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Gröschel S, Uphaus T, Gröschel K, Hahn M. P-100 Delirium in patients with acute cerebrovascular disease during visitation restrictions due to COVID-19 pandemic: A stroke-unit perspective. Clin Neurophysiol 2023. [PMCID: PMC9988268 DOI: 10.1016/j.clinph.2023.02.117] [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: 03/08/2023]
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Weller JM, Dorn F, Meissner JN, Stösser S, Beckonert NM, Nordsiek J, Kindler C, Riegler C, Keil F, Petzold GC, Bode FJ, Reich A, Nikoubashman O, Röther J, Eckert B, Braun M, Hamann GF, Siebert E, Nolte CH, Bohner G, Eckert RM, Borggrefe J, Schellinger P, Berrouschot J, Bormann A, Kraemer C, Leischner H, Petersen M, Stögbauer F, Boeck-Behrens T, Wunderlich S, Ludolph A, Henn KH, Gerloff C, Fiehler J, Thomalla G, Alegiani A, Schäfer JH, Tiedt S, Kellert L, Trumm C, Ernemann U, Poli S, Liman J, Ernst M, Gröschel K, Uphaus T. Antithrombotic treatment and outcome after endovascular treatment and acute carotid artery stenting in stroke patients with atrial fibrillation. Neurol Res Pract 2022; 4:42. [PMID: 36089621 PMCID: PMC9465921 DOI: 10.1186/s42466-022-00207-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Oral anticoagulation (OAC) is the mainstay of secondary prevention in ischemic stroke patients with atrial fibrillation (AF). However, in AF patients with large vessel occlusion stroke treated by endovascular therapy (ET) and acute carotid artery stenting (CAS), the optimal antithrombotic medication remains unclear.
Methods This is a subgroup analysis of the German Stroke Registry—Endovascular Treatment (GSR-ET), a prospective multicenter cohort of patients with large vessel occlusion stroke undergoing ET. Patients with AF and CAS during ET were included. We analyzed baseline and periprocedural characteristics, antithrombotic strategies and functional outcome at 90 days. Results Among 6635 patients in the registry, a total of 82 patients (1.2%, age 77.9 ± 8.0 years, 39% female) with AF and extracranial CAS during ET were included. Antithrombotic medication at admission, during ET, postprocedural and at discharge was highly variable and overall mortality in hospital (21%) and at 90 days (39%) was high. Among discharged patients (n = 65), most frequent antithrombotic regimes were dual antiplatelet therapy (DAPT, 37%), single APT + OAC (25%) and DAPT + OAC (20%). Comparing DAPT to single or dual APT + OAC, clinical characteristics at discharge were similar (median NIHSS 7.5 [interquartile range, 3–10.5] vs 7 [4–11], p = 0.73, mRS 4 [IQR 3–4] vs. 4 [IQR 3–5], p = 0.79), but 90-day mortality was higher without OAC (32 vs 4%, p = 0.02). Conclusions In AF patients who underwent ET and CAS, 90-day mortality was higher in patients not receiving OAC. Registration: https://www.clinicaltrials.gov; Unique identifier: NCT03356392. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-022-00207-7.
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Nedelmann M, Schlachetzki F, Allendörfer J, Gröschel K. Leserbrief zu Hansen HC, Helmke K: Review Optikussonografie – ein update 2020 Klinische Neurophysiologie 2020; 51: 201–213. KLIN NEUROPHYSIOL 2021. [DOI: 10.1055/a-1379-4982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M. Nedelmann
- Regio Kliniken, Klinik für Neurologie, Pinneberg
| | - F. Schlachetzki
- medbo Bezirksklinikum Regensburg, Zentrum für Vaskuläre Neurologie und Intensivmedizin
| | | | - K. Gröschel
- Universitätsmedizin Mainz, Klinik und Poliklinik für Neurologie
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Gröschel S, Lange B, Grond M, Jauss M, Kirchhof P, Rostock T, Wachter R, Gröschel K, Uphaus T. Automatic Holter electrocardiogram analysis in ischaemic stroke patients to detect paroxysmal atrial fibrillation: ready to replace physicians? Eur J Neurol 2020; 27:1272-1278. [DOI: 10.1111/ene.14250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 02/06/2023]
Affiliation(s)
- S. Gröschel
- Department of Neurology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - B. Lange
- Department of Cardiology II University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - M. Grond
- Department of Neurology Kreisklinikum Siegen Siegen Germany
| | - M. Jauss
- Department of Neurology Hainich Klinikum Mühlhausen Germany
| | - P. Kirchhof
- Institute of Cardiovascular Sciences University of Birmingham Birmingham UK
- Department of Cardiology SWBH and UHB NHS Trusts Birmingham UK
| | - T. Rostock
- Department of Cardiology II University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - R. Wachter
- Clinic and Policlinic for Cardiology University Hospital Leipzig Leipzig Germany
- Clinic for Cardiology and Pneumology University Medicine Göttingen Göttingen Germany
- German Cardiovascular Research Center (DZHK), Partner Site Göttingen Göttingen Germany
| | - K. Gröschel
- Department of Neurology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - T. Uphaus
- Department of Neurology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
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Ghanem A, Liebetrau C, Diener HC, Elsässer A, Grau A, Gröschel K, Mattle H, Massberg S, Möllmann H, Nef H, Sander D, Weimar C, Wöhrle J, Baldus S. Interventioneller PFO-Verschluss. Kardiologe 2018. [DOI: 10.1007/s12181-018-0277-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Uphaus T, Grings A, Gröschel S, Müller A, Weber-Krüger M, Wachter R, Gröschel K. Automatic detection of paroxysmal atrial fibrillation in patients with ischaemic stroke: better than routine diagnostic workup? Eur J Neurol 2017; 24:990-994. [PMID: 28503795 PMCID: PMC5518440 DOI: 10.1111/ene.13326] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 04/13/2017] [Indexed: 11/26/2022]
Abstract
Background and purpose Prolonged electrocardiogram (ECG) monitoring after ischaemic stroke increases the diagnostic yield of paroxysmal atrial fibrillation (pAF). In order to facilitate the additional workload involved in ECG analysis due to prolonged monitoring times, we investigated the effectiveness of pAF detection with an automated software algorithm (SA) in comparison to the routine staff‐based analysis (RA) during standard stroke‐unit care. Therefore, patients with acute ischaemic stroke or transitory ischaemic attack presenting with sinus rhythmus on the admission ECG and no history of atrial fibrillation were prospectively included. Methods A 24‐h Holter ECG assessment was performed using either RA based on a computer‐aided evaluation and subsequent review by a cardiologist or a commercially available automated SA. In the case of discordant results concerning the occurrence of pAF between the two methods, the data underwent an independent external rating. Results Of 809 prospectively enrolled patients, 580 patients fulfilled the inclusion criteria. pAF was ultimately diagnosed in 3.3% of the cohort (19 patients). SA and RA correctly diagnosed pAF in 17 patients resulting in a comparable diagnostic effectiveness of the analysis methods (sensitivity: SA 89.5% vs. RA 89.5%; specificity: SA 99.3% vs. RA 99.1%; κ, 0.686; P < 0.001; 95% confidence interval, 0.525–0.847). RA revealed clinically relevant ECG abnormalities in an additional seven patients. Conclusions Although it should not completely replace RA, SA‐based evaluation of Holter ECG reaches a high diagnostic effectiveness for the detection of pAF and can be used for a rapid and resource‐saving analysis of ECG data to deal with prolonged monitoring times.
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Affiliation(s)
- T Uphaus
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - A Grings
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - S Gröschel
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - A Müller
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - M Weber-Krüger
- Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany
| | - R Wachter
- Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany
| | - K Gröschel
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Diekmann S, Hörster L, Neumann A, Weber-Krüger M, Gelbrich G, Gröschel K, Wachter R, Wasem J. Sekundärprävention nach Schlaganfall (Find-AF randomised): Kosten-Nutzwert-Analyse eines verlängerten EKG-Monitorings. Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1586535] [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: 10/21/2022]
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Affiliation(s)
- A. Kastrup
- Department of Neurology, University of Göttingen, Göttingen, Germany
| | - K. Gröschel
- Department of Neurology, University of Göttingen, Göttingen, Germany
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Gröschel K, Grond M, Wachter R. Langzeit-EKG-Monitoring beim kryptogenen Schlaganfall. Akt Neurol 2014. [DOI: 10.1055/s-0034-1387398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- K. Gröschel
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Mainz
| | - M. Grond
- Klinik für Neurologie und Neurogeriatrie, Kreisklinikum Siegen
| | - R. Wachter
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen
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Hecking C, Hendelmeier M, von Bardeleben R, Gröschel K, Schinzel H. Recurrent cerebral ischaemia in a pregnant woman with patent foramen ovale II° and thrombophilia. Hamostaseologie 2014; 34:239-43. [PMID: 24975880 DOI: 10.5482/hamo-14-03-0022] [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: 03/24/2014] [Accepted: 06/17/2014] [Indexed: 11/05/2022] Open
Abstract
This case report concerns a pregnant multipara (age: 27 years) in the 16th gestational week. She developed a sudden onset of paraesthesia in her left lower arm although injecting dalteparin 5000 IU once daily subcutaneously (s. c.) due to a heterozygous factor V Leiden mutation and a prior miscarriage in the first pregnancy and preeclampsia in her third pregnancy. After the miscarriage she delivered two healthy children under prophylactic anticoagulation with low molecular weight heparin (LMWH). Now via magnetic resonance imaging (MRI) she was diagnosed as having multiple cerebral ischaemic lesions. Further workup revealed the presence of a patent foramen ovale (PFO) II° but no venous thrombosis in her legs. She was then treated with dalteparin 5000 IU twice daily by subcutaneous injections. At 19th gestational week she developed paraesthesia in her left lower arm again. The MRI showed a cortical lesion in the territory of the right median cerebral artery. The anticoagulation dose was increased stepwise under surveillance of the anti-FXa-level 3-4 h after subcutaneous injections aiming to achieve the supratherapeutic range of 1.2-1.5 IU/ml anti-Xa-units. No more neurological symptoms appeared under this antithrombotic therapy. The patient delivered by induction of labor at the 38th gestational week.
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Affiliation(s)
- C Hecking
- Carola Hecking, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Centrum für Thrombose und Hämostase, Langenbeckstraße 1, 55131 Mainz, Germany, Tel. +49/(0)61 31/17 41 73, Fax +49/(0)61 31/17 66 17, E-mail:
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Gröschel K, Röther J, Laufs U, Wachter R. [Heart or brain? Problem patients at the interface between cardiology and neurology]. Herz 2014; 38:395-401; quiz 402-3. [PMID: 23604111 DOI: 10.1007/s00059-013-3807-1] [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: 10/26/2022]
Abstract
A large number of patients fall into a category at the interface between heart or brain and are expected to require thorough clinical knowledge from both the cardiological as well as the neurological point of view for further patient-oriented treatment. The current article therefore addresses this important issue and aims to provide important information for clinical decision making for those patients at the interface between heart and brain. Due to the clinical impact, patients with carotid stenosis, a patent foramen ovale or non-valvular atrial fibrillation are described in more detail in this article.
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Affiliation(s)
- K Gröschel
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Mainz, Langenbeckstrasse 1, Mainz, Germany.
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Wohlfahrt J, Stahrenberg R, Weber-Krüger M, Gröschel S, Wasser K, Edelmann F, Seegers J, Wachter R, Gröschel K. Clinical predictors to identify paroxysmal atrial fibrillation after ischaemic stroke. Eur J Neurol 2013; 21:21-7. [DOI: 10.1111/ene.12198] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 04/15/2013] [Indexed: 11/28/2022]
Affiliation(s)
- J. Wohlfahrt
- Department of Neurology; University of Göttingen; Göttingen Germany
| | - R. Stahrenberg
- Department of Cardiology and Pneumology; University of Göttingen; Göttingen Germany
| | - M. Weber-Krüger
- Department of Cardiology and Pneumology; University of Göttingen; Göttingen Germany
| | - S. Gröschel
- Department of Psychiatry and Psychotherapy; University of Mainz; Mainz Germany
| | - K. Wasser
- Department of Neurology; University of Göttingen; Göttingen Germany
| | - F. Edelmann
- Department of Cardiology and Pneumology; University of Göttingen; Göttingen Germany
| | - J. Seegers
- Department of Cardiology and Pneumology; University of Göttingen; Göttingen Germany
| | - R. Wachter
- Department of Cardiology and Pneumology; University of Göttingen; Göttingen Germany
| | - K. Gröschel
- Department of Neurology; University of Mainz; Mainz Germany
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Psychogios MN, Kreusch A, Wasser K, Mohr A, Gröschel K, Knauth M. Recanalization of large intracranial vessels using the penumbra system: a single-center experience. AJNR Am J Neuroradiol 2012; 33:1488-93. [PMID: 22460339 DOI: 10.3174/ajnr.a2990] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The PS is an innovative mechanical device designed to recanalize large-vessel occlusions by thrombus aspiration. The purpose of this study was to evaluate the effectiveness and neurologic outcome of patients treated with the PS in the setting of acute ischemic stroke. MATERIALS AND METHODS A total of 91 patients with acute ischemic stroke due to large-vessel occlusion were treated with the PS and were included in our retrospective study. In 14 patients, only the PS was used for treatment; in 77 patients, mechanical recanalization was combined with IA and/or IV thrombolysis. Outcome was measured by using the mRS; recanalization was assessed with the TICI score. RESULTS Mean patient age was 62 ± 19.4 years; the average NIHSS score at hospital admission was 17. Successful recanalization was achieved in 77% of patients. Median time from arterial puncture to recanalization was 49 minutes (quartiles, 31-86 minutes). At follow-up, 36% of the patients showed an NIHSS improvement of ≥10%, and 34% of the patients with an anterior circulation occlusion had an mRS score of ≤2, whereas only 7% of the patients with a posterior occlusion had a favorable outcome at follow-up. In total, 20 patients died during hospitalization; none of these deaths were device-related. CONCLUSIONS In this study, the PS was an effective device for mechanical recanalization. Successful recanalization with the PS was associated with significant improvement of functional outcome in patients experiencing ischemic stroke secondary to anterior circulation occlusions.
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Affiliation(s)
- M-N Psychogios
- Department of Neuroradiology, University Medicine Goettingen, Goettingen, Germany.
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Psychogios MN, Schramm P, Buhk JH, Xyda A, Gröschel K, Jung K, Knauth M. Angiographic CT after intravenous contrast agent application: A noninvasive follow-up tool after intracranial angioplasty and stenting. AJNR Am J Neuroradiol 2010; 31:1886-91. [PMID: 20634309 DOI: 10.3174/ajnr.a2168] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE ICAS is one of the therapeutic options in symptomatic cerebral artery stenosis. iaDSA is the current criterion standard examination after ICAS for the detection of ISR. In this study, we evaluated ivACT as a potential noninvasive follow-up alternative. MATERIALS AND METHODS In 17 cases, ivACT and iaDSA were performed after ICAS. Both procedures were carried out on a flat-panel-detector-equipped angiography system. Postprocessing of ivACT acquisitions was performed on a dedicated workstation producing multiplanar reformations of the stent region and other intracranial arteries. Restenotic lesions were compared with iaDSA measurements. All studies were independently evaluated by 2 experienced neuroradiologists blinded to patients data. RESULTS In 5 cases, ISR was diagnosed on iaDSA images. All restenotic lesions were reliably detected (sensitivity, 100%; 95%CI, 48%-100%) and could be correctly quantified on ivACT images in comparison with iaDSA. The neuroradiologists correctly excluded ISR in 11 of 12 lesions after viewing the ivACT examinations (specificity, 92%; 95%CI, 62%-100%). Measurements of ISR on ivACT were highly correlated to iaDSA (Pearson r = 0.94, P < .01). CONCLUSIONS IvACT is a promising noninvasive follow-up examination after ICAS. With its high spatial resolution, it can reliably detect or exclude ISR. Contrary to iaDSA, there is no need for a recovery period after ivACT and the risk of neurologic complications is practically lowered to zero.
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Affiliation(s)
- M-N Psychogios
- Department of Neuroradiology, University Medicine Goettingen, Germany.
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Wasser K, Pilgram-Pastor SM, Stojanovic T, Schnaudigel S, Schmidt H, Knauf J, Gröschel K, Knauth M, Kastrup A. Führen DWI-Läsionen nach Revaskularisation der A. carotis interna zu einer Beeinträchtigung der Kognition? Akt Neurol 2009. [DOI: 10.1055/s-0029-1238408] [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: 10/20/2022]
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Riecker A, Gröschel K, Schnaudigel S, Ackermann H, Kassubek J, Kastrup A. The role of the unaffected hemisphere in motor recovery after stroke. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71849-x] [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: 10/20/2022] Open
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Terborg C, Gröschel K, Ringer T, Witte O, Kastrup A. Non-invasive assessment of cerebral blood flow and oxygenation in acute ischemic stroke by near-infrared spectroscopy. Akt Neurol 2008. [DOI: 10.1055/s-0028-1087037] [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: 10/21/2022]
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Wasser K, Gröschel K, Pilgram S, Ernemann U, Schnaudigel S, Nägele T, Knauth M, Kastrup A. Aortic calcification on plain chest radiography predicts embolic complications during carotid artery stenting. Akt Neurol 2008. [DOI: 10.1055/s-0028-1087019] [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: 10/21/2022]
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Gröschel K, Schnaudigel S, Buhk JH, Knauth M, Kastrup A. Intracranial stent restenosis diagnosed on routine duplex follow-up investigation. AJNR Am J Neuroradiol 2008; 29:e65; author reply e66. [PMID: 18641084 DOI: 10.3174/ajnr.a1080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Gröschel K, Schnaudigel S, Kastrup A. The optimal timing of carotid artery stenting after a recently symptomatic carotid stenosis is still under debate. Eur J Neurol 2008. [DOI: 10.1111/j.1468-1331.2008.02160.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gröschel K, Pilgram SM, Ernemann U, Schnaudigel S, Nägele T, Knauth M, Kastrup A. Aortic calcification on plain chest radiography predicts embolic complications during carotid artery stenting. Eur J Neurol 2008; 15:730-6. [DOI: 10.1111/j.1468-1331.2008.02183.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pilgram SM, Weber P, Gröschel K, Knauth M. Der Einfluss vom Weichplaqueanteil am Gesamtplaquevolumen bei der Entstehung peri- und postinterventioneller Mikroembolien bei Durchführung einer SPAC. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073608] [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: 10/21/2022]
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Gröschel K, Schnaudigel S, Pilgram SM, Wasser K, Kastrup A. [The diagnostic lumbar puncture]. Dtsch Med Wochenschr 2007; 133:39-41. [PMID: 18095209 DOI: 10.1055/s-2008-1017470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- K Gröschel
- Abteilung für Neurologie, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, 37075 Göttingen.
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Kastrup A, Gröschel K, Nägele T, Riecker A, Schmidt F, Schnaudigel S, Ernemann U. Effects of age and symptom status on silent ischemic lesions after carotid stenting with and without the use of distal filter devices. AJNR Am J Neuroradiol 2007; 29:608-12. [PMID: 18065503 DOI: 10.3174/ajnr.a0871] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The routine use of distal filter devices during carotid angioplasty and stent placement (CAS) is controversial. The aim of this study was to analyze their effects on the incidence of new diffusion-weighted imaging (DWI) lesions as surrogate markers for stroke in important subgroups. MATERIALS AND METHODS DWI was performed immediately before and after CAS in 68 patients with and 175 without protection, and patients were further subdivided according to their age or symptom status. RESULTS The proportion of patients with new ipsilateral DWI lesion(s) was significantly lower after protected versus unprotected CAS (52% versus 68%), as well as in symptomatic patients (56% versus 74%) or those at or younger than 75 years of age (46% versus 67%; all P < .05). Similarly, the total number of lesions was significantly lower after protected versus unprotected CAS (median, 1; interquartile range [IQR], 0-2; versus median, 1; IQR 0-4.75) and in symptomatic patients (median, 1; IQR, 0-3; versus median, 2; IQR, 0-6) or those at or younger than 75 years of age (median, 0; IQR, 0-2; versus median, 1; IQR, 0-4; all P < .05). In contrast, for asymptomatic patients (48% versus 52%; P = .8; median, 0; IQR, 0-2; versus median, 1; IQR, 0-2.5; P = .6) or those older than 75 years of age (73% versus 69%; P = .7; median, 1; IQR, 0-4; versus median, 1.5; IQR, 0-5.75; P = .6), the proportion of patients with new lesion(s) and the total number of these lesions were not significantly different between protected and unprotected CAS. CONCLUSIONS The use of distal filter devices generally reduces the incidence of new DWI lesions; however, this beneficial effect might not necessarily pertain to older and asymptomatic patients.
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Affiliation(s)
- A Kastrup
- Department of Neurology, University of Göttingen, Göttingen, Germany.
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Gröschel K, Knauth M, Ernemann U, Pilgram SM, Schnaudigel S, Kastrup A. Early treatment after a symptomatic event is not associated with an increased risk of stroke in patients undergoing carotid stenting. Eur J Neurol 2007; 15:2-5. [PMID: 18005050 DOI: 10.1111/j.1468-1331.2007.02002.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A recently symptomatic carotid artery stenosis carries a high risk of subsequent ischaemic events and thus requires rapid treatment. We investigated the influence of the time delay between the last symptomatic event of a carotid stenosis and subsequent carotid artery stenting (CAS) with respect to the combined 30-day outcome of stroke and death. In a group of 320 patients undergoing CAS the median delay before the intervention was 19 days (interquartile range 10-36) and the combined 30-day complication rate was 8.4%. Time delay was not significantly associated with peri-procedural complications, regardless of whether this variable was dichotomized (<14 days and > or =14 days), separated into interquartile ranges or analysed as a continuous variable. Our results indicate that early CAS is not associated with an increased complication rate in patients with a recently symptomatic carotid stenosis. Thus, if CAS has been selected as the treatment modality for a patient, it should be performed as soon as possible to maximize the benefit of the intervention in reducing the risk of stroke.
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Affiliation(s)
- K Gröschel
- Department of Neurology, University of Göttingen, Göttingen, Germany.
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Gröschel K, Ernemann U, Larsen J, Knauth M, Schmidt F, Artschwager J, Kastrup A. Preprocedural C-reactive protein levels predict stroke and death in patients undergoing carotid stenting. AJNR Am J Neuroradiol 2007; 28:1743-6. [PMID: 17885237 PMCID: PMC8134178 DOI: 10.3174/ajnr.a0650] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Elevated baseline levels of C-reactive protein (CRP) are associated with an adverse outcome during coronary stent placement. The aim of this study was to evaluate whether preprocedural CRP levels also are predictive of stroke and death in patients undergoing carotid stent placement (CAS). MATERIALS AND METHODS We reviewed data prospectively collected from 130 patients (97 men, 33 women; mean age, 68.5 +/- 10.1 years; range, 43-89 years) who underwent CAS for symptomatic carotid stenosis and from whom preprocedural CRP values had been obtained. A CRP value of >5 mg/L was considered to be elevated. The frequency of stroke and death within 30 days was compared between patients with and without elevated baseline CRP levels using chi(2) and multivariate logistic regression analysis. RESULTS Baseline CRP values were normal in 94 (72.3%) patients but were elevated in 36 (27.7%) patients. The demographic and clinical characteristics were similar in both treatment groups. The 30-day stroke and death rate was significantly higher in patients with elevated CRP values (8/36; 22.2%) than in those without (3/94; 3.2%; P < .01). After adjusting for demographic characteristics, degree of carotid stenosis, and use of cerebral protection devices and/or statin therapy, an elevated CRP value before CAS remained a significant and independent predictor of stroke and death within 30 days after CAS (odds ratio, 7.7; 95% confidence interval: 1.8-32.8, P = .006). CONCLUSIONS Baseline CRP is a powerful predictor of outcome in patients undergoing CAS, which underscores the role of inflammation in the pathogenesis of embolic complications during this procedure.
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Affiliation(s)
- K Gröschel
- Department of Neurology, University of Göttingen, Göttingen, Germany
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Terborg C, Gröschel K, Witte O, Kastrup A. Non invasive detection of hypoperfusion and deoxygenation by near-infrared spectroscopy (NIRS) in acute ischemic stroke. Clin Neurophysiol 2007. [DOI: 10.1016/j.clinph.2006.11.240] [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: 10/23/2022]
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Gröschel K, Terborg C, Riecker A, Witte O, Kastrup A. Effects of physiological aging and cerebrovascular risk factors on the hemodynamic response to brain activation: A functional transcranial doppler study. Clin Neurophysiol 2007. [DOI: 10.1016/j.clinph.2006.11.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kastrup A, Gröschel K. Carotid endarterectomy versus carotid stenting: an updated review of randomized trials and subgroup analyses. Acta Chir Belg 2007; 107:119-28. [PMID: 17515259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Atherosclerotic disease of the carotid arteries is responsible for a significant portion of ischemic strokes. Carotid endarterectomy (CEA) is currently the accepted standard of treatment for patients with severe symptomatic carotid stenosis. In the past few years, however, carotid angioplasty and stenting (CAS) has emerged as a potential alternative endovascular treatment strategy for this disorder. In fact, spurred by the positive results of single center studies and small, pivotal randomized trials, some even consider CAS as the treatment modality of choice, especially in presumably surgical high-risk patients. Yet, randomized trials directly comparing CAS with CEA are sparse and have produced conflicting results. The aim of this article is to review the current trial data on this issue and to define the role of these techniques for the management of two important subgroups of patients. An updated meta-analysis of seven randomized trials comparing CEA with CAS demonstrates that CAS is associated with a significantly increased risk of any stroke or death within 30 days (OR. 1.41, 95% CI 1.07-1.87, p < 0.05). Focusing on patients with a symptomatic carotid stenosis, there was also a significant difference in the odds of treatment-related stroke and death between CAS and CEA (OR, 1.41 ; CI 1.05 to 1.88, p < 0.05). Data on all disabling strokes and deaths within 30 days was available from five trials. The odds of disabling stroke or death at 30 days were similar in the endovascular and surgical group (OR, 1.33, 95% CI 0.89 to 1.98). Overall, these data do not justify a blind enthusiasm for CAS and a widespread use of this procedure for the treatment of carotid artery stenosis. On the other hand, a closer inspection of the current literature on elderly patients and those with a contralateral carotid occlusion clearly indicates that CAS and CEA already now have a complementary role. While elderly patients should preferentially be treated with CEA, CAS appears to be the treatment of choice in patients with a symptomatic carotid artery stenosis and a contralateral carotid occlusion in experienced centers.
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Affiliation(s)
- A Kastrup
- Department of Neurology, University of Göttingen, Göttingen, Germany.
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Gröschel K, Terborg C, Schnaudigel S, Ringer T, Riecker A, Witte OW, Kastrup A. Effects of physiological aging and cerebrovascular risk factors on the hemodynamic response to brain activation: a functional transcranial Doppler study. Eur J Neurol 2007; 14:125-31. [PMID: 17250718 DOI: 10.1111/j.1468-1331.2006.01563.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The influence of the vascular system on the coupling of cerebral blood flow (CBF) to focal brain activation during aging is incompletely understood. Using functional transcranial Doppler sonography and a hypercapnic challenge as a marker of intact cerebral vasoreactivity, we determined CBF velocity (CBFV) changes in response to a language and arithmetic task in a group of 43 healthy young subjects (mean age 32 +/- 8.6 years), 18 healthy old subjects (mean age 64 +/- 9.8 years) and 29 old subjects with risk factors for an atherosclerosis (mean age 69 +/- 8.4 years). Despite a similar performance during the cognitive tasks the CBFV changes were significantly lower in the group of old subjects with vascular risk factors compared with the healthy young and old subjects. Similarly, the CBFV changes during hypercapnia were significantly lower in the group of old subjects with vascular risk factors compared with the healthy young and old subjects. In contrast, both cognitive tasks and hypercapnia produced comparable CBFV changes in the group of healthy young and old subjects. These results suggest that the hemodynamic response to neuronal activation is unaffected by aging alone, whereas the presence of cardiovascular risk factors significantly diminishes the capability of cerebral vessels to react to vasodilating stimuli.
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Affiliation(s)
- K Gröschel
- Department of Neurology, University of Jena, Jena, Germany.
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Gröschel K, Terborg C, Riecker A, Witte OW, Kastrup A. Effects of physiological aging and cerebrovascular risk factors on the hemodynamic response to brain activation: A functional transcranial Doppler study. KLIN NEUROPHYSIOL 2006. [DOI: 10.1055/s-2006-939153] [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: 10/20/2022]
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Terborg C, Gröschel K, Witte OW, Kastrup A. Non invasive detection of hypoperfusion and deoxygenation by near-infrared spectroscopy (NIRS) in acute ischemic stroke. KLIN NEUROPHYSIOL 2006. [DOI: 10.1055/s-2006-939302] [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: 10/20/2022]
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Gröschel K, Ernemann U, Nägele T, Schmidt F, Kastrup A. Risk factors for early recurrent cerebral ischaemia prior to treatment of symptomatic carotid stenosis. Akt Neurol 2006. [DOI: 10.1055/s-2006-953271] [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: 10/20/2022]
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Gröschel K, Kastrup A, Litvan I, Schulz J. Midbrain atrophy in progressive supranuclear palsy: comparison of two dimensional planimetric- with three dimensional volumetric measurements. Akt Neurol 2006. [DOI: 10.1055/s-2006-953456] [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: 10/20/2022]
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Kastrup A, Gröschel K, Ackermann H, Witte O, Riecker A. Behavioural correlates of age-related differences in movement representation. Akt Neurol 2005. [DOI: 10.1055/s-2005-919568] [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: 10/26/2022]
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Ringer T, Riecker A, Gröschel K, Ernemann U, Witte O, Kastrup A. Incidence and risk factors for medical complications after carotid artery stenting. Akt Neurol 2005. [DOI: 10.1055/s-2005-919468] [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: 10/26/2022]
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Gröschel K, Riecker A, Witte O, Ernemann U, Schulz J, Kastrup A. Statin therapy at the time of carotid angioplasty and stenting reduces procedure-related neurological complications. Akt Neurol 2005. [DOI: 10.1055/s-2005-919462] [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: 10/26/2022]
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Gröschel K, Schulz JB, Riecker A, Kastrup A. Eine systematische Analyse der Literatur zur Restenoserate nach Stenteinlage in die A. carotis interna. Akt Neurol 2004. [DOI: 10.1055/s-2004-832986] [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: 10/28/2022]
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