one limitation of mechanical thrombectomy (Mt) is clot migration during procedure. this might be caused by abruption of the trapped thrombus at the distal access catheter (DAc) tip during stentretriever retraction due to the cylindrical shaped tip of the DAc. Aiming to solve this problem, this study evaluates the proof-of-concept of a new designed funnel-shaped tip, in an experimental in vitro setting. two catheter models, one with a funnel-shaped tip and one with a cylindrical-shaped tip, were compared in an experimental setup. for Mt a self-made vessel model and thrombi generated from pig's blood were used. MT was performed 20 times for each device using two different stent-retrievers, 10 times respectively. For the funnel-shaped model: for both stent-retrievers (Trevo XP ProVue 3/20 mm; Trevo XP ProVue 4/20 mm) MT was successful at first pass in 9/10 (90%), respectively. For the cylindricalshaped model: MT was successful at first pass in 5/10 (50%) with the smaller stent-retriever and in 6/10 (60%) with the larger stent-retriever. The experiments show a better recanalization rate for funnelshaped tips, than for cylindrical-shaped tips. these results are indicating a good feasibility for this new approach, thus the development of a prototype catheter seems reasonable.Mechanical thrombectomy (MT) has become the standard technique in the treatment of acute ischemic stroke in large vessel occlusion (LVO). Multiple randomized controlled trials (RCTs) demonstrated a safe and efficient use of MT in comparison to intravenous tissue plasminogen activator (IV t-PA) use alone 1-6 .Recently updated international and national guidelines 7,8 recommend MT for patients suffering from acute stroke up to 24 hours after the onset of symptoms, as well as for patients with wake-up strokes with an unknown time window, thus emphasizing the increasing relevance of endovascular treatment. The so-called "big five" 1-5 reports for MT in LVO show a good recanalization rate of 71%. A meta-analysis of 12 studies reports a successful recanalization rate (TICI 2b/3 score) of 81% for MT with stent-retriever in acute M2 occlusion 9 . Different techniques are possible for MT, like Direct Aspiration First Pass Technique (ADAPT), Stent-retriever Assisted Vacuum-locked Extraction (SAVE) or primary combined approach (PCA) of an aspiration catheter and stent-retriever 6,10 .Even though MT in combination with IVT is the state-of-the-art treatment for LVO, there are still limitations. Balami et al. 11 report an embolization to new vascular territories in 1-8.6% for most randomized controlled trials (RCTs) and in 1-12.5% for the non-RCTs. This can be caused by clot migration to proximal vessels during the retraction of the stent-retriever or persistence in the same vessel. Furthermore, the clot can break and dissipate www.nature.com/scientificreports www.nature.com/scientificreports/ learning algorithms to produce pixel based segmentations are available online 18,19 . Images were further processed and transformed into grayscale images. Then a binary im...

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Background Mechanical thrombectomy is the standard treatment for acute ischemic stroke in patients with large vessel occlusion and can be performed up to 24h after symptom onset. Despite high recanalization rates, embolism in new territories has been reported in 8.6% of the cases. Causes for this could be clot abruption during stent retrieval into the smaller opening of a standard distal access catheter, and antegrade blood flow via collaterals despite proximal balloon protection. A funnel-shaped tip with a larger internal diameter was developed to increase the rate of first-pass recanalization and to improve the safety and efficacy of mechanical thrombectomy. Methods This in vitro study compared the efficacy of a funnel-shaped tip with a standard tip in combination with different clot compositions. Mechanical thrombectomy was performed 80 times for each tip, using two stent retrievers (Trevo XP ProVue 3/20 mm, 4/20 mm) and four different clot types (hard vs. soft clots, 0–24h vs. 72h aged clots). Results Significantly higher first-pass recanalization rates (mTICI 3) were observed for the funnel-shaped tip, 70.0% versus 30.0% for the standard tip (absolute difference, 32; relative difference 57.1%; P < .001), regardless of the clot type and stent retriever. Recanalization could be increased using harder Chandler loop clots versus softer statically generated clots, as well as 0–24h versus 72h aged clots, respectively. Conclusion The funnel-shaped tip achieved higher first-pass recanalization rates than the smaller standard tip and lower rates of clot abruption at the tip. Clot compositions and aging times impacted recanalization rates.

Aims The 2012 NHS mandate recommended reduction in the length of stay for inpatients, to improve the care of patients with both long term conditions and those with acute problems. Reference was also made to improving patients' experience of care.In paediatrics, these visions are most easily realised within ambulatory paediatrics. In April 2014 a pioneering ambulatory care service was established at our hospital, with 'Healthcare at Home' (HAH). The first childrens' service of its kind, it is a consultant led, nurse delivered model of acute paediatric care. The nurses visit children up to four times a day, to administer medication, perform observations and provide clinical review. The observations and notes are recorded electronically. A daily consultant-led virtual ward round is conducted with the HAH nurses, facilitated by review of the patient's electronic health records. The initial goal was to enable early discharge from hospital, with future aspirations to facilitate admission avoidance with direct admission to HAH from the paediatric emergency department. Methods Activity data for the first 9 months has been analysed and patient experience feedback has been evaluated. Results 78 patients have been accepted onto the HAH service to date, giving 815 visits, and saving 389 bed days. 796/815 (97.7%) were for administration of IV medication, with 48% for medications needing to be administered more than once a day. Referrals are increasing, with the majority from the general paediatrics service (90.5%). Orthopaedics, gastroenterology and neurosurgery contribute the remainder. There have been 28 episodes of patients re-attending following transfer to HAH; 22/28 (78.6%) have been due to problems with intravenous access, and 6/28 (21.4%) for clinical review. No patients have required readmission to the hospital. Patient feedback has been excellent with 100% of questionnaire responders saying they would recommend HAH to their friends and relatives. Conclusion HAH is in its infancy but, thus far, has delivered exemplary clinical care. As stated in the NHS mandate, improving the experience of patients' and their families is essential The development of a flexible and robust community nursing service, which provides excellent acute clinical care is a proven means of facilitating this. Aims The Friends and Family Test (FFT) is currently used nationally in adult acute care settings, and from April 2015 it will be compulsory for all children and young people (or their parents) to be offered the question. Although the guidance suggests wording for younger patients, there is no evidence that it has been rigorously tested with them. Our research therefore explored children's views of the FFT question including wording, response options and overall design, to propose the most suitable version for children and young people. Methods A focus group with young patients explored views on patient feedback and different versions of the FFT. This informed the development of several child-friendly versions of the question, differing in ...