Occlusion length is a crucial determinant of efficiency and complication rate in thrombectomy for acute ischemic stroke

BACKGROUND AND PURPOSE: Although mechanical thrombectomy (MT) has an encouragingly high recanalization rate in treating stroke, it is associated with severe complications of which the underlying factors have yet to be identified. Because MT is a mechanical approach, the mechanical properties of the thrombus might be crucial for its success. The present study assesses the effect of thrombus length on the in vivo effectiveness and complication rate of MT. MATERIALS AND METHODS: Angiography and embolization of 21 cranial vessels with radiopaque whole-blood thrombi 10, 20, and 40 mm in length (7 occlusions each) were performed in 7 swine. MT was carried out using a distal snarelike device (BCR Roadsaver) with proximal balloon occlusion. A total of 61 retrievals were attempted. RESULTS: In the group of 10-mm occlusions, 77.8% of the attempts achieved complete recanalisation. For longer occlusions, the success rates decreased significantly to 20% of attempts for 20-mm occlusions (odds ratio [OR], 14; 95% confidence interval [CI], 2.2-89.2) and 11.1% for 40-mm occlusions (OR, 28; 95% CI, 3.9-202.2; P < .005). The low success rates were largely due to complications associated with thrombus compaction during retrieval. Similarly, the rate of thromboembolic events increased from 0% in 10-mm occlusions to 14.8% in 40-mm occlusions. CONCLUSIONS: MT using a distal device proved to be a fast, effective, and safe procedure for recanalizing short (10-mm) occlusions in the animal model. However, occlusion length emerged as a crucial determinant for MT with a significant decrease in recanalization success per attempt and increased complication rates. These findings suggest limitations of MT in the clinical application.

Sixty-four-detector CT angiography of infrarenal aortic neck length and angulation: prospective analysis of interobserver variability

PURPOSE: To quantify the interobserver variability of abdominal aortic aneurysm (AAA) neck length and angulation measurements. MATERIALS AND METHODS: A total of 25 consecutive patients scheduled for endovascular AAA repair underwent follow-up 64-row computed tomographic (CT) angiography in 0.625-mm collimation. AAA neck length and angulation were determined by four blinded, independent readers. AAA neck length was defined as the longitudinal distance between the first transverse CT slice directly distal to the lowermost renal artery and the first transverse CT slice that showed at least a 15% larger outer aortic wall diameter versus the diameter measured directly below the lowermost renal artery. Infrarenal AAA neck angulation was defined as the true angle between the longitudinal axis of the proximal AAA neck and the longitudinal axis of the AAA lumen as analyzed on three-dimensional CT reconstructions. RESULTS: Mean deviation in aortic neck length determination was 32.3% and that in aortic neck angulation was 32.1%. Interobserver variability of aortic neck length and angulation measurements was considerable: in any reader combination, at least one measurement difference was outside the predefined limits of agreement. CONCLUSIONS: Assessment of the longitudinal extension and angulation of the infrarenal aortic neck is associated with substantial observer variability, even if measurement is carried out according to a standardized protocol. Further studies are mandatory to assess dedicated technical approaches to minimize variance in the determination of the longitudinal extension and angulation of the infrarenal aortic neck.

Length of the annular regime for condensing flows inside a horizontal channel - the experimental determination of its values and its trends

The experiments observe and measure the length of the annular regime in fully condensing quasi-steady (steady-in-the-mean) flows of pure FC-72 vapor in a horizontal condenser (rectangular cross-section of 2 mm height, 15 mm width, and 1 m length). The sides and top of the duct are made of clear plastic that allows flow visualization. The experimental system in which this condenser is used is able to control and achieve different quasi-steady mass flow rates, inlet pressures, and wall cooling conditions (by adjustment of the temperature and flow rate of the cooling water flowing underneath the condensing-plate). The reported correlations and measurements for the annular length are also vital information for determining the length of the annular regime and proposing extended correlation (covering many vapors and a larger parameter set than the experimentally reported version here) by ongoing independent modeling and computational simulation approach.

Space trajectories optimization using variable-chromosome-length genetic algorithms

The problem of optimal design of a multi-gravity-assist space trajectories, with free number of deep space maneuvers (MGADSM) poses multi-modal cost functions. In the general form of the problem, the number of design variables is solution dependent. To handle global optimization problems where the number of design variables varies from one solution to another, two novel genetic-based techniques are introduced: hidden genes genetic algorithm (HGGA) and dynamic-size multiple population genetic algorithm (DSMPGA). In HGGA, a fixed length for the design variables is assigned for all solutions. Independent variables of each solution are divided into effective and ineffective (hidden) genes. Hidden genes are excluded in cost function evaluations. Full-length solutions undergo standard genetic operations. In DSMPGA, sub-populations of fixed size design spaces are randomly initialized. Standard genetic operations are carried out for a stage of generations. A new population is then created by reproduction from all members based on their relative fitness. The resulting sub-populations have different sizes from their initial sizes. The process repeats, leading to increasing the size of sub-populations of more fit solutions. Both techniques are applied to several MGADSM problems. They have the capability to determine the number of swing-bys, the planets to swing by, launch and arrival dates, and the number of deep space maneuvers as well as their locations, magnitudes, and directions in an optimal sense. The results show that solutions obtained using the developed tools match known solutions for complex case studies. The HGGA is also used to obtain the asteroids sequence and the mission structure in the global trajectory optimization competition (GTOC) problem. As an application of GA optimization to Earth orbits, the problem of visiting a set of ground sites within a constrained time frame is solved. The J2 perturbation and zonal coverage are considered to design repeated Sun-synchronous orbits. Finally, a new set of orbits, the repeated shadow track orbits (RSTO), is introduced. The orbit parameters are optimized such that the shadow of a spacecraft on the Earth visits the same locations periodically every desired number of days.

Near-infrared digital photography to estimate snow correlation length for microwave emission modeling

The study is based on experimental work conducted in alpine snow. We made microwave radiometric and near-infrared reflectance measurements of snow slabs under different experimental conditions. We used an empirical relation to link near-infrared reflectance of snow to the specific surface area (SSA), and converted the SSA into the correlation length. From the measurements of snow radiances at 21 and 35 GHz , we derived the microwave scattering coefficient by inverting two coupled radiative transfer models (the sandwich and six-flux model). The correlation lengths found are in the same range as those determined in the literature using cold laboratory work. The technique shows great potential in the determination of the snow correlation length under field conditions.