Hemodynamic and anatomic variations require an adaptable approach during intra-arterial chemotherapy for intraocular retinoblastoma: alternative routes, strategies and follow-up

Backgrounds and purpose Intra-arterial chemotherapy for retinoblastoma is not always a straightforward procedure and it may require an adaptable approach. This study illustrates strategies employed when the ophthalmic artery is difficult to catheterize or not visible as well as to ascertain their effectiveness and safety. Materials and methods A retrospective study was carried out on a series of 108 eyes affected by intraocular retinoblastoma and selected for intra-arterial chemotherapy (follow up range: 6 to 82 months). Three different patterns of drug delivery were recognized: a fixed pattern through the ophthalmic artery; a fixed pattern through branches of the external carotid artery; a variable pattern either through the ophthalmic or the external carotid arteries. Results We performed 448 sessions of intra-arterial chemotherapy: 83.70% of them through the ophthalmic artery, 16.29% via the external carotid artery. In 24.52% of eyes the procedure was carried out at least once through branches of the external carotid artery. In 73 eyes the pattern of drug delivery was fixed through the ophthalmic artery, for 9 eyes fixed through branches of the external carotid artery and for 17 eyes the pattern was variable. Statistical analysis did not show any significant difference in the clinical outcome of the eyes (remission vs. enucleation) treated with different patterns of drug delivery. Side effects could not be correlated with any particular pattern. Conclusion Alternative routes of intra-arterial chemotherapy for intraocular retinoblastoma appears in the short term as effective and safe as the traditional drug infusion through the ophthalmic artery

General Anesthesia Versus Conscious Sedation and Local Anesthesia During Thrombectomy for Acute Ischemic Stroke

As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA)