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An AVS-first, imaging-second approach could have avoided CT/MRI in 43% of patients. At a high volume, experienced center, performing AVS first on patients with PA may reduce unnecessary cross-sectional imaging studies.

To evaluate the prognostic value of CT venography for catheter-directed thrombolysis (CDT) in iliac vein compression syndrome (IVCS) patients with deep venous thrombosis (DVT) and to propose image-based criteria for CDT. Materials and Methods: The institutional review board approved this retrospective study and waived informed consent. This study initially enrolled 201 consecutive patients treated in our interventional suite for DVT from January 2001 to June 2013. Afterwards, 48 IVCS patients who underwent pre-procedural CT venography, CDT with stenting, and follow-up imaging were analyzed. To identify significant predictors of 6-month patency, CT venography was evaluated with Fisher's exact test and logistic regression analyses. Based on the results, image-based criteria were established and compared to the current symptom duration-based approach by ROC curve analyses and the McNemar test. Results: Recoiling of external iliac vein (EIV) diameter (o 120%) (hazard ratio [HR] ¼ 28.652, p ¼ .0073) and severe rim enhancement (HR ¼ 20.545, p ¼ .0155) were significant risk factors for venous occlusion within 6 months of CDT. The dual-parameter image-based criteria were significantly superior to the current symptom duration-based approach in terms of area under the curve value and specificity. With a 2-point cutoff, the proposed criteria demonstrated a sensitivity of 66.7%, specificity of 100.0%, and diagnostic accuracy of 92.9% for identifying non-responders of CDT. Conclusion: The image-based criteria may be useful in assessing CDT prognoses in IVCS patients, particularly to identify non-responders who demonstrate recoiling of EIV diameter and rim enhancement on CT venography.

The approval of the IL-17A inhibitor Secukinumab (Cosentyx; Novartis International, King of Prussia, Pennsylvania) was a major advance in psoriasis treatment, with most patients experiencing a 75% reduction in severity1. Known side effects include an increase in minor infections, but no major infectious adverse events and no nervous system involvement1–4, leading to broad use and an increase in clinical trials targeting the IL-17 pathway. Here, we describe a patient on Secukinumab who presented with severe neurologic deficits due to multifocal brain lesions. These were found to be disseminated streptococcal infection, and resolved after antibiotic treatment.

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