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Safety outcomes in endovascular treatment versus best medical management for basilar artery occlusion acute ischemic stroke: A systematic review and meta-analysis of randomized trials
No full textBackground: Endovascular therapy (EVT) improves functional outcomes and reduces mortality in acute ischemic stroke (AIS) due to basilar artery occlusion (BAO). However, data on hemorrhagic complications and nonneurologic adverse events remain limited. We conducted a systematic review and meta-analysis to assess these outcomes in randomized controlled trials (RCTs) comparing EVT versus best medical management (BMM).Methods: We searched PubMed, Cochrane Library, and Embase in December 2024 for RCTs comparing EVT and BMM (PROSPERO registry CRD42024617681). Outcomes included any parenchymal hematoma (PH), PH type 1 and 2, subarachnoid hemorrhage (SAH), systemic/extracranial hemorrhage, pneumonia, and heart failure. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model.
Results: Four RCTs, 988 patients (556 EVT, 432 BMM), were included. EVT increased the risk of SAH (RR 5.14; 95% CI [1.35-19.56]; I² = 0.0%) and PH type 2 (RR 5.53; 95% CI [1.47-20.84]; I² = 0.0%) compared to BMM. No significant differences were observed for any PH (RR 1.91; 95% CI [0.92-3.97]; I² = 0.0%), PH type 1 (RR 0.71; 95% CI [0.22-2.29]; I² = 3.4%), systemic/extracranial hemorrhage (RR 1.06; 95% CI [0.71-1.60]; I² = 12.2%), pneumonia (RR 1.00; 95% CI [0.83-1.21]; I² = 0.0%), or heart failure (RR 2.00; 95% CI [0.34-11.92]; I² = 55.4%).ConclusionIn patients with BAO AIS, EVT is associated with an increased risk of SAH and PH type 2 compared with BMM. There was no significant difference in any PH, PH type 1, systemic/extracranial hemorrhage, pneumonia, and heart failure between groups
Comparative analysis of cardiovascular outcomes between patients diagnosed with spontaneous coronary artery dissection and those with peripartum cardiomyopathy: A propensity-matched analysis using the TriNetX research network
No full textIncrease Anticoagulation Stewardship by Implementing Direct Oral Anticoagulant Monitoring by Anticoagulation Clinics
No full textComparing Different Dosing Strategies of Prothrombin Complex Concentrate in Factor Xa Inhibitor-Related Intracerebral Hemorrhage
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Testicular Embryonal Carcinoma Presenting as Right Ventricular Outflow Tract Obstruction – A Case Report
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Pathogenic variants in SMARCA1 cause an X-linked neurodevelopmental disorder modulated by NURF complex composition
No full textPathogenic variants in ATP-dependent chromatin remodeling proteins are a recurrent cause of neurodevelopmental disorders (NDDs). The NURF complex consists of BPTF and either the SMARCA5 or SMARCA1 ISWI-chromatin remodeling enzyme. Pathogenic variants in BPTF and SMARCA5 have been previously implicated in NDDs. Here, we describe 35 individuals from 26 families with de novo or maternally inherited variants in the X-linked SMARCA1 gene. This SMARCA1-related NDD is associated with a spectrum of involvement, including mild to severe ID/DD, delayed or regressive speech development, ASD features, facial dysmorphisms, and other variable features. Individuals carrying SMARCA1 truncating variants exhibit a mildly unique genome-wide DNA methylation profile and a high penetrance of macrocephaly. Genetic dissection of the NURF complex using Smarca1, Smarca5, and Bptf single and double mouse knockouts reveals the importance of NURF composition and dosage for proper forebrain development. We propose that genetic alterations affecting different NURF components, including SMARCA1, result in a NDD with a broad clinical spectrum
Exploring sex differences in myocardial fibrosis in patients with structurally normal hearts
No full textMyocardial fibrosis as evaluated by cardiovascular magnetic resonance (CMR) plays a central role in pathophysiology of cardiovascular diseases and exhibits sex-specific differences. The goal of our study was to assess sex-related differences in fibrosis in patients with structurally normal hearts. We retrospectively studied patients undergoing clinical CMR at 1.5T with preserved cardiac function and no structural abnormalities. Standardized CMR protocols included cine imaging, T1 mapping, and late gadolinium enhancement (LGE) imaging. LGE presence, extent, and pattern, and extracellular volume fraction (ECV) were evaluated according to sex. The primary outcomes were all cause mortality and new-onset heart failure. Of 525 patients studied (43.1 ± 14.2 years, 69.5% female), 258 (49.1%) exhibited nonischemic LGE. Nonischemic LGE was more common in males (61.3% vs. 43.8%, p \u3c 0.001), and remained so in multivariable analysis after adjustment for clinical covariates (OR 2.2, CI 1.17-4.13, p = 0.015). Women had higher ECV values (26.5 ± 4.3% vs. 23.2 ± 3.7, p \u3c 0.001), and these sex differences remained significant in multivariable analysis (β coefficient = 1.29, p = 0.02). During 5.8 years follow-up there was no association between primary outcomes and nonischemic LGE. There was a trend towards association between ECV increase and all-cause mortality. The optimal ECV cutoff for all-cause mortality was 31.3% for females and 27.5% for males. Among patients with structurally normal hearts with preserved systolic function referred for clinical CMR exams, nonischemic LGE is more frequently observed in males, whereas ECV values are higher in females. ECV increase may be associated with all-cause mortality, both in female and male cohorts
