Abstract TP302: Life After Thrombectomy

Abstract

Background: Multiple randomized clinical trials have shown the benefits of thrombectomy in the treatment of acute stroke after 90 days; a recent study showed extended benefit in the functional outcomes of the original cohort of randomized patients. However, data on real-world experience on long-term outcomes, including recurrent vascular events and risk factor controls, is lacking. Aim: To study long-term clinical outcomes, risk factor modification, medication compliance, and recurrent events in patients undergoing thrombectomy in a community-based setting. Methods: Retrospective data was collected on 143 cases performed between 2013 and 2017 in a non-academic medical center. Long-term follow-up was performed by reviewing hospital and clinic records of available patients. Results: At the time of discharge, 79% of the 143 thrombectomy patients survived, 11% had died, and 10% went to hospice. Post-hospitalization data, ranging from 30-days to 3 years, was available in 83 patients. A majority of the survivors (81%) were living with family at home. Within that time frame, cardiovascular events occurred in 39% of patients, with 5 deaths (6%). Only 7% (6/83) of patients had a recurrent stroke; most of them were lacunar. Two patients had repeat thrombectomies, and one was treated with IV tpa. Seventy-nine percent (66/83) continued to be on anti-platelet agents. A surprising number (34/83) of long-term survivors continued to smoke and drink heavily (20/83). Only 78% of patients had regular medical care. Twenty-percent of survivors were depressed and 20% were demented. Conclusions: Although thrombectomy helps reduce disability and benefits stroke survival, there is a high incidence of cardiovascular and cerebrovascular events afterwards, due to poor control of risk factors, inadequate medical follow-up, and lack of lifestyle changes. Thrombectomy is a costly procedure; to be cost-effective in the long-term, it is imperative that the survivors are not left without proper medical surveillance and secondary prevention strategies.

Faculty Opinions recommendation of Synergistic effects of stereochemistry and appendages on the performance diversity of a collection of synthetic compounds.

“…In order to evaluate the impact of functional variations on azetidine scaffolds of identical stereoconfiguration, we performed principal component and correlation analyses on all compounds of the selected series (3,4,6,7,11), rather than one series at a time (Figure 7 and Figure SI-2). In addition, we evaluated the statistical significance of differences in activities between stereoisomers using multidimensional perturbation (mp) values, as reported by Hutz et al 26 The effects of appendage diversification are consistent with those seen with series of compounds previously annotated using this method, 13,14 with the effects being most notable for the (2R,3R)-isomers.…”

“…22,23 Each compound at each concentration is thus associated with a profile consisting of 1140 robust z-scores characterizing specific morphological changes relative to vehicle control (DMSO). (B) Previously, we demonstrated the annotation of triads of constitutional isomers and of functionally diverse [6,5]-fused bicyclic compounds. Here, a stereochemically exhaustive library of azetidines enabled orthogonal annotation of stereochemical and functional changes.…”

“…The curation of compound collections is especially relevant in settings where molecular targets are unknown, when no structural information is available, or when difficult-to-culture but often more biologically meaningful (e.g., primary) cells are used. 3 In these contexts, two capabilities seem especially relevant: (1) new synthetic methods 4 and strategies 3,5 aimed at sampling novel, sp 3 -rich chemical space well-poised to uncover new biology, [6][7][8] and (2) rapid and inexpensive multiplexed (high-dimensional) methods to create biological fingerprints or profiles of compounds that are independent of specific, targeted biological processes.…”

Histological heterogeneity of tumours of female genital tract- an observation from commentary box of a tertiary care hospital in eastern India

“…Metastasis occurs in large number of patients (81%) most commonly to the lungs (74%), peritoneum (41%), bones(33%) and Liver (27%). (3) ovarian metastasis is less common. Alvarado Gay and vaga Silva (5) described a similar case like ours -an uterine leiomyosarcoma presenting with right sided uterine mass extending into the same sided fallopian tube and ovary, involving ovarian serosa.…”

“…Dandapani et al reported a case of uterine leiomyosarcoma metastatic to bilateral ovarian stroma without capsular involvement, which suggests spread by hematogenous dissemination. (3) Immunohistochemical techniques can be a useful adjunct in confirming a case of leiomyosarcoma particularly of epithelioid morphology. Consistent immunoreactivity is found for vimentin, smooth and common muscle actin, desmin, calponin and h-caldesmon; although reactivity for low molecular weight cytokeratin (CAM 5.2) and epithelial membrane antigen (EMA) can sometimes further complicate the matter.…”