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https://www.readbyqxmd.com/read/29760845/ruling-out-pulmonary-embolism-in-patients-with-high-pretest-probability
#1
Murtaza Akhter, Jeffrey Kline, Bikash Bhattarai, Mark Courtney, Christopher Kabrhel
Introduction: The American College of Emergency Physicians guidelines recommend more aggressive workup beyond imaging alone in patients with a high pretest probability (PTP) of pulmonary embolism (PE). However, the ability of multiple tests to safely rule out PE in high PTP patients is not known. We sought to measure the ability of negative computed tomography pulmonary angiography (CTPA) along with negative D-dimer to rule out PE in these high-risk patients. Methods: We analyzed data from a previous prospective observational study conducted in 12 emergency departments (ED)...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29754850/biologic-drug-effect-and-particulate-embolization-of-drug-eluting-stents-versus-drug-coated-balloons-in-healthy-swine-femoropopliteal-arteries
#2
Sho Torii, Kazuyuki Yahagi, Hiroyoshi Mori, Emanuel Harari, Maria E Romero, Frank D Kolodgie, Brandt Young, Anthony Ragheb, Renu Virmani, Aloke V Finn
PURPOSE: To compare the drug effect in treated vessels and downstream effects in distal skeletal muscle of drug-coated balloons (DCBs) and drug-eluting stents (DESs) in a healthy preclinical swine model. MATERIALS AND METHODS: Four groups of treated iliofemoral arteries (percutaneous transluminal angioplasty [PTA]+DES, DCB+DES, DCB+bare metal stent [BMS], and DCB alone) of 12 healthy swine were assessed, with euthanasia at 30 days. Biological drug effect was evaluated using smooth muscle cell (SMC) loss score according to both depth and circumference as well a neointimal fibrin and medial proteoglycan scores which were compared between the 4 groups...
May 10, 2018: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/29751183/onyx-embolization-before-the-surgical-treatment-of-grade-iii-spetzler-martin-brain-arteriovenous-malformations-single-center-experience-and-technical-nuances
#3
S Luzzi, M Del Maestro, D Bongetta, C Zoia, A V Giordano, D Trovarelli, Dehcordi S Raysi, R J Galzio
BACKGROUND: grade-III Spetzler-Martin (SM) brain arteriovenous malformations (AVMs) are a specific set of AVMs with a high variability in terms of site, size, angioarchitecture, flow dynamics and involvement of eloquent areas. Surgery preceded by pre-operative embolization has been reported as a useful treatment option for these lesions. The aim of this study is to report outcomes and personal experience of combined pre-operative Onyx embolization and surgical resection on a consecutive series of grade-III brain AVMs...
May 8, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29749576/clinical-outcomes-after-magnetic-resonance-angiography-mra-versus-computed-tomographic-angiography-cta-for-pulmonary-embolism-evaluation
#4
Michael D Repplinger, Scott K Nagle, John B Harringa, Aimee T Broman, Christopher R Lindholm, Christopher J François, Thomas M Grist, Scott B Reeder, Mark L Schiebler
PURPOSE: To compare patient outcomes following magnetic resonance angiography (MRA) versus computed tomographic angiography (CTA) ordered for suspected pulmonary embolism (PE). METHODS: In this IRB-approved, single-center, retrospective, case-control study, we reviewed the medical records of all patients evaluated for PE with MRA during a 5-year period along with age- and sex-matched controls evaluated with CTA. Only the first instance of PE evaluation during the study period was included...
May 10, 2018: Emergency Radiology
https://www.readbyqxmd.com/read/29745451/electronic-cardiac-arrest-triage-score-best-predicts-mortality-after-intervention-in-patients-with-massive-and-submassive-pulmonary-embolism
#5
Taishi Hirai, Steven Tate, Kathryn Dryer, Deshon Jones, Jonathan Rosenberg, Sandeep Nathan, Atman P Shah, Kyle Carey, Matthew Churpek, Dana Edelson, Janet Friant, Jonathan Paul, John E A Blair
OBJECTIVE: To determine if the cardiac arrest triage (CART) Score would better predict poor outcomes after pharmacomechanical therapy (PMT) for massive and submassive pulmonary embolism (PE) than traditional risk scores BACKGROUND: PMT for massive and submassive PE allows for clot lysis with minimal doses of fibrinolytics. Although PMT results in improved right ventricular function, and reduced pulmonary pressures and thrombus burden, predictors of poor outcome are not well-studied. METHODS: We conducted a retrospective analysis of all patients who underwent PMT for massive or submassive PE at a single institution from 2010 to 2016...
May 10, 2018: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29710413/automated-pulmonary-embolism-risk-classification-and-guideline-adherence-for-computed-tomography-pulmonary-angiography-ordering
#6
Christian A Koziatek, Emma Simon, Leora I Horwitz, Danil V Makarov, Silas W Smith, Simon Jones, Soterios Gyftopoulos, Jordan L Swartz
BACKGROUND: The assessment of clinical guideline adherence for the evaluation of pulmonary embolism (PE) via computed tomography pulmonary angiography (CTPA) currently requires either labor-intensive, retrospective chart review or prospective collection of PE risk scores at the time of CTPA order. The recording of clinical data in a structured manner in the electronic health record (EHR) may make it possible to automate the calculation of a patient's PE risk classification and determine whether the CTPA order was guideline concordant...
April 30, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29703470/apixaban-for-the-prevention-of-venous-thromboembolism-in-high-risk-ambulatory-cancer-patients-receiving-chemotherapy-rational-and-design-of-the-avert-trial
#7
Miriam Kimpton, Philip S Wells, Marc Carrier
Patients with active cancer have a heightened risk of venous thromboembolism (VTE). This risk is further increased by the initiation of chemotherapy. Although previous studies have suggested that the use of parenteral thromboprophylaxis in all ambulatory cancer patients receiving chemotherapy significantly decreases the rate of VTE, current clinical practice guidelines do not recommend routine use of thromboprophylaxis in this patient population. A major criticism of these studies has been the inclusion of patients at lower risk for VTE, which may have diluted the potential beneficial effect of the parenteral thromboprophylaxis...
April 2018: Thrombosis Research
https://www.readbyqxmd.com/read/29685402/angiomyolipoma-of-the-kidneys-current-perspectives-and-challenges-in-diagnostic-imaging-and-image-guided-therapy
#8
REVIEW
Abdul Razik, Chandan J Das, Sanjay Sharma
Angiomyolipomas (AML) are benign tumors of the kidneys frequently encountered in radiologic practice in large tertiary centers. In comparison to renal cell carcinomas (RCC), AML are seldom treated unless they are large, undergo malignant transformation or develop complications like acute hemorrhage. The common garden triphasic (classic) AML is an easy diagnosis, however, some variants lack macroscopic fat in which case the radiologic differentiation from RCC becomes challenging. Several imaging features, both qualitative and quantitative, have been described in differentiating the 2 entities...
March 20, 2018: Current Problems in Diagnostic Radiology
https://www.readbyqxmd.com/read/29683412/225-intracranial-aneurysms-treated-with-the-low-profile-visualized-intraluminal-support-lvis-stent-a-single-center-retrospective-study
#9
Wei Su, Yisen Zhang, Junfan Chen, Jian Liu, Gary Rajah, Xinjian Yang
Background For the treatment of intracranial aneurysms, the low-profile visualized intraluminal support (LVIS) stent is a new generation of highly visible-braided stent that was recently introduced in China. Here, we report our single-center retrospective experience of safety and efficacy utilizing LVIS for stent-assisted coiling of intracranial aneurysms. Methods We included 218 patients with intracranial aneurysms consecutively treated with LVIS SR stents at our center in this study. Postoperative and follow-up embolization scores, procedural complications, clinical and angiographic findings at mid-term follow-up, as well as recurrence rate, preoperative and follow-up mRS scores were analyzed...
April 23, 2018: Neurological Research
https://www.readbyqxmd.com/read/29681849/danhong-injection-combined-with-t-pa-improves-thrombolytic-therapy-in-focal-embolic-stroke
#10
Min Li, Jing Zhou, Weifeng Jin, Xiaohong Li, Yuyan Zhang
Background: Hemorrhagic transformation, neurotoxicity, short treatment time windows, and other defects are considered as the major limitations for the thrombolytic therapy. This study is devoted to figure out whether Danhong injection (DHI) combined with tissue-plasminogen activator (t-PA) could extend the treatment time windows and ameliorate brain injury, hemorrhagic complication and BBB disruption after focal embolic stroke. Methods: In vitro , the combined concentrations of DHI and t-PA were added to wells reacted with plasminogen and D-Val-Leu-Lys-AMC...
2018: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/29656169/international-multicenter-evaluation-of-a-new-d-dimer-assay-for-the-exclusion-of-venous-thromboembolism-using-standard-and-age-adjusted-cut-offs
#11
Blair Alden Parry, Anna Marie Chang, Sebastian M Schellong, Stacey L House, Gregory J Fermann, Erin K Deadmon, Nicholas J Giordano, Yuchiao Chang, Jason Cohen, Nancy Robak, Adam J Singer, Mary Mulrow, Ellen T Reibling, Samuel Francis, S Michelle Griffin, Jürgen H Prochaska, Barbara Davis, Patricia McNelis, Joao Delgado, Philipp Kümpers, Nikos Werner, Nina T Gentile, Eli Zeserson, Philipp S Wild, Alexander T Limkakeng, Elizabeth Lea Walters, Frank LoVecchio, Daniel Theodoro, Judd E Hollander, Christopher Kabrhel
INTRODUCTION: We sought to determine the test characteristics of an automated INNOVANCE D-dimer assay for the exclusion of pulmonary embolism (PE) and deep venous thrombosis (DVT) in emergency department (ED) patients using standard and age-adjusted cut-offs. METHODS: Cross-sectional, international, multicenter study of consecutive patients with suspected DVT or PE in 24 centers (18 USA, 6 Europe). Evaluated patients had low or intermediate Wells PE or DVT scores...
April 5, 2018: Thrombosis Research
https://www.readbyqxmd.com/read/29644411/noac-monotherapy-in-patients-with-concomitant-indications-for-oral-anticoagulation-undergoing-transcatheter-aortic-valve-implantation
#12
Nicolas A Geis, Christina Kiriakou, Emmanuel Chorianopoulos, Lorenz Uhlmann, Hugo A Katus, Raffi Bekeredjian
AIMS: Antithrombotic therapy after transcatheter aortic valve implantation (TAVI) is highly controversial and guideline recommendations are not evidence based. We assessed efficacy and safety of non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy in patients with concomitant indications for OAC undergoing TAVI. METHODS: Among more than 1300 TAVI patients since 2008, 154 patients were identified who received postinterventional NOAC monotherapy. Outcomes were compared to 172 patients treated with vitamin K antagonist (VKA) monotherapy...
April 11, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29623992/diagnostic-utility-of-an-age-specific-cut-off-for-d-dimer-for-pulmonary-embolism-assessment-when-used-with-various-pulmonary-embolism-risk-scores
#13
Imogen Ackerly, Sharon Klim, James McFarlane, Anne-Maree Kelly
This retrospective cohort study compared the diagnostic utility (sensitivity, specificity and negative predictive value (NPV)) of the age-times-10 adjusted d-dimer cut-off used in combination with the original and simplified Well's pulmonary embolism (PE) scores and the original and simplified revised Geneva scores to identify patients in whom PE is classified as unlikely according to each score. The PE risk scores performed similarly with high sensitivity (97.6, 97.1, 96.9 and 97.1% respectively) and NPV (99...
April 2018: Internal Medicine Journal
https://www.readbyqxmd.com/read/29613955/influence-of-postoperative-hepatic-angiography-on-mortality-after-laparotomy-in-grade-iv-v-hepatic-injuries
#14
Shokei Matsumoto, Emily Cantrell, Kyoungwon Jung, Alan Smith, Raul Coimbra
BACKGROUND: Mortality rate for severe liver injuries remains high. As an adjunct to surgery, postoperative hepatic angiography (PHA) may have a positive impact on outcomes. This study sought to compare outcomes following surgical management of severe liver injuries with and without PHA using propensity score matching analysis. METHODS: Data from the National Trauma Data Bank from 2007 - 2014 was analyzed. The study population consisted of patients greater than 18 years of age sustaining severe liver injuries (ie AAST-OIS grade IV or V) who underwent surgery...
April 2, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29603819/multicenter-evaluation-of-the-years-criteria-in-emergency-department-patients-evaluated-for-pulmonary-embolism
#15
Christopher Kabrhel, Astrid Van Hylckama Vlieg, Alona Muzikanski, Adam Singer, Gregory J Fermann, Samuel Francis, Alex Lim Kakeng, Ann Marie Chang, Nicholas Giordano, Blair Parry
BACKGROUND: It may be possible to safely rule out pulmonary embolism (PE) in patients with low pre-test probability (PTP) using a higher than standard D-dimer threshold. The YEARS criteria, which includes three questions from the Wells PE Score to identify low PTP patients and a variable D-dimer threshold, was recently shown to decrease the need for imaging to rule out PE by 14% in a multicenter study in the Netherlands. However, the YEARS approach has not been studied in the United States...
March 31, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29529233/flow-diversion-for-the-treatment-of-basilar-apex-aneurysms
#16
Adam A Dmytriw, Nimer Adeeb, Ashish Kumar, Christoph J Griessenauer, Kevin Phan, Christopher S Ogilvy, Paul M Foreman, Hussain Shallwani, Nicola Limbucci, Salvatore Mangiafico, Caterina Michelozzi, Timo Krings, Vitor Mendes Pereira, Charles C Matouk, Yuchen Zhang, Mark R Harrigan, Hakeem J Shakir, Adnan H Siddiqui, Elad I Levy, Leonardo Renieri, Christophe Cognard, Ajith J Thomas, Thomas R Marotta
BACKGROUND: Flow diversion for basilar apex aneurysms has rarely been reported. OBJECTIVE: To assess flow diversion for basilar apex aneurysms in a multicenter cohort. METHODS: Retrospective review of prospectively maintained databases at 8 academic institutions was performed from 2009 to 2016 to identify patients with basilar apex aneurysms treated with flow diversion. Clinical and radiographic data were analyzed. RESULTS: Sixteen consecutive patients (median age 54...
February 26, 2018: Neurosurgery
https://www.readbyqxmd.com/read/29513397/anticoagulation-use-and-clinical-outcomes-after-catheter-ablation-in-patients-with-persistent-and-longstanding-persistent-atrial-fibrillation
#17
Jackson J Liang, Melissa A Elafros, Michael T Mullen, Daniele Muser, Tatsuya Hayashi, Andres Enriquez, Rajeev K Pathak, Erica S Zado, Pasquale Santangeli, Jeffrey S Arkles, Robert D Schaller, Gregory E Supple, David S Frankel, Fermin C Garcia, Rajat Deo, David Lin, Michael P Riley, Saman Nazarian, Sanjay Dixit, Francis E Marchlinski, David J Callans
INTRODUCTION: Whether successful catheter ablation for atrial fibrillation (AF) reduces risk of cerebrovascular events (CVEs) remains controversial and whether oral anticoagulation therapy (OAT) can be safely discontinued in patients rendered free of AF recurrences remains unknown. We evaluated OAT use patterns and examined long-term rates of CVEs (stroke/TIA) and major bleeding episodes (MBEs) in patients with nonparoxysmal AF treated with catheter ablation. METHODS AND RESULTS: Four hundred patients with nonparoxysmal AF (200 persistent, 200 longstanding persistent; mean age 60...
March 7, 2018: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/29492398/prostatic-artery-embolization-versus-transurethral-resection-of-the-prostate-in-the-treatment-of-benign-prostatic-hyperplasia-protocol-for-a-non-inferiority-clinical-trial
#18
Saturnino Napal Lecumberri, Iñigo Insausti Gorbea, Ana Sáez de Ocáriz García, Saioa Solchaga Álvarez, José Luis Cebrián Lostal, Raquel Monreal Beortegui, Pedro José Giral Villalta, Fermín Urtasun Grijalba
Background: Benign prostatic hyperplasia (BPH) is a prevalent disease associated with lower urinary tract symptoms (LUTS). The standard of care for moderate-to-severe LUTS unresponsive to pharmacological treatment is the transurethral resection of the prostate (TURP). However, this intervention is not exempt from complications. Prostatic artery embolization (PAE) has been described as a new, effective and safe procedure for the treatment of LUTS secondary to BPH. To date, only one clinical trial has been published on the use of PAE for LUTS, but the study was methodologically flawed in terms of safety monitoring...
2018: Research and Reports in Urology
https://www.readbyqxmd.com/read/29447772/the-optimal-anti-coagulation-for-enhanced-risk-patients-post-catheter-ablation-for-atrial-fibrillation-ocean-trial
#19
Atul Verma, Andrew C T Ha, Paulus Kirchhof, Gerhard Hindricks, Jeff S Healey, Michael D Hill, Mukul Sharma, D George Wyse, Jean Champagne, Vidal Essebag, George Wells, Dhiraj Gupta, Hein Heidbuchel, Prashanthan Sanders, David H Birnie
BACKGROUND: The optimal long-term antithrombotic regimen for patients after successful catheter-based atrial fibrillation (AF) ablation is not well defined. Presently, practice variation exists, and the benefits of oral anticoagulation over antiplatelet therapy across the entire spectrum of stroke risk profile remain undefined in the postablation population. To date, there are no randomized trials to inform clinicians on this therapeutic question. OBJECTIVE: The objective was to assess whether rivaroxaban is superior to acetylsalicylic acid (ASA) in reducing the risk of clinically overt stroke, systemic embolism, or covert stroke among patients without apparent recurrent atrial arrhythmias for at least 1 year after their most recent AF ablation procedure...
March 2018: American Heart Journal
https://www.readbyqxmd.com/read/29445314/prognostic-assessment-for-patients-with-cancer-and-incidental-pulmonary-embolism
#20
George Bozas, Natalie Jeffery, Deiva Ramanujam-Venkatachala, Ged Avery, Andrew Stephens, Hilary Moss, June Palmer, Mandi Elliott, Anthony Maraveyas
Background: An incidental/unsuspected diagnosis of pulmonary embolism (IPE) in cancer patients is a frequent occurrence. This single-institution analysis of uniformly managed patients investigates short and long-term outcomes and proposes a prognostic risk score, aiming to assist clinical decision-making. Methods: Data from a prospectively recorded cohort of 234 consecutive cancer patients with IPE were analysed. Multivariate logistic regression and the Cox regression survival methods were used to identify factors with independent association with early (30-day, 3-month, 6-month) mortality and survival...
2018: Thrombosis Journal
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