Junior Recital: Savannah English, oboe and English horn

This recital is presented in partial fulfillment of requirements for the degree Bachelor of Music in Performance. Ms. English studies oboe with Elizabeth Koch Tiscione.https://digitalcommons.kennesaw.edu/musicprograms/2062/thumbnail.jp

Interhospital Transfer Before Thrombectomy Is Associated With Delayed Treatment and Worse Outcome in the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke).

BACKGROUND: Endovascular treatment with mechanical thrombectomy (MT) is beneficial for patients with acute stroke suffering a large-vessel occlusion, although treatment efficacy is highly time-dependent. We hypothesized that interhospital transfer to endovascular-capable centers would result in treatment delays and worse clinical outcomes compared with direct presentation. METHODS: STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) was a prospective, multicenter, observational, single-arm study of real-world MT for acute stroke because of anterior-circulation large-vessel occlusion performed at 55 sites over 2 years, including 1000 patients with severe stroke and treated within 8 hours. Patients underwent MT with or without intravenous tissue plasminogen activator and were admitted to endovascular-capable centers via either interhospital transfer or direct presentation. The primary clinical outcome was functional independence (modified Rankin Score 0-2) at 90 days. We assessed (1) real-world time metrics of stroke care delivery, (2) outcome differences between direct and transfer patients undergoing MT, and (3) the potential impact of local hospital bypass. RESULTS: A total of 984 patients were analyzed. Median onset-to-revascularization time was 202.0 minutes for direct versus 311.5 minutes for transfer patients ( CONCLUSIONS: In this large, real-world study, interhospital transfer was associated with significant treatment delays and lower chance of good outcome. Strategies to facilitate more rapid identification of large-vessel occlusion and direct routing to endovascular-capable centers for patients with severe stroke may improve outcomes. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02239640

MR fluoroscopy in vascular and cardiac interventions (review)

Vascular and cardiac disease remains a leading cause of morbidity and mortality in developed and emerging countries. Vascular and cardiac interventions require extensive fluoroscopic guidance to navigate endovascular catheters. X-ray fluoroscopy is considered the current modality for real time imaging. It provides excellent spatial and temporal resolution, but is limited by exposure of patients and staff to ionizing radiation, poor soft tissue characterization and lack of quantitative physiologic information. MR fluoroscopy has been introduced with substantial progress during the last decade. Clinical and experimental studies performed under MR fluoroscopy have indicated the suitability of this modality for: delivery of ASD closure, aortic valves, and endovascular stents (aortic, carotid, iliac, renal arteries, inferior vena cava). It aids in performing ablation, creation of hepatic shunts and local delivery of therapies. Development of more MR compatible equipment and devices will widen the applications of MR-guided procedures. At post-intervention, MR imaging aids in assessing the efficacy of therapies, success of interventions. It also provides information on vascular flow and cardiac morphology, function, perfusion and viability. MR fluoroscopy has the potential to form the basis for minimally invasive image–guided surgeries that offer improved patient management and cost effectiveness

Abstract Number ‐ 172: First‐in‐Human Experience: Route 92 Medical 132 cm FreeClimb 88 Catheter for Anterior Circulation LVOs

Introduction Direct aspiration thrombectomy of proximal anterior circulation large vessel occlusions (LVOs) with super‐bore catheters (SBCs, 0.088” ID) may result in improved first pass success, though their consistent delivery to the target occlusion remains challenging. We report the first‐in‐human experience with a novel full‐length 132 cm 0.088” ID FreeClimb ® 88 catheter (Route 92 Medical, San Mateo, CA, currently approved for neurovascular access), and its customized Tenzing ® 8 delivery catheter, for anterior circulation LVO acute stroke patients. Methods We performed a retrospective review of thrombectomy cases for proximal anterior circulation large vessel occlusions performed at three stroke centers from May 2022 through August 2022. All patients were treated using the Route 92 Medical 8F Base Camp® guide catheter, FreeClimb ® 88 catheter and Tenzing ® 8 delivery catheter in an off‐label fashion. Results Ten consecutive acute stroke patients with anterior circulation LVOs were treated. The median age was 71 (45‐91) and 6 were female (60%). The median presenting NIHSS score and ASPECT score were 17 (8‐24) and 9 (6‐10), respectively. LVO locations were as follows: two right carotid termini, three right M1 middle cerebral arteries, and five left M1 middle cerebral arteries. Three patients also had tandem occlusion/near‐occlusion of the respective cervical internal carotid artery. The FC88 catheter was delivered to the target occlusion with 100% success. The median time from groin puncture to catheter delivery to the target occlusion was 14 minutes (7‐35). First pass complete reperfusion (modified Thrombolysis in Cerebral Infarction score, mTICI, of 3) was achieved in 9/10 (90%) patients (self‐adjudicated). Adjunctive therapy for a residual M2 occlusion was utilized in 1/10 patients. There were no adverse events or post‐procedural symptomatic hemorrhages. Conclusions Our first‐in‐human experience with a novel 132 cm full‐length super‐bore catheter (Route 92 FreeClimb ® 88 catheter) and its customized catheter delivery device (Tenzing ® 8) for aspiration thrombectomy of proximal anterior circulation large vessel occlusions demonstrated 100% successful delivery to the target occlusion, with TICI 3 first pass reperfusion achieved in 90% of patients

Neuronal BDNF Signaling Is Necessary for the Effects of Treadmill Exercise on Synaptic Stripping of Axotomized Motoneurons

The withdrawal of synaptic inputs from the somata and proximal dendrites of spinal motoneurons following peripheral nerve injury could contribute to poor functional recovery. Decreased availability of neurotrophins to afferent terminals on axotomized motoneurons has been implicated as one cause of the withdrawal. No reduction in contacts made by synaptic inputs immunoreactive to the vesicular glutamate transporter 1 and glutamic acid decarboxylase 67 is noted on axotomized motoneurons if modest treadmill exercise, which stimulates the production of neurotrophins by spinal motoneurons, is applied after nerve injury. In conditional, neuron-specific brain-derived neurotrophic factor (BDNF) knockout mice, a reduction in synaptic contacts onto motoneurons was noted in intact animals which was similar in magnitude to that observed after nerve transection in wild-type controls. No further reduction in coverage was found if nerves were cut in knockout mice. Two weeks of moderate daily treadmill exercise following nerve injury in these BDNF knockout mice did not affect synaptic inputs onto motoneurons. Treadmill exercise has a profound effect on synaptic inputs to motoneurons after peripheral nerve injury which requires BDNF production by those postsynaptic cells

Improvement in intensive care unit outcomes in patients with subarachnoid hemorrhage after initiation of neurointensivist co-management

OBJECT: Neurointensivists are specialists trained to manage all aspects of the intensive care unit (ICU) stay of neurologically ill patients. No study to date has examined the role of neurointensivists specifically in subarachnoid hemorrhage (SAH) management. This study examined the use of a team-based neurointensivist co-management approach. METHODS: The authors reviewed all cases involving patients with SAH admitted to the neurosurgical service during a period of more than 4 years. A comparison was made between those patients admitted before and those admitted after the initiation of a mandatory neurointensivist co-management strategy. The primary outcome examined was length of ICU stay. Secondary outcomes included in-hospital mortality, ventriculoperitoneal shunt placement, and other complications such as fever, antibiotic use, pressor utilization, and ventilator-associated pneumonia. RESULTS: A total of 512 patients were included, 216 prior to and 296 after the initiation of neurointensivist comanagement. Length of ICU stay was significantly decreased after the initiation of neurointensivist co-management (mean 12.4 vs 10.9 days, p = 0.02), even after adjusting for demographic characteristics and admission Hunt and Hess grade. The percentage of patients requiring a ventriculoperitoneal shunt significantly decreased after initiation of the co-management approach (23.0 vs 11.5%, p = 0.001), but in-house mortality was unaffected. CONCLUSIONS: Initiation of a strategy of routine involvement of a neurointensivist, charged with managing all aspects of the patients\u27 care, resulted in a significantly reduced length of ICU stay for neurosurgical SAH patients. This team-based approach, using neurointensivists to manage neurosurgical SAH patients, merits further study as a successful model of care