Effectiveness of rivaroxaban in preventing cerebral venous thromboembolism: a systematic review and meta-analysis.

Background: Cerebral venous thromboembolism (CVT) poses a significant risk of venous infarction and haemorrhage, which can lead to neurological deficits and, in severe cases, even death. The optimal treatment regimen for patients with CVT remains unclear. Methods: MEDLINE, Embase, Google Scholar, Web of Science (WoS), and Cochrane Central databases were searched for randomized controlled trials (RCTs) and observational studies assessing the efficacy and safety of rivaroxaban in patients with CVT. All-site venous thromboembolism (VTE), risk of clinically relevant non-major bleeding, incidence of partial recanalization, complete recanalization and major haemorrhage were among outcomes of interest. Mantel-Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95% CIs. Results: The analysis included 1 RCT and 3 observational studies containing 211 patients. Compared to vitamin K antagonists (VKAs), rivaroxaban did not significantly decrease the all-site VTE [RR 0.31 (95% CI 0.01, 8.43); P=0.49, I2=0%]. Compared with VKAs, patients on rivaroxaban did not show a significantly reduced risk of recurrent cerebral venous thrombosis. In terms of incidence of partial recanalization, there was no discernible difference between rivaroxaban and VKAs [RR 0.90 (95% CI 0.66, 1.22); P=0.49, I2=0%]. There was no discernible difference in incidence of complete recanalization [RR 0.98 (95% CI 0.32, 3.03); P=0.97, I2=28%] and incidence of major haemorrhage [RR 0.19 (95% CI 0.01, 4.54); P=0.30]. Conclusion: Rivaroxaban was found to have similar efficacy to VKAs. Due to its lower risk of severe bleeding and no need for INR monitoring, rivaroxaban may be a preferable treatment option for CVT.

Navigating Fertility Challenges: A Comprehensive Review of Microsurgery for Fallopian Tubal Re-canalization in the Era of In Vitro Fertilization (IVF).

The journey of addressing fertility challenges, especially in the context of fallopian tubal issues, has witnessed remarkable advancements. This comprehensive review delves into microsurgery for fallopian tubal re-canalization within the era of in vitro fertilization (IVF). The review begins by providing the historical backdrop, tracing the evolution of this surgical technique, and highlighting the transformative impact of microsurgical methods and instrumentation on its precision and outcomes. Microsurgery for fallopian tubal re-canalization is characterized by a range of patient-specific considerations, diagnostic modalities, and factors influencing the choice between re-canalization and IVF. Microsurgical techniques are elaborated upon, showcasing the importance of laparoscopy and hysteroscopy, which not only diagnose but also treat tubal and uterine conditions. The review delves into the pivotal elements that steer the decision-making process, including patient preferences, medical necessity, ethical and religious considerations, financial constraints, and clinical evaluation. Furthermore, the intricate complications and risks associated with tubal re-canalization, both intraoperative and postoperative, are elucidated. Insights into recent advances in microsurgery, emerging research, and promising future directions set the stage for innovative and effective solutions. Recognizing the significance of patient counseling, shared decision-making, ethical considerations, and informed consent, the review underlines the critical role of healthcare providers in guiding individuals and couples through the complexities of fertility treatment choices. Finally, the conclusion synthesizes the key findings, implications for clinical practice, and future research directions, emphasizing the importance of tailored and patient-centered approaches to address fertility challenges in the modern era.

Relationship Between ABO Blood Type and Spontaneous Re-canalization in Patients With Acute Myocardial Infarction / 中国循环杂志

Objective: To study the relationship between ABO blood type and spontaneous re-canalization (SR) in patients with acute myocardial infarction (AMI). Methods: A total of 1209 consecutive AMI patients were enrolled. Based on TIMI grade, the patients were divided into 2 groups: Non-SR group, the patients with TIMI grade 0-1,n=442 and SR group, the patients with TIMI grade 2-3,n=767. The relationship between ABO blood type and SR was investigated. Results: Compared with Non-SR group, SR group had more patients with blood type O (32.3% vs 24.7%) and less blood type A (31.7% vs 24.9%). Meanwhile, we found that a lower cholesterol level was related to patients with O blood type and SR occurrence, bothP<0.05. Multi regression analysis indicated that with adjusted age, gender, BMI, hypertension, diabetes, smoking, LDL-C and C-reactive protein, ESR, fibrinogen, D-dimmer, endothelial cardiac function, blood type O may independently predict SR occurrence in AMI patients (OR=1.49, 95% CI 1.10-2.05), while blood type A may have disadvantage for SR (OR=0.65, 95% CI 0.48-0.80). Conclusion: ABO blood type has been related to SR in AMI patients, blood type O is in favor of SR, while blood type A has disadvantage for SR occurrence.

Evolución clínica y ultrasonográfica del síndrome postrombótico en su primer año de evolución / Clinical and ultrasonographic progression of posthrombotic syndrome in its first year

Introduccións: La insuficiencia venosa crónica es característica principal del síndrome postrombótico donde el estasis venoso es típico. Objetivos: Describir la evolución clínica y ultrasonográfica del síndrome postrombótico durante su primer año. Métodos: Estudio descriptivo prospectivo en 20 hombres (55,6 por ciento) y 16 mujeres (44,4 por ciento) con una edad promedio de 55,8 ± 14,2 años (IC95 por ciento : 41,6 ­ 70 años), ingresados en el Servicio de Flebolinfología del Instituto Nacional de Angiología y Cirugía Vascular con el diagnóstico de trombosis venosa profunda de los miembros inferiores. Las variables estudiadas fueron: tipos de síntomas clínicos, tipo de evolución ultrasonográfica por ecodoppler, estadios clínicos del síndrome postrombótico, tiempo y porcentaje de recanalización. Resultadoss: A los seis meses de evolución predominó la sintomatología severa (47,2 por ciento); en el sector fémoro­poplíteo la clasificación de buena. Al año, fue más frecuente la clasificación de moderada (52,8 por ciento) y de muy buena en el sector poplíteo; el edema pretibial fue el signo que predominó. En los sectores ocluidos fémoro-poplíteo el porcentaje de recanalización promedio aumentó al año y fue superior (p < 0,05) al obtenido a los seis meses. Se encontró asociación significativa entre el porcentaje de recanalización y el período de evolución (X2= 41,41; p= 0,0000); y entre el estadio clínico y el porcentaje de recanalización (X2= 32,95; p= 0,0000). Conclusións: durante el primer año de presentarse el síndrome postrombótico pueden ocurrir cambios clínicos y evolución favorable en la recanalización del sistema venoso profundo(AU)

Introduction: Chronic venous insufficiency is the main characteristic of the posthrombotic syndrome where the vein stasis is typical. Objective: to describe the clinical and ultrasonographic progression of the post-thrombotic syndrome in its first year. Methods: A descriptive prospective study was conducted in 20 men (55.6 percent) and 16 women (44.4 percent), with average age of 55.8 ± 14.2 years (IC95 percent : 41.6 ­ 70 years) diagnosed as deep venous thrombosis of the lower limb patients and hospitalized in the phlebolymphology service of the National Institute of Angiology and Vascular Surgery. The studied variables were types of clinical symptoms, type of ultrasonographic progression using Echodoppler device, clinical stagings of the posthrombotic syndrome, and time and percentage of re-canalization. Results: After six months of progression, severe symptoms predominated (47.2 percent); and in the femoral-popliteal area the classification was good. After a year, the moderate classification was more frequent (52.8 percent) and extremely good in the popliteal sector; the pretibial edema was the predominant sign (50 percent). In the occluded popliteal-femoral sector, the percentage of average re-canalization increased after a year, being higher (p< 0.05) than that of six months. A significant association was found between the percentage of re-channeling and the period of progression (X2= 41.41; p= 0.0000); and between the clinical staging and the percentage of re-canalization (X2= 32.95, p= 0.0000). Conclusions: During the first year of existence of the posthrombotic syndrome, clinical changes and favorable progression may occur in the re-canalization of the deep venous system(AU)

Evolución clínica y ultrasonográfica del síndrome postrombótico en su primer año de evolución / Clinical and ultrasonographic progression of posthrombotic syndrome in its first year

Introduccións: La insuficiencia venosa crónica es característica principal del síndrome postrombótico donde el estasis venoso es típico.Objetivos: Describir la evolución clínica y ultrasonográfica del síndrome postrombótico durante su primer año.Métodos: Estudio descriptivo prospectivo en 20 hombres (55,6 por ciento) y 16 mujeres (44,4 por ciento) con una edad promedio de 55,8 ± 14,2 años (IC95 por ciento: 41,6 70 años), ingresados en el Servicio de Flebolinfología del Instituto Nacional de Angiología y Cirugía Vascular con el diagnóstico de trombosis venosa profunda de los miembros inferiores. Las variables estudiadas fueron: tipos de síntomas clínicos, tipo de evolución ultrasonográfica por ecodoppler, estadios clínicos del síndrome postrombótico, tiempo y porcentaje de recanalización.Resultadoss: A los seis meses de evolución predominó la sintomatología severa (47,2 por ciento); en el sector fémoro–poplíteo la clasificación de buena. Al año, fue más frecuente la clasificación de moderada (52,8 por ciento) y de muy buena en el sector poplíteo; el edema pretibial fue el signo que predominó. En los sectores ocluidos fémoro-poplíteo el porcentaje de recanalización promedio aumentó al año y fue superior (p < 0,05) al obtenido a los seis meses. Se encontró asociación significativa entre el porcentaje de recanalización y el período de evolución(X2= 41,41; p= 0,0000); y entre el estadio clínico y el porcentaje de recanalización (X2= 32,95; p= 0,0000).Conclusións: durante el primer año de presentarse el síndrome postrombótico pueden ocurrir cambios clínicos y evolución favorable en la recanalización del sistema venoso profundo (AU)

Introduction: Chronic venous insufficiency is the main characteristic of the posthrombotic syndrome where the vein stasis is typical.Objective: to describe the clinical and ultrasonographic progression of the post-thrombotic syndrome in its first year.Methods: A descriptive prospective study was conducted in 20 men (55.6 percent) and 16 women (44.4 percent), with average age of 55.8 ± 14.2 years (IC95 percent: 41.6 70 years) diagnosed as deep venous thrombosis of the lower limb patients and hospitalized in the phlebolymphology service of the National Institute of Angiology and Vascular Surgery. The studied variables were types of clinical symptoms, type of ultrasonographic progression using Echodoppler device, clinical stagings of the posthrombotic syndrome, and time and percentage of re-canalization.Results: After six months of progression, severe symptoms predominated (47.2 percent); and in the femoral-popliteal area the classification was good. After a year, the moderate classification was more frequent (52.8 percent) and extremely good in the popliteal sector; the pretibial edema was the predominant sign (50 percent). In the occluded popliteal-femoral sector, the percentage of average re-canalization increased after a year, being higher (p< 0.05) than that of six months. A significant association was found between the percentage of re-channeling and the period of progression (X2= 41.41; p= 0.0000); and between the clinical staging and the percentage of re-canalization (X2= 32.95, p= 0.0000).Conclusions: During the first year of existence of the posthrombotic syndrome, clinical changes and favorable progression may occur in the re-canalization of the deep venous system

Amplatzer Vascular Plugs Versus Coils for Embolization of Pulmonary Arteriovenous Malformations in Patients with Hereditary Hemorrhagic Telangiectasia.

PURPOSE: Coil embolization of pulmonary arteriovenous malformations (PAVMs) has a high re-canalization/re-perfusion rate. Embolization with Amplatzer plugs has been previously described, but the long-term efficacy is not established. This study reports the experience of a referral medical center with the use of coils and Amplatzer plugs for treating PAVMs in patients with hereditary hemorrhagic telangiectasia. METHODS: The study was approved by the Institutional Review Board with waiver of informed consent. The cohort included all patients who underwent PAVM embolization in 2004-2014 for whom follow-up imaging scans were available. The medical files were retrospectively reviewed for background data, embolization method (coils, Amplatzer plugs, both), and complications. Re-canalization of treated PAVMs was assessed from intrapulmonary angiograms (following percutaneous procedures) or computed tomography angiograms. Fisher's exact test and Pearson Chi-squared test or t test were used for statistical analysis, with significance at p < 0.05. RESULTS: 16 patients met the study criteria. Imaging scans were available for 63 of the total 110 PAVMs treated in 41 procedures. Coils were used for embolization in 37 PAVMs, Amplatzer plugs in 21, and both in five. Median follow-up time was 7.7 years (range 1.4-18.9). Re-canalization was detected in seven vessels, all treated with coils; there were no cases of re-canalization in plug-occluded vessels (p = 0.0413). CONCLUSION: The use of Amplatzer plugs for the embolization of PAVMs in patients with hemorrhagic telangiectasia is associated with a significantly lower rate of re-canalization of feeding vessels than coils. Long-term prospective studies are required to confirm these findings.

Recanalization of extracranial internal carotid artery occlusion: A 12-year retrospective study.

This study aimed to summarize therapy experience of carotid endarterectomy, carotid endarterectomy combined with Fogarty catheter embolectomy, and hybrid surgery for the treatment of extracranial internal carotid artery occlusion. The study included 65 patients with extracranial internal carotid artery occlusion who underwent carotid endarterectomy, carotid endarterectomy combined with Fogarty catheter embolectomy, or hybrid surgery in the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China between January 2006 and December 2012. Prior to surgery, all patients underwent perfusion CT or xenon CT to evaluate the occlusion. The procedure for each patient was chosen according to digital subtraction angiography data. The carotid artery was successfully recanalized in 46 of 51 patients who underwent carotid endarterectomy, 9 of 10 patients who underwent carotid endarterectomy combined with Fogarty catheter embolectomy, and 3 of 4 patients who underwent hybrid surgery. In patients with symptomatic carotid artery occlusion, the carotid artery can be recanalized by choosing a treatment procedure based on imaging examination findings.

Intra-arterial versus intra-venous thrombolysis within and after the first 3 hours of stroke onset.

The NINDS trial demonstrated for the first time the effectiveness of intravenous thrombolysis in improving outcome after acute ischemic stroke. The absolute benefit of this intervention was 11-13% greater chance of being normal or near normal (MRS ≤ 1) at 3 months. However, if patients with severe stroke were considered (NIHSS ≥ 20), the absolute benefit dropped to 5-6%, indicating that IV thrombolysis may not be as effective for large vessel occlusion. This observation was further supported by TCD studies that clearly demonstrated that large artery occlusions had a recanalization rate of 13-18% with IV rt-PA. Intra-arterial thrombolysis achieves recanalization rates of 60-70%. Since tissue viability is clearly important, it is time to stop defining rigid time windows and if there is a large penumbra (20-50%) and the occlusion is in a large artery, there exists a logic and a growing evidence to consider either bridge therapy or direct intra-arterial therapy.