High haemoglobin levels at the time of occlusion predict worse outcome for patients with patent ductus arteriosus and pulmonary hypertension.

Introduction: Current guidelines discourage shunt closure in patients with pulmonary vascular resistance index >8 Wood units x m. The study examined the long-term outcome of patients over 15 years old, with pulmonary vascular resistance index >8 Wood units x m and patent ductus arteriosus.

Materials And Methods: This was a multi-institutional, retrospective study involving all consecutive patients (>15 years old) with patent ductus arteriosus and severe pulmonary hypertension.

Delta QRS distinguishes I -mediated J waves from pseudo J waves produced by conduction delay on body surface electrocardiographic.

Background: On surface electrocardiographic (ECGs), it is difficult to differentiate I -mediated J waves, a repolarization phenomenon seen in J wave syndromes (JWS) from terminal QRS deflections that mimic J waves (pseudo J waves) in intraventricular conduction delay (IVCD), an abnormality in depolarization. We hypothesize that the difference between the "maximum QRS duration" inclusive of J point or terminal QRS deflections and the minimum QRS duration identified across a 12-lead ECG is significantly larger in I -mediated J waves, and can serve as a marker to make this distinction.

Methods: A retrospective analysis was performed on adults with ECGs consisting of one of the four following manifestations: J waves associated with hypothermia and early repolarization, and pseudo J waves associated with right bundle branch block (RBBB) and non-specific intraventricular conduction delay (NS-IVCD).

Device profile of the tack endovascular system® for the treatment of peripheral arterial disease: overview of safety and efficacy.

: The 6 F Tack Endovascular System® is approved by the United States Food and Drug Administration (FDA) for post-percutaneous transluminal angioplasty (PTA) dissection repair in the superficial femoral and proximal popliteal arteries, and the 4 F System for post-PTA dissection repair in the mid/distal popliteal, peroneal and tibial arteries. The latter is the first FDA approval for an infra-popliteal implantable device.: An evaluation of the Tack Endovascular System® design and a summary of the current safety and efficacy data.

Outcomes of Transcarotid Versus Trans-Subclavian Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis.

Objectives: This study aimed to perform the first meta-analysis of studies comparing transcarotid (TC) and trans-subclavian (TSc) transcatheter aortic valve replacement (TAVR).

Background: The safety and feasibility of a TC and a TSc approach for performing TAVR in patients with prohibitive femoral anatomy have been well described. The potential advantage of one approach over the other is yet to be ascertained.

Role of Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke with Large Vessel Occlusion.

Objective: The goal of the present study was to determine the safety and efficacy of intravenous tissue plasminogen activator (IVT) in patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) undergoing mechanical thrombectomy (MT).

Methods: We performed a retrospective analysis of prospectively collected data gathered during a 3-year period for all our patients with AIS and LVO. We analyzed the stroke outcomes and complications between patients who had received a combination of IVT and MT and those who had undergone MT only.

Presigmoid Transpetrosal Approach for Superficial Temporal Artery to Distal Posterior Cerebral Artery Bypass and Trapping of Aneurysm.

Background And Importance: Aneurysms of the posterior cerebral artery (PCA) are uncommon, estimated at less than 1% of all cerebral aneurysms, and less than half occur distal to the P1/2 junction. Unfortunately, the conventional bypass approach for PCA aneurysms-primarily occipital artery to distal PCA cortical branches-has a history of unsatisfying results.

Clinical Presentation: A 42-yr-old female presented with Fisher 3 Hunt-Hess 2 subarachnoid hemorrhage secondary to ruptured distal PCA aneurysm.

Targeted Radiation Therapy Can Treat Myxomatous Cerebral Aneurysms.

Background: Neoplastic cerebral aneurysms are rare presentations of cardiac myxomas. The natural history of such aneurysms is not well understood, and the optimal treatment strategy remains unclear. Clipping and coiling are effective, although can carry significant morbidity.

In Vitro Modeling of Human Brain Arteriovenous Malformation for Endovascular Simulation and Flow Analysis.

Background: Current in vitro models for human brain arteriovenous malformation (AVM) analyzing the efficacy of embolic materials or flow conditions are limited by a lack of realistic anatomic features of complex AVM nidus. The purpose of this study was to evaluate a newly developed in vitro AVM model for embolic material testing, preclinical training, and flow analysis.

Methods: Three-dimensional (3D) images of the AVM nidus were extracted from 3D rotational angiography from a patient.

Taking the kidney to heart.

Growing evidence supports the role of Impella in the prevention of acute kidney injury in high-risk percutaneous interventions (HR-PCIs). The Mehran contrast-induced nephropathy risk score may serve as a helpful risk stratification tool in discerning patients undergoing HR-PCI who may benefit from renal protection with Impella support. Further research is warranted to validate this renal protection strategy.

Updates in the management of cranial dural arteriovenous fistula.

Dural arteriovenous fistula (dAVF) accounts for approximately 10% of all intracranial vascular malformations. While they can be benign lesions, the presence of retrograde venous drainage and cortical venous reflux makes the natural course of these lesions aggressive high risk of haemorrhage, neurological injury and mortality. Endovascular treatment is often the first line of treatment for dAVF.

Increased Rate of Successful First Passage Recanalization During Mechanical Thrombectomy for M2 Occlusion.

Background: Mechanical thrombectomy (MT) is the standard of care for the treatment of acute ischemic stroke (AIS) caused by anterior circulation large-vessel occlusion. However, the true safety and efficacy of MT in medium-size vessel occlusions such as the M2 segment of the middle cerebral artery have yet to be completely defined. In this study, we analyze the safety and efficacy of MT in M2 occlusions compared with M1 occlusions.

Thromboprophylaxis strategies for children with single-ventricle circulations (superior or total cavo-pulmonary connections) after stent implantation.

Objective: To define optimal thromboprophylaxis strategy after stent implantation in superior or total cavopulmonary connections.

Background: Stent thrombosis is a rare complication of intravascular stenting, with a perceived higher risk in single-ventricle patients.

Methods: All patients who underwent stent implantation within superior or total cavopulmonary connections (caval vein, innominate vein, Fontan, or branch pulmonary arteries) were included.

A systematic review of shunt-related extraneural metastases of primary central nervous system tumors.

Extraneural metastasis (ENM) of primary central nervous system (CNS) tumors is an uncommon occurrence. Case reports and case series describe ENM after shunting, but this phenomenon has not been well characterized. In this review we aim to better understand the risk factors and clinical implications of ENM associated with shunting.

Premounted stents for branch pulmonary artery stenosis in children: A short term solution.

Objective: Define outcomes of premounted stent implantation (PMS) for branch pulmonary artery stenosis (BPAS).

Background: PMS for BPAS in children raises concern of long term viability, with limited maximal expansion.

Methods: We reviewed our cardiac database over an 11-year period ending in 2013.

Angiographic follow-up of infants and children undergoing percutaneous carotid artery interventions.

Objective: The purpose of this study was to review the outcomes following the percutaneous carotid arterial (PCA) approach in infants and children with congenital heart disease.

Background: PCA access is becoming more commonly adopted following reports demonstrating it is a safe alternative to surgical carotid cutdown and even the femoral arterial route. However, follow-up outcomes after PCA remain unreported.

Reintervention Is Associated With Improved Survival in Pediatric Patients With Pulmonary Vein Stenosis.

Objectives: The aim of this study was to evaluate survival following catheter intervention in pediatric patients with pulmonary vein stenosis (PVS).

Background: Despite aggressive surgical and catheter intervention on PVS in children, recurrence and progression of stenosis can lead to right heart failure and death. Clinicians continue to seek effective treatment options for PVS.

Intervention on Surgical Systemic-to-Pulmonary Artery Shunts: Carotid Versus Femoral Access.

Objectives: The purpose of this study was to compare results between the femoral arterial (FA) and carotid arterial (CA) approaches in catheter-based interventions on Blalock-Taussig shunts (BTS).

Background: Transcatheter intervention on BTS is often performed in shunt-dependent, hypoxemic infants. The approach to BTS intervention likely has an impact on timeliness and overall success.

Pineal germ cell tumors: Two cases with review of histopathologies and biomarkers.

Pineal germ cell tumors (GCTs) are primarily seen in pediatric and Asian populations. These tumors are divided into germinomatous and non-germinomatous GCTs (NGGCTs). GCTs are thought to arise by misplacement of totipotent stem cells en route to gonads during embryogenesis.

Rigorous anaesthesia management protocol for patients with intracranial arterial stenosis: a prospective controlled-cohort study.

Objectives: Reducing variability is integral in quality management. As part of the ongoing Encephaloduroarteriosynangiosis Revascularisation for Symptomatic Intracranial Arterial Stenosis (ERSIAS) trial, we developed a strict anaesthesia protocol to minimise fluctuations in patient parameters affecting cerebral perfusion. We hypothesise that this protocol reduces the intraoperative variability of targeted monitored parameters compared to standard management.

Endotherapy is effective for pancreatic ductal disruption: A dual center experience.

Background And Study Aims: Pancreatic duct (PD) disruptions occur as a result of different etiologies and can be managed medically, endoscopically, or surgically. The aim of this study was to provide an evaluation on the efficacy of endotherapy for treatment of PD disruption in a large cohort of patients and identify factors that predict successful treatment outcome.

Patients And Methods: We retrospectively evaluated consecutive patients who underwent endoscopic retrograde pancreatography (ERP) for transpapillary pancreatic stent placement for PD disruption from 2008 to 2013 at two tertiary referral institutions.

Transcatheter Versus Surgical Closure of Atrial Septal Defects in Children: A Value Comparison.

Objectives: The purpose of this study was to determine whether a transcatheter procedure or surgical closure offers a better value proposition for atrial septal defect (ASD) closure.

Background: Secundum ASDs are common congenital heart defects with both transcatheter and surgical treatment options. Although both options have been shown to have excellent results in children, the relative value of the 2 procedures is unclear.

Matched Cohort Analysis of the Effects of Limb Remote Ischemic Conditioning in Patients with Aneurysmal Subarachnoid Hemorrhage.

Remote ischemic conditioning (RIC) is a powerful innate response to transient subcritical ischemia that protects against severe ischemic insults at distant sites. We have previously shown the safety and feasibility of limb RIC in aneurysmal subarachnoid hemorrhage (aSAH) patients, along with changes in neurovascular and cerebral metabolism. In this study, we aim to detect the potential effect of an established lower-limb conditioning protocol on clinical outcomes of aSAH patients.