28 research outputs found
Guide to Agriculture, U.S.A.
The purpose of the Guide is to introduce the reader to agriculture in the United States. Here will be found the general facts about the land and how it is used, the major crops and where they are grown, and the principal livestock products. Especial attention is given to farm families, where they live, how they do their work, and the way they help determine public policy as it affects agriculture. The Guide is prepared primarily for foreign visitors. It is hoped, however, that it will prove helpful also to citizens of the United States
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O-018 Thrombectomy outcomes in patients with low aspects treated within 24 hours of symptoms onset: insights from STAR
IntroductionOutcomes of mechanical thrombectomy (MT) depends largely of achieving reperfusion of a salvageable brain tissue. Patients with poor baseline images were excluded from most clinical trials so the data about their outcomes remain scarce and whether these patients could still benefit from MT remains unknown. In this study, we aim to investigate the safety and efficacy of EVT in patients with large vessel occlusion and large core infarct.MethodsThe Stroke Thrombectomy and Aneurysm Registry (STAR) that combined the prospectively maintained databases of 28 thrombectomy-capable stroke centers in the US, Europe, and Asia was interrogated. We included thrombectomy patient presenting with emergent large vessel occlusion within 24 hours and with a large core infarct as defined by Alberta Stroke Program Early CT Score (ASPECTS) 2b) was achieved in 84.7% and median procedure time was 54 minutes. sICH hemorrhage was observed in 22 (15.3%). Regarding 90-day outcome, median mRS was 4, favorable outcome (mRS 0-2) was observed in 41 patients (28.5%) and mortality occurred in in 59 (41%). There was no difference in 90-day functional outcome between patients in early and late windows. In patients presenting in the early window, age (aOR=0.905, p=0.0002; CI=0.858-0.954) and baseline NIHSS (aOR=0.909, p=0.0423; CI=0.829-0.997) were independently associated with 90-day outcome. In patients presenting in the late window, only age (aOR=0.934, p=0.0069; CI=0.888-0.981) was independently associated with good outcome.ConclusionMore than one in four patients presenting with ASPECTS<6 may achieve functional independence at 90-day following MT. Patient age remained the main predictors of 90-day outcome in patients with low ASPECTS in both late and early window.Disclosures Z. Hubbard: None. G. Porto: None. S. Al Kasab: None. E. Almallouhi: None. A. Alawieh: None. R. De Leacy: None. D. Raper: None. A. Rai: None. T. Dumont: None. S. Wolfe: None. P. Jabbour: None. C. Ogilvy: None. P. Park: None. M. Levitt: None. A. Polifka: None. R. Crowley: None. A. Arthur: None. J. Osbun: None. R. Crosa: None. I. Maier: None. K. Burchiel: None. J. Grossberg: None. S. Chowdhry: None. M. Mokin: None. C. Matouk: None. R. Williamson: None. A. Yoo: None. J. Mascitelli: None. P. Kan: None. M. Psychogios: None. R. Starke: None. A. Spiotta: None
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O-011 outcomes of mechanical thrombectomy in stroke patients presenting with low aspects in the early and late window-insight from STAR
IntroductionLimited data is available about the outcomes of mechanical thrombectomy (MT) in stroke patients presenting with a large core infarct. We aim to investigate the safety and efficacy of MT in patients with large vessel occlusion and Alberta Stroke Program Early CT Score (ASPECTS) of 2-5.MethodsData from Stroke Thrombectomy and Aneurysm Registry (STAR), which combined the prospectively maintained databases of 28 thrombectomy-capable stroke centers in the US, Europe, and Asia, was interrogated. We identified thrombectomy patients presenting with an occlusion in the Internal carotid artery (ICA) or M1 segment of the middle cerebral artery (MCA). Multivariable regression analysis was performed to assess factors associated with favorable 90-day outcome (modified Rankin scale 0-3), including interaction terms between ASPECTS 2-5 and receiving MT in the extended window (≥ 6 hours from symptom-onset).ResultsAmong MT patients who presented with ICA or M1 occlusion, 2132 had ASPECTS≥6 and 213 patients had ASPECTS 2-5. Patients in the low ASPECTS group were younger (70 vs. 72 years old, P=0.003) and more likely to present with an ICA occlusion (47.9% vs. 28.8%, P<0.001) compared to patients with ASPECTS≥6. At 90 days, mRS 0-3 was observed in 36.6% of the patients who presented with ASPECTS 2-5 (42% in patients who had successful recanalization and 10.8% in patients who had failed recanalization, P=0.001) (figure 1). Lower ASPECTS and presenting in the extended window were both associated with worse 90- day outcomes after controlling for potential confounders, without significant interaction between these two factors.ConclusionMore than one in three patients presenting with ASPECTS (2-5) may achieve favorable 90-day functional outcome following MT. Favorable outcome was 4 times higher in low ASPECTS patients who had successful recanalization. The effect of low ASPECTS on 90-day outcome did not differ in patients presenting in the early versus extended MT window.Abstract O-011 Figure 1Disclosures E. Almallouhi: None. S. Al Kasab: None. Z. Hubbard: None. G. Porto: None. A. Alawieh: None. R. Chalhoub: None. E. Bass: None. P. Jabbour: None. R. Starke: None. S. Wolfe: None. A. Arthur: None. I. Maier: None. J. Grossberg: None. A. Rai: None. M. Park: None. J. Mascitelli: None. M. Psychogios: None. R. De Leacy: None. D. Raper: None. T. Dumont: None. M. Levitt: None. A. Polifka: None. J. Osbun: None. R. Crosa: None. J. Kim: None. W. Casagrande: None. M. Mokin: None. C. Matouk: None. A. Shaban: None. I. Fragata: None. A. Yoo: None. A. Spiotta: 1; C; Stryker, Penumbra, and Medtronic. 2; C; Penumbra, Stryker, Cerenovus, Terumo
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E-006 Feasibility and safety of mechanical thrombectomy in stroke patients presenting with distal ACA occlusions – insights from star
BackgroundMechanical thrombectomy (MT) indications for acute stroke treatment have expanded in the last few years to include medium vessel occlusions. However, limited data is available about the safety and efficacy of MT in the distal anterior cerebral artery (ACA) segments (A2/A3). This study aims to assess the feasibility and outcomes of MT in stroke patients presenting with acute A2 and A3 occlusions in a large multicenter registry.MethodsThis is a retrospective analysis from the Stroke Thrombectomy and Aneurysm registry (STAR) which maintains data from 40 stroke centers in the United States, Europe, Asia, and South America. We included patients who presented with A2/A3 occlusions and were treated with MT using second generation thrombectomy devices between January 1, 2014, and December 31, 2020. Primary outcome of this analysis was the final modified treatment in cerebral infarction (mTICI) score. Other endpoints included the modified Rankin Scale (mRS) score at 90 days and the rate of symptomatic intracranial hemorrhage (sICH).ResultsWe identified 27 patients who met the inclusion criteria. Median age was 61 (IQR 53-81) years, 15 (55.6%) were female, and 14 (51.9%) were white. A2 segment occlusion was seen in 20 (74.1%) patients and A3 segment in 7 (25.9%) patients. Fourteen (51.9%) in patients received intravenous tissue plasminogen activator (tPA) prior to MT. Regarding MT technique used, contact aspiration first line (ADAPT) was used in 14 (51.9%) patients, stent retriever first-line was used in 4 (14.8%) patients, and a combination of both techniques was used in 9 (33.3%). Intraarterial tPA was used in 6 (22.2%) patients. Final mTICI ≥ 2B was recorded in 20 (74.1%) patients (13 [48.1%] had mTICI of 2C or 3). Periprocedural complications were seen in 4 (14.8%) patients and sICH occurred in 1 (3.7%) patient. At 90 days, 17 (63%) patients achieved functional independence (mRS 0-2).ConclusionIn this multicenter study, MT for distal ACA occlusions in the A2/A3 segments seem to be feasible and associated with low complication and symptomatic hemorrhage rates. Future studies are needed to compare the functional outcome of MT versus medical management for stroke patients presenting with A2/A3 occlusions.Disclosures D. Pullmann: None. E. Almallouhi: None. S. Al Kasab: None. A. Alawieh: None. R. Chalhoub: None. R. Starke: None. R. De Leacy: None. D. Raper: None. A. Rai: None. T. Dumont: None. S. Wolfe: None. P. Jabbour: None. C. Ogilvy: None. M. Park: None. M. Levitt: None. A. Polifka: None. R. Crowley: None. A. Arthur: None. J. Osbun: None. R. Crosa: None. I. Maier: None. J. Kim: None. W. Casagrande: None. A. Shaban: None. J. Grossberg: None. S. Chowdhry: None. M. Mokin: None. C. Matouk: None. I. Fragata: None. S. Webb: None. A. Yoo: None. J. Mascitelli: None. M. Psychogios: None. M. Azab: None. A. Spiotta: None