Abstract only Cerebral perfusion evaluation using CT or MR perfusion is the gold standard modality to select large vessel occlusion (LVO) stroke patients presenting >6 hours from symptom onset. The ...availability of cone beam C-arm CT perfusion (CBCTP) in angiography suites could reduce time to endovascular revascularization. We aimed to evaluate the reliability of using CBCTP when compared to multidetector CT perfusion (MDCTP). In this prospective, single-arm, interventional study, 14 LVO anterior circulation thrombectomy patients underwent both a 128 slice MDCTP in the ED and a CBCTP <30 minutes apart prior to groin puncture. CBCTP was acquired using a prototype acquisition mode enabling 10 consecutive C-Arm rotations with nearly continuous data acquisition. A total of 60 cc of contrast layered with 60 cc of saline were injected covering arterial inflow, parenchymal phase and venous outflow. Image data was reconstructed into CBF, CBV, MTT and TTP maps. Three types of measurements were used to compare modalities. In measurement 1, 6 circular regions of interest (ROI) (400mm 2 ) were placed in the anterior arterial territory. In measurement 2, circular ROIs were placed in the ASPECTS regions (cortical 300mm 2 , subcortical 200mm 2 ). In measurement 3, a ROI was drawn around the entire affected area. All ROIs were placed in the basal ganglia and supraganglionic level of both brain sides. Rates (unaffected/affected area) between MDCTP and CBCTP were compared for all sequences. The intraclass correlation coefficient (ICC) was calculated using a single rater, consistency, two-way random-effects model. Measurement 1 found a moderate degree of agreement between MDCTP and CBCTP in CBF, CBV, MTT and TTP rates with ICCs of 0.58 (CI 0.42 - 0.69), 0.65 (CI 0.53 - 0.74), 0.77 (CI 0.68 - 0.83) and 0.52 (CI 0.35 - 0.65). In measurement 2, moderate agreement was found in CBF, CBV and MTT rates; with ICCs of 0.51 (CI 0.32 - 0.65), 0.57 (CI 0.4 - 0.69) and 0.62 (CI 0.47 - 0.73). The results of measurement 3 found an excellent (ICC=0.95, CI 0.88 - 0.98), good (ICC=0.83, CI 0.62 - 0.9) and moderate (ICC=0.7, CI 0.34 - 0.87), degree of agreement in the CBV, MTT and CBF rates, respectively. These results demonstrate promising accuracy of CBCTP in the evaluating ischemic tissue in patient presenting with LVO acute stroke.
We aimed to evaluate the safety and feasibility of carotid artery stenting (CAS) performed in the hyperacute period.
We analyzed a retrospective database of CAS patients from our center. We included ...patients with symptomatic isolated ipsilateral extracranial carotid stenosis and acute tandem occlusions who underwent CAS. Hyperacute CAS (HCAS) and acute CAS (ACAS) groups were defined as CAS within 48 hours and >48 hours to 14 days from symptoms onset, respectively. The primary outcome was a composite of any stroke, myocardial infarction, or death at 3 months of follow-up. Secondary outcomes were periprocedural complications and restenosis or occlusion rates.
We included 97 patients, 39 with HCAS and 58 with ACAS. There was no significant difference between groups for the primary outcome (HCAS 3.3% vs. ACAS 6.1%; p = 1). There were no differences in the rate of perioperative complications between groups although a trend was observed (HCAS 15.3% vs. ACAS 3.4%; p = .057). The rate of restenosis or occlusion between groups (HCAS 8.1% vs. ACAS 9,1%; log-rank test p = .8) was similar with a median time of follow-up of 13.7 months.
Based on this study, CAS may be feasible in the hyperacute period. However, there are potential higher rates of perioperative complications in the hyperacute group, primarily occurring in MT patients with acute tandem occlusion. A larger multicenter study may be needed to further corroborate our findings.
Abstract only Introduction: Our understanding of the epidemiology, outcomes and management of spontaneous subarachnoid hemorrhage (sSAH) in pregnancy is limited by small, single center series, which ...suggest a slightly higher morbidity and mortality. Larger population studies are needed to accurately estimate the risk of sSAH during pregnancy, and the associated morbidity and mortality. Methods: A retrospective analysis was performed utilizing the Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project for the years 2002–2014. NIS is one of the largest administrative database and is designed to produce nationally weighted estimates. Female patients age 15-49 with spontaneous subarachnoid hemorrhage were identified with International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 430.Pregnancy and maternal diagnosis were identified using pregnancy related ICD codes validated by previous studies. Cochran-Armitage trend test and parametric tests were utilized to analyze temporal trends and group comparisons. Results: There were 73,692 admissions for sSAH occurred in women age group of 15-49 years from 2002-14, of which 3,978 (5.4%) were in pregnant women. Over the 12 years of study period, proportion of sSAH during pregnancy increased from 4.16 % to 6.33% {p-trend <0.001} whereas in non-pregnant women has slightly reduced. In the study cohort, African American women had higher proportion of sSAH during pregnancy (8.19%) followed by Hispanic (7.11%) as compare to Caucasian (3.83%) women. Proportion of sSAH during pregnancy was highest in age group 20-29 years (20.07%) as compared to age 15-19 years (11.39 %), 30-39 years (10.01%) and age 40-49 (0.69%). sSAH during pregnancy had less in-hospital mortality as compare to non-pregnant women with sSAH (7.7% vs 17.4%; p:<0.001) in age controlled cohort and had higher discharge to home as compare to non-pregnant women with sSAH (69.87% vs 53.85% %; p:<0.001). Conclusion: There is an upward trend in the pregnancy related spontaneous SAH from 2002 to 2014. African American race and 20-29 years’ age group have higher preponderance of pregnancy related spontaneous SAH. Clinical outcomes of spontaneous SAH in pregnant women were better than in non-pregnant women.
Abstract
Approximately one quarter of HIV-1 infected individuals will generate broadly neutralizing antibodies, but the exact mechanisms for triggering and maturation of these responses are presently ...undefined. We consequently investigated the roots of neutralization breadth. In a subtype A HIV-1 infected Rwandan seroconverter, we pinpointed the primary neutralizing antibody target and the successive routes of viral escape using envelope glycoproteins from the transmitted/founder virus and longitudinal escape variants along with autologous plasma and monoclonal antibodies. Initially, a single mutation at one of three clustered residues proximal to gp120’s third hypervariable loop conferred viral escape. This putative epitope subsequently elicited at least two somatically related monoclonal antibodies, which bound and neutralized the established escape mutations. Resistance to this secondary wave of immune pressure then arose in later viral envelopes through introduction of two glycans that obscured this consistently targeted space. At 16-months post-infection, what had been a narrow, regional response evolved to force recognition and neutralization of distinct envelope portions, which resulted in moderate cross-clade humoral breadth. Our data suggest that unveiling a certain chain of envelope mutations could drive B cells toward the production of broadly neutralizing antibodies. Appreciating this knowledge during immunogen construction could positively impact HIV-1 vaccine design.
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