The Stream Device-A Retrospective Review of 51 Cases

Publisher Copyright: © 2023 by the authors.Mechanical thrombectomy is the gold-standard treatment for patients that have suffered large-vessel occlusion (LVO) stroke. Various different stent-retrievers, aspiration catheters, and techniques have been developed to perform this procedure. We present our initial results regarding the Stream device. Materials and Methods: We performed a retrospective review of a prospectively maintained database at our high-volume centre to identify all patients treated with the Stream device between February 2021 and January 2023. We recorded baseline demographics, NIHSS, ASPECT scores, eTICI scores, complications, and 90-day mRS. Results: We identified 51 patients, 49.0% of whom were male (n = 25), with a median age of 73 (range: 51–89) and a median NIHSS score of 17 (range 4–22), and 68.6% received IV tPA. The median ASPECT score was 10 (range 6–10). Hyperdense clots were seen in 34 cases (66.7%), with a mean clot length of 12 ± 6.2 mm (range 2–26 mm). Clots were located in the anterior circulation in 49 patients. The standard Stream device was used in 78.4% of cases, with Stream 17 being used in 19.6% of cases. The FPE was observed in 25.5% of cases (n = 13), with the mFPE being seen in 31.4% of cases (n = 16). A final eTICI score of ≥2b was achieved in 90.2% of cases (n = 46), and eTICI 2c/3 was seen in 84.3% of cases (n = 43). Furthermore, 24 h CT scans showed that the median ASPECT score was 8 (range 0–10). Good functional outcomes at 90 days (mRS ≤ 2) were achieved in 21.6% of cases (n = 11). Conclusions: The Stream device shows acceptable rates of FPE and mFPE compared to existing devices. Further larger studies are required alongside an understanding of the optimal technique for this device’s use.Peer reviewe

Endovascular thrombectomy in anterior circulation stroke and clinical value of bridging with intravenous thrombolysis

Background Bridging treatment with intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) in acute ischemic stroke is applied under the assumption of benefits for patients with large vessel occlusion (LVO). However, the benefit of this additional step has not yet been proven. Purpose To compare procedural parameters (procedural time, number of attempts), complications, and clinical outcome in patients receiving EVT vs. patients with bridging treatment. Material and Methods In this prospective study all patients had acute anterior cerebral circulation occlusion and were treated with EVT. All patients were selected for treatment based on clinical criteria, multimodal computed tomography (CT) imaging. Eighty-four patients were treated with bridging IVT followed by EVT; 62 patients were treated with EVT only. Results Bridging therapy did not influence endovascular procedure time (P = 0.71) or number of attempts needed (P = 0.63). Bleeding from any site was more common in the bridging group (27, 32%) vs. the EVT group (12, 19%) (P = 0.09). Functional independence modified Rankin Scale after 90 days was slightly higher in the bridging group (44%) vs. the EVT group (42%) (P = 0.14). Mortality did not differ significantly at 90 days: 17% in the bridging group vs. 21% in EVT alone (P = 0.57). Both treatment methods showed high recanalization rates: 94% in the bridging group and 89% for EVT alone. Conclusion Bridging treatment in LVO did not show benefits or elevated risks of complications in comparison to EVT only. The bridging group did not show significantly better neurological outcome or significant impact on procedural parameters vs. EVT alonepublishersversionPeer reviewe

Long-term treatment with the oncolytic ECHO-7 virus Rigvir of a melanoma stage IV M1c patient, a small cell lung cancer stage IIIA patient, and a histiocytic sarcoma stage IV patient-three case reports

Publisher Copyright: © 2016 International Virotherapy Center. APMIS published by John Wiley & Sons LtdOncolytic virotherapy is a recent addition to cancer treatment. Here, we describe positive treatment outcomes in three patients using Rigvir virotherapy. One of the patients is diagnosed with melanoma stage IV M1c, one with small cell lung cancer stage IIIA, and one with histiocytic sarcoma stage IV. The diagnoses of all patients are verified by histology or cytology. All patients started Rigvir treatment within a few months after being diagnosed and are currently continuing Rigvir treatment. The degree of regression of the disease has been determined by computed tomography. Safety assessment of adverse events graded according to NCI CTCAE did not show any value above grade 1 during Rigvir® treatment. Using current standard treatments, the survival of patients with the present diagnoses is low. In contrast, the patients described here were diagnosed 3.5, 7.0, and 6.6 years ago, and their condition has improved and been stabile for over 1.5, 6.5, and 4 years, respectively. These observations suggest that virotherapy using Rigvir can successfully be used in long-term treatment of patients with melanoma stage IV M1c, small cell lung cancer stage IIIA, and histiocytic sarcoma stage IV and therefore could be included in prospective clinical studies.publishersversionPeer reviewe

Acute Ischemic Stroke Endovascular Treatment of Patients with Large Vessel Occlusions

Publisher Copyright: © 2015 by Arturs Balodis.Mechanical thrombectomy as an active treatment method has recently been chosen for patients with large artery occlusions and thrombolysis beyond a time window. The aim of our study was to evaluate the results of endovascular treatment in patients with proximal vessel occlusion, compare this group with the intravenous thrombolysis group, and to identify possible criteria of active treatment. The prospective study included 81 patients hospitalised in the Pauls Stradiņš Clinical University Hospital due to acute ischemic stroke; 48 of them received mechanical thrombectomy and 33-intravenous thrombolysis. Thrombectomy (TE) was performed using Solitaire FR stent retrievers. The NIHSS score was used for evaluation of early therapy results and mRS (modified Rankin Scale) was used for late therapy results. ASPECTS was used to define the lesion size using imaging on admission and after treatment. Median NIHSS on admission was higher in the TE group-16 (range 12 to 19) than in the TL group-12 (range 8 to 15) (p 0.05). Frequency of symptomatic intracerebral haemorrhages was similar in the groups. Mechanical thrombectomy can achieve better late functional outcome than thrombolysis in a selected patients group.publishersversionPeer reviewe

Endovascular and Surgical Treatment of Intracranial Aneurysms Choice of Method, Results and Justification

Intrakraniālu aneirismu endovaskulāras un ķirurģiskas ārstēšanas metodes izvēle, rezultāti un pamatojums. Promocijas darbs medicīnas zinātņu doktora grāda iegūšanai ķirurģijas specialitātē Dr.Kārlis Kupčs Anotācija. Pēdējo gadu moderno tehnoloģiju attīstība ir pavērusi jaunas iespējas intrakraniālu aneirismu diagnosticēšanai un ārstēšanai. Ilgstoši kā vienīgā radikālā intrakraniālu aneirismu ārstēšanas metode bija neiroķirurģiska operācija, taču relatīvi nesen tika rādīta un arvien plašāk pielietota intrakraniālu aneirismu endovaskulāra embolizācija, kas vairākos atzītos pētījumos ir pieradusi pārākumu ārstēšanas iznākumā. Tomēr jautājums par ārstēšanas taktikas izvēli konkrētā pacienta gadījumā joprojam paliek neskaidrs. Darba mērķis ir zinātniski pamatot intrakraniālu aneirismu ārstēšanas iznākumu, analizējot literatūrā un savā klīniskā praksē uzkrāto pieredzi, ka arī izstrādāt intrakraniālu aneirismu ārstēšanas algoritmu. Pētījuma rezultāti, ka arī literatūras datu analīze ļāva izstrādāt un rekomendēt ieviešanai klīniskajā praksē nerupturētu un rupturētu intrakraniālu aneirismu ārstēšanas algoritmu.Endovacscular and Surgical Treatment of Intracranial Aneurysms Choice of Method, Results and Justification. Doctorate Thesis. Dr. Karlis Kupcs Summary. For a long time the only radical treatment option for intracranial aneurysms was neurosurgical operation. However the last decade progress in the technologies and radiologic technique resulted in new treatment modality for intracranial aneurysm – the endovascular coiling. A many multi-center trials have shown significant improvement in clinical outcome for patients treated with endovascular coiling, comparing with the neurosurgical group. Despite of this the treatment tactic for many intracranial aneurysm patients remains empiric and not evidence based. The main goal of this work was to define the outcome of intracranial aneurysm treatment, aggregating evidence based literature data and personal experience in endovascular technique. The results of the work allowed developing of evidence-based ruptured and unruptured intracranial aneurysm treatment algorithm

A Rare Case of Cervical Spinal Arteriovenous Malformation: A Case Report

Arteriovenous malformation (AVM) is an abnormal connection of vasculature resulting in capillary bed bypassing and leading to neurological deterioration and high risk of bleeding. Intramedullary AVMs in the cervical spinal cord are rare and require precise diagnostics and treatment. We present a clinical case of recurrent AVMs in a 28-year-old Caucasian female with sudden and severe neck pain and variable neurological symptoms along with current diagnostic and treatment modalities. Conservative treatment was partially effective. MRI and DSA confirmed AVMs at C4 level with subsequent several endovascular treatment sessions at the age of 15 and 24 with mild neurological improvement. Afterwards the patient underwent rehabilitation with minor neurological improvement. This case highlights the clinical progression and treatment of AVMs along with showcasing current pathophysiology, classification, and imaging