sockalicious t1_j4yp9rc wrote

Yew want to know what the reel horror is, hey? Wal, it’s this—it ain’t what them fish devils hez done, but what they’re a-goin’ to do! They’re a-bringin’ things up aout o’ whar they come from into the taown—ben doin’ it fer years, an’ slackenin’ up lately. Them haouses north o’ the river betwixt Water an’ Main Streets is full of ’em—them devils an’ what they brung—an’ when they git ready. . . . I say, when they git ready . . . ever hear tell of a shoggoth?


sockalicious t1_j4fyuqd wrote

Most physicians wouldn't characterize catheter ablation as 'surgery', nor does the source NEJM article use that term, preferring 'ablation'. It's an interventional procedure done by a cardiologist via a catheter in the femoral or radial artery.

The properly-called "surgical" treatment for a-fib is Cox's MAZE procedure, which has undergone several modifications over the years and is sometimes called pulmonary vein isolation. It involves opening the chest and making a series of precise cuts in the back wall of the left atrium, then sewing it back up. It's usually - I dare say almost always - performed only when the surgeon is already in the chest for some other reason, such as surgical correction of mitral valve stenosis.


sockalicious t1_iyd0m0d wrote

From the Science artice you linked:

>Still, one reason to think lecanemab contributed to the woman’s death is that her autopsy revealed widespread cerebral amyloid angiopathy (CAA), a condition in which amyloid deposits gradually replace the smooth muscle of blood vessel walls. Castellani, Nicoll, and others who reviewed her case suspect CAA made her blood vessels vulnerable to weakening when lecanemab did what it is expected to do: strip amyloids from the brain. The tPA treatment then likely ruptured those weakened vessels, leading to serious ARIA—and apparently fatal brain bleeding, according to the Northwestern report authors and independent CAA or Alzheimer’s experts.

What the article doesn't mention is that CAA would be a contraindication to t-PA therapy for stroke, whether someone had received anti-amyloid therapy or not.

Considering t-PA therapy for stroke is always a "chaotic scene" because there is a brief window of time after stroke onset that it can be used, and the standard imaging studies used to see if t-PA is indicated don't detect CAA - you have to look back in the record and see if an MRI has been done, and that lookback isn't always possible in the emergency department setting.