Penumbral Rescue by normobaric O = O administration in patients with ischemic stroke and target mismatch proFile (PROOF): Study protocol of a phase IIb trial.

Oxygen is essential for cellular energy metabolism. Neurons are particularly vulnerable to hypoxia. Increasing oxygen supply shortly after stroke onset could preserve the ischemic penumbra until revascularization occurs. PROOF investigates the use of normobaric oxygen (NBO) therapy within 6 h of symptom onset/notice for brain-protective bridging until endovascular revascularization of acute intracranial anterior-circulation occlusion. Randomized (1:1), standard treatment-controlled, open-label, blinded endpoint, multicenter adaptive phase IIb trial. Primary outcome is ischemic core growth (mL) from baseline to 24 h (intention-to-treat analysis). Secondary efficacy outcomes include change in NIHSS from baseline to 24 h, mRS at 90 days, cognitive and emotional function, and quality of life. Safety outcomes include mortality, intracranial hemorrhage, and respiratory failure. Exploratory analyses of imaging and blood biomarkers will be conducted. Using an adaptive design with interim analysis at 80 patients per arm, up to 456 participants (228 per arm) would be needed for 80% power (one-sided alpha 0.05) to detect a mean reduction of ischemic core growth by 6.68 mL, assuming 21.4 mL standard deviation. By enrolling endovascular thrombectomy candidates in an early time window, the trial replicates insights from preclinical studies in which NBO showed beneficial effects, namely early initiation of near 100% inspired oxygen during short temporary ischemia. Primary outcome assessment at 24 h on follow-up imaging reduces variability due to withdrawal of care and early clinical confounders such as delayed extubation and aspiration pneumonia. ClinicalTrials.gov: NCT03500939; EudraCT: 2017-001355-31

Abstract of papers for full membership at the Belgian Society of Radiology Conebeam-CT and fluoroscopy guided percutaneous absolute alcohol sclerotherapy of aneurysmal bone cyst – A single centre experience

'Purpose: 'Aneurysmal bone cysts are benign bone lesions representing approximately 1% of all bone tumors. Lesions usually manifest in the first or second decade of life and are most frequently eccentrically located in the metaphysis of long tubular bones or in the axial skeleton. Etiologically lesions are considered as benign intra-osseous vascular malformations but can become locally aggressive, with significant extraosseous expansion. Conventional treatment protocols consisted of surgical curettage, with or without associated bone grafting. In some cases, the localization and extent of the cyst are such that operative treatment is extremely hazardous. Moreover surgical curettage is associated with high recurrence rates varying from 10 to 44%. We present a less invasive treatment option with fluoroscopy and conebeam-CT guided direct percutaneous sclerotherapy with intralesional absolute alcohol injections