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Maitz MF, Kaiser DPO, Cuberi A, Weich Hernández R, Mühl-Benninghaus R, Tomori T, Gawlitza M. Enhancing thromboresistance of neurovascular nickel-titanium devices with responsive heparin hydrogel coatings. J Neurointerv Surg 2024:jnis-2024-021836. [PMID: 38760168 DOI: 10.1136/jnis-2024-021836] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/01/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Neurointerventional devices, particularly laser-cut thin-strut stents made of self-expanding nickel-titanium alloy, are increasingly utilized for endovascular applications in intracranial arteries and dural venous sinuses. Preventing thrombosis and stroke necessitates systemic anticoagulant and antiplatelet therapies with the risk of bleeding complications. Antithrombotic coatings present a promising solution. METHODS In this study, we investigated the potential of hydrogels composed of four-armed poly(ethylene glycol) (starPEG) and heparin, with or without coagulation-responsive heparin release, as coatings for neurovascular devices to mitigate blood clot formation. We evaluated the feasibility and efficacy of these coatings on neurovascular devices through in vitro Chandler-Loop assays and implantation experiments in the supra-aortic arteries of rabbits. RESULTS Stable and coagulation-responsive starPEG-heparin hydrogel coatings exhibited antithrombotic efficacy in vitro, although with a slightly reduced thromboprotection observed in vivo. Furthermore, the hydrogel coatings demonstrated robustness against shear forces encountered during deployment and elicited only marginal humoral and cellular inflammatory responses compared with the reference standards. CONCLUSION Heparin hydrogel coatings offer promising benefits for enhancing the hemocompatibility of neurointerventional devices made of self-expanding nickel-titanium alloy. The variance in performance between in vitro and in vivo settings may be attributed to differences in low- and high-shear blood flow conditions inherent to these models. These models may represent the differences in venous and arterial systems. Further optimization is warranted to tailor the hydrogel coatings for improved efficacy in arterial applications.
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Affiliation(s)
- Manfred F Maitz
- Max Bergmann Center of Biomaterials, Leibniz Institute of Polymer Research Dresden, Dresden, Sachsen, Germany
| | - Daniel P O Kaiser
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Sachsen, Germany
| | - Ani Cuberi
- Institute of Radiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Rafaela Weich Hernández
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Sachsen, Germany
| | | | - Toshiki Tomori
- Department of Diagnostic and Interventional Neuroradiology, University Medical School of Saarland, Homburg/Saar, Germany
| | - Matthias Gawlitza
- Institute of Neuroradiology, University Hospital Leipzig, Leipzig, Sachsen, Germany
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2
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Pielenz D, Klisch J, Fiorella D, Gawlitza M, Steinbrecher A, Leinisch E, Lobsien E, Hoffmann KT, Lobsien D. The pEGASUS-HPC stent system for intracranial arterial stenosis: a single-center case series. J Neurointerv Surg 2024:jnis-2024-021737. [PMID: 38760166 DOI: 10.1136/jnis-2024-021737] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Intracranial arterial stenting is a technique for the treatment of symptomatic stenosis. In this single-center retrospective case series we evaluated a novel low profile laser-cut stent with an antithrombogenic hydrophilic polymer coating (pEGASUS-HPC, Phenox GmbH, Bochum, Germany) for the treatment of intracranial stenosis in the setting of acute ischemic stroke and elective cases. METHODS All patients treated with pEGASUS-HPC for one or more intracranial arterial stenoses at our institution were retrospectively included. Clinical, imaging and procedural parameters as well as clinical and imaging follow-up data were collected. RESULTS We performed 43 interventions in 41 patients with 42 stenoses in our neurovascular center between August 2021 and February 2024. Twenty-one patients (51.2%) were female and the mean±SD age was 71±10.8 years. Thirty-seven (86.1%) procedures were performed in the setting of endovascular acute ischemic stroke treatment. Technical or procedural complications occurred in seven patients (16.3%), six in the thrombectomy group and one in the elective group. One stent-related hemorrhagic complication (subarachnoid hemorrhage) occurred in emergency cases and symptomatic intracerebral hemorrhage occurred in one patient treated in an elective setting. Overall stenosis reduction following pEGASUS-HPC stent implantation was 53.0±18.0%. On follow-up imaging, which was available for 16 patients (37.2%) after an average of 32±58.6 days, 62.5% of the stents were patent. CONCLUSION Our single-center case series demonstrates the feasibility of using the pEGASUS-HPC stent system, especially in emergency situations when thrombectomy fails.
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Affiliation(s)
- Daniel Pielenz
- Department of Neuroradiology, Helios Hospital Erfurt, Erfurt, Thüringen, Germany
| | - Joachim Klisch
- Department of Neuroradiology, Helios Hospital Erfurt, Erfurt, Thüringen, Germany
- Department of Neuroradiology, Helios Vogtland Hospital Plauen, Plauen, Sachsen, Germany
| | - David Fiorella
- Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
| | - Matthias Gawlitza
- University Hospital Leipzig Institute for Neuroradiology, Leipzig, Sachsen, Germany
| | | | - Elke Leinisch
- Department of Neurology, Helios Hospital Erfurt, Erfurt, Thüringen, Germany
| | - Elmar Lobsien
- Department of Neurology, Helios Hospital Erfurt, Erfurt, Thüringen, Germany
| | - Karl-Titus Hoffmann
- University Hospital Leipzig Institute for Neuroradiology, Leipzig, Sachsen, Germany
| | - Donald Lobsien
- Department of Neuroradiology, Helios Hospital Erfurt, Erfurt, Thüringen, Germany
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3
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Deuschl C, Goertz L, Kabbasch C, Köhrmann M, Kleinschnitz C, Berlis A, Maurer CJ, Mühlen I, Kallmünzer B, Gawlitza M, Kaiser DPO, Klisch J, Lobsien D, Behme D, Thormann M, Flottmann F, Winkelmeier L, Gizewski ER, Mayer-Suess L, Holtmannspoetter M, Moenninghoff C, Schlunz-Hendann M, Grieb D, Arendt CT, Bohmann FO, Altenbernd J, Li Y, Sure U, Mühl-Benninghaus R, Rodt T, Kallenberg K, Durutya A, Elsharkawy M, Stracke CP, Schumann MG, Bock A, Nikoubashman O, Wiesmann M, Henkes H, Dolff S, Demircioglu A, Forsting M, Styczen H. Impact of Vaccination Status on Outcome of Patients With COVID-19 and Acute Ischemic Stroke Undergoing Mechanical Thrombectomy. J Am Heart Assoc 2024; 13:e031816. [PMID: 38639365 DOI: 10.1161/jaha.123.031816] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Data on impact of COVID-19 vaccination and outcomes of patients with COVID-19 and acute ischemic stroke undergoing mechanical thrombectomy are scarce. Addressing this subject, we report our multicenter experience. METHODS AND RESULTS This was a retrospective analysis of patients with COVID-19 and known vaccination status treated with mechanical thrombectomy for acute ischemic stroke at 20 tertiary care centers between January 2020 and January 2023. Baseline demographics, angiographic outcome, and clinical outcome evaluated by the modified Rankin Scale score at discharge were noted. A multivariate analysis was conducted to test whether these variables were associated with an unfavorable outcome, defined as modified Rankin Scale score >3. A total of 137 patients with acute ischemic stroke (48 vaccinated and 89 unvaccinated) with acute or subsided COVID-19 infection who underwent mechanical thrombectomy attributable to vessel occlusion were included in the study. Angiographic outcomes between vaccinated and unvaccinated patients were similar (modified Thrombolysis in Cerebral Infarction ≥2b: 85.4% in vaccinated patients versus 86.5% in unvaccinated patients; P=0.859). The rate of functional independence (modified Rankin Scale score, ≤2) was 23.3% in the vaccinated group and 20.9% in the unvaccinated group (P=0.763). The mortality rate was 30% in both groups. In the multivariable analysis, vaccination status was not a significant predictor for an unfavorable outcome (P=0.957). However, acute COVID-19 infection remained significant (odds ratio, 1.197 [95% CI, 1.007-1.417]; P=0.041). CONCLUSIONS Our study demonstrated no impact of COVID-19 vaccination on angiographic or clinical outcome of COVID-19-positive patients with acute ischemic stroke undergoing mechanical thrombectomy, whereas worsening attributable to COVID-19 was confirmed.
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Affiliation(s)
- Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology University Hospital Essen Essen Germany
| | - Lukas Goertz
- Department of Diagnostic and Interventional Radiology University Hospital Cologne Cologne Germany
| | - Christoph Kabbasch
- Department of Diagnostic and Interventional Radiology University Hospital Cologne Cologne Germany
| | - Martin Köhrmann
- Department of Neurology and Center for Translational Neurosciences and Behavioral Sciences University Hospital Essen Essen Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neurosciences and Behavioral Sciences University Hospital Essen Essen Germany
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Neuroradiology University Hospital Augsburg Augsburg Germany
| | - Christoph Johannes Maurer
- Department of Diagnostic and Interventional Neuroradiology University Hospital Augsburg Augsburg Germany
| | - Iris Mühlen
- Department of Neuroradiology University of Erlangen-Nuremberg Erlangen Germany
| | - Bernd Kallmünzer
- Department of Neurology University of Erlangen-Nuremberg Erlangen Germany
| | - Matthias Gawlitza
- Faculty of Medicine, Institute and Policlinic of Neuroradiology, University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany
- Department of Neuroradiology University Hospital Leipzig Leipzig Germany
| | - Daniel P O Kaiser
- Faculty of Medicine, Institute and Policlinic of Neuroradiology, University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany
| | - Joachim Klisch
- Department of Diagnostic and Interventional Radiology and Neuroradiology Helios General Hospital Erfurt Erfurt Germany
| | - Donald Lobsien
- Department of Diagnostic and Interventional Radiology and Neuroradiology Helios General Hospital Erfurt Erfurt Germany
| | - Daniel Behme
- Department of Neuroradiology University Hospital Magdeburg Magdeburg Germany
| | | | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Laurens Winkelmeier
- Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Elke Ruth Gizewski
- Department of Neuroradiology Medical University Innsbruck Innsbruck Austria
| | - Lukas Mayer-Suess
- Department of Neurology Medical University Innsbruck Innsbruck Austria
| | | | - Christoph Moenninghoff
- Department of Radiology, Neuroradiology and Nuclear Medicine Johannes Wesling University Hospital, Ruhr University Bochum Bochum Germany
| | - Martin Schlunz-Hendann
- Department of Radiology and Neuroradiology Klinikum Duisburg-Sana Kliniken Duisburg Germany
| | - Dominik Grieb
- Department of Radiology and Neuroradiology Klinikum Duisburg-Sana Kliniken Duisburg Germany
- Department of Diagnostic and Interventional Neuroradiology Medical School Hannover Hannover Germany
| | - Christophe T Arendt
- Institute of Neuroradiology, University Hospital Goethe University Frankfurt am Main Germany
| | - Ferdinand O Bohmann
- Institute of Neuroradiology, University Hospital Goethe University Frankfurt am Main Germany
| | - Jens Altenbernd
- Department of Radiology and Neuroradiology Gemeinschaftskrankenhaus Herdecke Herdecke Germany
| | - Yan Li
- Institute for Diagnostic and Interventional Radiology and Neuroradiology University Hospital Essen Essen Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery University Hospital of Essen Essen Germany
| | | | - Thomas Rodt
- Department of Radiology Klinikum Lueneburg Lueneburg Germany
| | - Kai Kallenberg
- Department of Neuroradiology Klinikum Fulda Fulda Germany
| | | | | | | | | | - Alexander Bock
- Department of Neuroradiology Vivantes Klinikum Neukoelln Berlin Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen University Aachen Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen University Aachen Germany
| | - Hans Henkes
- Clinic for Neuroradiology Klinikum Stuttgart Stuttgart Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases University Hospital Essen Essen Germany
| | - Aydin Demircioglu
- Institute for Diagnostic and Interventional Radiology and Neuroradiology University Hospital Essen Essen Germany
| | - Michael Forsting
- Institute for Diagnostic and Interventional Radiology and Neuroradiology University Hospital Essen Essen Germany
| | - Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology University Hospital Essen Essen Germany
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Kaiser DPO, Reiff T, Mansmann U, Schoene D, Strambo D, Michel P, Abdalkader M, Nguyen TN, Gawlitza M, Möhlenbruch MA, Ringleb PA, Puetz V, Gerber JC, Nagel S. Endovascular Treatment for Acute Isolated Internal Carotid Artery Occlusion : A Propensity Score Matched Multicenter Study. Clin Neuroradiol 2024; 34:125-133. [PMID: 37665352 PMCID: PMC10881648 DOI: 10.1007/s00062-023-01342-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/27/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The benefit of endovascular treatment (EVT) in patients with acute symptomatic isolated occlusion of the internal carotid artery (ICA) without involvement of the middle and anterior cerebral arteries is unclear. We aimed to compare clinical and safety outcomes of best medical treatment (BMT) versus EVT + BMT in patients with stroke due to isolated ICA occlusion. METHODS We conducted a retrospective multicenter study involving patients with isolated ICA occlusion between January 2016 and December 2020. We stratified patients by BMT versus EVT and matched the groups using propensity score matching (PSM). We assessed the effect of treatment strategy on favorable outcome (modified Rankin scale ≤ 2) 90 days after treatment and compared reduction in NIHSS score at discharge, rates of symptomatic intracranial hemorrhage (sICH) and 3‑month mortality. RESULTS In total, we included 149 patients with isolated ICA occlusion. To address imbalances, we matched 45 patients from each group using PSM. The rate of favorable outcomes at 90 days was 56% for EVT and 38% for BMT (odds ratio, OR 1.89, 95% confidence interval, CI 0.84-4.24; p = 0.12). Patients treated with EVT showed a median reduction in NIHSS score at discharge of 6 points compared to 1 point for BMT patients (p = 0.02). Rates of symptomatic intracranial hemorrhage (7% vs. 4%; p = 0.66) and 3‑month mortality (11% vs. 13%; p = 0.74) did not differ between treatment groups. Periprocedural complications of EVT with early neurological deterioration occurred in 7% of cases. CONCLUSION Although the benefit on functional outcome did not reach statistical significance, the results for NIHSS score improvement, and safety support the use of EVT in patients with stroke due to isolated ICA occlusion.
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Affiliation(s)
- Daniel P O Kaiser
- Institute of Neuroradiology, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
- Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Dresden, Germany.
| | - Tilman Reiff
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulrich Mansmann
- Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Daniela Schoene
- Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Davide Strambo
- Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrik Michel
- Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Thanh N Nguyen
- Division of Interventional Neurology/Neuroradiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Matthias Gawlitza
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter A Ringleb
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Volker Puetz
- Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Johannes C Gerber
- Institute of Neuroradiology, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen/Rhein, Germany
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5
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Gawlitza M, Hoffmann KT, Richter C. Does signal without noise and noise without signal exist? J Neurointerv Surg 2024:jnis-2024-021603. [PMID: 38378238 DOI: 10.1136/jnis-2024-021603] [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] [Received: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Matthias Gawlitza
- Department of Neuroradiology, Leipzig University Hospital, Leipzig, Germany
| | | | - Cindy Richter
- Department of Neuroradiology, Leipzig University Hospital, Leipzig, Germany
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6
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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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7
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Lobsien D, Holtmannspoetter M, Eff F, Berlis A, Maurer CJ, Behme D, Diamandis E, Gawlitza M, Fiorella D, Princiotta C, Cirillo L, Dall'Olio M, Keston P, Klisch J, Nania A. The pEGASUS-HPC stent system for stent-assisted coiling of cerebral aneurysms: a multicenter case series. J Neurointerv Surg 2024:jnis-2023-021074. [PMID: 38171613 DOI: 10.1136/jnis-2023-021074] [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: 09/29/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Stent-assisted coiling (SAC) is a well-established method for treatment of wide-necked intracranial aneurysms. In this multicenter, retrospective case series we evaluated SAC with a new low-profile, laser-cut stent with an antithrombogenic hydrophilic polymer coating (pEGASUS-HPC) for the treatment of intracranial aneurysms. METHODS Patients treated with pEGASUS-HPC SAC for one or more intracranial aneurysms were retrospectively included. Clinical, imaging, and procedural parameters as well as clinical and imaging follow-up data were recorded. RESULTS We treated 53 aneurysms in 52 patients in six neurovascular centers between August 2021 and November 2022. Thirty-seven patients (69.8%) were female. Mean age was 57 (±11.7) years. Twenty-nine patients were treated electively, 23 in the acute phase (22 with aneurysmal subarachnoid hemorrhage (SAH), and 1 with a partially thrombosed aneurysm causing ischemic events). One intraprocedural thromboembolic event and three postprocedural ischemic complications occurred in two (8.7 %) of the SAH patients and in one of the elective patients (3.45%). Overall aneurysm occlusion was Raymond Roy (RR) I in 36 (69.2%), RR II in 9, and RR III in 9 cases. Follow-up imaging was available for 23 patients after an average of 147.7 (±59.6) days demonstrating RR I occlusion in 22 (95.5%) and RR II in 1 patient. CONCLUSION SAC with the pEGASUS-HPC stent system demonstrates rates of periprocedural safety and effectiveness that are comparable with previously reported series for stent-assisted coil embolization.
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Affiliation(s)
- Donald Lobsien
- Clinic of Neuroradiology, HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Markus Holtmannspoetter
- Interventional and Diagnostic Neuroradiology, Nuremberg Hospital Campus South, Nuremberg, Germany
| | - Florian Eff
- Interventional and Diagnostic Neuroradiology, Nuremberg Hospital Campus South, Nuremberg, Germany
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Christoph Johannes Maurer
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Daniel Behme
- Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Elie Diamandis
- Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Matthias Gawlitza
- Institute of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - David Fiorella
- Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
| | - Ciro Princiotta
- Neuroradiology Department, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Luigi Cirillo
- Neuroradiology Department, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Massimo Dall'Olio
- Neuroradiology Department, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Peter Keston
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Joachim Klisch
- Clinic of Neuroradiology, HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Alberto Nania
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
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8
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Kaiser DPO, Cuberi A, Linn J, Gawlitza M. Flow diversion for compressive unruptured internal carotid artery aneurysms with neuro-ophthalmological symptoms: a systematic review and meta-analysis. J Neurointerv Surg 2023; 15:892-897. [PMID: 35918130 PMCID: PMC10447391 DOI: 10.1136/jnis-2022-019249] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/20/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Data on the safety and efficacy of flow diverters (FD) for the treatment of unruptured internal carotid artery (ICA) aneurysms with compressive neuro-ophthalmological symptoms (NOS) are scarce and comprise mainly small case series. METHODS We performed a search of three databases and included series with ≥10 patients, with unruptured aneurysms of the ICA and NOS, treated with FD. Random-effects analysis of treatment results and safety was performed. RESULTS A total of 22 studies reporting on 594 patients were included. Pooled proportions of NOS recovery, improvement, transient and permanent worsening were: 47.4% (95% CI 35.0% to 60.1%); 74.5% (95% CI 67.9% to 80.2%); 7.1% (95% CI 3.3% to 14.7%); and 4.9% (95% CI 3.2% to 7.4%), respectively. Rates of complete recovery and improvement in patients with isolated visual symptoms were 30.6% (95% CI 12.5% to 57.7%) and 56.6% (95% CI 42.3% to 69.9%). Isolated oculomotor symptoms recovered completely in 47.8% (95% CI 29.9% to 66.3%) and improved in 78% (95% CI 69.2% to 84.9%). Morbidity occurred in 5% (95% CI 2.8% to 9%) and mortality in 3.9% (95% CI 2% to 7.5%) of patients. An increased likelihood of symptom improvement was observed when treatment was performed early (<1 month) after symptom onset (OR=11.22, 95% CI 3.9% to 32.5%). CONCLUSION Flow diversion promotes recovery or improvement of compressive symptoms in a large proportion of patients but is associated with significant rates of morbidity and mortality. Transient and permanent NOS worsening is not uncommon. Early treatment is of utmost importance, as it increases the likelihood of symptom improvement more than 10-fold.
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Affiliation(s)
- Daniel P O Kaiser
- Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
- EKFZ for Digital Health, Dresden University of Technology, Dresden, Germany
| | - Ani Cuberi
- Department of Radiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jennifer Linn
- Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Matthias Gawlitza
- Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
- EKFZ for Digital Health, Dresden University of Technology, Dresden, Germany
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Kaiser DPO, Gawlitza M, Linn J, Engellandt K. Cerebral Venous T2-Susceptibility-Weighted Imaging-Mismatch: A Potential Surrogate of Severe Hypoxic-Ischemic Encephalopathy. Stroke 2023; 54:e209-e210. [PMID: 36916271 DOI: 10.1161/str.0000000000000435] [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] [Indexed: 03/16/2023]
Affiliation(s)
- Daniel P O Kaiser
- Institute of Neuroradiology, University Hospital Dresden, Germany (D.P.O.K., J.L., K.E.).,EKFZ for Digital Health, TU Dresden, Germany (D.P.O.K., M.G.)
| | - Matthias Gawlitza
- EKFZ for Digital Health, TU Dresden, Germany (D.P.O.K., M.G.).,Department of Neuroradiology, University Hospital Leipzig, Germany (M.G.)
| | - Jennifer Linn
- Institute of Neuroradiology, University Hospital Dresden, Germany (D.P.O.K., J.L., K.E.)
| | - Kay Engellandt
- Institute of Neuroradiology, University Hospital Dresden, Germany (D.P.O.K., J.L., K.E.)
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Gawlitza M, Klisch J, Kaiser DPO, Linn J, Pierot L, Lobsien D, Lobsien D. A Systematic Literature Review and Meta-Analysis of the Treatment of Ruptured Intracranial Aneurysms with Hydrophilic Polymer and Phosphorylcholine-Coated Flow Diverters Under Single Antiplatelet Therapy. World Neurosurg 2023; 170:e791-e800. [PMID: 36462697 DOI: 10.1016/j.wneu.2022.11.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE Flow diverters coated with antithrombogenic substances were recently introduced and have shown encouraging results in the preclinical setting. Our aim was to analyze their clinical application in patients with ruptured intracranial aneurysms using single antiplatelet therapy (SAPT). METHODS We performed a PRISMA-compliant systematic review and meta-analysis covering 3 major data bases until March 2022.Two reviewers independently reviewed clinical studies for eligibility.Random-effects analysis of proportions was used to pool safety outcomes (hemorrhagic, thrombembolic, and overall complications). Studies were tested for publication bias and heterogeneity. RESULTS Five studies reporting 43 patients with 46 aneurysms were identified. More than 1 stent was implanted in 16%, and additional coil embolization was performed in 53.8% of patients. SAPT with one of various acetylsalicylic acid regimens was used in 86%, altogether antiplatelet protocols were variable. The pooled risks of thromboembolic (23.9%; 95% confidence interval [CI], 9.6-47.9), hemorrhagic (9.4%; 95% CI, 3.6-22.6), and overall complications (28.3%; 95% CI, 12.4-52.5) were calculated in the absence of publication bias with low to moderate study heterogeneity measures. All complications occurred in patients under acetylsalicylic acid SAPT. Adequate aneurysm occlusion was described in 65.5% of patients.few retrospective observational studies with moderate heterogeneity, encompassing a limited number of patients treated with variable SAPT regimens. CONCLUSIONS Flow diversion for ruptured aneurysms under SAPT with coated stents is feasible. Although the risk of hemorrhagic complications was low, thromboembolic complications occurred in a significant number of patients, all under ASA SAPT.
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Affiliation(s)
- Matthias Gawlitza
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany; EKFZ for Digital Health, Technical University Dresden, Dresden, Germany.
| | - Joachim Klisch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Erfurt, Germany
| | - Daniel P O Kaiser
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany; EKFZ for Digital Health, Technical University Dresden, Dresden, Germany
| | - Jennifer Linn
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Laurent Pierot
- Department of Neuroradiology, Hôpital Maison Blanche, CHU Reims, Reims, France
| | - Donald Lobsien
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Erfurt, Germany
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11
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Styczen H, Maus V, Goertz L, Köhrmann M, Kleinschnitz C, Fischer S, Möhlenbruch M, Mühlen I, Kallmünzer B, Dorn F, Lakghomi A, Gawlitza M, Kaiser D, Klisch J, Lobsien D, Rohde S, Ellrichmann G, Behme D, Thormann M, Flottmann F, Winkelmeier L, Gizewski ER, Mayer-Suess L, Boeckh-Behrens T, Riederer I, Klingebiel R, Berger B, Schlunz-Hendann M, Grieb D, Khanafer A, du Mesnil de Rochemont R, Arendt C, Altenbernd J, Schlump JU, Ringelstein A, Sanio VJM, Loehr C, Dahlke AM, Brockmann C, Reder S, Sure U, Li Y, Mühl-Benninghaus R, Rodt T, Kallenberg K, Durutya A, Elsharkawy M, Stracke P, Schumann MG, Bock A, Nikoubashman O, Wiesmann M, Henkes H, Mosimann PJ, Chapot R, Forsting M, Deuschl C. Mechanical thrombectomy for acute ischemic stroke in COVID-19 patients: multicenter experience in 111 cases. J Neurointerv Surg 2022; 14:858-862. [PMID: 35292572 PMCID: PMC8931799 DOI: 10.1136/neurintsurg-2022-018723] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/02/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Data on the frequency and outcome of mechanical thrombectomy (MT) for large vessel occlusion (LVO) in patients with COVID-19 is limited. Addressing this subject, we report our multicenter experience. METHODS A retrospective cohort study was performed of consecutive acute stroke patients with COVID-19 infection treated with MT at 26 tertiary care centers between January 2020 and November 2021. Baseline demographics, angiographic outcome and clinical outcome evaluated by the modified Rankin Scale (mRS) at discharge and 90 days were noted. RESULTS We identified 111 out of 11 365 (1%) patients with acute or subsided COVID-19 infection who underwent MT due to LVO. Cardioembolic events were the most common etiology for LVO (38.7%). Median baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program Early CT Score were 16 (IQR 11.5-20) and 9 (IQR 7-10), respectively. Successful reperfusion (mTICI ≥2b) was achieved in 97/111 (87.4%) patients and 46/111 (41.4%) patients were reperfused completely. The procedure-related complication rate was 12.6% (14/111). Functional independence was achieved in 20/108 (18.5%) patients at discharge and 14/66 (21.2%) at 90 days follow-up. The in-hospital mortality rate was 30.6% (33/108). In the subgroup analysis, patients with severe acute COVID-19 infection requiring intubation had a mortality rate twice as high as patients with mild or moderate acute COVID-19 infection. Acute respiratory failure requiring ventilation and time interval from symptom onset to groin puncture were independent predictors for an unfavorable outcome in a logistic regression analysis. CONCLUSION Our study showed a poor clinical outcome and high mortality, especially in patients with severe acute COVID-19 infection undergoing MT due to LVO.
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Affiliation(s)
- Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Volker Maus
- Department of Radiology, Neuroradiology and Nuclear Medicine, University Medical Center Langendreer, Bochum, Germany
| | - Lukas Goertz
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Martin Köhrmann
- Department of Neurology and Center for Translational Neurosciences and Behavioral Sciences (CTNBS), University Hospital Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neurosciences and Behavioral Sciences (CTNBS), University Hospital Essen, Essen, Germany
| | - Sebastian Fischer
- Department of Radiology, Neuroradiology and Nuclear Medicine, University Medical Center Langendreer, Bochum, Germany
| | - Markus Möhlenbruch
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Iris Mühlen
- Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Bernd Kallmünzer
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Asadeh Lakghomi
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Matthias Gawlitza
- Institute and Policlinic of Neuroradiology, Universitatsklinikum Carl Gustav Carus, Dresden, Sachsen, Germany
| | - Daniel Kaiser
- Institute and Policlinic of Neuroradiology, Universitatsklinikum Carl Gustav Carus, Dresden, Sachsen, Germany
| | - Joachim Klisch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Erfurt, Germany
| | - Donald Lobsien
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Erfurt, Germany
| | - Stefan Rohde
- Department of Radiology and Neuroradiology, Klinikum Dortmund gGmbH, Dortmund, Germany
| | - Gisa Ellrichmann
- Department of Neurology, Klinikum Dortmund gGmbH, Dortmund, Germany
| | - Daniel Behme
- Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | | | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Laurens Winkelmeier
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Elke R Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Tobias Boeckh-Behrens
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Isabelle Riederer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Randolf Klingebiel
- Department of Diagnostic and Interventional Neuroradiology, University Hospital OWL (Campus Bethel), Bielefeld, Germany
| | - Björn Berger
- Department of Diagnostic and Interventional Neuroradiology, University Hospital OWL (Campus Bethel), Bielefeld, Germany
| | - Martin Schlunz-Hendann
- Department of Radiology and Neuroradiology, Klinikum Duisburg - Sana Kliniken, Duisburg, Germany
| | - Dominik Grieb
- Department of Radiology and Neuroradiology, Klinikum Duisburg - Sana Kliniken, Duisburg, Germany
| | - Ali Khanafer
- Clinic for Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Christophe Arendt
- Institute of Neuroradiology, University Hospital Frankfurt and Goethe University, Frankfurt am Main, Germany
| | - Jens Altenbernd
- Department of Radiology and Neuroradiology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Jan-Ulrich Schlump
- Department of Neuropediatrics, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Adrian Ringelstein
- Department of Radiology and Neuroradiology, Kliniken Maria Hilf, Moenchengladbach, Germany
| | | | - Christian Loehr
- Department of Radiology and Neuroradiology, Klinikum Vest, Recklinghausen, Germany
| | - Agnes Maria Dahlke
- Department of Radiology and Neuroradiology, Klinikum Vest, Recklinghausen, Germany
| | - Carolin Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany
| | - Sebastian Reder
- Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
| | - Yan Li
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | | | - Thomas Rodt
- Department of Radiology, Klinikum Lueneburg, Lueneburg, Germany
| | - Kai Kallenberg
- Department of Neuroradiology, Klinikum Fulda, Fulda, Germany
| | | | | | - Paul Stracke
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | | | - Alexander Bock
- Department of Neuroradiology, Vivantes Klinikum Neukoelln, Berlin, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Aachen, Aachen, Germany
| | - Hans Henkes
- Clinic for Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany
| | - Pascal J Mosimann
- Department of Neuroradiology, Alfried Krupp Hospital Ruttenscheid, Essen, Germany
| | - René Chapot
- Department of Neuroradiology, Alfried Krupp Hospital Ruttenscheid, Essen, Germany
| | - Michael Forsting
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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12
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Kaiser DPO, Boulouis G, Soize S, Maus V, Fischer S, Lobsien D, Klisch J, Styczen H, Deuschl C, Abdullayev N, Kabbasch C, Jamous A, Behme D, Janot K, Bellanger G, Cognard C, Pierot L, Gawlitza M. Flow Diversion for ICA Aneurysms with Compressive Neuro-Ophthalmologic Symptoms: Predictors of Morbidity, Mortality, and Incomplete Aneurysm Occlusion. AJNR Am J Neuroradiol 2022; 43:998-1003. [PMID: 35738674 DOI: 10.3174/ajnr.a7550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/12/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Flow diversion is an effective treatment for aneurysms of the ICA with compression-related neuro-ophthalmologic symptoms, especially when treatment is initiated early after symptom onset and aneurysm occlusion is complete. However, non-negligible complication rates have been reported. Our aim was to identify risk factors for morbidity/mortality and incomplete aneurysm occlusion. MATERIALS AND METHODS We performed a secondary analysis of a previous publication, which included all patients treated with flow diversion for an unruptured aneurysm of the ICA with compression-related symptoms. RESULTS Fifty-four patients with 54 aneurysms (48 women, 88.9%; mean age, 59.2 [SD, 15.9] years; range, 21-86 years) treated with flow diversion were included. We observed morbidity and mortality rates of 7.4% and 3.7%. Increasing age (OR per decade, 3.2; 95% CI, 1.23-8.49; P = .02) and dual-antiplatelet therapy with ticagrelor (OR, 13.9; 95% CI, 1.16-165.97; P = .04) were significantly associated with morbidity/mortality. After a median follow-up of 13.3 [SD, 10.5] months, the rates of complete aneurysm occlusion, neck remnant, and aneurysm remnant were 74%, 14%, and 12%. Incomplete occlusion at follow-up was less frequently observed in aneurysms treated with additional coil embolization (OR, 0.1; 95% CI, 0.01-0.86; P = .04). CONCLUSIONS Although a promising treatment for compressive ICA aneurysms, flow diversion carries a relevant risk for complications and incomplete aneurysm occlusion. Our results may help identify patients in which flow diversion may not be the ideal treatment method. Additional coil embolization increased the likelihood of complete aneurysm occlusion at follow-up.
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Affiliation(s)
- D P O Kaiser
- From the Institute of Neuroradiology (D.P.O.K., M.G.), University Hospital Carl Gustav Carus, Dresden, Germany.,Else Kröner-Fresenius Center for Digital Health (D.P.O.K., M.G.), Technical University Dresden, Dresden, Germany
| | - G Boulouis
- Department of Neuroradiology (G. Boulouis, K.J.), Regional and University Hospital Center Tours, Tours, France
| | - S Soize
- Department of Neuroradiology (S.S., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire Reims, Reims, France
| | - V Maus
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine (V.M., S.F.), University Hospital Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität, Bochum, Germany
| | - S Fischer
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine (V.M., S.F.), University Hospital Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität, Bochum, Germany
| | - D Lobsien
- Department of Diagnostic and Interventional Radiology and Neuroradiology (D.L., J.K.), Helios General Hospital Erfurt, Erfurt, Germany
| | - J Klisch
- Department of Diagnostic and Interventional Radiology and Neuroradiology (D.L., J.K.), Helios General Hospital Erfurt, Erfurt, Germany
| | - H Styczen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology (H.S., C.D.), University Hospital Essen, Essen, Germany
| | - C Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology (H.S., C.D.), University Hospital Essen, Essen, Germany
| | - N Abdullayev
- Department of Diagnostic and Interventional Radiology (N.A., C.K.), University Hospital Cologne, Cologne, Germany
| | - C Kabbasch
- Department of Diagnostic and Interventional Radiology (N.A., C.K.), University Hospital Cologne, Cologne, Germany
| | - A Jamous
- Institute of Diagnostic and Interventional Neuroradiology (A.J., D.B.), Universitätsmedizin Göttingen, Göttingen, Germany
| | - D Behme
- Institute of Diagnostic and Interventional Neuroradiology (A.J., D.B.), Universitätsmedizin Göttingen, Göttingen, Germany.,Department of Neuroradiology (D.B.), University Hospital Magdeburg, Magdeburg, Germany
| | - K Janot
- Department of Neuroradiology (G. Boulouis, K.J.), Regional and University Hospital Center Tours, Tours, France
| | - G Bellanger
- Diagnostic and Therapeutic Neuroradiology (G. Bellanger, C.C.), Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - C Cognard
- Diagnostic and Therapeutic Neuroradiology (G. Bellanger, C.C.), Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - L Pierot
- Department of Neuroradiology (S.S., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire Reims, Reims, France
| | - M Gawlitza
- From the Institute of Neuroradiology (D.P.O.K., M.G.), University Hospital Carl Gustav Carus, Dresden, Germany .,Else Kröner-Fresenius Center for Digital Health (D.P.O.K., M.G.), Technical University Dresden, Dresden, Germany
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Boulouis G, Soize S, Maus V, Fischer S, Lobsien D, Klisch J, Styczen H, Deuschl C, Abdullayev N, Kabbasch C, Kaiser D, Jamous A, Behme D, Janot K, Bellanger G, Cognard C, Pierot L, Gawlitza M. Flow diversion for internal carotid artery aneurysms with compressive neuro-ophthalmologic symptoms: clinical and anatomical results in an international multicenter study. J Neurointerv Surg 2021; 14:1090-1095. [PMID: 34795018 DOI: 10.1136/neurintsurg-2021-018188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/27/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Scientific data on the safety and efficacy of flow diverter stents (FDS) for the treatment of unruptured internal carotid artery (ICA) aneurysms with compressive neuro-ophthalmological symptoms are scarce. We studied this subject in a retrospective international multicenter series, pooling data of 9 tertiary care neurointerventional departments. OBJECTIVE To investigate, in a retrospective, multicentric cohort of patients presenting with visual or oculomotor symptoms attributed to a compressive carotid artery in an unruptured intracranial aneurysm, the safety and efficacy profiles of FDS, by analyzing neuro-opthalmologic symptom evolution following FDS placement, complications, and aneurysm obliteration rates. METHODS All patients treated since 2015 with a FDS for an unruptured aneurysm of the ICA with signs of compressive cranial nerve symptoms (CN II, III, IV, VI) were included. RESULTS We treated 55 patients with 55 aneurysms; 21 (38.2%) patients had oculomotor and 15 (27.3%) visual symptoms only; 19 (34.5%) presented with a combination of both. Treatment-related morbidity/mortality occurred in 7.2% and 3.6%, respectively. At last imaging follow-up (13.1±10.5 months) rates of complete aneurysm occlusion, neck remnant, and aneurysm remnant were 72%, 14%, and 14%, respectively. At last clinical follow-up after 13±10.5 months, 19/51 (37.3%) patients had recovered completely and 18/51 (35.3%) had recovered at least partially from their neuro-ophthalmological symptoms. In multivariable models, a longer delay between symptom onset and treatment was associated with higher odds for incomplete recovery and lower odds for any improvement (aOR 1.03 (95% CI 1.01 to 1.07), p=0.047 and 0.04 (0-0.81), p=0.020). Incomplete recovery was independently associated with older age and fusiform aneurysms. CONCLUSION FDS are effective to treat patients with compressive aneurysms of the ICA causing neuro-ophthalmological symptoms, especially when treatment is initiated early after symptom onset, and aneurysm occlusion is adequate. However, serious complications are not rare.
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Affiliation(s)
| | - Sebastien Soize
- Department of Neuroradiology, Hôpital Maison Blanche, CHU Reims, Reims, France
| | - Volker Maus
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum,Universitätsklinik der Ruhr-Universität, Bochum, Germany
| | - Sebastian Fischer
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum,Universitätsklinik der Ruhr-Universität, Bochum, Germany
| | - Donald Lobsien
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Joachim Klisch
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Nuran Abdullayev
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Daniel Kaiser
- EKFZ for Digital Health, Dresden University of Technology, Dresden, Germany.,Department of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Ala Jamous
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Daniel Behme
- Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Kevin Janot
- Department of Neuroradiology, CHRU Tours, Tours, France
| | | | - Cristophe Cognard
- Diagnostic and Therapeutic Neuroradiology, CHU Toulouse, Toulouse, France
| | - Laurent Pierot
- Department of Neuroradiology, Hôpital Maison Blanche, CHU Reims, Reims, France
| | - Matthias Gawlitza
- EKFZ for Digital Health, Dresden University of Technology, Dresden, Germany .,Department of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
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Rahmig J, Akgün K, Simon E, Gawlitza M, Hartmann C, Siepmann T, Pallesen LP, Barlinn J, Puetz V, Ziemssen T, Barlinn K. Serum neurofilament light chain levels are associated with stroke severity and functional outcome in patients undergoing endovascular therapy for large vessel occlusion. J Neurol Sci 2021; 429:118063. [PMID: 34488043 DOI: 10.1016/j.jns.2021.118063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/25/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND We aimed to analyze serum neurofilament light chain (sNfL) levels in patients undergoing endovascular therapy (EVT) for anterior circulation large vessel occlusion (acLVO). METHODS Prospective study of consecutive patients with acLVO receiving EVT (12/2020-01/2021). sNfL was serially measured prior to and at 30-min, 6-h, 12-h, 24-h, 48-h and 7-days following EVT. ANOVA and Spearman correlation were run to assess sNfL levels (ie, absolute values) and ΔsNfL levels (ie, absolute values subtracted by baseline value) and their association with clinical (ie, NIHSS), imaging (ie, ASPECTS) surrogates of stroke severity as well as functional outcome (ie, mRS) at 90-days. RESULTS 175 sNfL samples were retrieved from 25 patients. While there were no differences among serial sNfL levels in the first 12-h post-EVT, a constant increase was observed afterwards (maximum day 7, median: 383 [IQR, 209-907] pg/mL, p < 0.001). ΔsNfL showed a constant increase from 30-min measurement onwards peaking after 7 days (median 363.5 [IQR, 114.3-851.1] pg/mL). sNfL levels at 7 days correlated with ASPECTS post-EVT (r = -0.59, p < 0.001), NIHSS at discharge (r = -0.50, p = 0.011) and mRS at 90-days (r = 0.45, p = 0.027). CONCLUSIONS Serum NFL may complement established clinical and imaging predictors of treatment response and functional outcome in stroke patients undergoing EVT for acLVO.
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Affiliation(s)
- Jan Rahmig
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Katja Akgün
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Erik Simon
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Matthias Gawlitza
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Hartmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Lars-Peder Pallesen
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jessica Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Kaiser D, Krukowski P, Hädrich K, Winzer R, Pallesen LP, Gawlitza M, Linn J, Puetz V, Gerber JC. Association of Regular Thrombus Surface Phenotype With Complete Recanalization in First-Line Contact Aspiration Thrombectomy for Basilar Artery Occlusion. Front Neurol 2021; 12:666933. [PMID: 34566832 PMCID: PMC8462661 DOI: 10.3389/fneur.2021.666933] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess whether angiographic thrombus surface phenotype has an impact on efficacy of contact aspiration (CA) thrombectomy in patients with basilar artery occlusion (BAO). Methods: From January 2016 to December 2019, consecutive stroke patients with a BAO and first-line CA were analyzed in this retrospective study. We assessed baseline and imaging characteristics and treatment and clinical outcomes. We rated thrombus surface phenotype on pre-treatment digital subtraction angiography in a three-reader-consensus setting. Primary outcome was complete recanalization (modified treatment in cerebral ischemia [mTICI] 3 and arterial occlusive lesion [AOL] 3) after first-line CA without additionally stent retriever passes. Data analysis was stratified according to thrombus surface phenotype and complete first-line recanalization. Results: Seventy-eight patients met the inclusion criteria. Median age was 74 years (IQR 64-80), 64% were male, and median baseline NIHSS score was 24 (IQR 7-32). Thirty patients had a regular and 16 patients had an irregular thrombus phenotype. Thrombus surface was not assessable in 32 patients. In patients with a regular phenotype, complete recanalization was more often achieved compared to irregular and non-ratable phenotypes (50 vs. 18.8% and 21.9%; p = 0.027). Patients with a regular phenotype [odds ratio [OR] 8.3; 95% confidence interval [CI]: 1.9-35.8; p = 0.005], cardioembolic stroke (OR 12.1, 95% CI: 2.0-72.8; p = 0.007), and proximal end of the thrombus in the middle basilar artery segment (OR 5.2, 95% CI: 1.0-26.6; p = 0.046) were more likely to achieve complete recanalization after first-line CA without rescue therapy. Conclusion: The efficacy of CA may differ according to the angiographic thrombus surface phenotype in patients with BAO. A regular phenotype is associated with higher rates of complete recanalization in first-line CA. However, assessment of thrombus phenotype is frequently not feasible in BAO.
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Affiliation(s)
- Daniel Kaiser
- Institute and Policlinic of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany.,Else Kröner-Fresenius Center for Digital Health, Dresden University of Technology, Dresden, Germany
| | - Pawel Krukowski
- Institute and Policlinic of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Kevin Hädrich
- Institute and Policlinic of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Robert Winzer
- Institute and Policlinic of Radiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Lars-Peder Pallesen
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Matthias Gawlitza
- Institute and Policlinic of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany.,Else Kröner-Fresenius Center for Digital Health, Dresden University of Technology, Dresden, Germany
| | - Jennifer Linn
- Institute and Policlinic of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Johannes C Gerber
- Institute and Policlinic of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
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16
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Styczen H, Fischer S, Gawlitza M, Meyer L, Goertz L, Maurer C, Alexandrou M, Khanafer A, Lobsien D, Deuschl C, Klisch J, Kabbasch C, Fiehler J, Berlis A, Papanagiotou P, Henkes H, Maus V. Reconstructive endovascular treatment of basilar artery fenestration aneurysms: A multi-centre experience and literature review. Neuroradiol J 2021; 35:319-328. [PMID: 34476993 DOI: 10.1177/19714009211042877] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Data on outcome after endovascular treatment of basilar artery fenestration aneurysms (BAFAs) is limited. This study presents our multi-centre experience of BAFAs treated by different reconstructive techniques including coils, stent-assisted coiling (SAC), flow diversion and intra-saccular flow disruption with the Woven Endobridge (WEB). METHODS Retrospective analysis of 38 BAFAs treated endovascularly between 2003 and 2020. The primary endpoint was complete aneurysm obliteration defined as Raymond-Roy occlusion classification (RROC) I on immediate and follow-up (FU) angiography. The secondary endpoints were procedure-related complications, rate of re-treatment, and clinical outcome. RESULTS Endovascular treatment was feasible in 36/38 aneurysms (95%). The most frequent strategy was coiling (21/36, 58%), followed by SAC (7/36, 19%), WEB embolization (6/36, 17%) and flow diversion (2/36, 6%). A successful aneurysm occlusion (defined as RROC 1 and 2) on the final angiogram was achieved in 30/36 (83%) aneurysms including all patients presenting with baseline subarachnoid haemorrhage and 25/36 (69%) were occluded completely. Complete occlusion (RROC 1) was more frequently achieved in ruptured BAFAs (15/25, 60% v. 2/11, 18%; p = 0.031). Procedure-related complications occurred in 3/36 (8%) aneurysms. Re-treatment was executed in 12/36 (33%) aneurysms. After a median angiography FU of 38 months, 30/31 (97%) BAFAs were occluded successfully and 25/31 (81%) showed complete occlusion. CONCLUSION Reconstructive endovascular treatment of BAFAs is technically feasible with a good safety profile. Although in some cases re-treatment was necessary, a high rate of final aneurysm occlusion was achieved.
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Affiliation(s)
- Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Sebastian Fischer
- Department of Radiology, Neuroradiology and Nuclear Medicine, Ruhr-University Bochum, Germany
| | - Matthias Gawlitza
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Germany
| | - Lukas Goertz
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Germany
| | - Christoph Maurer
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Germany
| | - Maria Alexandrou
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte, Germany
| | - Ali Khanafer
- Neuroradiological Clinic, Klinikum Stuttgart, Germany
| | - Donald Lobsien
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Joachim Klisch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Germany
| | - Christoph Kabbasch
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Germany
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Germany
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte, Germany.,Department of Radiology, Aretaieion University Hospital, Greece
| | - Hans Henkes
- Neuroradiological Clinic, Klinikum Stuttgart, Germany
| | - Volker Maus
- Department of Radiology, Neuroradiology and Nuclear Medicine, Ruhr-University Bochum, Germany
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17
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Styczen H, Gawlitza M, Abdullayev N, Brehm A, Serna-Candel C, Fischer S, Gerber J, Kabbasch C, Psychogios MN, Forsting M, Henkes H, Maus V. Mechanical thrombectomy in acute ischaemic stroke patients with pre-interventional intracranial haemorrhage following intravenous thrombolysis. Neuroradiol J 2021; 34:456-461. [PMID: 33840277 PMCID: PMC8551424 DOI: 10.1177/19714009211009112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Data on outcome of endovascular treatment in patients with acute ischaemic
stroke due to large vessel occlusion suffering from intravenous
thrombolysis-associated intracranial haemorrhage prior to mechanical
thrombectomy remain scarce. Addressing this subject, we report our
multicentre experience. Methods A retrospective analysis of consecutive acute ischaemic stroke patients
treated with mechanical thrombectomy due to large vessel occlusion despite
the pre-interventional occurrence of intravenous thrombolysis-associated
intracranial haemorrhage was performed at five tertiary care centres between
January 2010–September 2020. Baseline demographics, aetiology of stroke and
intracranial haemorrhage, angiographic outcome assessed by the Thrombolysis
in Cerebral Infarction score and clinical outcome evaluated by the modified
Rankin Scale at 90 days were recorded. Results In total, six patients were included in the study. Five individuals
demonstrated cerebral intraparenchymal haemorrhage on pre-interventional
imaging; in one patient additional subdural haematoma was observed and one
patient suffered from isolated subarachnoid haemorrhage. All patients except
one were treated by the ‘drip-and-ship’ paradigm. Successful reperfusion was
achieved in 4/6 (67%) individuals. In 5/6 (83%) patients, the
pre-interventional intracranial haemorrhage had aggravated in
post-interventional computed tomography with space-occupying effect.
Overall, five patients had died during the hospital stay. The clinical
outcome of the survivor was modified Rankin Scale=4 at 90 days
follow-up. Conclusion Mechanical thrombectomy in patients with intravenous thrombolysis-associated
intracranial haemorrhage is technically feasible. The clinical outcome of
this subgroup of stroke patients, however, appears to be devastating with
high mortality and only carefully selected patients might benefit from
endovascular treatment.
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Affiliation(s)
- Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Matthias Gawlitza
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Germany
| | - Nuran Abdullayev
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Germany
| | - Alex Brehm
- Department of Neuroradiology, University Hospital Basel, Switzerland
| | | | - Sebastian Fischer
- Department of Radiology, Neuroradiology and Nuclear Medicine, Ruhr-University Bochum, Germany
| | - Johannes Gerber
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Germany
| | - Christoph Kabbasch
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Germany
| | | | - Michael Forsting
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Hans Henkes
- Neuroradiological Clinic, Klinikum Stuttgart, Germany
| | - Volker Maus
- Department of Radiology, Neuroradiology and Nuclear Medicine, Ruhr-University Bochum, Germany
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18
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Soize S, Eymard JB, Cheikh-Rouhou S, Manceau PF, Gelmini C, Sahnoun M, Gawlitza M, Zuber M, Pierot L, Touzé E. Fast Stent Retrieval during Mechanical Thrombectomy Improves Recanalization in Patients with the Negative Susceptibility Vessel Sign. AJNR Am J Neuroradiol 2021; 42:726-731. [PMID: 33574100 DOI: 10.3174/ajnr.a6989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/02/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND PURPOSE In acute ischemic stroke, the negative susceptibility vessel sign on T2*-weighted images traditionally highlights fibrin-rich clots, which are particularly challenging to remove. In vitro, fast stent retrieval improves fibrin-rich clot extraction. We aimed to evaluate whether the speed of stent retrieval influences the recanalization and clinical outcome of patients presenting with the negative susceptibility vessel sign. MATERIALS AND METHODS Patients were identified from a registry of patients with ischemic stroke receiving mechanical thrombectomy between January 2016 and January 2020. Inclusion criteria were the following: 1) acute ischemic stroke caused by an isolated occlusion of the anterior circulation involving the MCA (Internal Carotid Artery-L, M1, M2) within 8 hours of symptom onset; 2) a negative susceptibility vessel sign on prethrombectomy T2*-weighted images; and 3) treatment with a combined technique (stent retriever + contact aspiration). Patients were dichotomized according to retrieval speed (fast versus slow). The primary outcome was the first-pass recanalization rate. RESULTS Of 68 patients who met inclusion criteria, 31 (45.6%) were treated with fast retrieval. Patients receiving a fast retrieval had greater odds of first-pass complete (relative risk and 95% confidence interval [RR 95% CI], 4.30 [1.80-10.24]), near-complete (RR 95% CI, 3.24 [1.57-6.68]), and successful (RR 95% CI, 2.60 [1.53-4.43]) recanalization as well as greater odds of final complete (RR 95% CI, 4.18 [1.93-9.04]), near-complete (RR 95% CI, 2.75 [1.55-4.85]), and successful (RR 95% CI, 1.52 [1.14-2.03]) recanalization. No significant statistical differences in procedure-related serious adverse events, distal embolization, or symptomatic intracranial hemorrhage were reported. No differences were noted in terms of functional independence (RR 95% CI, 1.01 [0.53-1.93]) and all-cause mortality (RR 95% CI, 0.90 [0.35-2.30]) at 90 days. CONCLUSIONS A fast stent retrieval during mechanical thrombectomy is safe and improves the retrieval of clots with the negative susceptibility vessel sign.
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Affiliation(s)
- S Soize
- From the Unité Mixte de recherche-S U1237 (S.S., M.Z., E.T.), Institut National de la Santé et de la Recherche Médicale, Normandie University , Université Caen-Normandie, Cyceron, Caen, France .,Department of Neuroradiology (S.S., J.-B.E., S.C.-R., P.-F.M., C.G., M.S., M.G., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Université de Champagne-Ardenne, Reims, France
| | - J-B Eymard
- Department of Neuroradiology (S.S., J.-B.E., S.C.-R., P.-F.M., C.G., M.S., M.G., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Université de Champagne-Ardenne, Reims, France
| | - S Cheikh-Rouhou
- Department of Neuroradiology (S.S., J.-B.E., S.C.-R., P.-F.M., C.G., M.S., M.G., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Université de Champagne-Ardenne, Reims, France
| | - P-F Manceau
- Department of Neuroradiology (S.S., J.-B.E., S.C.-R., P.-F.M., C.G., M.S., M.G., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Université de Champagne-Ardenne, Reims, France
| | - C Gelmini
- Department of Neuroradiology (S.S., J.-B.E., S.C.-R., P.-F.M., C.G., M.S., M.G., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Université de Champagne-Ardenne, Reims, France
| | - M Sahnoun
- Department of Neuroradiology (S.S., J.-B.E., S.C.-R., P.-F.M., C.G., M.S., M.G., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Université de Champagne-Ardenne, Reims, France
| | - M Gawlitza
- Department of Neuroradiology (S.S., J.-B.E., S.C.-R., P.-F.M., C.G., M.S., M.G., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Université de Champagne-Ardenne, Reims, France
| | - M Zuber
- From the Unité Mixte de recherche-S U1237 (S.S., M.Z., E.T.), Institut National de la Santé et de la Recherche Médicale, Normandie University , Université Caen-Normandie, Cyceron, Caen, France.,Department of Neurology (M.Z.), Université de Paris, Hôpital Saint-Joseph, Paris, France
| | - L Pierot
- Department of Neuroradiology (S.S., J.-B.E., S.C.-R., P.-F.M., C.G., M.S., M.G., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Université de Champagne-Ardenne, Reims, France
| | - E Touzé
- From the Unité Mixte de recherche-S U1237 (S.S., M.Z., E.T.), Institut National de la Santé et de la Recherche Médicale, Normandie University , Université Caen-Normandie, Cyceron, Caen, France.,Department of Neurology (E.T.), Centre Hospitalier Universitaire Caen Normandie, Caen, France
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19
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Apfaltrer P, Wenz H, Böhme J, Gawlitza M, Groden C, Alonso A, Förster A. FLAIR Vascular Hyperintensities Indicate Slow Poststenotic Blood Flow in ICA Stenosis. Clin Neuroradiol 2020; 31:827-831. [PMID: 32865598 DOI: 10.1007/s00062-020-00941-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/24/2019] [Accepted: 07/22/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Occlusion or significant stenosis of the internal carotid artery (ICA) in the cervical segment is commonly associated with a poststenotic decrease in the downstream blood flow and perfusion. Fluid attenuated inversion recovery (FLAIR) vascular hyperintensities (FVH) are a phenomenon that represents slow arterial blood flow. In this study, we investigated the frequency and extent of FVH in the distal ICA in patients with proximal ICA stenosis. METHODS We analyzed the magnetic resonance imaging (MRI) findings in 51 patients with a total of 60 cervical ICA stenoses with special focus on the frequency and extent of FVH in the area of the petrous segment of the ICA on FLAIR images and correlated these with Doppler/duplex sonography results. RESULTS In 46 (76.7%) patients with ICA stenosis, FVH could be detected in the petrous segment of the ICA: in 19 (41.3%) patients a thin hyperintense rim near the vessel wall (grade 1), in 24 (52.2%) patients a strong hyperintense rim near the vessel wall (grade 2), and in 3 (6.5%) patients a hyperintense filling of the entire lumen (grade 3) was observed. The extent of FVH in the ICA in the petrous segment showed a high negative correlation with the poststenotic flow velocity (Spearman correlation, R = -0.75, p < 0.001), and moderate correlation with the degree of ICA stenosis (Spearman correlation, R = 0.51, p< 0.001). CONCLUSION An FVH in the petrous ICA is commonly seen among patients with steno-occlusive disease in proximal ICA and could therefore be useful to recognize a proximal ICA stenosis even on FLAIR images.
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Affiliation(s)
- Paul Apfaltrer
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Holger Wenz
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Johannes Böhme
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Matthias Gawlitza
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Christoph Groden
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Angelika Alonso
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Alex Förster
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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20
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Pierot L, Barbe C, Nguyen HA, Herbreteau D, Gauvrit JY, Januel AC, Bala F, Comby PO, Desal H, Velasco S, Aggour M, Chabert E, Sedat J, Trystram D, Marnat G, Gallas S, Rodesch G, Clarençon F, Soize S, Gawlitza M, Spelle L, White P. Intraoperative Complications of Endovascular Treatment of Intracranial Aneurysms with Coiling or Balloon-assisted Coiling in a Prospective Multicenter Cohort of 1088 Participants: Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm (ARETA) Study. Radiology 2020; 296:E130-E133. [DOI: 10.1148/radiol.2020204013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Soize S, Pierot L, Mirza M, Gunning G, Gilvarry M, Gawlitza M, Vivien D, Zuber M, Touzé E. Fast Stent Retrieval Improves Recanalization Rates of Thrombectomy: Experimental Study on Different Thrombi. AJNR Am J Neuroradiol 2020; 41:1049-1053. [PMID: 32409312 DOI: 10.3174/ajnr.a6559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/02/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE About 20% of patients with acute ischemic stroke due to large-artery occlusion do not achieve recanalization with mechanical thrombectomy. We aimed to determine whether the speed of retrieval of the stent retriever influences the efficacy in removing different clot types. MATERIALS AND METHODS Sixty mechanical thrombectomies were performed using an in vitro pulsatile cerebrovascular circulation model with controlled pressure and flow rate. Experiments were dichotomized into fast and slow retrieval using a wedging technique, in which the stent retriever and distal catheter are retrieved together. We used 3 different clot types: erythrocyte-rich, fibrin-rich, and friable clots. Primary end points were complete (TICI 3) and successful (TICI 2b-3) recanalizations. Secondary measures were distal and new territory embolizations. RESULTS Fast retrieval was more frequently associated with complete (RR = 1.83; 95% CI, 1.12-2.99) and successful recanalization (RR = 1.50; 95% CI, 1.03-2.19) than slow retrieval, without a difference in distal embolization (RR = 0.75; 95% CI, 0.29-1.90). There were no emboli in a new territory. The advantage of fast retrieval over slow retrieval differed according to the clot composition, with a stronger effect with fibrin-rich clots with regard to complete (RR = 4.00; 95% CI, 1.11-14.35; Pint = .04) and successful (Pint = .10) recanalization. CONCLUSIONS In our experimental model, a fast removal improved recanalization rates of mechanical thrombectomy, especially in the case of fibrin-rich clots. An in vivo confirmation is warranted to see whether our findings can have an impact in clinical practice.
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Affiliation(s)
- S Soize
- From the Department of Neuroradiology (S.S., L.P., M. Gawlitza), Hôpital Maison Blanche, Champagne-Ardenne University, Reims, France .,Unité Mixte de Recherche (UMR)-S 1237 Physiopathology and Imaging of Neurological Disorders (S.S., D.V., E.T.), National Institute for Health and Medical Research, Normandie University, Université Caen Normandie, Cyceron, Caen, France
| | - L Pierot
- From the Department of Neuroradiology (S.S., L.P., M. Gawlitza), Hôpital Maison Blanche, Champagne-Ardenne University, Reims, France
| | - M Mirza
- Neuravi/Cerenovus (M.M., G.G., M. Gilvarry), Galway, Ireland
| | - G Gunning
- Neuravi/Cerenovus (M.M., G.G., M. Gilvarry), Galway, Ireland
| | - M Gilvarry
- Neuravi/Cerenovus (M.M., G.G., M. Gilvarry), Galway, Ireland
| | - M Gawlitza
- From the Department of Neuroradiology (S.S., L.P., M. Gawlitza), Hôpital Maison Blanche, Champagne-Ardenne University, Reims, France
| | - D Vivien
- Unité Mixte de Recherche (UMR)-S 1237 Physiopathology and Imaging of Neurological Disorders (S.S., D.V., E.T.), National Institute for Health and Medical Research, Normandie University, Université Caen Normandie, Cyceron, Caen, France
| | - M Zuber
- Department of Neurology (M.Z.), Hôpital Saint-Joseph, Paris Descartes University, Paris, France
| | - E Touzé
- Unité Mixte de Recherche (UMR)-S 1237 Physiopathology and Imaging of Neurological Disorders (S.S., D.V., E.T.), National Institute for Health and Medical Research, Normandie University, Université Caen Normandie, Cyceron, Caen, France
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Pierot L, Barbe C, Nguyen HA, Herbreteau D, Gauvrit JY, Januel AC, Bala F, Comby PO, Desal H, Velasco S, Aggour M, Chabert E, Sedat J, Trystram D, Marnat G, Gallas S, Rodesch G, Clarençon F, Soize S, Gawlitza M, Spelle L, White P. Intraoperative Complications of Endovascular Treatment of Intracranial Aneurysms with Coiling or Balloon-assisted Coiling in a Prospective Multicenter Cohort of 1088 Participants: Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm (ARETA) Study. Radiology 2020; 295:381-389. [DOI: 10.1148/radiol.2020191842] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kaesmacher J, Chaloulos-Iakovidis P, Panos L, Mordasini P, Michel P, Hajdu SD, Ribo M, Requena M, Maegerlein C, Friedrich B, Costalat V, Benali A, Pierot L, Gawlitza M, Schaafsma J, Mendes Pereira V, Gralla J, Fischer U. Mechanical Thrombectomy in Ischemic Stroke Patients With Alberta Stroke Program Early Computed Tomography Score 0-5. Stroke 2020; 50:880-888. [PMID: 30827193 PMCID: PMC6430594 DOI: 10.1161/strokeaha.118.023465] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [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: 12/15/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— If anterior circulation large vessel occlusion acute ischemic stroke patients presenting with ASPECTS 0–5 (Alberta Stroke Program Early CT Score) should be treated with mechanical thrombectomy remains unclear. Purpose of this study was to report on the outcome of patients with ASPECTS 0–5 treated with mechanical thrombectomy and to provide data regarding the effect of successful reperfusion on clinical outcomes and safety measures in these patients. Methods— Multicenter, pooled analysis of 7 institutional prospective registries: Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the SOLITAIRE FR With the Intention for Thrombectomy (Clinical Trial Registration—URL: https://www.clinicaltrials.gov. Unique identifier: NCT03496064). Primary outcome was defined as modified Rankin Scale 0–3 at day 90 (favorable outcome). Secondary outcomes included rates of day 90 modified Rankin Scale 0–2 (functional independence), day 90 mortality and occurrence of symptomatic intracerebral hemorrhage. Multivariable logistic regression analyses were performed to assess the association of successful reperfusion with clinical outcomes. Outputs are displayed as adjusted Odds Ratios (aOR) and 95% CI. Results— Two hundred thirty-seven of 2046 patients included in this registry presented with anterior circulation large vessel occlusion and ASPECTS 0–5. In this subgroup, the overall rates of favorable outcome and mortality at day 90 were 40.1% and 40.9%. Achieving successful reperfusion was independently associated with favorable outcome (aOR, 5.534; 95% CI, 2.363–12.961), functional independence (aOR, 5.583; 95% CI, 1.964–15.873), reduced mortality (aOR, 0.180; 95% CI, 0.083–0.390), and lower rates of symptomatic intracerebral hemorrhage (aOR, 0.235; 95% CI, 0.062–0.887). The mortality-reducing effect remained in patients with ASPECTS 0–4 (aOR, 0.167; 95% CI, 0.056–0.499). Sensitivity analyses did not change the primary results. Conclusions— In patients presenting with ASPECTS 0–5, who were treated with mechanical thrombectomy, successful reperfusion was beneficial without increasing the risk of symptomatic intracerebral hemorrhage. Although the results do not allow for general treatment recommendations, formal testing of mechanical thrombectomy versus best medical treatment in these patients in a randomized controlled trial is warranted.
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Affiliation(s)
- Johannes Kaesmacher
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland.,Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland.,University Institute of Diagnostic, Interventional and Pediatric Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Panagiotis Chaloulos-Iakovidis
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Leonidas Panos
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Pasquale Mordasini
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Patrik Michel
- Department of Neurology (P. Michel) and Department of Radiology (S.D.H.), CHUV Lausanne, Switzerland
| | - Steven D Hajdu
- Department of Neurology (P. Michel) and Department of Radiology (S.D.H.), CHUV Lausanne, Switzerland
| | - Marc Ribo
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain (M. Ribo, M. Requena)
| | - Manuel Requena
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain (M. Ribo, M. Requena)
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Germany (C.M., B.F.)
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Germany (C.M., B.F.)
| | - Vincent Costalat
- Department of Neuroradiology, CHU Montpellier, France (V.C., A.B.), Toronto Western Hospital, ON
| | - Amel Benali
- Department of Neuroradiology, CHU Montpellier, France (V.C., A.B.), Toronto Western Hospital, ON
| | - Laurent Pierot
- Department of Neuroradiology, CHU Reims, France (L.P., M.G.), Toronto Western Hospital, ON
| | - Matthias Gawlitza
- Department of Neuroradiology, CHU Reims, France (L.P., M.G.), Toronto Western Hospital, ON
| | | | | | - Jan Gralla
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Urs Fischer
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
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Michelozzi C, Darcourt J, Guenego A, Januel AC, Tall P, Gawlitza M, Bonneville F, Cognard C. Flow diversion treatment of complex bifurcation aneurysms beyond the circle of Willis: complications, aneurysm sac occlusion, reabsorption, recurrence, and jailed branch modification at follow-up. J Neurosurg 2019; 131:1751-1762. [DOI: 10.3171/2018.7.jns18654] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/19/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe purpose of this study is to present the authors’ medium-term results, with special emphasis on complications, occlusion rate of the aneurysm sac (digital subtraction angiography [DSA] and MRI), and the fate of cortical branches and perforating arteries covered (“jailed”) by the flow diverter (FD) stent.METHODSBetween January 2010 and September 2017, 29 patients (14 female) with 30 aneurysms were treated with an FD stent. Twenty-one aneurysms were at the middle cerebral artery bifurcation, 8 were in the anterior communicating artery region, and 1 was a pericallosal artery bifurcation. Thirty-five cortical branches were covered. A single FD stent was used in all patients. Symptomatic and asymptomatic periprocedural and delayed complications were reported. DSA and MRI controls were analyzed to evaluate modification of the aneurysm sac and jailed branches.RESULTSPermanent morbidity was 3.4% (1/29), due to a jailed branch occlusion, with a modified Rankin Scale (mRS) score of 2 at the last follow-up. Mortality and permanent complication with poor prognosis (mRS score > 2) rates were 0%. The mean follow-up time for DSA and MRI (mean ± SD) was 21 ± 14.5 months (range 3–66 months) and 19 ± 16 months (range 3–41 months), respectively. The mean time to aneurysm sac occlusion (available for 24 patients), including stable remodeling, was 11.8 ± 6 months (median 13, range 3–27 months). The overall occlusion rate was 82.1% (23/28), and it was 91.7% (22/24) in the group of patients with at least 2 DSA control sequences. One recanalization occurred at 41 months posttreatment. At the time of publication, at the latest follow-up, 7 (20%) of 35 covered branches were occluded, 18 (51.4%) showed a decreased caliber, and the remaining 10 (28.5%) were unchanged. MRI T2-weighted sequences showed complete sac reabsorption in 7/29 aneurysms (24.1%), and the remaining lesions were either smaller (55.2%) or unchanged (17.2%). MRI revealed asymptomatic and symptomatic ischemic events in perforator territories in 7/28 (25%) and 4/28 (14.3%) patients, respectively, which were reversible within 24 hours.CONCLUSIONSFlow diversion of bifurcation aneurysms is feasible, with low rates of permanent morbidity and mortality and high occlusion rates; however, recurrence may occur. Caliber reduction and asymptomatic occlusion of covered cortical branches as well as silent perforator stroke are common. Ischemic complications may occur with no identified predictable factors. MRI controls should be required in all patients to evaluate silent ischemic lesions and aneurysm sac reabsorption over time.
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Affiliation(s)
- Caterina Michelozzi
- 1Service de Neuroradiologie, Hôpital Pierre-Paul Riquet, CHU de Toulouse; and
| | - Jean Darcourt
- 1Service de Neuroradiologie, Hôpital Pierre-Paul Riquet, CHU de Toulouse; and
| | - Adrien Guenego
- 1Service de Neuroradiologie, Hôpital Pierre-Paul Riquet, CHU de Toulouse; and
| | | | - Philippe Tall
- 1Service de Neuroradiologie, Hôpital Pierre-Paul Riquet, CHU de Toulouse; and
| | | | - Fabrice Bonneville
- 1Service de Neuroradiologie, Hôpital Pierre-Paul Riquet, CHU de Toulouse; and
| | - Christophe Cognard
- 1Service de Neuroradiologie, Hôpital Pierre-Paul Riquet, CHU de Toulouse; and
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25
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Guerreiro-Simoes R, Soize S, Gawlitza M, Manceau PF, Pierot L. Intracranial aneurysms treatment with Barricade coils: Safety and 1-year efficacy in a prospective, single-center series. J Neuroradiol 2019; 46:331-335. [DOI: 10.1016/j.neurad.2018.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
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26
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Meinel TR, Kaesmacher J, Chaloulos-Iakovidis P, Panos L, Mordasini P, Mosimann PJ, Michel P, Hajdu S, Ribo M, Requena M, Maegerlein C, Friedrich B, Costalat V, Benali A, Pierot L, Gawlitza M, Schaafsma J, Pereira VM, Gralla J, Fischer U. Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation. J Neurointerv Surg 2019; 11:1174-1180. [PMID: 31239331 PMCID: PMC6902072 DOI: 10.1136/neurintsurg-2018-014516] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [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: 11/26/2018] [Revised: 04/03/2019] [Accepted: 04/11/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Performing mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO) is currently not evidence-based. OBJECTIVE To compare patients' outcome, relative merits of achieving recanalization, and predictors of futile recanalization (FR) between BAO and anterior circulation large vessel occlusion (ACLVO) MT. METHODS In the multicenter BEYOND-SWIFT registry (NCT03496064), univariate and multivariate (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI) outcome comparisons between BAO (N=165) and ACLVO (N=1574) were performed. The primary outcome was favorable outcome at 90 days (modified Rankin Scale, mRS 0-2). Secondary outcome included mortality, symptomatic intracranial hemorrhage (sICH) and FR. The relative merits of achieving successful recanalization between ACLVO and BAO were evaluated with interaction terms. RESULTS MT in BAO was more often technically effective and equally safe in regards to mortality and sICH when compared to ACLVO. When adjusting for baseline differences, there was no significant difference between BAO vs ACLVO regarding rates of favorable outcome (aOR 0.986, 95%-CI 0.553 - 1.758). However, BAO were associated with increased rates of FR (aOR 2.146, 95%-CI 1.267 - 3.633). Predictors for FR were age, stroke severity, maneuver count and intracranial stenting. No significant heterogeneity on the relative merits of achieving successful recanalization on several outcome parameters were observed when comparing BAO and ACLVO. CONCLUSIONS In selected patients, similar outcomes can be achieved in BAO and ACLVO patients treated with MT. Randomized controlled trials comparing patient selection and interventional strategies seem warranted to avoid FR. TRIAL REGISTRATION NUMBER NCT03496064.
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Affiliation(s)
- Thomas Raphael Meinel
- Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric Radiology and Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | | | - Leonidas Panos
- Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- Department for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal J Mosimann
- Department for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrik Michel
- Department of Neurology, CHUV Lausanne, Lausanne, Switzerland
| | - Steven Hajdu
- Department of Interventional and Diagnostic Neuroradiology, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - Marc Ribo
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Requena
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - Vincent Costalat
- Department of Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
| | - Amel Benali
- Department of Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
| | - Laurent Pierot
- Department of Neuroradiology, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Matthias Gawlitza
- Department of Neuroradiology, Centre Hospitalier Universitaire de Reims, Reims, France
| | | | - Vitor M Pereira
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jan Gralla
- Department for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Meinel TR, Kaesmacher J, Mordasini P, Mosimann PJ, Jung S, Arnold M, Heldner MR, Michel P, Hajdu SD, Ribo M, Requena M, Maegerlein C, Friedrich B, Costalat V, Benali A, Pierot L, Gawlitza M, Schaafsma J, Pereira VM, Gralla J, Fischer U. Outcome, efficacy and safety of endovascular thrombectomy in ischaemic stroke according to time to reperfusion: data from a multicentre registry. Ther Adv Neurol Disord 2019; 12:1756286419835708. [PMID: 30944585 PMCID: PMC6437320 DOI: 10.1177/1756286419835708] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/03/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE In acute ischaemic stroke (AIS) of the anterior circulation (AC) treated with mechanical thrombectomy (MT), data point to a decline of treatment effect with increasing time from symptom onset to treatment. However, the magnitude of the decline will depend on the clinical setting and imaging selection used. The aims of this study were (1) to evaluate the clinical effect of time to reperfusion (TTR); and (2) to assess the safety and technical efficacy of MT according to strata of TTR. METHODS Using the retrospective multicentre BEYOND-SWIFT registry data (ClinicalTrials.gov identifier: NCT03496064), we compared safety and efficacy of MT in 1461 patients between TTR strata of 0-180 min (n = 192), 180-360 min (n = 876) and >360 min (n = 393). Clinical effect of TTR was evaluated using multivariable logistic regression analyses adjusting for pre-specified confounders [adjusted odds ratios (aOR) and 95% confidence intervals (95% CI)]. Primary outcome was good functional outcome (modified Rankin Scale: mRS 0-2) at day 90. RESULTS Every hour delay in TTR was a significant factor related to mRS 0-2 (aOR 0.933, 95% CI 0.887-0.981) with an estimated 1.5% decreased probability of good functional outcome per hour delay of reperfusion, and mRS 0-1 (aOR 0.929, 95% CI 0.877-0.985). Patients with late TTR had lower rates of successful and excellent reperfusion, higher complication rates and number of passes. CONCLUSIONS TTR is an independent factor related to long-term functional outcome. With increasing TTR, interventional procedures become technically less effective. Efforts should be made to shorten TTR through optimized prehospital and in-hospital pathways.
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Affiliation(s)
- Thomas Raphael Meinel
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric Radiology and Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Pascal J. Mosimann
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Mirjam Rachel Heldner
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Patrik Michel
- Department of Neurology, CHUV Lausanne, Lausanne, Switzerland
| | - Steven D. Hajdu
- Department of Radiology, CHUV Lausanne, Lausanne, Switzerland
| | - Marc Ribo
- Department of Neurology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Manuel Requena
- Department of Neurology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Vincent Costalat
- Department of Neuroradiology, CHU Montpellier, Montpellier, France
| | - Amel Benali
- Department of Neuroradiology, CHU Montpellier, Montpellier, France
| | - Laurent Pierot
- Department of Neurology, Toronto Western Hospital, Toronto, Canada
| | | | - Joanna Schaafsma
- Department of Neurology, Toronto Western Hospital, Toronto, Canada
| | | | - Jan Gralla
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 8, CH-3010, Switzerland
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Gawlitza M, Soize S, Barbe C, le Clainche A, White P, Spelle L, Pierot L. Aneurysm Characteristics, Study Population, and Endovascular Techniques for the Treatment of Intracranial Aneurysms in a Large, Prospective, Multicenter Cohort: Results of the Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm Study. AJNR Am J Neuroradiol 2019; 40:517-523. [PMID: 30819769 DOI: 10.3174/ajnr.a5991] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 08/15/2018] [Accepted: 12/25/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm (ARETA) prospective study aims to determine factors predicting recurrence after endovascular treatment for intracranial aneurysms. In this publication, we review endovascular techniques and present the study population. Characteristics of treated and untreated unruptured aneurysms were analyzed. MATERIALS AND METHODS Sixteen neurointerventional departments prospectively enrolled patients treated for ruptured and unruptured intracranial aneurysms between December 2013 and May 2015. Patient demographics, aneurysm characteristics, and endovascular techniques were recorded. RESULTS A total of 1289 patients with 1761 intracranial aneurysms, 835 (47.4%) ruptured, were enrolled. Of these, 1359 intracranial aneurysms were treated by endovascular means. Ruptured intracranial aneurysms were treated by coiling and balloon-assisted coiling in 97.8% of cases. In unruptured intracranial aneurysms, the rates of flow diversion, flow disruption, and stent-assisted coiling were 11.6%, 6.9%, and 7.8%, respectively. Rupture status and aneurysm location, neck diameter, and sac size significantly influenced the chosen technique. Treated unruptured intracranial aneurysms, compared with untreated counterparts, had larger aneurysm sacs (7.6 ± 4.0 versus 3.4 ± 2.0 mm; P < 0.001) and neck dimensions (4.1 ± 2.2 versus 2.4 ± 1.3 mm; P < 0.001) and more frequently an irregular form (84.6% versus 44.4%; P < 0.001). Also, its location influenced whether an unruptured intracranial aneurysm was treated. CONCLUSIONS Our study provides an overview of current neurointerventional practice in the ARETA cohort. The technique choice was influenced by aneurysm morphology, location, and rupture status. Flow diversion, flow disruption, and stent-assisted coiling were commonly used in unruptured intracranial aneurysms, while most ruptured intracranial aneurysms were treated with coiling and balloon-assisted coiling.
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Affiliation(s)
- M Gawlitza
- From the Department of Neuroradiology (M.G., S.S., L.P.), Hôpital Maison-Blanche, Centre Hospitalier Universitaire Reims, Reims, France
| | - S Soize
- From the Department of Neuroradiology (M.G., S.S., L.P.), Hôpital Maison-Blanche, Centre Hospitalier Universitaire Reims, Reims, France
| | - C Barbe
- Department of Research and Public Health (C.B., A.l.C.), Hôpital Robert Debré, Centre Hospitalier Universitaire Reims, Reims, France
| | - A le Clainche
- Department of Research and Public Health (C.B., A.l.C.), Hôpital Robert Debré, Centre Hospitalier Universitaire Reims, Reims, France
| | - P White
- Department of Neuroradiology (P.W.), Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - L Spelle
- Interventional Neuroradiology (L.S.), NEURI Center, Hopital Bicêtre, Le Kremlin-Bicêtre, France
| | - L Pierot
- From the Department of Neuroradiology (M.G., S.S., L.P.), Hôpital Maison-Blanche, Centre Hospitalier Universitaire Reims, Reims, France
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29
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Kaesmacher J, Chaloulos-Iakovidis P, Panos L, Mordasini P, Heldner MR, Kurmann CC, Michel P, Hajdu SD, Ribo M, Requena M, Maegerlein C, Friedrich B, Costalat V, Benali A, Pierot L, Gawlitza M, Schaafsma J, Pereira VM, Gralla J, Fischer U. Clinical effect of successful reperfusion in patients presenting with NIHSS < 8: data from the BEYOND-SWIFT registry. J Neurol 2019; 266:598-608. [PMID: 30617997 PMCID: PMC6394689 DOI: 10.1007/s00415-018-09172-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/22/2018] [Accepted: 12/25/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE If patients presenting with large vessel occlusions (LVO) and mild symptoms should be treated with endvoascular treatment (EVT) remains unclear. Aims of this study were (1) assessing the safety and technical efficacy of EVT in patients with NIHSS < 8 as opposed to a comparison group of patients presenting with NIHSS ≥ 8 and (2) evaluation of the clinical effect of reperfusion in patients with NIHSS < 8. METHODS Patients included into the retrospective multicenter BEYOND-SWIFT registry (NCT03496064) were analyzed. Clinical effect of achieving successful reperfusion (defined as modified Thrombolysis in Cerebral Infarction grade 2b/3) in patients presenting with NIHSS < 8 (N = 193) was evaluated using multivariable logistic regression analyses (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI). Primary outcome was excellent functional outcome (modified Rankin Scale, mRS 0-1) at day 90. Safety and efficacy of mechanical thrombectomy in patients with NIHSS < 8 was compared to patients presenting with NIHSS ≥ 8 (N = 1423). RESULTS Among patients with NIHSS < 8 (N = 193, 77/193, 39.9% receiving pre-interventional IV-tPA), successful reperfusion was significantly related to mRS 0-1 (aOR 3.217, 95%-CI 1.174-8.816) and reduced the chances of non-hemorrhagic neurological worsening (aOR 0.194, 95%-CI 0.050-0.756) after adjusting for prespecified confounders. In interaction analyses, the relative merits of achieving successful reperfusion were mostly comparable between patients presenting with NIHSS < 8 and NIHSS ≥ 8 as evidenced by non-significantly different aOR. Interventional safety and efficacy metrics were similar between patients with NIHSS < 8 and NIHSS ≥ 8. CONCLUSIONS Achieving successful reperfusion is beneficial in patients with persisting LVO presenting with NIHSS < 8 and reduces the risk of non-hemorrhagic neurological worsening.
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Affiliation(s)
- Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Panagiotis Chaloulos-Iakovidis
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Leonidas Panos
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Christoph C Kurmann
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Patrik Michel
- Department of Neurology, CHUV Lausanne, Lausanne, Switzerland
| | - Steven D Hajdu
- Department of Radiology, CHUV Lausanne, Lausanne, Switzerland
| | - Marc Ribo
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Requena
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Vincent Costalat
- Department of Neuroradiology, CHU Montpellier, Montpellier, France
| | - Amel Benali
- Department of Neuroradiology, CHU Montpellier, Montpellier, France
| | | | | | - Joanna Schaafsma
- Department of Neurology, Toronto Western Hospital, Toronto, ON, Canada
| | - Vitor Mendes Pereira
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, ON, Canada
| | - Jan Gralla
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland.
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Gawlitza M, Soize S, Manceau PF, Pierot L. An update on intrasaccular flow disruption for the treatment of intracranial aneurysms. Expert Rev Med Devices 2019; 16:229-236. [DOI: 10.1080/17434440.2019.1584035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Matthias Gawlitza
- Service de neuroradiologie, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Sébastien Soize
- Service de neuroradiologie, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Pierre-François Manceau
- Service de neuroradiologie, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Laurent Pierot
- Service de neuroradiologie, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Reims, France
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Soize S, Fabre G, Gawlitza M, Serre I, Bakchine S, Manceau PF, Pierot L. Can early neurological improvement after mechanical thrombectomy be used as a surrogate for final stroke outcome? J Neurointerv Surg 2018; 11:450-454. [DOI: 10.1136/neurintsurg-2018-014332] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 11/04/2022]
Abstract
Background and purposeWe aimed to identify the best definition of early neurological improvement (ENI) at 2 and 24 hours after mechanical thrombectomy (MT) and determine its ability to predict a good functional outcome at 3 months.MethodsThis retrospective analysis was based on a prospectively collected registry of patients treated by MT for ischemic stroke from May 2010 to March 2017. We included patients treated with stent-retrievers with National Institute of Health Stroke Scale (NIHSS) score before treatment and at 2 and/or 24 hours after treatment and modified Rankin Score (mRS) at 3 months. Receiver operating characteristic curve analysis was performed to estimate optimal thresholds for ENI at 2 and 24 hours. The relationship between optimal ENI definitions and good outcome at 3 months (mRS 0–2) was assessed by logistic regression.ResultsThe analysis included 246 patients. At 2 hours, the optimal threshold to predict a good outcome at 3 months was improvementin the NIHSS score of >1 point (AUC 0.83,95% CI 0.77 to 0.87), with sensitivity and specificity 78.3% (62.2–85.7%) and 84.6% (77.2–90.3%), respectively, and OR 12.67 (95% CI 4.69 to 31.10, p<0.0001). At 24 hours, the optimal threshold was an improvementin the NIHSS score of >4 points (AUC 0.93, 95% CI 0.89 to 0.96), with sensitivity and specificity 93.8% (87.7–97.5%) and 83.2% (75.7–89.2%), respectively, and OR 391.32 (95% CI 44.43 to 3448.35, p<0.0001).ConclusionsENI 24 hours after thrombectomy appears to be a straightforward surrogate of long-term endpoints and may have value in future research.
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Blassiau A, Gawlitza M, Manceau PF, Bakchine S, Serre I, Soize S, Pierot L. Mechanical Thrombectomy for Tandem Occlusions of the Internal Carotid Artery-Results of a Conservative Approach for the Extracranial Lesion. Front Neurol 2018; 9:928. [PMID: 30455664 PMCID: PMC6230960 DOI: 10.3389/fneur.2018.00928] [Citation(s) in RCA: 12] [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: 08/15/2018] [Accepted: 10/12/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Mechanical thrombectomy (MT) is of clinical benefit for patients with extracranial-intracranial tandem lesions of anterior circulation. However, the optimal approach to the cervical lesion of the internal carotid artery (ICA) during MT has yet to be established. Data on a conservative approach for the proximal lesion during the acute phase are scarce. Methods: A retrospective study on an institutional, prospective database was conducted. We included patients with anterior circulation stroke presenting with a tandem lesion that was approached conservatively during MT. Results: Thirty-five 35 patients were included, of whom 25 (71.4%) had an atheromatous ICA lesion and 10 (28.6%) a dissection. Despite implementing a conservative strategy, acute percutaneous transluminal angioplasty (PTA) and/or stenting was necessary in 8 (22.9%) and 3 patients (8.6%), respectively. Of 27 surviving patients, 7 (25.9%) underwent delayed treatment of the ICA lesion. No new embolic events occurred between MT and delayed treatment. A favorable clinical outcome (mRS ≤ 2) was achieved in 15/35 patients (45.7%) and was associated with higher baseline ASPECTS (OR 1.62, 95% CI 1.08–2.45, p = 0.002) and successful recanalization (OR 9.39, 95% CI 1.92–45.80, p = 0.0005). Successful recanalization (TICI ≥ 2B) itself was observed in 54.3% of patients and was more likely with acute treatment of the proximal ICA lesion (OR 6.3, 95% CI 11–35.67, p = 0.03) and, more importantly, by the use of distal access catheters (OR 16.25, 95% CI 3.06–86.41, p = 0.0001). Conclusion: A conservative approach for ICA lesions during MT is feasible and offers favorable outcomes and successful recanalization for a significant proportion of patients. However, acute treatment of the cervical lesion is often necessary (31.4%) to make the distal occlusion accessible. Clinical outcome is influenced by the size of the baseline ischemic core and by successful recanalization; the latter is strongly favored by the use of distal access catheters to pass the proximal lesion. The fact that acute treatment of the ICA lesion favored intracranial recanalization but had no effect on clinical outcome is probably due to sample size, emphasizing the need for large scale, randomized studies to determine the optimal treatment strategy for this pathology.
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Affiliation(s)
| | | | | | - Serge Bakchine
- Department of Neurology, Hôpital Maison-Blanche, Reims, France
| | - Isabelle Serre
- Department of Neurology, Hôpital Maison-Blanche, Reims, France
| | - Sébastien Soize
- Department of Neuroradiology, Hôpital Maison-Blanche, Reims, France
| | - Laurent Pierot
- Department of Neuroradiology, Hôpital Maison-Blanche, Reims, France
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Manceau PF, Soize S, Gawlitza M, Fabre G, Bakchine S, Durot C, Serre I, Metaxas GE, Pierot L. Existe-t-il un bénéfice de la thrombectomie mécanique chez les patients atteints d’AVC ischémiques étendus (DWI-ASPECTS ≤ 5) ? J Neuroradiol 2018. [DOI: 10.1016/j.neurad.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Soize S, Fabre G, Manceau PF, Durot C, Gawlitza M, Metaxas G, Serre I, Bakchine S, Pierot L. L’amélioration neurologique précoce est un marqueur simple et fiable du succès de la thrombectomie mécanique. J Neuroradiol 2018. [DOI: 10.1016/j.neurad.2018.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Soize S, Gawlitza M, Pierot L. Complications du traitement endovasculaire des anévrismes cérébraux : incidences, analyses en sous-groupes et facteurs de risques issus de l’étude ARETA. J Neuroradiol 2018. [DOI: 10.1016/j.neurad.2017.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Jonas S, Krenzien F, Atanasov G, Hau HM, Gawlitza M, Moche M, Wiltberger G, Pratschke J, Schmelzle M. Hilar en bloc resection for hilar cholangiocarcinoma in patients with limited liver capacities-preserving parts of liver segment 4. Eur Surg 2018; 50:22-29. [PMID: 30459814 PMCID: PMC6223732 DOI: 10.1007/s10353-017-0507-8] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/12/2017] [Indexed: 01/15/2023]
Abstract
Background A right trisectionectomy with portal vein resection represents the conventional approach for hilar cholangiocarcinoma. Here, we present a technical modification of hilar en bloc resection in order to increase the remnant volume by partially preserving liver segment 4. Methods The caudal parenchymal dissection line starts centrally between the left lateral and left medial segments. Cranially, the resection line switches to the right towards Cantlie's line and turns again upwards perpendicularly. Hence, segment 4a and subtotal segment 4b are partially preserved by this novel technique. The left hepatic duct is dissected at the segmental ramification and reconstruction is performed as a single hepaticojejunostomy. The feasibility of the novel parenchyma-sparing approach for hilar cholangiocarcinoma was proven in a case series and medical records were reviewed retrospectively. Results Ten patients (6 male, 4 female) underwent segment 4 partially preserving right trisectionectomy for hilar cholangiocarcinoma. Estimated future liver remnant volume was significantly increased (FLRV 38.3%), when compared to standard right trisectionectomy (FLRV 23.9%; p < 0.01). Three of 10 liver resections were associated with major surgical complications (≥IIIb; n = 3); categorized according to the Dindo-Clavien classification. No patient died due to complications associated with postoperatively impaired liver function. Tumor-free margins could be achieved in 8 patients while median overall survival and disease-free survival were 547 and 367 days, respectively. Conclusion This novel parenchyma-sparing modification of hilar en bloc resection by partially preserving segment 4 allows to safely increase the remnant liver volume without neglecting principles of local radicality.
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Affiliation(s)
- Sven Jonas
- Department of Surgery, 310Klinik, Nürnberg, Germany
| | - Felix Krenzien
- 2Department of Surgery, Campus Virchow-Klinikum and Campus Mitte, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Georgi Atanasov
- 2Department of Surgery, Campus Virchow-Klinikum and Campus Mitte, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Hans-Michael Hau
- 3Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Matthias Gawlitza
- Department of Diagnostic and Interventional Radiology, 310Klinik, Nürnberg, Germany
| | - Michael Moche
- Department of Diagnostic and Interventional Radiology, 310Klinik, Nürnberg, Germany
| | - Georg Wiltberger
- 3Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Johann Pratschke
- 2Department of Surgery, Campus Virchow-Klinikum and Campus Mitte, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Moritz Schmelzle
- 2Department of Surgery, Campus Virchow-Klinikum and Campus Mitte, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
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Gawlitza M, Soize S, Januel AC, Mihalea C, Metaxas GE, Cognard C, Pierot L. Treatment of recurrent aneurysms using the Woven EndoBridge (WEB): anatomical and clinical results. J Neurointerv Surg 2017; 10:629-633. [PMID: 29054913 PMCID: PMC6031282 DOI: 10.1136/neurintsurg-2017-013287] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 06/27/2017] [Revised: 09/27/2017] [Accepted: 09/30/2017] [Indexed: 11/16/2022]
Abstract
Background The safety and efficacy of the Woven EndoBridge (WEB) for the treatment of naïve intracranial aneurysms has been confirmed. Purpose To analyze the safety and efficacy of the WEB in the treatment of recurrent aneurysms. Methods Anatomical and clinical results in consecutive patients with a recurrent aneurysm, who were treated using the WEB device in two French neurointerventional centers, were evaluated. Results Seventeen patients with 17 aneurysms were included. Treatment was feasible in 16 patients. In seven patients (41.2%), ancillary devices were used. Permanent morbidity due to a thromboembolic complication occurred in one patient (5.9%). There was no mortality. Follow-up angiographic studies were available for 15 patients after a mean of 12.1±6.1 months. Rates of complete occlusion, neck remnant, and aneurysm remnant were 33.3%, 40.0%, and 26.7%, respectively. Conclusions Treatment of recurrent aneurysms using the WEB device may be reasonably safe and effective.
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Affiliation(s)
- Matthias Gawlitza
- Service de Neuroradiologie, Hôpital Maison Blanche, CHU de Reims, Reims, France
| | - Sebastien Soize
- Service de Neuroradiologie, Hôpital Maison Blanche, CHU de Reims, Reims, France
| | - Anne-Christine Januel
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Purpan, CHU de Toulouse, Toulouse, France
| | - Cristian Mihalea
- Service de Neuroradiologie Interventionnelle, NEURI, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Christophe Cognard
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Purpan, CHU de Toulouse, Toulouse, France
| | - Laurent Pierot
- Service de Neuroradiologie, Hôpital Maison Blanche, CHU de Reims, Reims, France
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Manceau PF, Soize S, Gawlitza M, Fabre G, Bakchine S, Durot C, Serre I, Metaxas GE, Pierot L. Is there a benefit of mechanical thrombectomy in patients with large stroke (DWI-ASPECTS ≤ 5)? Eur J Neurol 2017; 25:105-110. [DOI: 10.1111/ene.13460] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 09/06/2017] [Indexed: 12/17/2022]
Affiliation(s)
- P. -F. Manceau
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - S. Soize
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - M. Gawlitza
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - G. Fabre
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - S. Bakchine
- Department of Neurology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - C. Durot
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - I. Serre
- Department of Neurology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - G. -E. Metaxas
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
| | - L. Pierot
- Department of Neuroradiology; CHU Reims; Hôpital Maison Blanche; Université Reims-Champagne Ardenne; Reims France
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Pierot L, Gawlitza M, Soize S. Techniques for endovascular treatment of acute ischemic stroke. Rev Neurol (Paris) 2017; 173:594-599. [PMID: 28982494 DOI: 10.1016/j.neurol.2017.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 08/23/2017] [Revised: 08/30/2017] [Accepted: 09/12/2017] [Indexed: 01/19/2023]
Abstract
Early recanalization of occluded vessels in patients with acute ischemic stroke (AIS) by either intravenous thrombolysis (IVT) or endovascular revascularization has been shown to be associated with improved clinical outcomes and reduced mortality. Since the initial report regarding endovascular treatment (EVT) of AIS in 1983, endovascular techniques have been tremendously improved, advancing from intra-arterial administration of thrombolytic drugs to stent retrievers. IVT has been evaluated in several large randomized trials and has been shown to improve clinical outcomes at 90 days if treatment was initiated within 3h of stroke onset, while its benefit at 3-4.5h was subsequently demonstrated in the European Cooperative Acute Stroke Study (ECASS) III. Thus, EVT had to be evaluated against IVT. The first randomized controlled trials (RCTs) were published in 2013, and demonstrated no major differences between IVT and EVT for AIS, although these trials had important limitations. The positive results of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke (MR CLEAN) in the Netherlands, followed by five other positive RCTs, finally established the efficacy of mechanical thrombectomy (MT) with stent retrievers (also called 'stentrievers') in AIS due to large vessel occlusion within 6h of stroke onset. Currently, the European and US guidelines recommend MT with stent retrievers as a first-line treatment in the management of AIS. The recent publication of the DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late-Presenting Strokes Undergoing Neurointervention (DAWN) trial is expected to lead to extension of the time window for patients carefully selected by imaging. Thus, optimizing the selection of patients as well as the EVT procedures and techniques used is still an important goal to be evaluated in further trials.
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Affiliation(s)
- L Pierot
- Department of Neuroradiology, hôpital Maison-Blanche, université Reims-Champagne-Ardenne, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - M Gawlitza
- Department of Neuroradiology, hôpital Maison-Blanche, université Reims-Champagne-Ardenne, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - S Soize
- Department of Neuroradiology, hôpital Maison-Blanche, université Reims-Champagne-Ardenne, 45, rue Cognacq-Jay, 51092 Reims cedex, France
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Surova G, Gawlitza M, Hegerl U, Hoffmann K, Lobsien D, Schönknecht P, Olbrich S. P 24 Electrophysiological connectivity during oscillatory cycles of alpha activity and the BOLD-signal correlate in major depression. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pierot L, Gawlitza M, Soize S. Unruptured intracranial aneurysms: management strategy and current endovascular treatment options. Expert Rev Neurother 2017; 17:977-986. [DOI: 10.1080/14737175.2017.1371593] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Laurent Pierot
- Department of Neuroradiology, CHU Reims, University Reims-Champagne-Ardenne, Reims, France
| | - Matthias Gawlitza
- Department of Neuroradiology, CHU Reims, University Reims-Champagne-Ardenne, Reims, France
| | - Sébastien Soize
- Department of Neuroradiology, CHU Reims, University Reims-Champagne-Ardenne, Reims, France
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Schaudinn A, Friedrich B, Raviolo M, Fritzsch D, Quäschling U, Hoffmann K, Lobsien D, Gawlitza M. Der Kollateralstatus beim akuten Schlaganfall: Die Rolle des Capillary Index Score (CIS) in Korrelation zu Parametern der Perfusions-CT. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600406] [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: 10/19/2022]
Affiliation(s)
- A Schaudinn
- Universitätsklinikum Leipzig, Klinik für Diagnostische und Interventionelle Radiologie, Leipzig
| | - B Friedrich
- Klinikum rechts der Isar, Technische Universität München, Abteilung für Diagnostische und Interventionelle Neuroradiologie, München
| | - M Raviolo
- Universitätsklinikum Leipzig, Abteilung für Neuroradiologie, Leipzig
| | - D Fritzsch
- Diakonissenkrankenhaus Leipzig, Abteilung für Radiologie, Leipzig
| | - U Quäschling
- Universitätsklinikum Leipzig, Abteilung für Neuroradiologie, Leipzig
| | - K Hoffmann
- Universitätsklinikum Leipzig, Abteilung für Neuroradiologie, Leipzig
| | - D Lobsien
- Abteilung für Neuroradiologie, Klinik für Diagnostische und Interventionelle Radiologie, Leipzig
| | - M Gawlitza
- Hôpital Maison Blanche, Centre Hospitalier Universitaire Reims, Service de Neuroradiologie, Reims
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Gawlitza M, Böhme J, Maros M, Lobsien D, Michalski D, Groden C, Hoffmann KT, Förster A. FLAIR vascular hyperintensities and 4D MR angiograms for the estimation of collateral blood flow in anterior cerebral artery ischemia. PLoS One 2017; 12:e0172570. [PMID: 28234996 PMCID: PMC5325299 DOI: 10.1371/journal.pone.0172570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 01/23/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess FLAIR vascular hyperintensities (FVH) and dynamic (4D) angiograms derived from perfusion raw data as proposed magnetic resonance (MR) imaging markers of leptomeningeal collateral circulation in patients with ischemia in the territory of the anterior cerebral artery (ACA). METHODS Forty patients from two tertiary care university hospitals were included. Infarct volumes and perfusion deficits were manually measured on DWI images and TTP maps, respectively. FVH and collateral flow on 4D MR angiograms were assessed and graded as previously specified. RESULTS Forty-one hemispheres were affected. Mean DWI lesion volume was 8.2 (± 13.9; range 0-76.9) ml, mean TTP lesion volume was 24.5 (± 17.2, range 0-76.7) ml. FVH were observed in 26/41 (63.4%) hemispheres. Significant correlations were detected between FVH and TTP lesion volume (ρ = 0.4; P<0.01) absolute (ρ = 0.37; P<0.05) and relative mismatch volume (ρ = 0.35; P<0.05). The modified ASITN/SIR score correlated inversely with DWI lesion volume (ρ = -0.58; P<0.01) and positively with relative mismatch (ρ = 0.29; P< 0.05). ANOVA of the ASITN/SIR score revealed significant inter-group differences for DWI (P<0.001) and TTP lesion volumes (P<0.05). No correlation was observed between FVH scores and modified ASITH/SIR scores (ρ = -0.16; P = 0.32). CONCLUSIONS FVH and flow patterns on 4D MR angiograms are markers of perfusion deficits and tissue at risk. As both methods did not show a correlation between each other, they seem to provide complimentary instead of redundant information. Previously shown evidence for the meaning of these specific MR signs in internal carotid and middle cerebral artery stroke seems to be transferrable to ischemic stroke in the ACA territory.
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Affiliation(s)
- Matthias Gawlitza
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
- * E-mail:
| | - Johannes Böhme
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maté Maros
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Donald Lobsien
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Dominik Michalski
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Christoph Groden
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Alex Förster
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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Surov A, Meyer HJ, Gawlitza M, Höhn AK, Boehm A, Kahn T, Stumpp P. Correlations Between DCE MRI and Histopathological Parameters in Head and Neck Squamous Cell Carcinoma. Transl Oncol 2016; 10:17-21. [PMID: 27888709 PMCID: PMC5124350 DOI: 10.1016/j.tranon.2016.10.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 10/11/2016] [Accepted: 10/11/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND: Dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) can characterize perfusion and vascularization of tissues. DCE MRI parameters can differentiate between malignant and benign lesions and predict tumor grading. The purpose of this study was to correlate DCE MRI findings and various histopathological parameters in head and neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS: Sixteen patients with histologically proven HNSCC (11 cases primary tumors and in 5 patients with local tumor recurrence) were included in the study. DCE imaging was performed in all cases and the following parameters were estimated: Ktrans, Ve, Kep, and iAUC. The tumor proliferation index was estimated on Ki 67 antigen stained specimens. Microvessel density parameters (stained vessel area, total vessel area, number of vessels, and mean vessel diameter) were estimated on CD31 antigen stained specimens. Spearman's non-parametric rank sum correlation coefficients were calculated between DCE and different histopathological parameters. RESULTS: The mean values of DCE perfusion parameters were as follows: Ktrans 0.189 ± 0.056 min−1, Kep 0.390 ± 0.160 min−1, Ve 0.548 ± 0.119%, and iAUC 22.40 ± 12.57. Significant correlations were observed between Kep and stained vessel areas (r = 0.51, P = .041) and total vessel areas (r = 0.5118, P = .043); between Ve and mean vessel diameter (r = −0.59, P = .017). Cell count had a tendency to correlate with Ve (r = −0.48, P = .058). In an analysis of the primary HNSCC only, a significant inverse correlation between Ktrans and KI 67 was identified (r = −0.62, P = .041). Our analysis showed significant correlations between DCE parameters and histopathological findings in HNSCC.
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Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
| | - Hans Jonas Meyer
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06097 Halle, Germany
| | - Matthias Gawlitza
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Anne-Kathrin Höhn
- Department of Pathology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Andreas Boehm
- ENT Department, University Hospital of Leipzig, Liebigstrasse 10-14, 04103 Leipzig, Germany
| | - Thomas Kahn
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Patrick Stumpp
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
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Zidan M, Gawlitza M, Metaxas G, Foussier C, Soize S, Pierot L. Endovascular treatment of intracranial aneurysms with Barricade coils: Feasibility, procedural safety, and immediate postoperative anatomical results. J Neuroradiol 2016; 43:353-7. [DOI: 10.1016/j.neurad.2016.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 05/09/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
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Schob S, Meyer J, Gawlitza M, Frydrychowicz C, Müller W, Preuss M, Bure L, Quäschling U, Hoffmann KT, Surov A. Diffusion-Weighted MRI Reflects Proliferative Activity in Primary CNS Lymphoma. PLoS One 2016; 11:e0161386. [PMID: 27571268 PMCID: PMC5003362 DOI: 10.1371/journal.pone.0161386] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 08/04/2016] [Indexed: 12/13/2022] Open
Abstract
Purpose To investigate if apparent diffusion coefficient (ADC) values within primary central nervous system lymphoma correlate with cellularity and proliferative activity in corresponding histological samples. Materials and Methods Echo-planar diffusion-weighted magnetic resonance images obtained from 21 patients with primary central nervous system lymphoma were reviewed retrospectively. Regions of interest were drawn on ADC maps corresponding to the contrast enhancing parts of the tumors. Biopsies from all 21 patients were histologically analyzed. Nuclei count, total nuclei area and average nuclei area were measured. The proliferation index was estimated as Ki-67 positive nuclei divided by total number of nuclei. Correlations of ADC values and histopathologic parameters were determined statistically. Results Ki-67 staining revealed a statistically significant correlation with ADCmin (r = -0.454, p = 0.038), ADCmean (r = -0.546, p = 0.010) and ADCmax (r = -0.515, p = 0.017). Furthermore, ADCmean correlated in a statistically significant manner with total nucleic area (r = -0.500, p = 0.021). Conclusion Low ADCmin, ADCmean and ADCmax values reflect a high proliferative activity of primary cental nervous system lymphoma. Low ADCmean values—in concordance with several previously published studies—indicate an increased cellularity within the tumor.
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Affiliation(s)
- Stefan Schob
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
- * E-mail:
| | - Jonas Meyer
- Department of Radiology, Martin Luther University of Halle-Wittenberg, Halle-Wittenberg, Germany
| | - Matthias Gawlitza
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | | | - Wolf Müller
- Department of Neuropathology, University Hospital Leipzig, Leipzig, Germany
| | - Matthias Preuss
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Lionel Bure
- Department of Radiology, McGill University Health Center, Montreal General Hospital, Montreal, Canada
| | - Ulf Quäschling
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | | | - Alexey Surov
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
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Gawlitza M, Fiedler E, Schob S, Hoffmann KT, Surov A. Peritumoral Brain Edema in Meningiomas Depends on Aquaporin-4 Expression and Not on Tumor Grade, Tumor Volume, Cell Count, or Ki-67 Labeling Index. Mol Imaging Biol 2016; 19:298-304. [DOI: 10.1007/s11307-016-1000-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schob S, Frydrychowicz C, Gawlitza M, Bure L, Preuß M, Hoffmann KT, Surov A. Signal Intensities in Preoperative MRI Do Not Reflect Proliferative Activity in Meningioma. Transl Oncol 2016; 9:274-9. [PMID: 27567949 PMCID: PMC4941203 DOI: 10.1016/j.tranon.2016.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/09/2016] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Identification of high-grade meningiomas in preoperative magnetic resonance imaging (MRI) is important for optimized surgical strategy and best possible resection. Numerous studies investigated subjectively determined morphological features as predictors of tumor biology in meningiomas. The aim of this study was to identify the predictive value of more reliable, quantitatively measured signal intensities in MRI for differentiation of high- and low-grade meningiomas and identification of meningiomas with high proliferation rates, respectively. PATIENTS AND METHODS Sixty-six patients (56 World Health Organization [WHO] grade I, 9 WHO grade II, and 1 WHO grade I) were included in the study. Preoperative MRI signal intensities (fluid-attenuated inversion recovery [FLAIR], T1 precontrast, and T1 postcontrast as genuine and normalized values) were correlated with Ki-67 expression in tissue sections of resected meningiomas. Differences between the groups (analysis of variance) and Spearman rho correlation were computed using SPSS 22. RESULTS Mean values of genuine signal intensities of meningiomas in FLAIR, T1 native, and T1 postcontrast were 323.9 ± 59, 332.8 ± 67.9, and 768.5 ± 165.3. Mean values of normalized (to the contralateral white matter) signal intensities of meningiomas in FLAIR, T1 native, and T1 postcontrast were 1.5 ± 0.3, 0.8 ± 0.1, and 1.9 ± 0.4. There was no significant correlation between MRI signal intensities and WHO grade or Ki-67 expression. Signal intensities did not differ significantly between WHO grade I and II/III meningiomas. Ki-67 expression was significantly increased in high-grade meningiomas compared with low-grade meningiomas (P < 0.01). Objectively measured values of MRI signal intensities (FLAIR, T1 precontrast, and T1 postcontrast enhancement) did not distinguish between high-grade and low-grade meningiomas. Furthermore, there was no association between MRI signal intensities and Ki-67 expression representing proliferative activity.
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Affiliation(s)
- Stefan Schob
- Department of Neuroradiology, University Leipzig, Germany.
| | | | | | - Lionel Bure
- Department of Radiology, McGill University Health Center, Montreal General Hospital
| | | | | | - Alexey Surov
- Department of Diagnostic and Interventional Radiology, University Leipzig, Germany
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Surov A, Stumpp P, Meyer HJ, Gawlitza M, Höhn AK, Boehm A, Sabri O, Kahn T, Purz S. Simultaneous (18)F-FDG-PET/MRI: Associations between diffusion, glucose metabolism and histopathological parameters in patients with head and neck squamous cell carcinoma. Oral Oncol 2016; 58:14-20. [PMID: 27311397 DOI: 10.1016/j.oraloncology.2016.04.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/03/2016] [Accepted: 04/18/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To analyze possible associations between functional simultaneous (18)F-FDG-PET/MR imaging parameters and histopathological parameters in head and neck squamous cell carcinoma (HNSCC). MATERIAL AND METHODS 11 patients (2 female, 9 male; mean age 56.0years) with biopsy-proven primary HNSCC underwent simultaneous (18)F-FDG-PET/MRI with a dedicated head and neck protocol including diffusion weighted imaging. For each tumor, glucose metabolism was estimated with standardized uptake values (SUV) and diffusion restriction was calculated using apparent diffusion coefficients (ADC). The tumor proliferation index was estimated on Ki 67 antigen stained specimens. Cell count, total nucleic area, and average nucleic area were estimated in each case. Pearson's correlation coefficient was used to analyze possible associations between the estimated parameters. RESULTS The mean SUVmax value was 24.41±6.51, and SUVmean value 15.01±4.07. Mean values (×10(-3)mm(2)s(-1)) of ADC parameters were as follows: ADCmin: 0.65±0.20; ADCmean: 1.28±0.18; and ADCmax: 2.16±0.35. Histopathological analysis identified the following results: cell count 1069.82±388.66, total nucleic area 150771.09±61177.12μm(2), average nucleic area 142.90±57.27μm(2) and proliferation index 49.09±22.67%. ADCmean correlated with Ki 67 level (r=-0.728, p=0.011) and total nucleic area (r=-0.691, p=0.019) and tended to correlate with average nucleic area (r=-0.527, p=0.096). ADCmax correlated with Ki 67 level (r=-0.633, p=0.036). SUVmax also tended to correlate with average nucleic area (r=0.573, p=0.066). Combined parameter SUVmax/ADCmin correlated with average nucleic area (r=0.627, p=0.039). CONCLUSION ADC and SUV values showed significant correlations with different histopathological parameters and can be used as biological markers in HNSCC.
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Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
| | - Patrick Stumpp
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Hans Jonas Meyer
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06097 Halle, Germany
| | - Matthias Gawlitza
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Anne-Kathrin Höhn
- Department of Pathology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Andreas Boehm
- ENT Department, University Hospital of Leipzig, Liebigstrasse 10-14, 04103 Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Thomas Kahn
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Sandra Purz
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
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Soize S, Gawlitza M, Raoult H, Pierot L. Imaging Follow-Up of Intracranial Aneurysms Treated by Endovascular Means. Stroke 2016; 47:1407-12. [DOI: 10.1161/strokeaha.115.011414] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 02/23/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Sebastien Soize
- From the Department of Neuroradiology, Hôpital Maison Blanche, Université Reims-Champagne-Ardenne, Reims, France (S.S., L.P.); Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany (M.G.); and Department of Neuroradiology, Hôpital Pontchaillou, University of Rennes, Rennes, France (H.R.)
| | - Matthias Gawlitza
- From the Department of Neuroradiology, Hôpital Maison Blanche, Université Reims-Champagne-Ardenne, Reims, France (S.S., L.P.); Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany (M.G.); and Department of Neuroradiology, Hôpital Pontchaillou, University of Rennes, Rennes, France (H.R.)
| | - Hélène Raoult
- From the Department of Neuroradiology, Hôpital Maison Blanche, Université Reims-Champagne-Ardenne, Reims, France (S.S., L.P.); Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany (M.G.); and Department of Neuroradiology, Hôpital Pontchaillou, University of Rennes, Rennes, France (H.R.)
| | - Laurent Pierot
- From the Department of Neuroradiology, Hôpital Maison Blanche, Université Reims-Champagne-Ardenne, Reims, France (S.S., L.P.); Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany (M.G.); and Department of Neuroradiology, Hôpital Pontchaillou, University of Rennes, Rennes, France (H.R.)
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