Introduction The purpose of this study was to evaluate intraocular pressure (IOP) lowering and safety of XEN ® stent in medically refractory, progressive, open-angle glaucoma (OAG). Methods Forty-seven eyes of 42 patients were treated with XEN ® stent alone or combined with phacoemulsification. Results Mean IOP decreased from 22.34 ± 7.34 mmHg to 12.91 ± 4.21, 12.95 ± 4.36, 13.49 ± 3.91, and 13.36 ± 3.63 mmHg at 1, 3, 6, and 12 months (95% confidence interval [CI] [20.24, 24.44], [11.71, 14.12], [11.63, 14.27], [12.36, 14.62], and [12.10, 14.62]), respectively. Mean number of medications decreased from 2.96 ± 1.20 (95% CI [2.62, 3.30]) at baseline to 0.75 ± 1.27 (95% CI [0.31, 1.19]) at 1 year. At 1 year ( n = 32), complete success was achieved in 68.8% ( n = 22/32) (i.e., IOP reduction ≥ 20% and IOP < 18 mmHg without medication or any secondary glaucoma intervention). Qualified success was achieved in 90.6% ( n = 29/32) (i.e., IOP reduction of ≥ 20% and IOP < 18 mmHg with and without medication or any secondary glaucoma intervention). Eleven eyes had not yet reached 12 months. Two patients (three eyes) died before 1 year; one patient (one eye) was lost to follow up. Adverse events: localized choroidal hemorrhage in one eye; hypotony (IOP < 6 mmHg) at day 1 in 10 eyes, with full resolution by 2 weeks. No persistent hypotony or maculopathy occurred. Stent erosion with removal occurred in two eyes. Fourteen eyes (29.8%) underwent needling. One patient required trabeculectomy. Conclusions XEN ® stent is effective and relatively safe surgery for medically refractory, progressive, OAG out to 1 year. Intraocular pressure and medications were significantly reduced.

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Introduction: The purpose of this study was to identify the conditions in which bypassing a near Primary Stroke Centers (PSC) to go straight to a further Comprehensive Stroke Centers (CSC) leads to shorter time to treatment (IV Alteplase and mechanical thrombectomy). Methods: For this study, two simulations were performed. The first simulation evaluated time to IV Alteplase, taking in account travel and door-to-needle (DTN) times. The second simulation evaluated time to thrombectomy and accounted for travel time, door-in-door-out time if patient goes to PSC first, presence of absence of CTA at PSC, and door-to-groin (DTG) time at the CSC. In both simulations, we assumed that thrombectomy can only happen at the CSC. Regarding travel time, we implemented a rule that the longest distance between the three points of interest must be within three times the sum of the two smaller distances to be considered feasible. For example, if the patient was 5 minutes from the PSC and 5 minutes from the CSC, it would not be logical to consider a case where it takes over 30 minutes to travel from the PSC to the CSC. Results: For the first simulation, in 46.6% of cases DTN was faster going to the PSC. This occurred when the combination of travel time and PSC efficiency outweighed those elements at the CSC. In 6.8% of cases, the hospitals provided treatment within an equal amount of time. For the second simulation, DTG was better going straight to CSC in the vast majority (86.7%) of cases, assuming CTA must be done at the CSC. If CTA can be done at either hospital, going to PSC first was favored in a small number of cases (10.5%). In 2.8% of cases, the hospitals provided treatment within an equal amount of time. Conclusion: This study illustrates that an efficient PSC with CTA capability would lead to faster DTN and DTG times. A universal prehospital triaging model would not benefit all patients in all scenarios if it is only based on time to reach destination hospital. Such a model should take in account the quality of care and the available resources in the community.

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Introduction: Several tools have been developed aimed at predicting large vessel occlusion (LVO) in the prehospital setting. If these tools are used to bypass Alteplase-but-not-thrombectomy-capable hospitals, this would speed the care for some patients, delay it for others, and unnecessarily redistribute some patients between hospitals. Methods: We examined a hypothetical scenario of 1,000 patients evaluated by EMS for possible stroke. We used data published by RACE (Rapid Arterial oCclusion Evaluation) that included 357 patients to calculate the rates of the different stroke subtypes. Ischemic stroke represented 67.2% of patients, hemorrhagic stroke 14.6%, transient ischemic attack 5.6%, and stroke mimic 12.6%. We applied the following assumptions: rate of LVO as 20% of total ischemic stroke, all patients evaluated by EMS within 3 hours from their last known well time with a rate of tPA utilization is 50%, endovascular-capable hospital is further away, similar door-to-needle (DTN) time in all hospitals, delay in DTN in false positive patients, and delay in door-to-groin time (DTG) in false negative patients. Seven tools were studied using published values for sensitivity and specificity. Results: Using no tools would lead to evaluation of all patients at the nearer hospital first, leading to delay in DTG of all 134 LVO patients, however no delay in DTN. Comparing the various tools, DTN delay would be highest with Cincinnati Prehospital Stroke Severity Scale (CPSSS; n=175) and least with 3-item stroke scale (3I-SS; n=23). DTG delay would be highest with Prehospital Acute Stroke Severity (PASS) and Field Assessment Stroke Triage for Emergency Destination (FAST-ED) (n=52 for both) and least with RACE (n=20). Redistribution of patients would be highest with CPSSS and lowest with 3I-SS (reduction in patient volume to non-thrombectomy capable hospital 63% and 16% respectively and increase in volume for the thrombectomy-capable hospital by 371% and 19% respectively). Conclusion: Current tools have a very wide variation in performance. Although some tools would likely reduce the delay in DTG time for most (but not all) LVO patients, they risk delaying care for other patients and may cause an unnecessary redistribution of patients between hospitals.