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BackgroundIn acute ischemic stroke due to anterior large vessel occlusion (AIS-LVO), accessing the target occluded vessel for mechanical thrombectomy (MT) is sometimes impossible through the femoral approach. We aimed to evaluate the safety and efficacy of direct carotid artery puncture (DCP) for MT in patients with failed alternative vascular access.MethodsWe retrospectively analyzed data from 45 stroke centers in France, Switzerland and Germany through two research networks from January 2015 to July 2019. We collected physician-centered data on DCP practices and baseline characteristics, procedural variables and clinical outcome after DCP. Uni- and multivariable models were conducted to assess risk factors for complications.ResultsFrom January 2015 to July 2019, 28 149 MT were performed, of which 108 (0.39%) resulted in DCP due to unsuccessful vascular access. After DCP, 77 patients (71.3%) had successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) score ≥2b) and 28 (25.9%) were independent (modified Rankin Scale (mRS) score 0–2) at 3 months. 20 complications (18.5%) attributed to DCP occurred, all of them during or within 1 hour of the procedure. Complications led to extension of the intubation time in the intensive care unit in 7 patients (6.4%) and resulted in death in 3 (2.8%). The absence of use of a hemostatic closure device was associated with a higher complication risk (OR 3.04, 95% CI 1.03 to 8.97; p=0043).ConclusionIn this large multicentric study, DCP was scantly performed for vascular access to perform MT (0.39%) in patients with AIS-LVO and had a high rate of complications (18.5%). Our results provide arguments for not closing the cervical access by manual compression after MT.

Respiratory syncytial virus (RSV) is a common cause of respiratory tract infections in children and immunocompromised individuals. A multi-center surveillance of the epidemiologic and molecular characteristics of RSV circulating in Lebanon was performed. The attachment (G) and fusion (F) glycoproteins were analyzed and compared to those reported regionally and globally. 16% (83/519) of the nasopharyngeal swabs collected during the 2016/17 season tested positive for RSV; 50% (27/54) were RSV-A and 50% (27/54) were RSV-B. Phylogenetic analysis of the G glycoprotein revealed predominance of the RSVA ON1 genotype, in addition to two novel Lebanese genotype variants, hereby named LBA1 and LBA2, which descended from the ON1 and NA2 RSV-A genotypes, respectively. RSV-B strains belonged to BA9 genotype except for one BA10. Deduced amino acid sequences depicted several unique substitutions, alteration of glycosylation patterns and the emergence of palivizumab resistance among the Lebanese viruses. The emergence of ON1 and other novel genotypes that are resistant to palivizumab highlights the importance of monitoring RSV globally.

To ensure practice guidelines contribute to improving equity, guideline developers need to consciously consider populations experiencing inequities throughout the process. Our aim was to describe whether and how guideline-producing organizations consider equity in the guideline development process as described in their guidance documents on guideline development. We conducted a descriptive summary of guideline-producing organizations using different sources and retrieved their publicly available guidance documents on guideline development (eg, handbooks). We screened guidance documents and abstracted information about equity consideration within topics of the GIN-McMaster guideline development checklist. Of 133 identified guideline-producing organizations with guidance documents on guideline development, 52% considered equity in their guidance documents in at least one of the 18 topics of the GIN-McMaster checklist. Most organizations were professional (55%) and national (77%). The median number of topics considered per organization was 2 (IQR = 1–4), with the World Health Organization (WHO) considering the highest number of topics. The topic in which equity was considered the most was “guideline group membership” (57%), while the topic in which equity was considered the least was “conflict of interest considerations” (1%). In addition, some of the terms related to equity and populations experiencing inequities used were “inequitable or equality” and “minority or disadvantaged”, respectively. More than half of guideline-producing organizations consider equity in guideline development, with considerations limited to a few groups of populations and a few topics of the guideline development process. [Display omitted] Key findings•52% of guideline-producing organizations considered equity in their guidance documents.•A median number of 2 (IQR = 1–4) GIN-McMaster checklist topics were addressed per organization.•A median number of 3 (IQR = 2–5) PROGRESS-Plus factors were addressed per organization.What this adds to what was known before?•This paper shows the suboptimal equity consideration in guideline development processes.What is the implication and what should change now?•Equity consideration should be expanded to additional populations and topics of the guideline development process.