a significant improvement in clinical symptoms within 1 month following middle meningeal artery embolization. Hematoma size and midline shift resolved faster for patients who underwent embolization for recurrent hematoma or concurrent surgical evacuation of the hematoma in addition to embolization.

Demographic Profile and Upper Gastrointestinal Endoscopic Findings among Children with Gastrointestinal Symptoms

Background: Upper endoscopy is an essential, safe and sensitive tool for diagnosing pediatric gastrointestinal issues. In Bangladesh, the practice of pediatric endoscopy remain rudimentary due to lackoftrained pediatricendoscopist. There is limited study on pediatric upper GI endoscopy in our country. The aim of the study was to find out the indications, common endoscopic findings and immediate post procedure complication of UGI endoscopy in children. Materials and methods: This is a retrospective study, the medical records of all patients whose age is under 18 years and who underwent upper GI endoscopy in last 2 years were included. Results: Among the total of 150 children (Age &lt;18 years), the most common indications were recurrent abdominal pain in 95 (63.3%) patients followed by Vomiting 26(17.33%), hematemesis 22(17.67%), dysphagia 4(2.7%), jaundice 3(2%). In almost half of the patients 75 (50%), the endoscopic findings were normal. The most common abnormal endoscopic findings were esophagitis seen in 42(28%) of patients followed by 18(12%) cases of superficial gastritis, duodenal ulcer 5 (3.3%), esophageal varix 4(2.6%), gastric polyp 3 (n=2%), antral gastritis 1(0.7%), biliary ascariasis 1(0.7%), esophageal ulceration 1(0.7%). Conclusion: The commonest indication for Pediatric UGI endoscopy was recurrent abdominal pain and the commonest endoscopic feature was esophagitis. No significant post procedure complication was noted in this study. Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 75-78

Clinical Outcomes and Practicality of Transferring Patients Immediately to Originating Hospitals After Primary Percutaneous Coronary Intervention-A Retrospective Study.

Primary Percutaneous Coronary Intervention (PPCI) is the preferred treatment for ST-Segment Elevation Myocardial Infarction (STEMI) patients in both PCI centers and those transferred from non-PCI centers, provided it can be performed in a timely manner. The challenges in transferring patients from non-PCI centers include not only potential delays beyond 120 min but also the risk of overwhelming the resources at the PPCI hospital. We report a novel strategy implemented within the Serdang STEMI Network involving immediate transfer of patients back to the originating hospitals within 2 h post procedure. This study aims to evaluate the clinical outcomes and practicality of immediately transferring stable STEMI patients back to their originating hospitals within 2 h postprimary PCI, within the Serdang STEMI Network. Specifically, it seeks to assess the in-hospital mortality rate and 30-day major adverse cardiac events (MACE) among these patients to determine the safety and feasibility of this novel early transfer strategy. This retrospective cohort study involved 1374 STEMI patients participating in the Serdang STEMI network from May 2015 to December 2022, including 570 patients admitted directly to Hospital Sultan Idris Shah, Serdang (HSIS) and 804 transferred from non-PCI centers. Of the 804 transferred patients, 415 (52%) were transferred back to referring hospitals within 2 h of PPCI. These patients met specific criteria including hemodynamic stability, absence of procedural complications, and fit for transfer at the discretion of the attending cardiologist. The primary outcomes measured were in-hospital and 30-day mortality rates, as well as major adverse cardiac events (MACE). MACE was defined as a composite of death, myocardial infarction, stroke, or repeat revascularization. In the early return group, there was no in-hospital or 30-day mortality. No patient required repeat revascularization or readmission within 30 days. Our results indicate that carefully selected patients can be safely returned to their originating hospitals very early following successful PPCI. These findings have important implications for large regional STEMI networks worldwide, particularly in areas where PPCI centers may have limited resources to handle high STEMI volumes.

The Effects of Selective Laser Trabeculoplasty in Patients With Angle Recession Glaucoma: A Case Series.

To evaluate the effectiveness of selective laser trabeculoplasty (SLT) in reducing intraocular pressure (IOP) and medication use in treated and untreated eyes of angle recession glaucoma (ARG) patients within a year post procedure. A retrospective chart review was conducted on nine ARG patients treated with SLT at George Washington University between January 1, 2008, and January 1, 2022. Patients were excluded if they had no ARG diagnosis, did not undergo SLT, lacked follow-up within one year after SLT, or had undergone laser or glaucoma surgery in the treated or untreated eye within 12 months before SLT. Primary outcomes were IOP reduction and SLT success, defined as a ≥20% reduction in IOP without additional IOP-lowering procedures or medications. Follow-up assessments were conducted at six weeks, six months, and 12 months. Statistical analysis included paired t-tests and ANOVA. A total of nine eyes from nine ARG patients were included, with a mean age of 62.33 years. SLT treatment success was observed in five out of nine (55.5%) treated eyes at various time points. In untreated contralateral eyes, success was noted in three out of nine patients (33.3%). The mean IOPfor SLT-treated eyes at baseline, six-week, six-month, and 12-month visits was 20 ± 6.22 mmHg, 17.39 ± 5.11 mmHg (P > 0.05), 18.69 ± 4.99 mmHg (P > 0.05), and 16.83 ± 3.87 mmHg (P > 0.05), respectively. For the same time points, the mean IOPfor untreated eyes was 15 ± 3.28 mmHg (P > 0.05), 14 ± 3.20 mmHg (P > 0.05), 14.38 ± 4.24 mmHg (P > 0.05), and 14.83 ± 3.82 mmHg (P > 0.05), respectively. The average number of medications used for the ipsilateral eye at the baseline, six-week, six-month, and 12-month visits was 3.11 ± 1.27, 3.11 ± 1.05, 3.25 ± 1.04, and 3.50 ± 0.55, with no significant changes over time (P > 0.05). Meanwhile, for the contralateral eye, the average medication use at those same points was 1.00 ± 1.32, 1.00 ± 1.32, 1.13 ± 1.36, and 0.67 ± 0.82, also showing no significant changes (P > 0.05). SLT was safe and effective in reducing IOP in a subset of treated ARG eyes, with better outcomes observed in those with higher baseline IOP. While individual responses varied, SLT could be considered a viable treatment option for delaying invasive surgery in ARG patients. Larger studies are needed to confirm long-term efficacy and identify predictors of success.

Abstract 4135984: Comparison of Immediate and Staged Complete Revascularization in STEMI Patients with Multivessel Disease: Meta-Analysis of Randomized Controlled Trial

Background: Patients diagnosed with ST-segment elevation myocardial infarction (STEMI) frequently present with multivessel coronary artery disease (CAD) at the time of primary percutaneous coronary intervention (PCI). The optimal timing of complete revascularization (CR) in these cases remains a subject of ongoing debate. Objective: To assess major cardiovascular outcomes and procedural complications in STEMI patients with multivessel CAD undergoing immediate versus staged CR post index procedure. Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing immediate to staged CR in STEMI and multivessel CAD. Trials were identified via a systematic search of MEDLINE, Embase, and Cochrane Libraries from database inception to March 6, 2024. The data were analyzed using RevMan software. Results: Among five RCTs (n=1,415) the majority of participants were male, the weighted mean follow-up duration across studies was 15.6 months. Immediate versus staged CR showed no significant differences in MACE (13.3% vs 9.8%; RR: 1.07, 95% CI [0.62, 1.83]), all-cause mortality (3% vs 4.55%; RR: 0.70, 95% CI [0.41, 1.21]), or MI (4.5% vs 2.6%; RR: 1.43, 95% CI [0.58, 3.55]). However, the staged group had higher unplanned revascularization incidence (8.6% vs 4.4%; RR: 1.92, 95% CI [1.21, 3.04]). Conclusion: Staged revascularization in STEMI patients with multivessel CAD demonstrates comparable effectiveness to immediate revascularization but leads to a greater number of unplanned revascularization procedures, likely due to delayed intervention. The early implementation of staged PCI during the initial hospitalization phase may provide equivalent efficacy to immediate complete revascularization. Nonetheless, further research is necessary to corroborate these findings.

Abstract 4138225: In-Hospital Outcomes of Percutaneous Coronary Intervention (PCI) in patients primarily admitted with ST-Elevation Myocardial Infarction (STEMI) at PCI centers versus patients transferred from non-PCI centers, a retrospective study involving the National Inpatient Sample (NIS 2016-2021) database.

Background: Timely transfer for PCI is paramount in the management of STEMI. This has been shown to reduce myocardial damage, optimize reperfusion therapy and mitigate the post procedural complications associated with PCI. This study's aim was to describe the in-hospital outcomes associated with acute inter-hospital transfer of patients with STEMI for PCI in comparison with patients directly admitted to a primary PCI center. Methods: The National Inpatient Sample (NIS) was used to identify patients who underwent PCI for STEMI between the years 2016-2021. Based on several transfer indicators, primarily admitted patients and patients with acute inter-hospital transfer were identified. Logistic and linear regression models were used to analyze the primary outcome of in-hospital mortality and secondary outcomes of length of hospital stay, hospital charge, and occurrences of post-procedure complications. Results: Observations were weighted to obtain a national estimate of 748,430 patients with known transfer status who underwent PCI for STEMI. Of these, 625,520 patients were primarily admitted at PCI centers and 122, 910 patients were transferred from non-PCI centers. The mean age of patients with STEMI undergoing PCI was 62 years, and 72 % of the patients were male. There was no significant difference in mortality between patients transferred and patients primarily admitted for PCI due to STEMI. However, patients transferred had longer hospital stay and significantly higher healthcare cost, with a mean difference of 0.72 days (95% CI: 0.65 - 0.81 days, p-value &lt;0.000) and $3,354 (95% CI: $339 - $6371, p-value &lt;0.029), respectively. Patients transferred also had significantly higher odds of post procedure complications, including cardiogenic shock (Odds ratio: 1.49, 95% CI: 1.08 - 2.06, p-value &lt;0.014), cerebrovascular accident (Odds ratio: 3.64 , 95% CI: 1.15 - 11.45, p-value &lt;0.014) and kidney failure (Odds ratio: 2.10 , 95% CI: 1.09 - 4.02, p-value &lt;0.026). Conclusion: Patients with STEMI who were transferred for PCI experienced longer hospital stay and incurred higher healthcare costs. These patients had significantly higher odds of post procedure complications including cardiogenic shock, cerebrovascular accidents and kidney failure.

Percutaneous Anterograde Varicocele Embolisation: Technique and Clinical Outcomes

Transcatheter retrograde testicular vein embolisation for symptomatic varicoceles is well-established but has a documented failure rate. Percutaneous anterograde varicocele embolisation may be a suitable alternative. A retrospective observational, descriptive study of consecutive patients who underwent percutaneous anterograde varicocele embolisation at a single centre was performed. Twenty patients (16 adults, 4 adolescents) underwent unilateral varicocele treatment. Technical success rate was 100%. Mean (SD) fluoroscopy time was 106.5 (24.9) seconds. For patients treated for subfertility, mean (SD) DNA fragmentation index significantly decreased from 29.4 (4.48)% to 22 (2.45)% pre and post procedure. No clinical or radiological evidence of varicocele recurrence was detected at 1- and 2- year follow-up. Four patients (20%) experienced self-limiting pain. No major adverse events occurred. Percutaneous anterograde varicocele embolisation appears to be safe with high technical and clinical success rate. Larger studies are required to further evaluate this. Radiation dose may be lower than with retrograde embolisation.

Abstract 427: The Turkish National Thrombectomy Registry: Design and Initial Results

Background and Aims Recent randomized controlled trials demonstrated the benefit of thrombectomy for large vessel occlusion in acute ischemic stroke patients. Real‐world data aid in assessing reproducibility of outcomes outside of clinical trials in various countries. We have designed and implemented a national registry in Turkiye. We present the design, progress, and initial data from the Turkish National Thrombectomy Registry. Methods Patients aged ≥18 years who underwent thrombectomy for acute ischemic stroke were registered. The key items on the data collection form were divided into general stroke demographics and thrombectomy related sections. The main outcomes of effectiveness are post procedure angiographic recanalization graded using modified Thrombolysis in Cerebral Infarction grade and functional independence (modified Rankin Scale score, 0‐2) at 3 months. Results As of August 2024, 6 hospitals (involving 9 interventional neurologists) from 4 cities have joined the registry. A total of 560 patients (mean age±standard deviation of 67±13 year; median baseline NIHSS score of 16, IQR 12‐18) treated with thrombectomy are entered in the registry. Occlusion sites were internal carotid artery (n=335), middle cerebral artery M1 or M2 segment (n=306), posterior circulation (n=11), and distal vascular locations (n=11). The mean time mean (minutes±standard deviation) from symptom onset to thrombectomy was 261+/‐148 minutes. Symptomatic intracerebral hemorrhage (≥4 points NIHSS score increase) within 24 hours was observed in 57 subjects. Overall, functional independence at 90 days was observed in 301 (53.7%) of 560 subjects.

Abstract 208: BIUXX

Introduction Efficacy of transvenous endovascular complete embolisation of the superior ophthalmic vein (SOV) through external jugular venous approach in cranial and extra cranial arterio venous malformations. Methods Tranvenous endovascular embolisation of the superior ophthalmic vein was done in the following 3 patients. First patient, 40yr male had sudden onset right sided rapidly progressing proptosis and eye redness following a bout of cough during bronchoscopy for evaluation of a lung mass. Immediate CECT imaging brain and orbit showed phleboliths in a slow flow vascular malformation with rupture in the intra conal space with venous drainage into the SOV. No definite arterial feeders were identified. Second patient, 50 yr old lady, had gradually progressive right sided proptosis with peri orbital pain and eye redness over a period of 5 months. CECT brain and orbit showed indirect carotico cavernous fistula (CCF Barrow type B) with dilated right SOV. Third patient, 38yr old male, had a slowly progressive left sided peri orbital tortous swelling and mild proptosis over a period of 3 months following forehead trauma. CECT brain and face showed left frontal scalp and peri orbital arterio venous fistula with feeders from the superficial temporal artery and ophthalmic artery with venous drainage into the dilated SOV, facial vein and superficial temporal vein opening into the external jugular vein. Feeder from the superficial temporal artery was initially embolised from the arterial side in this patient followed by embolisation of the SOV through the trans venous approach. In all the 3 patients, SOV was the main or one of the major draining vein of the vascular malformations causing the orbital symptoms. In all the 3 patients, under general anaesthesia, USG guided access was taken from the ipsilateral external jugular vein with a 5F radial slender sheath. SOV was reached with a 2.4F microcatheter and 0.014 wire combinations manoeuvring the catheter via the facial vein and angular vein. Complete SOV embolisation was done using coils or glue mixed with lipiodol in1:1 ratio. Arterial access (Common femoral artery) was taken only in two patients. One with indirect CCF and another with left frontal arterio venous fistula to indentify the filling of the SOV in the former and to embolise the arterial feeders from the superficial temporal artery in the latter. Results Each of the 3 patients successfully underwent SOV embolisation via the trans venous approach. All the 3 patients had progressive decrease in proptosis and eye congestion in immediate post procedure period and follow up till now. Conclusions Endovascular trans venous SOV embolisation is simple and effective technique in treating indirect CCF, slow flow orbital venous malformations and extra cranial arterio venous fistula. This backdoor approach is also effective in cases where in there is no definite identifiable arterial feeder to the vascular malformation or when the feeder is a very tiny artery (ophthalmic artery) with difficult cannulation.

Abstract 375: Predictors of Good Clinical Outcomes After First Pass Effect in Anterior Circulation Tandem Occlusions

Introduction First pass effect (FPE) is an independent predictor of good clinical outcomes following mechanical thrombectomy (MT) in non‐tandem occlusions. A proximal tandem carotid steno‐occlusion introduces additional times and technical complexities which can influence recanalization and reperfusion dynamics and potentially, clinical outcomes in the long run. We evaluated the predictors of good clinical outcomes, specifically mRS0‐1 and mRS0‐2 at 90 days, in patients with anterior circulation tandem occlusions where recanalization was achieved through FPE from MT with emergent carotid artery angioplasty and stenting (eCAS), and had a baseline mRS0‐2.; Methods We perform a retrospective analysis of institutional thrombectomy database to identify univariate predictors. Significant predictors will be included in a multivariate logistic regression to determine significant predictors of mRS0‐1 and mRS0‐2 at 90 days post‐MT and eCAS.; Results We included 88 (66.2%) patients who achieved first pass effect among 133 anterior tandem occlusions undergoing MT with eCAS. Among patients with mRS0‐2 at 90 days, multivariate regression identified age (OR:0.857[0.772‐0.952],p=0.004), intravenous alteplase (OR:12.3[1.3‐114],p=0.027), use of a ballon guide catheter as opposed to conventional guides (OR:0.02[0.01‐0.63],p=0.027), time from arterial access to recanalization (OR:0.96[0.92‐0.999],p=0.043), pre‐eCAS oral aspirin/ticagrelor load as opposed to intravenous eptifibatide load (OR:0.017[0.001‐0.964],p=0.048) and symptomatic ICH (OR:0.025[0.001‐0.723],p=0.032) to be significant predictors. Significant predictors for mRS0‐1 at 90‐days were male sex (OR:41.33[1.45‐1179.31],p=0.03), hypertension (OR:0.03[0‐0.44],p=0.012), diabetes (OR:0.04[0‐0.63],p=0.023), use of a ballon guide catheter as opposed to conventional guides (OR:0.03[0‐0.66],p=0.027), distal embolization (OR:0.02[0‐1.71],p=0.082), time from arterial access to recanalization (OR:0.93[0.86‐0.99],p=0.026), residual carotid stenosis after eCAS (OR:0.003[0‐0.18],p=0.005), pre‐eCAS oral aspirin/ticagrelor load as opposed to intravenous eptifibatide load (OR:0.02[0‐0.25],p=0.016) and symptomatic ICH (OR:0.01[0‐0.38],p=0.012). Notably, heparin infusion post procedure predicted improved outcomes but was insignificant (OR: 55.54[0.59‐5226.65],p=0.083).; Conclusion The study highlights important considerations for eCAS, including the choice of antiplatelet loading agent, residual carotid stenosis and longer recanalization times which seem to impact good clinical outcomes.

A novel bionic constructional left atrial appendage occlude device: the result of preclinical experiment and first-in-human study

Abstract Objectives Left atrial appendage occlusion (LAAO) has emerged as a viable substitute for oral anticoagulation (OAC) for stroke prevention among individuals with atrial fibrillation (AF) these years. The high variability of left atrial appendage (LAA) in different individuals would lead to failure of LAAO or significant PDL post procedure using the existing occluders. Therefore, novel occluder which could address these issues is of great urgent. Methods SimuLock® occluders were implanted in 18 healthy canines percutaneously. Angiography and transesophageal echocardiography were employed to evaluate the effect of closure. The canines were sacrificed post-procedure immediately or on 30th, 90th and 180th. Subsequently, the gross anatomy was examined and endothelialization of device surface was evaluated by HE staining. 3 patients who had non-valvular AF and underwent LAAO in Zhongshan hospital, Fudan University using SimuLock® were enrolled in this study. They all had a follow-up of 3 months. Results All animals were implanted with the SimuLock® device. In 27.8% of animal cases, a LAA occluder of the "large umbrella and small disc" type which could adapt to LAA morphology well was employed, and all surpassed the specifications of existing occluders. None of residual shunt was observed all canines in 180 days post procedure. In addition, none adverse events were documents during the 6-month follow-up. In the first-in-human study, the SimuLock® occluder were successfully implanted in 3 subjects, all subjects achieved complete occlusion, without residual shunt &amp;gt; 3mm. The incidence of major adverse events, operation-related serious adverse events and device-related serious adverse events in all subjects were not documented in 3 months after operation. Conclusions In the animal experiment and first-in-human study, SimuLock® device showed the ability of adapting to various LAA morphology well and rapid endothelialization. The utilization of SimuLock® for LAAO exhibited high efficacy and safety.Central figure

Feasibility of ultra-low volume contrast pulmonary arterial injection protocol for CTA in TAVI candidates with severe renal failure

Abstract Introduction Computer tomography angiography (CTA) has an important role in patient screening before TAVI. The high volumes of iodinated contrast media (CM) injected during the examination represents the main limitation of CTA with a dose-dependent association with contrast-induced nephropathy. Purpose Show the feasibility of an ultra-low-dose CM pulmonary arterial injection protocol for CTA in TAVI candidates in high risk patients with severe renal failure. Methods In our retrospective study seventy-seven (77) patients with CKD on stage 3b or worse (eGFR ≤ 45/min/1.73 m2) underwent pre-procedural CTA for TAVI-planning with a pulmonary arterial administration of CM. All CTA examinations were performed using a Dual Source 256-slice CT system. All enhanced CT acquisitions were performed using our dedicated biphasic injection protocol composed of two connected phases of contrast medium injection using different amount of CM (8, 10, 15 and 20 ml) according to BMI (&amp;lt;22 kg/m2; 22-24 kg/m2; 24-28 kg/m2; &amp;gt;28 kg/m2). The CM was administered directly into the pulmonary artery in all patients. For each examination was measured Intraluminal attenuation at thoraco-abdominal aorta and along the ilio-femoral vessels using the ROI (mean SD in HU) as objective image parameters (Picture 1). Serum creatinine and the eGFR were recorded pre-TAVI CT scan and after the procedures as reference of CM to renal function. Results CTA was successfully performed in all patients. Mean creatinine was 2.25 ± 0,76 mg/dL and mean GFR was 26.5± 8.1 mL/min/m2. Mean vessel attenuation was 352±164 HU at the aortic annulus, 238.1 ± 141,3 HU in the aortic arch and 266±168 in the iliac arteries (Picture 2). The mean image noise was 28.2 ± 7 HU in the aortic annulus, 24.4 ± 10,9 in the right external iliac artery, and 25. ± 12,8 HU in the left external iliac artery. After CTA examination, a total of 74 patients (96%) underwent TAVI. Mean CM dose administered during TAVI procedure was 150,6 ± 85,8. Three patients (3.9%) were abolished for TAVI. Postprocedural settings complications were recorded. A total of 31 patients (41%) had grade 1 paravalvular regurgitation, 10 patients (14%) grade 2. No cases of valve embolization or anulus rupture occured. No major vascular complications occured. No significant differences between creatine and eGFR pre and post procedures (p&amp;lt;0,001). Conclusions The use of an ultra-low-dose CM pulmonary arterial injection protocol for CTA in TAVI candidates does not affect the renal function and procedural success rate is high and the clinical outcomes after TAVI is satisfactory according to the litterature.

Transcatheter closure of atrial septal defect (ASD) in adult and paediatric population without transoesophageal echocardiography/general anaesthesia

Abstract Background Transcatheter device closure is the preferred therapeutic option for ostium secundum atrial septal defect(OS-ASD). Standard practice is to perform it under transoesophageal echocardiography(TEE) guidance. However, TEE is performed under general anaesthesia (GA) and leads to increases in cost, procedural duration, ICU stay, total hospital stays, risk of oesophageal injury and complications of GA. Transthoracic echocardiography(TTE) is an excellent alternative and prior studies have shown it to be a safe alternative in paediatric population. In current study we analysed safety and efficacy of TTE-guided device closure of OS-ASD in all comer population irrespective of age, weight, defect size. Methods The study enrolled all patients who underwent device closure of OS-ASD between March 2017 and December 2023. All procedures were performed under LA for adults and conscious sedation for children. The device was placed under fluoroscopy guidance and position were confirmed on TTE. Procedural success, device, defect size ratio, procedural time, fluoroscopy time, complications, intensive care unit/hospital stay duration were analysed and compared with our own experience of 125 patients with TEE-guided closures before switching to complete TTE-guided procedure(before 2017). Results 340 patients underwent TTE-guided device closure of ASD. Procedure success was 97.4% with acceptable risk of major complications. Three(0.8%) had embolization into pulmonary artery, successfully operated surgically. Two had tamponade requiring drainage. In 9 patients, device could not be deployed despite multiple attempts and approaches. All of these had defect size of &amp;gt; 34mm and deficient IVC rim along with shorter (other than aortic) rim. Findings were compared with our own previous experience of TOE guided closure (practised before 2017). Compared to TOE group, TTE group had significantly lower total procedural duration (75±4 vs. 28 ±1 min; p &amp;lt; 0.01), intensive care unit stay (24±10 vs. 10.5±1 h; p &amp;lt; 0.01), and hospital (48±12 vs. 25.5±4h; p &amp;lt; 0.01) stay duration. Fluoroscopic time was similar in both. There was no mortality in either group. Major complications were comparable, TTE-guided group had less post-procedure complications of vomiting and headache. Additional findings of less pre-procedure fasting duration and early commencement of post procedure oral intake were noted in TTE group. Conclusion TTE-guided device closure of OS-ASD is a safe and feasible in all-comer population in experienced hands. It can definitely negate the use of TEE except in very poor echo window. The added advantages include utilization of physiological variations in PV/LV pressure during cough, Valsalva manoeuvres in awake patients. It definitely reduces the procedural duration, cost of procedure and dependence on GA and trained transoesophageal echocardiographer.