Care for acute ischaemic stroke is one of the most rapidly evolving fields due to the robust outcomes achieved by mechanical thrombectomy. Large vessel occlusion (LVO) accounts for up to 38% of acute ischaemic stroke and comes with devastating outcomes for patients, families and society in the pre-intervention era. A paradigm shift and a breakthrough brought mechanical thrombectomy back into the spotlight for acute ischaemic stroke; this was because five randomised controlled trials from several countries concluded that mechanical thrombectomy for acute stroke offered overwhelming benefits. This review article will present a comprehensive overview of LVO management, techniques and devices used, and the future of stroke therapy. In addition, we review our institution experience of mechanical thrombectomy for posterior and distal circulation occlusion.on July 13, 2020 by guest. Protected by copyright.

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Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods and results CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure. Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ClinicalTrials identifier ISRCTN43070564

Background: Deep Brain Stimulation (DBS) is an underutilized surgical therapy for Parkinson's Disease (PD). Both physician and patient hesitancies have been described as potential barriers to DBS, but the specifics of patient perceptions of DBS have not been well-characterized in the general PD population.Objective: To characterize the understanding and impressions of surgical therapy in PD patients prior to formal surgical evaluation.Methods: A 30-question survey assessing impressions of surgical therapy for PD and understanding of DBS for PD was administered to PD patients seen at an urban movement disorders clinic.Results: One hundred and two patients completed the survey. When asked if they would undergo a hypothetical risk-free, curative brain surgery for PD, 98 patients responded “yes.” Patients were more agreeable to “reversible,” “minimally-invasive,” and “incisionless” surgery. 51.2% thought DBS is an “effective” treatment for PD, 76.6% thought it was “invasive,” and 18.3% thought it was “reversible.” 45.2% reported fear of being awake during DBS surgery. Regarding costs, 52.4% were concerned that DBS was “very expensive” or “not covered by insurance.” Initial source of information and perceived treatment effectiveness were not associated with concerns about DBS effectiveness or threats to normality. Negative perceptions of past surgery were associated with concerns about DBS altering mood and personality.Conclusion: Overall, patients expressed concerns regarding procedural efficacy, invasiveness, cost, and irreversibility—independent of the original source of information. Future studies are required to allow us to better understand the impact of these initial findings on DBS hesitancy and underutilization.

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Purpose: To determine the association of Fitzpatrick skin type (FST) with conjunctival melanoma. Methods: Retrospective case series of 540 patients with conjunctival melanoma to assess clinical features and outcomes per FST. Results: The FST was Type I (n = 126, 23%), II (n = 337, 62%), III (n = 56, 10%), IV (n = 8, 2%), V (n = 12, 2%), and VI (n = 1, <1%). A comparison (FST I vs. II vs. III, IV, V, and VI) revealed Types I and II associated with older mean patient age (63.9 vs. 60.7 vs. 51.1 years, p < 0.001), greater percentage of female patients (68% vs. 44% vs. 42%, p < 0.001), lower frequency of complexion associated melanosis (1% vs. 2% vs. 13%, p < 0.001), smaller tumor thickness (2.1 vs. 2.8 vs. 3.6 mm, p = 0.01), and less eyelid involvement (13% vs. 13% vs. 28%, p = 0.02). Kaplan–Meier estimates for 5-year risk showed no difference by Types for visual acuity loss ≥3 lines, local tumor recurrence, exenteration, metastasis, or death. Conclusion and relevance: Most patients with conjunctival melanoma show FST I or II, and this demonstrated no association with 5-year rate of vision loss, tumor recurrence, exenteration, metastasis, or death.

BACKGROUND AND PURPOSE: Intra-arterial chemotherapy for retinoblastoma has dramatically altered the natural history of the disease. The remarkable outcomes associated with a high safety profile have pushed the envelope to offer treatment for patients weighing #10 kg. The purpose was to determine the efficacy and safety of IAC infusions performed in infants weighing #10 kg with intraocular retinoblastoma. MATERIALS AND METHODS:A retrospective chart review was performed for patients diagnosed with retinoblastoma and managed with intra-arterial chemotherapy. RESULTS:The total study cohort included 207 retinoblastoma tumors of 207 eyes in 196 consecutive patients who underwent 658 intra-arterial chemotherapy infusions overall. Of these, patient weights were 10 kg in 69 (35.2%) and .10 kg in 127 (64.8%) patients. Comparison (#10 kg versus .10 kg) revealed that the total number of intra-arterial chemotherapy infusions was 222 versus 436. Periprocedural complications were not significantly different (2 [0.9%] versus 2 [0.5%]; P ¼ .49). Cumulative radiation exposure per eye was significantly lower in infants weighing #10 kg (5.0 Gym 2 versus 7.7 Gym 2 ; P ¼ .01). Patients weighing 10 kg had a greater frequency of complete tumor regression (82.6% versus 60.9%; P ¼ .02). Mean fluoroscopy time was not significantly different (7.5 versus 7.2; P ¼ .71). There was a significant difference in the frequency of enucleation (16 [21.6%] versus 52 [39.1%]; P ¼ .01). Patients weighing 10 kg had greater number of aborted procedures (12 [5.4%] versus 7 [1.6%]; P ¼ .01). On multivariate analysis, weight #10 kg was not an independent predictor of complications or procedure failure.CONCLUSIONS: Intra-arterial chemotherapy in patients weighing #10 kg is a safe and effective treatment.

Objective: To investigate the clinical feasibility (technical feasibility and patient-/clinician adherence) of remote telemonitoring, using a mobile phone, in an international and diverse HF population. Methods: HF patients from five centers in the USA, India and Sweden were equipped with a blood pressure apparatus, digital weight scale and a mobile phone device with custom made software for remote telemonitoring (Vitalbeat®). Patients were asked to record and transmit daily information on body weight, blood pressure and pulse rate as well as symptoms and adherence to medical therapy for 90 days. The primary endpoint, for assessment of general feasibility was defined as % of days with a combination of successful data transmission from patients and data read by clinicians. Acceptable clinical feasibility was a priori set as ≥ 66% of days meeting the primary endpoint. A survey was used to assess patients’ opinions about the remote monitoring system. Data was analyzed according to Intention to treat. Results: 46 HF patients were included (India=20, USA=13, Sweden=13; 59±16yrs; 84% male; NYHA-class 2.4±0.8) and followed for a total of 4410 days. The primary endpoint occurred in 3178 days (77%) and 34/46 patients (74%) exceeded the cut-off ≥ 66% of days meeting endpoint criteria. In the majority of patients (n=28; 61 %) the primary endpoint was met ≥ 90% of the days, and in 6 patients (13%) 66-89% of the days.Twelve patients (26%) opted to drop out of the study prematurely or were hospitalized for HF related causes. Compared to patients with acceptable clinical feasibility (≥ 66%), patients with less than acceptable feasibility (< 66%) were older (72±12 vs. 56±15 yrs, p=0.003) and more likely to be followed at a center in USA or Sweden (p=0.02 vs. Indian centers). The monitoring system was described as user friendly by 91 % of patients. Conclusion: This study shows that remote telemonitoring using a mobile phone is clinically feasible in an international and diverse heart failure population. However, monitoring was less feasible in elderly patients and depended on the geographic location. Further studies are warranted to assess whether clinical feasibility can improve with improved software/hardware design and/or patient selection.