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Research Article | DOI: https://doi.org/10.31579/2690-8794/272
Hospital do Servidor Público Estadual de São Paulo, IAMSPE
*Corresponding Author: Rafael de Athayde Soares, Hospital do Servidor Público Estadual de São Paulo, IAMSPE.
Citation: Guilherme Centofante, Bruna De Fina, Henrique Elkis, Rafael N. Cavalcante, Matheus R. Araujo, et al, (2025), The experience of Mechanical Thrombectomy of Pulmonary Emboli with Use of the Lightning FlashTM: a Case Series Report, Clinical Medical Reviews and Reports, 7(5); DOI:10.31579/2690-8794/272
Copyright: © 2025, Rafael de Athayde Soares. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 21 July 2025 | Accepted: 22 August 2025 | Published: 19 September 2025
Keywords: reparative osteogenesis; residual bone cavity; platelet-rich fibrin; enucleation; large radicular cyst
Background: The burden of Pulmonary embolism (PE) is explained by the fact that it is the third leading cause of cardiovascular death. Over the last 2 decades, the steady rise in incidence and stagnant 10% overall 30-day mortality rate underscore the unmet need for more effective PE treatment with advanced therapy.
Methods: This case series report about patients with PE submitted to Computer-Assisted Vacuum Thrombectomy (CAVT) with the Indigo System Lightning FlashTM. The main objective of this study is to describe a case series report on the experience of using Lightning FlashTM aspiration system (Penumbra, Inc.) for PE.
Results: there were nine patients submitted to mechanical thrombectomy (MT) with Lightning FlashTM (Penumbra, Inc.) due to PE. The mean age was 55,89 years and most of the patients had a high-intermediate risk for PE (88.9%). The mean right ventricle (RV)–to–left ventricle (LV) ratio before thrombectomy was 1,11, reducing to 0,75 48hs after MT (p = 0.042). The mean blood loss was 266,67ml, and no patients required blood transfusion during the procedures. The mean time of MT was 18.33 min, the mean time of procedure was 49.44 min, and the mean pre-procedure pulmonary artery pressure (mPAP) was 60,11mmHg, decreasing to 47,75mmHg after the procedure (p = 0.039). There were no major adverse events or deaths related to the procedures. Technical success was 100% and the perioperative mortality rate was 0%.
Conclusion: This study showed significant improvement in right ventricular function, no cases of perioperative mortality, no events of major bleeding, no cardiac injury, and fast procedure times. Thrombectomy with the use of Indigo System Lightning FlashTM (Penumbra, Inc.) demonstrated safety and efficacy endpoints for the treatment of acute PE and may be considered by endovascular physicians for use in intermediate-risk PE. Larger, randomized studies should be performed to properly evaluate the outcomes and device-related serious adverse events.
The burden of Pulmonary embolism (PE) is explained by the fact that it is the third leading cause of cardiovascular death. Over the last 2 decades, the steady rise in incidence and stagnant 10% overall 30-day mortality rate underscore the unmet need for more effective PE treatment with advanced therapy.1,2 Currently treatments for pulmonary embolism are divided into 4 categories: systemic anticoagulation, systemic thrombolysis (ST), catheter-directed thrombolysis (CDT), and mechanical thrombectomy (MT). There is consensus that high-risk PE, which is defined by hemodynamic instability, necessitates rapid reperfusion treatment due to an early mortality rate exceeding 30%.3 In general, MT has several advantages over CDT and ST in the treatment of submassive and potentially massive PE, due to the shorter length of time to restore the blood flow and reduced risk of bleeding.
Recently, some published trials compared the different forms of treatment for PE. In the SEATTLE II (Submassive and Massive Pulmonary Embolism Treatment With Ultrasound Accelerated Thrombolysis Therapy) trial, which evaluated CDT, thrombolytic agents were associated with a >10% rate of bleeding complications.4 The results in an ST trial, PEITHO (Pulmonary Embolism Thrombolysis Study), were similar.5 In the SEATTLE II trial, thrombolytic agents were given to patients in intensive care for 12 to 24 hours; in the more recent OPTALYSE PE (Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Pulmonary Embolism) trial, CDT was performed in as short a time as 4 hours.6
The EXTRACT-PE (Evaluating the Safety and Efficacy of the Indigo Aspiration System in Acute Pulmonary Embolism) trial evaluated 119 patients with submassive PE and showed significantly reduced right ventricular-to-left ventricular ratios at 48 hours (0.43 ratio reduction; 95% CI, 0.38–0.47; P <0>
Recently, a new device has been introduced to perform MT in patients with submassive/massive PE. Indigo System Lightning FlashTM (Penumbra, Inc) is a next-generation catheter-directed aspiration thrombectomy system, which has recently been introduced to the European market for the reperfusion treatment of acute PE. Larger size, 16 French aspiration catheters, and the innovative computer-assisted vacuum thrombectomy system potentially translate into improved efficacy and safety.8
The main objective of this study is to describe a case series report experience about the use of Lightning FlashTM Intelligent Aspiration systems (Penumbra, Inc.) for PE.
This is a case series report about patients with PE submitted to Computer-Assisted Vacuum Thrombectomy (CAVT) with the Indigo System Lightning FlashTM. The primary effectiveness endpoint is the change in the right ventricle (RV)–to-left ventricle (LV) ratio from before the thrombectomy to 48 hours after the procedure. RV/LV ratio is available at both imaging times and acquired by using the same imaging modality (computed tomography pulmonary angiography or echocardiography).
The primary safety endpoint is a composite of major adverse events (MAEs)—device-related death, major bleeding, device-related clinical deterioration, device-related pulmonary vascular injury, and device-related cardiac injury—48 hours after the procedure.
The secondary outcomes are the incidences of device-related serious adverse events (SAEs), all-cause mortality within 30 days, and symptomatic PE recurrence within 30 days.
All statistical analyses were performed by using SPSS 21.0 for Mac. Descriptive statistics were calculated. Median results were calculated by comparative medians tests, using ANOVA and Wilcoxon tests. P < 0>
Technique Description
Lightning Flash features dual clot detection algorithms, improving upon the singular algorithm featured in Lightning 12 and 7. One algorithm detects clot based on pressure differentiation, while the other algorithm detects the interaction of flow through the system. The communication between these two algorithms results in rapid recognition of whether the catheter is actively engaging clot or is in patent flow, which is designed to maximize case efficiency. 9
The Lightning Flash catheter is 16-F sheath compatible. The catheter features MaxID technology, which allows for a large inner diameter comparable to large-bore catheters while still maintaining a lower profile. The Lightning Flash catheter was engineered to optimize its lower profile size to make it extremely trackable and atraumatic but also very powerful, giving the capability to navigate through tortuous anatomy and remove heavy thrombus burden. Despite the increase in size, the Lightning Flash catheter is two times softer than Lightning 12. This catheter is available in HTORQ and XTORQ tip shapes, designed for optimal engagement of wall-adherent thrombus regardless of the size of the vessel. Lightning Flash comes packaged with a 6-F Select+ Access Catheter. The Select+ Catheter is designed for excellent tracking and navigation, allowing for further deliverability and vessel selection. Penumbra’s Lightning System is the only computer-assisted vacuum thrombectomy device on the United States market. The combination of dual clot detection algorithms and MaxID technology enable Lightning Flash to be minimally invasive and maximally effective, thus resulting in the most powerful and advanced thrombectomy device for pulmonary embolism (PE) and venous thrombus. This allows for the potential to remove a higher volume of thrombus in less device time.10
Procedural Details
Usually, access was gained in the right femoral vein, and a 16-F, 65-cm Gore DrySeal sheath (Gore & Associates) was introduced into the vasculature and placed in the right or left main pulmonary artery (PA). A Lightning Flash HTORQ was then advanced into the right main PA. To place Lightning Flash into the correct anatomy, the catheter was deftly tracked over a 6-F Select Catheter (Penumbra, Inc.) with a Bernstein tip shape and a 0.035-inch Amplatz guidewire (Boston Scientific Corporation). With the catheter in place, aspiration was initiated. In 2.5 minutes of device time, the thrombus burden was extracted from the right or left main PA (Figure 1),
Figure 1: Thrombus burden was extracted from the left main pulmonary artery
and pulmonary angiography displayed considerable improvement from the beginning of the case (Figure 2).
Figure 2: Right Pulmonary artery post-operative image.
Regarding the results, there were nine patients submitted to MT with Lightning Flash (Penumbra, Inc.) due to PE. The mean age was 55,89 years and most of the patients had a high-intermediate risk for PE (88.9%). Concerning the comorbidities, 2 patients had arterial hypertension and diabetes, 2 patients’ previous history of deep venous thrombosis, 3 patients had active cancer, and 2 patients had severe obesity. Furthermore, four patients were diagnosed with acute deep venous thrombosis in lower limbs during the PE. (Details in Table I).
| Cases | Age | Comorbidities | Risk of PE | Deep venous thrombosis |
| Case 1 | 75 | HA1, diabetes | Intermediate High | No |
| Case 2 | 48 | Breast cancer | Intermediate High | No |
| Case 3 | 63 | DVT2 | Intermediate High | No |
Case 4 Case 5 Case 6 Case 7 Case 8 Case 9 | 37 53 78 35 74 40 | DVT and PE3 Bowel cancer Uterus Cancer Obesity HA, diabetes Obesity | Intermediate High Intermediate High Intermediate High Intermediate High Intermediate High High | Yes No Yes Yes Yes No |
Table I: Clinical Data of the patients
1 – arterial hypertension
2 – previous deep venous thrombosis
3 – previous pulmonary embolism
All patients were submitted to a preoperative pulmonary CT-SCAN, showing a large thrombus burden at main pulmonary arteries (figures 3 and 4).
Figure 3: CT-Scan demonstrating large thrombus burden at left pulmonary artery
Figure 4: CT-Scan demonstrating large thrombus burden at righ and left pulmonary artery
Moreover, concerning the technical data of the procedures, the mean right ventricle (RV)–to–left ventricle (LV) ratio before thrombectomy was 1,11, reducing to 0,75 48hs after MT (p = 0.042). The mean blood loss was 266.67ml, and no patients required blood transfusion during the procedures. The mean time of MT was 18.33 min, the mean time of operating was 49.44 min, and the mean pre-procedure pulmonary artery pressure was 60,11mmHg, decreasing to 47,75mmHg after the procedure (p = 0.039) (figure 5).
Figure 5: Thrombi removal after MT
The mean tricuspid annular plane systolic excursion (TAPSE) preoperative was 14.24mmHg preoperative, ranging to 17.88mmHg post-operative (p = 0.042). Those data demonstrate an increase in the hemodynamic status of the patients after the MT. There were no major events or deaths related to the procedures. Technical success was 100% and the perioperative mortality rate was 0% (Details in Tables II and III).
| Cases | ECOpre1 | TAPSE pre2 | ECO post-operative | TAPSE post-operative | Blood loss (ml) |
| Case 1 | 1 | 15 | 0,78 | 19 | 300 |
| Case 2 | 1.05 | 10 | 0,65 | 19 | 200 |
| Case 3 | 1.17 | 13 | 0,8 | 20 | 400 |
Case 4 Case 5 Case 6 Case 7 Case 8 Case 9 | 1.09 0.9 1.5 1.14 1 1.16 | 18 16.2 14 15 14 13 | 0,8 0,8 0,8 0,65 0,73 0,65 | 17 18 19 14 17 14 | 300 300 300 200 200 200 |
Table II – Technical procedures data
1 - Right ventricle (RV)–to–left ventricle (LV) ratio
2 - The mean tricuspid annular plane systolic excursion
| Cases | Thrombectomy time (min) | Operating time (min) |
| Case 1 | 25 | 55 |
| Case 2 | 15 | 60 |
| Case 3 | 30 | 70 |
Case 4 Case 5 Case 6 Case 7 Case 8 Case 9 | 15 15 20 15 15 15 | 40 45 50 40 40 45 |
Table III: Technical procedures data
Discussion
This paper presents a challenging case series report of patients with PE submitted to MT with Lightning Flash. Recently, the STRIKE-PE study was the first report on the use of computer-assisted vacuum thrombectomy (CAVT) with the Indigo Aspiration System (Penumbra, Alameda, California).11 The authors reported 150 consecutive patients treated with CAVT, with a mean age of 61,3 years, 54.7% men and 94.7% presenting intermediate-risk PE. Moreover, Median thrombectomy and procedure times were 33.5 minutes and 70.0 minutes, respectively, resulting in a mean reduction in systolic pulmonary artery pressure of 16.3% (P < .001). The mean RV/LV ratio decreased from 1.39 to 1.01 at 48 hours, a 25.7% reduction (P < .001). Four (2.7%) patients experienced a composite MAE within 48 hours. The authors concluded that Interim results from the STRIKE-PE study demonstrated a significant reduction in pulmonary artery pressure and RV/LV ratio, promoting significant improvements in 90-day functional and QoL outcomes in patients with PE. These data are comparable with those found in this present case series report, whereas the mean right ventricle (RV)–to–left ventricle (LV) ratio before thrombectomy was 1.11, reducing to 0.75 48hs after MT (p = 0.042) demonstrating an increasing of the hemodynamic status of the patients after the MT. Moreover, the mean thrombectomy and procedure times were 18.33min and 49.44min respectively, demonstrating the feasibility and safety of the MT procedures.
Acute PE encompasses a heterogeneous spectrum of disease manifestation and severity with considerable mortality rates and unsatisfactory long-term outcomes of advanced stages. Hemodynamic deterioration in PE results from right ventricular pressure overload, leading to progressive RV failure and subsequently to the development of the spiral of cardiogenic shock and death. The estimated early mortality is up to 30% in high-risk (HR) PE and up to 15% in intermediate-risk (IHR) PE.12 Submassive PE, defined by normal blood pressure but right ventricular (RV) dysfunction, carries the best therapeutic approach uncertainty. Although anticoagulation alone does not prevent death or clinical deterioration in 5% of these patients, systemic thrombolysis, the most extensively studied active thrombus treatment strategy, carries a high risk of major bleeding.13 In a meta-analysis evaluating 866 submassive PE patients treated with thrombolytics and 889 treated with anticoagulation alone, all-cause mortality was lower in the thrombolytic group than in the anticoagulation group (1.39% vs. 2.92%). However, rates of major bleeding were significantly higher in the thrombolytic group (7.74% vs. 2.25%).14
To avoid the high-risk bleeding rates of systemic thrombolysis, catheter-directed thrombolysis, and percutaneous mechanical aspiration have been developed to perform a local activity in thrombolysis at pulmonary circulation. The SEATTLE II (A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism) study enrolled 150 acute PE patients treated with ultrasound-assisted catheter-directed thrombolysis and reported an associated reduction in the RV-to-left ventricular (RV/LV) ratio at 48 h, but also a 10% major bleeding rate within 72 h of treatment.7 In a recent meta-analysis of 860 patients treated with catheter-directed thrombolysis and ultrasound-assisted catheter-directed thrombolysis, it was observed that the patients had an average RV/LV ratio reduction of 0.34.15 In the FLARE (A Prospective, Single-Arm, Multicenter Trial of Catheter-Directed Mechanical Thrombectomy for Intermediate-Risk Acute Pulmonary Embolism) study which prospectively evaluated the FlowTriever System (Inari Medical, Irvine, California), patients treated with the device had an average RV/LV ratio reduction of 0.38.16.
In this present case report study, the major bleeding was 0%. No patients needed a blood transfusion. The major bleeding rate in the EXTRACT-PE study was 1.7%.7 Overall, the bleeding rate is lower in MT than in thrombolysis trials: major bleeding occurred in 11.5% of patients in the systemic thrombolysis trial, PEITHO (Pulmonary Embolism Thrombolysis Trial5 and 10% of patients in the SEATTLE II ultrasound-assisted catheter-directed thrombolysis study.7 The low bleeding rate is encouraging and reflects the fact that thrombus aspiration does not require a thrombolytic agent, demonstrating the feasibility and safety of the MT procedures.
Another important data is that the patients in this present paper had no cardiac injuries during 16F aspiration catheter passage through the right heart. Indeed, the STRIKE-PE study evaluating 150 patients showed that one patient experienced major bleeding, device-related pulmonary vascular injury, and device-related clinical deterioration due to a pulmonary artery perforation (device-related serious adverse event - SAE; the patient fully recovered. Another patient experienced major bleeding and device-related clinical deterioration due to pulmonary artery hemorrhage (device-related SAE).11 Previously, the EXTRACT-PE study showed that no cardiac injury occurred, indicating that the 8-F Indigo aspiration catheter could pass through the right heart with minimal risk for cardiac injury. However, 2 events qualified as pulmonary vascular injury; one was related to a small perforation likely from the guidewire, and the other was due to a distal vessel perforation after multiple passes were attempted. The Indigo Separator is advanced and retracted out of and back into the Indigo aspiration catheter to facilitate the clearing of the thrombus from the Indigo aspiration catheter tip. Although the aspiration catheter has a soft atraumatic edge, excessive manipulation of a guidewire or the separator in distal anatomy can lead to vascular injury.7
This study has some limitations since it is a case-series report with too small sample size, lack of randomization, a comparator arm, and no longer follow-up. Larger, randomized studies should be performed to properly evaluate the outcomes and device-related serious adverse events.
This study showed significant improvement in right ventricular function, no cases of perioperative mortality, no events of major bleeding, no cardiac injury, and fast procedure times. Thrombectomy with the use of Lightning Flash (Penumbra, Inc.) demonstrated safety and efficacy endpoints for the treatment of acute PE and may be considered by endovascular physicians for use in intermediate-risk PE. Larger, randomized studies should be performed to properly evaluate the outcomes and device-related serious adverse events.
The Authors declare that there is no conflict of interest regarding this paper. Informed consent has been obtained from the patient for publication of the case report and accompanying images.
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My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
