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Strittmatter C, Meyer L, Broocks G, Alexandrou M, Politi M, Boutchakova M, Henssler A, Reinges M, Simgen A, Papanagiotou P, Roth C. Procedural Outcome Following Stent-Assisted Coiling for Wide-Necked Aneurysms Using Three Different Stent Models: A Single-Center Experience. J Clin Med 2022; 11:jcm11123469. [PMID: 35743537 PMCID: PMC9225175 DOI: 10.3390/jcm11123469] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/29/2022] [Accepted: 06/10/2022] [Indexed: 02/06/2023] Open
Abstract
Previous case series have described the safety and efficacy of different stent models for stent-assisted aneurysm coiling (SAC), but comparative analyses of procedural results are limited. This study investigates the procedural outcome and safety of three different stent models (Atlas™, LEO+™ (Baby) and Enterprise™) in the setting of elective SAC treated at a tertiary neuro-endovascular center. We retrospectively reviewed all consecutively treated patients that received endovascular SAC for intracranial aneurysms between 1 July 2013 and 31 March 2020, excluding all emergency angiographies for acute subarachnoid hemorrhage. The primary procedural outcome was the occlusion rate evaluated with the Raymond–Roy occlusion classification (RROC) assessed on digital subtraction angiography (DSA) at 6- and 12-month follow-up. Safety assessment included periprocedural adverse events (i.e., symptomatic ischemic complications, symptomatic intracerebral hemorrhage, iatrogenic perforation, dissection, or aneurysm rupture and in-stent thrombosis) and in-house mortality. Uni- and multivariable logistic regression analyses were performed to identify patient baseline and aneurysm characteristics that were associated with complete aneurysm obliteration at follow-up. A total of 156 patients undergoing endovascular treatment via SAC met the inclusion criteria. The median age was 62 years (IQR, 55–71), and 73.7% (115) of patients were female. At first follow-up (6-month) and last available follow-up (12 and 18 months), complete aneurysm occlusion was observed in 78.3% (90) and 76.9% (102) of patients, respectively. There were no differences regarding the occlusion rates stratified by stent model. Multivariable logistic analysis revealed increasing dome/neck ratio (adjusted odds ratio (aOR), 0.26.; 95% CI, 0.11–0.64; p = 0.003), increasing neck size (aOR, 0.70; 95% CI, 0.51–0.96; p = 0.027), and female sex (aOR, 4.37; 95% CI, 1.68–11.36; p = 0.002) as independently associated with treatment success. This study showed comparable rates of complete long-term aneurysm obliteration and safety following SAC for intracranial aneurysm with three different stent-models highlighting the procedural feasibility of this treatment strategy with currently available stent-models. Increased neck size and a higher dome/neck ratio were independent variables associated with less frequent complete aneurysm obliteration.
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Affiliation(s)
- Catherine Strittmatter
- Department of Neurosurgery, Hospital Bremen-Mitte, 28205 Bremen, Germany; (C.S.); (A.H.); (M.R.)
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, 28205 Bremen, Germany; (M.A.); (M.P.); (M.B.); (P.P.)
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (L.M.); (G.B.)
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (L.M.); (G.B.)
| | - Maria Alexandrou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, 28205 Bremen, Germany; (M.A.); (M.P.); (M.B.); (P.P.)
| | - Maria Politi
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, 28205 Bremen, Germany; (M.A.); (M.P.); (M.B.); (P.P.)
- Interventional Radiology Unit, Evangelismos General Hospital, 10676 Athens, Greece
| | - Maria Boutchakova
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, 28205 Bremen, Germany; (M.A.); (M.P.); (M.B.); (P.P.)
| | - Andreas Henssler
- Department of Neurosurgery, Hospital Bremen-Mitte, 28205 Bremen, Germany; (C.S.); (A.H.); (M.R.)
| | - Marcus Reinges
- Department of Neurosurgery, Hospital Bremen-Mitte, 28205 Bremen, Germany; (C.S.); (A.H.); (M.R.)
| | - Andreas Simgen
- Department of Diagnostic and Interventional Neuroradiology, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany;
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, 28205 Bremen, Germany; (M.A.); (M.P.); (M.B.); (P.P.)
- Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Christian Roth
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, 28205 Bremen, Germany; (M.A.); (M.P.); (M.B.); (P.P.)
- Correspondence: ; Tel.: +49-421-497-3625
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Ernst E, Papanagiotou P, Politi M, Alexandrou M, Kastrup A, Boutchakova M, Roth C. Safety and effectiveness of CATCH+ as a first-line device for revascularization in the treatment of acute ischemic stroke. J Neuroradiol 2021; 48:5-9. [DOI: 10.1016/j.neurad.2019.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/01/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022]
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Zhu F, Anadani M, Labreuche J, Spiotta A, Turjman F, Piotin M, Steglich-Arnholm H, Holtmannspötter M, Taschner C, Eiden S, Haussen DC, Nogueira RG, Papanagiotou P, Boutchakova M, Siddiqui AH, Lapergue B, Dorn F, Cognard C, Killer-Oberpfalzer M, Mangiafico S, Ribo M, Psychogios MN, Labeyrie MA, Mazighi M, Biondi A, Anxionnat R, Bracard S, Richard S, Gory B, Grossberg JA, Guenego A, Darcourt J, Vukasinovic I, Pomero E, Davies J, Renieri L, Hecker C, Muchada MM, Consoli A, Rodesch G, Houdart E, Lockau J, Kastrup A, Blanc R, Redjem H, Behme D, Shallwani H, Christopher M, Mione G, Humbertjean L, Lacour JC, Riou-Comte N, Derelle AL, Tonnelet R, Liao L. Impact of Antiplatelet Therapy During Endovascular Therapy for Tandem Occlusions. Stroke 2020; 51:1522-1529. [DOI: 10.1161/strokeaha.119.028231] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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—
Antiplatelet agents could be used in the setting of endovascular therapy for tandem occlusions to reduce the risk of de novo intracranial embolic migration, reocclusion of the extracranial internal carotid artery lesion, or in-stent thrombosis in case of carotid stent placement but have to be balanced with the intracerebral hemorrhagic transformation risk. In this study, we aim to investigate the impact of acute antiplatelet therapy administration on outcomes during endovascular therapy for anterior circulation tandem occlusions.
Methods—
This is a retrospective analysis of a collaborative pooled analysis of 11 prospective databases from the multicenter observational TITAN registry (Thrombectomy in Tandem Lesions). Patients were divided into groups based on the number of antiplatelet administered during endovascular therapy. The primary outcome was favorable outcome, defined as a modified Rankin Scale score of 0 to 2 at 90 days.
Results—
This study included a total of 369 patients; 145 (39.3%) did not receive any antiplatelet agent and 224 (60.7%) received at least 1 antiplatelet agent during the procedure. Rate of favorable outcome was nonsignificantly higher in patients treated with antiplatelet therapy (58.3%) compared with those treated without antiplatelet (46.0%; adjusted odds ratio, 1.38 [95% CI, 0.78–2.43];
P
=0.26). Rate of 90-day mortality was significantly lower in patients treated with antiplatelet therapy (11.2% versus 18.7%; adjusted odds ratio, 0.47 [95% CI, 0.22–0.98];
P
=0.042), without increasing the risk of any intracerebral hemorrhage. Successful reperfusion (modified Thrombolysis in Cerebral Ischemia score 2b-3) rate was significantly better in the antiplatelet therapy group (83.9% versus 71.0%; adjusted odds ratio, 1.89 [95% CI, 1.01–3.64];
P
=0.045).
Conclusions—
Administration of antiplatelet therapy during endovascular therapy for anterior circulation tandem occlusions was safe and was associated with a lower 90-day mortality. Optimal antiplatelet therapy remains to be assessed, especially when emergent carotid artery stenting is performed. Further randomized controlled trials are needed.
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Affiliation(s)
- François Zhu
- From the Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, France (F.Z., R.A., S.B., B.G.)
| | - Mohammad Anadani
- Department of Neurology, Washington University School of Medicine, St. Louis, MO (M.A.)
- Department of Neurosurgery, Medical University of South Carolina, Charleston (A.S., M.A.)
| | - Julien Labreuche
- Department of Biostatistics, EA 2694–Santé Publique: Epidémiologie et Qualité des Soins, University of Lille, CHU Lille, France (J.L.)
| | - Alejandro Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston (A.S., M.A.)
| | - Francis Turjman
- Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (F.T.)
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.)
| | | | | | - Christian Taschner
- Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.T., S.E.)
| | - Sebastian Eiden
- Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.T., S.E.)
| | - Diogo C. Haussen
- Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA (D.C.H, R.G.N.)
| | - Raul G. Nogueira
- Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA (D.C.H, R.G.N.)
| | - Panagiotis Papanagiotou
- Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Deutschland (P.P., M.B.)
| | - Maria Boutchakova
- Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Deutschland (P.P., M.B.)
| | - Adnan H. Siddiqui
- Department of Neurosurgery, State University of New York, Buffalo (A.H.S.)
| | - Bertrand Lapergue
- Department of Neurology Stroke Center, Foch Hospital, Suresnes, France (B.L.)
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital of Munich, Germany (F.D.)
| | - Christophe Cognard
- Department of Neuroradiology, University Hospital of Toulouse, France (C.C.)
| | | | - Salvatore Mangiafico
- Department of Interventional Neuroradiology, Careggi University Hospital, Florence, Italy (S.M.)
| | - Marc Ribo
- Department of Neurology, Hospital Vall D’Hebron, Barcelona, Spain (M.R.)
| | - Marios N. Psychogios
- Department of Neuroradiology, University Medical Center Göttingen, Germany (M.N.P.)
| | - Marc-Antoine Labeyrie
- Department of Interventional Neuroradiology, Lariboisière Hospital, Paris, France (M.-A.L.)
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.)
| | - Alessandra Biondi
- Department of Neuroradiology, University Hospital of Besançon, France (A.B.)
| | - René Anxionnat
- From the Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, France (F.Z., R.A., S.B., B.G.)
- INSERM U1254, IADI, F-5400, Université de Lorraine, Nancy, France (R.A., S.B., B.G.)
| | - Serge Bracard
- From the Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, France (F.Z., R.A., S.B., B.G.)
- INSERM U1254, IADI, F-5400, Université de Lorraine, Nancy, France (R.A., S.B., B.G.)
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, Unversity Hospital of Nancy, Centre d’Investigation Clinique Plurithématique, CIC-P 1433, INSERM U1116, Université de Lorraine, Nancy, France (S.R.)
| | - Benjamin Gory
- From the Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, France (F.Z., R.A., S.B., B.G.)
- INSERM U1254, IADI, F-5400, Université de Lorraine, Nancy, France (R.A., S.B., B.G.)
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Anadani M, Spiotta A, Alawieh A, Turjman F, Piotin M, Steglich-Arnholm H, Holtmannspötter M, Taschner C, Eiden S, Haussen DC, Nogueira R, Papanagiotou P, Boutchakova M, Siddiqui AH, Lapergue B, Dorn F, Cognard C, Killer-Oberpfalzer M, Mangiafico S, Ribo M, Psychogios MN, Labeyrie MA, Mazighi M, Biondi A, Anxionnat R, Bracard S, Richard S, Gory B. Effect of extracranial lesion severity on outcome of endovascular thrombectomy in patients with anterior circulation tandem occlusion: analysis of the TITAN registry. J Neurointerv Surg 2019; 11:970-974. [DOI: 10.1136/neurintsurg-2018-014629] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/02/2019] [Accepted: 02/09/2019] [Indexed: 11/04/2022]
Abstract
IntroductionEndovascular treatment (EVT) for tandem occlusion (TO) of the anterior circulation is complex but effective. The effect of extracranial internal carotid artery (EICA) lesion severity on the outcomes of EVT is unknown. In this study we investigated the effect of EICA lesion severity on the outcomes of tandem occlusion EVT.MethodsA multicenter retrospective TITAN (Thrombectomy In TANdem lesions) study that included 18 international endovascular capable centers was performed. Patients who received EVT for atherosclerotic TO with or without EICA lesion intervention were included. Patients were divided into two groups based on the EICA lesion severity (high-grade stenosis (≥90% North American Symptomatic Carotid Endarterectomy Trial) vs complete occlusion). Outcome measures included the 90-day clinical outcome (modified Rankin Scale score (mRS)), angiographic reperfusion (modified Thrombolysis In Cerebral Ischemia (mTICI) at the end of the procedure), procedural complications, and intracranial hemorrhage at 24 hours follow-up.ResultsA total of 305 patients were included in the study, of whom 135 had complete EICA occlusion and 170 had severe EICA stenosis. The EICA occlusion group had shorter mean onset-to-groin time (259±120 min vs 305±202 min; p=0.037), more patients with diabetes, and fewer with hyperlipidemia. With respect to the outcome, mTICI 2b–3 reperfusion was lower in the EICA occlusion group (70% vs 81%; p=0.03). The favorable outcome (90-day mRS 0–2), intracerebral hemorrhage and procedural complications were similar in both groups.ConclusionAtherosclerotic occlusion of the EICA in acute tandem strokes was associated with a lower rate of mTICI 2b–3 reperfusion but similar functional and safety outcomes when compared with high-grade EICA stenosis.
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5
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Haussen DC, Turjman F, Piotin M, Labreuche J, Steglich-Arnholm H, Holtmannspötter M, Taschner C, Eiden S, Nogueira RG, Papanagiotou P, Boutchakova M, Siddiqui AH, Lapergue B, Dorn F, Cognard C, Killer M, Mangiafico S, Ribo M, Psychogios MN, Spiotta AM, Labeyrie MA, Mazighi M, Biondi A, Richard S, Grossberg JA, Anxionnat R, Bracard S, Gory B. Head or Neck First? Speed and Rates of Reperfusion in Thrombectomy for Tandem Large Vessel Occlusion Strokes. Interv Neurol 2019; 8:92-100. [PMID: 32508890 DOI: 10.1159/000496292] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/06/2018] [Indexed: 11/19/2022]
Abstract
Background We aim to evaluate the speed and rates of reperfusion in tandem large vessel occlusion acute stroke patients undergoing upfront cervical lesion treatment (Neck-First: angioplasty and/or stent before thrombectomy) as compared to direct intracranial occlusion therapy (Head-First) in a large international multicenter cohort. Methods The Thrombectomy In TANdem Lesions (TITAN) collaboration pooled individual data of prospectively collected thrombectomy international databases for all consecutive anterior circulation tandem patients who underwent emergent thrombectomy. The co-primary outcome measures were rates of successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/3) and time from groin puncture to successful reperfusion. Results In total, 289 patients with tandem atherosclerotic etiology were included in the analysis (182 Neck-First and 107 Head-First patients). Except for differences in the Alberta Stroke Program Early CT Score (ASPECTS; median 8 [range 7-10] Neck-First vs. 7 [range 6-8] Head-First; p < 0.001) and cervical internal carotid artery (ICA) lesion severity (complete occlusion in 35% of the Neck-First vs. 57% of the Head-First patients; p < 0.001), patient characteristics were well balanced. After adjustments, there was no difference in successful reperfusion rates between the study groups (odds ratio associated with Neck-First: 1.18 [95% confidence interval, 0.60-2.17]). The time to successful reperfusion from groin puncture was significantly shorter in the Head-First group after adjustments (median 56 min [range 39-90] vs. 70 [range 50-102]; p = 0.001). No significant differences in the rates of full reperfusion, symptomatic hemorrhage, 90-day independence, or mortality were observed. Sensitivity analysis excluding patients with complete cervical ICA occlusion yielded similar results. Conclusions The upfront approach of the intracranial lesion in patients with tandem large vessel occlusion strokes leads to similar reperfusion rates but faster reperfusion as compared to initial cervical revascularization followed by mechanical thrombectomy. Controlled studies are warranted.
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Affiliation(s)
- Diogo C Haussen
- Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Francis Turjman
- Department of Interventional Neuroradiology, Hospices Civils, Lyon, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Julien Labreuche
- Department of Biostatistics, University of Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France
| | | | | | - Christian Taschner
- Department of Neuroradiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Sebastian Eiden
- Department of Neuroradiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Raul G Nogueira
- Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Panagiotis Papanagiotou
- Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, Germany
| | - Maria Boutchakova
- Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, Germany
| | - Adnan H Siddiqui
- Department of Neurosurgery, State University of New York, Buffalo, New York, USA
| | - Bertrand Lapergue
- Department of Neurology, Stroke Center, Foch Hospital, Suresnes, France
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital of Munich, Munich, Germany
| | - Christophe Cognard
- Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | - Monika Killer
- Department of Neuroradiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Salvatore Mangiafico
- Department of Interventional Neuroradiology, Careggi University Hospital, Florence, Italy
| | - Marc Ribo
- Department of Neurology, Hospital Vall D'Hebron, Barcelona, Spain
| | - Marios N Psychogios
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Mikael Mazighi
- Department of Interventional Neuroradiology, Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.,INSERM U1148, Paris, France.,Paris Denis Diderot University, Paris, France
| | - Alessandra Biondi
- Department of Neuroradiology and Endovascular Therapeutic, University Hospital of Besançon, Besançon, France
| | - Sébastien Richard
- Stroke Unit, Department of Neurology, University Hospital of Nancy, Nancy, France.,Centre d'Investigation Clinique Plurithématique, INSERM U1116, Nancy, France
| | - Jonathan A Grossberg
- Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, Georgia, USA
| | - René Anxionnat
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France.,University of Lorraine, INSERM U1254, Nancy, France
| | - Serge Bracard
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France.,University of Lorraine, INSERM U1254, Nancy, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France.,University of Lorraine, INSERM U1254, Nancy, France
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Anadani M, Spiotta A, Piotin M, Turjman F, Steglich-Arnholm H, Holtmannspötter M, Holtmannspötter M, Taschner C, Eiden S, Haussen DC, Nogueira RG, Papanagiotou P, Boutchakova M, Siddiqui A, Lapergue B, Dorn F, Cognard C, Killer M, Mangiafico S, Ribo M, Psychogios MN, Labeyrie MA, Mazighi M, Biondi A, Richard S, Anxionnat R, Bracard S, Gory B. Abstract TP29: Complete Occlusion is Associated With Lower Recanalization Rate in Patients With Acute Stroke With Tandem Lesion Treated With Thrombectomy. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tp29] [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:
Previous studies showed that mechanical thrombectomy (MT) is safe and effective in tandem steno-occlusive lesion. The effect on initial tandem extracranial internal carotid artery (ICA) lesion severity on outcome is unknown. In this study, we aimed to compare angiographic, functional and hemorrhagic outcomes according to initial lesion severity
Methods:
A multicenter international retrospective study that included 18 stroke centers. Patients were included if they presented with ischemic stroke due to tandem lesion and were treated with MT with or without carotid stenting. Tandem lesion was defined as proximal intracranial occlusion (distal ICA, M1/M2) and extracranial internal carotid artery (ICA) occlusion or ≥90% stenosis NASCET. We divided patients into two groups based on extracranial ICA lesion severity (severe stenosis vs. complete occlusion) at the first angiographic run. Outcome measures included 90 day mRS, final mTICI score, procedural complications and symptomatic hemorrhage. Symptomatic hemorrhage (Sich) was defined based on ECASS criteria.
Results:
A total of 305 patients were included in the present analysis. 134 patients had complete ICA occlusion (group 1) ,and 170 had ≥90% ICA stenosis (group 2). Hyperlipidemia was more frequent in group 1 ((46.5% vs. 33.6%, p=0.032), and diabetes was less frequent (12.4 vs. 23.8%;p=0.011). Otherwise there was no significant difference in baseline characteristics, pretreatment tPA , and ASPECTS between two groups. With respect to outcome, successful recanalization (TICI 2b-3) was lower in group 1 than group 2 (70% vs. 80%; p=0.038). Similarly TICI 3 was achieved in less patients in group 1 (24% vs. 40%;p=0.022). Favorable outcome (mRS 0-2), sICH and procedural complications were similar in both groups.
Conclusion:
Initial angiographic severity of extracranial ICA lesion in tandem occlusions was associated with lower recanalization rates after MT, without impact on clinical outcomes.
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Affiliation(s)
| | | | - Michel Piotin
- Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marc Ribo
- Hosp Vall D’Hebron, Barcelona, Spain
| | | | | | - Mikael Mazighi
- Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
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Anadani M, Spiotta AM, Piotin M, Turjman F, Steglich-Arnholm H, Holtmannspötter M, Taschner C, Eiden S, Haussen DC, Nogueira RG, Papanagiotou P, Boutchakova M, Siddiqui A, Lapergue B, Dorn F, Cognard C, Killer M, Mangiafico S, Ribo M, Psychogios MN, Labeyrie MA, Mazighi M, Biondi A, Lauzon S, Richard S, Anxionnat R, Bracard S, Gory B. Abstract WP10: Impact of Prior Intravenous Thrombolysis on the Outcome of Emergent Carotid Stenting in Acute Stroke Patients With Tandem Occlusion: A Collaborative Pooled Analysis. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp10] [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
Background:
Acute tandem occlusion (ATO) management is technically challenging and was not sufficiently evaluated in trials. There is evidence suggesting the efficacy and safety of emergent carotid stenting in conjunction with mechanical thrombectomy (MT) for ATO treatment. However, the safety of carotid stenting (CS) post intravenous tPA (IVT) treatment remains unclear.
Objective:
to report the safety and functional outcomes of emergent CS post IVT, and compare it to non-IVT patients.
Methods:
This was a retrospective multicenter international TITAN collaboration including 18 endovascular databases. In the present analysis, patients were included if they presented with acute ischemic stroke (AIS) due to ATO and were treated with CS in conjunction with MT. ATO was defined as an extracranial internal carotid artery (ICA) lesion (complete occlusion or stenosis >=90%) and an intracranial proximal occlusion (distal ICA and/or first or second segment of the middle cerebral artery). Outcome measures included final mTICI score, 90 day-modified Rankin Scale (mRS), mortality, procedural complications, and symptomatic intracerebral hemorrhage. Mixed effects logistic model was used to determine the predictors of each outcome
Results:
Among 454 patients with ATO, 289 were treated with CS and included in the present analysis. One hundred seventy-five patients (60%) of the included patients received IVT prior to MT. Onset to groin was shorter in the IVT group (259 ±251 vs. 353±238; p=0.013). Otherwise, there was no difference in baseline characteristics between the two groups. Heparin use during procedure was less in IVT group (20% vs. 54%; p<0.001). With respect to the outcome, there was no significant difference in the rate of successful recanalization (mTICI 2b-3), complete recanalization (mTICI 3), and favorable outcome (90-day mRS 0-2) between two groups. In addition, there was no difference in rate of sICH or procedural complications between two groups. In a mixed logistic regression model adjusting for potential confounders, IVT was not a predictor of sICH, successful recanalization or favorable outcome.
Conclusion:
Emergent CS in association with MT after IVT was safe and was not associated with an increased risk of sICH or procedural complications.
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Affiliation(s)
| | | | - Michel Piotin
- Dept of Interventional Neuroradiology,, Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Francis Turjman
- Interventional Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | | | | | | | - Sebastian Eiden
- Neuroradiology, Med Cntr-Univ of Freiburg, Freiburg, Germany
| | | | | | | | - Maria Boutchakova
- Interventional Neuroradiology, Hosp Bremen-Mitte/Bremen-Ost,, Bremen, Germany
| | | | | | | | | | - Monika Killer
- Neurology/Institue of Neurointervention, Paracelsus Med Univ, Salzburg, Austria
| | | | - Marc Ribo
- Neurology, Hosp Vall D’Hebron, Barcelona, Spain
| | | | | | - Mikael Mazighi
- Interventional Neuroradiology, Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Alessandra, Biondi
- Neuroradiology and Endovascular Therapeutic, Univ Hosp of Besançon, Besançon, France
| | - Steven Lauzon
- Neurology, Med Univ of South Carolina, Charleston, SC
| | | | - René Anxionnat
- Neuroradiology and Endovascular Therapeutic,, Univ Hosp of Besançon, Besançon, France
| | - Serge Bracard
- Diagnostic and Therapeutic Neuroradiology, Univ Hosp of Nancy, Nancy, France
| | - Benjamin Gory
- Diagnostic and Therapeutic Neuroradiology, Univ Hosp of Nancy, Nancy, France
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Papanagiotou P, Haussen DC, Turjman F, Labreuche J, Piotin M, Kastrup A, Steglich-Arnholm H, Holtmannspötter M, Taschner C, Eiden S, Nogueira RG, Boutchakova M, Siddiqui A, Lapergue B, Dorn F, Cognard C, Killer M, Mangiafico S, Ribo M, Psychogios MN, Spiotta A, Labeyrie MA, Biondi A, Mazighi M, Richard S, Anxionnat R, Bracard S, Gory B, Grossberg JA, Guenego A, Darcourt J, Vukasinovic I, Pomero E, Davies J, Renieri L, Hecker C, Muchada MM, Consoli A, Rodesch G, Houdart E, Turner R, Turk A, Chaudry I, Labeyrie PE, Riva R, Lockau J, Blanc R, Redjem H, Behme D, Shallwani H, Christopher M, Derelle AL, Tonnelet R, Liao L, Amaz C. Carotid Stenting With Antithrombotic Agents and Intracranial Thrombectomy Leads to the Highest Recanalization Rate in Patients With Acute Stroke With Tandem Lesions. JACC Cardiovasc Interv 2018; 11:1290-1299. [DOI: 10.1016/j.jcin.2018.05.036] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/23/2018] [Accepted: 05/15/2018] [Indexed: 11/26/2022]
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Gory B, Haussen DC, Piotin M, Steglich-Arnholm H, Holtmannspötter M, Labreuche J, Kyheng M, Taschner C, Eiden S, Nogueira RG, Papanagiotou P, Boutchakova M, Siddiqui AH, Lapergue B, Dorn F, Cognard C, Killer M, Mangiafico S, Ribo M, Psychogios MN, Spiotta AM, Labeyrie MA, Biondi A, Mazighi M, Turjman F. Impact of intravenous thrombolysis and emergent carotid stenting on reperfusion and clinical outcomes in patients with acute stroke with tandem lesion treated with thrombectomy: a collaborative pooled analysis. Eur J Neurol 2018; 25:1115-1120. [DOI: 10.1111/ene.13633] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/26/2018] [Indexed: 11/29/2022]
Affiliation(s)
- B. Gory
- Department of Diagnostic and Interventional Neuroradiology; INSERM U947; University Hospital of Nancy; Nancy France
| | - D. C. Haussen
- Department of Neurology; Emory University/Grady Memorial Hospital; Atlanta GA USA
| | - M. Piotin
- Department of Interventional Neuroradiology; Rothschild Foundation; Paris France
| | | | | | - J. Labreuche
- Department of Biostatistics; EA2694-Santé Publique: Epidémiologie et Qualité Des Soins; Lille University; Lille France
| | - M. Kyheng
- Department of Biostatistics; EA2694-Santé Publique: Epidémiologie et Qualité Des Soins; Lille University; Lille France
| | - C. Taschner
- Department of Neuroradiology; Medical Center-University of Freiburg; Freiburg
| | - S. Eiden
- Department of Neuroradiology; Medical Center-University of Freiburg; Freiburg
| | - R. G. Nogueira
- Department of Neurology; Emory University/Grady Memorial Hospital; Atlanta GA USA
| | - P. Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology; Klinikum Bremen-Mitte/Bremen-Ost; Bremen Germany
| | - M. Boutchakova
- Department of Diagnostic and Interventional Neuroradiology; Klinikum Bremen-Mitte/Bremen-Ost; Bremen Germany
| | - A. H. Siddiqui
- Department of Neurosurgery; University at Buffalo; State University of New York; Buffalo NY USA
| | - B. Lapergue
- Department of Neurology; Stroke Center; Foch Hospital; Suresnes France
| | - F. Dorn
- Department of Neuroradiology; University Hospital of Munich; Munich Germany
| | - C. Cognard
- Department of Neuroradiology; University Hospital of Toulouse; Toulouse France
| | - M. Killer
- Department of Neuroradiology; Christian Doppler Clinic; Research Institute for Neurointervention; Paracelsus Medical University; Salzburg Austria
| | - S. Mangiafico
- Department of Interventional Neuroradiology; Careggi University Hospital; Florence Italy
| | - M. Ribo
- Department of Neurology; Hospital Vall D'Hebron; Barcelona Spain
| | - M. N. Psychogios
- Department of Neuroradiology; University Medical Center Göttingen; Göttingen Germany
| | - A. M. Spiotta
- Department of Neurosurgery; Medical University of South Carolina; Charleston SC USA
| | - M. A. Labeyrie
- Department of Interventional Neuroradiology; Lariboisière Hospital; Paris
| | - A. Biondi
- Department of Neuroradiology and Endovascular Therapeutic; University Hospital of Besançon; Besançon
| | - M. Mazighi
- Department of Interventional Neuroradiology; Rothschild Foundation; Paris France
| | - F. Turjman
- Department of Interventional Neuroradiology; Hospices Civils de Lyon; Lyon France
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Gory B, Piotin M, Haussen DC, Steglich-Arnholm H, Holtmannspötter M, Labreuche J, Taschner C, Eiden S, Nogueira RG, Papanagiotou P, Boutchakova M, Siddiqui A, Lapergue B, Dorn F, Cognard C, Killer-Oberpfalzer M, Mangiafico S, Ribo M, Behme D, Spiotta AM, Mazighi M, Turjman F. Thrombectomy in Acute Stroke With Tandem Occlusions From Dissection Versus Atherosclerotic Cause. Stroke 2017; 48:3145-3148. [DOI: 10.1161/strokeaha.117.018264] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/25/2017] [Accepted: 08/21/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Benjamin Gory
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Michel Piotin
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Diogo C. Haussen
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Henrik Steglich-Arnholm
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Markus Holtmannspötter
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Julien Labreuche
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Christian Taschner
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Sebastian Eiden
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Raul G. Nogueira
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Panagiotis Papanagiotou
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Maria Boutchakova
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Adnan Siddiqui
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Bertrand Lapergue
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Franziska Dorn
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Christophe Cognard
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Monika Killer-Oberpfalzer
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Salvatore Mangiafico
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Marc Ribo
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Daniel Behme
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Alejandro M. Spiotta
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Mikael Mazighi
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
| | - Francis Turjman
- From the Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (B.G., F.T.); Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.P., M.M.); Departments of Neurology (H.S.A.) and Neuroradiology (M.H.), Rigshospitalet, Copenhagen, Denmark; University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.); Department of Neuroradiology, Medical Center-University of Freiburg, Germany (C.A.T., S.E.); Department
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Boutchakova M, Papanagiotou P. [Endovascular treatment of acute extracranial carotid artery occlusion]. Radiologe 2016; 56:18-23. [PMID: 26728157 DOI: 10.1007/s00117-015-0060-z] [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: 10/22/2022]
Abstract
Acute extracranial internal carotid artery (ICA) occlusions resulting in ischemic stroke are different from other forms of acute occlusions of cerebral vessels. The pathophysiological process involved in occlusion of the extracranial ICA is similar to processes observed in acute occlusion of the coronary arteries. The occluded segment of the ICA predominantly consists of an atherosclerotic plaque and a superimposed thrombus. Although the value of endovascular therapy has been established for intracranial occlusions, the acute treatment of extracranial ICA occlusions has not yet been proven in randomized studies. In these patients primary stenting of acute extracranial occlusions of the ICA is a treatment option with good clinical results. This review discusses the endovascular treatment of acute extracranial ICA occlusions.
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Affiliation(s)
- M Boutchakova
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Bremen-Mitte/Bremen-Ost, Bremen, Deutschland
| | - P Papanagiotou
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Bremen-Mitte/Bremen-Ost, Bremen, Deutschland.
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Papanagiotou P, Boutchakova M. [Spinal canal stenosis]. Radiologe 2014; 54:1087-92. [PMID: 25398571 DOI: 10.1007/s00117-014-2729-0] [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: 11/28/2022]
Abstract
Spinal stenosis is a narrowing of the spinal canal by a combination of bone and soft tissues, which can lead to mechanical compression of spinal nerve roots or the dural sac. The lumbal spinal compression of these nerve roots can be symptomatic, resulting in weakness, reflex alterations, gait disturbances, bowel or bladder dysfunction, motor and sensory changes, radicular pain or atypical leg pain and neurogenic claudication. The anatomical presence of spinal canal stenosis is confirmed radiologically with computerized tomography, myelography or magnetic resonance imaging and play a decisive role in optimal patient-oriented therapy decision-making.
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Affiliation(s)
- P Papanagiotou
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Klinikum Bremen-Mitte/Bremen-Ost, St.-Jürgen-Str. 1, 28205, Bremen, Deutschland,
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