Explore the vast range of titles available.

Extensive application of coronary intravascular procedures has led to the increased need of understanding the injury inflicted to the coronary arterial wall. We aimed to investigate acute and prolonged coronary endothelial injury as a result of guidewire use, repeated intravascular imaging and stenting. These interventions were performed in swine (N = 37) and injury was assessed per coronary segment (n = 81) using an Evans Blue dye-exclusion-test. Scanning electron microscopy and light microscopy were then used to visualize the extent and nature of acute (<4 hours) and prolonged (5 days) endothelial injury. Guidewire and imaging injury was mainly associated with denudation and returned to control levels at 5 days. IVUS and OCT combined (Evans Blue staining 28 ± 16%) did not lead to more acute injury than IVUS alone (33 ± 15%). Stent placement caused most injury (85 ± 4%) and despite early stent re-endothelialization at 5 days, the endothelium proved highly permeable (97 ± 4% at 5 days; p < 0.001 vs acute). Imaging of in-stent neointima at 28 days after stent placement did not lead to neointimal rupture. Guidewire, IVUS and OCT induce acute endothelial cell damage, which does not increase during repeated imaging, and heals within 5 days. Interestingly, endothelial permeability increases 5 days post stenting despite near complete re-endothelialization.

BackgroundEndovascular catheters and devices used for thrombectomy in patients who had a stroke can damage the vessel lumen leading to microthrombi. During stroke recanalisation, microthrombi could migrate distally and occlude cerebral microvasculature, potentially limiting the benefit of recanalisation therapy.ObjectivesTo describe vascular injury occurring after endovascular therapy (EVT), with stent retrievers (SR) and direct aspiration (DA), to open up avenues for further improvement of EVT technique.MethodsSR and DA were performed according to clinical procedures in extracranial vessels in a swine model of thromboembolic arterial occlusion. Treated vessels were collected at 2 hours or 3 days post-EVT to assess respectively acute injury and early healing (remnant vascular injury) as assessed by Evans-Blue (EB) dye exclusion. The presence of microthrombi was quantified using scanning electron microscopy. Markers of coagulation activation were measured periprocedurally in plasma.ResultsBoth SR and DA induced vascular injury. SR tended to result in larger EB positive areas than DA at 2 hours (99.5 vs 84.5; p=0.072) which reached statistical significance at day 3 (78.6 vs 48.6; p=0.040) post-EVT. Both EVT methods similarly yielded microthrombi in treated areas which were still observed at 3 days post-EVT. In addition, both EVT methods immediately increased systemic plasma levels of complexes of intrinsic-pathway coagulation activation: thrombin, Factor IX and Factor Xa:Antithrombin.ConclusionsIn this preclinical thromboembolic model, SR thrombectomy and DA lead to acute vascular injury, yield microthrombi and trigger contact activation of the coagulation system. At 3 days after intervention, healing remains incomplete, showing remnant vascular injury in the treated arteries, especially in SR thrombectomy.

Objectives Thrombus computed tomography (CT) characteristics might be used to assess histopathologic thrombus composition in patients treated with endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). We aimed to assess the variability in thrombus composition that could be predicted with combined thrombus CT characteristics. Methods Thrombi of patients enrolled in the MR CLEAN Registry between March 2014 and June 2016 were histologically analyzed with hematoxylin-eosin staining and quantified for percentages of red blood cells (RBCs) and fibrin/platelets. We estimated the association between general qualitative characteristics (hyperdense artery sign [HAS], occlusion location, clot burden score [CBS]) and thrombus composition with linear regression, and quantified RBC variability that could be explained with individual and combined characteristics with R 2 . For patients with available thin-slice (≤ 2.5 mm) imaging, we performed similar analyses for general and quantitative characteristics (HAS, occlusion location, CBS, [relative] thrombus density, thrombus length, perviousness, distance from ICA-terminus). Results In 332 included patients, the presence of HAS ( aβ 7.8 [95% CI 3.9–11.7]) and shift towards a more proximal occlusion location ( aβ 3.9 [95% CI 0.6–7.1]) were independently associated with increased RBC and decreased fibrin/platelet content. With general characteristics, 12% of RBC variability could be explained; HAS was the strongest predictor. In 94 patients with available thin-slice imaging, 30% of RBC variability could be explained; thrombus density and thrombus length were the strongest predictors. Conclusions Quantitative thrombus CT characteristics on thin-slice admission CT improve prediction of thrombus composition and might be used to further guide clinical decision-making in patients treated with EVT for AIS in the future. Key Points • With hyperdense artery sign and occlusion location, 12% of variability in thrombus RBC content can be explained. • With hyperdense artery sign, occlusion location, and quantitative thrombus characteristics on thin-slice (≤ 2.5 mm) non-contrast CT and CTA, 30% of variability in thrombus RBC content can be explained. • Absolute thrombus density and thrombus length were the strongest predictors for thrombus composition.

Background Despite evidence of a quite large beneficial effect of endovascular treatment (EVT) for ischemic stroke caused by anterior circulation large vessel occlusion, many patients do not recover even after complete recanalization. To some extent, this may be attributable to incomplete microvascular reperfusion, which can possibly be improved by antiplatelet agents and heparin. It is unknown whether periprocedural antithrombotic medication in patients treated with EVT improves functional outcome. The aim of this study is to assess the effect of acetylsalicylic acid (ASA) and unfractionated heparin (UFH), alone, or in combination, given to patients with an ischemic stroke caused by an intracranial large vessel occlusion in the anterior circulation during EVT. Methods MR CLEAN-MED is a multicenter phase III trial with a prospective, 2 × 3 factorial randomized, open label, blinded end-point (PROBE) design, which aims to enroll 1500 patients. The trial is designed to evaluate the effect of intravenous ASA (300 mg), UFH (low or moderate dose), both or neither as adjunctive therapy to EVT. We enroll adult patients with a clinical diagnosis of stroke (NIHSS ≥ 2) and with a confirmed intracranial large vessel occlusion in the anterior circulation on CTA or MRA, when EVT within 6 h from symptom onset is indicated and possible. The primary outcome is the score on the modified Rankin Scale (mRS) at 90 days. Treatment effect on the mRS will be estimated with ordinal logistic regression analysis, with adjustment for main prognostic variables. Secondary outcomes include stroke severity measured with the NIHSS at 24 h and at 5–7 days, follow-up infarct volume, symptomatic intracranial hemorrhage (sICH), and mortality. Discussion Clinical equipoise exists whether antithrombotic medication should be administered during EVT for a large vessel occlusion, as ASA and/or UFH may improve functional outcome, but might also lead to an increased risk of sICH. When one or both of the study treatments show the anticipated effect on outcome, we will be able to improve outcome of patients treated with EVT by 5%. This amounts to more than 50 patients annually in the Netherlands, more than 1800 in Europe, and more than 1300 in the USA. Trial registration ISRCT, ISRCTN76741621 . Dec 6, 2017.

Analyzing stochastic algorithms for comprehensive performance and comparison across diverse contexts is essential. By evaluating and adjusting algorithm effectiveness across a wide spectrum of test functions, including both classical benchmarks and CEC-C06 2019 conference functions, distinct patterns of performance emerge. In specific situations, underscoring the importance of choosing algorithms contextually. Additionally, researchers have encountered a critical issue by employing a statistical model randomly to determine significance values without conducting other studies to select a specific model for evaluating performance outcomes. To address this concern, this study employs rigorous statistical testing to underscore substantial performance variations between pairs of algorithms, thereby emphasizing the pivotal role of statistical significance in comparative analysis. It also yields valuable insights into the suitability of algorithms for various optimization challenges, providing professionals with information to make informed decisions. This is achieved by pinpointing algorithm pairs with favorable statistical distributions, facilitating practical algorithm selection. The study encompasses multiple nonparametric statistical hypothesis models, such as the Wilcoxon rank-sum test, single-factor analysis, and two-factor ANOVA tests. This thorough evaluation enhances our grasp of algorithm performance across various evaluation criteria. Notably, the research addresses discrepancies in previous statistical test findings in algorithm comparisons, enhancing result reliability in the later research. The results proved that there are differences in significance results, as seen in examples like Leo versus the FDO, the DA versus the WOA, and so on. It highlights the need to tailor test models to specific scenarios, as p-value outcomes differ among various tests within the same algorithm pair.

The effect of tehina processing and storage during six months at 25°C and 35°C on total phenolics, antioxidant activity, anthocyanins, and fatty acid analysis was evaluated. Tehina processing, storage period and temperature significantly (p≤0.05) decreased total phenolics, antioxidant activity and anthocyanins contents. The results showed that raw sesame seeds had the highest total phenolics (99.98 mg GAE/100 g) and lower levels were found in dehulled unroasted sesame seeds, tehina at zero time and roasted sesame seeds (62.53, 60.61 and 47.03 mg GAE/100 g, respectively). In addition, tehina during storage showed a significant decrease in total phenolics (60.61 to 42.45 mg GAE/100 g). Raw sesame seeds had the highest antioxidant activity (0.51 mg/mL), while the tehina, dehulled unroasted and roasted sesame had antioxidant activity values of 1.21, 1.35 and 1.79 mg/mL, respectively. Also, antioxidant activity of tehina at zero time was highest (1.21 mg/mL) and lowest was in tehina stored for six months (1.70 mg/mL). Sesame seeds and tehina had low levels of anthocyanins (1.26 and 0.50 mg cya-3-glu/100 g). Fatty acid analysis showed that sesame seeds (raw, dehulled unroasted and roasted) and tehina samples contain high percent of unsaturated fatty acid oleic (C18:1) and linoleic (C18:2).