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Mining activities are crucial in driving economic and industrial progress, yet they present significant environmental and public health challenges. This study evaluated a conventional physicochemical treatment and a Reverse Osmosis (RO) system for highly contaminated effluents generated during gold cyanidation within the mining sector. Total organic and inorganic carbon, heavy metal(loid)s (Cu, Fe, Mn, Zn, Cr, Pb, AsTOTAL), and CNTOTAL were monitored in the conventional treatment system and permeate product of a pilot-scale RO unit equipped with a BW30 membrane during approximately five weeks of in-situ operation. The conventional treatment process substantially reduced organic carbon load (e.g., 79% removal efficiency). However, it proved ineffective in lowering AsTOTAL and CNTOTAL concentrations, with levels ranging from 0.2 to 0.3 mg L−1 for AsTOTAL and 110–1620 mg L−1 for CNTOTAL after treatment, thus exceeding environmental standards. In contrast, the RO treatment achieved removal rates of approximately 99% for AsTOTAL and CNTOTAL, resulting in concentrations

Background and Purpose Randomized trials proved the benefits of mechanical thrombectomy (MT) for select patients with large vessel occlusion (LVO) within 24 hours of last-known-well (LKW). Recent data suggest that LVO patients may benefit from MT beyond 24 hours. This study reports the safety and outcomes of MT beyond 24 hours of LKW compared to standard medical therapy (SMT). Methods This is a retrospective analysis of LVO patients presented to 11 comprehensive stroke centers in the United States beyond 24 hours from LKW between January 2015 and December 2021. We assessed 90-day outcomes using the modified Rankin Scale (mRS). Results Of 334 patients presented with LVO beyond 24 hours, 64% received MT and 36% received SMT only. Patients who received MT were older (67±15 vs. 64±15 years, P=0.047) and had a higher baseline National Institutes of Health Stroke Scale (NIHSS; 16±7 vs.10±9, P

This research aims to evaluate the feasibility of a laboratory-scale batch electrocoagulation system for removing hardness, SO42−, and manganese from groundwater in San Cristobal, a rural community in the Austro region of Ecuador. The efficiency of the electrocoagulation process was compared to the conventional chemical precipitation with lime and alum coagulation. Various variables were analyzed to evaluate the performance of the electrocoagulation system, including initial pH, operating time, current density, and lime addition. The results showed that a basic environment (∼ pH 8.5) proved more effective in removing hardness and SO42− electrolytes by producing ferric flocs with high adsorption properties. Achieving reasonable removal efficiencies for hardness and SO42− under neutral or alkaline solution required a minimum of 80 min. Increasing the current density enhanced the removal of hardness and sulfate, and the addition of small amounts of lime (125 mg L−1) increased the hardness removal efficiency from approximately 35 to 50.5%. Under the operating conditions of pH 8.5, 80 min of operation, a current density of 1.0 mA cm−2, and a lime concentration of 75 mg L−1, the system achieved a removal efficiency of 37.6% for hardness, 14.7% for SO42−, and a 65.3% for manganese to comply with Ecuadorian drinking water criteria. While lime precipitation and alum coagulation reduced hardness to meet the Ecuadorian INEN 1108 Regulation requirements, the significant demand for treatment chemicals to reduce hardness content rendered the process unsustainable for implementation in the San Cristobal treatment plant. The conventional treatment method failed to reduce sulfate or manganese, and the excessive chemical consumption was not economically viable (1 kg of lime and 0.02 kg of alum per cubic meter of water). In conclusion, this study demonstrates that electrocoagulation, as a chemical-free system, minimizes the use of chemical additives to provide safe water to the population of San Cristobal.

Introduction There is growing evidence supporting endovascular treatment with middle meningeal artery embolization (MMAE) for the treatment of chronic subdural hematoma (cSDH). We aimed to compare Onyx vs. N‐Butyl cyanoacrylate (n‐BCA) as liquid embolic materials for MMAE. Methods We included all eligible patients undergoing MMAE for cSDH at University of Pittsburgh Medical Center from April 2019 to December 2022. The main outcomes included radiographic resolution of cSDH with at least 50% reduction of hematoma thickness as a surrogate for treatment success in addition to the need for rescue surgical intervention. Additional outcomes including complication rates and hematoma thickness at the last available follow up. Results A total of 195 patients underwent embolization of 234 hemispheres including 39 bilateral procedures and had available data for final analysis (168 (71.8%) in Onyx group vs. 66 (28.2%) in n‐BCA group). There were no significant differences in age, sex, co‐morbidities, prior SDH/evacuation, pre‐operative cSDH thickness, or use of antithrombotic therapy(P>0.05) while concurrent surgical intervention and midline shift showed a statistically significant difference (P

Abstract Objective Despite successful endovascular therapy, a proportion of stroke patients exhibit long‐term functional decline, regardless of the cortical reperfusion. Our objective was to evaluate the early activation of the adaptive immune response and its impact on neurological recovery in patients with large vessel occlusion (LVO). Methods Nineteen (13 females, 6 males) patients with acute LVO were enrolled in a single‐arm prospective cohort study. During endovascular therapy (EVT), blood samples were collected from pre and post‐occlusion, distal femoral artery, and median cubital vein (controls). Cytokines, chemokines, cellular and functional profiles were evaluated with immediate and follow‐up clinical and radiographic parameters, including cognitive performance and functional recovery. Results In the hyperacute phase (within hours), adaptive immune activation was observed in the post‐occlusion intra‐arterial environment (post). Ischemic vascular tissue had a significant increase in T‐cell‐related cytokines, including IFN‐γ and MMP‐9, while GM‐CSF, IL‐17, TNF‐α, IL‐6, MIP‐1a, and MIP‐1b were decreased. Cellularity analysis revealed an increase in inflammatory IL‐17+ and GM‐CSF+ helper T‐cells, while natural killer (NK), monocytes and B‐cells were decreased. A correlation was observed between hypoperfused tissue, infarct volume, inflammatory helper, and cytotoxic T‐cells. Moreover, helper and cytotoxic T‐cells were also significantly increased in patients with improved motor function at 3 months. Interpretation We provide evidence of the activation of the inflammatory adaptive immune response during the hyperacute phase and the association of pro‐inflammatory cytokines with greater ischemic tissue and worsening recovery after successful reperfusion. Further characterization of these immune pathways is warranted to test selective immunomodulators during the early stages of stroke rehabilitation.

Introducción: La fatiga, sensación integrada por síntomas físicos, mentales y neurosensoriales de agotamiento, cansancio y falta de energía, puede ser un condicionante que incremente la vulnerabilidad en la población laboralmente activa para adquirir conductas nocivas como el consumo de alcohol, especialmente en conductores de carga pesada. Objetivo: Identificar la relación de la fatiga y el consumo de alcohol en conductores de carga pesada de Nuevo Laredo, frontera norte de México. Metodología: Estudio transversal, con diseño descriptivo-correlacional, en una muestra de 224 conductores seleccionados mediante muestreo no probabilístico. Se incluyeron participantes laboralmente activos y que condujeran camiones de quinta rueda, y se excluyeron a quienes no cumplieran con el llenado completo de los cuestionarios. Se aplicó una Cédula de Datos Sociodemográficos, la Prueba de Síntomas Subjetivos de Fatiga y la Prueba AUDIT. Se garantizó la confidencialidad y anonimato de los participantes. Los datos fueron procesados a través del paquete estadístico SPSS versión 24.0, mediante análisis inferencial no paramétrico. Resultados: Prevalecieron los conductores con fatiga baja 87.1 %, y quienes tenían un consumo riesgoso 58.0 %, y un consumo dependiente 23.2 %. Se identificó una relación positiva estadísticamente significativa entre fatiga y consumo de alcohol de los conductores con rs = .230, p = .001. Conclusiones: Los hallazgos indican que a mayor fatiga mayor consumo de alcohol en los conductores de carga pesada, lo cual pone en evidencia la necesidad del diseño e implementación de intervenciones eficaces y oportunas de enfermería que contribuyan a disminuir conductas de riesgo para la salud.

Background Balloon‐assisted coiling (BAC) and stent‐assisted coiling (SAC) have been established as feasible approaches to manage ruptured wide‐necked intracranial aneurysms. Antiplatelet medications used with SAC theoretically increase risk of thrombotic and hemorrhagic complications. This study aims to evaluate safety and efficacy of SAC versus BAC for acutely ruptured wide‐necked intracranial aneurysms. Methods We performed a 2‐center retrospective observational study of consecutive patients treated with SAC or BAC for ruptured wide‐necked intracranial aneurysms from 2015 to 2020. Baseline demographics, comorbidities, and aneurysm characteristics were collected. Primary and secondary efficacy outcomes were radiographic aneurysm occlusion at follow‐up and functional status at 3 months. Safety outcomes included periprocedural hemorrhagic/ischemic complications and symptomatic ventriculostomy tract and cerebrospinal shunt hemorrhage rates. Univariable and multivariable analyses with multiple imputations to account for follow‐up loss were performed. Results A total of 112 and 109 patients underwent SAC and BAC, respectively. Median cohort age was 56 years, and 72% were female. Baseline characteristics were similar. Hydrocephalus rate was higher in the SAC group (78% versus 64%; P=0.02). Median aneurysm size was 5.1 mm. Anterior circulation aneurysms were most common (81%). Aneurysm and neck size were different, more aneurysms measuring

Introduction Intracranial dural arteriovenous fistulae (dAVFs) are typified by pathological anastomoses between meningeal arteries and dural venous sinuses or cortical veins. DAVFs can mimic other neurologic disorders and produce a broad spectrum of signs and symptoms, including headache, tinnitus, vertigo, Parkinsonism, and visual field and gait disturbances. We present a case report of extensive dural AV Fistula which lead to brainstem ischemic stroke from compression of brainstem flow void. Methods Case Report Results 64 year old man with past medical History of Rheumatoid arthritis, presented with sudden onset of right facial weakness. On arrival patient was noted to be hypertensive to 200/105 and on exam noted to have right complete facial nerve palsy. Patient also revealed a significant history of severe, throbbing, posterior headaches in the last 1–2 months. Patient had CT head which was negative for bleed. CT angiography showed Abnormal hyperattenuating tubular vessel extending along the right cerebellar hemisphere and posterolateral pons extending towards the venous confluence at Galen. Over the course of 5 hours, the patient reported difficulty swallowing and intense headaches. MRI brain showed acute to early subacute infarct involving the right dorsolateral medulla and abnormal T2 prolongation involving essentially the entire cross‐section of the upper medulla and inferior pons representing edema. The patient was taken for Diagnostic catheter angiogram which showed dural AV fistula extending along the right cerebellar hemisphere. Onyx embolization was performed on the Right Middle meningeal artery and right Superior cerebellar artery with complete obliteration of dAVF. Conclusions The spectrum of signs and symptoms associated with DAVFs has been attributed to any one or combination of 6 pathophysiologic factors: the arteriovenous shunt, cerebral hypoxia and ischemia, increased venous pressure, retrograde drainage and secondary engorgement of basal sinuses, sinus obstruction, and subarachnoid hemorrhage secondary to involvement of the pial venous system. Prompt evaluation and management is necessary for patients presenting with neurological symptoms with headache.

Introduction Intracranial pseudoaneurysms are rare lesions that represent less than 1% of all intracranial aneurysms.1They typically occur due to disruption of the arterial wall layers and subsequent extramural/extraluminal hematoma formation following traumatic brain injury, resulting in a higher risk of rebleeding than that of saccular cerebral aneurysms.2Pseudoaneurysms have higher incidence in children and young adults, and given their association with high morbidity and mortality, early detection and management is essential.2‐4The purpose of this study is to highlight the importance of early recognition and management of traumatic pseudoaneurysms prior to decompressive hemicraniectomy. Methods This is a case report of a six‐year‐old previously healthy male who presented as a level 1 trauma alert after sustaining a gunshot wound to the face while manipulating an unsecured weapon at his residence. Upon arrival, lack of airway protection requiring intubation, entry wound to the anterior forehead, and diffuse forehead and periorbital edema were observed. CT head demonstrated multicompartmental hemorrhage with 6mm right to left midline shift and diffuse cerebral edema. CTA head and neck noted possible thrombosed right anterior cerebral artery (ACA) pseudoaneurysm in the right frontoparietal region (Figure 1‐A). Prior to decompressive hemicraniectomy, neuro‐endovascular consultation was obtained, and emergent cerebral angiogram was recommended. This case highlights the findings demonstrated on cerebral angiography, the technique by which the pseudoaneurysm was detected and secured, and the importance of doing so prior to further neurosurgical interventions. Results The patient was taken for diagnostic cerebral angiogram via femoral artery access. Initial angiographic run of the right internal carotid artery demonstrated distal right pericallosal artery slowing without clear evidence of underlying vascular injuries. Given concern for underlying thrombosed pseudoaneurysm and its parent branch, selective catheterization of the proximal pericallosal artery off the distal ACA was performed. Gentle angiographic run was obtained via microcatheter that demonstrated superior parietal artery pseudoaneurysm without active extravasation (Figure 1‐B). The microcatheter was advanced and placed in the proximal portion of the pseudoaneurysm sac and five platinum coils were deployed to fully obliterate the pseudoaneurysm and its parent feeder while protecting the adjacent paracentral artery (Figure 1‐C, 1‐D). Following completion of the endovascular procedure, the patient was transferred to the operative room for right decompressive hemicraniectomy and clot evacuation, which were completed successfully. Conclusions Prompt detection and securement of traumatic intracranial pseudoaneurysms are essential prior to invasive neurosurgical interventions to reduce risk of recurrent bleeding. Selective angiographic evaluation of the parent injured vessel(s) is crucial for optimal assessment of the underlying lesion. Neuro‐endovascular interventions including coil embolization, stenting, flow‐diverter implantation, and parental artery occlusion have emerged as alternatives to conventional neurosurgical management.2 This case highlights the successful early detection and treatment of a traumatic intracranial pseudoaneurysm with coil embolization followed by uncomplicated decompressive hemicraniectomy.

Background The infarct growth rate (IGR) measures ischemic stroke progression and varies among patients. Clinicoradiological phenotypes of IGR are poorly understood. We evaluated the association of presentation stroke severity and early ischemic changes with infarct progression in patients who underwent successful thrombectomy. Methods This is a retrospective cohort observational study of consecutive endovascular therapy patients with anterior circulation large‐vessel occlusion strokes and successful reperfusion (modified Thrombolysis in Cerebral Ischemia≥2b) from 2 comprehensive stroke centers. National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT [Computed Tomography] Score (ASPECTS) were scored at admission. IGR was defined as the final infarct volume after endovascular therapy divided by the time from stroke onset to successful reperfusion. We used the Youden J index to identify the optimal IGR cutoff to stratify fast and slow progressors. A multivariate logistic regression was used to identify variables associated with a fast IGR and clinical outcomes. Results A total of 212 patients were included in the study. The optimal IGR threshold was 3.2 mL/h, and 135 patients (63.6%) were classified as fast progressors. Presentation National Institutes of Health Stroke Scale score (odds ratio [OR], 1.12; 95% CI, 1.06–1.19) and ASPECTS (OR, 0.56; 95% CI, 0.41–0.73) were accurate predictors of a fast IGR after adjusting for significant confounders. For each 1‐point increase in National Institutes of Health Stroke Scale score at admission, the likelihood of being a fast progressor increased by 12%; for each 1‐point increase in ASPECTS, the likelihood of being a fast progressor decreased by 44%. In the early window (≤6 hours), all patients with ASPECTS

Flow diversion is an evolving endovascular modality for treating intracranial aneurysms. Although rare, serious adverse events following flow diversion may include ischemic stroke, intracranial hemorrhage, or delayed rupture of the treated aneurysm. This dataset describes 141 flow diversion procedures performed with the Pipeline Embolization Device, Pipeline Flex, or Surpass Streamline on 126 subjects with intracranial aneurysms [1]. The retrospective data were collected from electronic medical records at two large tertiary centers. Baseline patient data included age, sex, and medical comorbidities. The dataset also describes aneurysm characteristics including laterality, anatomic location, morphology, dome height, and neck width. In addition, digital subtraction images showing the internal carotid artery tortuosity were included for aneurysms in the anterior cerebral circulation [2]. Procedural data include case duration, radiation exposure, number of flow diverters deployed, and complications encountered during deployment. In addition, data related to the duration of hospitalization and postoperative adverse events are included. Finally, time to follow up and rates of total aneurysm obliteration at first and second postoperative visits are included. This data is propensity score matching are included. This data is presented as a starting point for future prospective comparisons in the safety and efficacy of flow diverters as more devices become approved and commercially available.

Objetivo: Comparar las actitudes hacia el consumo de cigarrillos en adolescentes de secundaria, después de la exposición a tres pósters de contrapublicidad. Materiales y métodos: Diseño pre experimental por comparación de grupos no equivalentes; muestra de 50 adolescentes seleccionados mediante muestreo no probabilístico y asignados a un grupo expuesto a contrapublicidad (n = 25) y un grupo de comparación (n = 25) que permaneció en lista de espera. La estrategia de contrapublicidad consistió en tres pósters administrados por internet. Los pósters incluyeron imágenes y mensajes sobre consecuencias del consumo de cigarrillos. La recolección de datos se efectuó en línea mediante Google Forms. Se utilizó una cédula sociodemográfica y la escala de actitudes hacia el tabaco. Los datos obtenidos fueron procesados a través del paquete estadístico SPSS versión 24.0, mediante análisis inferencial no paramétrico (prueba U de Mann-Whitney). Resultados: Se encontraron diferencias estadísticamente significativas entre ambos grupos (U = 145.0, p < 0.001), donde los estudiantes expuestos a la contrapublicidad mostraron menor mediana de actitudes favorables hacia el cigarrillo (Med = 17.0, DE = 5.11) en comparación con los participantes no expuestos (Med = 25.0, DE = 7.91). En particular, la dimensión del índice de desagrado hacia el consumo de cigarrillos mostró diferencias significativas entre el grupo expuesto y el de comparación (U = 127.5, p < .001). Conclusiones: Los resultados sugieren que los adolescentes que recibieron la contrapublicidad, mostraron menos actitudes favorables hacia los cigarrillos. La información emitida a través de los pósters sobre las consecuencias del consumo de cigarrillos, inclusive al ser administrada por internet, podría beneficiar en la modificación de las actitudes hacia el consumo de este producto en adolescentes mexicanos. Con base en esto, la contrapublicidad puede ser una estrategia útil para el personal sanitario de prevención primaria contra el consumo de cigarrillos

Background Despite thrombectomy having become the standard of care for large‐vessel occlusion strokes, acute endovascular management in tandem occlusions, especially of the cervical internal carotid artery lesion, remains uncertain. We aimed to compare efficacy and safety of acute carotid artery stenting to balloon angioplasty alone on treating the cervical lesion in tandem occlusions. Similarly, we aimed to explore those outcomes’ associations with technique approaches and use of thrombolysis. Methods and Results We performed a systematic review and meta‐analysis to compare functional outcomes (modified Rankin Scale), reperfusion, and symptomatic intracranial hemorrhage and 3‐month mortality. We explored the association of first approach (anterograde/retrograde) and use of thrombolysis with those outcomes as well. Two independent reviewers performed the screening, data extraction, and quality assessment. A random‐effects model was used for analysis. Thirty‐four studies were included in our systematic review and 9 in the meta‐analysis. Acute carotid artery stenting was associated with higher odds of modified Rankin Scale score ≤2 (odds ratio [OR], 1.95 [95% CI, 1.24–3.05]) and successful reperfusion (OR, 1.89 [95% CI, 1.26–2.83]), with no differences in mortality or symptomatic intracranial hemorrhage rates. Moreover, a retrograde approach was significantly associated with modified Rankin Scale score ≤2 (OR, 1.72 [95% CI, 1.05–2.83]), and no differences were found on thrombolysis status. Conclusions Carotid artery stenting and a retrograde approach had higher odds of successful reperfusion and good functional outcomes at 3 months than balloon angioplasty and an anterograde approach, respectively, in patients with tandem occlusions. A randomized controlled trial comparing these techniques with structured antithrombotic regimens and safety outcomes will offer definitive guidance in the optimal management of this complex disease.

Background A direct admission to angiosuite (DAA) strategy in transfer patients with large vessel occlusion (LVO) is considered to decrease stroke time metrics and benefit functional outcomes. However, feasibility and effectiveness of DAA have not been established in rural settings. Fast door‐to‐reperfusion times and high‐quality reperfusion are key predictors of outcome in patients with LVO. To reduce treatment times in transferred patients with suspected LVO, we initiated a DAA triage protocol in 2017. Methods We conducted a nested interventional cohort study of adult patients with anterior LVO from January 2015 to August 2019 transferred to our center from an outside hospital. Patients were divided into DAA for mechanical thrombectomy (MT) and patients directly admitted to the emergency department (DAED). DAED was subdivided into patients undergoing MT and patients who did not. Workflow times and clinical and radiographic outcomes were analyzed. Results Forty‐five DAA patients and 241 DAED patients (DAED patients undergoing MT=134 patients and DAED patients not undergoing MT=107 patients) were identified. DAA patients had significantly shorter median door‐to‐arterial‐puncture times (15 versus 71 minutes) and puncture‐to‐recanalization times (27 versus 42.5 minutes). At discharge, DAA patients had a significant decrease in median admission National Institutes of Health Stroke Scale (NIHSS) score (ΔNIHSS score 10 versus 4; P=0.02), and higher rate of dramatic clinical improvement (ΔNIHSS score >10; 48.9% versus 23.5%; P

Introduction: Flow diversion has established itself as standard treatment of wide complex intracranial aneurysms (IA). Its recognition has been validated with positive occlusion rates and favorable clinical outcomes. The Surpass Streamline (SS) flow diverter (FD) is a braided cobalt/chromium alloy implant with 72 or 96 wires approved by the FDA in 2018. The aim of this study is to determine the safety and efficacy of the SS in a post‐marketing large US cohort. Methods: We performed a multicenter, retrospective study for consecutive patients treated with the SS FD for IA between January 2018 and June 2021 in the United States. Inclusion criteria for participants were: 1. Adults (≥ 18 years) and 2. Treatment with SS FD for IA. Primary safety end point was a major ipsilateral stroke (increase in National Institutes of Health Stroke Scale Score of ≥ 4) or neurological death within 12 months. Primary efficacy was assessed using the 3‐point Raymond‐Roy (RR) occlusion scale on digital subtraction angiography (DSA) at 6‐12‐month follow‐up. Results: A total of 276 patients with 313 aneurysms were enrolled. The median age was 59 years and 199 (72%) were females. The most common comorbidities included hypertension in 156 (57%) subjects followed by hyperlipidemia in 76 (28%) patients. One hundred and twenty‐two (44%) patients were asymptomatic while subarachnoid hemorrhage was present in only 10 (4%) patients. A total of 143 (46%) aneurysms were left‐sided. Aneurysms were located as follows: 274 (88%) were in the anterior circulation with paraophthalmic being the most common in 120 (38%) followed by petrocavernous ICA in 81 (26%); 33 (11%) aneurysms were located in the posterior circulation with basilar trunk being the most common in 14 (5%). The mean maximum aneurysm dome width was 5.77 ± 4.7 mm, neck width 4.22 ± 3.8 mm and dome to neck ratio was 1.63 ± 1.3 mm. The mean number of SS FD implanted per aneurysm was 1.06 (range 1–3) with more than one SS FD implanted in 21 (7%) aneurysms. Modified Rankin Scale (mRS) of 0–2 was present in 206/213 (97%) patients at 6–12 month follow‐up. The complete aneurysm occlusion (RR 1) rate was 145/175 (83%) among subjects who had angiographic follow‐up at 6–12 months. Major stroke and death was encountered in 7 (2%) and 5 (1.8%) of the patients respectively. Conclusions: Our data represent the largest real‐world study using SS FD. These results corroborate its post‐marketing safety and efficacy for the treatment of intracranial aneurysms showing more favorable rates to the initial experience during SCENT trial.

Introduction: Chronic internal carotid occlusion is responsible for 10–15% ischemic strokes or transit ischemic attacks (TIA). Subsequent ipsilateral ischemic stroke rate is 5.9% per year. However, this risk can increase up to 23% in two years in a subgroup of patients with poor collaterals regardless of medical therapy with antiplatelet or anticoagulant agents. Prevention of subsequent stroke in patients with carotid artery occlusion remains a difficult challenge. Carotid artery stenting (CAS) has recently been considered in its management. However, there is ambiguity on its safety. We aim to evaluate the safety and feasibility of CAS and compared it with medical management. Methods: We performed a systematic review and meta‐analysis to compare long‐term outcome (stroke recurrence) of current carotid occlusion treatments (CAS vs medical therapy). Two independent reviewers performed the screening, data extraction, and quality assessment. A random effects model was used for analysis. Results: A total of 5720 studies were screened. Of these, 11 studies were included in our systematic review and meta‐analysis of proportions. The CAS group has lower proportions of recurrent strokes (5% vs 30%,) after 30 days than medical therapy alone. Additionally, the proportion of periprocedural intracranial hemorrhage was 4.4% (95% CI 2.5 to 6.8) in the CAS group. Conclusions: CAS of the chronically occluded cervical ICA seems to be a safe procedure with lower rates of recurrent stroke in clinical follow up. Future randomized studies are warranted to guide the optimal management of this complex disease.

Background: Patients with an obstructive subclavian artery (SA) may exhibit symptoms of vertebrobasilar insufficiency known as subclavian steal syndrome (SSS). Endovascular treatment with stent assisted percutaneous transluminal angioplasty (SAPTA) demonstrates significantly lower percentage of intraoperative and postoperative complications in comparison with open surgery. There is a 1–5% risk of distal intracranial embolization through the ipsilateral vertebral artery (VA) during SAPTA.Objective: To assess the safety and feasibility of a novel technique for distal embolic protection using balloon catheters during SA revascularization with a dual transfemoral and transradial access.Methods: We describe a case series of patients with SSS who underwent SAPTA due to severe stenosis or occlusion of the SA using a combined anterograde/retrograde approach. Transfemoral access to SA was obtained using large bore guide sheaths. Ipsilateral transradial access was obtained using intermediate bore catheters. A Scepter XC balloon catheter was introduced through the transradial intermediate catheter into the ipsilateral VA at the ostium during SAPTA for distal embolic protection.Results: A total of eight patients with SSS underwent subclavian SAPTA. Four patients had the combined anterograde/retrograde approach. Successful revascularization was achieved in three of them. It was difficult to create a channel in the fourth unsuccessful case due to heavily calcified plaque burden. No peri-operative ischemic events were identified. On follow-up, we demonstrated patency of the stents with resolution of symptoms and without any adverse events.Conclusion: Subclavian stenting using a combined transradial and transfemoral access with compliant balloon catheters at the vertebral ostium for prevention of distal emboli may represent an alternative therapeutic approach for the treatment of SA stenosis and occlusions.

Objet¡vos: determinar la relación entre la percepción del riesgo frente a las bebidas alcohólicas y el consumo de alcohol en adolescentes mexicanos e identificar la prevalencia de consumo de alcohol, el nivel de percepción de riesgo y los patrones de consumo de alcohol según el sexo.Mater¡ales y métodos: estudio cuantitativo de corte transversal y diseño correlacional, con una muestra probabilística de 251 adolescentes de Nuevo Laredo, México, en 2017. Se utilizó una cédula de datos personales, el Cuestionario de Percepción de Riesgo hacia el Consumo de Alcohol y el Alcohol Use Disorders Identification Test (AUDIT) o Prueba de Identificación de Trastornos Relacionados con el Consumo de Alcohol.Resultados: un mayor nivel de percepción del riesgo frente al alcohol se relacionó con un menor consumo de dicha sustancia (rs= -.235,p

Introduction: Selecting the appropriate Woven EndoBridge (WEB) device sizing for the treatment of wide-neck bifurcation aneurysms (WNBAs) remains challenging. The aim of this study was to evaluate different volumetric-based imaging methodologies to predict an accurate WEB device size selection to result in a successful implantation. Methods: All consecutive patients treated with WEB devices for intracranial aneurysms from January 2019 to June 2020 were included. Aneurysm dimensions to calculate aneurysm volumes were measured using three different modalities: automated three-dimensional (3D) digital subtraction angiography (DSA), manual 3D DSA, and two-dimensional (2D) DSA. The device–aneurysm volume (DAV) ratio was defined as device volume divided by the aneurysm volume. WEB volumes and the DAV ratios were used for assessing the device implantation success and follow-up angiographic outcomes at six months. Pearson correlation, Wilcoxon Rank Sum test, and density approximations were used for estimating the WEB volumes and the imaging modality volumes for successful implantation. Results: A total of 41 patients with 43 aneurysms were included in the study. WEB device and aneurysm volume correlation coefficient was highest for 3D automatic (r = 0.943), followed by 3D manual (r = 0.919), and 2D DSA (r = 0.882) measurements. Measured median volumes were significantly different for 3D automatic and 2D DSA (p = 0.017). The highest rate of successful implantation (87.5%) was between 0.6 and 0.8 DAV ratio. Conclusion: Pre-procedural assessment of DAV ratios may increase WEB device implantation success. Our results suggest that volumetric measurements, especially using automated 3D volumes of the aneurysms, can assist in accurate WEB device size selection.