First-Pass Effect in M1-Occlusion Stroke Patients Treated with Combined Stent-Retriever/Large-Bore Distal Aspiration Catheter Thrombectomy.

INTRODUCTION: Combined stent-retriever/large-bore distal aspiration catheter (LB-DAC) thrombectomy was recently introduced to treat large-vessel occlusion; however, it is unclear whether larger inner diameters improve outcomes. We compared angiographic and clinical outcomes in patients with occlusions of the M1 segment of the middle cerebral artery treated with mechanical thrombectomy using extra-LB-DAC versus LB-DAC in combination with stent-retrievers. METHODS: We analyzed consecutive patients with M1 occlusion included in the ROSSETTI registry treated with non-balloon guide catheter combined LB-DAC/stent-retriever thrombectomy between June 2019 and April 2022. We compared demographics, baseline clinical variables, procedural variables, angiographic outcomes, and clinical outcomes [National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) and modified Rankin scale score at 3 months] between patients treated with extra-LB-DAC (Sofia Plus, MIVI Q6, Catalyst7; inner diameter, 0.068″-0.070″) versus LB-DAC (Sofia 5F, MIVI Q5, Catalyst 6; inner diameter, 0.055″-0.064″). Primary outcome was the first-pass effect (FPE) rate, defined as near-complete/complete reperfusion (mTICI 2c-3) after a single pass of the device. RESULTS: We included 324 patients (extra-LB-DAC, 185, 57.1% patients). Demographics, clinical data, and clinical outcomes were similar between the two groups; however, there was a trend towards improvement in National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) in the cohort treated with extra-LB-DAC 9 points (IQR 4;16 points) vs. 12 points (IQR 4;18 points, P = 0.083). Patients treated with extra-LB-DAC had higher FPE rate (47% vs. 30.9%; P = 0.003) and higher modified FPE (mTICI ≥ 2b after a single pass) rate (65.9% vs 46.8%; P = 0.001). The use of extra-LB-DAC was an independent factor in predicting FPE (odds ratio 1.982, 95% confidence interval 1.250-3.143, P = 0.004). CONCLUSION: Our results suggest that in combined LB-DAC/stent-retriever thrombectomy, a larger aspiration catheter inner diameter is associated with higher rates of FPE and mFPE.

Diagnóstico perinatal de rabdomiomas intracardiacos y esclerosis tuberosa / Perinatal diagnosis of cardiac rhabdomyomas and tuberous sclerosis

Los tumores cardiacos son poco comunes, y los más frecuentes son los rabdomiomas. Su diagnóstico puede realizarse durante la época fetal. La evolución es variable: algunos son asintomáticos y otros se manifiestan por una obstrucción al flujo o en forma de arritmia. Este tipo de tumores puede ser la clave diagnóstica de una esclerosis tuberosa. Dado el amplio espectro en su presentación, mostramos dos casos, uno de diagnóstico prenatal y otro a partir de un hallazgo en la ecocardiografía(AU)

Primary cardiac tumors are not very common. Rhabdomyomas are those most frequently reported during childhood. They can be diagnosed as early as the fetal period. The course varies; in some cases, there are no symptoms, while in others, the diagnosis is based on the presence of an obstruction to the flow or an arrhythmia. Tumors of this type can be the clue to the diagnosis of tuberous sclerosis. Because of the wide variety of presenting features, we describe two cases, one diagnosed prenatally and the other through a finding on echocardiography(AU)