1
|
Boriesosdick J, Michael AE, Kröger JR, Niehoff JH, Saeed S, Pflug M, Schellinger P, Maus V, Borggrefe J, Mönninghoff C. Mechanical thrombectomy using the Nimbus stent-retriever - initial experiences in a single-center observational study. Interv Neuroradiol 2022:15910199221129097. [PMID: 36147011 DOI: 10.1177/15910199221129097] [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: 11/16/2022] Open
Abstract
BACKGROUND The Nimbus stent-retriever (NSR) was developed for mechanical thrombectomy of wall-adherent thrombi in cerebral arteries. It features a novel geometry with a proximal spiral section and a distal barrel section. The new device is designed to retrieve tough clots with a micro-clamping technique. In the first case series reporting on the NSR, we share our initial experience about the first 12 treated cases. METHODS In total, 12 patients (5 men, 7 women; mean age 78 years) with occlusion of the internal carotid artery or the middle cerebral artery (M1 or M2 segment) were treated with the NSR, 11 after unsuccessful recanalization attempts with conventional stent-retrievers or aspiration thrombectomy. RESULTS Retrieving maneuvers with the NSR recovered a thrombus in 7 patients (58%), of which 6 resulted in vessel recanalization mTICI ≥ 2b. Successful recanalization improved the mTICI score by a median of 3 points. In 5 of 7 cases, this required only one thrombectomy maneuver. In 5 cases, no improvement of recanalization could be achieved with the NSR (1-3 attempts). No NSR-related complications occurred in this case series. CONCLUSIONS In our initial experience, the NSR appeared to be a safe and effective second-line stent-retriever after unsuccessful MT with conventional stent-retrievers or aspiration thrombectomy allowing for mTICI ≥ 2b rescue thrombectomy in ab 50% of cases. No NSR associated complications occurred in our case series.
Collapse
Affiliation(s)
- Jan Boriesosdick
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Arwed Elias Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jan-Robert Kröger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Julius Henning Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Saher Saeed
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Marc Pflug
- Department of Neurology and Neurogeriatrics, Johannes Wesling University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Peter Schellinger
- Department of Neurology and Neurogeriatrics, Johannes Wesling University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Volker Maus
- Department of Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Langendreer, Ruhr-University Bochum, Bochum, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Christoph Mönninghoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr-University Bochum, Bochum, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
2
|
Lawrence BJ, Urbizu A, Allen PA, Loth F, Tubbs RS, Bunck AC, Kröger JR, Rocque BG, Madura C, Chen JA, Luciano MG, Ellenbogen RG, Oshinski JN, Iskandar BJ, Martin BA. Cerebellar tonsil ectopia measurement in type I Chiari malformation patients show poor inter-operator reliability. Fluids Barriers CNS 2018; 15:33. [PMID: 30554565 PMCID: PMC6296028 DOI: 10.1186/s12987-018-0118-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/22/2018] [Indexed: 12/29/2022] Open
Abstract
Background Type 1 Chiari malformation (CM-I) has been historically defined by cerebellar tonsillar position (TP) greater than 3–5 mm below the foramen magnum (FM). Often, the radiographic findings are highly variable, which may influence the clinical course and patient outcome. In this study, we evaluate the inter-operator reliability (reproducibility) of MRI-based measurement of TP in CM-I patients and healthy controls. Methods Thirty-three T2-weighted MRI sets were obtained for 23 CM-I patients (11 symptomatic and 12 asymptomatic) and 10 healthy controls. TP inferior to the FM was measured in the mid-sagittal plane by seven expert operators with reference to McRae’s line. Overall agreement between the operators was quantified by intraclass correlation coefficient (ICC). Results The mean and standard deviation of cerebellar TP measurements for asymptomatic (CM-Ia) and symptomatic (CM-Is) patients in mid-sagittal plane was 6.38 ± 2.19 and 9.57 ± 2.63 mm, respectively. TP measurements for healthy controls was 0.48 ± 2.88 mm. The average range of TP measurements for all data sets analyzed was 7.7 mm. Overall operator agreement for TP measurements was relatively high with an ICC of 0.83. Conclusion The results demonstrated a large average range (7.7 mm) of measurements among the seven expert operators and support that, if economically feasible, two radiologists should make independent measurements before radiologic diagnosis of CM-I and surgery is contemplated. In the future, an objective diagnostic parameter for CM-I that utilizes automated algorithms and results in smaller inter-operator variation may improve patient selection.
Collapse
Affiliation(s)
- Braden J Lawrence
- Department of Biological Engineering, University of Idaho, 875 Perimeter Drive MS 0904, Moscow, ID, 83844-0904, USA.,School of Medicine, University of Washington, Seattle, WA, USA
| | - Aintzane Urbizu
- Center for Human Disease Modeling, Duke University Medical Center, Durham, NC, USA
| | - Philip A Allen
- Department of Psychology, University of Akron, Akron, OH, USA
| | - Francis Loth
- Department of Mechanical Engineering, University of Akron, Akron, OH, USA
| | | | - Alexander C Bunck
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Jan-Robert Kröger
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Brandon G Rocque
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama, USA
| | - Casey Madura
- Department of Neurosurgery, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Jason A Chen
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Mark G Luciano
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | | | - John N Oshinski
- Department of Radiology & Imaging Science and Biomedical Engineering, Emory University, Atlanta, GA, USA
| | - Bermans J Iskandar
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Bryn A Martin
- Department of Biological Engineering, University of Idaho, 875 Perimeter Drive MS 0904, Moscow, ID, 83844-0904, USA.
| |
Collapse
|
3
|
Bunck AC, Kröger JR, Jüttner A, Brentrup A, Fiedler B, Crelier GR, Schwindt W, Heindel W, Niederstadt T, Maintz D. MRT-basierte 4D-Flussbildgebung der Liquorflussdynamik auf Höhe des kraniozervikalen Übergangs und des Zervikalkanals bei Patienten mit Chiari-Malformation. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
4
|
Bunck AC, Kröger JR, Jüttner A, Tiemann K, Crelier G, Heindel W, Maintz D. Untersuchung zur Anwendbarkeit und Validität der zeitaufgelösten 3D-Phasenkontrastflussmessung zur Flussvisualisierung und -quantifizierung in peripheren Gefäßstents. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|