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Tekieli L, Dzierwa K, Grunwald IQ, Mazurek A, Urbanczyk-Zawadzka M, Wiewiorka L, Banys RP, Dabrowski W, Podlasek A, Weglarz E, Stefaniak J, Nizankowski RT, Musialek P. Outcomes in acute carotid-related stroke eligible for mechanical reperfusion: SAFEGUARD-STROKE Registry. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:231-248. [PMID: 39007556 DOI: 10.23736/s0021-9509.24.13093-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
BACKGROUND Carotid-related strokes (CRS) are largely unresponsive to intravenous thrombolysis and are often large and disabling. Little is known about contemporary CRS referral pathways and proportion of eligible patients who receive emergency mechanical reperfusion (EMR). METHODS Referral pathways, serial imaging, treatment data, and neurologic outcomes were evaluated in consecutive CRS patients presenting over 18 months in catchment area of a major carotid disease referral center with proximal-protected CAS expertise, on-site neurology, and stroke thrombectomy capability (Acute Stroke of CArotid Artery Bifurcation Origin Treated With Use oF the MicronEt-covered CGUARD Stent - SAFEGUARD-STROKE Registry; companion to SAFEGUARD-STROKE Study NCT05195658). RESULTS Of 101 EMR-eligible patients (31% i.v.-thrombolyzed, 39.5% women, age 39-89 years, 94.1% ASPECTS 9-10, 90.1% pre-stroke mRS 0-1), 57 (56.4%) were EMR-referred. Referrals were either endovascular (Comprehensive Stroke Centre, CSC, 21.0%; Stroke Thrombectomy-Capable CAS Centre, STCC, 70.2%) or to vascular surgery (VS, 1.8%), with >1 referral attempt in 7.0% patients (CSC/VS or VS/CSC or CSC/VS/STCC). Baseline clinical and imaging characteristics were not different between EMR-treated and EMR-untreated patients. EMR was delivered to 42.6% eligible patients (emergency carotid surgery 0%; STCC rejections 0%). On multivariable analysis, non-tandem CRS was a predictor of not getting referred for EMR (OR 0.36; 95%CI 0.14-0.93, P=0.03). Ninety-day neurologic status was profoundly better in EMR-treated patients; mRS 0-2 (83.7% vs. 34.5%); mRS 3-5 (11.6% vs. 53.4%), mRS 6 (4.6% vs. 12.1%); P<0.001 for all. CONCLUSIONS EMR-treatment substantially improves CRS neurologic outcomes but only a minority of EMR-eligible patients receive EMR. To increase the likelihood of brain-saving treatment, EMR-eligible stroke referral and management pathways, including those for CSC/VS-rejected patients, should involve stroke thrombectomy-capable centres with endovascular carotid treatment expertise.
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Affiliation(s)
- Lukasz Tekieli
- Stroke Thrombectomy-Capable Center, St. John Paul II Hospital, Krakow, Poland -
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland -
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland -
| | - Karolina Dzierwa
- Cardiovascular Imaging Laboratory, St. John Paul II Hospital, Krakow, Poland
| | - Iris Q Grunwald
- Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee, UK
- Department of Radiology, University of Dundee Ninewells Hospital, Dundee, UK
| | - Adam Mazurek
- Stroke Thrombectomy-Capable Center, St. John Paul II Hospital, Krakow, Poland
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | | | - Lukasz Wiewiorka
- Department of Radiology, St. John Paul II Hospital, Krakow, Poland
| | - R Pawel Banys
- Department of Radiology, St. John Paul II Hospital, Krakow, Poland
| | - Wladyslaw Dabrowski
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Podlasek
- Tayside Innovation MedTech Ecosystem (TIME), University of Dundee, Dundee, UK
- Precison Imaging Beacon, Radiological Sciences, University of Nottingham, Nottingham, UK
| | - Ewa Weglarz
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Nursing, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Justyna Stefaniak
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Krakow, Poland
| | - Rafal T Nizankowski
- Quality Promotion in Healthcare, Sano Center for Computational Medicine, Krakow, Poland
| | - Piotr Musialek
- Stroke Thrombectomy-Capable Center, St. John Paul II Hospital, Krakow, Poland
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland
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Grunwald IQ, Musialek P, Podlasek A, Sievert H, Mathias K, Guyler P, Hopkins LN. World Federation for Interventional Stroke Treatment (WIST) multispecialty training guidelines for endovascular stroke intervention: Time is brain! - Response to commentary by UKNG. Clin Radiol 2024; 79:e637-e639. [PMID: 38311524 DOI: 10.1016/j.crad.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 02/06/2024]
Affiliation(s)
- I Q Grunwald
- NHS Tayside, Dundee, UK; Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK; Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany.
| | - P Musialek
- Jagiellonian University, Krakow, Poland; Stroke Thrombectomy-Capable Center, John Paul II Hospital, Krakow, Poland
| | - A Podlasek
- Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK
| | - H Sievert
- Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany; Goethe University Frankfurt, Frankfurt, Germany
| | - K Mathias
- Asklepios Clinik St Georg - Klinische und Interventionelle Angiologie, Hamburg, Germany
| | - P Guyler
- East of England Regional Stroke Network, UK; Mid and South Essex University Hospitals Group, Southend University Hospital, Westcliff-on-Sea, UK
| | - L N Hopkins
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY, USA
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Dzierwa K, Kedziora A, Tekieli L, Mazurek A, Musial R, Dobrowolska E, Stefaniak J, Pieniazek P, Paluszek P, Konstanty-Kalandyk J, Sobczynski R, Kapelak B, Kleczynski P, Brzychczy A, Kwiatkowski T, Trystula M, Piatek J, Musialek P. Endovascular carotid revascularization under open-chest extracorporeal circulation combined with cardiac surgery in unstable patients at increased risk of carotid-related stroke: SIMultaneous urgent cardiac surgery and MicroNet-covered stent carotid revascularization in extreme-risk patients-SIMGUARD Study. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:591-607. [PMID: 38078710 DOI: 10.23736/s0021-9509.23.12896-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND In patients at urgent need for cardiac surgery coexisting with increased-stroke-risk carotid stenosis, any staged intervention increases the risk of complications from the primarily unaddressed pathology. In this challenging cohort, we assessed safety and feasibility of endovascular carotid revascularization under open-chest extracorporeal circulation (ECC) combined with cardiac surgery (hybrid-room true simultaneous treatment). METHODS Per-protocol (PP), after general anesthesia induction, chest-opening and ECC stand-by installation, carotid stenting (CAS) was performed (femoral/radial or direct carotid access) with ad-hoc/on-hand switch to ECC cardiac surgery. RESULTS Over 78 months, 60 patients (70.7±6.9years, 85% male, all American Society of Anesthesiology grade IV) were enrolled. All were at increased carotid-related stroke risk (ipsilateral recent stroke/transient ischemick attack, asymptomatic cerebral infarct, increased-risk lesion morphology, bilateral severe stenosis). Majority of study procedures involved CAS+coronary bypass surgery or CAS+valve replacement±coronary bypass. 45 (75%) patients were PP- and 15 (25%) not-PP (NPP-) managed (context therapy). CAS was 100% neuroprotected (transient flow reversal-64.4%, filters-35.6%) and employed micronet-covered plaque-sequestrating stents with routine post-dilatation optimization/embedding. 4 deaths (6.7%) and 7 strokes (11.7%) occurred by 30-days. Despite CAS+surgery performed on aspirin and unfractionated heparin-only (delayed clopidogrel-loading), no thrombosis occurred in the stented arteries, and 30-days stent patency was 100%. NPP-management significantly increased the risk of death/ipsilateral stroke (OR 38.5; P<0.001) and death/any stroke (OR 12.3; P=0.002) by 30-days. CONCLUSIONS In cardiac unstable patients at increased carotid-related stroke risk who require urgent cardiac surgery, simultaneous cardiac surgery and CAS with micronet-covered stent lesion sequestration is feasible and safe and shows efficacy in minimizing stroke risk. Larger-scale, multicentric evaluation is warranted. (SIMGUARD NCT04973579).
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Affiliation(s)
- Karolina Dzierwa
- Cardiovascular Imaging Laboratory, St. John Paul II Hospital, Krakow, Poland -
| | - Anna Kedziora
- Department of Cardiac Surgery and Transplantation, Jagiellonian University Medical College, Krakow, Poland
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
| | - Lukasz Tekieli
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland
- Stroke Thrombectomy-Capable Center, St. John Paul II Hospital, Krakow, Poland
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Adam Mazurek
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Robert Musial
- Department of Anesthesia and Intensive Therapy, St. John Paul II Hospital, Krakow, Poland
| | - Elzbieta Dobrowolska
- Department of Anesthesia and Intensive Therapy, St. John Paul II Hospital, Krakow, Poland
| | - Justyna Stefaniak
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Pieniazek
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Vascular Surgery and Endovascular Interventions, St. John Paul II Hospital, Krakow, Poland
| | - Piotr Paluszek
- Department of Vascular Surgery and Endovascular Interventions, St. John Paul II Hospital, Krakow, Poland
| | - Janusz Konstanty-Kalandyk
- Department of Cardiac Surgery and Transplantation, Jagiellonian University Medical College, Krakow, Poland
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
| | - Robert Sobczynski
- Department of Cardiac Surgery and Transplantation, Jagiellonian University Medical College, Krakow, Poland
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
| | - Boguslaw Kapelak
- Department of Cardiac Surgery and Transplantation, Jagiellonian University Medical College, Krakow, Poland
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
| | - Pawel Kleczynski
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Brzychczy
- Department of Vascular Surgery and Endovascular Interventions, St. John Paul II Hospital, Krakow, Poland
| | - Tomasz Kwiatkowski
- Department of Vascular Surgery and Endovascular Interventions, St. John Paul II Hospital, Krakow, Poland
| | - Mariusz Trystula
- Department of Vascular Surgery and Endovascular Interventions, St. John Paul II Hospital, Krakow, Poland
| | - Jacek Piatek
- Department of Cardiac Surgery and Transplantation, Jagiellonian University Medical College, Krakow, Poland
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
| | - Piotr Musialek
- St. John Paul II Hospital in Krakow Clinical Medicine Departments, Krakow, Poland
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland
- Stroke Thrombectomy-Capable Center, St. John Paul II Hospital, Krakow, Poland
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Szkolka L, Lyko-Morawska D, Balocco S, Bedkowski L, Buczek M, Medon E, Wolkowski M, Dryjski M, Kuczmik W. Vascular surgery study of the CGuard MicroNet-covered stent in patients with indication to carotid revascularization: POLGUARD. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:615-623. [PMID: 37947755 DOI: 10.23736/s0021-9509.23.12891-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND In a recent randomized study, MicroNet-covered stent (CGuard) significantly reduced procedural and post-procedural cerebral embolism in relation to a single-layer CREST study carotid stent, but real-life clinical practice data are limited. The aim is to prospectively assess clinical outcomes of CGuard as a routine revascularization tool for patients with indication to carotid revascularization. METHODS From April 2019 to November 2021, 204 elective patients (age 71.0±7.1years, 69.6% males, 21.7% symptomatic) were enrolled. RESULTS Mean basal peak-systolic velocity was 251.41±91.85 cm/s with angiographic diameter stenosis 89.7±8.46%. About 34.4% lesions were severely calcified, 6.8% were angulated, and 4.4% showed significant access tortuosity. Access was femoral, with 100% protection device (filter) use. Two hundred and three lesions in 203 patients were treated (1 cross-over to surgery for lack of effective access, no cross-over to other devices); in most cases (66.9%) the stent was placed directly. For pre-dilated lesions, mean balloon diameter was 3.36±0.34mm. Mean nominal stent diameter was 7.64±0.5 mm; length was 37.19±4.5 mm. All stents were post-dilated (balloon diameter 5.2±0.25 mm). Residual stenosis was <30% in all (3.77±6.91%). By discharge, there were 2 minor strokes (0.9%) and one transient ischemic attack. By 30-days, one other minor stroke occurred in relation to de-novo atrial fibrillation. With no deaths or myocardial infarctions, 30-day total death/stroke/myocardial infarction rate was 1.48%. No in-stent thrombosis or patency loss occurred by 30-days. In-stent peak-systolic velocity was 55.49±22.73 cm/s. CONCLUSIONS Thirty-day results from POLGUARD study indicate safety and a low complication rate of the MicroNet-covered carotid stent use in every-day vascular surgery practice of carotid revascularization. Long-term observation is underway.
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Affiliation(s)
- Lukasz Szkolka
- Department of Vascular Surgery, General Surgery, Angiology and Phlebology, Silesian Medical University, Katowice, Poland -
| | - Dorota Lyko-Morawska
- Department of Vascular Surgery, General Surgery, Angiology and Phlebology, Silesian Medical University, Katowice, Poland
| | - Simone Balocco
- Department of Mathematics and Computer Science, University of Barcelona, Barcelona, Spain
| | - Lukasz Bedkowski
- Department of Vascular Surgery, General Surgery, Angiology and Phlebology, Silesian Medical University, Katowice, Poland
| | - Michal Buczek
- Department of Vascular Surgery, General Surgery, Angiology and Phlebology, Silesian Medical University, Katowice, Poland
| | - Ewa Medon
- Department of Vascular Surgery, General Surgery, Angiology and Phlebology, Silesian Medical University, Katowice, Poland
| | - Maciej Wolkowski
- Department of Vascular Surgery, General Surgery, Angiology and Phlebology, Silesian Medical University, Katowice, Poland
| | - Maciej Dryjski
- Department of Surgery at the University at Buffalo, Buffalo, NY, USA
| | - Waclaw Kuczmik
- Department of Vascular Surgery, General Surgery, Angiology and Phlebology, Silesian Medical University, Katowice, Poland
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Grunwald IQ, Mathias K, Bertog S, Snyder KV, Sievert H, Siddiqui A, Musialek P, Hornung M, Papanagiotou P, Comelli S, Pillai S, Routledge H, Nizankowski RT, Ewart I, Fassbender K, Kühn AL, Alvarez CA, Alekyan B, Skrypnik D, Politi M, Tekieli L, Haldis T, Gaikwad S, Houston JG, Donald-Simpson H, Guyler P, Petrov I, Roffe C, Abelson M, Hargroves D, Mani S, Podlasek A, Witkowski A, Sievert K, Pawlowski K, Dziadkiewicz A, Hopkins NL. World Federation for Interventional Stroke Treatment (WIST) Multispecialty Training Guidelines for Endovascular Stroke Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53:67-72. [PMID: 37012107 DOI: 10.1016/j.carrev.2023.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/09/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Today, endovascular treatment (EVT) is the therapy of choice for strokes due to acute large vessel occlusion, irrespective of prior thrombolysis. This necessitates fast, coordinated multi-specialty collaboration. Currently, in most countries, the number of physicians and centres with expertise in EVT is limited. Thus, only a small proportion of eligible patients receive this potentially life-saving therapy, often after significant delays. Hence, there is an unmet need to train a sufficient number of physicians and centres in acute stroke intervention in order to allow widespread and timely access to EVT. AIM To provide multi-specialty training guidelines for competency, accreditation and certification of centres and physicians in EVT for acute large vessel occlusion strokes. MATERIAL AND METHODS The World Federation for Interventional Stroke Treatment (WIST) consists of experts in the field of endovascular stroke treatment. This interdisciplinary working group developed competency - rather than time-based - guidelines for operator training, taking into consideration trainees' previous skillsets and experience. Existing training concepts from mostly single specialty organizations were analysed and incorporated. RESULTS The WIST establishes an individualized approach to acquiring clinical knowledge and procedural skills to meet the competency requirements for certification of interventionalists of various disciplines and stroke centres in EVT. WIST guidelines encourage acquisition of skills using innovative training methods such as structured supervised high-fidelity simulation and procedural performance on human perfused cadaveric models. CONCLUSIONS WIST multispecialty guidelines outline competency and quality standards for physicians and centres to perform safe and effective EVT. The role of quality control and quality assurance is highlighted. SUMMARY The World Federation for Interventional Stroke Treatment (WIST) establishes an individualized approach to acquiring clinical knowledge and procedural skills to meet the competency requirements for certification of interventionalists of various disciplines and stroke centres in endovascular treatment (EVT). WIST guidelines encourage acquisition of skills using innovative training methods such as structured supervised high-fidelity simulation and procedural performance on human perfused cadaveric models. WIST multispecialty guidelines outline competency and quality standards for physicians and centers to perform safe and effective EVT. The role of quality control and quality assurance is highlighted. SIMULTANEOUS PUBLICATION The WIST 2023 Guidelines are published simultaneously in Europe (Adv Interv Cardiol 2023).
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Affiliation(s)
- Iris Q Grunwald
- Department of Radiology, NHS Tayside, Dundee, UK; Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK; Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany.
| | - Klaus Mathias
- Asklepios Clinik St. Georg-Klinische und Interventionelle Angiologie, Hamburg, Germany
| | - Stefan Bertog
- Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany; Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY
| | - Horst Sievert
- Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany
| | - Adnan Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY
| | - Piotr Musialek
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Marius Hornung
- Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany; SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany
| | - Panagiotes Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, Germany; First Department of Radiology, School of Medicine, National & Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Simone Comelli
- S. C. Neuroradiologia ed Interventistica Vascolare, Ospedale S. Michele, Cagliari, Italy
| | | | - Helen Routledge
- Worcestershire Royal Hospital, Cardiology Department, Worcester, United Kingdom
| | - Rafal T Nizankowski
- Accreditation Council, National Centre for Health Quality Assessment, Krakow, Poland
| | - Ian Ewart
- Mid and South Essex NHS Foundation Trust, United Kingdom
| | - Klaus Fassbender
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Anna L Kühn
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA
| | - Carlos A Alvarez
- Hospital Italiano Regional Del Sur, Hospital Privado Del Sur and Hospital Regional Español, Bahia Blanca, Argentina
| | | | - Dmitry Skrypnik
- I.V. Davidovsky City Hospital, Moscow State University and Dentistry, Moscow, Russia
| | - Maria Politi
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, Germany
| | - Lukasz Tekieli
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | | | - Shailesh Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, Neurosciences Center, Ansari Nagar, All India Institute of Medical Sciences (A.I.I.M.S), New Delhi, India
| | - John Graeme Houston
- Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK
| | - Helen Donald-Simpson
- Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK
| | - Paul Guyler
- Mid and South Essex NHS Foundation Trust, United Kingdom
| | - Ivo Petrov
- Department of Cardiology and Angiology, Acibadem City Clinic-Cardiovascular Center, Sofia, Bulgaria
| | - Christine Roffe
- University Hospital of North Midlands, Keele University, Stoke-on-Trent, UK
| | - Mark Abelson
- Vergelegen MediClinic, Somerset West, University of Cape Town, South Africa
| | - David Hargroves
- East Kent Hospitals University NHS Foundation Trust, Ashford, United Kingdom
| | | | - Anna Podlasek
- Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK; Precision Imaging Beacon, Radiological Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Adam Witkowski
- Deptartment of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Kolja Sievert
- Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany
| | - Krzysztof Pawlowski
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, Wejherowo, Poland
| | - Artur Dziadkiewicz
- Department of Neurology and Stroke, Pomeranian Hospitals, Wejherowo, Poland
| | - Nelson L Hopkins
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY
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