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Chen L, Bian G, Zhu X, Duan X, Meng Y, Li L. Importance of computed tomography perfusion on assessing collateral circulation and prognosis of patients with acute anterior circulation large vessel occlusion after endovascular therapy. SLAS Technol 2024:100139. [PMID: 38734181 DOI: 10.1016/j.slast.2024.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/11/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
This study probed the importance of computed tomography perfusion (CTP) on assessing collateral circulation and prognosis in patients with acute anterior circulation large vessel occlusion (AAC-LVO) after endovascular therapy (EVT). Retrospective analysis was performed on the case data of 124 AAC-LVO patients who achieved EVT in the First People's Hospital of Lianyungang. All patients received computed tomography (CT) examination. Based on the multi-phase computed tomography angiography (mCTA) score, patients were separated into poor collateral circulation group and good collateral circulation group. Based on modified Rankin scale (mRS) score, patients were separated into good prognosis group and poor prognosis group. The receiver operating characteristic (ROC) curve was used to measure the efficacy of CTP parameters in predicting good collateral circulation or good prognosis. Correlation between CTP parameters with mCTA collateral and 90-day mRS circulation score was analyzed using the Spearman correlation analysis. The age and admission national Institutes of Health stroke scale (NIHSS) scores of the good collateral circulation group were lower than the poor collateral circulation group, and low perfusion area volume with Tmax > 6 s (VTmax>6s), infarct core area volume (VCBF<30%)and hypoperfusion intensity ratio (HIR) were also lower. The mCTA collateral cycle score was negatively related to VTmax>6 s, VCBF<30% and HIR. The area under the curve (AUC) values of VTmax>6 s and VCBF<30% and HIR for predicting good collateral circulation were 0.763, 0.884 and 0.842, respectively, which suggested that perfusion parameters VTmax>6 s, VCBF<30% and HIR could effectively indicate the status of patients' collateral circulation. Relative to the poor prognosis group, patients in the good prognosis group possessed lower admission NIHSS score, younger age, smaller final infarct volume, lower HIR, VCBF<30%, VTmax>6s, Alberta Stroke Program Early CT(ASPECT) score, and higher mCTA score. Spearman correlation analysis unveiled that ASPECT score, mCTA score and 90-day mRS were negatively correlated. The final infarct volume, perfusion parameters HIR and VCBF<30% were positively correlated with 90-day mRS. ROC analysis showed that all variates had good prognostic value for acute anterior circulation great vessel occlusion patients, while VCBF<30% and HIR had high diagnostic value for prognosis. To sum up, CTP can provide a comprehensive imaging assessment of the collateral circulation of patients with AAC-LVO and has a higher predictive value for the prognosis assessment of patients with EVT in terms of VCBF<30%, HIR score and mCTA collateral circulation score.
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Affiliation(s)
- Lei Chen
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China
| | - Guangjun Bian
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China
| | - Xiufang Zhu
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China
| | - Xinxiu Duan
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China
| | - Yue Meng
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China
| | - Lei Li
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China.
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Elli S, Cannizzo L, Rondelli E. Comment to On-demand use of peripheral arterial catheters outside the Intensive Care Unit: Development and retrospective evaluation of an internal protocol for insertion and management. J Vasc Access 2024; 25:1029-1030. [PMID: 36300754 DOI: 10.1177/11297298221113282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Affiliation(s)
- Stefano Elli
- Picc Team - Emergency Department and Intensive Care, University of Milan-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza (MB), Lombardy, Italy
| | - Luigi Cannizzo
- Picc Team - Emergency Department and Intensive Care, University of Milan-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza (MB), Lombardy, Italy
| | - Egle Rondelli
- Picc Team - Emergency Department and Intensive Care, University of Milan-Bicocca, A.S.S.T. Monza, San Gerardo Hospital, Monza (MB), Lombardy, Italy
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Abstract
Radial arterial catheters (RAC) are used extensively across critical care settings (Anesthesia, Intensive Care, Emergency Medicine) for continuous hemodynamic monitoring, allowing for immediate adjustments in vasopressor therapies and blood collection. Radial catheter failures are an ongoing significant issue for critical care clinicians with reported incidences at almost 25%. Common complications include loss of function, lack of blood return, poor quality waveforms and dislodgement, posing potential patient risks, and sudden loss of intra-arterial monitoring frequently requires prompt replacement. Contemporary research and technological improvements have highlighted several concepts to enhance the approach of RAC insertion and management while reducing immediate and late complications. The authors have prioritized the following 10 "best practice" aspects that may improve overall device function and reliability.
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Affiliation(s)
- Guglielmo Imbriaco
- Centrale Operativa 118 Emilia Est (Prehospital Emergency Medical Dispatch Centre), Helicopter Emergency Medical Services, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
- Department of Medical and Surgical Sciences, School of Medicine and Surgery, University of Bologna, Bologna, Italy
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Gore P, Liu H, Bohringer C. Can Currently Available Non-invasive Continuous Blood Pressure Monitors Replace Invasive Measurement With an Arterial Catheter? Cureus 2024; 16:e54707. [PMID: 38529464 PMCID: PMC10961923 DOI: 10.7759/cureus.54707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/27/2024] Open
Abstract
Deviations from normal blood pressure (BP) during general anesthesia have been clearly linked to several adverse outcomes. Measuring BP accurately is therefore critically important for producing excellent outcomes in health care. Normal BP does not necessarily guarantee adequate organ perfusion however and adverse events have occurred even when BP seemed adequate. Invasive blood pressure monitoring has recently evolved beyond merely measuring BP. Arterial line-derived pulse contour analysis is used now to assess both cardiac output and stroke volume variation as indices of adequate intravascular volume. Confirmation of acceptable cardiac output with data derived from invasive intra-arterial catheters has become very important when managing high-risk patients. Newer devices that measure BP continuously and non-invasively in the digital arteries via a finger cuff have also become available. Many clinicians contemplate now if these new devices are ready to replace invasive monitoring with an arterial catheter. Unlike non-invasive devices, intra-arterial catheters allow frequent blood sampling. This makes it possible to assess vital parameters like pH, hemoglobin concentration, ionized calcium, potassium, glucose, and arterial partial pressure of oxygen and carbon dioxide frequently. Non-invasive continuous BP measurement has been found to be unreliable in critically ill patients, the elderly, and patients with calcified arteries. Pulse contour-derived estimates of cardiac output and stroke volume variation have been validated better with data derived from arterial lines than that from the newer finger cuff monitors. Significant advances have been recently made with non-invasive continuous BP monitors. Invasive monitoring with an arterial line however remains the gold standard for measuring BP and assessing pulse contour analysis-derived hemodynamic variables in critically ill patients. In the future, non-invasive continuous BP monitors will likely replace intermittent oscillometers in the operating room and the postoperative period. They will however not eliminate the need for arterial catheterization in critically ill patients.
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Affiliation(s)
- Payton Gore
- Anesthesiology, University of California Davis Medical Center, Sacramento, USA
| | - Hong Liu
- Anesthesiology, University of California Davis Medical Center, Sacramento, USA
| | - Christian Bohringer
- Anesthesiology, University of California Davis Medical Center, Sacramento, USA
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Giustivi D, Baroni M, Di Capua M, Paglia S. Response to: "Comment to On-demand use of peripheral arterial catheters outside the Intensive Care Unit: Development and retrospective evaluation of an internal protocol for insertion and management". J Vasc Access 2024; 25:354. [PMID: 35766507 DOI: 10.1177/11297298221109660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Monica Baroni
- Vascular Access Team, ASST Lodi, Lodi, Lombardy, Italy
| | | | - Stefano Paglia
- Chief of A&E Department, ASST Lodi, Lodi, Lombardy, Italy
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Macdonald IR, Pickett GE, Herman C, Lee M, Volders D. All that glitters: case presentation and review of radial access complications in neurointervention. Interv Neuroradiol 2022:15910199221083787. [PMID: 35234068 PMCID: PMC10369111 DOI: 10.1177/15910199221083787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Radial artery access has experienced increasing adoption and rapid expansion of indications for neurointerventional procedures. This access is an attractive neurointervention route to be considered, with many advantages over the traditional femoral access in terms of ease of vasculature navigation and decreased risk of complications such as significant bleeding. Although a promising technique for neurointerventional procedures, there are inherent and unique considerations as well as potential complications involved. The following case report highlights some of these vital concepts associated with radial artery access, including appropriate patient selection as well as assessment of arterial size in the context of neurointerventional techniques. Early identification of complications such as arterial injury and compartment syndrome, with an emphasis on appropriate draping and inter-procedure monitoring, is discussed as well as approaches for subsequent management. Finally, the issue of radiation safety in this emerging technique is considered. These concepts are critical for the successful use and the continued growth of radial artery access for neurointervention procedures.
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Affiliation(s)
- Ian R Macdonald
- Division of Neuroradiology, Department of Diagnostic Radiology, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gwynedd E Pickett
- Division of Neurosurgery, Department of Surgery, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christine Herman
- Division of Vascular Surgery, Department of Surgery, 3688Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Cardiac Surgery, Department of Surgery, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | - Min Lee
- Division of Vascular Surgery, Department of Surgery, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Volders
- Division of Neuroradiology, Department of Diagnostic Radiology, 3688Dalhousie University, Halifax, Nova Scotia, Canada
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