In assessing thyroid nodules suspected of malignancy, the combined analysis of USE and BRAF is equally sensitive and more specific than conventional procedures, achieving more accurate preoperative diagnoses than US and cytology combined. USE and BRAF analysis for thyroid nodule evaluation might reduce the number of unnecessary surgical procedures.
BACKGROUND: Arterial perforation is a potentially serious complication during endovascular thrombectomy. PURPOSE: Our aim was to describe interventional approaches after arterial perforation during endovascular thrombectomy and to determine whether reperfusion remains associated with favorable outcome despite this complication.DATA SOURCES: Data from consecutive patients with acute stroke undergoing endovascular thrombectomy were retrospectively collected between 2015 to 2020 from a single-center cohort, and a systematic review was performed using PubMed, EMBASE, and Ovid MEDLINE up to June 2020.STUDY SELECTION: Articles reporting functional outcome after arterial perforation during endovascular thrombectomy were selected.DATA ANALYSIS: Functional outcomes of patients achieving successful reperfusion (TICI 2b/3) were compared with outcomes of those with unsuccessful reperfusion in our single-center cohort. We then summarized the literature review to describe interventional approaches and outcomes after arterial perforation during endovascular thrombectomy.DATA SYNTHESIS: In our single-center cohort, 1419 patients underwent endovascular thrombectomy, among whom 32 (2.3%) had vessel perforation and were included in the analysis. The most common hemostatic strategy was watchful waiting (71% of cases). Patients with successful reperfusion had a higher proportion of favorable 90-day mRS scores (60% versus 12.5%; P ¼ .006) and a lower mortality rate (13.3% versus 56.3%, P ¼ .01) than patients without successful reperfusion. Thirteen articles were included in the systematic review. Successful reperfusion also appeared to be associated with better outcomes.
LIMITATIONS:Given the low number of published reports, we performed only a descriptive analysis.CONCLUSIONS: Arterial perforation during endovascular thrombectomy is rare but is associated with high mortality rates and poor outcome. However, successful reperfusion remains correlated with favorable outcome in these patients.ABBREVIATIONS: EVT ¼ endovascular thrombectomy; IQR ¼ interquartile range; mTICI ¼ modified TICI; sICH ¼ symptomatic intracerebral hemorrhage E ndovascular therapy (EVT) is the standard of care for the treatment of patients with acute ischemic stroke due to largevessel occlusion. 1 Technologic advances have allowed development of new devices that have greatly improved the efficacy and safety of EVT compared with older-generation tools. 2 Despite these improvements, as well as greater comfort and expertise among interventionalists across time, the procedure is still not exempt from severe complications. 3,4 Arterial perforation, defined as contrast extravasation noticed during a procedural angiographic run, is one of the most serious and feared complications during EVT because it has been associated with poor functional outcomes and death. 5 In large EVT trials, the rate of procedural arterial perforations varied between 0.6% and 4.9%. 1
BACKGROUND AND PURPOSE: Computed tomography angiography offers a non-invasive alternative to DSA for the assessment of cerebral vasospasm following subarachnoid hemorrhage but there is limited evidence regarding its reliability. Our aim was to perform a systematic review (Part I) and to assess (Part II) the inter-and intraobserver reliability of CTA in the diagnosis of cerebral vasospasm.
MATERIALS AND METHODS:In Part I, articles reporting the reliability of CTA up to May 2018 were systematically searched and evaluated. In Part II, 11 raters independently graded 17 arterial segments in each of 50 patients with SAH for the presence of vasospasm using a 4-category scale. Raters were additionally asked to judge the presence of any moderate/severe vasospasm ($ 50% narrowing) and whether findings would justify augmentation of medical treatment or conventional angiography 6 balloon angioplasty. Four raters took part in the intraobserver reliability study.
RESULTS:In Part I, the systematic review revealed few studies with heterogeneous vasospasm definitions. In Part II, we found interrater reliability to be moderate at best (k # 0.6), even when results were stratified according to specialty and experience. Intrarater reliability was substantial (k . 0.6) in 3/4 readers. In the per arterial segment analysis, substantial agreement was reached only for the middle cerebral arteries, and only when senior raters' judgments were dichotomized (presence or absence of $50% narrowing). Agreement on the medical or angiographic management of vasospasm based on CTA alone was less than substantial (k # 0.6).
CONCLUSIONS:The diagnosis of vasospasm using CTA alone was not sufficiently repeatable among observers to support its general use to guide decisions in the clinical management of patients with SAH.
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