Gradient echo T2*-weighted imaging and susceptibility-weighted imaging are the recommended imaging protocols for evaluation of suspected CCMs. Diffusion tensor imaging-based tractography provides visualization of the eloquent white matter tracks in the brain. This imaging is increasingly used in clinical practice to assist in selecting the optimal surgical approach, especially for brainstem lesions. Quantitative susceptibility mapping and dynamic contrast-enhanced quantitative perfusion are presently considered experimental. Its proposed value might prove helpful in the future to monitor disease activity and response to treatments. The choice of imaging modality of CCMs depends on the goals the clinician expects to achieve, such as establishing the initial diagnosis, follow-up and monitoring disease activity, preoperative, intraoperative, and postoperative evaluation, or research and experimental work on patients with CCM.

Objectives: This report evaluates the safety of percutaneous mechanical thrombectomy with the Inari FlowTriever System (Inari Medical, Irvine, California) for the treatment of acute massive/submassive pulmonary embolism (PE) specifically in therapeutically anticoagulated patients with contraindication to thrombolysis. Material and Methods: A single-center retrospective chart review was performed on patients with contraindication to thrombolysis and massive/submassive PE who underwent FlowTriever thrombectomy between 2017 and 2019. Primary outcomes included procedure or device-related complications within 30 days of discharge. Secondary outcomes included technical and clinical success defined by improvement in mean pulmonary artery pressure (PAP), oxygen saturation, and heart rate. Results: Thirteen patients with contraindication to thrombolysis received FlowTriever thrombectomy with technical success achieved in all cases. Zero major or minor adverse events, technical complications, delayed procedure-related complications, or deaths within 30 days of hospital discharge occurred. Mean PAP decreased significantly by 19.1% (32.5 ± 13.3 mmHg to 26.3 ± 12.4 mmHg; P = 0.0074, 95% confidence interval (CI) 2.0–10.5 mmHg). Oxygen saturation improved post-procedure (increased 3.9 ± 3.8%; p = 0.0032, 95% CI 1.6– 6.1%) as did heart rate (decreased 22.2 ± 17.0 bpm; P < 0.001, 95% CI 11.9–32.4 bpm). Anticoagulation was maintained throughout every procedure and all patients were closed with purse-string suture only. Conclusion: FlowTriever mechanical thrombectomy appears safe for acute PE in therapeutically anticoagulated patients with contraindications to thrombolytic therapy. These patients may experience immediate hemodynamic improvements similar to those reported in other studies. Further data are needed to prospectively evaluate long-term safety in this population.

No abstract

Results: Patients underwent CDT for a mean 68 Ϯ 33 h with 46 Ϯ 31 mg t-PA. Median hospital stay was 8 d (range, 1-31 d); median clinical follow-up was 297 d (range, 1-2520 d). Mean systolic PAP significantly decreased from 53.5 Ϯ 15.3 mmHg at baseline to 45.0 Ϯ 12.3 mmHg at 19 Ϯ 5 h (Po0.001), 43.0 Ϯ 14.6 mmHg at 43 Ϯ 6 h (Po0.001) and 35.4 Ϯ 14.0 mmHg at CDT termination (85 Ϯ 27 h) (Po0.001). Significant incremental decreases in mean systolic PAP were observed beyond single-day CDT both at 43 h (P ¼ 0.004) and CDT termination (Po0.001) compared with 19 h. One GUSTO-defined severe bleed (fatal intracranial hemorrhage 22 h after CDT initiation in the setting of PTT4200s) occurred. No GUSTO-defined moderate bleeding events occurred. One patient died of cardiac arrest 16 h after CDT initiation; no additional deaths were observed within 30 days. Conclusions: Continuation of CDT beyond one day may result in greater PAP reduction in patients with submassive PE without increased incidence of severe bleeding events. An extended duration of thrombolysis should be considered for clinical trials assessing long-term outcomes of CDT for submassive PE.