The edition · Top Clinical Updates
Thrombectomy helped stroke patients up to 72 hours out, at a price in bleeding
A Chinese trial extended the thrombectomy window for patients with salvageable brain on imaging. Also: TAVR in moderate aortic stenosis, how often long COVID lifts, and pregnancy risk after kidney donation.
The edition in brief
Today's cross-specialty edition closes on LATE-MT, a randomised trial of 336 patients with anterior large-vessel occlusion stroke and salvageable tissue on imaging, enrolled a median 38.5 hours after last known well. Thrombectomy improved 90-day functional outcome (common odds ratio 1.74, 95% CI 1.19 to 2.55) but brought symptomatic intracranial haemorrhage of 4.8% against none, and 90-day death of 6.0% against 1.8%. PROGRESS randomised 744 people with moderate aortic stenosis and an at-risk feature to TAVR or surveillance; death or a heart-failure event at two years was 16.7% versus 23.9%, carried by heart failure rather than survival. In the RECOVER cohort of 1019 adults with long COVID at one year, about half had meaningfully improved by three years and about a quarter had fully recovered. A Canadian matched cohort found gestational hypertension or pre-eclampsia in 11.9% of pregnancies after living kidney donation against 8.3% in non-donors, and more small-for-gestational-age babies. The pearl covers why the time a patient was last known well, not the time they were found, decides stroke treatment.
TAVR for moderate aortic stenosis cut heart-failure events, not deaths
Refer moderate aortic stenosis with symptoms or ventricular changes for specialist review; guidelines still favour surveillance, so the decision belongs with a heart team.
Long COVID at one year: half improved meaningfully by three years, a quarter recovered fully
Counsel adults with long COVID at one year that meaningful improvement is likely over the next two years, but complete recovery is less common.
Pregnancy after living kidney donation: more hypertensive disorders and smaller babies
Treat a pregnancy after living kidney donation as one needing closer blood pressure and growth monitoring, and mention the risk when counselling potential donors.
In suspected stroke, the clock starts when the patient was last known well
Record the last-known-well time and its source in every suspected stroke, and call the stroke team even when that time is many hours ago.
Thrombectomy beyond 24 hours: better function at 90 days, but more bleeds and deaths
Refer suspected large-vessel stroke presenting 24 to 72 hours late to a stroke centre for imaging, since thrombectomy can still help selected patients.
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