Effect of chronic antiplatelet therapy on clinical outcomes of endovascular thrombectomy for treatment of acute ischemic stroke.

OBJECTIVE: The objective of this study was to investigate the prognostic significance of chronic antiplatelet therapy (APT) usage in acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT). Long-term APT may enhance recanalization but may also predispose patients to an increased risk of hemorrhagic transformation. METHODS: Weighted hospitalizations for anterior-circulation AIS treated with EVT were identified in a large United States claims-based registry. Baseline clinical characteristics and outcomes were compared between patients with and without chronic APT usage prior to admission. Multivariable logistic regression analysis was performed to assess adjusted associations between APT and study endpoints. RESULTS: This analysis identified 36,560 patients, of whom 8170 (22.3%) were on a chronic APT regimen prior to admission. These patients were older and demonstrated a higher burden of comorbid disease, but had similar stroke severity on presentation in comparison with those not on APT. On unadjusted analysis, patients with prior APT demonstrated higher rates of favorable outcomes (24.3% vs 21.5%, p < 0.001), lower rates of mortality (7.0% vs 10.1%, p < 0.001), and lower rates of any intracranial hemorrhage (ICH; 20.3% vs 24.2%, p < 0.001), but no difference in rates of symptomatic ICH (sICH). Following multivariable adjustment for baseline clinical characteristics including age, acute stroke severity, and comorbidity burden, prior APT was associated with favorable outcome (adjusted odds ratio [aOR] 1.21, 95% CI 1.17-1.24, p < 0.001) and a lower likelihood of mortality (aOR 0.73, 95% CI 0.70-0.77, p < 0.001), without an increased likelihood of ICH (any ICH aOR 0.84, 95% CI 0.81-0.87, p < 0.001; sICH aOR 0.92, 95% CI 0.82-1.03, p = 0.131). CONCLUSIONS: Retrospective evaluation of patients with AIS treated with EVT using registry-based data demonstrated an association of prior APT usage with favorable outcomes, without an increased risk of hemorrhagic transformation.

Use of a flow diverter in a small-caliber end artery anterior choroidal dissecting pseudoaneurysm: illustrative case.

BACKGROUND: Anterior choroidal artery (AChA) fusiform aneurysms are exceedingly rare and associated with high rebleeding and mortality rates. Their difficult anatomy comes with a broad range of treatment options, including bypass, stent-assisted coiling, and flow diversion. Currently, flow diverters are approved for large-caliber internal carotid artery segment aneurysms. However, many institutions have expanded their use to distal small-caliber vessels, which raises questions regarding device sizing and long-term patency. The authors present a dissecting distal AChA fusiform pseudoaneurysm treated successfully with flow diversion. OBSERVATIONS: A 40-year-old woman with monoclonal gammopathy of unknown significance, lichen sclerosis, and an unspecified connective tissue disease presented with diffuse subarachnoid hemorrhage. She had a dissecting, 5 × 3-mm, left AChA pseudoaneurysm 4 mm distal to the origin of the vessel. A 2.5-mm flow redirection endoluminal device was deployed. There were no procedural complications. A 6-month cerebral angiogram showed device patency and no pseudoaneurysm remnant. These results were maintained at 1 year as seen on head magnetic resonance angiography. LESSONS: Flow diversion is a successful and safe therapeutic intervention for challenging intracranial aneurysms originating from small-caliber vessels supplying eloquent vascular territories.

Effectiveness of the team-based learning (TBL) strategy on medical students' performance.

OBJECTIVES: Team-based learning (TBL) represents a new and interesting educational strategy. It helps to enhance students' professional competencies and ideally works to prepare them in their pursuit of lifelong learning. The aim of this study is to evaluate the effectiveness of TBL as an educational strategy on medical students' performance in a problem-based learning (PBL) curriculum. METHODS: A cross-sectional study was conducted through a self-designed questionnaire. It was constructed to examine several aspects of TBL, including cognition, social skills, high school educational system, and personal development. A total of 112 students were invited to participate in the study and 100 completed the survey. Individual-readiness assurance test (IRAT) and group-readiness assurance test (GRAT) scores were collected and the data were analysed and compared to the results of the final assessment using Statistical Package for the Social Sciences (SPSS). RESULTS: A total of 52 students (52%) described TBL as fostering a cooperative learning environment and 64 students (64%) found the materials to be easier to understand when discussed among themselves as a group. Compared to final examination results, there was a significant correlation (p = 0.0001) between IRAT performance and final exam score. In addition, there was a significant correlation between high school education system and IRAT score, where the best performance was observed among students coming from schools using the British curriculum. CONCLUSIONS: The overall perception and attitude of students toward the TBL system was positive and promising. Nevertheless, there are some notes and areas of concern that must be re-examined and remedied to improve TBL as an educational tool.