ABSTRACT
Background@#and Purpose Randomized trials proved the benefits of mechanical thrombectomy (MT) for select patients with large vessel occlusion (LVO) within 24 hours of last-known-well (LKW). Recent data suggest that LVO patients may benefit from MT beyond 24 hours. This study reports the safety and outcomes of MT beyond 24 hours of LKW compared to standard medical therapy (SMT). @*Methods@#This is a retrospective analysis of LVO patients presented to 11 comprehensive stroke centers in the United States beyond 24 hours from LKW between January 2015 and December 2021. We assessed 90-day outcomes using the modified Rankin Scale (mRS). @*Results@#Of 334 patients presented with LVO beyond 24 hours, 64% received MT and 36% received SMT only. Patients who received MT were older (67±15 vs. 64±15 years, P=0.047) and had a higher baseline National Institutes of Health Stroke Scale (NIHSS; 16±7 vs.10±9, P<0.001). Successful recanalization (modified thrombolysis in cerebral infarction score 2b-3) was achieved in 83%, and 5.6% had symptomatic intracranial hemorrhage compared to 2.5% in the SMT group (P=0.19). MT was associated with mRS 0–2 at 90 days (adjusted odds ratio [aOR] 5.73, P=0.026), less mortality (34% vs. 63%, P<0.001), and better discharge NIHSS (P<0.001) compared to SMT in patients with baseline NIHSS ≥6. This treatment benefit remained after matching both groups. Age (aOR 0.94, P<0.001), baseline NIHSS (aOR 0.91, P=0.017), Alberta Stroke Program Early Computed Tomography (ASPECTS) score ≥8 (aOR 3.06, P=0.041), and collaterals scores (aOR 1.41, P=0.027) were associated with 90-day functional independence. @*Conclusion@#In patients with salvageable brain tissue, MT for LVO beyond 24 hours appears to improve outcomes compared to SMT, especially in patients with severe strokes. Patients’ age, ASPECTS, collaterals, and baseline NIHSS score should be considered before discounting MT merely based on LKW.
ABSTRACT
Background@#and Purpose Mechanical thrombectomy (MT) is the standard treatment for large vessel occlusion (LVO) acute ischemic stroke. Patients with active malignancy have an increased risk of stroke but were excluded from MT trials. @*Methods@#We searched the National Readmission Database for LVO patients treated with MT between 2016–2018 and compared the characteristics and outcomes of cancer-free patients to those with metastatic cancer (MC). Primary outcomes were all-cause in-hospital mortality and favorable outcome, defined as a routine discharge to home (regardless of whether home services were provided or not). Multivariate regression was used to adjust for confounders. @*Results@#Of 40,537 LVO patients treated with MT, 933 (2.3%) had MC diagnosis. Compared to cancer-free patients, MC patients were similar in age and stroke severity but had greater overall disease severity. Hospital complications that occurred more frequently in MC included pneumonia, sepsis, acute coronary syndrome, deep vein thrombosis, and pulmonary embolism (P<0.001). Patients with MC had similar rates of intracerebral hemorrhage (20% vs. 21%) but were less likely to receive tissue plasminogen activator (13% vs. 23%, P<0.001). In unadjusted analysis, MC patients as compared to cancer-free patients had a higher in-hospital mortality rate and were less likely to be discharged to home (36% vs. 42%, P=0.014). On multivariate regression adjusting for confounders, mortality was the only outcome that was significantly higher in the MC group than in the cancerfree group (P<0.001). @*Conclusion@#LVO patients with MC have higher mortality and more infectious and thrombotic complications than cancer-free patients. MT nonetheless can result in survival with good outcome in slightly over one-third of patients.
ABSTRACT
The wide spectrum of therapies offered in the Dead Sea region includes the use of the natural mud, which has an unique composition reflecting the magnesium and mineral richness of the Dead Sea waters. Mud pack therapy applied to the whole body, alone, or in combination with other modalities of balneotherapy has been shown to improve many rheumatologic symptoms. The “Ahava Laboratories Ltd.” company located in the Dead Sea area, recently developed mud compresses that can be used in patients’ homes. The aim of the present study was to assess the efficacy of home application of such mud compresses onto the back of patients suffering from chronic low back pain (LBP). All patients were above age of 18 and had LBP for more than a year. The pain was localized to the region below the 12th rib and above the gluteal line. Exclusion criteria included acute back pain, inflammatory LBP, malignant disease, disk herniation, patients under narcotics, sensitivity to mud, Spa treatment in the last 6 months, scoliosis, pregnancy, infections, heart failure and osteoporosis. The patients were randomized into two groups: group 1 treated with mineral-rich mud compresses, and group 2 treated with mineral depleted compresses, serving as a control group. The study was double blinded, neither patients nor physicians were aware of which type of compresses a patient received. Heated mud compresses were applied 5 times a week (from Sunday to Thursday), for three consecutive weeks totaling 15 treatments; the duration of each treatment was 20 minutes. The study showed an improvement in patients suffering from chronic LBP self-treated at home with natural-mineral-rich mud packs. This improvement was demonstrated by the self-assessment of pain severity, based on a visual analog scale and by the score obtained through a functional questionnaire. The improvement in pain severity and functional score in the treatment group maintained one month after completing the therapy. In the control group, no improvement in the visual analog scale score was seen in any assessment, except for the Ronald & Morris score.
ABSTRACT
The wide spectrum of therapies offered in the Dead Sea region includes the use of the natural mud, which has an unique composition reflecting the magnesium and mineral richness of the Dead Sea waters. Mud pack therapy applied to the whole body, alone, or in combination with other modalities of balneotherapy has been shown to improve many rheumatologic symptoms. The “Ahava Laboratories Ltd.” company located in the Dead Sea area, recently developed mud compresses that can be used in patients’ homes.<BR> The aim of the present study was to assess the efficacy of home application of such mud compresses onto the back of patients suffering from chronic low back pain (LBP).<BR> All patients were above age of 18 and had LBP for more than a year. The pain was localized to the region below the 12th rib and above the gluteal line. Exclusion criteria included acute back pain, inflammatory LBP, malignant disease, disk herniation, patients under narcotics, sensitivity to mud, Spa treatment in the last 6 months, scoliosis, pregnancy, infections, heart failure and osteoporosis.<BR> The patients were randomized into two groups: group 1 treated with mineral-rich mud compresses, and group 2 treated with mineral depleted compresses, serving as a control group. The study was double blinded, neither patients nor physicians were aware of which type of compresses a patient received. Heated mud compresses were applied 5 times a week (from Sunday to Thursday), for three consecutive weeks totaling 15 treatments; the duration of each treatment was 20 minutes.<BR> The study showed an improvement in patients suffering from chronic LBP self-treated at home with natural-mineral-rich mud packs. This improvement was demonstrated by the self-assessment of pain severity, based on a visual analog scale and by the score obtained through a functional questionnaire. The improvement in pain severity and functional score in the treatment group maintained one month after completing the therapy. In the control group, no improvement in the visual analog scale score was seen in any assessment, except for the Ronald & Morris score.