Aspiration Thrombectomy Versus Stent Retriever Thrombectomy Alone for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

Introduction This meta-analysis was conducted to assess the safety and efficacy of aspiration thrombectomy versus stent retriever thrombectomy for acute ischemic stroke (AIS). Methods We queried online databases for original studies comparing aspiration thrombectomy with stent retriever thrombectomy in patients with AIS. After article selection, data were extracted on multiple baseline characteristics and prespecified endpoints. Dichotomous data were presented as risk ratios (RRs) and corresponding 95% confidence intervals (CIs); continuous data as mean differences and 95% CIs. The data were pooled using a random-effects model. Subgroup analysis was conducted based on study type, site of occlusion, and age. Results We shortlisted nine relevant studies (n=1453 patients; n=690 receiving aspiration thrombectomy and n=763 receiving stent retriever thrombectomy). Meta-analysis demonstrated no significant difference between the two groups in the rates of successful recanalization (RR: 0.96 [0.87, 1.06]; p=0.42), excellent functional outcome (RR: 0.90 [0.80, 1.01]; p=0.06), or procedure time (weighted mean difference (WMD): -5.39 minutes [-11.81, 1.04]; p=0.10). However, when removing the study by Nishi et al., sensitivity analysis resulted in a significant reduction in procedure time with aspiration (WMD: -11.01 [-15.54, -6.49]; p<0.0001). No significant difference was observed in safety outcomes, including all-cause mortality (RR: 0.82 [0.57, 1.19]; p=0.30), intracranial hemorrhage (RR: 0.93 [0.55, 1.59]; p=0.80), symptomatic intracranial hemorrhage (RR: 0.72[0.42, 1.21]; p=0.57), or embolization to new territory (RR: 0.71 [0.42, 1.19]; p=0.19). Subgroup analysis revealed that aspiration thrombectomy led to significantly better outcomes in patients with a mean age ≤65 (RR: 1.15 [1.03, 1.29]; p=0.001), and stent retriever thrombectomy led to increased recanalization success in patients with a mean age >65 (RR: 0.89 [0.80, 1.00]; p=0.05). Conclusions Our updated meta-analysis reveals that both aspiration and stent retriever thrombectomy are comparably effective in the management of AIS. Shorter procedure times may potentially be attained with aspiration thrombectomy, and outcomes with each procedure may be age-dependent.

Meta-analysis Evaluating the Safety and Efficacy of Transcarotid Transcatheter Aortic Valve Implantation.

We performed a systemic review and meta-analysis of studies evaluating transcarotid vascular access for transcatheter aortic valve implantation (TAVI). Published studies evaluating transcarotid vascular access for TAVI were included in this analysis. Outcomes of interest included 30-day mortality, stroke/transient ischemic attack (TIA), new pacemaker implantation, acute kidney injury (AKI), major vascular complication, major bleeding, and myocardial infarction. Pooled estimate for 30-day mortality was 5.3% (95% confidence interval [CI] 4.0% to 6.8%; I2 = 4%), stroke/TIA was 3.4% (95% CI 2.4% to 4.6%; I2 = 0%), new pacemaker implantation was 15.3% (95% CI 10.8% to 19.7%; I2 = 72%), AKI was 3.4% (95% CI 1.3% to 6.5%; I2 = 58%), major vascular complication was 2.4% (95% CI 1.1% to 3.7%; I2 = 46%), major bleeding was 4.3% (95% CI 2.8% to 6.1%; I2 = 11%), and myocardial infarction was 1.1% (95% CI 0.4% to 2.0%; I2 = 0%). Metaregression was carried out to study the association of effect size with the continuous study-level covariates that included average age, proportion of males, and mean STS score. In this regard, mean STS score showed association with major vascular complications (coefficient: 0.008; p = 0.049). Cumulative meta-analysis carried out showed that there was temporal trend of decreasing incidence of stroke/TIA, major vascular complications, and AKI for transcarotid TAVI. In conclusion, transcarotid access for TAVI is a reasonable choice in patients requiring alternate access to transfemoral route.

Comparison of Knowledge, Attitudes, and Practices of Educated and Uneducated Adults Regarding Human Immunodeficiency Virus in Karachi, Pakistan.

BACKGROUND: Despite the high prevalence of human immunodeficiency virus (HIV) in Pakistan, no prior work has been done to specifically highlight the importance of education as a social vaccine against HIV. Therefore, our study focuses on differences in knowledge and practices regarding HIV and acquired immunodeficiency syndrome (AIDS) among educated and uneducated adults. METHODOLOGY: A cross-sectional study was carried out in which data was collected from all over Karachi. An individual was designated as educated if he had received education above primary school level. Individuals who had studied till primary school or less were considered uneducated. The questionnaire was split into four sections that assessed respondents' demographics, knowledge, attitudes, and practices regarding HIV/AIDS. Chi square test was used as the primary statistical test. RESULTS: Out of the 446 adult participants, 235 (52.7%) were educated and 211 (47.3%) were uneducated. Educated participants were significantly more likely to have heard about HIV (183 vs. 39, p < 0.001) and had better knowledge about the symptoms of HIV/AIDS (p < 0.001). Among the participants who knew about AIDS, a greater percentage of uneducated (n = 28, 53%) than educated individuals (n = 68, 37%) believed that people suffering from AIDS should be isolated (p = o.o16) and that HIV can spread through water (40% vs 20% respectively, p < 0.001). Both educated (n = 49, 27%) and uneducated (n = 46, 89%) adults believed that awareness would help prevent the spread of HIV (p = 0.978) and were willing to educate their children about it (p = 0.696). CONCLUSION: Our study revealed a gap in the knowledge about HIV/AIDS between educated and uneducated adults. There is an urgent need for awareness programs that especially reach out to the uneducated masses that are otherwise uninformed about HIV and are under high risk of acquiring HIV.