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Broocks G, McDonough RV, Bechstein M, Klapproth S, Faizy TD, Schön G, Kniep HC, Bester M, Hanning U, Kemmling A, Zeleñák K, Fiehler J, Meyer L. Thrombectomy in Patients With Ischemic Stroke Without Salvageable Tissue on CT Perfusion. Stroke 2024; 55:1317-1325. [PMID: 38572635 DOI: 10.1161/strokeaha.123.044916] [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: 08/21/2023] [Accepted: 02/22/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Computed tomography perfusion (CTP) imaging is regularly used to guide patient selection for mechanical thrombectomy (MT). However, the effect of MT in patients without salvageable tissue on CTP has not been investigated. The purpose of this study was to assess the effect of MT in patients with stroke without perfusion mismatch profiles. METHODS This observational study analyzed patients with ischemic stroke consecutively treated between March 1, 2015, and January 31, 2022, triaged by multimodal-computed tomography undergoing MT. CTP lesion-core mismatch profiles were defined using a mismatch volume/ratio of ≥10 mL/1.2, respectively. The primary end point was the rate of functional independence at 90 days, defined as the modified Rankin Scale score of 0 to 2. Recanalization was evaluated with the modified Thrombolysis in Cerebral Infarction scale. The effect of baseline variables on functional outcome was assessed using multivariable logistic regression analysis. Outcomes of patients with and without CTP-mismatch profiles were compared using 1:1 propensity score matching. RESULTS Of 724 patients who met the inclusion criteria of this retrospective observational study, 110 (15%) patients had no CTP mismatch and were analyzed. The median age was 74 (interquartile range, 62-80) years and 53% were women. Successful recanalization (modified Thrombolysis in Cerebral Infarction score, ≥2b) was achieved in 66% (73) and associated with functional independence at 90 days (adjusted odds ratio, 7.33 [95% CI, 1.22-43.70]; P=0.03). A significant interaction was observed between recanalization and age, as well as the extent of infarction, indicating MT to be most effective in patients <70 years and with a baseline Alberta Stroke Program Early Computed Tomography Score range between 3 and 7. These findings remained stable after propensity score matching, analyzing 152 matched pairs with similar rates of functional independence between patients with and without CTP-mismatch profiles (17% versus 23%; P=0.42). CONCLUSIONS In patients without CTP-mismatch profiles defined according to the EXTEND (Extending the Time for Thrombolysis in Emergency Neurological Deficits) criteria, recanalization was associated with improved functional outcomes. This effect was associated with baseline Alberta Stroke Program Early Computed Tomography Score and age, but not with the time from onset to imaging.
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Affiliation(s)
- Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
- Department of Neuroradiology, HELIOS Medical Center, Campus of MSH Medical School Hamburg, Schwerin, Germany (G.B.)
| | | | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Susan Klapproth
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Tobias D Faizy
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology (G.S.) University Medical Center Hamburg-Eppendorf, Germany
| | - Helge C Kniep
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - André Kemmling
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Marburg, Marburg, Germany (A.K.)
| | - Kamil Zeleñák
- Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.)
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany
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Wagner S, Ewald C, Freitag D, Herrmann KH, Koch A, Bauer J, Vogl TJ, Kemmling A, Gufler H. Effects of Tetrahydrolipstatin on Glioblastoma in Mice: MRI-Based Morphologic and Texture Analysis Correlated with Histopathology and Immunochemistry Findings-A Pilot Study. Cancers (Basel) 2024; 16:1591. [PMID: 38672673 PMCID: PMC11048907 DOI: 10.3390/cancers16081591] [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: 03/24/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND This study aimed to investigate the effects of tetrahydrolipstatin (orlistat) on heterotopic glioblastoma in mice by applying MRI and correlating the results with histopathology and immunochemistry. METHODS Human glioblastoma cells were injected subcutaneously into the groins of immunodeficient mice. After tumor growth of >150 mm3, the animals were assigned into a treatment group (n = 6), which received daily intraperitoneal injections of orlistat, and a control group (n = 7). MRI was performed at the time of randomization and before euthanizing the animals. Tumor volumes were calculated, and signal intensities were analyzed. The internal tumor structure was evaluated visually and with texture analysis. Western blotting and protein expression analysis were performed. RESULTS At histology, all tumors showed high mitotic and proliferative activity (Ki67 ≥ 10%). Reduced fatty acid synthetase expression was measured in the orlistat group (p < 0.05). Based on the results of morphologic MRI-based analysis, tumor growth remained concentric in the control group and changed to eccentric in the treatment group (p < 0.05). The largest area under the receiver operating curve of the predictors derived from the texture analysis of T2w images was for wavelet transform parameters WavEnHL_s3 and WavEnLH_s4 at 0.96 and 1.00, respectively. CONCLUSIONS Orlistat showed effects on heterotopically implanted glioblastoma multiforme in MRI studies of mice based on morphologic and texture analysis.
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Affiliation(s)
- Sabine Wagner
- Department of Neuroradiology, Marburg University Hospital, Philipps University, 35043 Marburg, Germany;
- Department of Neuroradiology, Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany
| | - Christian Ewald
- Department of Neurosurgery, Brandenburg Medical School, Campus Brandenburg, 14770 Brandenburg a. d. Havel, Germany (J.B.)
| | - Diana Freitag
- Department of Neurosurgery, Section of Experimental Neurooncology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany;
| | - Karl-Heinz Herrmann
- Medical Physics Group, Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University, 07743 Jena, Germany;
| | - Arend Koch
- Department of Neuropathology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité University Medicine, 10117 Berlin, Germany
| | - Johannes Bauer
- Department of Neurosurgery, Brandenburg Medical School, Campus Brandenburg, 14770 Brandenburg a. d. Havel, Germany (J.B.)
| | - Thomas J. Vogl
- Department of Diagnostic and Interventional Radiology, Goethe University Hospital Frankfurt, 60590 Frankfurt am Main, Germany; (T.J.V.); (H.G.)
| | - André Kemmling
- Department of Neuroradiology, Marburg University Hospital, Philipps University, 35043 Marburg, Germany;
| | - Hubert Gufler
- Department of Diagnostic and Interventional Radiology, Goethe University Hospital Frankfurt, 60590 Frankfurt am Main, Germany; (T.J.V.); (H.G.)
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Rickel JK, Zeeb D, Knake S, Urban H, Konczalla J, Weber KJ, Zeiner PS, Pagenstecher A, Hattingen E, Kemmling A, Fokas E, Adeberg S, Wolff R, Sebastian M, Rusch T, Ronellenfitsch MW, Menzler K, Habermehl L, Möller L, Czabanka M, Nimsky C, Timmermann L, Grefkes C, Steinbach JP, Rosenow F, Kämppi L, Strzelczyk A. Status epilepticus in patients with brain tumors and metastases: A multicenter cohort study of 208 patients and literature review. Neurol Res Pract 2024; 6:19. [PMID: 38570823 PMCID: PMC10993483 DOI: 10.1186/s42466-024-00314-7] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Brain tumors and metastases account for approximately 10% of all status epilepticus (SE) cases. This study described the clinical characteristics, treatment, and short- and long-term outcomes of this population. METHODS This retrospective, multi-center cohort study analyzed all brain tumor patients treated for SE at the university hospitals of Frankfurt and Marburg between 2011 and 2017. RESULTS The 208 patients (mean 61.5 ± 14.7 years of age; 51% male) presented with adult-type diffuse gliomas (55.8%), metastatic entities (25.5%), intracranial extradural tumors (14.4%), or other tumors (4.3%). The radiological criteria for tumor progression were evidenced in 128 (61.5%) patients, while 57 (27.4%) were newly diagnosed with tumor at admission and 113 (54.3%) had refractory SE. The mean hospital length of stay (LOS) was 14.8 days (median 12.0, range 1-57), 171 (82.2%) patients required intensive care (mean LOS 8.9 days, median 5, range 1-46), and 44 (21.2%) were administered mechanical ventilation. All patients exhibited significant functional status decline (modified Rankin Scale) post-SE at discharge (p < 0.001). Mortality at discharge was 17.3% (n = 36), with the greatest occurring in patients with metastatic disease (26.4%, p = 0.031) and those that met the radiological criteria for tumor progression (25%, p < 0.001). Long-term mortality at one year (65.9%) was highest in those diagnosed with adult-type diffuse gliomas (68.1%) and metastatic disease (79.2%). Refractory status epilepticus cases showed lower survival rates than non-refractory SE patients (log-rank p = 0.02) and those with signs of tumor progression (log-rank p = 0.001). CONCLUSIONS SE occurrence contributed to a decline in functional status in all cases, regardless of tumor type, tumor progression status, and SE refractoriness, while long-term mortality was increased in those with malignant tumor entities, tumor progressions, and refractory SE. SE prevention may preserve functional status and improve survival in individuals with brain tumors.
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Affiliation(s)
- Johanna K Rickel
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt, Germany
| | - Daria Zeeb
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
- Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Susanne Knake
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt, Germany
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
| | - Hans Urban
- Dr Senckenberg Institute of Neurooncology, University Hospital and Goethe-University Frankfurt, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Jürgen Konczalla
- Department of Neurosurgery, Goethe-University Frankfurt, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Katharina J Weber
- Frankturt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ) Heidelberg, Germany and German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt, Germany
- Institute of Neurology (Edinger-Institute), Goethe-University Frankfurt, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Pia S Zeiner
- Dr Senckenberg Institute of Neurooncology, University Hospital and Goethe-University Frankfurt, Frankfurt, Germany
- Frankturt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ) Heidelberg, Germany and German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Axel Pagenstecher
- Institute of Neuropathology, Philipps-University Marburg, Marburg, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, Goethe-University Frankfurt, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - André Kemmling
- Department of Neuroradiology, Philipps-University Marburg, Marburg, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Emmanouil Fokas
- Frankturt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, UKGM Marburg, Marburg, Germany
- Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, UKGM Marburg, Marburg, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Robert Wolff
- Gamma Knife Frankfurt, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Martin Sebastian
- Hematology/Oncology, Department of Medicine II, University Hospital Frankfurt, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Tillmann Rusch
- Department of Hematology, Oncology & Immunology, Philipps-University Marburg, Marburg, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Michael W Ronellenfitsch
- Dr Senckenberg Institute of Neurooncology, University Hospital and Goethe-University Frankfurt, Frankfurt, Germany
- Frankturt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ) Heidelberg, Germany and German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Katja Menzler
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
| | - Lena Habermehl
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
| | - Leona Möller
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, Goethe-University Frankfurt, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany
| | - Christian Grefkes
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
| | - Joachim P Steinbach
- Dr Senckenberg Institute of Neurooncology, University Hospital and Goethe-University Frankfurt, Frankfurt, Germany
- Frankturt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ) Heidelberg, Germany and German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt, Germany
- University Cancer Center (UCT) Frankfurt-Marburg, Frankfurt, Marburg, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt, Germany
| | - Leena Kämppi
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
- Epilepsia Helsinki, European Reference Network EpiCARE, Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt, Germany.
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg, Germany.
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Tsalouchidou PE, Hoffmann J, Strehlau S, Linka L, Belke M, Habermehl L, Schulze M, Kemmling A, Menzler K, Knake S. Morphometric magnetic resonance imaging (MRI) postprocessing in MRI-negative patients with first unprovoked seizure. Epilepsia 2024; 65:1107-1114. [PMID: 38305932 DOI: 10.1111/epi.17909] [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: 09/27/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The aim of the study was to evaluate the benefits of morphometric magnetic resonance imaging (MRI) postprocessing in patients presenting with a first seizure and negative MRI results and to investigate these findings in the context of the clinical and electroencephalographic data, seizure recurrence rates, and epilepsy diagnosis in these patients. METHODS We retrospectively reviewed 97 MRI scans of patients with first unprovoked epileptic seizure and no evidence of epileptogenic lesion on clinical routine MRI. Morphometric Analysis Program (MAP; v2018), automated postprocessing software, was used to identify subtle, potentially epileptogenic lesions in the three-dimensional T1-weighted MRI data. The resulting probability maps were examined together with the conventional MRI images by a reviewer who remained blinded to the patients' clinical and electroencephalographical data. Clinical data were prospectively collected between February 2018 and May 2023. RESULTS Among the apparently MRI-negative patients, a total of 18 of 97 (18.6%) showed cortical changes suggestive of focal cortical dysplasia. Within the population with positive MAP findings (MAP+), seizure recurrence rates were 61.1% and 66.7% at 1 and 2 years after the first unprovoked seizure, respectively. Conversely, patients with negative MAP findings (MAP-) had lower seizure recurrence rates of 27.8% and 34.2% at 1 and 2 years after the first unprovoked seizure, respectively. Patients with MAP+ findings were significantly more likely to be diagnosed with epilepsy than those patients with MAP- findings (χ2 [1, n = 97] = 14.820, p < .001, odds ratio = 21.371, 95% CI = 2.710-168.531) during a mean follow-up time of 22.51 months (SD = 16.7 months, range = 1-61 months). SIGNIFICANCE MRI postprocessing can be a valuable tool for detecting subtle epileptogenic lesions in patients with a first seizure and negative MRI results. Patients with first seizure and MAP+ findings had high seizure recurrence rates, meeting the criteria for beginning epilepsy.
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Affiliation(s)
- Panagiota-Eleni Tsalouchidou
- Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Johanna Hoffmann
- Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Sascha Strehlau
- Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Louise Linka
- Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Marcus Belke
- Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg, Marburg, Germany
| | - Lena Habermehl
- Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Maximilian Schulze
- Department of Neuroradiology, Philipps University Marburg, Marburg, Germany
| | - André Kemmling
- Department of Neuroradiology, Philipps University Marburg, Marburg, Germany
| | - Katja Menzler
- Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg, Marburg, Germany
- Core Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
| | - Susanne Knake
- Epilepsy Center Hessen, Department of Neurology, Philipps University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg, Marburg, Germany
- Core Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
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5
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Meyer L, Stracke CP, Broocks G, Wallocha M, Elsharkawy M, Sporns PB, Piechowiak EI, Kaesmacher J, Maegerlein C, Hernandez Petzsche MR, Zimmermann H, Naziri W, Abdullayev N, Kabbasch C, Behme D, Thormann M, Maus V, Fischer S, Möhlenbruch MA, Weyland CS, Langner S, Ernst M, Jamous A, Meila D, Miszczuk M, Siebert E, Lowens S, Krause LU, Yeo LL, Tan BYQ, Gopinathan A, Gory B, Galvan Fernandez J, Schüller Arteaga M, Navia P, Raz E, Shapiro M, Arnberg F, Zeleňák K, Martínez-Galdámez M, Alexandrou M, Kastrup A, Papanagiotou P, Dorn F, Kemmling A, Psychogios MN, Andersson T, Chapot R, Fiehler J, Hanning U. Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery. J Neurointerv Surg 2024; 16:230-236. [PMID: 37142393 DOI: 10.1136/jnis-2023-020210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/13/2023] [Accepted: 04/14/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Numerous questions regarding procedural details of distal stroke thrombectomy remain unanswered. This study assesses the effect of anesthetic strategies on procedural, clinical and safety outcomes following thrombectomy for distal medium vessel occlusions (DMVOs). METHODS Patients with isolated DMVO stroke from the TOPMOST registry were analyzed with regard to anesthetic strategies (ie, conscious sedation (CS), local (LA) or general anesthesia (GA)). Occlusions were in the P2/P3 or A2-A4 segments of the posterior and anterior cerebral arteries (PCA and ACA), respectively. The primary endpoint was the rate of complete reperfusion (modified Thrombolysis in Cerebral Infarction score 3) and the secondary endpoint was the rate of modified Rankin Scale score 0-1. Safety endpoints were the occurrence of symptomatic intracranial hemorrhage and mortality. RESULTS Overall, 233 patients were included. The median age was 75 years (range 64-82), 50.6% (n=118) were female, and the baseline National Institutes of Health Stroke Scale score was 8 (IQR 4-12). DMVOs were in the PCA in 59.7% (n=139) and in the ACA in 40.3% (n=94). Thrombectomy was performed under LA±CS (51.1%, n=119) and GA (48.9%, n=114). Complete reperfusion was reached in 73.9% (n=88) and 71.9% (n=82) in the LA±CS and GA groups, respectively (P=0.729). In subgroup analysis, thrombectomy for ACA DMVO favored GA over LA±CS (aOR 3.07, 95% CI 1.24 to 7.57, P=0.015). Rates of secondary and safety outcomes were similar in the LA±CS and GA groups. CONCLUSION LA±CS compared with GA resulted in similar reperfusion rates after thrombectomy for DMVO stroke of the ACA and PCA. GA may facilitate achieving complete reperfusion in DMVO stroke of the ACA. Safety and functional long-term outcomes were comparable in both groups.
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Affiliation(s)
- Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Paul Stracke
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marta Wallocha
- Department of Endovascular Therapy, Alfred-Krupp Hospital, Essen, Germany
| | - Mohamed Elsharkawy
- Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany
| | - Peter B Sporns
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Eike I Piechowiak
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Moritz Roman Hernandez Petzsche
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Hanna Zimmermann
- Institute of Neuroradiology, University Hospitals, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Weis Naziri
- Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany
- Department of Neuroradiology, University Hospital Luebeck, Luebeck, Germany
| | - Nuran Abdullayev
- Department of Neuroradiology, University of Cologne, Cologne, Germany
| | | | - Daniel Behme
- Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Maximilian Thormann
- Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Volker Maus
- Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum, Germany
| | - Sebastian Fischer
- Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Soenke Langner
- Institute for Diagnostic and Interventional Radiology, Pediatric and Neuroradiology, University Hospital Rostock, Rostock, Germany
| | - Marielle Ernst
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany
| | - Ala Jamous
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany
| | - Dan Meila
- Department of Interventional Neuroradiology, Johanna-Étienne-Hospital, Neuss, Germany
| | - Milena Miszczuk
- Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Eberhard Siebert
- Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan Lowens
- Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany
| | - Lars Udo Krause
- Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany
| | - Leonard Ll Yeo
- Division of Neurology, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Benjamin Y Q Tan
- Division of Neurology, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anil Gopinathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore
| | - Benjamin Gory
- Université de Lorraine, CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, F-54000 Nancy, France, Université de Lorraine, IADI, INSERM U1254, F-54000, Nancy, France
| | - Jorge Galvan Fernandez
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Miguel Schüller Arteaga
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Pedro Navia
- Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain
| | - Eytan Raz
- Department of Radiology, New York Langone Medical Center, New York, New York, USA
| | - Maksim Shapiro
- Department of Radiology, New York Langone Medical Center, New York, New York, USA
| | - Fabian Arnberg
- Departments of Neuroradiology; Department of Clinical Neuroscience, Karolinska University Hospital; Karolinska Institutet, Stockholm, Sweden
| | - Kamil Zeleňák
- Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia
| | - Mario Martínez-Galdámez
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Maria Alexandrou
- Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany
| | - Andreas Kastrup
- Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany
| | - Panagiotis Papanagiotou
- Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany
- Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - André Kemmling
- Department of Neuroradiology, University Hospital Marburg, Marburg, Germany
| | - Marios-Nikos Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Tommy Andersson
- Departments of Neuroradiology; Department of Clinical Neuroscience, Karolinska University Hospital; Karolinska Institutet, Stockholm, Sweden
- Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| | - René Chapot
- Department of Endovascular Therapy, Alfred-Krupp Hospital, Essen, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Winkelmeier L, Heit JJ, Broocks G, Prüter J, Heitkamp C, Schell M, Albers GW, Lansberg MG, Wintermark M, Kemmling A, Stracke CP, Guenego A, Paech D, Fiehler J, Faizy TD. Association between occlusion location, net water uptake and ischemic lesion growth in large vessel anterior circulation strokes. J Cereb Blood Flow Metab 2024:271678X241232193. [PMID: 38329032 DOI: 10.1177/0271678x241232193] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Ischemic lesion net water uptake (NWU) represents a quantitative imaging biomarker for cerebral edema in acute ischemic stroke. Data on NWU for distinct occlusion locations remain scarce, but might help to improve the prognostic value of NWU. In this retrospective multicenter cohort study, we compared NWU between patients with proximal large vessel occlusion (pLVO; ICA or proximal M1) and distal large vessel occlusion (dLVO; distal M1 or M2). NWU was quantified by densitometric measurements of the early ischemic region. Arterial collateral status was assessed using the Maas scale. Regression analysis was used to investigate the relationship between occlusion location, NWU and ischemic lesion growth. A total of 685 patients met inclusion criteria. Early ischemic lesion NWU was higher in patients with pLVO compared with dLVO (7.7% vs 3.9%, P < .001). The relationship between occlusion location and NWU was partially mediated by arterial collateral status. NWU was associated with absolute ischemic lesion growth between admission and follow-up imaging (β estimate, 5.50, 95% CI, 3.81-7.19, P < .001). This study establishes a framework for the relationship between occlusion location, arterial collateral status, early ischemic lesion NWU and ischemic lesion growth. Future prognostic thresholds for NWU might be optimized by adjusting for the occlusion location.
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Affiliation(s)
- Laurens Winkelmeier
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeremy J Heit
- Department of Neuroradiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gabriel Broocks
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Prüter
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Heitkamp
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Schell
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gregory W Albers
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Maarten G Lansberg
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Max Wintermark
- Department of Neuroradiology, MD Anderson, Houston, Texas, USA
| | - André Kemmling
- Department of Neuroradiology, University Marburg, Marburg, Germany
| | | | - Adrien Guenego
- Department of Neuroradiology, Erasme Medical Center, Brussels, Belgium
| | - Daniel Paech
- Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias D Faizy
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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7
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Gohla G, Schwarz R, Bier G, Estler A, Bongers MN, Ditt H, Fritz J, Kemmling A, Ernemann U, Horger M. A novel fully automated method for measuring ASPECTS to improve stroke diagnosis: Comparison to traditional ASPECTS. J Neuroimaging 2024; 34:145-151. [PMID: 37807097 DOI: 10.1111/jon.13159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND AND PURPOSE To compare the accuracy of subjective Alberta Stroke Program Early CT Score (sASPECTS) evaluation and that of an automated prototype software (aASPECTS) on nonenhanced CT (NECT) in patients with early anterior territory stroke and controls using side-to-side quantification of hypoattenuated brain areas. METHODS We retrospectively analyzed the NECT scans of 42 consecutive patients with ischemic stroke before reperfusion and 42 controls using first sASPECTS and subsequently aASPECTS. We assessed the differences in Alberta Stroke Program Early CT Score (ASPECTS) and calculated the sensitivity and specificity of NECT with CT perfusion, whereas cerebral blood volume (CBV) served as the reference standard for brain infarction. RESULTS The clot was located in the middle cerebral artery (MCA) in 47.6% of cases and the internal carotid artery (ICA) in 28.6% of cases. Ten cases presented combined ICA and MCA occlusions. The stroke was right sided in 52.4% of cases and left sided in 47.6%. Reader-based NECT analysis yielded a median sASPECTS of 10. The median CBV-based ASPECTS was 7. Compared to the area of decreased CBV, sASPECTS yielded a sensitivity of 12.5% and specificity of 86.8%. The software prototype (aASPECTS) yielded an overall sensitivity of 65.5% and a specificity of 92.2%. The interreader agreement for ASPECTS evaluation of admission NECT and follow-up CT was almost perfect (κ = .93). The interreader agreement of the CBV color map evaluation was substantial (κ = .77). CONCLUSIONS aASPECTS of NECT can outperform sASPECTS for stroke detection.
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Affiliation(s)
- Georg Gohla
- Department of Diagnostic and Interventional Neuroradiology, Eberhard Karls-University Tübingen, Tübingen, Germany
| | - Ricarda Schwarz
- Department of Diagnostic and Interventional Radiology, Eberhard Karls-University Tübingen, Tübingen, Germany
| | - Georg Bier
- Department of Diagnostic and Interventional Neuroradiology, Eberhard Karls-University Tübingen, Tübingen, Germany
- Radiology Salzstraße, Muenster, Germany
| | - Arne Estler
- Department of Diagnostic and Interventional Neuroradiology, Eberhard Karls-University Tübingen, Tübingen, Germany
| | - Malte N Bongers
- Department of Diagnostic and Interventional Radiology, Eberhard Karls-University Tübingen, Tübingen, Germany
| | - Hendrik Ditt
- Siemens AG Healthcare; Imaging & Therapy Systems Computed Tomography & Radiation Oncology, Forchheim, Germany
| | - Jan Fritz
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - André Kemmling
- Institute of Neuroradiology, Philipps University of Marburg, Marburg, Germany
| | - Ulrike Ernemann
- Department of Diagnostic and Interventional Neuroradiology, Eberhard Karls-University Tübingen, Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard Karls-University Tübingen, Tübingen, Germany
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8
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Sporns PB, Kemmling A, Meyer L, Krogias C, Puetz V, Thierfelder KM, Duering M, Lukas C, Kaiser D, Langner S, Brehm A, Rotkopf LT, Kunz WG, Beuker C, Heindel W, Fiehler J, Schramm P, Wiendl H, Minnerup H, Psychogios MN, Minnerup J. Computed tomography hypoperfusion-hypodensity mismatch vs. automated perfusion mismatch to identify stroke patients eligible for thrombolysis. Front Neurol 2023; 14:1320620. [PMID: 38225983 PMCID: PMC10788186 DOI: 10.3389/fneur.2023.1320620] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/04/2023] [Indexed: 01/17/2024] Open
Abstract
Background and purpose Automated perfusion imaging can detect stroke patients with unknown time of symptom onset who are eligible for thrombolysis. However, the availability of this technique is limited. We, therefore, established the novel concept of computed tomography (CT) hypoperfusion-hypodensity mismatch, i.e., an ischemic core lesion visible on cerebral perfusion CT without visible hypodensity in the corresponding native cerebral CT. We compared both methods regarding their accuracy in identifying patients suitable for thrombolysis. Methods In a retrospective analysis of the MissPerfeCT observational cohort study, patients were classified as suitable or not for thrombolysis based on established time window and imaging criteria. We calculated predictive values for hypoperfusion-hypodensity mismatch and automated perfusion imaging to compare accuracy in the identification of patients suitable for thrombolysis. Results Of 247 patients, 219 (88.7%) were eligible for thrombolysis and 28 (11.3%) were not eligible for thrombolysis. Of 197 patients who were within 4.5 h of symptom onset, 190 (96.4%) were identified by hypoperfusion-hypodensity mismatch and 88 (44.7%) by automated perfusion mismatch (p < 0.001). Of 22 patients who were beyond 4.5 h of symptom onset but were eligible for thrombolysis, 5 patients (22.7%) were identified by hypoperfusion-hypodensity mismatch. Predictive values for the hypoperfusion-hypodensity mismatch vs. automated perfusion mismatch were as follows: sensitivity, 89.0% vs. 50.2%; specificity, 71.4% vs. 100.0%; positive predictive value, 96.1% vs. 100.0%; and negative predictive value, 45.5% vs. 20.4%. Conclusion The novel method of hypoperfusion-hypodensity mismatch can identify patients suitable for thrombolysis with higher sensitivity and lower specificity than established techniques. Using this simple method might therefore increase the proportion of patients treated with thrombolysis without the use of special automated software.The MissPerfeCT study is a retrospective observational multicenter cohort study and is registered with clinicaltrials.gov (NCT04277728).
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Affiliation(s)
- Peter B. Sporns
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Radiology, Westfaelische Wilhelms-University of Münster and University Hospital of Münster, Münster, Germany
| | - André Kemmling
- Department of Radiology, Westfaelische Wilhelms-University of Münster and University Hospital of Münster, Münster, Germany
- Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Lennart Meyer
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Kolja M. Thierfelder
- Department of Radiology and Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Rostock, Germany
| | - Marco Duering
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Carsten Lukas
- Department of Neuroradiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Daniel Kaiser
- Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Sönke Langner
- Department of Radiology and Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Rostock, Germany
| | - Alex Brehm
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Lukas T. Rotkopf
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Wolfgang G. Kunz
- Department of Radiology, University Hospital, LMU Munich, Germany
| | - Carolin Beuker
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Walter Heindel
- Department of Radiology, Westfaelische Wilhelms-University of Münster and University Hospital of Münster, Münster, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Schramm
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Heike Minnerup
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Marios Nikos Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Jens Minnerup
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
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Bilgin C, Ibrahim M, Azzam AY, Ghozy S, Elswedy A, Kobeissi H, Sobhi Jabal M, Kadirvel R, Boulouis G, Naggara O, Fiehler J, Psychogios M, Lee S, Wildgruber M, Kemmling A, Al-Mufti F, Kossorotoff M, Sporns PB, Kallmes DF. Mechanical Thrombectomy for Pediatric Large Vessel Occlusions : A Systematic Review and Meta-analysis. Clin Neuroradiol 2023; 33:635-644. [PMID: 36592199 DOI: 10.1007/s00062-022-01246-y] [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: 10/14/2022] [Accepted: 11/22/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Acute intracranial large vessel occlusion (LVO) is an important cause of morbidity and mortality among children; however, unlike in adults, no clinical trial has investigated the benefit of mechanical thrombectomy (MT) in pediatric LVO. Thus, MT remains an off-label procedure for pediatric stroke. PURPOSE To investigate the efficacy and safety of MT in pediatric LVO. METHODS A systematic literature search was conducted in Ovid MEDLINE, Ovid Embase, Scopus, Web of Science, and Cochrane Central Register of Clinical Trials databases. Studies reporting safety and efficacy outcomes for endovascular treatment of pediatric LVO were included. Data regarding recanalization, functional outcome, symptomatic intracranial hemorrhage (sICH), and mortality were extracted from the included studies. Functional outcome was assessed with the modified Rankin scale (mRS). A fixed or random-effects model was used to calculate pooled event rates and 95% confidence intervals (CI). RESULTS In this study 11 studies comprising 215 patients were included. The successful recanalization rate was 90.3% (95% CI = 85.77-95.11%), and complete recanalization was achieved in 52.7% (95% CI = 45.09-61.62%) of the cases. The favorable (mRS = 0-2) and excellent (mRS = 0-1) outcome rates were 83.3% (95% CI = 73.54-94.50%) and 59.5% (95% CI = 44.24-80.06%), respectively. The overall sICH prevalence was 0.59% (95% CI = 0-3.30%) and mortality rate was 3.2% (95% CI = 0.55-7.38%). CONCLUSION In our meta-analysis, MT demonstrated a promising safety and efficacy profile for pediatric patients, with consistently high efficacy outcomes and low complication rates. Our results support the utilization of MT in pediatric LVOs; however, prospective studies are still needed to further establish the role of pediatric MT as a first-line treatment strategy.
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Affiliation(s)
- Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
| | | | - Ahmed Y Azzam
- Faculty of Medicine, October 6 University, 6th of October City, Egypt
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Adam Elswedy
- Uppsala University Faculty of Medicine, Uppsala, Sweden
| | - Hassan Kobeissi
- College of Medicine, Central Michigan University, Mt. Pleasant, MI, USA
| | | | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Grégoire Boulouis
- Department of Neuroradiology, Université de Tours, CHRU Bretonneau, Tours, France
- French Center for Pediatric Stroke, Pediatric Neurology, APHP-University Hospital Necker-Enfants malades, Paris, France
| | - Olivier Naggara
- Department of Neuroradiology, Université de Paris City, INSERM U1266, GHU Paris, Sainte-Anne Hospital, Paris, France
- French Center for Pediatric Stroke, Pediatric Neurology, APHP-University Hospital Necker-Enfants malades, Paris, France
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios Psychogios
- Department of Radiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Sarah Lee
- Stanford Stroke Center, Stanford University, Palo Alto, CA, USA
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - André Kemmling
- Department of Neuroradiology, University Hospital Marburg, Marburg, Germany
| | - Fawaz Al-Mufti
- Department of Neurology, Westchester Medical Center, Valhalla, NY, USA
| | - Manoelle Kossorotoff
- French Center for Pediatric Stroke, Pediatric Neurology, APHP-University Hospital Necker-Enfants malades, Paris, France
| | - Peter B Sporns
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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10
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Kneffel M, Kemmling A, Timmermann L, Simon OJ. [Thromboembolism - A common cause of stroke]. Dtsch Med Wochenschr 2023; 148:899-907. [PMID: 37493951 DOI: 10.1055/a-1848-6834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
In the field of neurology, thromboembolic events are responsible for approximately 40% of ischemic strokes 1. The embolisms are differentiated according to their origin: One group includes emboli that occur in the heart, e.g. due to atrial fibrillation (cardioembolic stroke). Another group includes emboli, which are caused by arteriosclerotic plaques, e.g. in the area of the carotid bifurcation in the large vessels supplying the brain. After the acute therapy of the ischemic stroke, further diagnostics are essential to determine the exact cause of the ischemic stroke. Targeted therapy to prevent further strokes can only be initiated if the cause is known (secondary prevention). In the following - in addition to the current diagnostics and therapy of thromboembolic strokes - new guideline recommendations and COVID-19 will be discussed.
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11
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Meyer L, Stracke P, Broocks G, Elsharkawy M, Sporns P, Piechowiak EI, Kaesmacher J, Maegerlein C, Hernandez Petzsche MR, Zimmermann H, Naziri W, Abdullayev N, Kabbasch C, Diamandis E, Thormann M, Maus V, Fischer S, Möhlenbruch M, Weyland CS, Ernst M, Jamous A, Meila D, Miszczuk M, Siebert E, Lowens S, Krause LU, Yeo L, Tan B, Gopinathan A, Arenillas-Lara JF, Navia P, Raz E, Shapiro M, Arnberg F, Zeleňák K, Martínez-Galdámez M, Alexandrou M, Kastrup A, Papanagiotou P, Kemmling A, Dorn F, Psychogios M, Andersson T, Chapot R, Fiehler J, Hanning U. Thrombectomy versus Medical Management for Isolated Anterior Cerebral Artery Stroke: An International Multicenter Registry Study. Radiology 2023; 307:e220229. [PMID: 36786705 DOI: 10.1148/radiol.220229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Background Evidence supporting a potential benefit of thrombectomy for distal medium vessel occlusions (DMVOs) of the anterior cerebral artery (ACA) is, to the knowledge of the authors, unknown. Purpose To compare the clinical and safety outcomes between mechanical thrombectomy (MT) and best medical treatment (BMT) with or without intravenous thrombolysis for primary isolated ACA DMVOs. Materials and Methods Treatment for Primary Medium Vessel Occlusion Stroke, or TOPMOST, is an international, retrospective, multicenter, observational registry of patients treated for DMVO in daily practice. Patients treated with thrombectomy or BMT alone for primary ACA DMVO distal to the A1 segment between January 2013 and October 2021 were analyzed and compared by one-to-one propensity score matching (PSM). Early outcome was measured by the median improvement of National Institutes of Health Stroke Scale (NIHSS) scores at 24 hours. Favorable functional outcome was defined as modified Rankin scale scores of 0-2 at 90 days. Safety was assessed by the occurrence of symptomatic intracerebral hemorrhage and mortality. Results Of 154 patients (median age, 77 years; quartile 1 [Q1] to quartile 3 [Q3], 66-84 years; 80 men; 94 patients with MT; 60 patients with BMT) who met the inclusion criteria, 110 patients (median age, 76 years; Q1-Q3, 67-83 years; 50 men; 55 patients with MT; 55 patients with BMT) were matched. DMVOs were in A2 (82 patients; 53%), A3 (69 patients; 45%), and A3 (three patients; 2%). After PSM, the median 24-hour NIHSS point decrease was -2 (Q1-Q3, -4 to 0) in the thrombectomy and -1 (Q1-Q3, -4 to 1.25) in the BMT cohort (P = .52). Favorable functional outcome (MT vs BMT, 18 of 37 [49%] vs 19 of 39 [49%], respectively; P = .99) and mortality (MT vs BMT, eight of 37 [22%] vs 12 of 39 [31%], respectively; P = .36) were similar in both groups. Symptomatic intracranial hemorrhage occurred in three (2%) of 154 patients. Conclusion Thrombectomy appears to be a safe and technically feasible treatment option for primary isolated anterior cerebral artery occlusions in the A2 and A3 segment with clinical outcomes similar to best medical treatment with and without intravenous thrombolysis. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Zhu and Wang in this issue.
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Affiliation(s)
- Lukas Meyer
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Paul Stracke
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Gabriel Broocks
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Mohamed Elsharkawy
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Peter Sporns
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Eike I Piechowiak
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Johannes Kaesmacher
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Christian Maegerlein
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Moritz Roman Hernandez Petzsche
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Hanna Zimmermann
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Weis Naziri
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Nuran Abdullayev
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Christoph Kabbasch
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Elie Diamandis
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Maximilian Thormann
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Volker Maus
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Sebastian Fischer
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Markus Möhlenbruch
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Charlotte S Weyland
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Marielle Ernst
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Ala Jamous
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Dan Meila
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Milena Miszczuk
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Eberhard Siebert
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Stephan Lowens
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Lars Udo Krause
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Leonard Yeo
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Benjamin Tan
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Anil Gopinathan
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Juan F Arenillas-Lara
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Pedro Navia
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Eytan Raz
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Maksim Shapiro
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Fabian Arnberg
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Kamil Zeleňák
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Mario Martínez-Galdámez
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Maria Alexandrou
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Andreas Kastrup
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Panagiotis Papanagiotou
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - André Kemmling
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Franziska Dorn
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Marios Psychogios
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Tommy Andersson
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - René Chapot
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Jens Fiehler
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Uta Hanning
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
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- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
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Bopp MHA, Corr F, Saß B, Pojskic M, Kemmling A, Nimsky C. Augmented Reality to Compensate for Navigation Inaccuracies. Sensors (Basel) 2022; 22:9591. [PMID: 36559961 PMCID: PMC9787763 DOI: 10.3390/s22249591] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
This study aims to report on the capability of microscope-based augmented reality (AR) to evaluate registration and navigation accuracy with extracranial and intracranial landmarks and to elaborate on its opportunities and obstacles in compensation for navigation inaccuracies. In a consecutive single surgeon series of 293 patients, automatic intraoperative computed tomography-based registration was performed delivering a high initial registration accuracy with a mean target registration error of 0.84 ± 0.36 mm. Navigation accuracy is evaluated by overlaying a maximum intensity projection or pre-segmented object outlines within the recent focal plane onto the in situ patient anatomy and compensated for by translational and/or rotational in-plane transformations. Using bony landmarks (85 cases), there was two cases where a mismatch was seen. Cortical vascular structures (242 cases) showed a mismatch in 43 cases and cortex representations (40 cases) revealed two inaccurate cases. In all cases, with detected misalignment, a successful spatial compensation was performed (mean correction: bone (6.27 ± 7.31 mm), vascular (3.00 ± 1.93 mm, 0.38° ± 1.06°), and cortex (5.31 ± 1.57 mm, 1.75° ± 2.47°)) increasing navigation accuracy. AR support allows for intermediate and straightforward monitoring of accuracy, enables compensation of spatial misalignments, and thereby provides additional safety by increasing overall accuracy.
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Affiliation(s)
- Miriam H. A. Bopp
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), 35043 Marburg, Germany
| | - Felix Corr
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany
- EDU Institute of Higher Education, Villa Bighi, Chaplain’s House, KKR 1320 Kalkara, Malta
| | - Benjamin Saß
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Mirza Pojskic
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - André Kemmling
- Department of Neuroradiology, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), 35043 Marburg, Germany
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Broocks G, Hanning U, Bechstein M, Elsayed S, Faizy TD, Brekenfeld C, Flottmann F, Kniep H, Deb-Chatterji M, Schön G, Thomalla G, Kemmling A, Fiehler J, Meyer L. Association of Thrombectomy With Functional Outcome for Patients With Ischemic Stroke Who Presented in the Extended Time Window With Extensive Signs of Infarction. JAMA Netw Open 2022; 5:e2235733. [PMID: 36239941 PMCID: PMC9568804 DOI: 10.1001/jamanetworkopen.2022.35733] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
IMPORTANCE Only limited data are available about a potential benefit associated with endovascular treatment (EVT) for patients with ischemic stroke presenting in the extended time window who also show signs of extensive infarction. OBJECTIVE To assess the association of recanalization after EVT with functional outcomes for patients with ischemic stroke presenting in the extended time window who also show signs of extensive infarction. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included patients enrolled in the German Stroke Registry-Endovascular Treatment with an Alberta Stroke Program Early CT Score (ASPECTS) of 5 or less who presented between 6 and 24 hours after stroke onset and underwent computed tomography and subsequent EVT between July 1, 2015, and December 31, 2019. MAIN OUTCOMES AND MEASURES The primary end point was a modified Rankin Scale (mRS) score of 3 or less at day 90. The association between recanalization (defined as the occurrence of a modified Thrombolysis in Cerebral Infarction Scale score of 2b or 3) and outcome was assessed using logistic regression and inverse probability weighting analysis. INTERVENTION Endovascular treatment. RESULTS Of 5853 patients, 285 (5%; 146 men [51%]; median age, 73 years [IQR, 62-81 years]) met the inclusion criteria and were analyzed. Of these 285 patients, 79 (27.7%) had an mRS score of 3 or less at day 90. The rate of successful recanalization was 75% (215 of 285) and was independently associated with a higher probability of reaching an mRS score of 3 or less (adjusted odds ratio, 4.39; 95% CI, 1.79-10.72; P < .001). In inverse probability weighting analysis, a modified Thrombolysis in Cerebral Infarction Scale score of 2b or 3 was associated with a 19% increase (95% CI, 9%-29%; P < .001) in the probability for an mRS score of 3 or more. Multivariable logistic regression analysis suggested a significant treatment benefit associated with vessel recanalization in a time window of up to 17.6 hours and ASPECTS of 3 to 5. The rate of secondary symptomatic intracerebral hemorrhage was 6.3% (18 of 285). CONCLUSIONS AND RELEVANCE In this cohort study reflecting daily clinical practice, vessel recanalization for patients with a low ASPECTS and extended time window was associated with better functional outcomes in a time window up to 17.6 hours and ASPECTS of 3 to 5. The results of this study encourage current randomized clinical trials to enroll patients with a low ASPECTS, even within the extended time window.
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Affiliation(s)
- Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Elsayed
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias D. Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Caspar Brekenfeld
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Milani Deb-Chatterji
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Schön
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Kemmling
- Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Sporns PB, Höhne M, Meyer L, Krogias C, Puetz V, Thierfelder KM, Duering M, Kaiser D, Langner S, Brehm A, Rotkopf LT, Kunz WG, Fiehler J, Heindel W, Schramm P, Wiendl H, Minnerup H, Psychogios MN, Kemmling A, Minnerup J. Simplified Assessment of Lesion Water Uptake for Identification of Patients within 4.5 Hours of Stroke
Onset: An Analysis of the MissPerfeCT Study. J Stroke 2022; 24:390-395. [PMID: 36221942 PMCID: PMC9561216 DOI: 10.5853/jos.2022.00220] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/17/2022] [Accepted: 04/01/2022] [Indexed: 11/11/2022] Open
Abstract
Background and Purpose Many patients with stroke cannot receive intravenous thrombolysis because the time of symptom onset is unknown. We tested whether a simple method of computed tomography (CT)-based quantification of water uptake in the ischemic tissue can identify patients with stroke onset within 4.5 hours. Methods This retrospective analysis of the MissPerfeCT study (August 2009 to November 2017) includes consecutive patients with known onset of symptoms from seven tertiary stroke centers. We developed a simplified algorithm based on region of interest (ROI) measurements to quantify water uptake of the ischemic lesion and thereby quantify time of symptom onset within and beyond 4.5 hours. Perfusion CT was used to identify ischemic brain tissue, and its density was measured in non-contrast CT and related to the density of the corresponding area of the contralateral hemisphere to quantify lesion water uptake. Results Of 263 patients, 204 (77.6%) had CT within 4.5 hours. Water uptake was significantly lower in patients with stroke onset within (6.7%; 95% confidence interval [CI], 6.0% to 7.4%) compared to beyond 4.5 hours (12.7%; 95% CI, 10.7% to 14.7%). The area under the curve for distinguishing these patient groups according to percentage water uptake was 0.744 with an optimal cut-off value of 9.5%. According to this cut-off the positive predictive value was 88.8%, sensitivity was 73.5%, specificity 67.8%, negative predictive value was 42.6%. Conclusions Ischemic stroke patients with unknown time of symptom onset can be identified as being within a timeframe of 4.5 hours using a ROI-based method to assess water uptake on admission non-contrast head CT.
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Affiliation(s)
- Peter B. Sporns
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Correspondence: Peter B. Sporns Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland Tel: 41-61-328-6370 Fax: 41-61-328-6371 E-mail:
| | - Marco Höhne
- Department of Radiology, University Hospital of Münster, Westfaelische Wilhelms-University of Münster, Münster, Germany
| | - Lennart Meyer
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
- Neurovascular Center Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Kolja M. Thierfelder
- Department of Radiology and Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Rostock, Germany
| | - Marco Duering
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Daniel Kaiser
- Neurovascular Center Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Sönke Langner
- Department of Radiology and Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Rostock, Germany
| | - Alex Brehm
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Lukas T. Rotkopf
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Wolfgang G. Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walter Heindel
- Department of Radiology, University Hospital of Münster, Westfaelische Wilhelms-University of Münster, Münster, Germany
| | - Peter Schramm
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Heike Minnerup
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Marios Nikos Psychogios
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - André Kemmling
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Marburg, Marburg University, Marburg, Germany
| | - Jens Minnerup
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
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15
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Bopp MHA, Saß B, Pojskić M, Corr F, Grimm D, Kemmling A, Nimsky C. Use of Neuronavigation and Augmented Reality in Transsphenoidal Pituitary Adenoma Surgery. J Clin Med 2022; 11:jcm11195590. [PMID: 36233457 PMCID: PMC9571217 DOI: 10.3390/jcm11195590] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 07/29/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to report on the clinical experience with microscope-based augmented reality (AR) in transsphenoidal surgery compared to the classical microscope-based approach. AR support was established using the head-up displays of the operating microscope, with navigation based on fiducial-/surface- or automatic intraoperative computed tomography (iCT)-based registration. In a consecutive single surgeon series of 165 transsphenoidal procedures, 81 patients underwent surgery without AR support and 84 patients underwent surgery with AR support. AR was integrated straightforwardly within the workflow. ICT-based registration increased AR accuracy significantly (target registration error, TRE, 0.76 ± 0.33 mm) compared to the landmark-based approach (TRE 1.85 ± 1.02 mm). The application of low-dose iCT protocols led to a significant reduction in applied effective dosage being comparable to a single chest radiograph. No major vascular or neurological complications occurred. No difference in surgical time was seen, time to set-up patient registration prolonged intraoperative preparation time on average by twelve minutes (32.33 ± 13.35 vs. 44.13 ± 13.67 min), but seems justifiable by the fact that AR greatly and reliably facilitated surgical orientation and increased surgeon comfort and patient safety, not only in patients who had previous transsphenoidal surgery but also in cases with anatomical variants. Automatic intraoperative imaging-based registration is recommended.
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Affiliation(s)
- Miriam H. A. Bopp
- Department of Neurosurgery, University of Marburg, 35043 Marburg, Germany
- Marburg Center for Mind, Brain and Behavior (CMBB), 35032 Marburg, Germany
- Correspondence:
| | - Benjamin Saß
- Department of Neurosurgery, University of Marburg, 35043 Marburg, Germany
| | - Mirza Pojskić
- Department of Neurosurgery, University of Marburg, 35043 Marburg, Germany
| | - Felix Corr
- Department of Neurosurgery, University of Marburg, 35043 Marburg, Germany
- EDU Institute of Higher Education, Villa Bighi, Chaplain’s House, KKR 1320 Kalkara, Malta
| | - Dustin Grimm
- Department of Neurosurgery, University of Marburg, 35043 Marburg, Germany
- EDU Institute of Higher Education, Villa Bighi, Chaplain’s House, KKR 1320 Kalkara, Malta
| | - André Kemmling
- Department of Neuroradiology, University of Marburg, 35043 Marburg, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, 35043 Marburg, Germany
- Marburg Center for Mind, Brain and Behavior (CMBB), 35032 Marburg, Germany
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16
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Meyer L, Stracke P, Wallocha M, Broocks G, Sporns P, Piechowiak EI, Kaesmacher J, Maegerlein C, Hernandez Petzsche MR, Dorn F, Zimmermann H, Naziri W, Abdullayev N, Kabbasch C, Behme D, Jamous A, Maus V, Fischer S, Möhlenbruch M, Weyland CS, Langner S, Meila D, Miszczuk M, Siebert E, Lowens S, Krause LU, Yeo L, Tan B, Gopinathan A, Gory B, Galván-Fernández J, Schüller M, Navia P, Raz E, Shapiro M, Arnberg F, Zeleňák K, Martínez-Galdámez M, Kastrup A, Papanagiotou P, Kemmling A, Psychogios M, Andersson T, Chapot R, Fiehler J, Hanning U. Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study. Stroke 2022; 53:2449-2457. [PMID: 35443785 DOI: 10.1161/strokeaha.121.037792] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 11/16/2022]
Abstract
BACKGROUND The optimal endovascular strategy for reperfusing distal medium-vessel occlusions (DMVO) remains unknown. This study evaluates angiographic and clinical outcomes of thrombectomy strategies in DMVO stroke of the posterior circulation. METHODS TOPMOST (Treatment for Primary Medium Vessel Occlusion Stroke) is an international, retrospective, multicenter, observational registry of patients treated for DMVO between January 2014 and June 2020. This study analyzed endovascularly treated isolated primary DMVO of the posterior cerebral artery in the P2 and P3 segment. Technical feasibility was evaluated with the first-pass effect defined as a modified Thrombolysis in Cerebral Infarction Scale score of 3. Rates of early neurological improvement and functional modified Rankin Scale scores at 90 days were compared. Safety was assessed by the occurrence of symptomatic intracranial hemorrhage and intervention-related serious adverse events. RESULTS A total of 141 patients met the inclusion criteria and were treated endovascularly for primary isolated DMVO in the P2 (84.4%, 119) or P3 segment (15.6%, 22) of the posterior cerebral artery. The median age was 75 (IQR, 62-81), and 45.4% (64) were female. The initial reperfusion strategy was aspiration only in 29% (41) and stent retriever in 71% (100), both achieving similar first-pass effect rates of 53.7% (22) and 44% (44; P=0.297), respectively. There were no significant differences in early neurological improvement (aspiration: 64.7% versus stent retriever: 52.2%; P=0.933) and modified Rankin Scale rates (modified Rankin Scale score 0-1, aspiration: 60.5% versus stent retriever 68.6%; P=0.4). In multivariable logistic regression analysis, the time from groin puncture to recanalization was associated with the first-pass effect (adjusted odds ratio, 0.97 [95% CI, 0.95-0.99]; P<0.001) that in turn was associated with early neurological improvement (aOR, 3.27 [95% CI, 1.16-9.21]; P<0.025). Symptomatic intracranial hemorrhage occurred in 2.8% (4) of all cases. CONCLUSIONS Both first-pass aspiration and stent retriever thrombectomy for primary isolated posterior circulation DMVO seem to be safe and technically feasible leading to similar favorable rates of angiographic and clinical outcome.
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Affiliation(s)
- Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.)
| | - Paul Stracke
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.).,Department of Interventional Neuroradiology, University Hospital Muenster, Germany (P.S.).,Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Switzerland (P.S., M.P.)
| | - Marta Wallocha
- Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Germany (M.W., R.C.)
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.)
| | - Peter Sporns
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.)
| | - Eike I Piechowiak
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (E.I.P., J.K.)
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (E.I.P., J.K.).,Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (J.K.)
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.)
| | - Moritz Roman Hernandez Petzsche
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.)
| | - Franziska Dorn
- Institute of Neuroradiology, University Hospitals, LMU Munich, Germany (F.D., H.Z.)
| | - Hanna Zimmermann
- Institute of Neuroradiology, University Hospitals, LMU Munich, Germany (F.D., H.Z.)
| | - Weis Naziri
- Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.).,Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.)
| | - Nuran Abdullayev
- Department of Neuroradiology, University of Cologne, Germany (N.A., C.K.)
| | - Christoph Kabbasch
- Department of Neuroradiology, University of Cologne, Germany (N.A., C.K.)
| | - Daniel Behme
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital Goettingen, Germany (D.B., A.J.)
| | - Ala Jamous
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital Goettingen, Germany (D.B., A.J.)
| | - Volker Maus
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Germany (V.M., S.F.)
| | - Sebastian Fischer
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Germany (V.M., S.F.)
| | - Markus Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Germany (M.M., C.S.W.)
| | - Charlotte S Weyland
- Department of Neuroradiology, Heidelberg University Hospital, Germany (M.M., C.S.W.)
| | - Sönke Langner
- Institute for Diagnostic and Interventional Radiology, Pediatric and Neuroradiology, University Hospital Rostock, Germany (S.L.)
| | - Dan Meila
- Department of Interventional Neuroradiology, Johanna-Étienne-Hospital, Neuss, Germany (D.M.)
| | - Milena Miszczuk
- Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Germany (M.M., E.S.)
| | - Eberhard Siebert
- Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Germany (M.M., E.S.)
| | - Stephan Lowens
- Department of Radiology, Klinikum Osnabrück, Germany. (S.L.)
| | - Lars Udo Krause
- Department of Neurology, Klinikum Osnabrück, Germany. (L.U.K.)
| | - Leonard Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore. (L.Y., B.T.).,Yong Loo Lin School of Medicine, National University of Singapore (L.Y., B.T., A.G.)
| | - Benjamin Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore. (L.Y., B.T.).,Yong Loo Lin School of Medicine, National University of Singapore (L.Y., B.T., A.G.)
| | - Anil Gopinathan
- Department of Diagnostic imaging, National University Health System, Singapore. (A.G.)
| | - Benjamin Gory
- Yong Loo Lin School of Medicine, National University of Singapore (L.Y., B.T., A.G.).,Université de Lorraine, CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, France (B.G.).,Université de Lorraine, IADI, INSERM U1254, F-54000 Nancy, France (B.G.)
| | - Jorge Galván-Fernández
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Spain (J.G.-F., M.S., M.M.-G.)
| | - Miguel Schüller
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Spain (J.G.-F., M.S., M.M.-G.)
| | - Pedro Navia
- Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.)
| | - Eytan Raz
- Department of Radiology, New York Langone Medical Center (E.R., M.S.)
| | - Maksim Shapiro
- Department of Radiology, New York Langone Medical Center (E.R., M.S.)
| | - Fabian Arnberg
- Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.)
| | - Kamil Zeleňák
- Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.)
| | - Mario Martínez-Galdámez
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Spain (J.G.-F., M.S., M.M.-G.)
| | - Andreas Kastrup
- Department of Neurology, Hospital Bremen-Mitte, Germany (A.K.)
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Germany (P.P.).,Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Greece (P.P.)
| | - André Kemmling
- Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.).,Department of Neuroradiology, University Hospital Marburg, Germany (A.K.)
| | - Marios Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Switzerland (P.S., M.P.)
| | - Tommy Andersson
- Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.).,Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.)
| | - Rene Chapot
- Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Germany (M.W., R.C.)
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.)
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.)
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17
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Kunz WG, Sporns PB, Psychogios MN, Fiehler J, Chapot R, Dorn F, Grams A, Morotti A, Musolino P, Lee S, Kemmling A, Henkes H, Nikoubashman O, Wiesmann M, Jensen-Kondering U, Möhlenbruch M, Schlamann M, Marik W, Schob S, Wendl C, Turowski B, Götz F, Kaiser D, Dimitriadis K, Gersing A, Liebig T, Ricke J, Reidler P, Wildgruber M, Mönch S. Cost-Effectiveness of Endovascular Thrombectomy in Childhood Stroke: An Analysis of the Save ChildS Study. J Stroke 2022; 24:138-147. [PMID: 35135067 PMCID: PMC8829473 DOI: 10.5853/jos.2021.01606] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/23/2021] [Indexed: 12/02/2022] Open
Abstract
Background and Purpose The Save ChildS Study demonstrated that endovascular thrombectomy (EVT) is a safe treatment option for pediatric stroke patients with large vessel occlusions (LVOs) with high recanalization rates. Our aim was to determine the long-term cost, health consequences and cost-effectiveness of EVT in this patient population.
Methods In this retrospective study, a decision-analytic Markov model estimated lifetime costs and quality-adjusted life years (QALYs). Early outcome parameters were based on the entire Save ChildS Study to model the EVT group. As no randomized data exist, the Save ChildS patient subgroup with unsuccessful recanalization was used to model the standard of care group. For modeling of lifetime estimates, pediatric and adult input parameters were obtained from the current literature. The analysis was conducted in a United States setting applying healthcare and societal perspectives. Probabilistic sensitivity analyses were performed. The willingness-to-pay threshold was set to $100,000 per QALY.
Results The model results yielded EVT as the dominant (cost-effective as well as cost-saving) strategy for pediatric stroke patients. The incremental effectiveness for the average age of 11.3 years at first stroke in the Save ChildS Study was determined as an additional 4.02 lifetime QALYs, with lifetime cost-savings that amounted to $169,982 from a healthcare perspective and $254,110 when applying a societal perspective. Acceptability rates for EVT were 96.60% and 96.66% for the healthcare and societal perspectives.
Conclusions EVT for pediatric stroke patients with LVOs resulted in added QALY and reduced lifetime costs. Based on the available data in the Save ChildS Study, EVT is very likely to be a cost-effective treatment strategy for childhood stroke.
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Affiliation(s)
- Wolfgang G. Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Correspondence: Wolfgang G. Kunz Department of Radiology, University Hospital, LMU Munich, Marchioninistr 15, 81377 Munich, Germany Tel: +49-89-4400-73630 Fax: +49-89-4400-78832 E-mail:
| | - Peter B. Sporns
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios N. Psychogios
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - René Chapot
- Department of Neuroradiology, Alfried-Krupp Hospital, Essen, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Astrid Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Morotti
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Patricia Musolino
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology, Stanford University, Stanford, CA, USA
| | - André Kemmling
- Department for Neuroradiology, University Hospital Marburg, Marburg, Germany
| | - Hans Henkes
- Department of Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Martin Wiesmann
- Department of Neuroradiology, Aachen University, Aachen, Germany
| | - Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Markus Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc Schlamann
- Department of Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Wolfgang Marik
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Schob
- Department for Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Christina Wendl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Bernd Turowski
- Institute of Neuroradiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Friedrich Götz
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Daniel Kaiser
- Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Alexandra Gersing
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Liebig
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Paul Reidler
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Mönch
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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18
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Lee S, Jiang B, Wintermark M, Mlynash M, Christensen S, Sträter R, Broocks G, Grams A, Dorn F, Nikoubashman O, Kaiser D, Morotti A, Jensen-Kondering U, Trenkler J, Möhlenbruch M, Fiehler J, Wildgruber M, Kemmling A, Psychogios M, Sporns PB. Cerebrovascular Collateral Integrity in Pediatric Large Vessel Occlusion: Analysis of the Save ChildS Study. Neurology 2022; 98:e352-e363. [PMID: 34795051 DOI: 10.1212/wnl.0000000000013081] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/22/2021] [Accepted: 11/04/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Robust cerebrovascular collaterals in adult patients with large vessel occlusion stroke have been associated with longer treatment windows, better recanalization rates, and improved outcomes, but the role of collaterals in pediatric stroke is not known. The primary aim was to determine whether favorable collaterals correlated with better radiographic and clinical outcomes in children with ischemic stroke who underwent thrombectomy. METHODS This study analyzed a subset of children enrolled in SaveChildS, a retrospective, multicenter, observational cohort study of 73 pediatric patients with stroke who underwent thrombectomy between 2000 and 2018 at 27 US and European centers. Included patients had baseline angiographic imaging and follow-up modified Rankin Scale scores available for review. Posterior circulation occlusions were excluded. Cerebrovascular collaterals were graded on acute neuroimaging by 2 blinded neuroradiologists according to the Tan collateral score, in which favorable collaterals are defined as >50% filling and unfavorable collaterals as <50% filling distal to the occluded vessel. Collateral status was correlated with clinical and neuroimaging characteristics and outcomes. Between-group comparisons were performed with the Wilcoxon rank-sum test for continuous variables or Fisher exact test for binary variables. RESULTS Thirty-three children (mean age 10.9 [SD ±4.9]) years were included; 14 (42.4%) had favorable collaterals. Median final stroke volume as a percent of total brain volume (TBV) was significantly lower in patients with favorable collaterals (1.35% [interquartile range (IQR) 1.14%-3.76%] vs 7.86% [IQR 1.54%-11.07%], p = 0.049). Collateral status did not correlate with clinical outcome, infarct growth, or final Alberta Stroke Program Early CT Score (ASPECTS) in our cohort. Patients with favorable collaterals had higher baseline ASPECTS (7 [IQR 6-8] vs 5.5 [4-6], p = 0.006), smaller baseline ischemic volume (1.57% TBV [IQR 1.09%-2.29%] vs 3.42% TBV [IQR 1.26%-5.33%], p = 0.035), and slower early infarct growth rate (2.4 mL/h [IQR 1.5-5.1 mL/h] vs 10.4 mL/h [IQR 3.0-30.7 mL/h], p = 0.028). DISCUSSION Favorable collaterals were associated with smaller final stroke burden and slower early infarct growth rate but not with better clinical outcome in our study. Prospective studies are needed to determine the impact of collaterals in childhood stroke. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in children with ischemic stroke undergoing thrombectomy, favorable collaterals were associated with improved radiographic outcomes but not with better clinical outcomes.
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Affiliation(s)
- Sarah Lee
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland.
| | - Bin Jiang
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Max Wintermark
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Michael Mlynash
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Soren Christensen
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Ronald Sträter
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Gabriel Broocks
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Astrid Grams
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Franziska Dorn
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Omid Nikoubashman
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Daniel Kaiser
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Andrea Morotti
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Ulf Jensen-Kondering
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Johannes Trenkler
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Markus Möhlenbruch
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Jens Fiehler
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Moritz Wildgruber
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - André Kemmling
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Marios Psychogios
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Peter B Sporns
- From the Department of Neurology & Neurological Sciences, Stanford Stroke Center (S.L., M. Mlynash, S.C.), Department of Neurology & Neurological Sciences (S.L.), Division of Child Neurology, and Department of Radiology (B.J., M. Wintermark), Division of Neuroradiology, Stanford University School of Medicine, CA; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F., P.B.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (F.D.), University Hospital Bonn; Department of Neuroradiology (O.N.), RWTH Aachen University; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden, Germany; ASST Valcamonica (A.M.), UOSD Neurology, Esine (BS), Brescia, Italy; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Campus Kiel; Institute of Neuroradiology (U.J.-K.), UKSH Campus Lübeck, Germany; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M. Möhlenbruch), Heidelberg University Hospital; Department of Radiology (M. Wildgruber), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; and Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
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Sporns PB, Kemmling A, Minnerup H, Meyer L, Krogias C, Puetz V, Thierfelder K, Duering M, Kaiser D, Langner S, Massoth C, Brehm A, Rotkopf L, Kunz WG, Karch A, Fiehler J, Heindel W, Schramm P, Royl G, Wiendl H, Psychogios M, Minnerup J. CT Hypoperfusion-Hypodensity Mismatch to Identify Patients With Acute Ischemic Stroke Within 4.5 Hours of Symptom Onset. Neurology 2021; 97:e2088-e2095. [PMID: 34649883 DOI: 10.1212/wnl.0000000000012891] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 09/15/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To test the hypothesis that CT hypoperfusion-hypodensity mismatch identifies patients with ischemic stroke within 4.5 hours of symptom onset. METHODS We therefore performed the Retrospective Multicenter Hypoperfusion-Hypodensity Mismatch for The identification of Patients With Stroke Within 4.5 Hours study of patients with acute ischemic stroke and known time of symptom onset. The predictive values of hypoperfusion-hypodensity mismatch for the identification of patients with symptom onset within 4.5 hours were the main outcome measure. RESULTS Of 666 patients, 548 (82.3%) had multimodal CT within 4.5 hours and 118 (17.7%) beyond 4.5 hours. Hypoperfusion-hypodensity mismatch was visible in 516 (94.2%) patients with symptom onset within and in 30 (25.4%) patients beyond 4.5 hours. CT hypoperfusion-hypodensity mismatch identified patients within 4.5 hours of stroke onset with 94.2% (95% confidence interval [CI] 91.9%-95.8%) sensitivity, 74.6% (95% CI 66.0%-81.6%) specificity, 94.5% (95% CI 92.3%-96.1%) positive predictive value, and 73.3% (95% CI 64.8%-80.4%) negative predictive value. Interobserver agreement for hypoperfusion-hypodensity mismatch was substantial (κ = 0.61, 95% CI 0.53-0.69). DISCUSSION Patients with acute ischemic stroke with absence of a hypodensity on native CT (NCCT) within the hypoperfused core lesion on perfusion CT (hypoperfusion-hypodensity mismatch) are likely to be within the time window of thrombolysis. Applying this method may guide the decision to use thrombolysis in patients with unknown time of stroke onset. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT04277728. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that CT hypoperfusion-hypodensity mismatch identifies patients with stroke within 4.5 hours of onset.
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Affiliation(s)
- Peter B Sporns
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - André Kemmling
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Heike Minnerup
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Lennart Meyer
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Christos Krogias
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Volker Puetz
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Kolja Thierfelder
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Marco Duering
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Daniel Kaiser
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Soenke Langner
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Christina Massoth
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Alex Brehm
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Lukas Rotkopf
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Wolfgang G Kunz
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - André Karch
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Jens Fiehler
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Walter Heindel
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Peter Schramm
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Georg Royl
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Heinz Wiendl
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Marios Psychogios
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany
| | - Jens Minnerup
- From the Department of Neuroradiology (P.B.S., A.B., M.P.), Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Department of Radiology (P.B.S., W.H.), University Hospital Muenster; Department of Neuroradiology (A. Kemmling), University Hospital Marburg; Department of Neuroradiology (A. Kemmling, P.S.), University Medical Center Schleswig-Holstein, Luebeck; Institute of Epidemiology and Social Medicine (H.M., A. Karch), University of Muenster; Department of Neurology with Institute of Translational Neurology (L.M., H.W., J.M.), University Hospital Muenster; Department of Neurology (C.K.), St. Josef-Hospital, Ruhr University Bochum; Department of Neurology (V.P.), University Hospital Carl Gustav Carus, Dresden; Department of Radiology and Institute of Diagnostic and Interventional Radiology (K.T., S.L.), University Medical Center Rostock; Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden; Department of Anesthesiology (C.M.), Intensive Care and Pain Medicine, University Hospital Muenster; Department of Radiology (L.R.), German Cancer Research Center, Heidelberg; Department of Radiology (W.G.K.), University Hospital, LMU Munich; and Department of Neurology (G.R.), Center of Brain, Behaviour and Metabolism, University of Luebeck, Germany.
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Sporns PB, Kemmling A, Lee S, Fullerton H, Kunz WG, Wilson JL, Mackay MT, Steinlin M, Fiehler J, Psychogios M, Wildgruber M. A Prospective Multicenter Registry on Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke (Save ChildS Pro). Front Neurol 2021; 12:736092. [PMID: 34539563 PMCID: PMC8446378 DOI: 10.3389/fneur.2021.736092] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 07/30/2021] [Indexed: 11/19/2022] Open
Abstract
Rationale: Early evidence for the benefit of mechanical thrombectomy (MT) in pediatric patients with intracranial large vessel occlusion has been shown in previous retrospective cohorts. Higher-level evidence is needed to overcome the limitations of these studies such as the lack of a control group and the retrospective design. Randomized trials will very likely not be feasible, and several open questions remain, for example, the impact of arteriopathic etiologies or a possible lower age limit for MT. Save ChildS Pro therefore aims to demonstrate the safety and effectiveness of MT in pediatric patients compared to the best medical management and intravenous thrombolysis. Design: Save ChildS Pro is designed as a worldwide multicenter prospective registry comparing the safety and effectiveness of MT to the best medical care alone in the treatment of pediatric arterial ischemic stroke (AIS). It will include pediatric patients (<18 years) with symptomatic acute intracranial arterial occlusion who underwent either MT or best medical treatment including intravenous thrombolysis. Outcomes: The primary endpoint of Save ChildS Pro is the modified Rankin Scale score at 90 days post-stroke. Secondary endpoints will comprise the decrease of the Pediatric National Institutes of Health Stroke Scale score from admission to discharge and rate of complications. Discussion: Save ChildS Pro aims to provide high-level evidence for MT for pediatric patients with AIS, thereby improving functional outcome and quality of life and reducing the individual, societal, and economic burden of death and disability resulting from pediatric stroke. Clinical Trial Registration: Save ChildS Pro is registered at the German Clinical Trials Registry (DRKS; identifier: DRKS00018960).
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Affiliation(s)
- Peter B Sporns
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Kemmling
- Department of Neuroradiology, University Hospital Marburg, Marburg, Germany
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology, Stanford University, Stanford, CA, United States
| | - Heather Fullerton
- Department of Neurology and Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, Munich, Germany
| | - Jenny L Wilson
- Division of Pediatric Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Mark T Mackay
- Department of Neurology, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Maja Steinlin
- Division of Neuropediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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21
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Meyer L, Bechstein M, Bester M, Hanning U, Brekenfeld C, Flottmann F, Kniep H, van Horn N, Deb-Chatterji M, Thomalla G, Sporns P, Yeo LLL, Tan BYQ, Gopinathan A, Kastrup A, Politi M, Papanagiotou P, Kemmling A, Fiehler J, Broocks G. Thrombectomy in Extensive Stroke May Not Be Beneficial and Is Associated With Increased Risk for Hemorrhage. Stroke 2021; 52:3109-3117. [PMID: 34470489 DOI: 10.1161/strokeaha.120.033101] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 11/16/2022]
Abstract
Background and Purpose This study evaluates the benefit of endovascular treatment (EVT) for patients with extensive baseline stroke compared with best medical treatment. Methods This retrospective, multicenter study compares EVT and best medical treatment for computed tomography (CT)–based selection of patients with extensive baseline infarcts (Alberta Stroke Program Early CT Score ≤5) attributed to anterior circulation stroke. Patients were selected from the German Stroke Registry and 3 tertiary stroke centers. Primary functional end points were rates of good (modified Rankin Scale score of ≤3) and very poor outcome (modified Rankin Scale score of ≥5) at 90 days. Secondary safety end point was the occurrence of symptomatic intracerebral hemorrhage. Angiographic outcome was evaluated with the modified Thrombolysis in Cerebral Infarction Scale. Results After 1:1 pair matching, a total of 248 patients were compared by treatment arm. Good functional outcome was observed in 27.4% in the EVT group, and in 25% in the best medical treatment group (P=0.665). Advanced age (adjusted odds ratio, 1.08 [95% CI, 1.05–1.10], P<0.001) and symptomatic intracerebral hemorrhage (adjusted odds ratio, 6.35 [95% CI, 2.08–19.35], P<0.001) were independently associated with very poor outcome. Mortality (43.5% versus 28.9%, P=0.025) and symptomatic intracerebral hemorrhage (16.1% versus 5.6%, P=0.008) were significantly higher in the EVT group. The lowest rates of good functional outcome (≈15%) were observed in groups of failed and partial recanalization (modified Thrombolysis in Cerebral Infarction Scale score of 0/1–2a), whereas patients with complete recanalization (modified Thrombolysis in Cerebral Infarction Scale score of 3) with recanalization attempts ≤2 benefitted the most (modified Rankin Scale score of ≤3:42.3%, P=0.074) compared with best medical treatment. Conclusions In daily clinical practice, EVT for CT–based selected patients with low Alberta Stroke Program Early CT Score anterior circulation stroke may not be beneficial and is associated with increased risk for hemorrhage and mortality, especially in the elderly. However, first- or second-pass complete recanalization seems to reveal a clinical benefit of EVT highlighting the vulnerability of the low Alberta Stroke Program Early CT Score subgroup. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03356392.
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Affiliation(s)
- Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology (L.M., M. Bechstein, M. Bester, U.H., C.B., F.F., H.K., N.v.H., P.S., J.F., G.B.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology (L.M., M. Bechstein, M. Bester, U.H., C.B., F.F., H.K., N.v.H., P.S., J.F., G.B.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology (L.M., M. Bechstein, M. Bester, U.H., C.B., F.F., H.K., N.v.H., P.S., J.F., G.B.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology (L.M., M. Bechstein, M. Bester, U.H., C.B., F.F., H.K., N.v.H., P.S., J.F., G.B.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Caspar Brekenfeld
- Department of Diagnostic and Interventional Neuroradiology (L.M., M. Bechstein, M. Bester, U.H., C.B., F.F., H.K., N.v.H., P.S., J.F., G.B.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology (L.M., M. Bechstein, M. Bester, U.H., C.B., F.F., H.K., N.v.H., P.S., J.F., G.B.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology (L.M., M. Bechstein, M. Bester, U.H., C.B., F.F., H.K., N.v.H., P.S., J.F., G.B.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Noel van Horn
- Department of Diagnostic and Interventional Neuroradiology (L.M., M. Bechstein, M. Bester, U.H., C.B., F.F., H.K., N.v.H., P.S., J.F., G.B.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Milani Deb-Chatterji
- Department of Neurology (M.D.-C., G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology (M.D.-C., G.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Sporns
- Department of Diagnostic and Interventional Neuroradiology (L.M., M. Bechstein, M. Bester, U.H., C.B., F.F., H.K., N.v.H., P.S., J.F., G.B.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Switzerland (P.S.)
| | - Leonard Leong-Litt Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore (L.L.-L.Y., B.Y.-Q.T.).,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (L.L.-L.Y., B.Y.-Q.T., A.G.)
| | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore (L.L.-L.Y., B.Y.-Q.T.).,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (L.L.-L.Y., B.Y.-Q.T., A.G.)
| | - Anil Gopinathan
- Division of Interventional Radiology, Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore (A.G.).,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (L.L.-L.Y., B.Y.-Q.T., A.G.)
| | - Andreas Kastrup
- Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup)
| | - Maria Politi
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Germany (M.P., P.P.)
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Germany (M.P., P.P.).,Areteion University Hospital, National and Kapodistrian University of Athens, Greece (P.P.)
| | - André Kemmling
- Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (A. Kemmling).,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Marburg, Marburg University, Germany (A. Kemmling)
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology (L.M., M. Bechstein, M. Bester, U.H., C.B., F.F., H.K., N.v.H., P.S., J.F., G.B.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology (L.M., M. Bechstein, M. Bester, U.H., C.B., F.F., H.K., N.v.H., P.S., J.F., G.B.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lefevre PH, Schramm P, Kemmling A, Barreau X, Marnat G, Piotin M, Berlis A, Wanke I, Bonafe A, Houdart E. Multi-centric European post-market follow-up study of the Neuroform Atlas Stent System: primary results. J Neurointerv Surg 2021; 14:694-698. [PMID: 34475253 DOI: 10.1136/neurintsurg-2021-017849] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/07/2021] [Accepted: 08/03/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Few prospective series have described the safety and effectiveness of the Neuroform Atlas Stent System. We aimed to investigate the efficacy and safety of the device in patients treated for unruptured aneurysm. METHODS ATLAS EU PMCF is a consecutive, prospective, multicentric study that included patients with unruptured saccular aneurysm of all sizes. Follow-up visits were scheduled at 3-6 months and 12-16 months with digital subtraction angiography (DSA) or MRI imaging follow-up as per the site standard of care. The primary efficacy endpoint was adequate aneurysm occlusion (Raymond Roy occlusion grade I and II) on 12 month angiography. The primary safety endpoint was any major stroke or ipsilateral stroke or neurological death within 12 months. RESULTS Of the 106 patients consented, 105 were treated with at least one Neuroform Atlas stent. There was a failed implantation attempt in 1 patient, 85 patients received lateral stenting, and 19 patients received Y-stenting. Mean aneurysm neck size was 4.2 mm (range 1.9-33 mm). Adequate occlusion was observed in 95.1% immediately after the procedure and in 98.9% of cases at 1 year DSA follow-up. Overall, 1.0% (1/102; 95% CI 0.0% to 5.3%) of patients experienced a primary safety endpoint of major stroke. Three minor strokes resulted in a modified Rankin Scale score of 2. CONCLUSIONS In this multicentric, prospective study, stent-assisted coiling of medium size unruptured aneurysms with the Neuroform Atlas stent resulted in a favorable rate of satisfactory occlusion. In our findings, the use of the Y-stenting technique was associated with increased rates of procedural complications. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT02783339.
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Affiliation(s)
- Pierre-Henri Lefevre
- Neuroradiology department, Gui de Chauliac Hospital Montpellier University Hospital, Montpellier, France
| | - Peter Schramm
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - André Kemmling
- Institute of Neuroradiology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Xavier Barreau
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Gaultier Marnat
- Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Augsburg, Augsburg, Bayern, Germany
| | - Isabel Wanke
- Neuroradiology Department, Hirslanden Clinic, Zurich, Switzerland
| | - Alain Bonafe
- Neuroradiology department, Gui de Chauliac Hospital Montpellier University Hospital, Montpellier, France
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23
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Nawabi J, Elsayed S, Scholz H, Kemmling A, Meyer L, Kniep H, Bechstein M, Flottmann F, Faizy TD, Schön G, Fiehler J, Hanning U, Broocks G. Interaction Effect of Baseline Serum Glucose and Early Ischemic Water Uptake on the Risk of Secondary Hemorrhage After Ischemic Stroke. Front Neurol 2021; 12:690193. [PMID: 34305796 PMCID: PMC8297562 DOI: 10.3389/fneur.2021.690193] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose: Intracerebral hemorrhage (ICH) after mechanical thrombectomy (MT) for acute ischemic stroke (AIS) remains a major complication and its early prediction is of high relevance. Baseline serum glucose (BGL) is a known predictor of ICH, but its interaction with early ischemic changes remains uncertain. We hypothesized that BGL interacts with the effect of tissue water uptake on the occurrence of ICH. Methods: Three hundred and thirty-six patients with acute ischemic stroke treated with MT were retrospectively analyzed. ICH was diagnosed within 24 h on non-enhanced CT (NECT) and classified according to the Heidelberg Bleeding Classification. Early tissue water homeostasis has been assessed using quantitative lesion net water uptake (NWU) on admission CT. Multivariate logistic regression was used to identify predictors of ICH. Results: One hundred and seven patients fulfilled the inclusion criteria of which 37 (34.6%) were diagnosed with ICH. Patients with ICH had a significant higher BGL on admission (median 177 mg/dl, IQR: 127-221.75, P < 0.001). In patients with low BGL (<120 mg/dl), higher NWU was associated with 1.34-fold increased likelihood of ICH, while higher NWU was associated with a 2.08-fold increased likelihood of ICH in patients with a high BGL (>200 mg/dl). In multivariable logistic regression analysis, BGL (OR: 1.02, 95% CI: 1.00-1.04, P = 0.01) and NWU (OR: 2.32, 95% CI: 1.44-3.73, P < 0.001) were significantly and independently associated with ICH, showing a significant interaction (P = 0.04). Conclusion: A higher degree of early tissue water uptake and high admission BGL were both independent predictors of ICH. Higher BGL was significantly associated with accelerated effects of NWU on the likelihood of ICH. Although a clear causal relationship remains speculative, stricter BGL control and monitoring may be tested to reduce the risk of ICH in patients undergoing thrombectomy.
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Affiliation(s)
- Jawed Nawabi
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health, BIH Biomedical Innovation Academy, Berlin, Germany
| | - Sarah Elsayed
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henriette Scholz
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Kemmling
- University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- University Medical Center Marburg, Marburg University, Marburg, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias D. Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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24
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Meyer L, Stracke CP, Jungi N, Wallocha M, Broocks G, Sporns PB, Maegerlein C, Dorn F, Zimmermann H, Naziri W, Abdullayev N, Kabbasch C, Behme D, Jamous A, Maus V, Fischer S, Möhlenbruch M, Weyland CS, Langner S, Meila D, Miszczuk M, Siebert E, Lowens S, Krause LU, Yeo LLL, Tan BYQ, Anil G, Gory B, Galván J, Arteaga MS, Navia P, Raz E, Shapiro M, Arnberg F, Zelenák K, Martinez-Galdamez M, Fischer U, Kastrup A, Roth C, Papanagiotou P, Kemmling A, Gralla J, Psychogios MN, Andersson T, Chapot R, Fiehler J, Kaesmacher J, Hanning U. Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke: The TOPMOST Study. JAMA Neurol 2021; 78:434-444. [PMID: 33616642 DOI: 10.1001/jamaneurol.2021.0001] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Importance Clinical evidence of the potential treatment benefit of mechanical thrombectomy for posterior circulation distal, medium vessel occlusion (DMVO) is sparse. Objective To investigate the frequency as well as the clinical and safety outcomes of mechanical thrombectomy for isolated posterior circulation DMVO stroke and to compare them with the outcomes of standard medical treatment with or without intravenous thrombolysis (IVT) in daily clinical practice. Design, Setting, and Participants This multicenter case-control study analyzed patients who were treated for primary distal occlusion of the posterior cerebral artery (PCA) of the P2 or P3 segment. These patients received mechanical thrombectomy or standard medical treatment (with or without IVT) at 1 of 23 comprehensive stroke centers in Europe, the United States, and Asia between January 1, 2010, and June 30, 2020. All patients who met the inclusion criteria were matched using 1:1 propensity score matching. Interventions Mechanical thrombectomy or standard medical treatment with or without IVT. Main Outcomes and Measures Clinical end point was the improvement of National Institutes of Health Stroke Scale (NIHSS) scores at discharge from baseline. Safety end point was the occurrence of symptomatic intracranial hemorrhage and hemorrhagic complications were classified based on the Second European-Australasian Acute Stroke Study (ECASSII). Functional outcome was evaluated with the modified Rankin Scale (mRS) score at 90-day follow-up. Results Of 243 patients from all participating centers who met the inclusion criteria, 184 patients were matched. Among these patients, the median (interquartile range [IQR]) age was 74 (62-81) years and 95 (51.6%) were female individuals. Posterior circulation DMVOs were located in the P2 segment of the PCA in 149 patients (81.0%) and in the P3 segment in 35 patients (19.0%). At discharge, the mean NIHSS score decrease was -2.4 points (95% CI, -3.2 to -1.6) in the standard medical treatment cohort and -3.9 points (95% CI, -5.4 to -2.5) in the mechanical thrombectomy cohort, with a mean difference of -1.5 points (95% CI, 3.2 to -0.8; P = .06). Significant treatment effects of mechanical thrombectomy were observed in the subgroup of patients who had higher NIHSS scores on admission of 10 points or higher (mean difference, -5.6; 95% CI, -10.9 to -0.2; P = .04) and in the subgroup of patients without IVT (mean difference, -3.0; 95% CI, -5.0 to -0.9; P = .005). Symptomatic intracranial hemorrhage occurred in 4 of 92 patients (4.3%) in each treatment cohort. Conclusions and Relevance This study suggested that, although rarely performed at comprehensive stroke centers, mechanical thrombectomy for posterior circulation DMVO is a safe, and technically feasible treatment option for occlusions of the P2 or P3 segment of the PCA compared with standard medical treatment with or without IVT.
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Affiliation(s)
- Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Paul Stracke
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany
| | - Noël Jungi
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marta Wallocha
- Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter B Sporns
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Franziska Dorn
- Institute of Neuroradiology, University Hospitals, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Hanna Zimmermann
- Institute of Neuroradiology, University Hospitals, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Weis Naziri
- Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany.,Department of Neuroradiology, University Hospital Luebeck, Luebeck, Germany
| | - Nuran Abdullayev
- Department of Neuroradiology, University of Cologne, Cologne, Germany
| | | | - Daniel Behme
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital Goettingen, Goettingen, Germany
| | - Ala Jamous
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital Goettingen, Goettingen, Germany
| | - Volker Maus
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum, Germany
| | - Sebastian Fischer
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum, Germany
| | - Markus Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Sönke Langner
- Institute for Diagnostic and Interventional Radiology, Pediatric and Neuroradiology, University Hospital Rostock, Rostock, Germany
| | - Dan Meila
- Department of Interventional Neuroradiology, Johanna-Étienne-Hospital, Neuss, Germany
| | - Milena Miszczuk
- Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Eberhard Siebert
- Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan Lowens
- Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany
| | - Lars Udo Krause
- Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany
| | - Leonard L L Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gopinathan Anil
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Diagnostic Imaging, National University Health System, Singapore
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France.,Université de Lorraine, Imagerie Adaptative Diagnostique et Interventionnelle, INSERM U1254, Nancy, France
| | - Jorge Galván
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Miguel Schüller Arteaga
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Pedro Navia
- Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain
| | - Eytan Raz
- Department of Radiology, New York Langone Medical Center, New York
| | - Maksim Shapiro
- Department of Radiology, New York Langone Medical Center, New York
| | - Fabian Arnberg
- Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kamil Zelenák
- Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia
| | - Mario Martinez-Galdamez
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Kastrup
- Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany
| | - Christian Roth
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany.,Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - André Kemmling
- Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany.,Department of Neuroradiology, University Hospital Luebeck, Luebeck, Germany
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marios-Nikos Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Tommy Andersson
- Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rene Chapot
- Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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25
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Casolla B, de Leciñana MA, Neves R, Pfeilschifter W, Svobodova V, Jung S, Kemmling A, Mikulik R, Santalucia P. Simulation training programs for acute stroke care: Objectives and standards of methodology. Eur Stroke J 2021; 5:328-335. [PMID: 33598550 DOI: 10.1177/2396987320971105] [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: 07/23/2020] [Accepted: 10/09/2020] [Indexed: 01/22/2023] Open
Abstract
The European Stroke Organisation (ESO) Simulation Committee was established in 2017 with the intent to promote simulation education and training in the stroke field. The application of simulation methodology in education and training improves healthcare professional performances in real clinical practice and patient outcomes. We evaluated the implementation of simulation training in stroke medicine, how it can significantly affect stroke pathways and quality of care. We herewith describe simulation techniques in the acute stroke setting. Simulation programs place the trainees in a safe environment, allowing both role-playings for decision making training and procedural simulation for technical skills improvement. This paper includes the position of the Committee on the key points, principles, and steps in order to set up and promote simulation programs in European stroke centers. Stroke is an emergency, and hyperacute phase management requires knowledge, expertise, optimal multidisciplinary team working, and timely actions in a very narrow time window. The ESO Simulation Committee promotes the implementation of simulation training in stroke care according to a specific and validated methodology.
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Affiliation(s)
- Barbara Casolla
- Department of Neurology, Stroke Unit, Univ. Lille, Inserm U1172, CHU Lille, Lille, France
| | - Maria Alonso de Leciñana
- Department of Neurology, Stroke Center, University Hospital La Paz, Universidad Autónoma, Madrid, Spain
| | - Raquel Neves
- Royal Heath Group Czech Rehabilitation Hospital, Abu Dhabi, United Arab Emirates
| | - Waltraud Pfeilschifter
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Veronica Svobodova
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Simon Jung
- Department of Neurology, University Hospital of Bern, Bern, Switzerland
| | - André Kemmling
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Robert Mikulik
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.,Neurology Department, St. Anne's University Hospital and Masaryk University, Brno, Czech Republic
| | - Paola Santalucia
- Department of Neurology and Strategic Direction, Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
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26
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Cantré D, Langner S, Kaule S, Siewert S, Schmitz KP, Kemmling A, Weber MA. Three-dimensional imaging and three-dimensional printing for plastic preparation of medical interventions. Radiologe 2021; 60:70-79. [PMID: 32926194 DOI: 10.1007/s00117-020-00739-6] [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: 11/29/2022]
Abstract
Three-dimensional (3D) imaging has been available for nearly four decades and is regarded as state of the art for visualization of anatomy and pathology and for procedure planning in many clinical fields. Together with 3D image reconstructions in the form of rendered virtual 3D models, it has helped to better perceive complex anatomic and pathologic relations, improved preprocedural measuring and sizing of implants, and nowadays enables even photorealistic quality. However, presentation on 2D displays limits the 3D experience. Novel 3D printing technologies can transfer virtual anatomic models into true 3D space and produce both patient-specific models and medical devices constructed by computer-aided design. Individualized anatomic models hold great potential for medical and patient education, research, device development and testing, procedure training, preoperative planning, and fabrication of individualized instruments and implants. Hand in hand with 3D imaging, medical 3D printing has started to revolutionize medicine in certain fields and new applications are developed and introduced regularly. The demand for medical 3D printing will likely continue to rise, as it is a promising tool for plastic preparation of medical interventions. However, there is ongoing debate on the appropriateness of medical 3D printing and further research on its efficiency is needed. As experts in 3D imaging, radiologists are not only capable of advising on adequate imaging parameters, but should also become adept in 3D printing to participate in on-site 3D printing facilities and randomized controlled trials on the topic, thus contributing to improving patient outcomes via personalized medicine through patient-specific preparation of medical interventions.
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Affiliation(s)
- Daniel Cantré
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Mecklenburg Western Pomerania, Germany.
| | - Sönke Langner
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Mecklenburg Western Pomerania, Germany
| | - Sebastian Kaule
- Institute for Implant Technology and Biomaterials e. V., associated Institution of the University of Rostock, Friedrich-Barnewitz-Straße 4, 18119, Rostock-Warnemünde, Germany
| | - Stefan Siewert
- Institute for Implant Technology and Biomaterials e. V., associated Institution of the University of Rostock, Friedrich-Barnewitz-Straße 4, 18119, Rostock-Warnemünde, Germany
| | - Klaus-Peter Schmitz
- Institute for Implant Technology and Biomaterials e. V., associated Institution of the University of Rostock, Friedrich-Barnewitz-Straße 4, 18119, Rostock-Warnemünde, Germany.,Institute for Biomedical Engineering, Rostock University Medical Center, Friedrich-Barnewitz-Straße 4, 18119, Rostock-Warnemünde, Germany
| | - André Kemmling
- Institute of Neuroradiology, University Hospital Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057, Rostock, Mecklenburg Western Pomerania, Germany
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27
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Sporns PB, Sträter R, Minnerup J, Wiendl H, Hanning U, Chapot R, Henkes H, Henkes E, Grams A, Dorn F, Nikoubashman O, Wiesmann M, Bier G, Weber A, Broocks G, Fiehler J, Brehm A, Psychogios M, Kaiser D, Yilmaz U, Morotti A, Marik W, Nolz R, Jensen-Kondering U, Schmitz B, Schob S, Beuing O, Götz F, Trenkler J, Turowski B, Möhlenbruch M, Wendl C, Schramm P, Musolino P, Lee S, Schlamann M, Radbruch A, Rübsamen N, Karch A, Heindel W, Wildgruber M, Kemmling A. Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke: The Save ChildS Study. JAMA Neurol 2020; 77:25-34. [PMID: 31609380 DOI: 10.1001/jamaneurol.2019.3403] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Randomized clinical trials have shown the efficacy of thrombectomy of large intracranial vessel occlusions in adults; however, any association of therapy with clinical outcomes in children is unknown. Objective To evaluate the use of endovascular recanalization in pediatric patients with arterial ischemic stroke. Design, Setting, and Participants This retrospective, multicenter cohort study, conducted from January 1, 2000, to December 31, 2018, analyzed the databases from 27 stroke centers in Europe and the United States. Included were all pediatric patients (<18 years) with ischemic stroke who underwent endovascular recanalization. Median follow-up time was 16 months. Exposures Endovascular recanalization. Main Outcomes and Measures The decrease of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score from admission to day 7 was the primary outcome (score range: 0 [no deficit] to 34 [maximum deficit]). Secondary clinical outcomes included the modified Rankin scale (mRS) (score range: 0 [no deficit] to 6 [death]) at 6 and 24 months and rate of complications. Results Seventy-three children from 27 participating stroke centers were included. Median age was 11.3 years (interquartile range [IQR], 7.0-15.0); 37 patients (51%) were boys, and 36 patients (49%) were girls. Sixty-three children (86%) received treatment for anterior circulation occlusion and 10 patients (14%) received treatment for posterior circulation occlusion; 16 patients (22%) received concomitant intravenous thrombolysis. Neurologic outcome improved from a median PedNIHSS score of 14.0 (IQR, 9.2-20.0) at admission to 4.0 (IQR, 2.0-7.3) at day 7. Median mRS score was 1.0 (IQR, 0-1.6) at 6 months and 1.0 (IQR, 0-1.0) at 24 months. One patient (1%) developed a postinterventional bleeding complication and 4 patients (5%) developed transient peri-interventional vasospasm. The proportion of symptomatic intracerebral hemorrhage events in the HERMES meta-analysis of trials with adults was 2.79 (95% CI, 0.42-6.66) and in Save ChildS was 1.37 (95% CI, 0.03-7.40). Conclusions and Relevance The results of this study suggest that the safety profile of thrombectomy in childhood stroke does not differ from the safety profile in randomized clinical trials for adults; most of the treated children had favorable neurologic outcomes. This study may support clinicians' practice of off-label thrombectomy in childhood stroke in the absence of high-level evidence.
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Affiliation(s)
- Peter B Sporns
- Institute of Clinical Radiology, University Hospital of Muenster, Muenster, Germany
| | - Ronald Sträter
- Department of Pediatrics, University Hospital of Muenster, Muenster, Germany
| | - Jens Minnerup
- Department of Neurology, University Hospital of Muenster, Muenster, Germany
| | - Heinz Wiendl
- Department of Neurology, University Hospital of Muenster, Muenster, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - René Chapot
- Department of Neuroradiology, Alfried-Krupp Hospital, Essen, Germany
| | - Hans Henkes
- Department of Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany
| | - Elina Henkes
- Department of Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany
| | - Astrid Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Franziska Dorn
- Department for Diagnostic and Interventional Neuroradiology, University of Munich, Campus Grosshadern, Munich, Germany
| | | | - Martin Wiesmann
- Department of Neuroradiology, Aachen University, Aachen, Germany
| | - Georg Bier
- Institute of Clinical Radiology, University Hospital of Muenster, Muenster, Germany.,Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Anushe Weber
- Department of Radiology and Neuroradiology, Bochum, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alex Brehm
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
| | - Marios Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
| | - Daniel Kaiser
- Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Umut Yilmaz
- Department of Neuroradiology, Saarland University Hospital, Homburg, Germany
| | - Andrea Morotti
- Department of Neurology and Neurorehabilitation, Mondino Foundation, Pavia, Italy
| | - Wolfgang Marik
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Richard Nolz
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Bernd Schmitz
- Section of Neuroradiology, University of Ulm, Guenzburg, Germany
| | - Stefan Schob
- Department for Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Oliver Beuing
- Department of Neuroradiology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Friedrich Götz
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Johannes Trenkler
- Department of Neuroradiology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Bernd Turowski
- Institute of Neuroradiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Markus Möhlenbruch
- Department of Neuroradiology at Heidelberg University Hospital, Heidelberg, Germany
| | - Christina Wendl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Peter Schramm
- Department of Neuroradiology, University Hospital of Luebeck, Luebeck, Germany
| | - Patricia Musolino
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology, Stanford University, Stanford, California
| | - Marc Schlamann
- Department of Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Alexander Radbruch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Nicole Rübsamen
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - André Karch
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Walter Heindel
- Institute of Clinical Radiology, University Hospital of Muenster, Muenster, Germany
| | - Moritz Wildgruber
- Institute of Clinical Radiology, University Hospital of Muenster, Muenster, Germany
| | - André Kemmling
- Department of Neurology, University Hospital of Muenster, Muenster, Germany
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Sporns PB, Psychogios MN, Straeter R, Hanning U, Minnerup J, Chapot R, Henkes H, Henkes E, Grams A, Dorn F, Nikoubashman O, Wiesmann M, Bier G, Weber A, Broocks G, Fiehler J, Brehm A, Kaiser D, Yilmaz U, Morotti A, Marik W, Nolz R, Jensen-Kondering U, Braun M, Schob S, Beuing O, Goetz F, Trenkler J, Turowski B, Möhlenbruch M, Wendl C, Schramm P, Musolino PL, Lee S, Schlamann M, Radbruch A, Karch A, Rübsamen N, Wildgruber M, Kemmling A. Clinical Diffusion Mismatch to Select Pediatric Patients for Embolectomy 6 to 24 Hours After Stroke: An Analysis of the Save ChildS Study. Neurology 2020; 96:e343-e351. [PMID: 33144517 DOI: 10.1212/wnl.0000000000011107] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/28/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether thrombectomy is safe in children up to 24 hours after onset of symptoms when selected by mismatch between clinical deficit and infarct. METHODS A secondary analysis of the Save ChildS Study (January 2000-December 2018) was performed, including all pediatric patients (<18 years) diagnosed with arterial ischemic stroke who underwent endovascular recanalization at 27 European and United States stroke centers. Patients were included if they had a relevant mismatch between clinical deficit and infarct. RESULTS Twenty children with a median age of 10.5 (interquartile range [IQR] 7-14.6) years were included. Of those, 7 were male (35%), and median time from onset to thrombectomy was 9.8 (IQR 7.8-16.2) hours. Neurologic outcome improved from a median Pediatric NIH Stroke Scale score of 12.0 (IQR 8.8-20.3) at admission to 2.0 (IQR 1.2-6.8) at day 7. Median modified Rankin Scale (mRS) score was 1.0 (IQR 0-1.6) at 3 months and 0.0 (IQR 0-1.0) at 24 months. One patient developed transient peri-interventional vasospasm; no other complications were observed. A comparison of the mRS score to the mRS score in the DAWN and DEFUSE 3 trials revealed a higher proportion of good outcomes in the pediatric compared to the adult study population. CONCLUSIONS Thrombectomy in pediatric ischemic stroke in an extended time window of up to 24 hours after onset of symptoms seems safe and neurologic outcomes are generally good if patients are selected by a mismatch between clinical deficit and infarct. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for children with acute ischemic stroke with a mismatch between clinical deficit and infarct size, thrombectomy is safe.
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Affiliation(s)
- Peter B Sporns
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany.
| | - Marios-Nikos Psychogios
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Ronald Straeter
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Uta Hanning
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Jens Minnerup
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - René Chapot
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Hans Henkes
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Elina Henkes
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Astrid Grams
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Franziska Dorn
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Omid Nikoubashman
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Martin Wiesmann
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Georg Bier
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Anushe Weber
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Gabriel Broocks
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Jens Fiehler
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Alex Brehm
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Daniel Kaiser
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Umut Yilmaz
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Andrea Morotti
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Wolfgang Marik
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Richard Nolz
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Ulf Jensen-Kondering
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Michael Braun
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Stefan Schob
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Oliver Beuing
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Friedrich Goetz
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Johannes Trenkler
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Bernd Turowski
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Markus Möhlenbruch
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Christina Wendl
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Peter Schramm
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Patricia L Musolino
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Sarah Lee
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Marc Schlamann
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Alexander Radbruch
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - André Karch
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Nicole Rübsamen
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - Moritz Wildgruber
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
| | - André Kemmling
- From the Department of Neuroradiology (P.B.S., M.-N.P., A.B.), Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland; Department of Diagnostic and Interventional Neuroradiology (P.B.S., U.H., G.B., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg; Departments of Pediatrics (R.S.), and Neurology (J.M.), University Hospital of Muenster; Department of Neuroradiology (R.C.), Alfried-Krupp Hospital, Essen; Department of Neuroradiology (H.H., E.H.), Klinikum Stuttgart, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department for Diagnostic and Interventional Neuroradiology (F.D.), University of Munich (LMU), Campus Grosshadern; Department of Neuroradiology (O.N., M.W.), RWTH Aachen University; Diagnostic and Interventional Neuroradiology (G.B.), Eberhard Karls University Tuebingen; Department of Radiology and Neuroradiology (A.W.), University Hospital Knappschaftskrankenhaus Bochum Langendreer; Department of Neuroradiology (D.K.), University Hospital Carl Gustav Carus, Dresden7; Department of Neuroradiology (U.Y.), Saarland University Hospital, Homburg, Germany; ASST Valcamonica (A.M.), Ospedale di Esine, UOSD Neurologia, Esine, Italy; Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-Guided Therapy, and Department of Biomedical Imaging and Image-Guided Therapy (R.N.), Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria; Department of Radiology and Neuroradiology (U.J.-K.), University Hospital of Schleswig-Holstein, Kiel; Section of Neuroradiology (M.B.), University of Ulm, Guenzburg; Department for Neuroradiology (S.S.), University Hospital Leipzig; Department of Neuroradiology (O.B.), University Hospital of Magdeburg; Department of Diagnostic and Interventional Neuroradiology (F.G.), Hannover Medical School, Germany; Institute of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Institute of Neuroradiology (B.T.), University Hospital Duesseldorf; Department of Neuroradiology at Heidelberg University Hospital (M.M.); Department of Radiology (C.W.), University Hospital Regensburg; Department of Neuroradiology (P.S., A. Kemmling), University Hospital of Luebeck, Germany; Department of Neurology (P.L.M.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Child Neurology (S.L.), Department of Neurology, Stanford University, CA; Department of Neuroradiology (M.S.), University Hospital of Cologne; Department of Diagnostic and Interventional Radiology and Neuroradiology (A.R.), University Hospital Essen, University of Duisburg-Essen; Institute of Epidemiology and Social Medicine (A. Karch, N.R.), University of Muenster; and Department of Radiology, University of Munich (LMU) (M.W.), Campus Grosshadern, Germany
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Abstract
Background Several randomized trials have shown the efficacy of thrombectomy for large intracranial vessel occlusions in adults. However, the safety and efficacy of thrombectomy in children are unknown. We aimed to investigate the feasibility and outcome of thrombectomy in pediatric patients. Methods and Results We performed a retrospective analysis of all children (<18 years of age) who presented with large-vessel occlusion and were treated with mechanical thrombectomy at 3 German tertiary-care stroke centers. Interventional results and clinical outcomes were assessed using the Pediatric National Institutes of Health Stroke Scale at 24 hours and on day 7 after thrombectomy as well as after 3 months (modified Rankin Scale). After screening of local registries for all performed thrombectomies, 12 children were included. Median Pediatric National Institutes of Health Stroke Scale score on admission was 12.5 (interquartile range 8.0-21.5). Angiographic outcomes for thrombectomy were good in all patients (6×modified Treatment in Cerebral Infarction Score 3, 6×modified Treatment in Cerebral Infarction Score 2b). Moreover, most patients showed an improvement of neurological outcome after thrombectomy with a median Pediatric National Institutes of Health Stroke Scale of 3.5 (interquartile range 1-8) at day 7 and a modified Rankin Scale of 1.0 (interquartile range 0-2.0) at 3 months. No major periprocedural complications were observed. Conclusions In our retrospective study thrombectomy was safe in childhood stroke, and treated children had good neurological outcomes.
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Affiliation(s)
- Peter B Sporns
- 1 Institute of Clinical Radiology University Hospital of Muenster Germany
| | - André Kemmling
- 1 Institute of Clinical Radiology University Hospital of Muenster Germany.,2 Department of Neuroradiology University Hospital of Luebeck Germany
| | - Uta Hanning
- 3 Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg-Eppendorf Hamburg Germany
| | - Jens Minnerup
- 4 Department of Neurology University of Muenster Germany
| | - Ronald Sträter
- 5 Department of Pediatrics University of Muenster Germany
| | - Thomas Niederstadt
- 1 Institute of Clinical Radiology University Hospital of Muenster Germany
| | - Walter Heindel
- 1 Institute of Clinical Radiology University Hospital of Muenster Germany
| | - Moritz Wildgruber
- 1 Institute of Clinical Radiology University Hospital of Muenster Germany
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30
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Broocks G, Flottmann F, Schönfeld M, Bechstein M, Aye P, Kniep H, Faizy TD, McDonough R, Schön G, Deb-Chatterji M, Thomalla G, Sporns P, Fiehler J, Hanning U, Kemmling A, Meyer L. Incomplete or failed thrombectomy in acute stroke patients with Alberta Stroke Program Early Computed Tomography Score 0-5 - how harmful is trying? Eur J Neurol 2020; 27:2031-2035. [PMID: 32449311 DOI: 10.1111/ene.14358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE It is currently unknown whether mechanical thrombectomy (MT) for ischaemic stroke patients with low initial Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is clinically beneficial or even harmful. The purpose of this study was to investigate whether failed or incomplete MT in acute large vessel occlusion stroke with an initial ASPECTS ≤ 5 is associated with worse clinical outcome compared to patients not undergoing MT. METHODS This observational cohort study included a consecutive sample of patients with anterior circulation stroke and initial ASPECTS ≤ 5 admitted between March 2015 and August 2019. Failed recanalization was defined as Thrombolysis in Cerebral Infarction (TICI) score 0-2a, and incomplete recanalization as TICI 2b. Clinical outcome was assessed using the modified Rankin Scale (mRS) at 90 days defining very poor clinical outcome as mRS > 4. RESULTS One hundred and seventy patients were included. Ninety-nine patients underwent MT and 71 patients received best medical treatment only. Clinical outcome after failed or incomplete MT (TICI 0-2b) was significantly better compared to patients with medical treatment only (median mRS 5, interquartile range 4-6 vs 5-6, P = 0.03). In multivariable logistic regression analysis, failed or incomplete MT (TICI 0-2b) showed a significantly reduced likelihood for very poor outcome (odds ratio 0.39, 95% confidence interval 0.19-0.83, P = 0.01). Failed MT (TICI 0-2a) was not associated with a worse outcome compared to best medical treatment. CONCLUSIONS Patients with failed or incomplete recanalization results (TICI 0-2b) showed a reduced likelihood for very poor outcome compared with those who did not receive MT. Evidence from randomized trials is needed to confirm that even failed or incomplete MT is not harmful in these patients.
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Affiliation(s)
- G Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Schönfeld
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Aye
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T D Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Radiology, Stanford University, Stanford, CA, USA
| | - R McDonough
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Deb-Chatterji
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Sporns
- Department of Neuroradiology, Universitätsspital Basel, Basel, Switzerland
| | - J Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - U Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Kemmling
- Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany.,Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - L Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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31
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Kniep HC, Sporns PB, Broocks G, Kemmling A, Nawabi J, Rusche T, Fiehler J, Hanning U. Posterior circulation stroke: machine learning-based detection of early ischemic changes in acute non-contrast CT scans. J Neurol 2020; 267:2632-2641. [PMID: 32394015 PMCID: PMC7419359 DOI: 10.1007/s00415-020-09859-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Triage of patients with basilar artery occlusion for additional imaging diagnostics, therapy planning, and initial outcome prediction requires assessment of early ischemic changes in early hyperacute non-contrast computed tomography (NCCT) scans. However, accuracy of visual evaluation is impaired by inter- and intra-reader variability, artifacts in the posterior fossa and limited sensitivity for subtle density shifts. We propose a machine learning approach for detecting early ischemic changes in pc-ASPECTS regions (Posterior circulation Alberta Stroke Program Early CT Score) based on admission NCCTs. METHODS The retrospective study includes 552 pc-ASPECTS regions (144 with infarctions in follow-up NCCTs) extracted from pre-therapeutic early hyperacute scans of 69 patients with basilar artery occlusion that later underwent successful recanalization. We evaluated 1218 quantitative image features utilizing random forest algorithms with fivefold cross-validation for the ability to detect early ischemic changes in hyperacute images that lead to definitive infarctions in follow-up imaging. Classifier performance was compared to conventional readings of two neuroradiologists. RESULTS Receiver operating characteristic area under the curves for detection of early ischemic changes were 0.70 (95% CI [0.64; 0.75]) for cerebellum to 0.82 (95% CI [0.77; 0.86]) for thalamus. Predictive performance of the classifier was significantly higher compared to visual reading for thalamus, midbrain, and pons (P value < 0.05). CONCLUSIONS Quantitative features of early hyperacute NCCTs can be used to detect early ischemic changes in pc-ASPECTS regions. The classifier performance was higher or equal to results of human raters. The proposed approach could facilitate reproducible analysis in research and may allow standardized assessments for outcome prediction and therapy planning in clinical routine.
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Affiliation(s)
- Helge C Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Peter B Sporns
- Institute of Clinical Radiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - André Kemmling
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Jawed Nawabi
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Department of Radiology, Charité University Medical Center Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Thilo Rusche
- Institute of Clinical Radiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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32
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Sporns PB, Straeter R, Minnerup J, Wiendl H, Hanning U, Chapot R, Henkes H, Henkes E, Grams A, Dorn F, Nikoubashman O, Wiesmann M, Bier G, Weber A, Broocks G, Fiehler J, Brehm A, Psychogios M, Kaiser D, Yilmaz U, Morotti A, Marik W, Nolz R, Jensen-Kondering U, Schmitz B, Schob S, Beuing O, Goetz F, Trenkler J, Turowski B, Möhlenbruch M, Wendl C, Schramm P, Musolino P, Lee S, Schlamann M, Radbruch A, Rübsamen N, Karch A, Heindel W, Wildgruber M, Kemmling A. Does Device Selection Impact Recanalization Rate and Neurological Outcome? Stroke 2020; 51:1182-1189. [DOI: 10.1161/strokeaha.119.028221] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The recent Save ChildS study provides multicenter evidence for the use of mechanical thrombectomy in children with large vessel occlusion arterial ischemic stroke. However, device selection for thrombectomy may influence rates of recanalization, complications, and neurological outcomes, especially in pediatric patients of different ages. We, therefore, performed additional analyses of the Save ChildS data to investigate a possible association of different thrombectomy techniques and devices with angiographic and clinical outcome parameters.
Methods—
The Save ChildS cohort study (January 2000–December 2018) analyzed data from 27 European and United States stroke centers and included all pediatric patients (<18 years), diagnosed with arterial ischemic stroke who underwent endovascular recanalization. Patients were grouped into first-line contact aspiration (A Direct Aspiration First Pass Technique [ADAPT]) and non-ADAPT groups as well as different stent retriever size groups. Associations with baseline characteristics, recanalization rates (modified Treatment in Cerebral Infarction), complication rates, and neurological outcome parameters (Pediatric National Institutes of Health Stroke Scale after 24 hours and 7 days; modified Rankin Scale and Pediatric Stroke Outcome Measure at discharge, after 6 and 24 months) were investigated.
Results—
Seventy-three patients with a median age of 11.3 years were included. Currently available stent retrievers were used in 59 patients (80.8%), of which 4×20 mm (width×length) was the most frequently chosen size (36 patients =61%). A first-line ADAPT approach was used in 7 patients (9.6%), and 7 patients (9.6%) were treated with first-generation thrombectomy devices. In this study, a first-line ADAPT approach was neither associated with the rate of successful recanalization (ADAPT 85.7% versus 87.5% No ADAPT) nor with the complication rate or the neurological outcome. Moreover, there were no associations of stent retriever sizes with rates of recanalization, complication rates, or outcome parameters.
Conclusions—
Our study suggests that neurological outcomes are generally good regardless of any specific device selection and suggests that it is important to offer thrombectomy in eligible children regardless of technique or device selection.
Registration—
URL:
https://www.drks.de/
; Unique identifier: DRKS00016528.
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Affiliation(s)
- Peter B. Sporns
- From the Institute of Clinical Radiology (P.B.S., G. Bier, W.H., M. Wildgruber), University Hospital of Muenster, Germany
| | - Ronald Straeter
- Department of Pediatrics (R.S.), University Hospital of Muenster, Germany
| | - Jens Minnerup
- Department of Neurology (J.M., H.W.), University Hospital of Muenster, Germany
| | - Heinz Wiendl
- Department of Neurology (J.M., H.W.), University Hospital of Muenster, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H., G. Broocks, J.F.)
| | - René Chapot
- Department of Neuroradiology, Alfried-Krupp Hospital, Essen, Germany (R.C.)
| | - Hans Henkes
- Department of Neuroradiology, Klinikum Stuttgart, Germany (H.H., E.H.)
| | - Elina Henkes
- Department of Neuroradiology, Klinikum Stuttgart, Germany (H.H., E.H.)
| | - Astrid Grams
- Department of Neuroradiology, Medical University of Innsbruck, Austria (A.G.)
| | - Franziska Dorn
- Department for Diagnostic and Interventional Neuroradiology, University of Munich (LMU), Campus Grosshadern, Munich, Germany (F.D.)
| | - Omid Nikoubashman
- Department of Neuroradiology, RWTH Aachen University, Germany (O.N., M. Wiesmann)
| | - Martin Wiesmann
- Department of Neuroradiology, RWTH Aachen University, Germany (O.N., M. Wiesmann)
| | - Georg Bier
- From the Institute of Clinical Radiology (P.B.S., G. Bier, W.H., M. Wildgruber), University Hospital of Muenster, Germany
- Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, Germany (G. Bier)
| | - Anushe Weber
- Department of Radiology and Neuroradiology, Bochum, Germany (A.W.)
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H., G. Broocks, J.F.)
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H., G. Broocks, J.F.)
| | - Alex Brehm
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Germany (A.B., M.P.)
| | - Marios Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Goettingen, Germany (A.B., M.P.)
| | - Daniel Kaiser
- Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany (D.K.)
| | - Umut Yilmaz
- Department of Neuroradiology, Saarland University Hospital, Homburg, Germany (U.Y.)
| | - Andrea Morotti
- Department of Neurology and Neurorehabilitation, IRCCS Mondino Foundation, Pavia, Italy (A.M.)
| | - Wolfgang Marik
- Division of Neuroradiology and Musculoskeletal Radiology (W.M.), Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Richard Nolz
- Division of Cardiovascular and Interventional Radiology (R.N.), Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Kiel, Germany (U.J.-K.)
| | - Bernd Schmitz
- Section of Neuroradiology, University of Ulm, Guenzburg, Germany (B.S.)
| | - Stefan Schob
- Department for Neuroradiology, University Hospital Leipzig, Germany (S.S.)
| | - Oliver Beuing
- Department of Neuroradiology, University Hospital of Magdeburg, Germany (O.B.)
| | - Friedrich Goetz
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Germany (F.G.)
| | - Johannes Trenkler
- Institute of Neuroradiology, Kepler University Hospital, Johannes Kepler University Linz, Austria (J.T.)
| | - Bernd Turowski
- Institute of Neuroradiology, University Hospital Duesseldorf, Germany (B.T.)
| | - Markus Möhlenbruch
- Department of Neuroradiology at Heidelberg University Hospital, Germany (M.M.)
| | - Christina Wendl
- Department of Radiology, University Hospital Regensburg, Germany (C.W.)
| | - Peter Schramm
- Department of Neuroradiology, University Hospital of Luebeck, Germany (P.S.)
| | - Patricia Musolino
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (P.M.)
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology, Stanford University, California (S.L.)
| | - Marc Schlamann
- Department of Neuroradiology, University Hospital of Cologne, Germany (M.S.)
| | - Alexander Radbruch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Germany (A.R.)
| | - Nicole Rübsamen
- Institute of Epidemiology and Social Medicine, University of Muenster, Germany (N.R., A. Karch)
| | - André Karch
- Institute of Epidemiology and Social Medicine, University of Muenster, Germany (N.R., A. Karch)
| | - Walter Heindel
- From the Institute of Clinical Radiology (P.B.S., G. Bier, W.H., M. Wildgruber), University Hospital of Muenster, Germany
| | - Moritz Wildgruber
- From the Institute of Clinical Radiology (P.B.S., G. Bier, W.H., M. Wildgruber), University Hospital of Muenster, Germany
| | - André Kemmling
- Department of Neuroradiology, Westpfalz-Klinikum Kaiserslautern, Germany (A. Kemmling)
- Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany (A. Kemmling)
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Faizy TD, Thaler C, Broocks G, Flottmann F, Leischner H, Kniep H, Nawabi J, Schön G, Stellmann JP, Kemmling A, Reddy R, Heit JJ, Fiehler J, Kumar D, Hanning U. The Myelin Water Fraction Serves as a Marker for Age-Related Myelin Alterations in the Cerebral White Matter - A Multiparametric MRI Aging Study. Front Neurosci 2020; 14:136. [PMID: 32153358 PMCID: PMC7050496 DOI: 10.3389/fnins.2020.00136] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 11/25/2019] [Accepted: 02/03/2020] [Indexed: 12/13/2022] Open
Abstract
Quantitative MRI modalities, such as diffusion tensor imaging (DTI) or magnetization transfer imaging (MTI) are sensitive to the neuronal effects of aging of the cerebral white matter (WM), but lack the specificity for myelin content. Myelin water imaging (MWI) is highly specific for myelin and may be more sensitive for the detection of changes in myelin content inside the cerebral WM microstructure. In this multiparametric imaging study, we evaluated the performance of myelin water fraction (MWF) estimates as a marker for myelin alterations during normal-aging. Multiparametric MRI data derived from DTI, MTI and a novel, recently-proposed MWF-map processing and reconstruction algorithm were acquired from 54 healthy subjects (aged 18-79 years) and region-based multivariate regression analysis was performed. MWFs significantly decreased with age in most WM regions (except corticospinal tract) and changes of MWFs were associated with changes of radial diffusivity, indicating either substantial alterations or preservation of myelin content in these regions. Decreases of fractional anisotropy and magnetization transfer ratio were associated with lower MWFs in commissural fiber tracts only. Mean diffusivity had no regional effects on MWF. We conclude that MWF estimates are sensitive for the assessment of age-related myelin alterations in the cerebral WM of normal-aging brains.
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Affiliation(s)
- Tobias D Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Thaler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannes Leischner
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jawed Nawabi
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Schön
- Institute of Applied Biometrics and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Kemmling
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Muenster, Münster, Germany
| | - Ravinder Reddy
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeremy J Heit
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dushyant Kumar
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Affiliation(s)
- Peter B Sporns
- Institute of Clinical Radiology, Westfaelische Wilhelms-University of Münster, University Hospital of Muenster, Muenster, Germany
| | - Moritz Wildgruber
- Institute of Clinical Radiology, Westfaelische Wilhelms-University of Münster, University Hospital of Muenster, Muenster, Germany
| | - André Kemmling
- Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany
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Broocks G, Kniep H, Kemmling A, Flottmann F, Nawabi J, Elsayed S, Schön G, Thomalla G, Fiehler J, Hanning U. Effect of intravenous alteplase on ischaemic lesion water homeostasis. Eur J Neurol 2019; 27:376-383. [PMID: 31529738 DOI: 10.1111/ene.14088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/07/2019] [Accepted: 09/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Intravenous (IV) lysis with alteplase is known to increase biomarkers of blood-brain barrier breakdown and has therefore been associated with secondary injuries such as hemorrhagic transformation. The impact of alteplase on brain edema formation, however, has not been investigated yet. The purpose was to examine the effects of IV alteplase on ischaemic lesion water homeostasis differentiated from final tissue infarct in patients with and without successful endovascular therapy (sET). METHODS In all, 232 middle cerebral artery stroke patients were analyzed. 147 patients received IV alteplase, of whom 106 patients received subsequent sET. Out of 85 patients without IV alteplase, 50 received sET. Ischaemic brain edema was quantified at admission and follow-up computed tomography using quantitative lesion net water uptake (NWU) and its difference was calculated (ΔNWU). The relationship of alteplase on ΔNWU and edema-corrected final infarct volume was analyzed using univariate and multivariate linear regression models. RESULTS The mean ΔNWU was 11.8% (SD 7.9) in patients with alteplase and 11.5% (SD 8.3) in patients without alteplase (P = 0.8). Alteplase was not associated with lowered ΔNWU whilst being associated with reduced edema-corrected tissue infarct volume [-27.4 ml, 95% confidence interval (CI) -49.4 to -5.4 ml; P = 0.02], adjusted for the Alberta Stroke Program Early Computed Tomography Score and recanalization status. In patients with sET, ΔNWU was 10.5% (95% CI 6.3%-10.5%) for patients with IV alteplase and 8.4% (95% CI 9.1%-12.0%) for patients without IV alteplase. CONCLUSION The application of IV alteplase did not significantly alter ischaemic lesion water homeostasis but was associated with reduced edema-corrected tissue infarct volume, which might be directly linked to improved functional outcome.
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Affiliation(s)
- G Broocks
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Kniep
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Kemmling
- Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany.,Faculty of Medicine Mannheim, University of Heidelberg, Heidelberg, Germany
| | - F Flottmann
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Nawabi
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Elsayed
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Schön
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - U Hanning
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Sporns PB, Kemmling A, Schwake M, Minnerup J, Nawabi J, Broocks G, Wildgruber M, Fiehler J, Heindel W, Hanning U. Triage of 5 Noncontrast Computed Tomography Markers and Spot Sign for Outcome Prediction After Intracerebral Hemorrhage. Stroke 2019; 49:2317-2322. [PMID: 30355120 DOI: 10.1161/strokeaha.118.021625] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 12/30/2022]
Abstract
Background and Purpose- Besides the established spot sign (SS) in computed tomography angiography (CTA), there is growing evidence that different imaging markers in noncontrast CT offer great value for outcome prediction in patients with intracerebral hemorrhage (ICH). However, it is unclear how the concurrent presence of each sign independently contributes to the predictive power of poor outcome. We, therefore, aimed to clarify the predictive value of 5 recently published noncontrast CT parameters (blend sign, black hole sign, island sign, hematoma heterogeneity, and hypodensities) and the established SS in 1 consecutive series of patients with ICH. Methods- Retrospective study of patients with ICH at 2 German tertiary stroke centers; inclusion criteria were (1) spontaneous ICH and (2) noncontrast CT and CTA performed on admission within 6 hours after onset of symptoms. We defined a binary outcome (good outcome [modified Rankin Scale score of ≤3] versus poor outcome [modified Rankin Scale score of >3]) at discharge. The predictive value of each sign was assessed in univariate and multivariable logistic regression models. Results- Of 201 patients with spontaneous ICH, 28 (13.9%) presented with black hole sign, 38 (18.9%) with blend sign, 120 (59.7%) with hypodensities, 97 (48.3%) with heterogeneous densities, 53 with island sign (26.4%), and 45 (22.4%) with SS. In univariable logistic regression, higher hematoma volume ( P<0.001), intraventricular hemorrhage ( P=0.002), and the presence of black hole sign/blend sign/hypodensities/island sign/SS/heterogeneous density (all P<0.001) on admission CT were associated with poor outcome. Multivariable analysis confirmed intraventricular hemorrhage (odds ratio, 2.20; P=0.025), higher hematoma volume (odds ratio, 1.02 per mL; P<0.019), the presence of hypodensities (odds ratio, 2.47; P=0.018), and SS (odds ratio, 12.22; P<0.001) as independent predictors of poor outcome. Conclusions- This study demonstrates the degree of interaction between 5 recent noncontrast CT imaging markers and SS and their individual contribution for outcome prediction in patients with ICH. Of the CT variables indicating poor outcome SS on CTA and hypodensities were the most reliable outcome predictors.
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Affiliation(s)
- Peter B Sporns
- From the Institute of Clinical Radiology, Westfaelische Wilhelms-University of Münster (P.B.S., A.K., M.W., W.H.), University Hospital of Muenster, Germany
| | - André Kemmling
- From the Institute of Clinical Radiology, Westfaelische Wilhelms-University of Münster (P.B.S., A.K., M.W., W.H.), University Hospital of Muenster, Germany.,Institute of Neuroradiology, University Hospital of Luebeck, Germany (A.K.)
| | - Michael Schwake
- Department of Neurosurgery (M.S.), University Hospital of Muenster, Germany
| | - Jens Minnerup
- Department of Neurology (J.M.), University Hospital of Muenster, Germany
| | - Jawed Nawabi
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (J.N., G.B., J.F., U.H.)
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (J.N., G.B., J.F., U.H.)
| | - Moritz Wildgruber
- From the Institute of Clinical Radiology, Westfaelische Wilhelms-University of Münster (P.B.S., A.K., M.W., W.H.), University Hospital of Muenster, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (J.N., G.B., J.F., U.H.)
| | - Walter Heindel
- From the Institute of Clinical Radiology, Westfaelische Wilhelms-University of Münster (P.B.S., A.K., M.W., W.H.), University Hospital of Muenster, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (J.N., G.B., J.F., U.H.)
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Sporns PB, Jeibmann A, Minnerup J, Broocks G, Nawabi J, Schön G, Fiehler J, Wildgruber M, Heindel W, Kemmling A, Hanning U. Histological Clot Composition Is Associated With Preinterventional Clot Migration in Acute Stroke Patients. Stroke 2019; 50:2065-2071. [PMID: 31242825 DOI: 10.1161/strokeaha.118.023314] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 01/15/2023]
Abstract
Background and Purpose- The introduction of stent retrievers allows for a complete extraction and histological analysis of human clots. Initial studies describe an impact of preinterventional clot migration on technical and clinical success of thrombectomy and an association with worse clinical outcome. We, therefore, performed a large study of consecutive patients whose clots have been histologically analyzed and tried to determine whether clot composition influences the rates of clot migration and thereby interventional and clinical outcome. Methods- We retrospectively evaluated data of a prospectively collected cohort of 198 consecutive patients with occlusion of the middle cerebral artery. We investigated the relationship between clot histology expressed as percentage of the main components (fibrin, erythrocytes [red blood cell], and white blood cells), the preinterventional computed tomography attenuation of the emboli, embolus length, and clot migration. We defined a binary outcome (clot migration versus no clot migration). The impact of embolus composition and computed tomography features was assessed in univariable and multivariable logistic regression models. Results- One hundred sixty-three patients fulfilled the inclusion criteria, of which 36 (22.1%) showed a clot migration. Patients with proven clot migration had significantly higher levels of red blood cells than patients without clot migration (median 50% versus 26%, P<0.001). Lower amounts of fibrin were significantly more often observed in patients in the clot migration group as compared to the no clot migration group (43.5% versus 62.0%, P<0.001). Stroke cause did not differ between migrated and stable emboli. Multivariable analysis identified a higher amount of erythrocytes (adjusted odds ratio, 1.03 per median percentage, P<0.001) and a shorter embolus length (adjusted odds ratio, 0.90 per mm, P<0.008) as independent predictors of clot migration. Conclusions- Erythrocyte-rich clots and a shorter embolus length are independent reliable predictors for clot migration. This finding is clinically important as clot migration might have a negative impact on technical and clinical outcomes of patients suffering from emergent vessel occlusions of the middle cerebral artery undergoing endovascular therapy.
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Affiliation(s)
- Peter B Sporns
- From the Institute of Clinical Radiology (P.B.S., M.W., W.H., A.K.), University Hospital of Muenster, Germany
| | - Astrid Jeibmann
- Institute of Neuropathology (A.J.), University Hospital of Muenster, Germany
| | - Jens Minnerup
- Department of Neurology (J.M.), University Hospital of Muenster, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology (G.B., J.N., J.F., U.H.), University Medical Center Hamburg-Eppendorf, Germany
| | - Jawed Nawabi
- Department of Diagnostic and Interventional Neuroradiology (G.B., J.N., J.F., U.H.), University Medical Center Hamburg-Eppendorf, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology (G.S.), University Medical Center Hamburg-Eppendorf, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology (G.B., J.N., J.F., U.H.), University Medical Center Hamburg-Eppendorf, Germany
| | - Moritz Wildgruber
- From the Institute of Clinical Radiology (P.B.S., M.W., W.H., A.K.), University Hospital of Muenster, Germany
| | - Walter Heindel
- From the Institute of Clinical Radiology (P.B.S., M.W., W.H., A.K.), University Hospital of Muenster, Germany
| | - André Kemmling
- From the Institute of Clinical Radiology (P.B.S., M.W., W.H., A.K.), University Hospital of Muenster, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology (G.B., J.N., J.F., U.H.), University Medical Center Hamburg-Eppendorf, Germany
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Nawabi J, Kniep H, Schön G, Flottmann F, Leischner H, Kabiri R, Sporns P, Kemmling A, Thomalla G, Fiehler J, Broocks G, Hanning U. Hemorrhage After Endovascular Recanalization in Acute Stroke: Lesion Extent, Collaterals and Degree of Ischemic Water Uptake Mediate Tissue Vulnerability. Front Neurol 2019; 10:569. [PMID: 31214107 PMCID: PMC6558047 DOI: 10.3389/fneur.2019.00569] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 03/22/2019] [Accepted: 05/15/2019] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose: Intracranial hemorrhage (ICH) remains a major complication of endovascular treatment (ET) in acute stroke. The aim of this study was to identify clinical and imaging predictors for ICH in patients with acute ischemic stroke undergoing successful ET. Methods: We performed a retrospective analysis of patients with large vessel occlusion in the anterior circulation who underwent successful ET at our university medical center between 2015 and 2018. ICH was diagnosed on non-enhanced CT and a binary outcome was defined: ICH occurrence in the immediate post-interventional phase within 12–36 h (yes/no). The impacts of clinical, radiological, and interventional parameters on outcome were assessed in logistic regression models. Results: One hundred and seven patients fulfilled the inclusion criteria. 37 (34.6%) showed an ICH of which 7 (6.5%) patients were diagnosed as symptomatic and 30 (28.04%) as asymptomatic. Multivariable regression analyses identified a lower ASPECTS (adjusted odds ratio (OR) 1.95, 95%CI: 1.4–3.63, P = 0.037), low collateral score (adjusted OR 0.12, 95%CI: 0.03–0.49, P = 0.003) and high Net Water Uptake (NWU) (adjusted OR 1.56, 95%CI: 2.34–1.03, P = 0.007) as independent predictors of ICH after successful ET. Conclusions: CT-based quantitative NWU, ASPECTS, and collateral score mediate tissue vulnerability and are reliable independent predictors of a bleeding event after successful ET. This imaging-based prediction model might be useful for early stratification of patients at high risk of a bleeding event after ET, especially with low ASPECTS.
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Affiliation(s)
- Jawed Nawabi
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannes Leischner
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reza Kabiri
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Sporns
- Department of Radiology, University Hospital Münster, Münster, Germany
| | - André Kemmling
- Department of Radiology, University Hospital Münster, Münster, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Reidler P, Thierfelder KM, Rotkopf LT, Fabritius MP, Puhr-Westerheide D, Dorn F, Forkert ND, Kemmling A, Kunz WG. Attenuation Changes in ASPECTS Regions: A Surrogate for CT Perfusion–based Ischemic Core in Acute Ischemic Stroke. Radiology 2019; 291:451-458. [DOI: 10.1148/radiol.2019182041] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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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Kunz WG, Forkert ND, Tiedt S, Wollenweber FA, Kellert L, Liebig T, Kemmling A, Reidler P. Abstract WMP23: Automated Regional Density Measurements on Baseline Non-Contrast CT Predict Final Infarction in Acute Ischemic Stroke Patients. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wmp23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Early ischemic changes on non-contrast CT (NCCT) can be visually assessed using the Alberta Stroke Program Early CT Score (ASPECTS). We sought to determine if automated regional density quantification provides additional information on the development of final infarction.
Methods:
We selected 121 patients with middle cerebral artery stroke due to large vessel occlusion out of a consecutive cohort. Densities in ASPECTS regions were quantified as average Hounsfield Unit (HU) values using automated segmentation (Fig. 1). Relative HU (rHU) values were calculated dividing absolute regional densities of ischemic by non-ischemic hemispheres. Final infarction was quantified semi-automatically as total volume and was defined visually per ASPECTS region in a dichotomized fashion. A composite rHU score incorporating values from all ASPECTS regions weighted by regional relevance was calculated. ROC analysis was performed to calculate AUC values. Linear regression analysis was used for multivariable adjustment.
Results:
Median visual ASPECTS on NCCT was 8 (IQR: 6-9). Automated density measurements were feasible in all 121 patients within one minute of post-processing time. rHU values yielded significant regional classification of final infarction in ROC analyses for all ASPECTS regions except M3 and M6. Best classifications were achieved for lentiform nucleus (AUC=0.810, p<0.001), caudate nucleus (AUC=0.777, p<0.001), and insula (AUC=0.764, p<0.001). The composite rHU score was independently associated with final infarction volume (β=-0.353, p<0.001), outperforming visual ASPECTS assessment (β=-0.190, p=0.062) in multivariable regression analysis.
Conclusions:
Automated NCCT density changes identify ASPECTS regions that develop final infarction in stroke patients. The composite rHU score outperformed visual ASPECTS interpretation in the prediction of final infarction volumes and may serve as an observer-independent imaging biomarker.
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Sporns PB, Hanning U, Kemmling A. Letter by Sporns et al Regarding Article, “Thrombus Permeability in Admission Computed Tomographic Imaging Indicates Stroke Pathogenesis Based on Thrombus Histology”. Stroke 2019; 50:e35. [DOI: 10.1161/strokeaha.118.023891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter B. Sporns
- Institute of Clinical Radiology, Westfaelische Wilhelms-University of Münster, University Hospital of Muenster, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - André Kemmling
- Institute of Clinical Radiology, Westfaelische Wilhelms-University of Münster, University Hospital of Muenster, Germany
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Sporns PB, Kemmling A, Hanning U. Response by Sporns et al to Letter Regarding Article, "Triage of 5 Noncontrast Computed Tomography Markers and Spot Sign for Outcome Prediction After Intracerebral Hemorrhage". Stroke 2019; 50:e15. [PMID: 30580753 DOI: 10.1161/strokeaha.118.023866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter B Sporns
- Institute of Clinical Radiology, University Hospital of Muenster, Westfaelische Wilhelms-University of Münster, Germany
| | - André Kemmling
- Institute of Clinical Radiology, University Hospital of Muenster, Westfaelische Wilhelms-University of Münster, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
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Böhmer M, Niederstadt T, Heindel W, Wildgruber M, Sträter R, Hanning U, Kemmling A, Sporns PB. Impact of Childhood Arterial Ischemic Stroke Standardized Classification and Diagnostic Evaluation Classification on Further Course of Arteriopathy and Recurrence of Childhood Stroke. Stroke 2019; 50:83-87. [PMID: 30580701 DOI: 10.1161/strokeaha.118.023060] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 11/16/2022]
Abstract
Background and Purpose- Arterial ischemic stroke (AIS) in childhood is a severe disease with potentially lifelong restrictions. Apart from cardiac or prothrombotic embolism, arteriopathy has been identified as a major cause and significant target of secondary stroke prevention. The Childhood Arterial Ischemic Stroke Standardized Classification and Diagnostic Evaluation (CASCADE) criteria facilitate a structured tool for categorizing and reporting childhood strokes according to the underlying cause. Our study aims to identify the prognostic value of CASCADE classification on admission for further course of arteriopathy and risk of stroke recurrence. Moreover, we give recommendations for follow-up imaging based on different CASCADE subgroups. Methods- Between 2004 and 2017, we identified 86 children with an acute arterial ischemic stroke classified in the 7-basic and 19-expanded subgroups of the acute CASCADE criteria. All included children were diagnosed and followed-up by magnetic resonance imaging. All arteriopathic strokes (basic subgroups 1-4 of acute CASCADE criteria) were further categorized into the chronic CASCADE criteria, including progressive, stable, reversible, and indeterminate course. Outcomes were defined as stroke recurrence and course of arteriopathy according to chronic CASCADE criteria. Associations between acute CASCADE criteria classification and stroke recurrence were assessed by Fisher exact test and between acute CASCADE criteria and chronic CASCADE criteria by Fisher exact test and Mann-Whitney U test. Results- A total of 86 children were included; of these, 57 presented with arteriopathic stroke (CASCADE 1-4) and 29 as nonarteriopathic. Unilateral cerebral arteriopathy (CASCADE 2; P=0.036) and bilateral cerebral arteriopathy (CASCADE 3; P=0.016) significantly correlated with stroke recurrence, and progressive arteriopathy significantly correlated with unilateral focal cerebral arteriopathy (P<0.001). Time points of progress of arteriopathy differed; whereas patients with unilateral focal cerebral arteriopathy presented with early median progress after 11 days, patients with bilateral cerebral arteriopathy had a significantly later median progress after 124 days (P=0.005). Conclusions- Initial CASCADE classification is associated with risk of recurrent strokes and progress of arteriopathy. Moreover, time points of arteriopathic progress vary according to the underlying cause.
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Affiliation(s)
- Maik Böhmer
- From the Institute of Clinical Radiology (M.B., T.N., W.H., M.W., A.K., P.B.S.), Westfaelische Wilhelms-University of Muenster and Albert-Schweitzer-Campus 1, Germany
| | - Thomas Niederstadt
- From the Institute of Clinical Radiology (M.B., T.N., W.H., M.W., A.K., P.B.S.), Westfaelische Wilhelms-University of Muenster and Albert-Schweitzer-Campus 1, Germany
| | - Walter Heindel
- From the Institute of Clinical Radiology (M.B., T.N., W.H., M.W., A.K., P.B.S.), Westfaelische Wilhelms-University of Muenster and Albert-Schweitzer-Campus 1, Germany
| | - Moritz Wildgruber
- From the Institute of Clinical Radiology (M.B., T.N., W.H., M.W., A.K., P.B.S.), Westfaelische Wilhelms-University of Muenster and Albert-Schweitzer-Campus 1, Germany
| | - Ronald Sträter
- Department of Pediatrics, University Hospital of Muenster (R.S.), Westfaelische Wilhelms-University of Muenster and Albert-Schweitzer-Campus 1, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H.)
| | - André Kemmling
- From the Institute of Clinical Radiology (M.B., T.N., W.H., M.W., A.K., P.B.S.), Westfaelische Wilhelms-University of Muenster and Albert-Schweitzer-Campus 1, Germany
| | - Peter B Sporns
- From the Institute of Clinical Radiology (M.B., T.N., W.H., M.W., A.K., P.B.S.), Westfaelische Wilhelms-University of Muenster and Albert-Schweitzer-Campus 1, Germany
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Lucas C, Kemmling A, Bouteldja N, Aulmann LF, Madany Mamlouk A, Heinrich MP. Learning to Predict Ischemic Stroke Growth on Acute CT Perfusion Data by Interpolating Low-Dimensional Shape Representations. Front Neurol 2018; 9:989. [PMID: 30534108 PMCID: PMC6275324 DOI: 10.3389/fneur.2018.00989] [Citation(s) in RCA: 22] [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: 05/03/2018] [Accepted: 11/02/2018] [Indexed: 01/09/2023] Open
Abstract
Cerebrovascular diseases, in particular ischemic stroke, are one of the leading global causes of death in developed countries. Perfusion CT and/or MRI are ideal imaging modalities for characterizing affected ischemic tissue in the hyper-acute phase. If infarct growth over time could be predicted accurately from functional acute imaging protocols together with advanced machine-learning based image analysis, the expected benefits of treatment options could be better weighted against potential risks. The quality of the outcome prediction by convolutional neural networks (CNNs) is so far limited, which indicates that even highly complex deep learning algorithms are not fully capable of directly learning physiological principles of tissue salvation through weak supervision due to a lack of data (e.g., follow-up segmentation). In this work, we address these current shortcomings by explicitly taking into account clinical expert knowledge in the form of segmentations of the core and its surrounding penumbra in acute CT perfusion images (CTP), that are trained to be represented in a low-dimensional non-linear shape space. Employing a multi-scale CNN (U-Net) together with a convolutional auto-encoder, we predict lesion tissue probabilities for new patients. The predictions are physiologically constrained to a shape embedding that encodes a continuous progression between the core and penumbra extents. The comparison to a simple interpolation in the original voxel space and an unconstrained CNN shows that the use of such a shape space can be advantageous to predict time-dependent growth of stroke lesions on acute perfusion data, yielding a Dice score overlap of 0.46 for predictions from expert segmentations of core and penumbra. Our interpolation method models monotone infarct growth robustly on a linear time scale to automatically predict clinically plausible tissue outcomes that may serve as a basis for more clinical measures such as the expected lesion volume increase and can support the decision making on treatment options and triage.
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Affiliation(s)
- Christian Lucas
- Institute of Medical Informatics, University of Lübeck, Lübeck, Germany
- Graduate School for Computing in Medicine and Life Sciences, University of Lübeck, Lübeck, Germany
| | - André Kemmling
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Nassim Bouteldja
- Institute of Medical Informatics, University of Lübeck, Lübeck, Germany
| | - Linda F. Aulmann
- Institute of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Amir Madany Mamlouk
- Institute for Neuro- and Bioinformatics, University of Lübeck, Lübeck, Germany
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Pfau O, Kemmling A, Rostalski P. Low-cost physiological simulation system for endovascular treatment of aneurysms. Current Directions in Biomedical Engineering 2018. [DOI: 10.1515/cdbme-2018-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractMinimally invasive procedures are more and more becoming the standard treatment for many surgical procedures such as the treatment of cerebral aneurysms. In an endovascular procedure the aneurysm is filled with flexible platinum coils leading to embolization and blocking the blood flow in the aneurysm. This established treatment needs high skills and experience on the surgeon. In order to practice and plan a specific procedure or test a new device, a realistic simulation environment is needed. Modern 3D printing technology allows the fabrication of patient specific models incorporating the exact geometry of the pathological anatomy. This article describes the development of a low-cost physiological simulation system for the training of the endovascular treatment of aneurysms. In order to practice the procedure in a realistic scenario, a 3D printed model of the aneurysm is embedded in a fluidic simulation s ystem. In addition to the patient-specific anatomy of the aneurysm a pulsatile water flow is generated, which emulates the influence of blood flow on the behaviour of catheters and coils during deployment. The system consist of a controllable pump circuit generating a pulsatile flow which can be regulated automatically and additionally controlled externally by the user. For a suitable representation, a display which graphically represents the sensor data and settings is employed. The components were compactly integrated in a small case allowing for easy deployment in training workshops. The simulation setup was successfully tested in prospective patient specific treatment planning and workshops for students.
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Affiliation(s)
- Oskar Pfau
- 1Institute for Electrical Engineering in Medicine, University of Lübeck,Lübeck, Germany
| | - André Kemmling
- 2Institute of Neuroradiology, University Hospital of Schleswig-Holstein,Schleswig-Holstein, Germany
| | - Philipp Rostalski
- 1Institute for Electrical Engineering in Medicine, University of Lübeck,Lübeck, Germany
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Thomalla G, Simonsen CZ, Boutitie F, Andersen G, Berthezene Y, Cheng B, Cheripelli B, Cho TH, Fazekas F, Fiehler J, Ford I, Galinovic I, Gellissen S, Golsari A, Gregori J, Günther M, Guibernau J, Häusler KG, Hennerici M, Kemmling A, Marstrand J, Modrau B, Neeb L, Perez de la Ossa N, Puig J, Ringleb P, Roy P, Scheel E, Schonewille W, Serena J, Sunaert S, Villringer K, Wouters A, Thijs V, Ebinger M, Endres M, Fiebach JB, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Gerloff C. MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset. N Engl J Med 2018; 379:611-622. [PMID: 29766770 DOI: 10.1056/nejmoa1804355] [Citation(s) in RCA: 715] [Impact Index Per Article: 119.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Under current guidelines, intravenous thrombolysis is used to treat acute stroke only if it can be ascertained that the time since the onset of symptoms was less than 4.5 hours. We sought to determine whether patients with stroke with an unknown time of onset and features suggesting recent cerebral infarction on magnetic resonance imaging (MRI) would benefit from thrombolysis with the use of intravenous alteplase. METHODS In a multicenter trial, we randomly assigned patients who had an unknown time of onset of stroke to receive either intravenous alteplase or placebo. All the patients had an ischemic lesion that was visible on MRI diffusion-weighted imaging but no parenchymal hyperintensity on fluid-attenuated inversion recovery (FLAIR), which indicated that the stroke had occurred approximately within the previous 4.5 hours. We excluded patients for whom thrombectomy was planned. The primary end point was favorable outcome, as defined by a score of 0 or 1 on the modified Rankin scale of neurologic disability (which ranges from 0 [no symptoms] to 6 [death]) at 90 days. A secondary outcome was the likelihood that alteplase would lead to lower ordinal scores on the modified Rankin scale than would placebo (shift analysis). RESULTS The trial was stopped early owing to cessation of funding after the enrollment of 503 of an anticipated 800 patients. Of these patients, 254 were randomly assigned to receive alteplase and 249 to receive placebo. A favorable outcome at 90 days was reported in 131 of 246 patients (53.3%) in the alteplase group and in 102 of 244 patients (41.8%) in the placebo group (adjusted odds ratio, 1.61; 95% confidence interval [CI], 1.09 to 2.36; P=0.02). The median score on the modified Rankin scale at 90 days was 1 in the alteplase group and 2 in the placebo group (adjusted common odds ratio, 1.62; 95% CI, 1.17 to 2.23; P=0.003). There were 10 deaths (4.1%) in the alteplase group and 3 (1.2%) in the placebo group (odds ratio, 3.38; 95% CI, 0.92 to 12.52; P=0.07). The rate of symptomatic intracranial hemorrhage was 2.0% in the alteplase group and 0.4% in the placebo group (odds ratio, 4.95; 95% CI, 0.57 to 42.87; P=0.15). CONCLUSIONS In patients with acute stroke with an unknown time of onset, intravenous alteplase guided by a mismatch between diffusion-weighted imaging and FLAIR in the region of ischemia resulted in a significantly better functional outcome and numerically more intracranial hemorrhages than placebo at 90 days. (Funded by the European Union Seventh Framework Program; WAKE-UP ClinicalTrials.gov number, NCT01525290; and EudraCT number, 2011-005906-32 .).
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Affiliation(s)
- Götz Thomalla
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Claus Z Simonsen
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Florent Boutitie
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Grethe Andersen
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Yves Berthezene
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Bastian Cheng
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Bharath Cheripelli
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Tae-Hee Cho
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Franz Fazekas
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Jens Fiehler
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Ian Ford
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Ivana Galinovic
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Susanne Gellissen
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Amir Golsari
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Johannes Gregori
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Matthias Günther
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Jorge Guibernau
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Karl Georg Häusler
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Michael Hennerici
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - André Kemmling
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Jacob Marstrand
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Boris Modrau
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Lars Neeb
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Natalia Perez de la Ossa
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Josep Puig
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Peter Ringleb
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Pascal Roy
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Enno Scheel
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Wouter Schonewille
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Joaquin Serena
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Stefan Sunaert
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Kersten Villringer
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Anke Wouters
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Vincent Thijs
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Martin Ebinger
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Matthias Endres
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Jochen B Fiebach
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Robin Lemmens
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Keith W Muir
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Norbert Nighoghossian
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Salvador Pedraza
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
| | - Christian Gerloff
- From Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf (G.T., B. Cheng, S.G., A.G., C.G.), the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf (J.F.), and ZytoService Deutschland (E.S.), Hamburg, Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz (F.F.), Centrum für Schlaganfallforschung Berlin (I.G., K.G.H., K.V., M. Ebinger, M. Endres, J.B.F.) and Klinik und Hochschulambulanz für Neurologie (K.G.H., L.N., M. Endres), Charité-Universitätsmedizin Berlin, and Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin, Mediri (J. Gregori, M.G.), the Department of Neurology, Medical Faculty Mannheim, University of Heidelberg (M.H.), and Neurologische Klinik, Universitätsklinikum Heidelberg (P. Ringleb), Heidelberg, Fraunhofer MEVIS and University of Bremen, Bremen (M.G.), and Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck (A.K.) - all in Germany; the Department of Neurology, Aarhus University Hospital, Aarhus (C.Z.S., G.A.), the Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen (J.M.), and Department of Neurology, Stroke Unit, Aalborg University Hospital, Aalborg (B.M.) - all in Denmark; Hospices Civils de Lyon, Service de Biostatistique (F.B., P. Roy), the Neuroradiology Department, Neurological Hospital, University Lyon (Y.B.), and the Department of Stroke Medicine, Université Claude Bernard Lyon 1, and Hospices Civils de Lyon (T.-H.C., N.N.), Lyon, and Université Lyon 1 and Centre National de la Recherche Scientifique, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne (F.B., P. Roy) - all in France; the Institute of Neuroscience and Psychology (B. Cheripelli, K.W.M.) and the Robertson Centre for Biostatistics (I.F.), University of Glasgow, Glasgow, United Kingdom (I.F.); Fundació Salut Empordà Hospital, Figueres (J. Guibernau), Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona (N.P.O.), and the Department of Radiology (J.P., S.P.) and the Stroke Unit (J.S.), Hospital Universitari Doctor Josep Trueta, Institut d'Investigació Biomèdica de Girona, Girona - all in Spain; the Department of Neurology, St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht (W.S.) - both in the Netherlands; the Department of Imaging and Pathology, University of Leuven (S.S.), the Department of Neurology, University Hospitals Leuven (A.W., R.L.), KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology (A.W., R.L.), and the VIB-KU Leuven Center for Brain and Disease Research, Laboratory of Neurobiology (A.W., R.L.), Leuven, Belgium; and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.)
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Sporns PB, Kemmling A, Minnerup J, Hanning U, Heindel W. Imaging-based outcome prediction in patients with intracerebral hemorrhage. Acta Neurochir (Wien) 2018; 160:1663-1670. [PMID: 29943191 DOI: 10.1007/s00701-018-3605-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
Besides the established spot sign in computed tomography angiography (CTA), recently investigated imaging predictors of hematoma growth in noncontrast computed tomography (NCCT) suggest great potential for outcome prediction in patients with intracerebral hemorrhage (ICH). Secondary hematoma growth is an appealing target for therapeutic interventions because in contrast to other determined factors, it is potentially modifiable. Even more initial therapy studies failed to demonstrate clear therapeutic benefits, there is a need for an effective patient selection using imaging markers to identify patients at risk for poor outcome and thereby tailor individual treatments for every patient. Hence, this review gives an overview about the current literature on NCCT imaging markers for neurological outcome prediction and aims to clarify the association with the established spot sign. Moreover, it demonstrates the clinical impact of these parameters and gives a roadmap for future imaging research in patients with intracerebral hemorrhage.
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Schneider T, Kemmling A, Schroeder J, Pantel K, Glatzel M, Schoen G, Mohme M, Fiehler J, Gellißen S. Inverse Perfusion Requirements of Supra- and Infratentorial Brain Metastases Formation. Front Neurol 2018; 9:391. [PMID: 29899729 PMCID: PMC5989059 DOI: 10.3389/fneur.2018.00391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/14/2018] [Indexed: 12/21/2022] Open
Abstract
Background and Aims: Vascular border zones and the gray-white matter junction are preferred sites for the development of brain metastases (BM), whereas microvascular lesions are known to be a protective factor. In this proof of concept study, we aim to study the relationship of blood perfusion and the spatial distribution of BM. Materials and Methods: An average CT perfusion atlas of 107 healthy patients was created. Voxel-wise reference perfusion values were extracted from BM-negative and BM-positive regions in a second cohort of 100 untreated patients harboring 809 BM confirmed by MRI. A comparison of regional perfusion values was performed using the independent t-test. Results: In contrast to supratentorial BM that develop preferably in areas with lower CBV/CBF and longer MTT/TTP compared to the average regional perfusion (p < 0.001), infratentorial BM showed a higher CBV/CBF and shorter MTT/TTP (p < 0.001). Conclusion: Our results imply differing pathophysiological mechanisms underlying supra- and infratentorial BM spreading. The inverse perfusion patterns may result from differences in vascular supply, hemodynamic requirements, and/or production of pro-angiogenic factors.
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Affiliation(s)
- Tanja Schneider
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Radiology, Schoen Klinik Hamburg Eilbek, Hamburg, Germany
| | - André Kemmling
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Julian Schroeder
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Pantel
- Center for Experimental Medicine, Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Glatzel
- Center for Diagnostics, Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Schoen
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte Mohme
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Gellißen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Schröder J, Cheng B, Malherbe C, Ebinger M, Köhrmann M, Wu O, Kang DW, Liebeskind DS, Tourdias T, Singer OC, Campbell B, Luby M, Warach S, Fiehler J, Kemmling A, Fiebach JB, Gerloff C, Thomalla G. Impact of Lesion Load Thresholds on Alberta Stroke Program Early Computed Tomographic Score in Diffusion-Weighted Imaging. Front Neurol 2018; 9:273. [PMID: 29740391 PMCID: PMC5926541 DOI: 10.3389/fneur.2018.00273] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/06/2018] [Indexed: 12/31/2022] Open
Abstract
Background and aims Assessment of ischemic lesions on computed tomography or MRI diffusion-weighted imaging (DWI) using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is widely used to guide acute stroke treatment. However, it has never been defined how many voxels need to be affected to label a DWI-ASPECTS region ischemic. We aimed to assess the effect of various lesion load thresholds on DWI-ASPECTS and compare this automated analysis with visual rating. Materials and methods We analyzed overlap of individual DWI lesions of 315 patients from the previously published predictive value of fluid-attenuated inversion recovery study with a probabilistic ASPECTS template derived from 221 CT images. We applied multiple lesion load thresholds per DWI-ASPECTS region (>0, >1, >10, and >20% in each DWI-ASPECTS region) to compute DWI-ASPECTS for each patient and compared the results to visual reading by an experienced stroke neurologist. Results By visual rating, median ASPECTS was 9, 84 patients had a DWI-ASPECTS score ≤7. Mean DWI lesion volume was 22.1 (±35) ml. In contrast, by use of >0, >1-, >10-, and >20%-thresholds, median DWI-ASPECTS was 1, 5, 8, and 10; 97.1% (306), 72.7% (229), 41% (129), and 25.7% (81) had DWI-ASPECTS ≤7, respectively. Overall agreement between automated assessment and visual rating was low for every threshold used (>0%: κw = 0.020 1%: κw = 0.151; 10%: κw = 0.386; 20% κw = 0.381). Agreement for dichotomized DWI-ASPECTS ranged from fair to substantial (≤7: >10% κ = 0.48; >20% κ = 0.45; ≤5: >10% κ = 0.528; and >20% κ = 0.695). Conclusion Overall agreement between automated and the standard used visual scoring is low regardless of the lesion load threshold used. However, dichotomized scoring achieved more comparable results. Varying lesion load thresholds had a critical impact on patient selection by ASPECTS. Of note, the relatively low lesion volume and lack of patients with large artery occlusion in our cohort may limit generalizability of these findings.
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Affiliation(s)
- Julian Schröder
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Caroline Malherbe
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Institut für Computational Neuroscience, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Köhrmann
- Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - David S Liebeskind
- Neurovascular Imaging Research Core, Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Thomas Tourdias
- Service de Neuroimagerie Diagnostique de Thérapeutique, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Oliver C Singer
- Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Bruce Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Marie Luby
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Steven Warach
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, United States
| | - Jens Fiehler
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - André Kemmling
- Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Jochen B Fiebach
- Centrum für Schlaganfallforschung Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Hanning U, Sporns PB, Schmidt R, Niederstadt T, Minnerup J, Bier G, Knecht S, Kemmling A. Quantitative Rapid Assessment of Leukoaraiosis in CT : Comparison to Gold Standard MRI. Clin Neuroradiol 2017; 29:109-115. [PMID: 29058014 DOI: 10.1007/s00062-017-0636-2] [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: 06/08/2017] [Accepted: 09/30/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The severity of white matter lesions (WML) is a risk factor of hemorrhage and predictor of clinical outcome after ischemic stroke; however, in contrast to magnetic resonance imaging (MRI) reliable quantification for this surrogate marker is limited for computed tomography (CT), the leading stroke imaging technique. We aimed to present and evaluate a CT-based automated rater-independent method for quantification of microangiopathic white matter changes. METHODS Patients with suspected minor stroke (National Institutes of Health Stroke scale, NIHSS < 4) were screened for the analysis of non-contrast computerized tomography (NCCT) at admission and compared to follow-up MRI. The MRI-based WML volume and visual Fazekas scores were assessed as the gold standard reference. We employed a recently published probabilistic brain segmentation algorithm for CT images to determine the tissue-specific density of WM space. All voxel-wise densities were quantified in WM space and weighted according to partial probabilistic WM content. The resulting mean weighted density of WM space in NCCT, the surrogate of WML, was correlated with reference to MRI-based WML parameters. RESULTS The process of CT-based tissue-specific segmentation was reliable in 79 cases with varying severity of microangiopathy. Voxel-wise weighted density within WM spaces showed a noticeable correlation (r = -0.65) with MRI-based WML volume. Particularly in patients with moderate or severe lesion load according to the visual Fazekas score the algorithm provided reliable prediction of MRI-based WML volume. CONCLUSION Automated observer-independent quantification of voxel-wise WM density in CT significantly correlates with microangiopathic WM disease in gold standard MRI. This rapid surrogate of white matter lesion load in CT may support objective WML assessment and therapeutic decision-making during acute stroke triage.
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Affiliation(s)
- Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, Universal Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Department of Clinical Radiology, University Hospital of Münster, Münster, Germany.
- Department of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
| | | | - Rene Schmidt
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Thomas Niederstadt
- Department of Clinical Radiology, University Hospital of Münster, Münster, Germany
| | - Jens Minnerup
- Department of Neurology, University Hospital of Münster, Münster, Germany
| | - Georg Bier
- Department of Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Stefan Knecht
- Department of Neurology, Mauritius Hospital and University Hospital of Düsseldorf, Düsseldorf, Germany
| | - André Kemmling
- Institute of Neuroradiology, University Hospital of Lübeck, Lübeck, Germany
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