Ghozy, Sherief

Background The Woven EndoBridge (WEB) device is a novel intrasaccular flow disruptor tailored for bifurcation aneurysms. We aim to describe the degree of aneurysm occlusion at the latest follow-up, and the rate of complications of aneurysms treated with the WEB device stratified according to rupture status. Methods Our data were taken from the WorldWideWeb Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups: ruptured and unruptured. We compared clinical and radiologic outcomes of both groups. Propensity score matching (PSM) was done to match according to age, gender, bifurcation, location, prior treatment, neck, height, dome width, daughter sac, incorporated branch, pretreatment antiplatelets, and last imaging follow-up. Results The study included 676 patients with 691 intracranial aneurysms (529 unruptured and 162 ruptured) treated with the WEB device. The PSM analysis had 55 pairs. In both the unmatched (85.8% vs 84.3%, p=0.692) and matched (94.4% vs 83.3%, p=0.066) cohorts there was no significant difference in the adequate occlusion rate at the last follow-up. Likewise, there were no significant differences in both ischemic and hemorrhagic complications between the two groups. There was no documented aneurysm rebleeding after WEB device implantation. Conclusion There was no significant difference in both the radiologic outcomes and complications between unruptured and ruptured aneurysms. Our findings support the feasibility of treatment of ruptured aneurysms with the WEB device.

AbstractWe aimed to conduct the current meta‐analysis to provide better insight into the efficacy of mechanical thrombectomy (MT) in managing COVID‐19 patients suffering from a stroke. An electronic search was conducted through eight databases for collecting the current evidence about the efficacy of MT in stroke patients with COVID‐19 until 18 December 2021. The results were reported as the pooled prevalence rates and the odds ratios (ORs), with their corresponding 95% confidence intervals (CI). Out of 648 records, we included nine studies. The prevalence of stroke patients with COVID‐19 who received MT treatment was with TICI ≥2b 79% (95%CI: 73–85), symptomatic intracranial haemorrhage 6% (95%CI: 3–11), parenchymal haematoma type 1, 11.1% (95%CI: 5–23), and mortality 29% (95%CI: 24–35). On further comparison of MT procedure between stroke patients with COVID 19 to those without COVID‐19, we found no significant difference in terms of TICI ≥2b score (OR: 0.85; 95%CI: 0.03–23; p = 0.9). However, we found that stroke patients with COVID‐19 had a significantly higher mortality rate than stroke patients without COVID‐19 after MT procedure (OR: 2.99; 95%CI: 2.01–4.45; p < 0.001). Stroke patients with COVID‐19 can be safely and effectively treated with MT, with comparable reperfusion and complication rates to those without the disease.

Abstract Funding Acknowledgements Type of funding sources: None. Immunomodulatory effect of different statin regimens on regulatory T-cells among patients with acute coronary syndrome: a systematic review and network meta-analysis of randomized clinical trials Introduction In patients with acute coronary syndrome (ACS), studies suggest that statin therapy, besides its role in reducing the progression of atherosclerosis through its pharmacological effect, plays a pivotal role in controlling the pathogenesis of ACS through the anti-inflammatory effects of suppressor regulatory T cells (Tregs). Purpose We conducted a network meta-analysis (NMA) to determine the effects of low-dose conventional statin therapy (CST) (20 mg/day or less) and high-dose intensive statin therapy (IST) (40 mg/day or more) on the frequency of Tregs and their associated cytokines (IFN-γ, IL-10, TGF-β), compared to placebo. Methods The PubMed, Cochrane Library, and EMBASE databases were searched for randomized clinical trials (RCTs) to identify relevant articles published until June 2021. We pooled data extracted from the included studies using the standardized mean difference (SMD). A random-effects model was used to conduct this NMA. Heterogeneity was evaluated using Cochran's Q- and the I2-test. GRADE(Grading of Recommendations, Assessment, Development and Evaluations) was used to assess the study's quality. Data analysis was conducted using R software. Results A total of 505 patients were enrolled in the 5 RCTs. The NMA indicated a significant increase in Treg frequency in the CST group compared with the control group (SMD 1.77; 95% CI: 0.77 – 2.76; P-value = 0.0005) and a larger increase in the Treg frequency associated with the IST group compared with the control group (SMD 2.12; 95% CI: 1.15 – 3.10; P-value &lt; 0.0001). However, there was significant heterogeneity and inconsistency among the included studies (τ2 = 0.6096; τ = 0.7808; I2 = 91.2% [80.5%; 96.0%]). When compared to the placebo, both CST and IST increased levels of secreted IL-10 (SMD 2.69; 95% CI: 2.07 – 3.31; P-value &lt; 0.0001 and (SMD 2.14; 95% CI: 1.76 – 2.52; P-value &lt; 0.0001), respectively. In comparison to the control group, CST was associated with increased levels of TGF-β (SMD 3.83; 95% CI: 0.63 – 7.0; P-value = 0.0189). This association was not seen in the IST group. IFN-γ levels decreased significantly in both the IST and CST groups (SMD -1.52; 95% CI: -1.94 – -1.10; P-value &lt; 0.0001) and (SMD -2.34; 95% CI: -2.73 – -1.95; P-value &lt; 0.0001) respectively. Conclusions Our study suggests that both high and low dose statin groups showed increased Treg frequency compared to the placebo group. IST showed larger benefits. Statin therapy also increased IL-10 and TGF-β cytokine levels and decreased IFN-γ levels. Therefore, statins have the potential to be the main treatment to reduce the incidence of cardiovascular events and improve cardiac function in patients with ACS through immunomodulatory effect on Treg.

e22509 Background: Chronic inflammatory states are linked with increased cancer risk. However, it is unclear if chronic sinusitis (CS) is involved in the development of certain malignancies. Several observational studies reported conflicting results regarding its association with cancer risk. Methods: We searched MEDLINE, EMBASE, Scopus, and Web of Science from their inception till October 2020. The fully adjusted risk estimates were abstracted independently and pooled using the generic inverse variant random-effects model. The Newcastle Ottawa Scale (NOS) was used to assess the quality of included studies. Results: Of 184 articles meeting our eligibilty criteria, 6 cohort and 6 case-control studies reporting data from USA (n = 2), Japan (n = 3), Singapore (n = 1), Taiwan (n = 5), and France (n = 1) were included in the final analysis. Compared to patients without CS (n = 562818), the RR of overall cancer risk in patients with CS (n = 51436) pooled from two studies was = 1.06 (95% CI: 1.00 - 1.13, P = 0.037). CS was associated with an increased cancer risk of head and neck (RR = 1.42, 95%CI: 1.28 - 1.58, P < 0.001), nasopharyngeal (NP) (RR = 1.62, 95%CI: 1.40 - 1.88, P < 0.001), sinonasal (RR = 1.75, 95% CI: 1.34 - 2.29, P < 0.001), and lung cancers (RR = 1.19, 95% CI: 1.14 - 1.23, P < 0.001). No significant assocation was identified with colorectal (RR = 1.02, 95% CI: 0.72 – 1.45, P = 0.89), liver (RR = 1.06, 95% CI: 0.77 - 1.45, P = 0.73), prostate (RR = 1.43, 95% CI: 0.87 – 2.33, P = 0.16), bladder (RR = 1.20, 95% CI: 0.82 - 1.75, P = 0.36), and stomach cancer (RR = 0.97, 95% CI: 0.88 - 1.06, P = 0.47). On the subgroup analysis, CS was associated with an increased risk of lung cancer in females (HR = 2.32, 95% CI: 1.23–4.39) but not in males (HR = 1.32, 95% CI: 0.79 – 2.21). In addition, the association between CS and NP cancer disappeared 1 year or more after diagnosis with RR = 1.82, 95% CI: 0.98 – 3.39) when pooling results from the three studies reporting the interval between CS diagnosis and cancer occurence. According to the NOS, 8 of the included studies were with low risk of bias, 2 with moderate risk, and 2 with high risk of bias. Conclusions: Our analysis found a significant association between CS and risk of overall, head and neck, nasopharyngeal, sinonasal, and lung cancers. Paradoxically, The risk of CS and NP cancer was significant only in subjects with a shorter duration of CS diagnosis, suggesting that CS is a coexistent complication of yet undiagnosed NP cancer. The results of this meta-analysis should be interpreted carefully due to the high heterogeneity and the small number of included studies in the site-specific cancer analyses. This association warrants further investigation using proper study design taking into consideration the years of follow-up, the interval between CS diagnosis and cancer occurrence, as well as gender disparities.

Background Previous studies comparing a direct aspiration first pass technique (ADAPT) and stent retrievers have inconsistent methodologies and data reporting, limiting the ability to accurately assimilate data from different studies that would inform treatment of acute ischemic stroke (AIS) treatment. Objective To conduct a systematic review to discuss and compare the findings of all relevant meta-analysis studies comparing the efficacy of the ADAPT and stent retriever techniques. Methods The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), where meta-analyses comparing the efficacy of the ADAPT technique and stent retrievers in the treatment of AIS were included. We extracted all relevant data from the included studies and assessed the quality of the included meta-analyses using the Assessment of Multiple Systematic Review (AMSTAR-2). Results Seven relevant studies met our inclusion criteria and were suitable for the qualitative synthesis. All included studies obtained data from randomized controlled trials (RCTs) and observational investigations (including levels II, III, and IV). At the same time, none of them used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) for quality assessment. In accordance with AMSTAR-2, two studies were rated ‘high’, while the other five were rated ‘moderate’. Conclusions Present evidence is insufficient to clarify the superiority of one modality over the other. Further RCTs on this comparison must be conducted prior to designing further meta-analyses or making conclusive interpretations. Procedure duration and cost should be taken into consideration for any future studies.

Abstract In dengue‐endemic regions, the co‐infection with SARS‐CoV‐2 and dengue is a significant health concern. Therefore, we performed a literature search for relevant papers in seven databases on 26 Spetember 2021. Out of 24 articles, the mortality rate and intensive care unit (ICU) admission were 19.1% and 7.8%, respectively. The mean hospital stay was 11.4 days. In addition, we identified two pregnancies with dengue and COVID‐19 co‐infection; one ended with premature rupture of membrane and intrauterine growth restriction fetus, while the other one ended with maternal mortality and intrauterine fetal death. COVID‐19 and dengue co‐infection had worse outcomes regarding mortality rates, ICU admission, and prolonged hospital stay. Thus, wise‐decision management approaches should be adequately offered to these patients to enhance their outcomes. Establishing an early diagnosis might be the answer to reducing the estimated significant burden of these conditions.