Effect of COVID-19 Pandemic on Mechanical Thrombectomy for Acute Ischemic Stroke Treatment in United States

There is accumulating data suggesting that the ischemic stroke may be increased in patients with corona virus disease 2019 (COVID-19) due to hyper coagulopathy. An increase in acute ischemic stroke patients who require mechanical thrombectomy is to be expected particularly in regions with high rates of COVID-19

Abstract 028: Chronic Subdural Hematoma Treatment with Embolization Versus Surgery Study Protocol

Introduction Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diseases with a significant financial burden. Current management includes observation for mild or asymptomatic patients and surgical drainage for moderate and severe patients. However, surgical drainage is associated with a 15% reoperation rate and a mortality of up to 10%. Middle meningeal artery embolization (MMAE) is a promising minimally invasive alternative with an estimated surgical recurrence rate of 6.8% and 4.6% for standalone MMAE and combined MMAE and surgery respectively. However, randomized data is lacking for this emerging therapy. Methods CHESS is a NIH‐funded, prospective, multi‐center, randomized, open label clinical trial. Subjects with moderately symptomatic cSDH (de novo or recurrent) will be randomized in a 1:1 radio to standalone MMAE or conventional surgery. Moderately symptomatic patients are defined as patients with moderate weakness (4/5), gait ataxia and/or mild aphasia. Embosphere or PVA will be used for MMAE. Primary outcome is defined as the proportion of patients that require rescue surgery or die within 180 days. Safety outcomes include the proportion of subjects with ischemic strokes, serious/life threatening adverse events, worsening neurological status or development of new disabling neurological symptoms, seizures, and cranial neuropathies (blindness and facial paralysis) within 180 days of randomization. One interim analysis for overwhelming efficacy and futility will be performed assuming a group sequential design of O’Brien and Fleming boundary. Results Based on an effect size of 13% of the composite primary outcome, a two‐sided Type I and Type II error of 0.05 and 0.15, and a dropout rate of 10%, a sample size of 394 patients is estimated. Conclusion CHESS will be the first US randomized controlled trial to provide evidence on the safety and effectiveness of 1) standalone MMAE vs surgical drainage; 2) particles as the embolic agent, and 3) MMAE on recurrent, in addition to de novo, cSDHs

Abstract Number ‐ 108: Effect of Percutaneous Inferior Sympathetic Ganglion Block on Intracranial Artery Diameters on Cerebral Angiography

Introduction There is some data suggesting vasodilatory effect of sympathetic blockade in patients with aneurysmal subarachnoid hemorrhage but the effect on medium‐sized intracranial arteries remains unclear. Methods Serial ipsilateral intracranial angiograms were obtained before and after percutaneous inferior sympathetic ganglion block. The angiogram files were imported to a DICOM reader, Horos Open‐Source Medical Image Viewer (Version 3.3.6).The percent change of arterial diameter (compared with pre‐blockage image) was calculated in intracranial internal carotid (ICA), middle (MCA) and anterior cerebral (ACA) arteries. We also assessed the inter‐observer reliability of arterial diameter change using the Bland‐Altman method after two raters independently measured the arterial diameter in 2 images with a total of 12 arterial measurements. Results In Patient 1, there was an increase in diameter of intracranial ICA, MCA and ACA at 1 minute (9.62%, 10.34%, 8.64%), 5 minutes (11.38%, 12.22%, 14.42%) and 10 minutes (8.66%, 11.30%, 5.50%), respectively.In Patient 2, there was an increase in diameter at 1 minute (0.72%, 2.08%, ‐1.75%), 5 minutes (12.04%, 0.64%, 4.50%), 10 minutes (6.86%, 7.23%, 10.38%), 20 minutes (9.45%, ‐2.16%, 13.32%), and 30 minutes (7.31%, 12.02%, 6.50%), respectively. The Bland‐Altman coefficient of variation was 1.32 (range 0.01 ‐5.57) with majority (5 out of 6, 83%) of the data points within the upper and lower limits of acceptance. Conclusions We observed vasodilation in medium‐sized intracranial arteries ipsilateral to the percutaneous inferior sympathetic ganglion block as early as one minute post treatment and persisting for at least until 30 minutes post blockade

The Role of Parenteral Dantrolene in the Contemporary Management of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review.

OBJECTIVE: Cerebral vasospasm remains a significant source of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage. Dantrolene has shown promise in several animal studies in the treatment of cerebral vasospasm. The present study seeks to critically review the evidence of its use in human subjects, aiming to 1) describe the forms and dosages used, 2) describe its safety profile, and 3) describe its effectiveness in treating cerebral vasospasm. METHODS: A systematic review of intra-arterial dantrolene use in cerebral vasospasm was performed. A total of 86 articles were identified across all databases, 6 of which were ultimately included in the present study. Primary outcomes included a description of the form and dosage of dantrolene prescribed, the incidence of adverse effects after dantrolene use, and its efficacy for the treatment of cerebral vasospasm. RESULTS: Study designs included 2 randomized controlled trials (33.3%), 2 case series (33.3%), and 2 case reports (33.3%). Both the intra-arterial and intravenous administration of dantrolene has been performed with varying dose regimens. Although there exists limited clinical information regarding side effects, a case of liver toxicity was reported. All existing studies reported benefit in vasospasm measured either by transcranial Doppler or digital subtraction angiography. The level of evidence was low, consisting largely of retrospective studies that had a high likelihood of bias. CONCLUSIONS: Dantrolene is a promising new therapeutic agent in the treatment of cerebral vasospasm. Although existing reports of its use are encouraging, high-quality prospective randomized trials are necessary for recommendations pertaining to dose, route, indications, and efficacy

Association between Interleukin-10 promoter polymorphism with type 2 Diabetes mellitus

Type 2 diabetes mellitus is a multifactorial illness triggered by a complicated interplay of various genetic variants with various environmental variables. The quantity of replicated common genetic variants associated with type 2 diabetes mellitus has increased rapidly with the recent genome-wide association (GWA) research. Major health issue in the public are type 2 diabetes mellitus (T2DM) is common throughout the world. Diabetes mellitus incidence is growing and is anticipated to affect 300 million individuals by 2025. Diabetes has been suggested to alter patterns of cytokine expression as an immune-dependent illness. Insulin resistance (IR) is a disease that results in less than anticipated biological impact of a specified insulin concentration. Insulin resistance and insulin secretion decreased are both defined pathophysiology of T2DM. One of the most alarming health issues of the 21st century is the spread of diabetes around the globe. Our goal in this study was to identify the role of IL-10 polymorphism in T2DM patients. The average age of 60 median patients with type 2 diabetes mellitus (31 males and 29 females) ±SD (45.91667 ±16.08799), fasting blood sugar (FBS) is ±SD (184.25 ±57.76387), hypertension (35 positive/25 negative) and 60 non-diabetic controls (32 males and 28 females) is ± SD (47.31667 ±15.13722). The group (T2DM patients and their control) had not a substantial distinction (P=0.33) and in each group (CC, TT, CT) there was a comparison between IL-10 gene polymorphism. T2DM patients and healthy individuals are not associated with the polymorphism of the gene IL-10 (SNP rs 3021097 (C/T)

Association of vitamin D deficiency with diabetic gastroparesis and its intramuscular vitamin D treatment

Introduction: Diabetic gastroparesis (DGp) is a component of autonomic neuropathy resulting from long-standing poorly controlled type 1 and type 2 diabetes. There are currently no approved vitamin D supplementation recommendations for people with DGp. Objectives: To investigate the relationship between vitamin D insufficiency and DGp, as well as the efficacy of intramuscular vitamin D therapy. Methodology: 71 patients (18 DM Gp & 53 Non-DM Gp) seeking treatment for gastroparesis symptoms were studied. The blood levels of vitamin D, homocysteine, gastric emptying test (GET) at 1, 2, and 4 h were recorded. 25-OH vitamin D levels were detected by kit. Potential clinical and statistical correlations between all results, symptoms, and GET data were explored. Descriptive statistics were used to investigate etiologic differences at baseline while multiple linear regression models were employed to explore relationships of vitamin D deficiency with diabetic gastroparesis and its intramuscular vitamin D treatment. Results: Majority of DGp patients were older than 18 years (88%) and were non-smokers (83%). The majority of those with and without diabetes were married (11; 71% vs. 34; 64%). The majority of participants in the DM group had only completed elementary school (n=7/18; 38.8%).&nbsp