Arundhati Biswas

BACKGROUND: Endovascular thrombectomy (EVT) for distal and medium vessel occlusion stroke remains uncertain. We aimed to develop a medium and distal mechanical thrombectomy score integrating clinical need and procedural risk to guide patient selection. METHODS: This retrospective cohort analysis used an international distal and medium vessel occlusion stroke registry spanning the study period of 2017 to 2023. Patients with acute distal and medium vessel occlusion stroke who received medical management (MM) or EVT across 37 stroke centers were included, and those with baseline modified Rankin Scale score of ≥3 or those with missing covariable data were excluded. Multivariable logistic regression identified predictors of poor functional outcome (modified Rankin Scale score >2 at 90 days) in the MM cohort and predictors of EVT failure/complications in the EVT cohort. Predictors of poor outcome on MM were assigned positive weights (clinical need); predictors of EVT failure/harm were assigned negative weights (procedural risk). The medium and distal mechanical thrombectomy score summed these weighted points. Interaction analysis assessed the heterogeneity of EVT effect by score. RESULTS: A total of 1217 patients were identified, and 1007 were included (EVT: 822, MM: 185; median age 73 years; 41% female). Higher National Institutes of Health Stroke Scale score (+1 per point) and lack of intravenous thrombolysis (+7) predicted poor MM outcomes. In the EVT cohort, older age (−1 per 15 years above 25), absence of hypertension (−2), and absence of atrial fibrillation (−2) predicted failure/complications. The medium and distal mechanical thrombectomy score (range −8 to 49) significantly modified EVT effect versus MM ( P _interaction =0.048). In high-score patients (≥15; n=293), EVT yielded a better 90-day modified Rankin Scale score than MM (median, 3 versus 4; P =0.009). Conversely, in low-score patients (P =0.014). CONCLUSIONS: The medium and distal mechanical thrombectomy score is a pragmatic tool that identifies patients with distal and medium vessel occlusion most likely to benefit from EVT while minimizing risk, supporting patient-centered decisions and future trial design.

Background and Aim: Children under five years pose an increased risk of respiratory illnesses all over the world. In the light of the COVID-19 pandemic, this study sought to ascertain the seasonal patterns, demographic relationships, and prevalence of respiratory infections in this susceptible group. Materials and Methods: In this cross-sectional ...

Introduction: First pass effect (FPE), achievement of complete recanalization (mTICI 2c/3) with a single pass, is a significant predictor of favorable outcomes for endovascular treatment (EVT) in large vessel occlusion stroke (LVO). However, data concerning the impact on functional outcomes and predictors of FPE in medium vessel occlusions (MeVO) are scarce. Patients and Methods: We conducted an international retrospective study on MeVO cases. Multivariable logistic modeling was used to establish independent predictors of FPE. Clinical and safety outcomes were compared between the two study groups (FPE vs non-FPE) using logistic regression models. Good outcome was defined as modified Rankin Scale 0–2 at 3 months. Results: Eight hundred thirty-six patients with a final mTICI ⩾ 2b were included in this analysis. FPE was observed in 302 patients (36.1%). In multivariable analysis, hypertension (aOR 1.55, 95% CI 1.10–2.20) and lower baseline NIHSS score (aOR 0.95, 95% CI 0.93–0.97) were independently associated with an FPE. Good outcomes were more common in the FPE versus non-FPE group (72.8% vs 52.8%), and FPE was independently associated with favorable outcome (aOR 2.20, 95% CI 1.59–3.05). 90-day mortality and intracranial hemorrhage (ICH) were significantly lower in the FPE group, 0.43 (95% CI, 0.25–0.72) and 0.55 (95% CI, 0.39–0.77), respectively. Conclusion: Over 2/3 of patients with MeVOs and FPE in our cohort had a favorable outcome at 90 days. FPE is independently associated with favorable outcomes, it may reduce the risk of any intracranial hemorrhage, and 3-month mortality.

Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal non-Hodgkin's lymphoma that accounts for 4% of newly diagnosed central nervous system (CNS) tumors. Most primary lymphomas of the central nervous system are of the subtype of diffuse large B-cell lymphomas, which have highly aggressive behavior and may involve the brain, leptomeninges, eyes or spinal cord without evidence of systemic disease. Primary CNS lymphomas are very rare in immunocompetent patients, but their rates are increasing. So far, only 11 primary Gasser ganglion lymphomas have been reported, with an incidence of 2.5 cases per 30,000,000 inhabitants. However, B cell lymphomas of the marginal zone of the Gasserian ganglion have been very rarely reported. We report here a clinical presentation characteristic of B cell lymphoma of the marginal zone of the Gasser ganglion in an immunocompetent patient who was treated with surgery and radiotherapy, evolving with improvement of symptoms and without recurrence in 3 months of follow-up.

Background: To assess the relationship between the preoperative magnetic resonance imaging (MRI) appearance of the normal residual pituitary gland (NRPG) and pituitary functional outcome following transsphenoidal resection of pituitary macroadenomas. Methods: We retrospectively reviewed the medical records of 100 consecutive patients with a pituitary macroadenoma, who underwent transsphenoidal resection. The preoperative configuration of the displaced NRPG was stratified as superior, superolateral or lateral. The extent of postoperative restitution of the NRPG was divided into four groups: Group 1 - normal residual gland or almost normal; Group 2 - more than 50% restitution; Group 3 - less than 50% of the normal residual gland; and Group 4 - barely visible or absent residual gland. The pre- and postoperative NRPG appearance was correlated with pituitary functional status. Results: Preoperatively, the NRPG was identifiable in 79 patients, with extrasellar displacement in 53%. The displacement pattern was superior in 8%, superolateral in 32%, and lateral in 58% of the patients. If the NRPG was displaced laterally, the ipsilateral cavernous sinus was not invaded by the pituitary macroadenoma. Partial or complete pituitary function was lost in 6 / 23 (26.1%) patients with superior or superolateral displacement of the NRPG, compared to only 1 / 36 (2.8%) patients without superior displacement of the NRPG (P = 0.025). Progressive postoperative reconstitution of the NRPG was related to the preservation of the pituitary hormonal axis (Pearson Chi-Square P < 0.001). Conclusions: Progressive displacement of the NRPG preoperatively, and lack of restitution of the NRPG on postoperative MRI appeared to correlate with the postoperative pituitary functional loss.