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Rau A, Reisert M, Stein T, Mueller-Peltzer K, Rau S, Bamberg F, Taschner CA, Urbach H, Kellner E. Impact of temporal resolution on perfusion metrics, therapy decision, and radiation dose reduction in brain CT perfusion in patients with suspected stroke. Neuroradiology 2024; 66:749-759. [PMID: 38498208 PMCID: PMC11031466 DOI: 10.1007/s00234-024-03335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE CT perfusion of the brain is a powerful tool in stroke imaging, though the radiation dose is rather high. Several strategies for dose reduction have been proposed, including increasing the intervals between the dynamic scans. We determined the impact of temporal resolution on perfusion metrics, therapy decision, and radiation dose reduction in brain CT perfusion from a large dataset of patients with suspected stroke. METHODS We retrospectively included 3555 perfusion scans from our clinical routine dataset. All cases were processed using the perfusion software VEOcore with a standard sampling of 1.5 s, as well as simulated reduced temporal resolution of 3.0, 4.5, and 6.0 s by leaving out respective time points. The resulting perfusion maps and calculated volumes of infarct core and mismatch were compared quantitatively. Finally, hypothetical decisions for mechanical thrombectomy following the DEFUSE-3 criteria were compared. RESULTS The agreement between calculated volumes for core (ICC = 0.99, 0.99, and 0.98) and hypoperfusion (ICC = 0.99, 0.99, and 0.97) was excellent for all temporal sampling schemes. Of the 1226 cases with vascular occlusion, 14 (1%) for 3.0 s sampling, 23 (2%) for 4.5 s sampling, and 63 (5%) for 6.0 s sampling would have been treated differently if the DEFUSE-3 criteria had been applied. Reduction of temporal resolution to 3.0 s, 4.5 s, and 6.0 s reduced the radiation dose by a factor of 2, 3, or 4. CONCLUSION Reducing the temporal sampling of brain perfusion CT has only a minor impact on image quality and treatment decision, but significantly reduces the radiation dose to that of standard non-contrast CT.
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Affiliation(s)
- Alexander Rau
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Marco Reisert
- Department of Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Stein
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Mueller-Peltzer
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stephan Rau
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian A Taschner
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elias Kellner
- Department of Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Rau A, Reisert M, Taschner CA, Demerath T, Elsheikh S, Frank B, Köhrmann M, Urbach H, Kellner E. Reducing False-Positives in CT Perfusion Infarct Core Segmentation Using Contralateral Local Normalization. AJNR Am J Neuroradiol 2024; 45:277-283. [PMID: 38302197 DOI: 10.3174/ajnr.a8111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/20/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND AND PURPOSE The established global threshold of rCBF <30% for infarct core segmentation can lead to false-positives, as it does not account for the differences in blood flow between GM and WM and patient-individual factors, such as microangiopathy. To mitigate this problem, we suggest normalizing each voxel not only with a global reference value (ie, the median value of normally perfused tissue) but also with its local contralateral counterpart. MATERIALS AND METHODS We retrospectively enrolled 2830 CTP scans with suspected ischemic stroke, of which 335 showed obvious signs of microangiopathy. In addition to the conventional, global normalization, a local normalization was performed by dividing the rCBF maps with their mirrored and smoothed counterpart, which sets each voxel value in relation to the contralateral counterpart, intrinsically accounting for GM and WM differences and symmetric patient individual microangiopathy. Maps were visually assessed and core volumes were calculated for both methods. RESULTS Cases with obvious microangiopathy showed a strong reduction in false-positives by using local normalization (mean 14.7 mL versus mean 3.7 mL in cases with and without microangiopathy). On average, core volumes were slightly smaller, indicating an improved segmentation that was more robust against naturally low blood flow values in the deep WM. CONCLUSIONS The proposed method of local normalization can reduce overestimation of the infarct core, especially in the deep WM and in cases with obvious microangiopathy. False-positives in CTP infarct core segmentation might lead to less-than-optimal therapy decisions when not correctly interpreted. The proposed method might help mitigate this problem.
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Affiliation(s)
- Alexander Rau
- From the Department of Neuroradiology (A.R., C.A.T., T.D., S.E., H.U.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology (A.R.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Medical Physics, Department of Diagnostic and Interventional Radiology (M.R., E.K.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Stereotactic and Functional Neurosurgery (M.R.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian A Taschner
- From the Department of Neuroradiology (A.R., C.A.T., T.D., S.E., H.U.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Theo Demerath
- From the Department of Neuroradiology (A.R., C.A.T., T.D., S.E., H.U.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Samer Elsheikh
- From the Department of Neuroradiology (A.R., C.A.T., T.D., S.E., H.U.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benedikt Frank
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (B.F., M.K.), University Hospital Essen, Essen, Germany
| | - Martin Köhrmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (B.F., M.K.), University Hospital Essen, Essen, Germany
| | - Horst Urbach
- From the Department of Neuroradiology (A.R., C.A.T., T.D., S.E., H.U.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elias Kellner
- Medical Physics, Department of Diagnostic and Interventional Radiology (M.R., E.K.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Zander C, Diebold M, Shah MJ, Malzkorn B, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference: : 68-Year-Old Patient with Slurred Speech, Double Vision, and Increasing Gait Disturbance. Clin Neuroradiol 2024; 34:279-286. [PMID: 38345610 PMCID: PMC10881640 DOI: 10.1007/s00062-024-01385-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/22/2024]
Affiliation(s)
- C Zander
- Departments of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - M Diebold
- Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - M J Shah
- Neurosurgery, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - B Malzkorn
- Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - M Prinz
- Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - H Urbach
- Departments of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - D Erny
- Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - C A Taschner
- Departments of Neuroradiology, University of Freiburg, Freiburg, Germany.
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany.
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Herrmann ML, Franck C, Schuchardt FF, Meier S, Henningsen M, Wimmesberger N, Rau D, Busch H, Taschner CA, Farin‐Glattacker E, Brich J. The non-paretic-hand-to-opposite-ear test: A simple test to detect aphasia and neglect and an indicator of large anterior vessel occlusion in patients with suspected acute stroke. Brain Behav 2024; 14:e3450. [PMID: 38450998 PMCID: PMC10918592 DOI: 10.1002/brb3.3450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/28/2024] [Accepted: 02/04/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Aphasia and neglect in combination with hemiparesis are reliable indicators of large anterior vessel occlusion (LAVO). Prehospital identification of these symptoms is generally considered difficult by emergency medical service (EMS) personnel. Therefore, we evaluated the simple non-paretic-hand-to-opposite-ear (NPE) test to identify aphasia and neglect with a single test. As the NPE test includes a test for arm paresis, we also evaluated the diagnostic ability of the NPE test to detect LAVO in patients with suspected stroke. METHODS In this prospective observational study, we performed the NPE test in 1042 patients with suspected acute stroke between May 2021 and May 2022. We analyzed the correlation between the NPE test and the aphasia/neglect items of the National Institutes of Health Stroke Scale. Additionally, the predictive values of the NPE test for LAVO detection were calculated. RESULTS The NPE test showed a strong, significant correlation with both aphasia and neglect. A positive NPE test result predicted LAVO with a sensitivity of 0.70, a specificity of 0.88, and an accuracy of 0.85. Logistic regression analysis showed an odds ratio of 16.14 (95% confidence interval 10.82-24.44) for predicting LAVO. CONCLUSION The NPE test is a simple test for the detection of both aphasia and neglect. With its predictive values for LAVO detection being comparable to the results of LAVO scores in the prehospital setting, this simple test might be a promising test for prehospital LAVO detection by EMS personnel. Further prospective prehospital validation is needed.
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Affiliation(s)
- Matthias L. Herrmann
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine and Medical CenterUniversity of FreiburgFreiburgGermany
| | - Clara Franck
- Section of Health Care Research and Rehabilitation Research (SEVERA), Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical CenterUniversity of FreiburgFreiburgGermany
| | - Florian F. Schuchardt
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine and Medical CenterUniversity of FreiburgFreiburgGermany
| | - Simone Meier
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine and Medical CenterUniversity of FreiburgFreiburgGermany
| | - Max Henningsen
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine and Medical CenterUniversity of FreiburgFreiburgGermany
| | - Nicole Wimmesberger
- Section of Health Care Research and Rehabilitation Research (SEVERA), Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical CenterUniversity of FreiburgFreiburgGermany
| | - Diana Rau
- Section of Health Care Research and Rehabilitation Research (SEVERA), Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical CenterUniversity of FreiburgFreiburgGermany
| | - Hans‐Jörg Busch
- Department of Emergency Medicine, Faculty of Medicine and Medical CenterUniversity of FreiburgFreiburgGermany
| | - Christian A. Taschner
- Department of Neuroradiology, Faculty of Medicine and Medical CenterUniversity of FreiburgFreiburgGermany
| | - Erik Farin‐Glattacker
- Section of Health Care Research and Rehabilitation Research (SEVERA), Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical CenterUniversity of FreiburgFreiburgGermany
| | - Jochen Brich
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine and Medical CenterUniversity of FreiburgFreiburgGermany
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Richter C, Möhlenbruch MA, Vollherbst DF, Taschner CA, Elsheikh S, Klisch J, Lobsien D, Bester M, Ramdani N, Kaiser DPO, Gerber JC, Schob S, Gazis A, Smirnov P, Scherlach C, Hoffmann KT, Gawlitza M. Non-ischemic cerebral enhancing (NICE) lesions after flow diversion for intracranial aneurysms: a multicenter study. J Neurointerv Surg 2024:jnis-2023-021176. [PMID: 38184369 DOI: 10.1136/jnis-2023-021176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Non-ischemic cerebral enhancing (NICE) lesions have been reported as a rare complication of various neuroendovascular procedures, but information on their incidence after flow diversion is scant. It is unclear if specific devices or novel coating technologies may impact their occurrence. METHODS We conducted a multicenter study on the incidence of NICE lesions after flow diverter (FD) implantation for cerebral aneurysm treatment. RESULTS Eight centers identified 15 patients and provided detailed data. The clinical presentation ranged from asymptomatic to hemiplegia and cognitive impairment. The mean time to diagnosis after treatment was 65.1±101.5 days. Five centers disclosed information on all of their 1201 FD procedures during the inclusion period (2015-2022), during which 12 patients were diagnosed with NICE lesions in these institutions-that is, an incidence of 1%. FD coatings did not increase the incidence (6/591 patients (1%) treated with surface-modified FD vs 6/610 patients (1%) treated with bare FD; P=1.00). Significantly increased rates of 3.7% (6 cases in 161 procedures; P<0.01) and 3.3% (5 cases in 153 procedures; P<0.01) were found with stents of two specific product lines. The use of one product line was associated with a significantly lower incidence (0 cases in 499 procedures (0%); P<0.01). CONCLUSIONS Novel stent coatings are not associated with an increased incidence of NICE lesions. The incidence rate of 1% suggests that these lesions may occur more often after flow diversion than after other endovascular treatments. We found a concerning accumulation of NICE lesion cases when FDs from two product families were used.
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Affiliation(s)
- Cindy Richter
- Institute of Neuroradiology, Leipzig University Hospital, Leipzig, Germany
| | - Markus A Möhlenbruch
- Department of Interventional Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Dominik F Vollherbst
- Department of Interventional Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Christian A Taschner
- Department of Neuroradiology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Samer Elsheikh
- Department of Neuroradiology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Joachim Klisch
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, HELIOS Hospital Erfurt, Erfurt, Germany
| | - Donald Lobsien
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, HELIOS Hospital Erfurt, Erfurt, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nora Ramdani
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel P O Kaiser
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Johannes C Gerber
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Stefan Schob
- Department of Radiology and Neuroradiology, University Hospital Halle, Halle, Germany
| | - Angelos Gazis
- Department of Radiology and Neuroradiology, St Georg Hospital, Leipzig, Germany
| | - Paulina Smirnov
- Institute of Neuroradiology, Leipzig University Hospital, Leipzig, Germany
| | - Cordula Scherlach
- Institute of Neuroradiology, Leipzig University Hospital, Leipzig, Germany
| | | | - Matthias Gawlitza
- Institute of Neuroradiology, Leipzig University Hospital, Leipzig, Germany
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Frosch M, Demerath T, Fung C, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference : Headache, Mental Confusion and Mild Hemiparesis in a 68-year-old Patient. Clin Neuroradiol 2023; 33:1159-1164. [PMID: 37872367 PMCID: PMC10654210 DOI: 10.1007/s00062-023-01359-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 10/25/2023]
Affiliation(s)
- M Frosch
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - T Demerath
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - C Fung
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - D Erny
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany.
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany.
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Storz C, Sankowski R, Roelz R, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference : Recurrent Speech Arrest, Neologistic Jargon Aphasia, and Impaired Memory Function in a 39-year-old Patient. Clin Neuroradiol 2023; 33:869-876. [PMID: 37462746 PMCID: PMC10450002 DOI: 10.1007/s00062-023-01335-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/26/2023]
Affiliation(s)
- C Storz
- Department of Neuroradiology, Medical Centre-University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R Sankowski
- Department of Neuropathology, Medical Centre-University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R Roelz
- Department of Neurosurgery, Medical Centre-University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, Medical Centre-University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Centre-University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - D Erny
- Department of Neuropathology, Medical Centre-University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, Medical Centre-University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany.
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Wogram E, Schlunk F, Shah MJ, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference : A 51-year-old Patient Presenting with Epistaxis and Occasional Headaches 16 Years after Diagnosis of a Grade 1 Chondrosarcoma of the Left Petrous Apex. Clin Neuroradiol 2023; 33:569-575. [PMID: 37171609 DOI: 10.1007/s00062-023-01294-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/13/2023]
Affiliation(s)
- E Wogram
- Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - F Schlunk
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - M J Shah
- Department of Neurosurgery, Medical Centre, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - D Erny
- Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany.
- Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany.
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Simon B, Wogram E, Camp AT, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference : A 43-year-old Patient Presenting with a Right-sided, Slowly Progressing, Painless Exophthalmos and Ptosis. Clin Neuroradiol 2023; 33:255-260. [PMID: 36805296 PMCID: PMC10014779 DOI: 10.1007/s00062-023-01267-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Affiliation(s)
- B Simon
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - E Wogram
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - A T Camp
- Department of Ophthalmology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - D Erny
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany.
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany.
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Belachew NF, Diebold M, Reinacher PC, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference : A 51-year-old Patient Presenting with Transient Speech Disorder and a Mass Lesion in the Right Parietal White Matter. Clin Neuroradiol 2022; 32:875-881. [PMID: 35881163 PMCID: PMC9424149 DOI: 10.1007/s00062-022-01195-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 11/26/2022]
Affiliation(s)
- N F Belachew
- Departments of Neuroradiology, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Diebold
- Neuropathology, University of Freiburg, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - P C Reinacher
- Stereotactic & Functional Neurosurgery, University of Freiburg, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Fraunhofer Institute for Laser Technology, Aachen, Germany
| | - M Prinz
- Neuropathology, University of Freiburg, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Departments of Neuroradiology, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - D Erny
- Neuropathology, University of Freiburg, Freiburg, Germany.,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C A Taschner
- Departments of Neuroradiology, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany. .,Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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11
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Sankowski R, Lützen N, Hubbe U, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference : A 56-year-old Man Presenting with Progressive Gait Disorder, Neck Pain, and Lower Cranial Nerve Palsy. Clin Neuroradiol 2021; 31:1215-1221. [PMID: 34767051 PMCID: PMC8648702 DOI: 10.1007/s00062-021-01114-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Affiliation(s)
- R Sankowski
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre, University of Freiburg, Freiburg, Germany
| | - N Lützen
- Department of Neuroradiology, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
- Medical Centre, University of Freiburg, Freiburg, Germany
| | - U Hubbe
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
- Medical Centre, University of Freiburg, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
- Medical Centre, University of Freiburg, Freiburg, Germany
| | - D Erny
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre, University of Freiburg, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany.
- Medical Centre, University of Freiburg, Freiburg, Germany.
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12
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Taschner CA, Trinks A, Bardutzky J, Brich J, Hartmann R, Urbach H, Niesen WD. Drip-and-Ship for Thrombectomy Treatment in Patients With Acute Ischemic Stroke Leads to Inferior Clinical Outcomes in a Stroke Network Covering Vast Rural Areas Compared to Direct Admission to a Comprehensive Stroke Center. Front Neurol 2021; 12:743151. [PMID: 34790162 PMCID: PMC8591070 DOI: 10.3389/fneur.2021.743151] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction: Organizing regional stroke care considering thrombolysis as well as mechanical thrombectomy (MTE) remains challenging in light of a wide range of regional population distribution. To compare outcomes of patients in a stroke network covering vast rural areas in southwestern Germany who underwent MTE via direct admission to a single comprehensive stroke center [CSC; mothership (MS)] with those of patients transferred from primary stroke centers [PSCs; drip-and-ship (DS)], we undertook this analysis of consecutive stroke patients with MTE. Materials and Methods: Patients who underwent MTE at the CSC between January 2013 and December 2016 were included in the analysis. The primary outcome measure was 90-day functional independence [modified Rankin score (mRS) 0–2]. Secondary outcome measures included time from stroke onset to recanalization/end of MTE, angiographic outcomes, and mortality rates. Results: Three hundred and thirty-two consecutive patients were included (MS 222 and DS 110). Median age was 74 in both arms of the study, and there was no significant difference in baseline National Institutes of Health Stroke Scale scores (median MS 15 vs. 16 DS). Intravenous (IV) thrombolysis (IVT) rates differed significantly (55% MS vs. 70% DS, p = 0.008). Time from stroke onset to recanalization/end of MTE was 112 min shorter in the MS group (median 230 vs. 342 min, p < 0.001). Successful recanalization [thrombolysis in cerebral infarction (TICI) 2b-3] was achieved in 72% of patients in the MS group and 73% in the DS group. There was a significant difference in 90-day functional independence (37% MS vs. 24% DS, p = 0.017), whereas no significant differences were observed for mortality rates at 90 days (MS 22% vs. DS 17%, p = 0.306). Discussion: Our data suggest that patients who had an acute ischemic stroke admitted directly to a CSC may have better 90-day outcomes than those transferred secondarily for thrombectomy from a PSC.
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Affiliation(s)
- Christian A Taschner
- Department of Neuroradiology, Freiburg University Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexandra Trinks
- Department of Neuroradiology, Freiburg University Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Bardutzky
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Neurology and Neuroscience, Freiburg University Medical Center, Freiburg, Germany
| | - Jochen Brich
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Neurology and Neuroscience, Freiburg University Medical Center, Freiburg, Germany
| | - Ralph Hartmann
- Department of Neuroradiology, Freiburg University Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Freiburg University Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolf-Dirk Niesen
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Neurology and Neuroscience, Freiburg University Medical Center, Freiburg, Germany
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13
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Findler M, Turjman AS, Raymond J, White PM, Sadeh-Gonik U, Taschner CA, Mazighi M, Biondi A, Gory B, Turjman F. Interobserver Agreement in Scoring Angiographic Results of Basilar Artery Occlusion Stroke Therapy. AJNR Am J Neuroradiol 2021; 42:1458-1463. [PMID: 34117020 DOI: 10.3174/ajnr.a7182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/09/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The modified TICI Infarction grading system is a metric currently used to evaluate angiographic results of thrombectomy for large-vessel occlusion in ischemic stroke. Originally designed for evaluating MCA territories, it is currently used for other vessel occlusions, including the posterior circulation. We postulate that the modified TICI use for the posterior circulation is not accurate due to the different vascular territories supplied by vertebrobasilar vasculature, making grading more complex. MATERIALS AND METHODS We collected angiographic results from 30 patients who presented with acute posterior circulation occlusions between 2015 and 2018 and underwent thrombectomy in our institution. Eight observers were asked to evaluate the TICI scores before and after thrombectomy. The multirater statistics were computed using Fleiss κ analysis. Further data were collected regarding the potential brain territories at risk and the existence of atherosclerotic disease in the basilar artery. RESULTS The overall agreement κ reached 0.277 (SD, 0.013), which suggests a "fair" agreement among the raters. On average, 45% of observers achieved a high accuracy in predicting brain areas at risk of ischemia. As for the existence of basilar atherosclerotic disease, a high agreement (defined as at least 5 of 6 observers) was seen in 20 of the 30 patients. CONCLUSIONS Despite TICI being ubiquitous in stroke diagnostics, the high variability of posterior circulation TICI scores calls into question its use in these strokes. Other methods should be developed to assess recanalization in the posterior circulation.
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Affiliation(s)
- M Findler
- Department of Neurology and Interventional Neuroradiology (M.F.), Rabin Medical Center, Petah Tikva, Israel
| | - A S Turjman
- Cognition Medical Corporation (Alexis S. Turjman), Boston, Massachusetts
| | - J Raymond
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire (J.R.), Université de Montréal, Montreal, Quebec, Canada
| | - P M White
- Department of Neuroradiology (P.M.W.), Royal Victoria Infirmary, Newcastle, UK
| | - U Sadeh-Gonik
- Department of Radiology and Interventional Neuroradiology (U.S.-G.), Tel Aviv Medical Center, Tel-Aviv, Israel
| | - C A Taschner
- Department of Neuroradiology (C.A.T.), University Medical Centre Freiburg, Freiburg, Germany
| | - M Mazighi
- Department of Interventional Neuroradiology (M.M.), Fondation Rothschild Hospital, Paris, France
| | - A Biondi
- Department of Neuroradiology and Endovascular Therapy (A.B.), Besancon University Hospital, Besancon, France
| | - B Gory
- Department of Diagnostic and Therapeutic Neuroradiology (B.G.), Centre Hospitalier Régional Universitaire Nancy, Nancy, France
| | - F Turjman
- Department of Interventional Neuroradiology (Francis Turjman), Hospices Civils de Lyon, Lyon,France
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14
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Frosch M, Kremers N, Lisko K, Urbach H, Prinz M, Taschner CA. Freiburg Neuropathology Case Conference : A 42-year-old Patient with Progressive Neurological Deficits, Multiple Brain Lesions and Accompanying Affection of Peripheral Nerves. Clin Neuroradiol 2021; 31:529-535. [PMID: 34115143 PMCID: PMC8211581 DOI: 10.1007/s00062-021-01021-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 12/02/2022]
Affiliation(s)
- M Frosch
- Departments of Neuropathology, Medical Centre, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - N Kremers
- Departments of Neuroradiology, Medical Centre, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - K Lisko
- Departments of Neurology and Neurophysiology, Medical Centre, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Departments of Neuroradiology, Medical Centre, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - M Prinz
- Departments of Neuropathology, Medical Centre, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C A Taschner
- Departments of Neuroradiology, Medical Centre, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany.
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15
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Doostkam S, Würtemberger U, Coenen V, Urbach H, Prinz M, Taschner CA. Freiburg Neuropathology Case Conference: : Blurred Vision and Headaches in a 15-year-old Boy. Clin Neuroradiol 2020; 30:879-884. [PMID: 33230629 PMCID: PMC7728650 DOI: 10.1007/s00062-020-00973-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- S Doostkam
- Department of Neuropathology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - U Würtemberger
- Department of Neuroradiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - V Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany.
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16
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Bechstein M, Elsheikh S, Wodarg F, Taschner CA, Hanning U, Buhk JH, McDonough R, Goebell E, Fiehler J, Bester M. Republished: Interhospital teleproctoring of endovascular intracranial aneurysm treatment using a dedicated live-streaming technology: first experiences during the COVID-19 pandemic. J Neurointerv Surg 2020; 13:e1. [PMID: 33082292 PMCID: PMC7848056 DOI: 10.1136/neurintsurg-2020-016722.rep] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 12/19/2022]
Abstract
This is a report of the first three cases of endovascular aneurysm treatment that were proctored by a remote interventionalist using a novel high-resolution low-latency streaming technology. The proctor was located in a neurovascular centre and supported the treating interventional teams in two distant cities (up to 800 km/500 miles apart). All aneurysms were treated using the Woven EndoBridge (WEB) embolisation system, either electively or following subarachnoid haemorrhage. On-site proctoring was not possible due to travel restrictions during the COVID-19 pandemic. WEB placement was feasible in all cases. Good rapport between proctors and treating physicians was reported, enabled by the high-resolution image transmission and uninterrupted feedback/discussion via audiostream. No clinical complications were encountered. Short-term follow-up revealed adequate occlusion of all treated aneurysms. The employed streaming technology provided effective remote proctoring during complex aneurysm cases, including the management of technical complications.
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Affiliation(s)
- Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Samer Elsheikh
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Christian A Taschner
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Hendrik Buhk
- Neuroradiology, Asklepios Hospitals St. Georg and Wandsbek, Hamburg, Germany
| | - Rosalie McDonough
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Einar Goebell
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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17
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Bechstein M, Elsheikh S, Wodarg F, Taschner CA, Hanning U, Buhk JH, McDonough R, Goebell E, Fiehler J, Bester M. Interhospital teleproctoring of endovascular intracranial aneurysm treatment using a dedicated live-streaming technology: first experiences during the COVID-19 pandemic. BMJ Case Rep 2020; 13:13/10/e016722. [PMID: 33012707 PMCID: PMC7536784 DOI: 10.1136/bcr-2020-016722] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This is a report of the first three cases of endovascular aneurysm treatment that were proctored by a remote interventionalist using a novel high-resolution low-latency streaming technology. The proctor was located in a neurovascular centre and supported the treating interventional teams in two distant cities (up to 800 km/500 miles apart). All aneurysms were treated using the Woven EndoBridge (WEB) embolisation system, either electively or following subarachnoid haemorrhage. On-site proctoring was not possible due to travel restrictions during the COVID-19 pandemic. WEB placement was feasible in all cases. Good rapport between proctors and treating physicians was reported, enabled by the high-resolution image transmission and uninterrupted feedback/discussion via audiostream. No clinical complications were encountered. Short-term follow-up revealed adequate occlusion of all treated aneurysms. The employed streaming technology provided effective remote proctoring during complex aneurysm cases, including the management of technical complications.
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Affiliation(s)
- Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Samer Elsheikh
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Christian A Taschner
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Hendrik Buhk
- Neuroradiology, Asklepios Hospitals St. Georg and Wandsbek, Hamburg, Germany
| | - Rosalie McDonough
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Einar Goebell
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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18
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Taschner CA, Stracke CP, Dorn F, Kadziolka KB, Kreiser K, Solymosi L, Pham M, Buhk JH, Turowski B, Reith W, Elsheikh S, Meckel S, Janssen H, Hammer A, Beuing O, Jansen O, Urbach H, Knauth M, Jenkner C, Chapot R. Derivo embolization device in the treatment of unruptured intracranial aneurysms: a prospective multicenter study. J Neurointerv Surg 2020; 13:541-546. [PMID: 32900908 PMCID: PMC8142444 DOI: 10.1136/neurintsurg-2020-016303] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 11/24/2022]
Abstract
Background Flow diverters (FD) are used regularly for the endovascular treatment of unruptured intracranial aneurysms. We aimed to assess the safety and effectiveness of the Derivo embolization device (DED) with respect to long-term clinical and angiographic outcomes. Methods A prospective multicenter trial was conducted at 12 centers. Patients presenting with modified Rankin Score (mRS) of 0–1, treated for unruptured intracranial aneurysms with DED were eligible. Primary endpoint was the mRS assessed at 18 months with major morbidity defined as mRS 3–5. Satisfactory angiographic occlusion was defined as 3+4 on the Kamran scale. Results Between July 2014 and February 2018, 119 patients were enrolled. Twenty-three patients were excluded. Ninety-six patients, 71 (74%) female, mean age 54±12.0 years, were included in the analysis. Mean aneurysm size was 14.2±16.9 mm. The mean number of devices implanted per patient was 1.2 (range 1–3). Clinical follow-up at 18 months was available in 90 (94%) patients, resulting in a mean follow-up period of 14.8±5.2 months. At last available follow-up of 96 enrolled patients, 91 (95%) remained mRS 0–1. The major morbidity rate (mRS 3–5) was 3.1% (3/96), major stroke rate was 4.2% (4/96), and mortality was 0%. Follow-up angiographies were available in 89 (93%) patients at a median of 12.4±5.84 months with a core laboratory adjudicated satisfactory aneurysm occlusion in 89% (79/89). Conclusion Our results suggest that DED is a safe and effective treatment for unruptured aneurysms with high rates of satisfactory occlusion and comparably low rates of permanent neurological morbidity and mortality. Trial registration DRKS00006103
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Affiliation(s)
- Christian A Taschner
- Department of Neuroradiology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christian Paul Stracke
- Department of Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus Essen, Essen, Germany
| | - Franziska Dorn
- Department of Neuroradiology, LMU University Hospital of Munich, Munich, Germany
| | - Krzysztof Bartosz Kadziolka
- Endovascular Neurosurgery, Neurosurgery Department, The Children's Memorial Health Institute, Western Hospital, Grodzisk Mazowiecki, Poland
| | - Kornelia Kreiser
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - László Solymosi
- Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Mirko Pham
- Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Jan Hendrik Buhk
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - Bernd Turowski
- Department of Neuroradiology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Reith
- Department of Diagnostic and Interventional Neuroradiology, Saarland University, Homburg-Saar, Germany
| | - Samer Elsheikh
- Department of Neuroradiology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
| | - Stephan Meckel
- Department of Neuroradiology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
| | - Hendrik Janssen
- Department of Neuroradiology, Paracelsus Medical University, Nuremberg, Germany.,Department of Neuroradiology, Klinikum Ingolstadt, Ingolstadt, Germany
| | - Alexander Hammer
- Department of Neuroradiology, Paracelsus Medical University, Nuremberg, Germany
| | - Oliver Beuing
- Department of Neuroradiology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, Campus Kiel, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Horst Urbach
- Department of Neuroradiology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
| | - Michael Knauth
- Institute for Diagnostic and Interventional Neuroradiology, University Medicine Göttingen, Göttingen, Germany
| | - Carolin Jenkner
- Faculty of Medicine, Universityof Freiburg, Freiburg, Germany
| | - René Chapot
- Department of Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus Essen, Essen, Germany
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19
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Erny D, Taschner U, Nakagawa J, Urbach H, Prinz M, Taschner CA. Freiburg Neuropathology Case Conference : Back Pain and Rapidly Progressing Gait Disorder in a 70-year-old Patient. Clin Neuroradiol 2020; 30:647-653. [PMID: 32845352 PMCID: PMC7471148 DOI: 10.1007/s00062-020-00945-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- D Erny
- Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - U Taschner
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - J Nakagawa
- Department of Neurosurgery, Medical Centre, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.
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20
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Affiliation(s)
- C A Taschner
- Department of Neuroradiology, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.
| | - D Erny
- Department of Neuropathology, Medical Center - University of Freiburg, Freiburg, Germany
| | - O Schnell
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - I E Duman
- Department of Neuroradiology, Medical Center - University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, Medical Center - University of Freiburg, Freiburg, Germany
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ten Brinck MFM, Jäger M, de Vries J, Grotenhuis JA, Aquarius R, Mørkve SH, Rautio R, Numminen J, Raj R, Wakhloo AK, Puri AS, Taschner CA, Boogaarts HD. Flow diversion treatment for acutely ruptured aneurysms. J Neurointerv Surg 2019; 12:283-288. [DOI: 10.1136/neurintsurg-2019-015077] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/04/2019] [Accepted: 08/07/2019] [Indexed: 11/04/2022]
Abstract
Background and purposeFlow diverters are sometimes used in the setting of acutely ruptured aneurysms. However, thromboembolic and hemorrhagic complications are feared and evidence regarding safety is limited. Therefore, in this multicenter study we evaluated complications, clinical, and angiographic outcomes of patients treated with a flow diverter for acutely ruptured aneurysms.MethodsWe conducted a retrospective observational study of 44 consecutive patients who underwent flow diverter treatment within 15 days after rupture of an intracranial aneurysm at six centers. The primary end point was good clinical outcome, defined as modified Rankin Scale score (mRS) 0–2. Secondary endpoints were procedure-related complications and complete aneurysm occlusion at follow-up.ResultsAt follow-up (median 3.4 months) 20 patients (45%) had a good clinical outcome. In 20 patients (45%), 25 procedure-related complications occurred. These resulted in permanent neurologic deficits in 12 patients (27%). In 5 patients (11%) aneurysm re-rupture occurred. Eight patients died resulting in an all-cause mortality rate of 18%. Procedure-related complications were associated with a poor clinical outcome (mRS 3–6; OR 5.1(95% CI 1.0 to 24.9), p=0.04). Large aneurysms were prone to re-rupture with rebleed rates of 60% (3/5) vs 5% (2/39) (p=0.01) for aneurysms with a size ≥20 mm and <20 mm, respectively. Follow-up angiography in 29 patients (median 9.7 months) showed complete aneurysm occlusion in 27 (93%).ConclusionFlow diverter treatment of ruptured intracranial aneurysms was associated with high rates of procedure-related complications including aneurysm re-ruptures. Complications were associated with poor clinical outcome. In patients with available angiographic follow-up, a high occlusion rate was observed.
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Süß P, Volz F, Lang C, Staszewksi O, Palmedo G, Taschner CA, Scheiwe C, Kurz P, Mentzel T, Prinz M. A Case of Large Meningeal Epithelioid Hemangioendothelioma With WWTR1–CAMTA1 Gene Rearrangement and Slow Growth Over 15 Years. J Neuropathol Exp Neurol 2018; 77:871-876. [DOI: 10.1093/jnen/nly066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Patrick Süß
- Institute of Neuropathology, Faculty of Medicine
| | - Florian Volz
- Department of Neurosurgery, University Medical Center
| | - Christine Lang
- Department of Neuroradiology, University Medical Center, University of Freiburg, Freiburg, Germany
| | | | | | - Christian A Taschner
- Department of Neuroradiology, University Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Philipp Kurz
- Comprehensive Cancer Center Freiburg, Freiburg, Germany
- Department of Pathology, Faculty of Medicine
| | - Thomas Mentzel
- Dermatopathologie Friedrichshafen, Friedrichshafen, Germany
| | - Marco Prinz
- Institute of Neuropathology, Faculty of Medicine
- BIOSS Center for Biological Signalling Studies, University of Freiburg, Freiburg, Germany
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Taschner CA, Chapot R, Costalat V, Machi P, Courthéoux P, Barreau X, Berge J, Pierot L, Kadziolka K, Jean B, Blanc R, Biondi A, Brunel H, Gallas S, Berlis A, Herbreteau D, Berkefeld J, Urbach H, Elsheikh S, Fiehler J, Desal H, Graf E, Bonafé A. Second-Generation Hydrogel Coils for the Endovascular Treatment of Intracranial Aneurysms: A Randomized Controlled Trial. Stroke 2018; 49:667-674. [PMID: 29437981 PMCID: PMC5839703 DOI: 10.1161/strokeaha.117.018707] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/29/2017] [Accepted: 12/07/2017] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Endovascular embolization of intracranial aneurysms with hydrogel-coated coils lowers the risk of major recurrence, but technical limitations (coil stiffness and time restriction for placement) have prevented their wider clinical use. We aimed to assess the efficacy of softer, second-generation hydrogel coils. Methods— A randomized controlled trial was conducted at 22 centers in France and Germany. Patients aged 18 to 75 years with untreated ruptured or unruptured intracranial aneurysms measuring 4 to 12 mm in diameter were eligible and randomized (1:1 using a web-based system, stratified by rupture status) to coiling with either second-generation hydrogel coils or bare platinum coils. Assist devices were allowed as clinically required. Independent imaging core laboratory was masked to allocation. Primary end point was a composite outcome measure including major aneurysm recurrence, aneurysm retreatment, morbidity that prevented angiographic controls, and any death during treatment and follow-up. Data were analyzed as randomized. Results— Randomization began on October 15, 2009, and stopped on January 31, 2014, after 513 patients (hydrogel, n=256; bare platinum, n=257); 20 patients were excluded for missing informed consent and 9 for treatment-related criteria. Four hundred eighty-four patients (hydrogel, n=243; bare platinum, n=241) were included in the analysis; 208 (43%) were treated for ruptured aneurysms. Final end point data were available for 456 patients. Forty-five out of 226 (19.9%) patients in the hydrogel group and 66/230 (28.7%) in the control group had an unfavorable composite primary outcome, giving a statistically significant reduction in the proportion of an unfavorable composite primary outcome with hydrogel coils—adjusted for rupture status—of 8.4% (95% confidence interval, 0.5–16.2; P=0.036). Adverse and serious adverse events were evenly distributed between groups. Conclusions— Our results suggest that endovascular coil embolization with second-generation hydrogel coils may reduce the rate of unfavorable outcome events in patients with small- and medium-sized intracranial aneurysms. Clinical Trial Registration— URL: https://www.drks.de/drks_web/. Unique identifier: DRKS00003132.
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Affiliation(s)
- Christian A Taschner
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.).
| | - René Chapot
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Vincent Costalat
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Paolo Machi
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Patrick Courthéoux
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Xavier Barreau
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Jérôme Berge
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Laurent Pierot
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Krzysztof Kadziolka
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Betty Jean
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Raphaël Blanc
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Alessandra Biondi
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Hervé Brunel
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Sophie Gallas
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Ansgar Berlis
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Denis Herbreteau
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Joachim Berkefeld
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Horst Urbach
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Samer Elsheikh
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Jens Fiehler
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Hubert Desal
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Erika Graf
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
| | - Alain Bonafé
- From the Department of Neuroradiology (C.A.T., H.U., S.E.) and Clinical Trials Unit (E.G.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Germany; Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus, Essen, Germany (R.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Montpellier, France (V.C., P.M., A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Caen, France (P.C.); Department of Neuroradiology, Centre Hospitalier Universitaire Bordeaux, France (X.B., J.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Reims, France (L.P., K.K.); Department of Neuroradiology, Centre Hospitalier Universitaire Clermont-Ferrand, France (B.J.); Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France (R.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Besançon, France (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Marseille, France (H.B.); Department of Neuroradiology, Hôpital Henri-Mondor, Créteil, France (S.G.); Department of Neuroradiology, Augsburg Hospital, Germany (A.B.); Department of Neuroradiology, Centre Hospitalier Universitaire Tours, France (D.H.); Institute of Neuroradiology, University Hospital Frankfurt, Germany (J.B.); Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Germany (J.F.); and Department of Neuroradiology, Centre Hospitalier Universitaire Nantes, France (H.D.)
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Taschner CA, Süß P, Hohenhaus M, Urbach H, Lützen N, Prinz M. Freiburg Neuropathology Case Conference : Tumor Located in the Anterior Portion of the Third Ventricle. Clin Neuroradiol 2018; 28:139-143. [PMID: 29392346 DOI: 10.1007/s00062-018-0668-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, Medical Centre - University of Freiburg, University of Freiburg, Freiburg, Germany.
| | - P Süß
- Department of Neuropathology, Medical Centre - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - M Hohenhaus
- Department of Stereotactic and Functional Neurosurgery, Medical Centre - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Centre - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - N Lützen
- Department of Neuroradiology, Medical Centre - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, Medical Centre - University of Freiburg, University of Freiburg, Freiburg, Germany
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Taschner CA, Erny D, Sajonz B, Urbach H, Guggenberger K, Prinz M. Freiburg Neuropathology Case Conference: A Cystic Lesion of the Cerebellum in an Adolescent. Clin Neuroradiol 2017; 27:121-126. [PMID: 28130565 DOI: 10.1007/s00062-017-0562-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, Medical Centre, University of Freiburg, Freiburg, Germany.
| | - D Erny
- Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - B Sajonz
- Department of Functional and Stereotactic Neurosurgery, Medical Centre, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - K Guggenberger
- Department of Neuroradiology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
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Taschner CA, Vedantham S, de Vries J, Biondi A, Boogaarts J, Sakai N, Lylyk P, Szikora I, Meckel S, Urbach H, Kan P, Siekmann R, Bernardy J, Gounis MJ, Wakhloo AK. Surpass Flow Diverter for Treatment of Posterior Circulation Aneurysms. AJNR Am J Neuroradiol 2016; 38:582-589. [PMID: 28007769 DOI: 10.3174/ajnr.a5029] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/11/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Flow diverters for the treatment of posterior circulation aneurysms remain controversial. We aimed to identify factors contributing to outcome measures in patients treated with the Surpass flow diverter for aneurysms in this location. MATERIALS AND METHODS We conducted an observational study of 53 patients who underwent flow-diverter treatment for posterior circulation aneurysms at 15 centers. Key outcome measures were mortality, complete aneurysm occlusion, and modified Rankin Scale score at follow-up. RESULTS At follow-up (median, 11.3 months; interquartile range, 5.9-12.7 months), 9 patients had died, resulting in an all-cause mortality rate of 17.3% (95% CI, 7%-27.6%); 7 deaths (14%) were directly related to the procedure and none occurred in patients with a baseline mRS score of zero. After adjusting for covariates, a baseline mRS of 3-5 was more significantly (P = .003) associated with a higher hazard ratio for death than a baseline mRS of 0-2 (hazard ratio, 17.11; 95% CI, 2.69-109.02). After adjusting for follow-up duration, a 1-point increase in the baseline mRS was significantly (P < .001) associated with higher values of mRS at follow-up (odds ratio, 2.93; 95% CI, 1.79-4.79). Follow-up angiography in 44 patients (median, 11.3 months; interquartile range, 5.9-12.7 months) showed complete aneurysm occlusion in 29 (66%; 95% CI, 50.1%-79.5%). CONCLUSIONS Clinical results of flow-diverter treatment of posterior circulation aneurysms depend very much on patient selection. In this study, poorer outcomes were related to the treatment of aneurysms in patients with higher baseline mRS scores. Angiographic results showed a high occlusion rate for this subset of complex aneurysms.
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Affiliation(s)
- C A Taschner
- From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany
| | | | - J de Vries
- Department of Neurosurgery (J.d.V., J.B.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - A Biondi
- Department of Neuroradiology and Endovascular Therapy (A.B.), University of Besançon, Besançon, France
| | - J Boogaarts
- From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany.,Department of Neurosurgery (J.d.V., J.B.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - N Sakai
- Department of Neurosurgery (N.S.), Kobe City Medical Center General Hospital, Kobe, Japan
| | - P Lylyk
- Department of Neurosurgery (P.L.), Equipo de Neurocirugía Endovascular Radiología Intervencionista, Buenos Aires, Argentina
| | - I Szikora
- National Institute of Neurosciences (I.S.), Budapest, Hungary
| | - S Meckel
- From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany
| | - H Urbach
- From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany
| | - P Kan
- Department of Neurosurgery (P.K.), Baylor College of Medicine, Houston, Texas
| | - R Siekmann
- Department of Neuroradiology (R.S.), Klinikum Kassel, Kassel, Germany
| | - J Bernardy
- From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany
| | - M J Gounis
- New England Center for Stroke Research (M.J.G.)
| | - A K Wakhloo
- Division of Neuroimaging and Intervention (A.K.W.), Departments of Radiology, Neurology, and Neurosurgery, University of Massachusetts Medical School, Worcester, Massachusetts
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Taschner CA, Sankowski R, Shah JM, Urbach H, Hartmann R, Prinz M. Freiburg Neuropathology Case Conference : A Pituitary Mass Lesion. Clin Neuroradiol 2016; 26:493-497. [PMID: 27830265 DOI: 10.1007/s00062-016-0549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Medical Centre Freiburg, Freiburg, Germany.
| | - R Sankowski
- Department of Neuropathology, University Medical Centre Freiburg, Freiburg, Germany
| | - J M Shah
- Department of Neurosurgery, University Medical Centre Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, University Medical Centre Freiburg, Freiburg, Germany
| | - R Hartmann
- Department of Neuroradiology, University Medical Centre Freiburg, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, University Medical Centre Freiburg, Freiburg, Germany
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Taschner CA, Chapot R, Costalat V, Machi P, Courthéoux P, Barreau X, Berge J, Pierot L, Kadziolka K, Jean B, Blanc R, Biondi A, Brunel H, Gallas S, Berlis A, Herbreteau D, Berkefeld J, Urbach H, El Shikh S, Fiehler J, Desal H, Graf E, Bonafé A. GREAT-a randomized controlled trial comparing HydroSoft/HydroFrame and bare platinum coils for endovascular aneurysm treatment: procedural safety and core-lab-assessedangiographic results. Neuroradiology 2016; 58:777-86. [PMID: 27137926 DOI: 10.1007/s00234-016-1693-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/25/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hybrid hydrogel-platinum coils (HydroCoil) have proven effective for endovascular aneurysm treatment. To overcome technical limitations (coil stiffness, time restriction for placement), a second generation of softer hydrogel coils has been brought to clinical practice (HydroSoft, HydroFrame). We report on procedural safety and core-lab-assessed angiographic results from an open-label multicenter randomized controlled trial. METHODS Web-based randomization occurred in 15 medical centers in France and seven in Germany between coil embolization with second-generation hydrogel coils and treatment with any bare platinum coil. Assist devices could be used as clinically required. Primary endpoint is a composite outcome including major aneurysm recurrence and poor clinical outcome at 18 months follow-up. RESULTS Five hundred thirteen patients were randomized (hydrogel n = 256, bare platinum n = 257). Twenty patients were excluded for missing informed consent and nine patients for treatment related criteria. Four hundred eighty-four patients were analyzed as randomized (hydrogel n = 243, bare platinum n = 241). Two hundred eight had ruptured aneurysms (43 %). Prespecified procedural complications occurred in 58 subjects (hydrogel n = 28, bare platinum n = 30, p = 0.77). The 14-day mortality rate was 2.1 % in both arms of the study. The median calculated packing densities for aneurysms assigned to hydrogel and bare platinum were 39 and 31 % respectively (p < 0.001). No statistically significant differences were found between arms in the post procedural angiographic occlusion rate (p = 0.8). CONCLUSION Second-generation hydrogel coils can be used in a wide spectrum of aneurysms with a risk profile equivalent to bare platinum. Packing density was significantly higher in aneurysms treated with hydrogel coils. TRIAL REGISTRATION http://www.germanctr.de , DRKS00003132.
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Affiliation(s)
- Christian A Taschner
- Department of Neuroradiology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - René Chapot
- Department of Intracranial Endovascular Therapy, Alfried-Krupp Krankenhaus Hospital, Essen, Germany
| | - Vincent Costalat
- Department of Neuroradiology, CHU Montpellier, Montpellier, France
| | - Paolo Machi
- Department of Neuroradiology, CHU Montpellier, Montpellier, France
| | | | - Xavier Barreau
- Department of Neuroradiology, CHU Bordeaux, Bordeaux, France
| | - Jérôme Berge
- Department of Neuroradiology, CHU Bordeaux, Bordeaux, France
| | | | | | - Betty Jean
- Department of Neuroradiology, Hôpital Gabriel-Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | | | - Hervé Brunel
- Department of Neuroradiology, Hôpital La Timone, CHU Marseille, Marseille, France
| | - Sophie Gallas
- Department of Neuroradiology, Hôpital Henri-Mondor, AP-HP, Créteil, France
| | - Ansgar Berlis
- Department of Radiology and Neuroradiology, Augsburg Hospital, Augsburg, Germany
| | | | - Joachim Berkefeld
- Institute of Neuroradiology, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Samer El Shikh
- Department of Neuroradiology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hubert Desal
- Department of Neuroradiology, Hôpital G et R Laënnec, CHU Nantes, Nantes, France
| | - Erika Graf
- Clinical Trials Unit, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alain Bonafé
- Department of Neuroradiology, CHU Montpellier, Montpellier, France
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Taschner CA, Erny D, Weyerbrock A, Urbach H, Maurer C, Prinz M. Freiburg Neuropathology Case Conference. A Mass Lesion of the Fourth Ventricle. Clin Neuroradiol 2015; 25:439-43. [PMID: 26541140 DOI: 10.1007/s00062-015-0479-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Medical Centre Freiburg, Freiburg, Germany.
| | - D Erny
- Department of Neuropathology, University Medical Centre Freiburg, Freiburg, Germany
| | - A Weyerbrock
- Department of Neurosurgery, University Medical Centre Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, University Medical Centre Freiburg, Freiburg, Germany
| | - C Maurer
- Department of Neuroradiology, University Medical Centre Freiburg, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, University Medical Centre Freiburg, Freiburg, Germany
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Reinhard M, Taschner CA, Hörsch N, Allignol A, Maurer CJ, Niesen WD, Lambeck J, Wallesch CW, Urbach H, Weiller C, Schuchardt V, Griesser-Leute HJ. Endovascular Treatment versus Sonothrombolysis for Acute Ischemic Stroke. Cerebrovasc Dis 2015; 40:205-14. [PMID: 26402300 DOI: 10.1159/000439142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/28/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Currently, there are 2 strategies to increase the effect of systemic thrombolysis with alteplase (rtPA) in acute major stroke: endovascular treatment via stent retrieval and ultrasound enhancement (sonothrombolysis). This study compares these 2 approaches in patients with proximal intracranial occlusion of the anterior circulation. METHODS Consecutive data on the treatment outcome of acute middle cerebral artery (M1) or carotid T occlusion were collected from 2 stroke centers: one center used rtPA plus endovascular stent retrieval as standard treatment and the other rtPA plus ultrasound (sonothrombolysis). The primary outcome was functional independence (modified Rankin scale (mRS) 0-2) after neurorehabilitation. RESULTS A total of 132 patients were assessed (n = 73 endovascular, n = 59 sonothrombolysis). The rate of functional independence was higher for endovascular treatment (adjusted OR 3.89 (95% CI 1.36-12.58)). Additionally, ordinal mRS analysis favored the endovascular strategy (adjusted common OR 1.70 (95% CI 0.88-3.31)). Subgroup analysis showed that endovascular treatment was superior for carotid T occlusion (adjusted common OR 5.61 (95% CI 1.60-20.93)), but not for middle cerebral artery occlusion (adjusted common OR 1.07 (95% CI 0.47-2.43)). Symptomatic intracerebral hemorrhage occurred in 3 patients from the endovascular group. CONCLUSIONS This observational study suggests that endovascular treatment of acute major anterior circulation stroke is superior to sonothrombolysis in terms of functional outcome. This benefit seems to pertain primarily to patients with carotid T occlusion, whereas patients with M1 occlusion seem to profit in a similar way from both methods. ( CLINICAL TRIAL REGISTRATION URL: http://www.germanctr.de. Unique identifier: DRKS0000x200B;5305.).
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Affiliation(s)
- Matthias Reinhard
- Department of Neurology, University Medical Center Freiburg, Freiburg, Germany
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Kallenberg K, Solymosi L, Taschner CA, Berkefeld J, Schlamann M, Jansen O, Arnold S, Tomandl B, Knauth M, Turowski B. Endovascular stroke therapy with the Aperio thrombectomy device. J Neurointerv Surg 2015. [PMID: 26220408 DOI: 10.1136/neurintsurg-2015-011678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The pharmaceutical therapy for acute ischemic stroke has shortcomings in reopening large vessels and dissolving long thrombi, and endovascular treatment has been found to provide added value. The Aperio thrombectomy device showed promising results in an experimental study. The purpose of this study was to evaluate the device clinically. METHODS 119 patients with acute stroke were treated in nine centers using the Aperio thrombectomy device. Target vessel, diameter, thrombus length, procedure time, recanalization, number of deployments, additional use of anticoagulants, complications, and the use of additional devices were assessed. RESULTS The median thrombus length was 15 mm (range 1.5-20 mm) and the average time from device insertion to recanalization was 30 min (range 5-120 min). Blood flow restoration (Thrombolysis In Cerebral Infarction (TICI) 2-3) was achieved in 85%. In the majority of cases complete clot removal was achieved (TICI 0, 12%; TICI 1, 2%; TICI 2a, 14%; TICI 2b, 18%; TICI 3, 53%). The median number of deployments was 2 (range 1-6). Twelve procedural complications (10%) occurred. CONCLUSIONS The Aperio thrombectomy device seems to be an effective and adequately safe tool for reopening occluded cerebral arteries in the setting of acute stroke.
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Affiliation(s)
- Kai Kallenberg
- Institute for Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Laszlo Solymosi
- Department of Neuroradiology, University Würzburg, Würzburg, Germany
| | - Christian A Taschner
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Joachim Berkefeld
- Institute for Neuroradiology, University Medical Center Frankfurt, J W Goethe-University Frankfurt, Frankfurt, Germany
| | - Marc Schlamann
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, UKSH Campus Kiel, Kiel, Germany
| | - Sebastian Arnold
- Institute for Diagnostic and Interventional Radiology, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Germany
| | - Bernd Tomandl
- Clinic for Radiology and Neuroradiology, Klinikum Christophsbad, Göppingen, Germany
| | - Michael Knauth
- Institute for Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Bernd Turowski
- Section of Neuroradiology, Institute for Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
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Taschner CA, Erny D, Shah MJ, Eckenweiler M, Urbach H, Lutz K, Prinz M. Freiburg Neuropathology Case Conference: An Infant with a Supratentorial Mass Lesion. Clin Neuroradiol 2015; 25:211-7. [PMID: 25967602 DOI: 10.1007/s00062-015-0400-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 04/24/2015] [Indexed: 11/30/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, Medical Centre-University of Freiburg, Freiburg, Germany,
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Taschner CA, Brendecke S, Campos M, Urbach H, Lützen N, Prinz M. Freiburg neuropathology case conference: periorbital bone lesion causing proptosis in a 31-year-old patient. Clin Neuroradiol 2014; 24:399-403. [PMID: 25366715 DOI: 10.1007/s00062-014-0354-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 10/10/2014] [Indexed: 10/24/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany,
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Klisch J, Sychra V, Strasilla C, Taschner CA, Reinhard M, Urbach H, Meckel S. Double solitaire mechanical thrombectomy in acute stroke: effective rescue strategy for refractory artery occlusions? AJNR Am J Neuroradiol 2014; 36:552-6. [PMID: 25324495 DOI: 10.3174/ajnr.a4133] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy by using a single stent retriever system has demonstrated high efficacy for recanalization of large-artery occlusions in acute stroke. We aimed to evaluate the feasibility, safety, and efficacy of a novel double Solitaire stent retriever technique as an escalating treatment for occlusions that are refractory to first-line single stent retriever mechanical thrombectomy. MATERIALS AND METHODS All patients treated with the double stent retriever technique by using the Solitaire system were retrospectively selected from 2 large neurointerventional centers. Time to recanalization, angiographic (TICI) and clinical outcomes (mRS), and complications were assessed. RESULTS Ten patients (median NIHSS score, 16; mean age, 70 years) with MCA M1 segment (n = 5) and terminal ICA (n = 5 including 2 ICA tandem) occlusions were included. Prior single stent retriever mechanical thrombectomy had been performed in 9 patients (median number of passes, 3). Median time to recanalization was 60 minutes (interquartile range, 45-87 minutes). Procedure-related complications occurred in 1 patient; overall mortality was 20%. Recanalization of the target vessel (TICI 2b/3) was achieved in 80%. Good clinical outcome (mRS 0-2) was 50%. CONCLUSIONS In this preliminary feasibility study, the double Solitaire stent retriever technique proved to be an effective method for recanalization of anterior circulation large-artery occlusions refractory to standard stent retriever mechanical thrombectomy.
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Affiliation(s)
- J Klisch
- From the Institute of Diagnostic und Interventional Radiology and Neuroradiology (J.K., V.S., C.S.), Helios Klinikum, Erfurt, Germany
| | - V Sychra
- From the Institute of Diagnostic und Interventional Radiology and Neuroradiology (J.K., V.S., C.S.), Helios Klinikum, Erfurt, Germany
| | - C Strasilla
- From the Institute of Diagnostic und Interventional Radiology and Neuroradiology (J.K., V.S., C.S.), Helios Klinikum, Erfurt, Germany
| | - C A Taschner
- Departments of Neuroradiology (C.A.T., H.U., S.M.)
| | - M Reinhard
- Neurology (M.R.), University Hospital Freiburg, Freiburg, Germany
| | - H Urbach
- Departments of Neuroradiology (C.A.T., H.U., S.M.)
| | - S Meckel
- Departments of Neuroradiology (C.A.T., H.U., S.M.)
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Taschner CA, Staszewski O, Weyerbrock A, Urbach H, Egger K, Prinz M. Freiburg neuropathology case conference: tumor of the cerebellum with mild, gyriform enhancement in a 19-year-old patient. Clin Neuroradiol 2014; 24:301-6. [PMID: 25081236 DOI: 10.1007/s00062-014-0325-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany,
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Taschner CA, Doostkam S, Weyerbrock A, Schaefer HE, Urbach H, Keuler A, Prinz M. Freiburg neuropathology case conference: multiple small ring-enhancing lesions in a 75-year-old patient. Clin Neuroradiol 2014; 24:193-7. [PMID: 24823686 DOI: 10.1007/s00062-014-0307-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 04/14/2014] [Indexed: 11/29/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany,
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Meckel S, McAuliffe W, Fiorella D, Taschner CA, Phatouros C, Phillips TJ, Vasak P, Schumacher M, Klisch J. Endovascular treatment of complex aneurysms at the vertebrobasilar junction with flow-diverting stents: initial experience. Neurosurgery 2014; 73:386-94. [PMID: 23787879 DOI: 10.1227/01.neu.0000431472.71913.07] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Large or giant complex vertebrobasilar junction aneurysms have a dismal natural history and are often challenging to treat with standard endovascular or neurosurgical techniques. OBJECTIVE To report initial experience with endovascular treatment of these aneurysms using flow-diverting stents (FDS). METHODS Ten patients with FDS treatment of complex vertebrobasilar junction aneurysms were collected from 4 large cerebrovascular centers. Clinical/angiographic presentation and outcome were retrospectively analyzed. RESULTS Of 10 aneurysms, 7 presented with brainstem compression, 2 with ischemia, and 1 with subarachnoid hemorrhage, and 3 were recurrent after stent-assisted treatments. Eight were giant. Morphology was fusiform in 5, fusiform dissecting in 1, and multilobulated saccular in 4. Six were partially thrombosed. In addition to FDS (mean number of devices, 3.9; range, 1-9), contralateral vertebral artery sacrifice and adjunctive coiling were performed in 9 and 5 of the 10 patients, respectively. At follow-up, 5 of 10 were completely occluded, 4 showed minimal residual filling, and 1 was retreated with an additional FDS. Postinterventionally, worsening mass effect and ischemic complications were seen in 2 and 4 of 10, respectively. Clinical outcome was good in 6 (modified Rankin Scale score, 0-2). Four fatalities were related to sequelae of subarachnoid hemorrhage, late FDS thrombosis, progressive mass effect, and delayed intracranial hemorrhage. CONCLUSION FDS may be used to treat complex vertebrobasilar junction aneurysms with overall good angiographic outcome. A combined reconstructive/deconstructive approach appears useful to avoid endoleaks. FDS strategies, like other endovascular and neurosurgical approaches to these lesions, are associated with significant risk and therefore should be reserved for those cases in which alternative approaches either are deemed unsafe or are likely to be ineffective. ABBREVIATIONS FDS, flow-diverting stentPED, Pipeline Embolization DeviceSAH, subarachnoid hemorrhageVA, vertebral arteryVBJ, vertebrobasilar junction.
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Affiliation(s)
- Stephan Meckel
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany.
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Taschner CA, Erny D, Scheiwe C, Urbach H, Mader I, Prinz M. Freiburg neuropathology case conference: a temporal, partially calcified tumor in a child. Clin Neuroradiol 2014; 24:83-7. [PMID: 24469068 DOI: 10.1007/s00062-014-0290-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Indexed: 10/25/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany,
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Taschner CA, Staszewski O, Scheiwe C, Mader I, Prinz M. Freiburg neuropathology case conference: a contrast-enhancing orbital, intra-conal lesion. Clin Neuroradiol 2013; 23:249-53. [PMID: 23857629 DOI: 10.1007/s00062-013-0240-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Indexed: 10/26/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany.
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Singh P, Doostkam S, Reinhard M, Ivanovas V, Taschner CA. Immunohistochemical Analysis of Thrombi Retrieved During Treatment of Acute Ischemic Stroke. Stroke 2013; 44:1720-2. [DOI: 10.1161/strokeaha.113.000964] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paramdeep Singh
- From the Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany (P.S., V.I., C.A.T.); Department of Radiology, Guru Gobind Singh Medical College and Hospital, Faridkot, India (P.S.); Institute of Neuropathology, University Hospital Freiburg, Freiburg, Germany (S.D.); and Department of Neurology, University Hospital Freiburg, Freiburg, Germany (M.R.)
| | - Soroush Doostkam
- From the Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany (P.S., V.I., C.A.T.); Department of Radiology, Guru Gobind Singh Medical College and Hospital, Faridkot, India (P.S.); Institute of Neuropathology, University Hospital Freiburg, Freiburg, Germany (S.D.); and Department of Neurology, University Hospital Freiburg, Freiburg, Germany (M.R.)
| | - Matthias Reinhard
- From the Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany (P.S., V.I., C.A.T.); Department of Radiology, Guru Gobind Singh Medical College and Hospital, Faridkot, India (P.S.); Institute of Neuropathology, University Hospital Freiburg, Freiburg, Germany (S.D.); and Department of Neurology, University Hospital Freiburg, Freiburg, Germany (M.R.)
| | - Vera Ivanovas
- From the Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany (P.S., V.I., C.A.T.); Department of Radiology, Guru Gobind Singh Medical College and Hospital, Faridkot, India (P.S.); Institute of Neuropathology, University Hospital Freiburg, Freiburg, Germany (S.D.); and Department of Neurology, University Hospital Freiburg, Freiburg, Germany (M.R.)
| | - Christian A. Taschner
- From the Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany (P.S., V.I., C.A.T.); Department of Radiology, Guru Gobind Singh Medical College and Hospital, Faridkot, India (P.S.); Institute of Neuropathology, University Hospital Freiburg, Freiburg, Germany (S.D.); and Department of Neurology, University Hospital Freiburg, Freiburg, Germany (M.R.)
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Taschner CA, Brendecke S, Trippel M, Keuler A, Prinz M. Freiburg neuropathology case conference: contrast-enhancing white matter lesion adjacent to the lateral ventricle. Clin Neuroradiol 2013; 23:165-8. [PMID: 23665946 DOI: 10.1007/s00062-013-0226-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Indexed: 10/26/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany.
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Taschner CA, Staszewski O, Jabbarli R, Keuler A, Prinz M. Freiburg neuropathology case conference: a partially calcified, dura-based tumour of the frontal lobe. Clin Neuroradiol 2013; 23:63-8. [PMID: 23307262 DOI: 10.1007/s00062-013-0199-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2013] [Indexed: 11/25/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany.
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Taschner CA, Brendecke S, Weyerbrock A, Egger K, Prinz M. Freiburg neuropathology case conference: widespread mass lesions after resection of a glioblastoma multiforme. Clin Neuroradiol 2012; 22:375-80. [PMID: 23132173 DOI: 10.1007/s00062-012-0179-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2012] [Indexed: 11/24/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Hospital Freiburg, Germany.
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Taschner CA, Staszewski O, Pinsker M, El Shikh S, Prinz M. Freiburg neuropathology case conference: cystic mass lesions of the temporal and occipital lobes in an elderly patient. Clin Neuroradiol 2011; 21:251-5. [PMID: 22086499 DOI: 10.1007/s00062-011-0112-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany.
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Taschner CA, Staszewski O, van Velthoven V, Müller M, Kontny U, Hader C, Prinz M. Freiburg neuropathology case conference: a midline mass lesion in an infant. Clin Neuroradiol 2011; 21:101-6. [PMID: 21769656 DOI: 10.1007/s00062-011-0085-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article presents the case of a 10-month-old baby girl with an atypical teratoid/rhabdoid tumor. The differential diagnosis relied on the findings from magnetic resonance with T1 and T2-weighted imaging as well as histological and immunohistochemical methods. The characteristics of the possible candidate lesions considered for the differential diagnosis are described.
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Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany.
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Leschka SC, Babic D, El Shikh S, Wossmann C, Schumacher M, Taschner CA. C-arm cone beam computed tomography needle path overlay for image-guided procedures of the spine and pelvis. Neuroradiology 2011; 54:215-23. [PMID: 21476020 DOI: 10.1007/s00234-011-0866-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 03/23/2011] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The aim of this study is to report our early clinical experience using C-arm cone beam computed tomography with fluoroscopic overlay for image guidance during percutaneous needle procedures of the spine and pelvis. METHODS Twelve consecutive patients (four female and eight male patients; mean age, 64 years; range, 47-74 years; SD ± 7.6 years) who underwent percutaneous biopsy of the spine and pelvis for suspected metastasis (n = 12), spondylodiscitis (n = 6), abscess (n = 5) or bone tumour (n = 1) were prospectively included between March 2009 and November 2010. The procedures were performed on the Allura Xper FD20/20 (Philips, Best, the Netherlands) using cone beam computed tomography (XperCT) with the C-arm combined with fluoroscopic overlay for needle guidance. Based on an initial XperCT, entry and target points were defined using dedicated guidance software (XperGuide). The needle path was visualised in various reconstructed planes and could be adjusted when considered necessary. For percutaneous interventions, the entry view (overlay of entry and target point in the bull's eye fashion), the progression view (perpendicular to the entry view) as well as two additional views could automatically be piloted to with the C-arm system. Needle navigation was supported by a biopsy guidance device (Seestar, Radi, Uppsala, Sweden). Correct needle positioning was confirmed with a second XperCT acquisition. Technical success was defined as any target point reached via the planned needle trajectory with a distance of final needle tip within 5 mm of the planned target point in any direction. RESULTS In all 12 patients, target areas could be defined based on XperCT data. In 11 of 12 (92%) cases, the target point was successfully reached on the planned trajectory with a mean error of 2.8 mm (range, 0.5-9.4 mm; SD, 2.4 mm). No peri- or post-interventional complications occurred. CONCLUSION XperCT-guided interventions with the XperGuide system seem a safe and reliable tool for percutaneous needle interventions of the spine and pelvis. The advantage of the technique when compared to CT- or fluoroscopy-guided interventions needs to be determined in a comparative study of a larger scale.
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Affiliation(s)
- Simon C Leschka
- Department of Neuroradiology, Neurocentre, University Hospital Freiburg, Breisgauer Strasse 64, 79106, Freiburg, Germany
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Taschner CA, Staszewski O, Weyerbrock A, Hader C, Prinz M. Freiburg neuropathology case conference: osteolytic lesion. Clin Neuroradiol 2011; 21:35-9. [PMID: 21461688 DOI: 10.1007/s00062-011-0065-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany.
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Taschner CA, Staszewski O, van Velthoven V, Mader I, Prinz M. Freiburg neuropathology case conference: an intraventricular mass lesion. Clin Neuroradiol 2010; 20:261-5. [PMID: 21127824 DOI: 10.1007/s00062-010-0044-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany.
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Taschner CA, Staszewski O, van Velthoven V, Steinhoff BJ, Mader I, Prinz M. Freiburg neuropathology case conference: a medial temporal lobe lesion. Clin Neuroradiol 2010; 20:179-82. [PMID: 20809101 DOI: 10.1007/s00062-010-0027-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany
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