Rate Of Embolism Research Articles

Is CT pulmonary angiography overutilized in the evaluation of patients with suspected pulmonary embolism? A retrospective study.

Despite the high mortality rate of acute untreated pulmonary embolism (PE) at 30%, diagnosing PE is challenging. While the prevalence of PE has decreased in recent years, the overuse of computed tomography pulmonary angiography (CTPA) remains a concern. The National Institute for Health and Care Excellence (NICE) provides guidelines using the Wells score for PE assessment. The Royal College of Radiologists (RCR) recommends a positive yield of 15.4% - 37% for CTPA tests. This study assesses the positive yield of CTPA for suspected PE patients and evaluates the potential reduction through Wells score/D-dimer assessment as recommended by NICE. All patients who underwent CTPA between September 1, 2019, and January 31, 2020, at Salmaniya Medical Complex were included. Data on patient demographics and pre-CTPA workup were collected from electronic patient records (EPR) and stored in MS Excel 2019 for analysis. Of 188 suspected PE patients (mean age 50 ±12.3 years; 62.8% female), 12.2% were diagnosed with PE. None had documented Wells scores. A low-risk Wells score (≤4) was assigned to 68.6% of patients, with only 26.1% undergoing D-dimer testing. PE was confirmed in 4 patients with low-risk Wells scores and elevated D-dimers. All 10 patients with low-risk Wells scores and negative D-dimers were PE-negative. In total, 5.3% - 47.9% of the CTPAs conducted could have been avoided by following NICE guidelines. We propose integrating an algorithm-based checklist with validated tools like the Wells and Geneva scores into the ePMA system to guide appropriate CTPA referrals, promote evidence-based decision-making, reduce unnecessary imaging, and optimize patient care and resource use.

SPEED (SPlEnic Embolisation Decisions) study-Decision to treat acute traumatic splenic artery injury in the context of trauma protocol.

The spleen is commonly injured in trauma and this may be managed with a conservative approach, embolisation or splenectomy. There is uncertainty how splenic embolisation fits into the treatment paradigm and the delivery of IR services remains variable. The primary objectives are to determine if service design significantly affects splenic embolisation (SE) rates in AAST grade 2-5 acute traumatic splenic injuries (ATSI) across the Major Trauma Centres (MTCs) in England and to determine if variation in treatment affects SE outcomes in ATSI. We will include 5 years of data from traumatic splenic injury patients in the MTCs from 01/01/2016 to 31/12/2020 available from the Trauma Audit and Research Network (TARN) database. Inclusion Criteria will be all patients with ATSI registered with TARN. Those without a CT available to grade radiologically will be excluded. Data available from the TARN database and then correlated with data that will be collected at each MTC, where detail as to the embolisation technique, specific injury pattern, imaging based follow up and patient survival will be available. A short service-based questionnaire will be sent to each centre to establish centre-specific details such as on call rota, IR response activation, reporting practices and capture data around routine decision-making at that site. Data will be collected on an anonymised (REDCap) database. This project will evaluate the impact of service design on embolisation rates and outcomes, as well as evaluating the impact of the variation upon treatment selection and outcomes. Logistic regression will be used to identify factors associated with treatment selection and mortality at 30 days.

Incidence and Predictors of Clinical Outcomes in Real-Life Patients With Atrial Fibrillation Treated With Oral Factor Xa Inhibitors: The Follow-Up Results of the ANATOLIA-AF Study.

The main objective of this study is to determine the incidence and predictors of clinical outcomes in patients with AF treated with factor Xa inhibitors in a real-world setting. The present study was a multicentre and observational study that included patients with AF who were treated with factor Xa inhibitors. The primary outcome was the composite of ischemic stroke, TIA, systemic embolism, major bleeding, and all-cause mortality. A total of 1162 patients from 26 cardiology centers were included in this study, with a median age of 72 years. During the median 12-month follow-up period, the primary outcome occurred in 195 patients (16.8%). Treatment with rivaroxaban compared with apixaban and edoxaban showed a lower rate of ischemic stroke, TIA, and/or systemic embolism (2.2% vs. 4.7% vs. 6.5%, respectively, p = 0.014). The major bleeding rate was similar between all three factor Xa inhibitors. The all-cause mortality rate in the rivaroxaban group was lower compared with the apixaban and edoxaban groups (9.8% vs. 15.1% vs. 12.4%, respectively, p = 0.042). Overall, the frequency of primary outcome was 13.8%, 19.6%, and 20.6% for patients treated with rivaroxaban, apixaban, and edoxaban, respectively (p = 0.019). Older age, male sex, low body weight, high bleeding risk, heart failure, hypertension, liver failure, and treatment with apixaban 2.5 mg b.i.d. were independently associated with the development of primary outcome. The follow-up data from the ANATOLIA-AF study provides detailed data about the incidence and independent predictors of adverse clinical outcomes in patients with AF treated with factor Xa inhibitor treatment.

Safety and efficacy of a light antithrombotic regimen after left atrial appendage occlusion: Insights from the LOGIC (left atrial appendage occlusion in patients with gastrointestinal or IntraCranial bleeding) international multicenter registry.

Antithrombotic therapy (AT) after left atrial appendage occlusion (LAAO) in patients with non-valvular atrial fibrillation (NVAF) has the purpose of preventing device related thrombosis (DRT), avoiding embolic events; nevertheless, the correct antithrombotic regimen after LAAO is still under debate. Aim of this substudy of the observational LOGIC registry was to describe the efficacy and safety of a light antithrombotic regimen, comprising single antiplatelet therapy or none, compared to a standard antithrombotic regimen, after a successful LAAO. Patients with NVAF that underwent LAAO were previously included in the LOGIC registry. Patients receiving single or no AT were considered as light therapy group, while other regimen were considered as standard regimen group. Outcomes of interest were death from any causes and cardiovascular death, ischemic stroke, transient ischemic attack and systemic embolization, any bleeding and major bleeding at 12months. Six hundred and twenty-eight patients were considered in the analysis, 31.4% received a light antithrombotic regimen. There were no differences in overall and cardiovascular mortality (5.1% Vs 6.7%, p=0.426 and 2.0% Vs 1.4%, p=0.553 respectively). Cerebrovascular stroke and transient ischemic attack were similar between the two groups (1.5% Vs 1.4%, p=0.898 and 1.5% Vs 1.3%, p=0.847). Light regimen was not associated with an increased rate of systemic embolism (1.0% Vs 0.7%, p=0.447 and HR 0.88 [95% CI: 0.34-2.27; p=0.79]). A light AT regimen did not affect bleeding events being not different between the two groups (HR 0.71; 95% CI: 0.33-1.59; p=0.41). An AT regimen based on single or no antithrombotic therapy after LAAO seems to be safe in patients with high-bleeding risk, without increasing cerebrovascular or peripheral ischemic events.

Treatment of saccular wide-neck intracranial aneurysm using Leo baby stent: a single-center experience based on 156 cases.

To describe the mid-term safety and efficacy of Leo baby stent applied in saccular wide-neck intracranial aneurysms (IAs). 151 patients harboring 156 IAs treated with Leo baby stent from March 2021 to October 2023 were enrolled for further analysis. Among 156 IAs, 142 cases (91.0%) received one single Leo baby stent deployment while 14 cases (9.0%) received dual stents deployment. Stent-assisted coiling strategy was applied in all cases and the success rate was 100%. Immediate IAs occlusion results showed that 48 cases (30.8%) obtained Raymond grade I, 39 cases (25.0%) obtained Raymond grade II and 69 cases (44.2%) obtained Raymond grade III. Perioperative complications occurred in 10 cases (6.4%). Overall morbidity rate was 3.5% and mortality rate was 0% during follow-up. Clinical follow-up was available in 141 patients (93.4%). 136 patients (96.5%) got favorable clinical prognosis (mRS score 0-2) while 5 patients (3.5%) were in a poor neurological condition (mRS score 3-6). Angiographic follow-up was available in 136 cases (87.2%). The results showed that Raymond grade I was obtained in 112 cases (82.4%), Raymond grade II was obtained in 11 cases (8.1%) and Raymond grade III was obtained in 13 cases (9.6%). 4 cases (2.9%) were confirmed with IAs recurrence and received retreatment. Asymptomatic in-stent stenosis was detected in 8 patients (5.9%). The results demonstrate that stent-assisted coiling using Leo baby stent with favorable IAs embolization rate and the low complication rate is a feasible way in treating complex IAs.

Effect of Proximal Blood Flow Arrest During Endovascular Thrombectomy (ProFATE): A Multicenter, Blinded-End Point, Randomized Clinical Trial.

The effect of temporary blood flow arrest during endovascular thrombectomy for acute ischemic stroke is uncertain due to the lack of evidence from randomized controlled trials. We aimed to investigate whether temporary blood flow arrest during endovascular thrombectomy using a balloon guide catheter improves intracranial vessel recanalization compared with nonflow arrest. The ProFATE trial (Proximal Blood Flow Arrest During Endovascular Thrombectomy) was a multicenter, randomized, participant- and outcome-blinded trial at 4 thrombectomy centers in the United Kingdom. Adults with acute ischemic stroke due to anterior circulation large vessel occlusion were randomly assigned (1:1) by a central, Web-based program with a minimization algorithm to undergo thrombectomy with temporary proximal blood flow arrest or nonflow arrest during each attempt. The primary outcome was the proportion of participants achieving near-complete/complete vessel recanalization (expanded Thrombolysis in Cerebral Infarction score of 2c or 3) at the end of the thrombectomy procedure, adjudicated by a blinded independent imaging core laboratory. Analyses were performed on the intention-to-treat population, adjusted for age, IV thrombolysis, onset-to-randomization time, Alberta Stroke Program Early CT Score, occlusion site, randomization site, and National Institutes of Health Stroke Scale. Between October 10, 2021, and June 27, 2023, we recruited 134 participants, of whom 131 participants (mean age, 75 years; 62 [47%] women and 69 [53%] men) were included in the final analysis. Sixty-six participants were allocated to the temporary blood flow arrest group and 65 to the nonflow arrest group. The proportion of participants with an expanded Thrombolysis in Cerebral Infarction 2c/3 score at the end of the endovascular procedure was 74.4% (49/66) in the flow arrest group and 70.8% (46/65) in the nonflow arrest group (adjusted odds ratio, 1.07 [95% CI, 0.45-2.55]; P=0.88). Among the prespecified secondary efficacy outcomes, a lower rate of emboli to a new vascular territory occurred in the blood flow arrest group compared with the nonflow arrest group (1.5% versus 12.3%; adjusted odds ratio, =0.04 [95% CI, 0.01-0.53]; P=0.014) and a higher rate of complete recanalization (expanded Thrombolysis in Cerebral Infarction score, 3) after the first attempt in the flow arrest group versus the nonflow arrest group (33.0% versus 15.3%; adjusted odds ratio, =3.80 [95% CI, 1.40-10.01]; P=0.007). No between-group differences were identified for the remaining procedural or clinical efficacy (modified Rankin Scale at 90 days) or safety outcomes (worsening of the stroke severity at 24 hours, adverse events, symptomatic intracranial hemorrhage, or mortality). Among patients presenting with anterior circulation large vessel occlusion acute ischemic stroke, temporary proximal blood flow arrest during endovascular thrombectomy, compared with nonflow arrest, did not significantly improve the near-complete/complete vessel recanalization (expanded Thrombolysis in Cerebral Infarction score, 2c-3) at the end of the procedure. Larger randomized controlled trials are warranted to confirm or refute a clinically significant treatment effect of temporary flow arrest on the functional outcome following endovascular thrombectomy. URL: https://www.clinicaltrials.gov; Unique identifier: NCT05020795.

Enhancing thrombectomy outcomes with Adaptive Pulsatile Aspiration (APA): the role of complete clot ingestion in reducing thrombectomy time and distal embolization

BackgroundComplete clot ingestion (CCI) is defined as full ingestion of the clot into the catheter or pump canister without any external clot remnants at the catheter tip. The aim of...

Differences in Management and Outcomes in Atraumatic Splenic Rupture Compared to Traumatic Injury Following Blunt Abdominal Trauma.

Background/Objectives: To evaluate the differences in treatment and outcomes between traumatic and atraumatic splenic lacerations. Methods: This retrospective study included all patients with a diagnosis of splenic lacerations confirmed by computed tomography that presented from 01/2010 to 03/2023 at one tertiary hospital. The exclusion criteria included missing image data and death in the first 24 h due to extensive trauma. The etiology of the splenic laceration, demographic characteristics, and clinical parameters were recorded and evaluated as prognostic factors in therapy success and mortality. Subgroup analyses were undertaken according to the etiology of the splenic laceration and the primary treatment. The extent of splenic laceration was assessed by using the American Association for the Surgery of Trauma (AAST) score in its latest revision (2018). Results: Of all 291 enrolled patients (mean age 47 ± 21 years, 204 males), 50 presented with atraumatic splenic lacerations due to different underlying causes. The occurrence of moderate and high-grade laceration differed significantly between the atraumatic and traumatic study group (45/50 [90%] vs. 139/241 [58%], p < 0.001). Accordingly, the number of patients being treated conservatively differed greatly (20/50 [40%] vs. 164/241 [56%]), with a worse clinical success rate for atraumatic lacerations (75% vs. 94.5%). Atraumatic splenic injuries showed a higher conversion rate to surgery (2/20 [10%] vs. 2/164 [1%]). Despite the lower clinical success rate of splenic artery embolization (SAE) in atraumatic injuries (87% vs. 97%), the number of patients needing treatment for primary SAE in AAST 3 injuries was 14.1 in the traumatic population and only 4 in the atraumatic population. Conclusions: Atraumatic splenic injuries should not be treated as traumatic splenic injuries. An early upgrade to SAE or surgery should be considered for moderate splenic injuries, and they should be evaluated by an interdisciplinary team on a case-by-case basis. However, due to the underlying multimorbidity of patients with atraumatic splenic injuries, a higher mortality is to be expected.

IVC filter use in patients with a history of venous thromboembolism undergoing bariatric surgery: a MBSAQIP study.

Research on the use of prophylactic inferior vena cave filter (IVCF) placement prior to metabolic and bariatric surgery (MBS) in high risk patients has yielded conflicting results. We evaluated thrombotic events and mortality in patients with a history of venous thromboembolism (VTE) who underwent IVCF placement in anticipation of MBS. We queried the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for all patients undergoing primary sleeve gastrectomy or Roux-en-Y gastric bypass from 2015 to 2019 with a history of VTE. We tabulated yearly IVCF use and compared 30-day rates of deep venous thrombosis (DVT), pulmonary embolism (PE), readmission, mortality, and serious adverse events in patients with and without prophylactic IVCF placement. Multivariate logistic regression was used to assess the relationship between preoperative placement of an IVCF and postoperative outcomes. Of 754,397 patients undergoing MBS, 16,683 (2.2%) had a prior VTE. Placement of IVCF in anticipation of MBS decreased from 285/2245 (10.4%) in 2015 to 85/3750 (2.2%) in 2019 (p < 0.01). The incidence of PE did not differ significantly between patients with prophylactic IVCF vs. those without (0.1% vs 0.5%, p = 0.13). Postoperative DVT was more common in patients who underwent IVCF placement (1.7% vs. 0.8%, p < 0.01). No significant differences were observed in mortality. Preoperative placement of an IVCF was an independent risk factor for development of a postoperative DVT (OR 2.45; 95% CI 1.39-4.32). These data do not support a history of VTE as an indication for prophylactic IVCF placement in anticipation of MBS.

Intraoperative Tranexamic Acid in Radical Cystectomy: Impact on Bleeding, Thromboembolism, and Survival Outcomes.

Perioperative blood transfusion has been reported in > 50% of patients undergoing radical cystectomy (RC). Unfortunately, perioperative blood transfusion (PBT) in patients undergoing RC has been associated with poor oncological outcomes. Tranexamic acid (TXA) use has been proposed to decrease the need for PBT. Here, we seek to investigate the impact of intraoperative TXA on the risk of perioperative bleeding and venous thromboembolism (VTE) in patients undergoing RC. We also investigate its long-term impact on overall survival (OS) and cancer-specific survival (CSS) outcomes. We queried the prospectively maintained Mayo Clinic Radical Cystectomy registry and identified all RC performed for bladder cancer between 1990 and 2021. Primary outcomes assessed include the risk of perioperative bleeding, the need for blood transfusion, and the risk of VTE. Secondary outcomes include the impact of using TXA on OS and CSS. Of 2862 patients with complete available data, 468 received TXA (TXA recipient) and were matched 1:1 for age, neoadjuvant chemotherapy, pathologic staging, and preoperative hemoglobin with a group who did not receive TXA (TXA nonrecipient). TXA recipients experienced less estimated blood loss intraoperatively (median of 600 vs 650) cc and were less likely to need PBT (31% vs 50%, P value < .001) compared with TXA nonrecipients. There was no difference between groups in deep venous thrombosis and pulmonary embolism rates within 90 days of RC. In the adjusted survival model, use of TXA was not independently associated with significant impact on OS or CSS. However, perioperative blood transfusion was associated with poor OS and CSS (P value < .001). TXA use was associated with a significant reduction in estimated blood loss and PBT without increased risk of VTE. In univariable analyses, we observed an association between TXA use and improved OS as well as CSS. However, in multivariable analyses, TXA itself was not independently associated with improved OS or CSS; instead, PBT was. Further studies are warranted to explore strategies for minimizing PBTs and their impact on survival outcomes.

Ophthalmic artery feeders in meningioma reduce the effectiveness of transarterial embolization with n-butyl cyanoacrylate

N-butyl cyanoacrylate (n-BCA) is often used for preoperative transarterial embolization (TAE) of meningiomas. However, factors affecting the embolization effect with n-BCA remain unclear. This study aimed to clarify the factors associated with the embolization rate after TAE using n-BCA in meningioma, from the aspect of feeder architecture. We retrospectively analyzed 62 patients with meningioma who underwent preoperative TAE with n-BCA between 2016 and 2021. Patient variables, including characteristics, intraoperative findings, and outcomes, were collected. Feeder architecture was classified into 7 groups: 1) internal maxillary artery, 2) occipital artery, 3) ascending pharyngeal artery, 4) posterior meningeal artery, 5) infraclinoidal internal carotid artery, 6) ophthalmic artery (OphA), and 7) pial feeder group, based on preoperative angiography. We set primary outcome as the embolization rate, representing the reduction rate of the gadolinium-enhanced lesion volume observed on contrast-enhanced magnetic resonance imaging. Angiographic findings following n-BCA injection were classified as feeder occlusion or intratumoral embolization. We analyzed the factors associated with the embolization rate. The OphA feeder group showed a decrease in the embolization rate (P= 0.008). The number of feeder groups with intratumoral embolization showed a robust positive correlation (r= 0.557). The OphA feeder group showed an increase in the number of feeder groups (P < 0.001) and larger tumor volume (P= 0.005). The OphA feeder group was associated with a lower embolization rate. Our study suggested that the vascular architecture in meningioma affected the efficacy of TAE with n-BCA.

Hormone Replacement Therapy in Postmenopausal Women Undergoing Total Hip Arthroplasty is Associated With Reduced 10-Year Periprosthetic Femoral Fracture Rate.

In postmenopausal women who are estrogen deficient, hormone replacement therapy (HRT) has been shown to improve fragility fracture risk. However, few studies have examined the relationship between HRT and periprosthetic fracture (PPF) risk after total hip arthroplasty (THA). The purpose of this study was to determine the impact of HRT use on 10-year PPF risk following THA. A retrospective cohort study was conducted using a large national database. Women who underwent elective THA were identified and stratified based on preoperative (< 6 months) HRT use. Those taking HRT were propensity score matched at a 1:2 ratio to those who do not have a history of HRT use based on age and Charlson Comorbidity Index score. Kaplan-Meier and Cox proportional hazards analyses were conducted to determine rates of PPF, revision, and aseptic loosening within 10 years of surgery. Regression analyses were performed to determine 90-day rates of venous thromboembolism (VTE) after controlling for perioperative VTE prophylaxis. In total, 21,220 patients were included. Patients who were taking HRT before THA demonstrated a lower risk of PPF (hazard ratio: 0.8; 95% confidence interval: 0.6 to 0.9) within 10 years of THA, but a similar risk of all-cause revision surgery and revision for aseptic loosening. The HRT cohort demonstrated lower odds of deep vein thrombosis (odds ratio: 0.7; 95% confidence interval: 0.6 to 1.0) and similar rates of pulmonary embolism. In postmenopausal women, HRT use before elective THA was associated with lower rates of PPF within 10 years of surgery and was not associated with increased VTE risk. Given these results, appropriate HRT usage in patients may have a role in reducing PPF after THA.

Early vs later non-vitamin K antagonist oral anticoagulants in patients with acute ischemic stroke and atrial fibrillation: A meta-analysis and systematic review of randomized trials.

There are conflicting published data on the optimal timing of non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with acute ischemic stroke. To compare the efficacy and safety of early initiation of NOACs with later initiation of NOACs in those patients, we conducted a meta-analysis of phase 3 or phase 4 randomized controlled trials. We systematically searched the Cochrane Library, PubMed, and Embase databases. A random effects model was selected to pool the effect measurement estimates (risk ratios [RRs] and 95% confidence intervals [CIs]). Three randomized controlled trials with 6442 enrolled patients with AF and acute ischemic stroke were included. Compared with later NOAC therapy, early NOAC therapy was associated with nonsignificant reductions in the risk of primary outcomes (RR, 0.82; 95% CI, 0.65-1.05). Subgroup analysis found that in reducing risk of primary outcomes, early anticoagulation may benefit female patients more than male patients (0.54 [0.35-0.83] vs 0.97 [0.63-1.50]; P for interaction, .06). Numerically lower rates of recurrent ischemic stroke (RR, 0.80; 95% CI, 0.56-1.15), death (RR, 0.96; 95% CI, 0.81-1.15), and systemic embolism (RR, 0.43; 95% CI, 0.16-1.11) were observed in early initiation of NOACs in comparison with later initiation of NOACs. There was no difference in major bleeding (RR, 0.98; 95% CI, 0.55-1.74), symptomatic intracranial hemorrhage (RR, 0.93; 95% CI, 0.43-1.96), or major extracranial bleeding (RR, 0.73; 95% CI, 0.28-1.95) between groups. In AF patients with acute ischemic stroke, early initiation of NOACs is not inferior to later initiation of NOACs in reducing composite events, without increased hazard of bleeding, especially in female patients.

Embolization of persistent type 2 endoleaks after endovascular treatment of abdominal aortic aneurysms: a study of long-term success

Endovascular treatment of abdominal aortic aneurysms (EVAR) has been shown to be effective, with lower perioperative mortality and morbidity than open surgical treatment in patients with compatible anatomy. This benefit is lost after three years of follow-up. This could be explained by the higher rate of reintervention in EVAR patients due to endoleaks. Around half of patients with a persistent type 2 endoleak have an increase in aneurysm size. Either endovascular or by conventional surgery techniques have been described to treat this type of endoleak. The aim of this study was to measure the long-term success rate of embolization of type 2 endoleaks (T2EL) in a pragmatic retrospective series.A total of 592 patients underwent stent-graft surgery at CHU Amiens Picardie during the study period. During follow-up, endoleaks were observed in 140 patients (25 type 1, 122 T2EL, 8 type 3, 1 type 4 and 4 type 5 endoleaks). Concerning T2EL type, 53 were not persistent. Treatment decision was ordered for 30 patients. Among them, 22 patients underwent primary embolization (73%), 7 patients underwent primary surgical treatment (23%) and 1 patient underwent emergency endovascular extension for aortic rupture. The technical success were achieved in all procedures (n=22) , after embolization, the median follow up was 51 months [29.25 – 59.75]. At the end oft he study 8 patients (36%) were considered in „clinical success“ with no difference among embolization procedure, embolization agent used or initial clinical characteristics.We report that embolization procedures have a low clinical sucess rate durign follow-up. Further studies should investigate the etiologies of sac enlargement after embolization, that could be related with of a wrong categorization of initial endoleak.

The clinical effect of flow-diverting stent for treatment of unruptured internal carotid artery small- and medium-sized wide-neck aneurysms

Objective: To study the feasibility of domestic flow diverter(TFD) for the treatment of unruptured internal carotid artery small- and medium-sized wide-neck aneurysms. Methods: This is a retrospective case series study.The study retrospectively evaluated consecutive 54 patients with unruptured intracranial small- and medium-sized wide-neck aneurysms treated with TFD in the Department of Cerebrovascular Disease,the Second Affiliated Hospital of Kunming Medical University between October 2019 and January 2024. There were 11 males and 43 females, and the age of patients was (54.9±9.6) years (range:36 to 74 years). There were 63 aneurysms in 54 patients,6 of which were tandem multiple small aneurysms. One case had saccular aneurysms of bilateral internal carotid artery. The maximum diameter of aneurysm was (4.1±0.8) mm (range: 1.5 to 10.0 mm).The ratio of the maximum diameter of the aneurysm to the neck width diameter was 1.3±0.4 (range:0.4 to 2.4). The surgical and follow-up data were collected. The aneurysm embolization rate at the immediate operation and follow-up,and the complications were analyzed. The degree of aneurysm embolization was evaluated using the O'Kelly-Marotta (OKM) grading system,with OKM grade D as complete occlusion and grade C and above (C1,C2,C3 and D) as successful occlusion. Clinical outcomes of all patients were evaluated by modified Rankin scale(mRS). Results: For 63 aneurysms, 48 aneurysms were treated with TFD alone,and 15 aneurysms were treated with a combination of TFD and coiling. The immediate postoperative successful occlusion rate was 14.3% (9/63) and the complete occlusion rate was 3.2% (2/63). Follow-up results were obtained for all of the patients. The follow-up time (M(IQR)) was 124 (182) days (range: 85 to 754 days). The time to aneurysm successful occlusion was 140.5 (151.5) days (range: 85 to 308 days). At final follow-up,the successful aneurysm occlusion rate was 68.3% (43/63) and the complete occlusion rate was 58.7% (37/63). The complete occlusion rate of the TFD group was 50.0% (24/48) and the TFD+coiling group was 13/15. All patients had no aneurysm rupture,ischemic complications and no recurrence of the aneurysm needed to retreatment during the intraoperative and follow-up period. A total of 3 mild haemorrhagic complications which were related to dual-antiplatelet agents. Twelve patients had asymptomatic mild-moderate stent stenosis. TFD covered 66 branch vessels totally. Only 6 branches were affected by the time of the last follow-up and none of the patients had relevant ischaemic symptoms. All of 54 patients were evaluated as mRS score<2 points at the last follow-up. Conclusion: Using TFD to treat internal carotid artery unruptured small and medium-sized wide-neck aneurysms can simplify the surgical procedure with low complication rate, which is a clinically optional treatment approach.

National trends in surgical treatment and clinical outcomes among patients with aneurysmal subarachnoid hemorrhage in the Republic of Korea.

In this study, changes in treatment methods and patient prognosis were analyzed using a Korean nationwide medical insurance information database. Patients with subarachnoid hemorrhage who received surgical treatment for cerebral aneurysm from 2005 to 2020 were included. The specific surgery type was classified using the surgical code and according to whether stents were used. Yearly trends in mortality rates and poor prognosis, using tracheostomy as proxy, were analyzed by a simple regression analysis. A multistep logistic regression analysis was performed to evaluate the risk factors of mortality and poor prognosis. Overall, 83,587 patients were included. Females were predominant (64.5%). Microsurgical clip usage rate decreased by approximately two-thirds from 78.8% in 2005 to 24.4% in 2020. Contrarily, endovascular treatment proportion gradually increased, and stent-assisted coil embolization rate surpassed microsurgical clip usage rate in 2020 (24.6% vs. 24.4%). In the multivariate analysis, endovascular treatment correlated positively with 3-month mortality (hazard ratio [HR]: 1.13, 95% confidence interval [CI]: 1.07-1.19, P<0.0001), although correlated negatively with poor prognosis (tracheostomy) (HR: 0.93, 95% CI: 0.89-0.98, P=0.0050). According to the treatment trend analysis, during the 16 years studied, for patients with subarachnoid hemorrhage due to ruptured cerebral aneurysm, the endovascular treatment rate increased rapidly and stent-assisted coil embolization rate surpassed that of microsurgical clip ligation. Diversification of treatment methods has led to a decrease in mortality and improved prognosis.

The Effects of Syphilis Infection on Total Knee Arthroplasty Outcomes: A Retrospective Cohort Study.

Objective: This study investigated the impact of recent syphilis infection on postoperative outcomes following total knee arthroplasty (TKA). We hypothesized that patients with a documented history of syphilis infection would experience a higher rate of postoperative complications compared to those without such a history. Methods: We conducted a retrospective cohort analysis using a national insurance claims database. Our study population included 237,360 patients who underwent primary TKA between 2005 and 2024. Patients were classified into two groups based on the presence (+Syph) or absence (-Syph) of a syphilis diagnosis within one year prior to the TKA. We evaluated the rates of several postoperative complications at 30 days postsurgery, including infection, hematologic issues, and cardiac events. Statistical analyses between groups was performed using chi-squared tests and Fisher's exact tests. Routine demographic data such as age, sex, race, and comorbidities were also analyzed. Results: Among the 237,360 TKA patients, we identified 71 with a history of syphilis within one year of their surgery. The +Syph group exhibited significantly higher rates of periprosthetic infection (4.23% vs. 0.81%, p = 0.001), need for manipulation under anesthesia (MUA) at four months (7.04% vs. 2.82%, p = 0.032), deep venous thrombosis (4.23% vs. 1.27%, p = 0.026), periprosthetic fracture (2.82% vs. 0.23%, p < 0.001), and pneumonia (2.82% vs. 0.62%, p = 0.019) within 30 days postTKA. No significant differences were observed in 30-day mortality, deep or superficial surgical site infections, wound dehiscence, blood loss anemia, or transfusion requirements. Additionally, rates of acute renal failure, pulmonary embolism, and cardiac events did not differ significantly between groups. Demographically, patients in the syphilis cohort had a higher prevalence of smoking and diabetes preoperatively within one year of their surgical date. Conclusions: A documented syphilis diagnosis within one year of TKA significantly affects postoperative outcomes, increasing the rates of prosthetic joint infection, MUA, deep venous thrombosis, periprosthetic fracture, and pneumonia. These findings underscore the need for heightened vigilance in the pre- and postoperative management of patients with a history of syphilis infection undergoing TKA. Further research is warranted to explore the relationship between prior syphilis infection and TKA outcomes, as well as to develop strategies to mitigate this increased risk.

A Meta-Analysis and Meta-Regression of Embolisation Outcomes of Pulmonary Arteriovenous Malformations.

Embolisation is a widely utilised therapeutic intervention for pulmonary arteriovenous malformation (PAVM). We conducted a meta-analysis to evaluate outcomes of PAVM embolisation and factors associated with embolisation outcomes. MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 2000 to July 2022 on studies that assessed embolisation outcomes of PAVM. Immediate technical success rate defined as the complete occlusion of the PAVM at the time of embolisation and treatment success rate defined as ≥ 70% venous sac reduction on follow-up imaging were pooled from included studies with use of random effects proportion meta-analysis. Heterogeneity across studies was assessed with the I2 statistic. Forty-four studies including 1865 patients (604 (32%) males, mean age (range) 45 (24-59) years, 1125 (60%) had hereditary haemorrhagic telangiectasia (HHT)) were included in the meta-analysis. Studies included a total of 4314 PAVMs of which 4047 (94%) were treated. Studies reported morphology of 3074 PAVMs (2519 (58%) simple and 555 (13%) complex). The pooled overall immediate technical success rate for PAVM embolisation was 99%, 95% CI (98-100%) and the treatment success rate was 86%, 95% CI (84-89%). Younger age (p = 0.041), simple PAVM (0.020), and embolisation using plugs (p = 0.001) were associated with higher treatment success. Feeding artery and sac embolisation (p = 0.021) and using coils (p = 0.001) were associated with lower treatment success. There was no significant difference in recanalisation rate between different embolisation agents (OR 0.64, 95% CI -0.09- 1.38). This meta-analysis shows that PAVM embolisation is safe and effective. Higher treatment success rates for PAVM embolisation can be achieved using plugs as the primary embolisation agent. Embolisation agent used had no effect on recanalisation rates.

Abstract 4143224: Feasibility of Left Atrial Appendage Occlusion with Dual-Seal Technology without Pre-Procedural CT: Early Single-Center Experience

Background: Left Atrial Appendage (LAA) Occlusion with Amulet has shown promising results in achieving complete closure with minimal periprocedural leak. Amulet’s dual-sealed technology and numerous sizing options provide versatility for different LAA morphologies. Pre-procedural CT is routinely recommended for pre-procedural planning. However, this brings risks including use of contrast, risk of renal failure, radiation exposure, and patient inconvenience. Here, we share initial results of our Amulet implantation protocol without pre-procedural CT: 83 cases were reviewed; number of devices used, procedural time, periprocedural bleeding complications, success in coming off oral anticoagulation, and incidences of stroke and embolism were followed. Methods: We followed 83 AF patients who underwent LAA closure with Amulet, implanted with intraprocedural TEE, intracardiac left atrial echocardiography, and intraprocedural angiography. Pre-procedural CT was not used. Patients were followed to assess safety and efficacy of this protocol. Safety endpoints included rates of procedural and bleeding complications. Efficacy endpoints included rates of stroke and embolism, and number of devices used. Results: All 83 procedures were successfully completed with no perioperative procedural complications and no documented leaks on follow-up TEE. Patients had early ambulation with closure. On average, 1.14 devices were used per case: 88% of cases required 1 device, and nine cases required 2 devices; one case required 4 devices to fit as patient was noted to have an interrupted IVC, requiring implantation via right IJV. There were no cases of stroke or embolism following implantation, and all patients were safely able to come off oral anticoagulation. Conclusions: Results demonstrate that Amulet with its dual-sealed technology can be effectively and safely implanted without pre-procedural CT. No perioperative complications were observed. 88% of cases closed with single device usage. No post-procedure leaks were noted on follow-up TEE. Safety endpoints revealed minimal adverse events, with 2 cases of late pericardial effusion managed without long-term consequences. This protocol demonstrated high efficacy, as all patients were successfully able to come off oral anticoagulation with no reported strokes or embolic events. Intraprocedural TEE, intracardiac left atrial echocardiography, and intraprocedural angiography are typically appropriate for periprocedural sizing of the device.

Efficacy of direct oral anticoagulants vs. warfarin in left ventricular thrombus in myocardial infarction: systematic review and meta-analysis.

Current recommendations for antithrombotic strategies in left ventricular (LV) thrombus following myocardial infarction (MI) remain uncertain. This study aimed to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) compared to warfarin in LV thrombus following MI. A systematic search using four databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, was conducted from inception to 8 July 2024, without language restrictions. The inclusion criteria were studies that included patients with LV thrombus following MI and compared the efficacy or safety of DOACs and warfarin. There were 11 studies (3 randomized and 8 nonrandomized) included in this meta-analysis, involving 14 927 participants. We used a random-effects model for this meta-analysis. DOACs were associated with higher thrombus resolution than warfarin, with a risk ratio (RR) of 1.07 [95% confidence interval (CI) 1.00-1.15], P = 0.04. Similarly, DOACs were associated with a lower rate of stroke and systemic embolism, with an RR of 0.84 (95% CI 0.78-0.90), P < 0.01. DOACs also marginally reduced the rate of major bleeding compared with warfarin, with an RR of 0.87 (95% CI 0.75-1.00), P = 0.05. DOACs were associated with higher rates of LV thrombus resolution, lower rates of stroke/systemic embolism, and marginally reduced major and bleeding events compared with warfarin in patients with LV thrombus following acute MI. Therefore, DOACs may be a reasonable alternative to warfarin in this setting.