Abstract Number ‐ 191: Barriers to Mechanical Thrombectomy in Africa

Introduction The emergence of mechanical thrombectomy (MT) as a standard of care has revolutionized the management of proximal large vessel occlusions (LVOs) in patients with acute ischemic stroke (AIS). Endovascular therapy has already been shown to provide better long‐term outcomes when compared to standard treatment alone. However, despite the significant advances and benefits associated with MT in the treatment of proximal LVOs in developed countries, Africa continues to lag in the use and adaptability of the “gold standard” for proximal LVO stroke treatment. With the prevalence of stroke in Africa approaching the highest rates in the world, this study seeks to highlight the problems threatening endovascular therapy in Africa. This is an important step in advocacy for more radical, effective, and evidence‐based management of patients with proximal LVOs in Africa. Methods For this narrative review, PubMed and Google Scholar were used to search for literature on mechanical thrombectomy and endovascular treatment of LVOs in Africa. Selection criteria were manuscripts published in the last 10 years, written in English language, and addressed challenges with MT. Results 42 papers from 21 African nations were found and reviewed. The major challenges and impediments to MT in Africa were, a lack of government policy on stroke care, a suboptimal health care financing model that makes endovascular treatment nearly impossible to afford, delay in presenting to the hospital after stroke onset coupled with very few emergency services with some countries having none, lack of specialized training, as well as, scarcity of neuroradiological infrastructure. Conclusions Despite these challenges, there is still hope for Africa. With its four domains (surveillance, prevention, acute treatment, and rehabilitation), the stroke quadrangle, adapted by many countries allows for focused initiatives aimed at successfully lowering the burden of stroke in Africa at the community level through prevention and education. There is still an urgent need for increased global support to address these challenges in Africa, even as programs like the MT2020+ by the Society of Vascular and Interventional Neurology (SVIN) have given Africa hope for the future of endovascular therapy by fostering collaboration, training, and policy development

Gallbladder Disease and Risk of Type 2 Diabetes in Postmenopausal Women: A Women's Health Initiative Study.

Studies have suggested that adults with gallbladder disease have increased risk of type 2 diabetes. This prospective cohort study assessed the risk of type 2 diabetes in postmenopausal women with gallbladder disease. Data from women enrolled in the Women's Health Initiative from 1993 to 2005, aged 50-79 years (mean = 63.2; standard deviation, 7.2), were analyzed. Cox proportional hazards regression models were used to estimate the risk of type 2 diabetes associated with gallbladder disease. There were 8,896 new cases of type 2 diabetes after 1,025,486 person-years of follow-up. Gallbladder disease was significantly associated with type 2 diabetes (hazard ratio = 1.52; 95% confidence interval (CI): 1.38,1.67). The observed risk of type 2 diabetes in women with both gallbladder disease and central obesity was 37% higher than expected (relative excess risk due to interaction = 0.37, 95% CI: 0.11,0.63) on the additive scale. The hazard ratios for type 2 diabetes associated with gallbladder disease were 1.25 (95% CI: 1.19,1.32) and 1.48 (95% CI: 1.34,1.63) in women with and without central obesity, respectively, on the multiplicative scale. Results of this study support further studies to determine whether interventions in older women with gallbladder disease would reduce type 2 diabetes risk, especially among those with central obesity. Future research should examine the pathophysiological basis of the association between gallbladder disease and type 2 diabetes

Atherogenic index of plasma and triglyceride- glucose index to predict more advanced coronary artery diseases in patients with the first diagnosis of acute coronary syndrome

OBJECTIVE: Coronary heart dis-ease (CHD) is the most common cause of mor-tality and morbidity. Acute coronary syndrome (ACS) is the most advanced form of the CHD spectrum. The triglyceride-glucose index (TGI) and atherogenic plasma index (AIP) are asso-ciated with future cardiovascular events. This study investigated the association of these pa-rameters with the severity of CAD and prognosis in the first-diagnosed ACS patients.PATIENTS AND METHODS: Our study was designed retrospectively, including 558 patients. Patients were divided into four subgroups: high and low TGI and high and low AIP. SYNTAX scores, in-hospital mortality, major adverse car-diac events (MACE), and survival were com-pared at 12-month follow-up.RESULTS: More three-vessel disease and high-er SYNTAX scores have been detected in the high AIP and TGI groups. More MACEs have been ob-served in high AIP and TGI groups than low groups. AIP and TGI were found to be independent predic-tors for SYNTAX = 23. While AIP has been found to be an independent risk factor for MACE, TGI has not been detected as an independent risk factor. In addition to AIP, age, three-vessel disease, and low-er EF were the independent risk factors for MACE. Survival was lower in high TGP and AIP groups.CONCLUSIONS: AIP and TGI are costless bedside parameters that can be easily calculat-ed. These parameters can predict the severity of CAD in first-diagnosed ACS patients. Besides, AIP is an independent risk factor for MACE. AIP and TGI parameters can guide our treatment in this patient population