From Perviousness to Plaque Imaging in Acute Basilar Occlusions: The Impact of Underlying Stenosis and How to Detect It.

Background and Purpose- Recent studies show that mechanical thrombectomy of acute basilar artery occlusions (BAO) results in high rates of successful recanalization and good outcomes, but predictors are not completely established yet. Varying occlusion types may benefit differently, and especially, an underlying basilar stenosis (BS) seems to have an impact. Aim of this study was to investigate angiographic and clinical differences in BAO subtypes and to test the potential of perviousness measures for a preinterventional identification of clinically relevant different occlusion types. Methods- All consecutive patients with acute BAO, endovascular treated at a single comprehensive stroke center, were included. Different occlusion patterns, especially underlying BS, were identified and analyzed in respect of angiographic and clinical (National Institutes of Health Stroke Scale/modified Rankin Scale) outcome parameters (N=115). Thrombus perviousness measures (change in thrombus attenuation Δt and corrected void fraction ε) were assessed in admission computed tomography imaging and correlated to different etiological subgroups. Results- Despite comparable rates of successful recanalization (87% for BAO with BS versus 95% without BS), the BS group showed worse clinical outcome with higher National Institutes of Health Stroke Scale/modified Rankin Scale values (P=0.002/0.003). The group of BS turned out to have lower thrombus density values in unenhanced scans (mean, 42.0 Hounsfield units) and higher perviousness measures Δt (mean, 34.6 Hounsfield units) and ε (mean, 0.23) than thrombi without an underlying BS (mean, 53.6 Hounsfield units/13.1 Hounsfield units/0.08, P=0.01/ 0.004/ 0.001). Conclusions- In agreement with previous studies, outcome of mechanical thrombectomy of BAO seems to depend on pathogenesis with less clinical benefit for underlying BS, raising the question of early identification of this subgroup. Perviousness showed a high potential to differentiate acute BAO with and without BS, possibly usable as an admission imaging marker for BS.

Vertebral Artery Patency and Thrombectomy in Basilar Artery Occlusions.

Background and Purpose- Factors influencing recanalization success in basilar artery occlusions are largely unknown. Preliminary evidence has suggested that flow arrest in the vertebral artery contralateral to the catheter bearing vertebral artery may facilitate recanalization. The aim of this analysis was to assess the impact of anatomic variations and flow conditions on recanalization success in basilar artery occlusion treated with mechanical thrombectomy. Methods- Consecutive basilar artery occlusions treated with second-generation thrombectomy devices at a single-center were retrospectively analyzed. Baseline patients' characteristics, occlusion length, collateral circulation, underlying stenosis, incomplete occlusions, and patency of the vertebral arteries were analyzed with regards to recanalization success. Aplastic or hypoplastic vertebral artery contralateral to the catheter position was defined as contralateral low flow condition. Logistic regression analysis was used to examine the association between anatomic variations and flow conditions in relation to complete recanalization and the modified Rankin Scale score while controlling for several potentially confounding variables. Clinical impact was evaluated using the modified Rankin Scale score of ≤3. Results- One hundred fifteen patients were included (mean age 71.5±12.8, m:f=2:1, median National Institutes of Health Stroke Scale =15, interquartile range =10-22). Complete recanalization was more often observed in patients with contralateral low flow conditions (80.6% versus 50.0%), which remained an independent predictor of complete recanalization in multivariable analysis (adjusted odds ratio, 5.81; 95% CI, 1.97-17.19). Patients with complete posterior recanalization had lower in-hospital mortality (16.4% versus 41.7%) and more often achieved modified Rankin Scale score of ≤3 (49.4% versus 8.3%), even after adjusting for potential confounders (adjusted odds ratio, 15.93; 95% CI, 1.42-179.00). Conclusions- Contralateral low flow condition (vertebral artery aplasia or hypoplasia) seems to be an independent factor for fewer distal emboli and complete recanalization in basilar artery occlusion patients treated by modern endovascular devices. Complete recanalization reflecting the absence of peri-interventional clot fragmentation brings clear clinical benefit. Further studies are warranted to evaluate the need for contralateral flow modulation or ipsilateral balloon guide catheter during posterior circulation thrombectomy in patients with bilaterally patent vertebral arteries.

Endovascular Stroke Treatment: How Far Downstream Should We Go?

BACKGROUND: Endovascular thrombectomy has become the de facto standard in the treatment of large vessel occlusion. Previously, a correlation between good outcome and the occlusion site, measured by the 'distance to thrombus' (DT)-as the distance from the carotid T to the beginning of the thrombus-after thrombolysis could be shown. In the present study, we analyze the differences between the chances of a good outcome in respect of DT between patients treated endovascularly or intravenously. METHODS: A dual-center database analysis including patients with stroke due to occlusion of the middle cerebral artery (MCA) was performed. Inclusion criteria were a completed treatment and full documentation of the clinical course. DT was measured in pre-treatment images. DT was correlated with the mRS at 90 days stratified according to the different treatment methods. RESULTS: A total of 280 patients could be included. We were able to show a correlation between the chances of good clinical outcome and the occlusion site measured by DT after i.v. thrombolysis. The outcome after endovascular treatment showed no correlation with DT (p = 0.227). After a DT of 26 mm, the chances of a good outcome after i.v. thrombolysis exceeded those after endovascular treatment. CONCLUSION: In patients with MCA occlusion, the probability for a good outcome after endovascular treatment is independent of the occlusion site in contrast to the treatment with i.v. thrombolysis. If the occlusion occurred in the periphery of the M2 region (DT > 26 mm), i.v. thrombolysis alone was superior to endovascular treatment in achieving a good outcome.

Impact of sub-lethal residues of azinphos-methyl on the pheromone-communication systems of insecticide-susceptible and insecticide-resistant obliquebanded leafrollers Choristoneura rosaceana (Lepidoptera: Tortricidae).

The effects of sub-lethal residues of azinphos-methyl on pheromone production, calling, female attractiveness and the ability of males to locate sources of natural and synthetic pheromone were compared in azinphos-methyl-susceptible (susceptible) and azinphos-methyl-resistant (resistant) obliquebanded leafrollers, Choristoneura rosaceana (Harris). The amount of pheromone in susceptible females was reduced by 29-33% after exposure to azinphos-methyl; this treatment did not affect the pheromone content of resistant females. Azinphos-methyl-treated resistant females contained 39-43% less pheromone than azinphos-methyl-treated susceptible females. Resistant females that were not treated with azinphos-methyl contained 35-56% less pheromone than susceptible females that were not treated with insecticide. The incidence of calling was reduced by 67-100% in azinphos-methyl-treated susceptible females; the incidence of calling by resistant females was not affected by exposure to azinphos-methyl. The incidence of calling by azinphos-methyl-treated susceptible females was 58-100% lower than that of azinphos-methyl-treated resistant females. There was no difference in the incidence of calling between susceptible and resistant females that had not been treated with insecticide. In a flight tunnel, treatment with insecticide reduced the attractiveness of susceptible females by 38%; treatment with insecticide did not affect the attractiveness of resistant females. There was no difference in the proportion of males attracted to susceptible and resistant females that had, or had not been treated with insecticide. In an apple orchard, the attractiveness of susceptible and resistant females treated with azinphos-methyl was reduced by 84 and 12%, respectively. The proportion of males attracted to azinphos-methyl-treated susceptible females was 58% lower than the proportion attracted to azinphos-methyl-treated resistant females, whereas, if females were not treated with insecticide, the proportion attracted to resistant females was 57% lower than the proportion attracted to susceptible females. In a flight tunnel, azinphos-methyl did not affect the ability of susceptible or resistant males to locate a source of pheromone gland extract. Likewise, in an apple orchard, the insecticide treatment had no effect on the ability of susceptible or resistant males to locate a source of synthetic pheromone. In a flight tunnel, there was no difference in the proportion of azinphos-methyl-treated susceptible and resistant males locating a source of pheromone gland extract; however, in the orchard, 39% fewer azinphos-methyl-treated resistant males located a source of synthetic pheromone than azinphos-methyl-treated susceptible males. A similar proportion of susceptible and resistant males that had not been treated with insecticide located a source of pheromone gland extract in the flight tunnel, but in the orchard, the proportion of resistant males not treated with azinphos-methyl that located the source of synthetic pheromone was 32% lower than the proportion of susceptible males not treated with this insecticide. The implications of the differences in the effect of sub-lethal residues of azinphos-methyl on the pheromone communication system of susceptible and resistant moths are discussed in relation to the theory of the development of insecticide resistance, the detection of resistance in feral populations of moths using sex pheromone-baited traps, and the control of moths using sex pheromone-mediated mating disruption.

Management of insecticide resistance in Oriental fruit moth (Grapholita molesta; Lepidoptera: Tortricidae) populations from Ontario.

The development of resistance in the Oriental fruit moth, Grapholita molesta (Busck) to organophosphorus (OP) insecticides (azinphos-methyl and phosmet) is a serious threat to the tender fruit industry in Ontario (50% crop losses in 1994). Resistance to carbamate insecticides and increased survival of field-collected moths at diagnostic concentrations of pyrethroids were widespread. As a result, four different treatment regimes were tested to manage resistance in G molesta, and the changes in resistance frequencies under each treatment regime were monitored from 1996 to 1999. The data indicated that the levels of resistance were significantly influenced by the various treatment regimes. The seasonal pattern of resistance was similar for all treatment regimes, in that resistance peaked in mid-season and declined in the late season. Levels of resistance in G molesta to OPs decreased from 55% to 14% and that to pyrethroids declined from 30% to 10% from 1996 to 1999 under a treatment regime consisting of endosulfan-organophosphate-pyrethroid rotation. Similarly, under a treatment regime implemented in commercial orchards (organophosphate-pyrethroid rotation), resistance to OP insecticides declined from 50% to 12% and resistance to pyrethroids evolved to around 16%. The overall data indicated that resistance was unstable; a strategy based on rotation of insecticides by class for each generation of G molesta was successful in managing resistance to both OP and pyrethroid insecticides. The rotational strategy has been widely adopted by growers and is applied to ca 85% of the acreage.

Mechanisms of resistance to organophosphorus insecticides in populations of the obliquebanded leafroller Choristoneura rosaceana (Harris) (Lepidoptera: Tortricidae) from southern Ontario.

Populations of Choristoneura rosaceana (Harris) from orchards in Ontario were shown to be resistant to azinphos-methyl and to other types of organophosphorus insecticides. Resistance extended to methyl carbamates and to methomyl. The laboratory population used for these assays and selected with azinphosmethyl was also resistant to the pyrethroid, cypermethrin. Resistance was associated with increased esterase activity and was reduced by the addition of the synergist DEF. IEF studies of esterases also indicated increased activity in resistant populations, but did not identify any unique esterases associated with the resistance. Resistance was highly correlated (r = 0.78) with elevated esterases but not with increased glutathione-S transferase activity (r = 0.13). Other mechanisms did not appear to be related.