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Background Ischemic stroke remains a leading cause of morbidity and mortality worldwide. Understanding stroke etiology is critical in future stroke prevention. A cardioembolic etiology of stroke makes up a significant proportion of all ischemic stroke. Part of the evaluation for a cardioembolic etiology requires a structural evaluation of the heart to evaluate for sources of thrombus. Traditionally, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have been utilized for this purpose, although both have limitations. Cardiac computed tomography (CCT) has emerged as a potential alternative, offering non‐invasive imaging with high sensitivity and specificity for detecting intracardiac thrombi. This study aimed to evaluate the diagnostic yield of CCT compared to TTE and TEE in detecting high‐risk cardioaortic sources of embolism, including left ventricular (LV) thrombus, left atrial (LA) thrombus, valvular sources of thrombus, and ulcerated aortic plaques, in patients with ischemic stroke. Methods We conducted a retrospective, single‐center cohort study at Mayo Clinic, Rochester, MN, on patients who underwent CCT within 30 days of stroke onset between March 2019 and June 2023. We compared the diagnostic yields of CCT, TTE, and TEE in detecting structural cardiac sources of embolism. Results 426 patients were included in our study. 87 patients underwent both CCT and TEE, 257 underwent CCT and TTE, and 82 only underwent CCT. The overall diagnostic yield of CCT for detecting high‐risk cardioaortic sources was 15.5%. Specifically, CCT identified LV thrombus in 2.3% of patients, LA thrombus in 4.0%, valvular thrombus in 2.8%, and ulcerated aortic plaques in 7.0%. In comparative analysis, CCT demonstrated a higher yield than TTE (16.0% vs. 3.5%) and a comparable or higher yield than TEE (25.3% vs. 20.7%) in detecting these sources. Conclusions CCT proved to be a viable and potentially superior alternative to traditional echocardiography for identifying some high‐risk structural sources of cardioembolism in ischemic stroke patients. Its non‐invasive nature, coupled with the ability to perform imaging soon after stroke onset, underscores its clinical utility. However, further prospective and blinded studies are required to validate these findings and fully establish the efficacy of CCT in this context.

Background Diagnostic Cerebral Angiography (CA) is a relatively common procedure that provides detailed evaluation of the brain's blood vessels. With the growing preference for Transradial artery (TRA) access over Transfemoral artery (TFA) access, our review aims to compare clinical outcomes and complications associated with these two approaches. Methods We carried out a systematic review using PubMed, Embase, Web of Science, Scopus databases, following the Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines. Inclusion was limited to studies that exclusively compared TRA versus TFA approaches for cerebral diagnostic purposes. Results Our study included 27 studies encompassing a total of 12,806 patients. The TRA arm comprised 6,284 patients with a median age of 57.9 years (range: 13.6‐78.2), and 46.4% were male (range: 27.8%‐82%). The TFA arm included 6,522 patients with a median age of 59.0 years (range: 13.0‐79.3), and 44.8% were male (range: 20.7%‐78.4%). Our analysis revealed that the TFA group had a higher successful Cerebral Angiography (CA) rate (OR= 0.62, CI [0.40; 0.95], p=0.03), and lower crossover rate (OR: 2.85, CI [1.39; 5.84], p<0.01) compared to the TRA group. However, the TRA group demonstrated a significantly lower rate of total complications (OR: 0.52, CI [0.33; 0.82], p<0.01, I 2 =59%, p< 0.001) and shorter hospital length of stay (LOS) in hours ([MD]: ‐33.25, CI [‐51.40; ‐15.11], p< 0.001) compared to the TFA group. There were no significant differences between groups in terms of puncture time, procedural time, mean contrast dose, radiation exposure, and radiation dose. Conclusion The choice of access site for cerebral angiography depends on various factors, including facility protocol, provider preference, vascular anatomy, and patient preferences. Our review highlighted the superiority of the transfemoral artery approach in terms of success rates and lower crossover rates. However, transradial artery access may be preferred due to its association with lower complication rates and shorter hospital stays, aligning with patient‐centered outcomes.

Accurate identification of surgical instruments is crucial for efficient workflows and patient safety within the operating room, particularly in preventing complications such as retained surgical instruments. Artificial Intelligence (AI) models have shown the potential to automate this process. This study evaluates the accuracy of publicly available Large Language Models (LLMs)—ChatGPT-4, ChatGPT-4o, and Gemini—and a specialized commercial mobile application, Surgical-Instrument Directory (SID 2.0), in identifying surgical instruments from images. The study utilized a dataset of 92 high-resolution images of 25 surgical instruments (retractors, forceps, scissors, and trocars) photographed from multiple angles. Model performance was evaluated using accuracy, weighted precision, recall, and F1 score. ChatGPT-4o exhibited the highest accuracy (89.1%) in categorizing instruments (e.g., scissors, forceps). SID 2.0 (77.2%) and ChatGPT-4 (76.1%) achieved comparable accuracy, while Gemini (44.6%) demonstrated lower accuracy in this task. For precise subtype identification of instrument names (like “Mayo scissors” or “Kelly forceps”), all models had low accuracy, with SID 2.0 having an accuracy of 39.1%, followed by ChatGPT-4o (33.69%). Subgroup analysis revealed ChatGPT-4 and 4o recognized trocars in all instances. Similarly, Gemini identified surgical scissors in all instances. In conclusion, publicly available LLMs can reliably identify surgical instruments at the category level, with ChatGPT-4o demonstrating an overall edge. However, precise subtype identification remains a challenge for all models. These findings highlight the potential of AI-driven solutions to enhance surgical-instrument management and underscore the need for further refinements to improve accuracy and support patient safety.

ABSTRACTBackgroundOlfactory neuroblastoma (ONB) is a rare sinonasal malignancy primarily treated with surgery. For tumors arising from the olfactory area, traditional treatment involves transcribriform resection of the anterior cranial fossa. Surgery can be performed with unilateral or bilateral resection depending on extent of involvement; however, there are currently no studies comparing outcomes between the two.MethodsProspective and retrospective data on primary ONB patients were collected from a multicenter registry involving eight academic sites. Propensity score matching (PSM) was used to create patient cohorts with similar baseline characteristics. Cox proportional hazards and Kaplan Meier analyses assessed overall survival (OS). Logistic regression assessed associations between extent of resection (unilateral versus bilateral) and tumor recurrence or postoperative cerebrospinal fluid (CSF) leak.ResultsA total of 187 ONB patients (47.6% female) with an average age of 53.6 ± 15.1 years were analyzed. Most tumors were unilateral (81.3%) and predominantly Kadish C (58.3%) or Hyams II (55.8%). Overall, 56.7% of patients underwent bilateral resection. Fifty‐four patients experienced tumor recurrence and nine had postoperative CSF leaks. Following PSM (n = 45/group), extent of resection was not associated with mortality (hazard ratio [HR] 1.73; p = 0.407) or OS (p = 0.400). There was no association between extent of resection and recurrence (odds ratio [OR] 0.90; p = 0.814) or postoperative CSF leak (OR 1.54; p = 0.647).ConclusionsFor ONB tumors where unilateral resection may be feasible and oncologically sound, the decision for unilateral versus bilateral resection showed no significant effect on survival, recurrence, or postoperative CSF leak. Oncologic outcomes may be comparable when resection is tailored to individual patient and tumor characteristics.