Sutter Health California Pacific Medical Center (CPMC) is a general medical/surgical and teaching hospital in San Francisco, California. It was created by a merger of some of the city's longest established hospitals and currently operates three acute care campuses.Its primary campuses in San Francisco are the Van Ness Campus in The Tenderloin, the Davies Campus in Duboce Triangle, and the Mission Bernal Campus in the Mission District. While it is a privately funded entity, CPMC has strong academic ties to the University of California, San Francisco (UCSF), Stanford University Medical Center as well as the Geisel School of Medicine of Dartmouth College.
ABSTRACT Background Passive advancement—antegrade movement of the aspiration catheter upon inner delivery device withdrawal without active operator force—is a physical phenomenon observed during mechanical thrombectomy, with anecdotal reports of favorable recanalization outcomes. This study characterizes its prevalence and associations with recanalization. Methods Consecutive thrombectomy cases at two high-volume stroke centers (January 2019– December 2025) were retrospectively reviewed. Stored fluoroscopy and angiograms were assessed for passive advancement and final catheter tip position at arterial branch points. Per-pass and per-vessel mixed-effects multivariable regression identified independent associations with eTICI score, first-pass effect (FPE, eTICI ≥2c-3), modified FPE (mFPE, eTICI ≥2b-3), secondary occlusion, and complications. Results Of 1,824 passes in 995 consecutive patients (1,027 occlusions), 733 had imaging adequate for passive advancement assessment. Passive advancement occurred in 525/733 passes (71.6%), including to an arterial branch in 306/733 (41.7%). On per-pass analysis, passive advancement was associated with higher eTICI ≥2b-3 (71.0% vs 19.7%) and eTICI ≥2c-3 (57.5% vs 10.1%); advancement to a branch amplified these associations (90.5% vs 32.1% and 79.4% vs 18.7%; all p<0.001). Among 429 first passes, mFPE was 74.1% vs 10.8% and FPE 63.4% vs 7.5% with vs without passive advancement; rates reached 95.0% and 87.2%, respectively, at a branch point (all p<0.001). Passive advancement to a branch was inversely associated with secondary occlusion (13.3% vs 31.3%; p<0.001). On multivariable analysis, passive advancement independently predicted eTICI score, eTICI ≥2b-3, and eTICI ≥2c-3 (all p<0.001); final catheter position at a branch was the dominant independent predictor of FPE, mFPE, secondary occlusion, any complication, and intracranial complication on per-vessel analysis (all p≤0.046). Conclusions Passive advancement is a prevalent physical phenomenon and an independent predictor of successful recanalization. When advancing to an arterial branch point, it is associated with mFPE >87%. Passive advancement should be a technical objective of aspiration thrombectomy. KEY MESSAGES What is already known on this topic Catheter tip position relative to the thrombus and target vessel anatomy affects recanalization success in aspiration thrombectomy. Maximizing outer catheter-to-vessel inner diameter ratio and achieving distal catheter positioning improve aspiration success. Secondary occlusion is an important complication and can be caused by clot fragmentation during thrombectomy. What this study adds This manuscript describes and systematically characterizes a physical phenomenon— passive advancement of the aspiration catheter upon inner delivery device withdrawal— that occurs in 71.6% of assessed thrombectomy passes and is independently associated with higher rates of successful recanalization. When passive advancement carries the catheter to an arterial branch point, first-pass complete reperfusion (eTICI ≥2c-3) is achieved in 87.2% of cases. Final catheter position at an arterial branch is the dominant independent predictor of recanalization success, secondary occlusion prevention, and complication avoidance on per-vessel multivariable analysis. How this study might affect research, practice or policy Operators performing aspiration thrombectomy should recognize passive advancement of the aspiration catheter as a favorable prognostic sign and allow this to occur during inner device withdrawal, including allowing the catheter tip to passively advance to an arterial branch point. Future thrombectomy device designs, operator training protocols, and procedural guidelines should include passive advancement as a primary technical objective, and prospective studies should validate these observations.
BackgroundProstate cancer (PC) is the most common cancer in men in the United States with a 5-year relative survival rate for people with distant metastases of 36%. We conducted a single institution, retrospective cohort study of patients with metastatic PC to investigate whether certain gene mutations can be used as predictive biomarkers.Methods200 patients with metastatic hormone sensitive (mHSPC) and castration resistant (mCRPC) prostate cancer who had a FoundationOne report and were treated from June 2007 to October 2024 were included in the study. Disease progression was evaluated according to RECIST criteria, PCWG3 criteria, and PSA values. Assessed gene mutations included SPOP, p53, Rb, PTEN, and HRR genes. Overall survival (OS) and progression-free survival (PFS) were calculated for mHSPC and mCRPC.ResultsAmong 200 patients, there were 182 patients with mHSPC and 174 patients with mCRPC. Average age at diagnosis of metastatic disease was 71.5, ECOG was 0.76, and median PSA was 75.6 ng/mL. 152 patients had high-volume disease. 102 patients passed away. Patients with a p53 mutation (n=99) had lower OS in mHSPC (50.7 months vs 86.2 months, p<0.01). Patients with a PTEN mutation (n=50) had a lower OS in mHSPC (50.6 months vs 65.8 months, p=0.03) and mCRPC (29.5 months vs 46.0 months, p=0.04). Patients with HRR mutations (n=43) had lower OS in mHSPC (41.4 months vs 64.6 months, p<0.01) and mCRPC (18.4 months vs 42.8 months, p=0.04). p53 and PTEN mutations were associated with shorter PFS in mCRPC (13.8 months vs 23.2 months, p=0.03; 12.2 months vs 22.6 months, p<0.01, respectively). Mutations in SPOP (n=13 mHSPC, n=9 mCRPC) and RB1 (n=12 mHSPC, n=10 mCRPC) were not associated with statistically significant differences in OS and PFS.ConclusionsPTEN, and HRR mutations were associated with shorter OS in both mHSPC and mCRPC. p53 mutations are associated with shorter OS only in mHSPC. p53 and PTEN mutations were associated with shorter PFS only in mCRPC.
Amyloid-related imaging abnormalities (ARIA) observed on magnetic resonance imaging (MRI) are known adverse events associated with beta-amyloid plaque-lowering monoclonal antibodies. A spectrum of radiographic and clinical presentations of ARIA have been observed. ARIA-E refer to vasogenic edema in the brain parenchyma and/or leptomeningeal/subpial sulcal effusion; ARIA-H refer to hemosiderin deposits including cerebral microhemorrhage and localized superficial siderosis. With clinical availability of anti-amyloid therapies for treatment of early clinical stage Alzheimer's disease, there is an important need for better awareness of ARIA and education among a diversity of clinicians and practice settings. To illustrate the wide spectrum of ARIA, we present the clinical history, course, and MRI findings as well as summarize learnings and implications of 10 ARIA-E cases from the aducanumab phase 3 clinical trials EMERGE and ENGAGE (ClinicalTrials.gov identifiers NCT02484547 and NCT02477800). Monitoring and management of ARIA, including criteria and timing of MRI, and drug dosing actions were defined per protocol and based upon radiographic severity and clinical symptoms associated with ARIA. ARIA were detected by MRI performed at pre-specified intervals or in response to symptoms or for safety follow-up reasons. The majority of ARIA-E events were asymptomatic. Most ARIA-E events occurred within the first 8 aducanumab doses and generally resolved within 3–4 months whether dosing was continued (i.e. when ARIA-E was asymptomatic and of mild radiographic severity) or whether dosing was suspended or discontinued. Occasionally, ARIA-E were recurrent. ARIA-H (microhemorrhages and superficial siderosis) most commonly occurred concurrently with ARIA-E. However, ARIA-H without ARIA-E, termed isolated ARIA-H, occurred at a similar frequency in aducanumab- and placebo-treated groups. 10
