The recanalization rate and clinical outcome of mechanical thrombectomy for acute ischemic stroke manifesting with basilar artery occlusion are worse for patients with in situ atherosclerotic thrombosis compared with those with embolic origin. BackgroundAcute stroke because of basilar artery occlusion (BAO) represents 1% of all ischemic strokes. However, recanalization rates and treatment outcome for the different pathologic subtypes of BAO stroke are not fully understood.PurposeTo compare the recanalization rate and clinical outcomes of mechanical thrombectomy in different subtypes of BAO.Materials and MethodsEighty-two patients (46 men and 36 women; mean age, 73 years; age range, 20–90 years; mean age in men, 70 years [age range, 20–90 years]; mean age in women, 75 years [age range; 61–90 years]) with acute BAO who underwent mechanical thrombectomy between March 2010 and December 2017 were retrospectively analyzed. Patients were classified into three groups: embolism without vertebral artery (VA) steno-occlusion (group 1), embolism from tandem VA steno-occlusion (group 2), and in situ atherosclerotic thrombosis (group 3). Clinical and angiographic characteristics, recanalization rate, procedure times, and clinical outcomes were compared betwe...

Accurate image interpretation of Waters’ and Caldwell view radiographs used for sinusitis screening is challenging. Therefore, we developed a deep learning algorithm for diagnosing frontal, ethmoid, and maxillary sinusitis on both Waters’ and Caldwell views. The datasets were selected for the training and validation set (n = 1403, sinusitis% = 34.3%) and the test set (n = 132, sinusitis% = 29.5%) by temporal separation. The algorithm can simultaneously detect and classify each paranasal sinus using both Waters’ and Caldwell views without manual cropping. Single- and multi-view models were compared. Our proposed algorithm satisfactorily diagnosed frontal, ethmoid, and maxillary sinusitis on both Waters’ and Caldwell views (area under the curve (AUC), 0.71 (95% confidence interval, 0.62–0.80), 0.78 (0.72–0.85), and 0.88 (0.84–0.92), respectively). The one-sided DeLong’s test was used to compare the AUCs, and the Obuchowski–Rockette model was used to pool the AUCs of the radiologists. The algorithm yielded a higher AUC than radiologists for ethmoid and maxillary sinusitis (p = 0.012 and 0.013, respectively). The multi-view model also exhibited a higher AUC than the single Waters’ view model for maxillary sinusitis (p = 0.038). Therefore, our algorithm showed diagnostic performances comparable to radiologists and enhanced the value of radiography as a first-line imaging modality in assessing multiple sinusitis.

Background The optimal first-line mechanical thrombectomy (MT) method in cancer-related stroke (CRS) patients with emergent large vessel occlusion (ELVO) remains largely unknown. The aim of this study is to evaluate the efficacy and safety between contact aspiration (CA) first-line thrombectomy and stent retriever (SR) first-line thrombectomy in CRS patients. Methods Sixty-two CRS patients with ELVO, who underwent MT between January 2013 and October 2019 at our institution, were retrospectively analyzed. Patients were divided into two groups based on the first-line MT method and compared: the CA group (n=28), which included those who received CA alone or combined CA with SR, and the SR group (n=34), which included those who received conventional SR alone. Results Overall, reperfusion was successful in 75.8% (47/62) of CRS patients, and a good clinical outcome at 90 days was observed in 17.7%. The CA group showed a higher rate of successful reperfusion (89.3% vs 64.7%, P=0.025) shorter procedure time (22 vs 42 min; P=0.029), higher rate of first pass effect (35.7% vs 11.8%, P=0.025), and lower number of passes (1 vs 3, P=0.023) when compared with the SR group. The procedural and hemorrhagic complication rates were similar between the CA and SR groups. The first-line contact aspiration (OR 11.624, 95% CI 1.041 to 129.752; P=0.046) was an independent predictor of successful reperfusion. Conclusions Among patients with CRS, CA – whether alone or in combination with SR – as first-line MT seems to provide more rapid and successful reperfusion when compared with SR.

Mechanical thrombectomy for acute posterior circulation strokes (PCSs) is recommended based on evidence from anterior circulation strokes (ACSs). Two recent randomized controlled trials showed that endovascular treatment (EVT) leads to better functional outcomes than those of the best medical care. However, many studies have shown that patients undergoing PC-EVT have a higher rate of futile recanalization than those undergoing AC-EVT. The characteristics and outcomes of PC-EVT may differ according to the pathological mechanisms, including cardioembolism, intracranial atherosclerosis, and tandem vertebrobasilar occlusion. We reviewed PC-EVT outcomes reported in recent studies and discussed technical considerations for maximizing treatment efficacy according to the etiology of a PCS.

Jeong-Kui Ku, Na-Hee Chang, Yeong-Kon Jeong, Sung Hyun Baik, Sun-Kyu Choi. JKAOMS 2020;46:328-34. https://doi.org/10.5125/jkaoms.2020.46.5.328

In this paper we report on the molecular defect underlying apolipoprotein CII (apoCII) deficiency in an Italian kindred. ApoCII serves as cofactor for lipoprotein lipase (LPL) in triglyceride hydrolysis of chylomicrons and very low density lipoproteins. Homozygous apoCII deficiency manifests with type I hyperlipoproteinaemia and is a rare disorder of lipoprotein metabolism. Until now, only 10 kindreds with apoCII deficiency have been published and all underlying mutations were unique. The proband was the offspring of a consanguineous mating. Sequencing of cloned DNA from the proband presented in this report showed homozygosity for a C-->A substitution at position 3002 in the apoCII gene, resulting in the introduction of a premature stop codon at residue 37 of the mature apoCII protein. Therefore, a truncated apoCII is synthesised, lacking the part of the apolipoprotein that activates LPL. This mutation has previously been described in another Italian family and is known as apoCIIPadova. We propose that apoCIIPadova is a frequent cause of apoCII deficiency in persons of Italian descent.