ABSTRACT
BACKGROUND AND PURPOSE: Intra-arterial thrombolytics may be used to treat distal vessel occlusions, which cause incomplete reperfusion following mechanical thrombectomy. Because immediate reperfusion after intra-arterial thrombolytics occurs rarely, the aim of this study was to assess the delayed effect of intra-arterial thrombolytics using follow-up perfusion imaging. MATERIALS AND METHODS: We included patients from a prospective stroke registry (February 2015 to September 2022) who had undergone mechanical thrombectomy and had incomplete reperfusion (expanded TICI 2a-2c) and available 24 hour perfusion imaging. Perfusion imaging was rated as delayed reperfusion if time-sensitive perfusion maps did not show wedge-shaped delays suggestive of persisting occlusions corresponding to the post-mechanical thrombectomy angiographic deficit. Patients treated with intra-arterial thrombolytics were compared with controls using multivariable logistic regression and inverse probability of treatment weighting matching for baseline differences and factors associated with delayed reperfusion. RESULTS: The median age of the final study population (n = 459) was 74 years (interquartile range, 63-81 years), and delayed reperfusion occurred in 61% of cases. Patients treated with additional intra-arterial thrombolytics (n = 40) were younger and had worse expanded TICI scores. After matching was performed, intra-arterial thrombolytics was associated with higher rates of delayed reperfusion (adjusted OR = 2.7; 95% CI, 1.1-6.4) and lower rates of new infarction in the residually hypoperfused territory after mechanical thrombectomy (adjusted OR = 0.3; 95% CI, 0.1-0.7). No difference was found in the rates of functional independence (90-day mRS, 0-2; adjusted OR = 1.4; 95% CI, 0.4-4.1). CONCLUSIONS: Rescue intra-arterial thrombolytics is associated with delayed reperfusion of remaining vessel occlusions following incomplete mechanical thrombectomy. The value of intra-arterial thrombolytics as a potential therapy for incomplete reperfusions after mechanical thrombectomy should be assessed in the setting of randomized controlled trials.
Subject(s)
Brain Ischemia , Stroke , Humans , Middle Aged , Aged , Aged, 80 and over , Treatment Outcome , Stroke/drug therapy , Stroke/surgery , Thrombectomy/methods , Fibrinolytic Agents/therapeutic use , Reperfusion/methods , Thrombolytic Therapy , Brain Ischemia/therapy , Retrospective StudiesSubject(s)
Dentures , Malocclusion/therapy , Molar, Third/surgery , Serial Extraction , Adult , Humans , MaleSubject(s)
Crowns , Periodontal Diseases/prevention & control , Adult , Dental Alloys , Dental Cavity Preparation , Dental Porcelain , Denture Design , Female , HumansSubject(s)
Dental Porcelain , Denture Design , Resins, Synthetic , Dental Occlusion, Balanced , HumansSubject(s)
Dental Porcelain , Denture, Partial , Plastics , Adult , Crowns , Dental Bonding , Denture Design , Denture Repair , Female , Gold Alloys , HumansSubject(s)
Crowns , Dental Porcelain , Plastics , Dental Alloys , Dental Bonding , Denture Design , Denture Repair , HumansSubject(s)
Crowns , Denture Design , Denture, Partial , Plastics , Dental Porcelain , Post and Core TechniqueABSTRACT
Examinations on models were undertaken under similar experimental conditions to determine the elastic behavior of supported maxillary combination prostheses, which differ according to the shape of the transverse palatal elements. On the basis of the determination of the deformation indices the typical functional behaviour is demonstrated and recommendations are made regarding the construction of the base and connector elements.
Subject(s)
Denture Design , Denture Retention , Dental Abutments , Dental Stress Analysis , Denture, Partial, Removable/standards , Humans , Maxilla , Models, DentalABSTRACT
The conclusion was reached on the basis of statistically significant results that the tendency to cleft formation is significantly less in cast plates than in plastic plates, particularly in the region of the critical dorsal border zone.
