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Khanafer A, von Gottberg P, Albiña-Palmarola P, Liebig T, Forsting M, Ganslandt O, Henkes H. Is Stent Retraction to ReLieve Arterial Cerebral VaSospasm Caused by SAH (Stent-ReLACSS) Using PRELAX the Long-awaited Solution for Treatment of Posthemorrhagic Cerebral Vasospasm? : Treatment of Posthemorrhagic Cerebral Vasospasm with PRESET and PRELAX: Technical Aspects, Efficacy, and Safety Margins in a Case Series. Clin Neuroradiol 2024:10.1007/s00062-024-01402-6. [PMID: 38634888 DOI: 10.1007/s00062-024-01402-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/04/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Recent observational studies have indicated the efficacy of stent retriever devices for the treatment of posthemorrhagic cerebral vasospasm (CVS), both by deployment and on-site withdrawal into the microcatheter (stent angioplasty, SA) and deployment followed by retraction through the target vessel similar to thrombectomy (Stent Retraction to reLieve Arterial Cerebral vaSospasm caused by SAH, Stent-ReLACSS). This article reports the findings with each application of pRESET and pRELAX in the treatment of CVS. METHODS We retrospectively enrolled 25 patients with severe CVS following aneurysmal subarachnoid hemorrhage. For the SA group, a stent retriever or a pRELAX was temporarily deployed into a narrow vessel segment and retrieved into the microcatheter after 3 min. For the Stent-ReLACSS group, a pRELAX was temporarily deployed into a narrow vessel and pulled back unfolded into the internal carotid artery. If intra-arterial vasodilators were administered, they were given exclusively after mechanical vasospasmolysis to maximize the effectiveness of the stent treatment. RESULTS In this study fifteen patients and 49 vessels were treated with SA. All were technically successful without periprocedural complications; however, 8/15 patients (53.3%) required additional treatment of the CVS. A total of 10 patients and 23 vessel segments were treated with Stent-ReLACSS. All maneuvers were technically successful without periprocedural complications and all vessels showed significant angiographic improvement. No recurrent CVS requiring further endovascular treatment occurred in-hospital, and neither territorial ischemia in the treated vessels nor vascular injury were observed in follow-up angiography. CONCLUSION Based on the presented data it appears that Stent-ReLACSS with pRELAX does not pose any additional risks when used to treat CVS and might be superior to SA, especially concerning mid-term and long-term efficacy. The mechanism of action may be an effect on the endothelium rather than mechanical vasodilation. As many patients with CVS are diagnosed too late, prophylactic treatment of high-risk patients (e.g., poor grade, young, female) is potentially viable.
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Affiliation(s)
- A Khanafer
- Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany.
| | - P von Gottberg
- Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
| | - P Albiña-Palmarola
- Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
| | - T Liebig
- Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - M Forsting
- Medizinische Fakultät, Universität Duisburg-Essen, Essen, Germany
| | - O Ganslandt
- Neurochirurgische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
| | - H Henkes
- Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
- Medizinische Fakultät, Universität Duisburg-Essen, Essen, Germany
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Masouris I, Wischmann J, Schniepp R, Müller R, Fuhry L, Hamann GF, Trumm C, Liebig T, Kellert L, Schöberl F. Basilar artery occlusion: drip-and-ship versus direct-to-center for mechanical thrombectomy within the Neurovascular Network of Southwest Bavaria (NEVAS). J Neurol 2024; 271:1885-1892. [PMID: 38095722 DOI: 10.1007/s00415-023-12126-x] [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: 09/20/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Recent clinical trials revealed a substantial clinical benefit for mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO). While urban areas are sufficiently covered with comprehensive stroke centers and MT expertise, rural areas lack such resources. Structured telemedical stroke networks offer rural hospitals instant consultation by stroke experts, enabling swift administration of intravenous thrombolysis (IVT) on-site and transportation for MT. For BAO patients, data on performance and clinical outcomes in telemedical stroke networks are lacking. METHODS We retrospectively analyzed data from patients with acute BAO eligible for MT: those treated directly in our comprehensive stroke center (direct-to-center/DC) and those treated in rural hospitals that were telemedically consulted by the Neurovascular Network of Southwest Bavaria (NEVAS) and transferred to our center for MT (drip-and-ship, DS). Key time intervals, stroke management performance and functional outcome after 90 days were compared. RESULTS Baseline characteristics, including premorbid status and stroke severity, were comparable. Time from symptom onset to IVT was identical in both groups (118 min). There was a delay of 180 min until recanalization in DS patients, mainly due to patient transport for MT. Procedural treatment time intervals, success of recanalization and complications were comparable. Clinical outcome at 3 months follow-up of DS patients was not inferior to DC patients. CONCLUSION We show for the first time that patients with BAO in rural areas benefit from a structured telemedicine network such as NEVAS, regarding both on-site processing and drip-and-ship for MT. Clinical outcomes are comparable among DS and DC patients.
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Affiliation(s)
- Ilias Masouris
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany.
| | - J Wischmann
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - R Schniepp
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - R Müller
- Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Guenzburg, Günzburg, Germany
| | - L Fuhry
- Department of Neurology, Klinikum Ingolstadt, Ingolstadt, Germany
| | - G F Hamann
- Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Guenzburg, Günzburg, Germany
| | - C Trumm
- Institute of Neuroradiology, LMU University Hospital, LMU, Munich, Germany
| | - T Liebig
- Institute of Neuroradiology, LMU University Hospital, LMU, Munich, Germany
| | - L Kellert
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - F Schöberl
- Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
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Stoecklein VM, Wunderlich S, Papazov B, Thon N, Schmutzer M, Schinner R, Zimmermann H, Liebig T, Ricke J, Liu H, Tonn JC, Schichor C, Stoecklein S. Perifocal Edema in Patients with Meningioma is Associated with Impaired Whole-Brain Connectivity as Detected by Resting-State fMRI. AJNR Am J Neuroradiol 2023:ajnr.A7915. [PMID: 37385680 PMCID: PMC10337612 DOI: 10.3174/ajnr.a7915] [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] [Received: 11/03/2022] [Accepted: 05/28/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND PURPOSE Meningiomas are intracranial tumors that usually carry a benign prognosis. Some meningiomas cause perifocal edema. Resting-state fMRI can be used to assess whole-brain functional connectivity, which can serve as a marker for disease severity. Here, we investigated whether the presence of perifocal edema in preoperative patients with meningiomas leads to impaired functional connectivity and if these changes are associated with cognitive function. MATERIALS AND METHODS Patients with suspected meningiomas were prospectively included, and resting-state fMRI scans were obtained. Impairment of functional connectivity was quantified on a whole-brain level using our recently published resting-state fMRI-based marker, called the dysconnectivity index. Using uni- and multivariate regression models, we investigated the association of the dysconnectivity index with edema and tumor volume as well as cognitive test scores. RESULTS Twenty-nine patients were included. In a multivariate regression analysis, there was a highly significant association of dysconnectivity index values and edema volume in the total sample and in a subsample of 14 patients with edema, when accounting for potential confounders like age and temporal SNR. There was no statistically significant association with tumor volume. Better neurocognitive performance was strongly associated with lower dysconnectivity index values. CONCLUSIONS Resting-state fMRI showed a significant association between impaired functional connectivity and perifocal edema, but not tumor volume, in patients with meningiomas. We demonstrated that better neurocognitive function was associated with less impairment of functional connectivity. This result shows that our resting-state fMRI marker indicates a detrimental influence of peritumoral brain edema on global functional connectivity in patients with meningiomas.
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Affiliation(s)
- V M Stoecklein
- From the Department of Neurosurgery (V.M.S., N.T., M.S., J.-C.T., C.S.)
- German Cancer Consortium (V.M.S., N.T., J.-C.T., C.S.)
| | - S Wunderlich
- Department of Radiology (S.W., B.P., R.S., J.R., S.S.)
| | - B Papazov
- Department of Radiology (S.W., B.P., R.S., J.R., S.S.)
| | - N Thon
- From the Department of Neurosurgery (V.M.S., N.T., M.S., J.-C.T., C.S.)
- German Cancer Consortium (V.M.S., N.T., J.-C.T., C.S.)
| | - M Schmutzer
- From the Department of Neurosurgery (V.M.S., N.T., M.S., J.-C.T., C.S.)
| | - R Schinner
- Department of Radiology (S.W., B.P., R.S., J.R., S.S.)
| | - H Zimmermann
- Department of Neuroradiology (H.Z., T.L.), Ludwig-Maximilians-University Munich, Munich, Germany
| | - T Liebig
- Department of Neuroradiology (H.Z., T.L.), Ludwig-Maximilians-University Munich, Munich, Germany
| | - J Ricke
- Department of Radiology (S.W., B.P., R.S., J.R., S.S.)
| | - H Liu
- Department of Radiology (H.L.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
- Department of Neuroscience (H.L.), Medical University of South Carolina, Charleston, South Carolina
| | - J-C Tonn
- From the Department of Neurosurgery (V.M.S., N.T., M.S., J.-C.T., C.S.)
- German Cancer Consortium (V.M.S., N.T., J.-C.T., C.S.)
| | - C Schichor
- From the Department of Neurosurgery (V.M.S., N.T., M.S., J.-C.T., C.S.)
- German Cancer Consortium (V.M.S., N.T., J.-C.T., C.S.)
| | - S Stoecklein
- Department of Radiology (S.W., B.P., R.S., J.R., S.S.)
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Hachem E, Meliga P, Goetz A, Rico PJ, Viquerat J, Larcher A, Valette R, Sanches AF, Lannelongue V, Ghraieb H, Nemer R, Ozpeynirci Y, Liebig T. Reinforcement learning for patient-specific optimal stenting of intracranial aneurysms. Sci Rep 2023; 13:7147. [PMID: 37130900 PMCID: PMC10154322 DOI: 10.1038/s41598-023-34007-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/22/2023] [Indexed: 05/04/2023] Open
Abstract
Developing new capabilities to predict the risk of intracranial aneurysm rupture and to improve treatment outcomes in the follow-up of endovascular repair is of tremendous medical and societal interest, both to support decision-making and assessment of treatment options by medical doctors, and to improve the life quality and expectancy of patients. This study aims at identifying and characterizing novel flow-deviator stent devices through a high-fidelity computational framework that combines state-of-the-art numerical methods to accurately describe the mechanical exchanges between the blood flow, the aneurysm, and the flow-deviator and deep reinforcement learning algorithms to identify a new stent concepts enabling patient-specific treatment via accurate adjustment of the functional parameters in the implanted state.
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Affiliation(s)
- E Hachem
- MINES Paris, PSL Research University, Centre de mise en forme des matériaux (CEMEF), CNRS UMR 7635, 06904, Sophia Antipolis Cedex, France.
| | - P Meliga
- MINES Paris, PSL Research University, Centre de mise en forme des matériaux (CEMEF), CNRS UMR 7635, 06904, Sophia Antipolis Cedex, France
| | - A Goetz
- MINES Paris, PSL Research University, Centre de mise en forme des matériaux (CEMEF), CNRS UMR 7635, 06904, Sophia Antipolis Cedex, France
| | - P Jeken Rico
- MINES Paris, PSL Research University, Centre de mise en forme des matériaux (CEMEF), CNRS UMR 7635, 06904, Sophia Antipolis Cedex, France
| | - J Viquerat
- MINES Paris, PSL Research University, Centre de mise en forme des matériaux (CEMEF), CNRS UMR 7635, 06904, Sophia Antipolis Cedex, France
| | - A Larcher
- MINES Paris, PSL Research University, Centre de mise en forme des matériaux (CEMEF), CNRS UMR 7635, 06904, Sophia Antipolis Cedex, France
| | - R Valette
- MINES Paris, PSL Research University, Centre de mise en forme des matériaux (CEMEF), CNRS UMR 7635, 06904, Sophia Antipolis Cedex, France
| | - A F Sanches
- Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - V Lannelongue
- MINES Paris, PSL Research University, Centre de mise en forme des matériaux (CEMEF), CNRS UMR 7635, 06904, Sophia Antipolis Cedex, France
| | - H Ghraieb
- MINES Paris, PSL Research University, Centre de mise en forme des matériaux (CEMEF), CNRS UMR 7635, 06904, Sophia Antipolis Cedex, France
| | - R Nemer
- MINES Paris, PSL Research University, Centre de mise en forme des matériaux (CEMEF), CNRS UMR 7635, 06904, Sophia Antipolis Cedex, France
| | - Y Ozpeynirci
- Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - T Liebig
- Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
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Goertz L, Liebig T, Siebert E, Özpeynirci Y, Pennig L, Celik E, Schlamann M, Dorn F, Kabbasch C. Treatment of Proximal Posterior Inferior Cerebellar Artery Aneurysms by Intrasaccular Flow Disruption: A Multicenter Experience. AJNR Am J Neuroradiol 2022; 43:1158-1163. [PMID: 35863779 PMCID: PMC9575426 DOI: 10.3174/ajnr.a7566] [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] [Received: 01/24/2022] [Accepted: 05/12/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Treatment of PICA aneurysms can be technically challenging by either surgical or endovascular means. Our aim was to report our preliminary experience with intrasaccular flow disruption using the Woven EndoBridge (WEB) for the treatment of proximal PICA aneurysms. MATERIALS AND METHODS Sixteen PICA aneurysms treated with the WEB at 3 institutions were retrospectively reviewed. Baseline patient and aneurysm characteristics, procedural specifics, clinical outcomes, and angiographic results were evaluated. RESULTS All aneurysms were located at the proximal, anteromedullary segment of the PICA. Seven aneurysms were ruptured. The median aneurysm size was 3.9 mm (range, 2-12 mm), and all aneurysms were wide-neck. WEB deployment failed in 1 case due to WEB protrusion in a small PICA aneurysm. Additional stent implantation was required for 2 aneurysms to improve intra-aneurysmal WEB positioning. One patient developed a partial posterior cerebral artery territory infarction with transient hemianopsia. Intraoperative rerupture of a ruptured aneurysm could be immediately stopped by WEB deployment due to intrasaccular stasis; however, it might have contributed to a slight disability of the patient. At last angiographic follow-up, 12/15 aneurysms (80%) were completely occluded and 3/15 (20%) had a neck remnant. CONCLUSIONS The preliminary results indicate that WEB treatment of proximal PICA aneurysms is feasible with a reasonable safety and efficacy profile. The advantages of intrasaccular flow disruption include preservation of the PICA, durable aneurysm occlusion, and omission of antiplatelet therapy. The low-profile WEB 17 delivery system might enable navigation to distal PICA aneurysms, which needs to be addressed further.
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Affiliation(s)
- L Goertz
- From the Department of Radiology and Neuroradiology (L.G., L.P., E.C., M.S., C.K.), University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - T Liebig
- Department of Neuroradiology (T.L., Y.Ö.), University Hospital Munich, Munich, Germany
| | - E Siebert
- Department of Neuroradiology (E.S.), University Hospital of Berlin (Charité), Berlin, Germany
| | - Y Özpeynirci
- Department of Neuroradiology (T.L., Y.Ö.), University Hospital Munich, Munich, Germany
| | - L Pennig
- From the Department of Radiology and Neuroradiology (L.G., L.P., E.C., M.S., C.K.), University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - E Celik
- From the Department of Radiology and Neuroradiology (L.G., L.P., E.C., M.S., C.K.), University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - M Schlamann
- From the Department of Radiology and Neuroradiology (L.G., L.P., E.C., M.S., C.K.), University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - F Dorn
- Department of Neuroradiology (F.D.), University Hospital Bonn, Bonn, Germany
| | - C Kabbasch
- From the Department of Radiology and Neuroradiology (L.G., L.P., E.C., M.S., C.K.), University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
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Gerstl L, Olivieri M, Heinen F, Bidlingmaier C, Schroeder AS, Reiter K, Hoffmann F, Kurnik K, Liebig T, Trumm CG, Haas NA, Jakob A, Borggraefe I. Notfall-Neuropädiatrie – Der arteriell ischämische Schlaganfall als einer der zeitkritischsten Notfälle bei Kindern und Jugendlichen. Nervenarzt 2022; 93:158-166. [PMID: 35072763 PMCID: PMC8785019 DOI: 10.1007/s00115-021-01252-4] [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] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/21/2022]
Abstract
Der arteriell ischämische Schlaganfall im Kindes- und Jugendalter gehört zu den zeitkritischsten Notfällen in der Pädiatrie. Dennoch wird er häufig mit einer oft prognostisch relevanten Zeitverzögerung diagnostiziert. Gründe dafür liegen neben der geringen Awareness auch in der zuweilen unspezifischen klinischen Präsentation mit einer herausfordernden Breite kritischer Differenzialdiagnosen sowie in der Fläche noch wenig verzahnter Akutversorgungsstrukturen. Gleichwohl zeigen grundsätzlich die beim Erwachsenen etablierten Revaskularisationsstrategien auch beim Kind ihre möglichen, zum Teil spektakulären Erfolge. Es gilt also, diese nach Möglichkeit auch den betroffenen Kindern zur Verfügung zu stellen, auch wenn hier derzeit ein nicht annähernd vergleichbarer Grad an Evidenz erreicht ist. Postakut ist die ätiologische Aufarbeitung durch die größere Bandbreite zu bedenkender Risikofaktoren besonders komplex, muss aber in der Lage sein, das individuelle Risikoprofil mit Sekundärprophylaxe, Rezidivrisiko und Outcome präzise zu identifizieren. Die Langzeitbetreuung im multiprofessionellen, interdisziplinären Team muss die biopsychosozialen Aspekte des Kindes in seiner jeweiligen Entwicklungsphase berücksichtigen und damit eine bestmögliche Integration des Kindes in sein soziales und schulisches, später berufliches Umfeld realisieren.
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Abdullayev N, Maus V, Behme D, Barnikol UB, Kutschke S, Stockero A, Goertz L, Celik E, Zaeske C, Borggrefe J, Schlamann M, Liebig T, Kabbasch C, Mpotsaris A. True first-pass effect in basilar artery occlusions: First-pass complete reperfusion improves clinical outcome in stroke thrombectomy patients. J Clin Neurosci 2021; 89:33-38. [PMID: 34119289 DOI: 10.1016/j.jocn.2021.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/20/2021] [Accepted: 04/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complete reperfusion (mTICI 3) in anterior circulation ischemic stroke patients after a single mechanical thrombectomy (MT) pass has been identified as a predictor of favorable outcome (modified Rankin Score 0-2) and defined as true first-pass effect recently. This effect has not yet been demonstrated in posterior circulation ischemic stroke. We hypothesized a true first-pass effect for the subgroup of acute basilar artery occlusions (BAO). METHODS Consecutive patients with acute thromboembolic occlusions in the posterior circulation, treated between 2010 and 2017, were screened and all BAO patients with complete angiographic reperfusion and known symptom onset included for unmatched and matched analysis after adjustment for multiple confounding factors (demographics, time intervals, stroke severity, posterior circulation Alberta Stroke Program early computed tomography Score and comorbidity. The primary objective was outcome at 90 days between matched cohorts of single pass vs. multi pass complete reperfusion patients. RESULTS 90 MTs in BAO were analyzed, yielding 56 patients with known symptom onset, in whom we achieved complete reperfusion (mTICI 3), depending on whether complete reperfusion was achieved after a single pass (n = 28) or multiple passes (n = 28). Multivariable analysis of 56 non-matched patients revealed a significant association between first-pass complete reperfusion and favorable outcome (p < 0.01). In matched cohorts (n = 7 vs. n = 7), favorable outcome was only seen if complete reperfusion was achieved after a single pass (86% vs. 0%). CONCLUSION Single pass complete reperfusion in acute basilar artery occlusion is an independent predictor of favorable outcome. Achieving complete reperfusion after multiple passes might impair favorable patient recovery.
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Affiliation(s)
- N Abdullayev
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany.
| | - V Maus
- Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Bochum, Ruhr University Bochum, In der Schornau 23-25, 44892 Bochum, Germany
| | - D Behme
- Department of Neuroradiology, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - U B Barnikol
- Department of Child and Adolescence Psychiatry, Research Unit Ethics in Translational Oncology Clinica1 of Internal Medicine, University Hospital Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - S Kutschke
- Department of Neuroradiology, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - A Stockero
- Department of Neuroradiology, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - L Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - E Celik
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - C Zaeske
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - J Borggrefe
- Institute of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Klinikum Minden, Hans-Nolte-Straße 1, 32429 Minden, Germany
| | - M Schlamann
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - T Liebig
- Institute of Neuroradiology, University Hospital Munich (LMU), Marchioninistraße 15, 81377 Munich, Germany
| | - C Kabbasch
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - A Mpotsaris
- Department of Neuroradiology, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
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Miszczuk M, Bauknecht H, Kleine J, Liebig T, Bohner G, Siebert E. Direct Puncture of the Carotid Artery as a Bailout Vascular Access Technique for Mechanical Thrombectomy in Acute Ischemic Stroke—The Revival of an Old Technique in a Modern Setting. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.09.003] [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: 11/17/2022]
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Abdullayev N, Maus V, Mpotsaris A, Henning TD, Goertz L, Borggrefe J, Chang DH, Onur OA, Liebig T, Schlamann M, Kabbasch C. Comparative analysis of CGUARD embolic prevention stent with Casper-RX and Wallstent for the treatment of carotid artery stenosis. J Clin Neurosci 2020; 75:117-121. [PMID: 32173154 DOI: 10.1016/j.jocn.2020.03.008] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/28/2019] [Accepted: 03/08/2020] [Indexed: 10/24/2022]
Abstract
Stent protected Angioplasty of extracranial carotid artery stenosis using the dual-layered CGUARD stent is a novel treatment option. In this study we evaluate the feasibility and the safety of the CGUARD in symptomatic and asymptomatic patients in comparison to Casper-RX and Wallstent. This is a multi-center study of consecutive patients treated with the CGUARD, Casper-RX and Wallstent at two German high volume neurovascular centers between April 2017 and May 2018. Patient characteristics, neuroimaging data and angiographic outcome were retrospectively analyzed. The primary end points of the study were acute occlusion of the carotid stent and symptomatic intracerebral hemorrhage (sICH). Carotid artery stenting was performed in 76 patients; of those 26 (34%) were treated with the CGUARD, 25 (33%) with Casper-RX, and 25 (33%) with Wallstent. In 58/76 (76%) cases carotid artery stenosis was symptomatic with a median baseline National Institutes of Health Stroke Scale of 4. Angioplasty and stenting as part of a mechanical thrombectomy for acute ischemic stroke was performed in 25/76 (33%) patients. Baseline patient characteristics were similar between the treatment groups, except for a higher portion of scheduled cases in the Casper-RX group. There were no significant differences in the rate of acute in stent occlusions (CGUARD, 2/26 (8%); Casper-RX, 1/25(4%); Wallstent, 1/25 (4%)) and postinterventional sICH (1/26 (4%), 0/25(0%), 0/25 (0%)). Clinical outcome at discharge did not differ between groups. Treatment of carotid artery stenosis using CGUARD is feasible with a good safety profile comparable to that of Casper-RX and Wallstent.
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Affiliation(s)
- N Abdullayev
- Institute for Diagnostic and Interventional Radiology, University Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - V Maus
- Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Bochum, Ruhr University Bochum, In der Schornau 23-25, 44892 Bochum, Germany
| | - A Mpotsaris
- Department of Neuroradiology, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - T D Henning
- Department of Radiology, Krankenhaus der Barmherzigen Brüder Trier, Nordallee 1, 54292 Trier, Germany
| | - L Goertz
- Department of Neurosurgery, University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - J Borggrefe
- Institute for Diagnostic and Interventional Radiology, University Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - D H Chang
- Department of Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - O A Onur
- Department of Neurology, University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - T Liebig
- Institute of Neuroradiology, University Hospital Munich (LMU), Marchioninistraße 15, 81377 Munich, Germany
| | - M Schlamann
- Institute for Diagnostic and Interventional Radiology, University Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - C Kabbasch
- Institute for Diagnostic and Interventional Radiology, University Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Goertz L, Liebig T, Siebert E, Herzberg M, Pennig L, Schlamann M, Borggrefe J, Krischek B, Dorn F, Kabbasch C. Low-Profile Intra-Aneurysmal Flow Disruptor WEB 17 versus WEB Predecessor Systems for Treatment of Small Intracranial Aneurysms: Comparative Analysis of Procedural Safety and Feasibility. AJNR Am J Neuroradiol 2019; 40:1766-1772. [PMID: 31488499 DOI: 10.3174/ajnr.a6183] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/14/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE The Woven EndoBridge 17 has recently been introduced to the market for facilitated endovascular treatment of small bifurcation aneurysms (≤7 mm) with low-profile microcatheters. We compared the Woven EndoBridge 17 with its predecessor versions in terms of procedural safety and feasibility. MATERIALS AND METHODS This was a multicenter review of aneurysms ranging from 3 to 7 mm treated with the Woven EndoBridge between 2011 and 2019. Aneurysm characteristics, procedural parameters, and complications were retrospectively compared between treatment with the Woven EndoBridge 17 and a control group that was treated with its predecessor versions, using inverse probability of treatment weighting. RESULTS Thirty-eight aneurysms treated with a Woven EndoBridge 17 (mean size, 4.9 ± 1.5 mm) and 70 treated with a predecessor version of the Woven EndoBridge 17 (mean size, 5.6 ± 1.4 mm) were included. The predecessor version of the Woven EndoBridge 17 had a higher failure rate (10.3%) than the Woven EndoBridge 17 (0%, P = .05). Additional stent placement was performed more often with the predecessor version of the Woven EndoBridge 17 (10.0%) than with the Woven EndoBridge 17 (2.6%, adjusted P = .005). The predecessor version of the Woven EndoBridge 17 was associated with a higher thromboembolic event rate (14.3%) than the Woven EndoBridge 17 (5.3%, adjusted P = .002). Neurologic complications (Woven EndoBridge 17: 2.6%; predecessor version of the Woven EndoBridge 17: 2.9%, adjusted P = 1.0) and immediate complete aneurysm occlusion rates (Woven EndoBridge 17: 57.9%; predecessor version of the Woven EndoBridge 17: 54.3%, adjusted P = .21) did not differ significantly between groups. CONCLUSIONS In the current study, the Woven EndoBridge 17 was associated with a potentially lower thromboembolic event rate than the predecessor version of the Woven EndoBridge 17, without compromising the immediate aneurysm occlusion rate. Long-term clinical and angiographic outcome analysis will be necessary to draw a definite conclusion.
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Affiliation(s)
- L Goertz
- From the Department of Neuroradiology (L.G., L.P., M.S., J.B., C.K.), University Hospital of Cologne, Cologne, Germany .,Center for Neurosurgery (L.G., B.K.), University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - T Liebig
- Department of Neuroradiology (T.L., M.H., F.D.), University Hospital Munich, Munich, Germany
| | - E Siebert
- Department of Neuroradiology (E.S.), University Hospital of Berlin (Charité), Berlin, Germany
| | - M Herzberg
- Department of Neuroradiology (T.L., M.H., F.D.), University Hospital Munich, Munich, Germany
| | - L Pennig
- From the Department of Neuroradiology (L.G., L.P., M.S., J.B., C.K.), University Hospital of Cologne, Cologne, Germany
| | - M Schlamann
- From the Department of Neuroradiology (L.G., L.P., M.S., J.B., C.K.), University Hospital of Cologne, Cologne, Germany
| | - J Borggrefe
- From the Department of Neuroradiology (L.G., L.P., M.S., J.B., C.K.), University Hospital of Cologne, Cologne, Germany
| | - B Krischek
- Center for Neurosurgery (L.G., B.K.), University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - F Dorn
- Department of Neuroradiology (T.L., M.H., F.D.), University Hospital Munich, Munich, Germany
| | - C Kabbasch
- From the Department of Neuroradiology (L.G., L.P., M.S., J.B., C.K.), University Hospital of Cologne, Cologne, Germany
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11
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Feil K, Reidler P, Kunz WG, Küpper C, Heinrich J, Laub C, Müller K, Vöglein J, Liebig T, Dieterich M, Kellert L. Addressing a real-life problem: treatment with intravenous thrombolysis and mechanical thrombectomy in acute stroke patients with an extended time window beyond 4.5 h based on computed tomography perfusion imaging. Eur J Neurol 2019; 27:168-174. [PMID: 31349393 DOI: 10.1111/ene.14051] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/22/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Acute ischemic stroke treatment with intravenous thrombolysis (IVT) is restricted to a time window of 4.5 h after known or presumed onset. Recently, magnetic resonance imaging-guided treatment decision-making in wake-up stroke (WUS) was shown to be effective. The aim of this study was to determine the safety and outcome of IVT in patients with a time window beyond 4.5 h selected by computed tomography perfusion (CTP) imaging. METHODS We analyzed all consecutive patients last seen well beyond 4.5 h after stroke onset treated with IVT based on CTP between January 2015 and October 2018. CTP was visually assessed to estimate the mismatch between cerebral blood flow and cerebral blood volume maps. Early infarct signs were documented according to Alberta Stroke Program Early CT Score (ASPECTS). Safety data were obtained for mortality and symptomatic intracerebral hemorrhage (sICH). Follow-up was assessed with the modified Rankin Scale (mRS). RESULTS A total of 70 patients fulfilled the inclusion criteria (mean age ± SD 77.6 ± 11.5 years, 50.0% female). Median National Institutes of Health Stroke Scale score on admission was 8.0 [interquartile range (IQR), 4-14]. The most frequent reasons for an extended time window were WUS (60.0%) and delayed hospital admission (27.1%). Median time from last seen well to IVT was 11.4 h. Median ASPECTS was 10 (IQR, 9-10) and CTP mismatch 90% (IQR, 80%-100%). A total of 24 patients (34.3%) underwent additional mechanical thrombectomy. sICH occurred in four patients (5.7%). At follow-up, 49.3% had an mRS score of 0-2 and 22.4% had an mRS score of 0-1. CONCLUSIONS In patients presenting in an extended time window beyond 4.5 h, IVT treatment with decision-making based on CTP might be a safe procedure. Further evaluation in clinical trials is needed.
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Affiliation(s)
- K Feil
- Department of Neurology, Ludwig Maximilian University, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig Maximilian University, Munich, Germany
| | - P Reidler
- Department of Radiology, Ludwig Maximilian University, Munich, Germany
| | - W G Kunz
- Department of Radiology, Ludwig Maximilian University, Munich, Germany
| | - C Küpper
- Department of Neurology, Ludwig Maximilian University, Munich, Germany
| | - J Heinrich
- Department of Neurology, Ludwig Maximilian University, Munich, Germany
| | - C Laub
- Department of Neurology, Ludwig Maximilian University, Munich, Germany
| | - K Müller
- Department of Neurology, Ludwig Maximilian University, Munich, Germany
| | - J Vöglein
- Department of Neurology, Ludwig Maximilian University, Munich, Germany.,German Center for Neurodegenerative Diseases, Munich, Germany
| | - T Liebig
- Department of Neuroradiology, Ludwig Maximilian University, Munich, Germany
| | - M Dieterich
- Department of Neurology, Ludwig Maximilian University, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig Maximilian University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - L Kellert
- Department of Neurology, Ludwig Maximilian University, Munich, Germany
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Vitezica I, Mohr F, Liebig T, Thomale UW, Czernik C, Dame C, Henrich W. Management einer duralen Sinus transversus Malformation mit multiplen arteriellen Feeder-Gefäßen und massivem Hydrocephalus. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671567] [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: 10/28/2022] Open
Affiliation(s)
- I Vitezica
- Klinik für Geburtsmedizin, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - F Mohr
- Klinik für Neonatologie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - T Liebig
- Institut für Neuroradiologie, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - UW Thomale
- Pädiatrische Neurochirurgie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - C Czernik
- Klinik für Neonatologie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - C Dame
- Klinik für Neonatologie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - W Henrich
- Klinik für Geburtsmedizin, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Deutschland
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13
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Bender Y, Böker S, Diederichs G, Walter T, Wagner M, Fallenberg E, Liebig T, Rickert M, Hamm B, Makowski M. MRI for the detection of calcific features of vertebral haemangioma. Clin Radiol 2017; 72:692.e1-692.e7. [DOI: 10.1016/j.crad.2017.02.018] [Citation(s) in RCA: 5] [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: 09/28/2016] [Revised: 02/11/2017] [Accepted: 02/15/2017] [Indexed: 11/16/2022]
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14
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Posch H, Kahn J, Steffen I, Geisel D, Bauknecht C, Liebig T, Denecke T. Evaluation einer möglichen langfristigen cerebralen Anreicherung des leberspezifischen MRT-Kontrastmittels Gd-EOB – eine prospektive Querschnittstudie. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600324] [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: 10/19/2022]
Affiliation(s)
- H Posch
- Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Radiologie, Berlin
| | - J Kahn
- Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Radiologie, Berlin
| | - I Steffen
- Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Radiologie, Berlin
| | - D Geisel
- Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Radiologie, Berlin
| | - C Bauknecht
- Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Institut für Radiologie, Berlin
| | - T Liebig
- Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Radiologie, Berlin
| | - T Denecke
- Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Radiologie, Berlin
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15
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Maus V, You S, Kalkan A, Borggrefe J, Kabbasch C, Dorn F, Dohmen C, Liebig T, Fink G, Mpotsaris A. Angiografisches und klinisches Ergebnis nach mechanischer Thrombektomie bei Schlaganfallpatienten mit partieller Okklusion der Hirngefäße. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600399] [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: 10/19/2022]
Affiliation(s)
- V Maus
- Uniklinik Köln, Diagnostische und Interventionelle Radiologie, Köln
| | - S You
- Uniklinik Köln, Diagnostische und Interventionelle Radiologie, Köln
| | - A Kalkan
- Uniklinik Köln, Diagnostische und Interventionelle Radiologie, Köln
| | - J Borggrefe
- Uniklinik Köln, Diagnostische und Interventionelle Radiologie, Köln
| | - C Kabbasch
- Uniklinik Köln, Diagnostische und Interventionelle Radiologie, Köln
| | - F Dorn
- LMU, Abteilung für Neuroradiologie, Muenchen
| | - C Dohmen
- Uniklinik Köln, Zentrum für Neurologie und Psychatrie, Köln
| | - T Liebig
- Charite, Institut für Neuroradiologie, Berlin
| | - G Fink
- Uniklinik Köln, Zentrum für Neurologie und Psychatrie, Köln
| | - A Mpotsaris
- Uniklinik Köln, Diagnostische und Interventionelle Radiologie, Köln
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16
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Siebert E, Bohner G, Liebig T, Endres M, Liman TG. Factors associated with fatal outcome in posterior reversible encephalopathy syndrome: a retrospective analysis of the Berlin PRES study. J Neurol 2016; 264:237-242. [PMID: 27815684 DOI: 10.1007/s00415-016-8328-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/25/2016] [Accepted: 10/25/2016] [Indexed: 01/23/2023]
Abstract
Although often reversible, fatal outcome in posterior reversible encephalopathy syndrome (PRES) is well known. However, data on predictors of PRES-associated in-hospital death are scarce. In this study, we aimed to investigate predictors of in-hospital death in a large cohort. Radiological report databases between January 1999 and February 2015 were retrospectively searched for patients with PRES. Patients were included if they met criteria for PRES after detailed investigation of clinical charts and imaging studies. Various clinical, paraclinical and brain MRI data as well as data on in-hospital mortality were analyzed. 151 patients were included into the study, 64% were female. Seventeen (11.2%) patients died during hospital stay. In univariate analyses, higher age (p = 0.04), higher levels of C-reactive protein (p < 0.001), etiology of PRES (sepsis and chemotherapy; p = 0.02), altered coagulation (p = 0.002), altered mental state at onset (p = 0.03), and subarachnoid hemorrhage (SAH; p = 0.01) were related to in-hospital death. In multivariate analyses adjusted for age and sex, elevated CRP levels (OR 1.1 95% CI 1.1-1.2), altered coagulation (OR 5.1 95% CI 1.8-14.7), subarachnoid hemorrhage (OR 10.1 95% CI 2.2-46.1) and altered mental state (OR 3.3; 95% CI 1.1-9.4) were independently associated with in-hospital death. Altered mental state, subarachnoid hemorrhage as well as the higher levels of CRP and altered coagulation were significantly more frequent in patients who died in hospital. However, prospective studies are warranted to establish predictors of fatality in patients with PRES.
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Affiliation(s)
- Eberhard Siebert
- Institut für Neuroradiologie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - G Bohner
- Institut für Neuroradiologie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - T Liebig
- Institut für Neuroradiologie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - M Endres
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Klinik für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Disease (DZNE), Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - T G Liman
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Klinik für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
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17
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Kabbasch C, Möhlenbruch M, Stampfl S, Mpotsaris A, Behme D, Liebig T. First-line lesional aspiration in acute stroke thrombectomy using a novel intermediate catheter: Initial experiences with the SOFIA. Interv Neuroradiol 2016; 22:333-9. [PMID: 26908589 DOI: 10.1177/1591019916632370] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/21/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Five randomized controlled trials (RCTs) on endovascular therapy (EVT) of stroke have proven a clinical benefit over conservative treatment or IV-thrombolysis alone. Lesional clot aspiration with a dedicated system can achieve revascularization without an additional retriever (a direct-aspiration first-pass technique, ADAPT), and the SOFIA has been shown to be both safe and efficacious in a multicentric retrospective study. We have evaluated a subset of these data acquired in two major stroke centers with regard to using the SOFIA for first-line lesional aspiration. METHODS Thirty patients with large-vessel occlusions treated with first-line lesional aspiration were identified. Procedural data, clot length, reperfusion success (mTICI), procedural timings, complications, and clinical status at admission, discharge and at 90 days were analyzed. RESULTS The median baseline NIHSS was 16. IV thrombolysis was administered in 15/30 patients. Ninety-three percent of occlusions were in the anterior circulation. TICI ≥ 2b was achieved in 90% of multimodality treatments; lesional aspiration was successful in 67% within a median time of 20 minutes. The highest first-attempt success rate was in MCA occlusions (median time to recanalization 10 minutes). There were no device-related events. Symptomatic intracerebral hemorrhage (sICH) occurred in 10%, but never with sole lesional aspiration. Embolization to new territories was recorded in 1/30 (3%). Median discharge NIHSS was 7; 30% were mRS ≤ 2 at discharge and 43% at 90-day follow-up. CONCLUSIONS Lesional aspiration with SOFIA is in line with published data. The SOFIA may be used as a first-line device, aiming at fast recanalization by sole aspiration with good safety and efficacy. If unsuccessful, it converts into part of a stent retriever-based multimodality treatment.
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Affiliation(s)
- C Kabbasch
- University Hospital of Cologne, Neuroradiology, Germany
| | - M Möhlenbruch
- University Hospital of Heidelberg, Neuroradiology, Germany
| | - S Stampfl
- University Hospital of Heidelberg, Neuroradiology, Germany
| | - A Mpotsaris
- University Hospital of Cologne, Neuroradiology, Germany
| | - D Behme
- University Hospital of Goettingen, Neuroradiology, Germany
| | - T Liebig
- Charité University Hospital of Berlin, Neuroradiology, Germany
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18
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Kabbasch C, Mpotsaris A, Reiner M, Liebig T. WEB as part of a multimodality treatment in complex, large, and partially thrombosed intracranial aneurysms: a single-center observational study of technical success, safety, and recurrence. J Neurointerv Surg 2016; 8:1235-1239. [DOI: 10.1136/neurintsurg-2015-012126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/16/2015] [Accepted: 12/19/2015] [Indexed: 11/04/2022]
Abstract
IntroductionComplex, large, wide-neck aneurysms, but particularly partially thrombosed intracranial aneurysms (PTIAs), have a greater tendency to recanalize after coil occlusion. The Woven Endovascular Bridge (WEB) combines shape memory wires braided to a relatively uniform, dense surface, which may limit its compaction and its incorporation into an existing aneurysm clot and may thus reduce PTIA recurrence.ObjectiveTo carry out a retrospective analysis of our experience with the WEB as part of a complex treatment in conjunction with other implants to assess the efficacy and safety of this technique.MethodsAmong 43 aneurysms treated with the WEB in our center, eight complex, large, wide-neck aneurysms were treated in conjunction with other implants (additional WEBs, coils, stents, flow diverters). Six of these eight aneurysms were PTIAs. All patients were followed up by DSA between 3½ and 38 months.ResultsAll eight (100%) of the complex, large, wide-neck aneurysms were treated successfully and without periprocedural adverse events (0%). At follow-up, the two non-thrombosed aneurysms were completely occluded, but all six PTIAs recurred (75%) and were re-treated. There was no morbidity or mortality in these eight patients.ConclusionsTreatment of large, complex aneurysms with the WEB in conjunction with other implants was technically successful and safe but did not prevent recurrence of partially thrombosed aneurysms in our center. PTIA re-treatment was possible and not limited by the previously placed WEB.
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19
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Caroff J, Mihalea C, Klisch J, Strasilla C, Berlis A, Patankar T, Weber W, Behme D, Jacobsen EA, Liebig T, Prothmann S, Cognard C, Finkenzeller T, Moret J, Spelle L. Single-Layer WEBs: Intrasaccular Flow Disrupters for Aneurysm Treatment—Feasibility Results from a European Study. AJNR Am J Neuroradiol 2015; 36:1942-6. [PMID: 26159516 DOI: 10.3174/ajnr.a4369] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/25/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The safety and efficiency of the dual-layer Woven EndoBridge (WEB) device has already been published. However, this international multicenter study sought to evaluate the safety of single-layer devices, which are the newest generation of the WEB intrasaccular flow-disrupter family. They have been designed to offer smaller-sized devices with a lower profile to optimize navigability and delivery, which may, in turn, broaden their range of use. MATERIALS AND METHODS Data from all consecutive patients treated with a single-layer WEB device, in 10 European centers from June 2013 to May 2014 were included. Clinical presentations, technical details, intra- and perioperative complications, and outcomes at discharge were recorded. Clinical and angiographic data at last follow-up were also analyzed when available. RESULTS Ninety patients with 98 WEB-treated aneurysms were included in this study. In 93 cases (95%), WEB placement was possible. Complete occlusion at the end of the procedure was obtained in 26 instances (26%). Additional treatment during the procedure (coiling and/or stent placement) was necessary in 12 cases (12.7%). Procedure-related complications occurred in 13 cases, leading to permanent neurologic deficits in 4 patients (4.4%). Early vascular imaging follow-up data were available for 44 patients (57%), with an average time interval of 3.3 months. Treatment-related morbidity and mortality rates at last follow-up were 2.2% and 1.1%, respectively. CONCLUSIONS In this study, the feasibility and safety of the single-layer WEB device was comparable with that of the double-layer. However, further studies are needed to evaluate long-term efficacies.
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Affiliation(s)
- J Caroff
- From the Interventional Neuroradiology NEURI Center (J.C., C.M., J.M., L.S.), Beaujon Hospital, Clichy, France
| | - C Mihalea
- From the Interventional Neuroradiology NEURI Center (J.C., C.M., J.M., L.S.), Beaujon Hospital, Clichy, France Department of Neurosurgery (C.M.), University of Medicine and Pharmacy "Victor Babes," Timisoara, Romania
| | - J Klisch
- Department of Neuroradiology (J.K., C.S.), Helios General Hospital, Erfurt, Germany
| | - C Strasilla
- Department of Neuroradiology (J.K., C.S.), Helios General Hospital, Erfurt, Germany
| | - A Berlis
- Department of Diagnostic and Interventional Neuroradiology (A.B.), Klinikum Augsburg, Augsburg, Germany
| | - T Patankar
- MRI Department (T.P.), Leeds Teaching Hospitals National Health Service Trust, Leeds, UK
| | - W Weber
- Interventional Neuroradiology (W.W.), Ruhr University Medical Center, Bochum, Germany
| | - D Behme
- Departments of Radiology and Neuroradiology (D.B.), Klinikum Vest, Recklinghausen, Germany
| | - E A Jacobsen
- Interventional Neuroradiology (E.A.J.), Oslo University Hospital, Oslo, Norway
| | - T Liebig
- Interventional Neuroradiology (T.L.), Universitatsklinik Koeln, Köln, Germany
| | - S Prothmann
- Abteilung für Diagnostische und Interventionelle Neuroradiologie (S.P.), Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - C Cognard
- Interventional Neuroradiology (C.C.), Centre Hospitalier Universitaire Hôpital Purpan, Toulouse, France
| | - T Finkenzeller
- Interventional Neuroradiology (T.F.), Klinikum Nürnberg Süd, Nürnberg, Germany
| | - J Moret
- From the Interventional Neuroradiology NEURI Center (J.C., C.M., J.M., L.S.), Beaujon Hospital, Clichy, France
| | - L Spelle
- From the Interventional Neuroradiology NEURI Center (J.C., C.M., J.M., L.S.), Beaujon Hospital, Clichy, France
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Dorn F, Prothmann S, Patzig M, Lockau H, Kabbasch C, Nikoubashman O, Liebig T, Zimmer C, Brückmann H, Wiesmann M, Stetefeld H, Poppert H, Reich A, Kellert L, Fesl G. Stent Retriever Thrombectomy in Patients Who Are Ineligible for Intravenous Thrombolysis: A Multicenter Retrospective Observational Study. AJNR Am J Neuroradiol 2015; 37:305-10. [PMID: 26338915 DOI: 10.3174/ajnr.a4520] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 06/27/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intravenous thrombolysis with rtPA is the standard of care for patients with acute ischemic stroke within 4.5 hours after symptom onset. However, a considerable number of patients are ineligible for IV thrombolysis due to various contraindications. Recent studies have proved the superiority of mechanical thrombectomy for patients with large-vessel occlusions in combination with IV rtPA compared with IV rtPA alone. We aimed to demonstrate the efficacy of mechanical thrombectomy for patients who are ineligible for IV rtPA. MATERIALS AND METHODS Patients from the stroke registries of 4 dedicated centers who were treated with mechanical thrombectomy from January 2010 to October 2014 were retrospectively evaluated. Inclusion criteria were the following: acute stroke due to proved large-artery occlusion, ineligibility for IV thrombolysis, and a timeframe of ≤4.5 hours between stroke and the start of mechanical thrombectomy. Recanalization success, periprocedural complications, clinical outcome, and hemorrhages were evaluated. RESULTS One hundred thirty endovascular recanalization procedures were identified. The locations were the following: proximal ICA in 17 (13.1%), terminus ICA in 25 (19.2%), M1 segment in 77 (59.2%), and M2 segment in 11 (8.5%). TICI 2b/3 results were achieved in 101 (77.7%), and an mRS score of 0-2 in 47 patients (37.9%). There was a significant correlation between TICI 2b/3 results and good clinical outcomes (87.2% versus 6.8%; P = .048). A good clinical result was most frequent when recanalization was achieved within 4.5 hours (37/74 = 50% versus 10/50 = 20.0%; P = .001). Symptomatic hemorrhage occurred in 13.1% of patients; mortality was 24.2%. Periprocedural complications were recorded in 10 patients (7.7%). CONCLUSIONS Mechanical thrombectomy can achieve good clinical outcomes in patients with acute large-artery occlusion ineligible for IV thrombolysis, in particular when recanalization is reached early.
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Affiliation(s)
- F Dorn
- From the Departments of Neuroradiology and Radiology (F.D., H.L., C.K., T.L.) Departments of Neuroradiology (F.D., M.P., H.B., G.F.)
| | | | - M Patzig
- Departments of Neuroradiology (F.D., M.P., H.B., G.F.)
| | - H Lockau
- From the Departments of Neuroradiology and Radiology (F.D., H.L., C.K., T.L.)
| | - C Kabbasch
- From the Departments of Neuroradiology and Radiology (F.D., H.L., C.K., T.L.)
| | | | - T Liebig
- From the Departments of Neuroradiology and Radiology (F.D., H.L., C.K., T.L.)
| | - C Zimmer
- Departments of Neuroradiology (S.P., C.Z.)
| | - H Brückmann
- Departments of Neuroradiology (F.D., M.P., H.B., G.F.)
| | - M Wiesmann
- Departments of Neuroradiology (O.N., M.W.)
| | - H Stetefeld
- Neurology (H.S.), University Hospital of Cologne, Cologne, Germany
| | - H Poppert
- Neurology (H.P.), Klinikum Rechts der Isar, Technical University, Munich, Germany
| | - A Reich
- Neurology (A.R.), University Hospital of Aachen, Aachen, Germany
| | - L Kellert
- Neurology (L.K.), University Hospital of Munich, Munich, Germany
| | - G Fesl
- Departments of Neuroradiology (F.D., M.P., H.B., G.F.)
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Behme D, Mpotsaris A, Zeyen P, Psychogios MN, Kowoll A, Maurer CJ, Joachimski F, Liman J, Wasser K, Kabbasch C, Berlis A, Knauth M, Liebig T, Weber W. Emergency Stenting of the Extracranial Internal Carotid Artery in Combination with Anterior Circulation Thrombectomy in Acute Ischemic Stroke: A Retrospective Multicenter Study. AJNR Am J Neuroradiol 2015; 36:2340-5. [PMID: 26294652 DOI: 10.3174/ajnr.a4459] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/13/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Several small case series reported a favorable clinical outcome for emergency stent placement in the extracranial internal carotid artery combined with mechanical thrombectomy in acute stroke. The rate of postinterventional symptomatic intracranial hemorrhages was reported to be as high as 20%. Therefore, we investigated the safety and efficacy of this technique in a large multicentric cohort. MATERIALS AND METHODS The data bases of 4 German stroke centers were screened for all patients who received emergency stent placement of the extracranial internal carotid artery in combination with mechanical thrombectomy of the anterior circulation between 2007 and 2014. The primary outcome measure was the rate of symptomatic intracranial hemorrhage according to the European Cooperative Acute Stroke Study III criteria; secondary outcome measures included the angiographic revascularization results and clinical outcome. RESULTS One hundred seventy patients with a median age of 64 years (range, 25-88 years) were treated. They presented after a median of 98 minutes (range, 52-160 minutes) with a median NIHSS score of 15 (range, 12-19). Symptomatic intracranial hemorrhages occurred in 15/170 (9%) patients; there was no statistically significant difference among groups pertaining to age, sex, intravenous rtPA, procedural timings, and the rate of successful recanalization. In 130/170 (77%) patients, a TICI score of ≥ 2b could be achieved. The in-hospital mortality rate was 19%, and 36% of patients had a favorable outcome at follow-up. CONCLUSIONS Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is effective and safe. It is not associated with a significantly higher risk of symptomatic intracranial hemorrhage compared with published series for mechanical thrombectomy alone.
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Affiliation(s)
- D Behme
- From the Departments of Neuroradiology (D.B., M.N.P., M.K.)
| | - A Mpotsaris
- Department of Radiology and Neuroradiology (A.M., P.Z., C.K., T.L.), University Cologne, University Hospital Cologne, Cologne, Germany
| | - P Zeyen
- Department of Radiology and Neuroradiology (A.M., P.Z., C.K., T.L.), University Cologne, University Hospital Cologne, Cologne, Germany
| | - M N Psychogios
- From the Departments of Neuroradiology (D.B., M.N.P., M.K.)
| | - A Kowoll
- Department of Radiology and Neuroradiology (A.K., W.W.), Ruhr-University-Bochum, University Medical Center Langendreer, Bochum, Germany
| | - C J Maurer
- Departments of Radiology and Neuroradiology (C.J.M., A.B.)
| | - F Joachimski
- Neurology (F.J.), Klinikum Augsburg, Augsburg, Germany
| | - J Liman
- Neurology (J.L., K.W.), Georg-August-University Göttingen, University Medical Center, Göttingen, Germany
| | - K Wasser
- Neurology (J.L., K.W.), Georg-August-University Göttingen, University Medical Center, Göttingen, Germany
| | - C Kabbasch
- Department of Radiology and Neuroradiology (A.M., P.Z., C.K., T.L.), University Cologne, University Hospital Cologne, Cologne, Germany
| | - A Berlis
- Departments of Radiology and Neuroradiology (C.J.M., A.B.)
| | - M Knauth
- From the Departments of Neuroradiology (D.B., M.N.P., M.K.)
| | - T Liebig
- Department of Radiology and Neuroradiology (A.M., P.Z., C.K., T.L.), University Cologne, University Hospital Cologne, Cologne, Germany
| | - W Weber
- Department of Radiology and Neuroradiology (A.K., W.W.), Ruhr-University-Bochum, University Medical Center Langendreer, Bochum, Germany
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Pierot L, Klisch J, Liebig T, Gauvrit JY, Leonardi M, Nuzzi NP, Di Paola F, Sychra V, Mine B, Lubicz B. WEB-DL Endovascular Treatment of Wide-Neck Bifurcation Aneurysms: Long-Term Results in a European Series. AJNR Am J Neuroradiol 2015; 36:2314-9. [PMID: 26228882 DOI: 10.3174/ajnr.a4445] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/15/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flow disruption with the WEB-DL device has been used safely for the treatment of wide-neck bifurcation aneurysms. The stability of aneurysm occlusion after this treatment was evaluated in the short and midterm, but not in the long term. This retrospective multicenter European study is the continuation of an already published series dealing with short- and midterm anatomic results and analyzes long-term data in patients treated with the WEB-DL. MATERIALS AND METHODS Twelve European neurointerventional centers initially participated in the study. In addition to data collected for the initial publication, images obtained at long-term follow-up were collected and independently analyzed by the same experienced interventional neuroradiologist. RESULTS Of the initial 45 patients, 26 (20 women and 6 men; 35-73 years of age; mean, 55.2 ± 10.6 years; median, 55.5 years) with 26 aneurysms treated with the WEB-DL device had long-term follow-up (median, 27.4 months). Three of 26 patients (11.5%) were retreated between short- and midterm follow-up, and none, between mid- and long-term follow-up. Long-term aneurysm occlusion in the 19 patients treated with the WEB only and not retreated during follow-up was complete occlusion in 13/19 patients (68.4%), including aneurysms with opacification of the proximal recess in 9/19 patients (47.4%), neck remnant in 3/19 patients (15.8%), and aneurysm remnant in 3/19 patients (15.8%). In all patients (100.0%), aneurysm occlusion was stable between midterm and long-term follow-up. CONCLUSIONS The results suggest that WEB treatment of wide-neck bifurcation aneurysms offers long-term stable occlusion.
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Affiliation(s)
- L Pierot
- From the Department of Neuroradiology (L.P.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - J Klisch
- Department of Diagnostic and Interventional Radiology and Neuroradiology (J.K., V.S.), Helios General Hospital, Erfurt, Germany
| | - T Liebig
- Department of Neuroradiology (T.L.), Universitätsklinikum Köln, Cologne, Germany
| | - J-Y Gauvrit
- Department of Neuroradiology (J.-Y.G.), CHU Rennes, Rennes, France
| | - M Leonardi
- Department of Neuroradiology (M.L.), Ospedale Bellaria, Bologna University, Bologna, Italy
| | - N P Nuzzi
- Department of Neuroradiology (N.P.N.), Ospedale Galliera, Genova, Italy
| | - F Di Paola
- Department of Neuroradiology (F.D.P.), Ospedale Santa Maria, Treviso, Italy
| | - V Sychra
- Department of Diagnostic and Interventional Radiology and Neuroradiology (J.K., V.S.), Helios General Hospital, Erfurt, Germany
| | - B Mine
- Department of Neuroradiology (B.M., B.L.), Erasme University Hospital, Brussels, Belgium
| | - B Lubicz
- Department of Neuroradiology (B.M., B.L.), Erasme University Hospital, Brussels, Belgium
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Liebig T, Kabbasch C, Strasilla C, Berlis A, Weber W, Pierot L, Patankar T, Barreau X, Dervin J, Kuršumović A, Rath S, Lubicz B, Klisch J. Intrasaccular Flow Disruption in Acutely Ruptured Aneurysms: A Multicenter Retrospective Review of the Use of the WEB. AJNR Am J Neuroradiol 2015; 36:1721-7. [PMID: 26138139 DOI: 10.3174/ajnr.a4347] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/02/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Use of the WEB intra-aneurysmal flow-disruption device in unruptured wide-neck bifurcation aneurysms has proven safety and efficacy. However, ruptured aneurysms are underrepresented in existing studies. This retrospective multicenter study describes the use of the WEB in patients with a ruptured intracranial aneurysm. MATERIALS AND METHODS Ten centers contributed to this study. Clinical and procedural data of 47 patients with 52 aneurysms were analyzed retrospectively together with follow-up angiographies. RESULTS There were 37 anterior and 15 posterior circulation aneurysms with a neck size of ≥4 mm in 49 of 52 (94%) aneurysms; 45 (87%) aneurysms were <10 mm, and 2 were partially thrombosed. Successful placement of the WEB was possible in every case. Adjunctive devices were used in 8 of 52 (15%) aneurysms. Thromboembolic events were observed in 4 of 52 (8%) patients. Adverse events occurred in 15 patients with 16 aneurysms, 9 of which were potentially related to the WEB procedure (3 thromboembolic events, 5 protrusions, and 1 perforations; 2 perforations were caused by the wire or catheter), but none had a clinical impact. Four patients were retreated. Short-term follow-up in 25 of 39 patients revealed complete occlusion in 15 of 25 (60%), 5 of 25 (20%) with residual neck, and 5 of 25 (20%) with residual aneurysm filling. Short- to midterm imaging in 9 of 25 patients revealed complete occlusion in 5 (55.6%), residual neck in 2 (22%), and residual aneurysm filling in 2 (22%). Of 47 patients, 23 (49%) had an mRS score of 0, 1, or 2; 13 (28%) had an mRS score of 3 or 4; and none had an mRS score of 5 at discharge. CONCLUSIONS This retrospective series showed good procedural safety, feasibility, and stability of midterm occlusion in ruptured wide-neck bifurcation aneurysms.
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Affiliation(s)
- T Liebig
- From the Department of Radiology (T.L., C.K.), Universitätsklinikum Köln, Cologne, Germany
| | - C Kabbasch
- From the Department of Radiology (T.L., C.K.), Universitätsklinikum Köln, Cologne, Germany
| | - C Strasilla
- Department of Diagnostic and Interventional Radiology and Neuroradiology (C.S., J.K.), Helios General Hospital, Erfurt, Germany
| | - A Berlis
- Department of Diagnostic Imaging and Neuroradiology (A.B.), Klinikum Augsburg, Augsburg, Germany
| | - W Weber
- Department of Neuroradiology (W.W.), Knappschaftskrankenhaus, Recklinghausen, Germany Department of Neuroradiology (W.W.), Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - L Pierot
- Department of Neuroradiology (L.P.), Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - T Patankar
- Leeds General Infirmary (T.P.), Leeds, United Kingdom
| | - X Barreau
- Department of Neuroimaging (X.B.), CHU Pellegrin, Bordeaux, France
| | - J Dervin
- Southern General Hospital (J.D.), Glasgow, United Kingdom
| | - A Kuršumović
- Department of Neuroradiology (A.K., S.R.), Klinikum Deggendorf, Deggendorf, Germany
| | - S Rath
- Department of Neuroradiology (A.K., S.R.), Klinikum Deggendorf, Deggendorf, Germany
| | - B Lubicz
- Department of Neuroradiology (B.L.), Erasme University Hospital, Brussels, Belgium
| | - J Klisch
- Department of Diagnostic and Interventional Radiology and Neuroradiology (C.S., J.K.), Helios General Hospital, Erfurt, Germany
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Pierot L, Klisch J, Liebig T, Gauvrit J, Leonardi M, Nunzi N, Di Paola F, Sychra V, Mine B, Lubicz B. O-026 web endovascular treatment of wide-neck bifurcation aneurysms: long-term results in a european series. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.26] [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: 11/04/2022]
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Kabbasch C, Liebig T, Faymonville A, Dorn F, Mpotsaris A. Initial Clinical Experience with a New Self-Expanding Nitinol Microstent for the Treatment of Wide-Neck Intracranial Cerebral Aneurysms: The Acandis Acclino Stent. J Vasc Interv Neurol 2015; 8:1-6. [PMID: 26301024 PMCID: PMC4535594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND PURPOSE The Acclino is a laser-cut closed-cell microstent composed of nitinol. It was developed for stent-assisted coiling of wide-neck intracranial aneurysms. The key feature of the stent is its deployability via low-profile microcatheters with an inner diameter of 0.0165 inch, which are also suited for coil deployment. The objective of this study was to evaluate the safety and feasibility as well as the immediate and mid-term results of this new device. MATERIALS AND METHODS Our database was screened for all Acclino-based stent-assisted intracranial coil embolizations since its introduction to the European market in June 2012. Case files and imaging data were retrospectively analyzed for angiographical and clinical outcome parameters, including immediate and mid-term modified Raymond-Roy aneurysm occlusion classification (RROC) rates and procedural complications. RESULTS Fourteen patients comprising 14 aneurysms (9 unruptured and 5 ruptured) were treated with the Acclino. All except for a dissecting one were wide-neck saccular aneurysms. Immediate complete occlusion (RROC1) was observed in 8/14 cases (57%), a residual neck (RROC2) in 4/14 (29%), and a persistent filling of the dome (RROC 3) in 1/14 cases (7%). An in-stent thrombus formation in one case (7%) was medically resolved without neurological deficit. Follow-up was available in 9/14 cases (64%) after a mean of 137 days (SD ± 50). All followed cases depicted a complete occlusion (RROC1). CONCLUSIONS The Acclino microstent showed a satisfactory safety profile and a promising rate of immediate and mid-term complete aneurysm occlusion for stent-assisted coil embolization in wide-neck intracranial aneurysms, warranting further investigation of the device.
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Affiliation(s)
- C Kabbasch
- Department of Radiology and Neuroradiology, University of Cologne, University Medical Center, Cologne, Germany
| | - T Liebig
- Department of Radiology and Neuroradiology, University of Cologne, University Medical Center, Cologne, Germany
| | - A Faymonville
- Department of Neurosurgery, University of Cologne, University Medical Center, Cologne, Germany
| | - F Dorn
- Department of Radiology and Neuroradiology, University of Cologne, University Medical Center, Cologne, Germany
| | - A Mpotsaris
- Department of Radiology and Neuroradiology, University of Cologne, University Medical Center, Cologne, Germany
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Hos NJ, Bauer C, Liebig T, Plum G, Seifert H, Hampl J. Autoinfection as a cause of postpartum subdural empyema due to Mycoplasma hominis. Infection 2014; 43:241-4. [PMID: 25491170 DOI: 10.1007/s15010-014-0713-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/03/2014] [Indexed: 01/29/2023]
Abstract
Mycoplasma hominis is a commensal of the genitourinary tract, which is infrequently associated with urogenital infections. Extra-urogenital infections due to M. hominis are rare. Here, we report an unusual case of M. hominis subdural empyema in a woman occurring shortly after delivery. The patient presented with symptoms suggestive of bacterial meningitis. Spinal imaging revealed a subdural empyema that required neurosurgical intervention. Cultures from intraoperatively obtained biopsies identified M. hominis as the causative pathogen. The patient was treated with oral moxifloxacin for 4 weeks resulting in the resolution of the spinal lesion. The subdural empyema was presumably caused by a contaminated epidural blood patch performed with the patient's own blood during an episode of transient M. hominis bacteremia after delivery. The blood patch was indicated for the treatment of cerebrospinal fluid leakage, which had occurred after epidural anesthesia. Our findings highlight the significance of transient M. hominis bacteremia after delivery and implicate that M. hominis should be considered as a causative agent of extra-genitourinary tract infections particularly during the postpartum period or after genitourinary manipulation.
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Affiliation(s)
- N J Hos
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr. 19-21, 50935, Cologne, Germany,
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Lockau H, Liebig T, Henning T, Neuschmelting V, Stetefeld H, Kabbasch C, Dorn F. Mechanical thrombectomy in tandem occlusion: procedural considerations and clinical results. Neuroradiology 2014; 57:589-98. [PMID: 25404414 DOI: 10.1007/s00234-014-1465-5] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/04/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Acute tandem occlusions of the cervical and distal internal carotid artery (ICA) or middle cerebral artery (MCA) are associated with major stroke with intravenous (i.v.) thrombolysis alone in approximately 90 % of patients. The data on endovascular management of tandem occlusions is still limited. The purpose of this study was to review technical aspects and the current state of the literature on acute ICA stenting in combination with stent retriever-based intracranial thrombectomy. METHODS We retrospectively reviewed the data of 37 consecutive patients with tandem occlusions including clinical parameters, angiographic results, procedural aspects, complications, and hemorrhages. RESULTS Median National Institutes of Health Stroke Scale (NIHSS) on admission was 17 (3-30). Intracranial thrombectomy was performed prior to ICA stenting in 25/37 (67.6 %) and after stenting in 12/37 (32.4 %) patients. ICA stenting was successful in all cases, and a thrombolysis in cerebral infarction (TICI) scale 2b/3 result was achieved in 27/37 (73 %) cases. The mean angiography time was significantly shorter in the "thrombectomy first" group (43.1 ± 30.8 vs. 110.8 ± 43.0 min, p < 0.001), and more patients had favorable outcomes after 3 months (13/25 = 52.0 vs. 4/12 = 33.3 %, p = 0.319). In this group, intermediate catheters were used and successfully prevented embolism to unaffected territories in all cases. CONCLUSION Acute stenting of the cervical ICA in combination with intracranial thrombectomy was technically feasible and safe in our series. Thrombectomy prior to proximal stenting was associated with shorter reperfusion times and a tendency towards better clinical outcome leading to a good outcome in about 50 % of the patients. Therefore, we recommend this approach in tandem occlusion requiring stent angioplasty.
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Affiliation(s)
- H Lockau
- Department of Radiology, University Hospital of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany
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Pierot L, Klisch J, Gauvrit J, Szikora I, Leonardi M, Liebig T, Nunzi N, Boccardi E, Di Paola F, Holtmanspötter M, Weber W, Calgliari E, Lubicz B. P-009 WEB Endovascular Treatment of Wide-neck Bifurcation Aneurysms: Short- and Midterm Results in a European Study. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pierot L, Spelle L, Costalat V, Szikora I, Klisch J, Herbreteau D, Holtmannspoetter M, Weber W, Liebig T, Cognard C, Bonafé A, Moret J, Byrne J, Molyneux A. E-029 WEB Flow Disruption: Preliminary Results from WEBCAST trial. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ubben S, Weiss-Blankenhorn P, Kaesberg S, Kalbe E, Kessler J, Liebig T, Fink G. P366: Where language meets action: a combined behaviour and lesion analysis of aphasia and apraxia due to left-hemisphere stroke. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50475-0] [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: 10/25/2022]
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Rehme AK, Volz LJ, Feis DL, Bomilcar-Focke I, Liebig T, Eickhoff SB, Fink GR, Grefkes C. Identifying Neuroimaging Markers of Motor Disability in Acute Stroke by Machine Learning Techniques. Cereb Cortex 2014; 25:3046-56. [PMID: 24836690 DOI: 10.1093/cercor/bhu100] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Conventional mass-univariate analyses have been previously used to test for group differences in neural signals. However, machine learning algorithms represent a multivariate decoding approach that may help to identify neuroimaging patterns associated with functional impairment in "individual" patients. We investigated whether fMRI allows classification of individual motor impairment after stroke using support vector machines (SVMs). Forty acute stroke patients and 20 control subjects underwent resting-state fMRI. Half of the patients showed significant impairment in hand motor function. Resting-state connectivity was computed by means of whole-brain correlations of seed time-courses in ipsilesional primary motor cortex (M1). Lesion location was identified using diffusion-weighted images. These features were used for linear SVM classification of unseen patients with respect to motor impairment. SVM results were compared with conventional mass-univariate analyses. Resting-state connectivity classified patients with hand motor deficits compared with controls and nonimpaired patients with 82.6-87.6% accuracy. Classification was driven by reduced interhemispheric M1 connectivity and enhanced connectivity between ipsilesional M1 and premotor areas. In contrast, lesion location provided only 50% sensitivity to classify impaired patients. Hence, resting-state fMRI reflects behavioral deficits more accurately than structural MRI. In conclusion, multivariate fMRI analyses offer the potential to serve as markers for endophenotypes of functional impairment.
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Affiliation(s)
- A K Rehme
- Max Planck Institute for Neurological Research, Cologne, Germany Department of Neurology, University of Cologne, Cologne, Germany Institute of Neuroscience and Medicine (INM-2, INM-3), Research Centre Juelich, Juelich, Germany
| | - L J Volz
- Max Planck Institute for Neurological Research, Cologne, Germany Department of Neurology, University of Cologne, Cologne, Germany
| | - D-L Feis
- Max Planck Institute for Neurological Research, Cologne, Germany
| | - I Bomilcar-Focke
- Max Planck Institute for Neurological Research, Cologne, Germany
| | - T Liebig
- Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany
| | - S B Eickhoff
- Institute of Neuroscience and Medicine (INM-2, INM-3), Research Centre Juelich, Juelich, Germany Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University, Düsseldorf, Germany
| | - G R Fink
- Department of Neurology, University of Cologne, Cologne, Germany Institute of Neuroscience and Medicine (INM-2, INM-3), Research Centre Juelich, Juelich, Germany
| | - C Grefkes
- Max Planck Institute for Neurological Research, Cologne, Germany Department of Neurology, University of Cologne, Cologne, Germany Institute of Neuroscience and Medicine (INM-2, INM-3), Research Centre Juelich, Juelich, Germany
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Lubicz B, Klisch J, Gauvrit JY, Szikora I, Leonardi M, Liebig T, Nuzzi NP, Boccardi E, Paola FD, Holtmannspötter M, Weber W, Calgliari E, Sychra V, Mine B, Pierot L. WEB-DL endovascular treatment of wide-neck bifurcation aneurysms: short- and midterm results in a European study. AJNR Am J Neuroradiol 2014; 35:432-8. [PMID: 24457823 DOI: 10.3174/ajnr.a3869] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [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 Flow disruption with the WEB-DL device has been used safely for the treatment of wide-neck bifurcation aneurysms, but the stability of aneurysm occlusion after this treatment is unknown. This retrospective multicenter European study analyzed short- and midterm data in patients treated with WEB-DL. MATERIALS AND METHODS Twelve European neurointerventional centers participated in the study. Clinical data and pre- and postoperative short- and midterm images were collected. An experienced interventional neuroradiologist independently analyzed the images. Aneurysm occlusion was classified into 4 grades: complete occlusion, opacification of the proximal recess of the device, neck remnant, and aneurysm remnant. RESULTS Forty-five patients (34 women and 11 men) 35-74 years of age (mean, 56.3 ± 9.6 years) with 45 aneurysms treated with the WEB device were included. Aneurysm locations were the middle cerebral artery in 26 patients, the posterior circulation in 13 patients, the anterior communicating artery in 5 patients, and the internal carotid artery terminus in 1 patient. Forty-two aneurysms were unruptured. Good clinical outcome (mRS < 2) was observed in 93.3% of patients at the last follow-up. Adequate occlusion (complete occlusion, opacification of the proximal recess, or neck remnant) was observed in 30/37 patients (81.1%) in short-term follow-up (median, 6 months) and in 26/29 patients (89.7%) in midterm follow-up (median, 13 months). Worsening of the aneurysm occlusion was observed in 2/28 patients (7.1%) at midterm follow-up. CONCLUSIONS The results suggest that the WEB endovascular treatment of wide-neck bifurcation aneurysms offers stable occlusion in a class of aneurysms that are historically unstable. Additionally, our data show that opacification of the WEB recess can be delineated from true neck or aneurysm remnants.
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Affiliation(s)
- B Lubicz
- From the Department of Neuroradiology (B.L., B.M.), Erasme University Hospital, Brussels, Belgium
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Lichtenstein T, Lockau H, Beutner D, Dorn F, Liebig T. Life threatening transmural arteritis of the internal carotid artery: reconstructive treatment with flow diverting stents. Clin Neuroradiol 2013; 24:377-80. [PMID: 23955687 DOI: 10.1007/s00062-013-0253-7] [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] [Received: 05/16/2013] [Accepted: 08/04/2013] [Indexed: 10/26/2022]
Affiliation(s)
- T Lichtenstein
- Department of Radiology and Neuoradiology, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany,
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Pierot L, Liebig T, Sychra V, Kadziolka K, Dorn F, Strasilla C, Kabbasch C, Klisch J. Intrasaccular flow-disruption treatment of intracranial aneurysms: preliminary results of a multicenter clinical study. AJNR Am J Neuroradiol 2012; 33:1232-8. [PMID: 22678844 DOI: 10.3174/ajnr.a3191] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [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 endovascular treatment of intracranial aneurysms with unfavorable anatomy (large aneurysms, wide-neck) is frequently challenging and is also associated with a high incidence of significant recurrences. The WEB, an intrasaccular flow disrupter, was designed for use in this type of aneurysm. We report our early experience with this device in this multicenter study. MATERIALS AND METHODS Twenty patients with 21 aneurysms were treated by using the WEB in 3 European centers. The ability to successfully deploy the WEB, immediate posttreatment angiographic results, adverse events, clinical outcome, and angiographic follow-up results were recorded. RESULTS Aneurysm location was the ICA (4/21, 19.1%), MCA (8/21, 38.1%), AcomA (5/21, 23.8%), and BA (4/21, 19.1%). No treatment failures were reported. Treatment was performed exclusively with the WEB in 16/21 (76.2%) patients. Additional treatment (coiling and/or stent placement) was used in 5/21 (23.8%) patients. One patient (4.8%) experienced transient clinical worsening (mRS 1 at 1 month, mRS 0 at 3 months) related to a thromboembolic event. Inadvertent detachment of the WEB was observed, and the WEB was retrieved in 1 patient, without adverse effects. In the short-term follow-up (2-8 months), adequate occlusion (total occlusion or neck remnant) was observed in 80.0% of aneurysms. CONCLUSIONS Intrasaccular flow disruption is a new endovascular approach for aneurysm treatment. In our preliminary experience, this treatment was feasible and mostly used in bifurcation aneurysms (MCA, BA, ICA) with unfavorable anatomy. Further studies are needed to precisely evaluate the indications, safety, and efficacy of this new technique.
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Affiliation(s)
- L Pierot
- Department of Radiology, Maison Blanche Hospital, University of Reims, France.
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Barbe MT, Liebig T, Fink GR, Meister IG, Dorn F. Aneurysm of the internal carotid artery with bone arrosion and extradural compression of the optic nerve. Neurol Clin Pract 2012; 2:167-168. [DOI: 10.1212/cpj.0b013e31825a61a9] [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: 11/15/2022]
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Koerber F, Schulze Uphoff U, Koerber S, Schoenau E, Liebig T, Semler O. Score zur Bewertung von Röntgenaufnahmen der Wirbelsäule bei Osteogenesis imperfecta (OI). ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311244] [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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37
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Liebig T, Dorn F, Kabbasch C. Flowdiverter - Eine interventionelle Wunderwaffe?! ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310949] [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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38
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Klein JC, Barbe MT, Seifried C, Baudrexel S, Runge M, Maarouf M, Gasser T, Hattingen E, Liebig T, Deichmann R, Timmermann L, Weise L, Hilker R. The tremor network targeted by successful VIM deep brain stimulation in humans. Neurology 2012; 78:787-95. [PMID: 22377809 DOI: 10.1212/wnl.0b013e318249f702] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Deep brain stimulation (DBS) of the ventral intermediate nucleus of thalamus (VIM) is a treatment option in medically intractable tremor, such as essential tremor or tremor-dominant Parkinson disease (PD). Although functional studies demonstrated modulation of remote regions, the structural network supporting this is as yet unknown. In this observational study, we analyzed the network mediating clinical tremor modulation. METHODS We studied 12 patients undergoing VIM stimulation for debilitating tremor. We initiated noninvasive diffusion tractography from tremor-suppressive VIM electrode contacts. Moreover, we tested for the contribution of primary motor projections in this structural correlate of a functional tremor network, comparing the connectivity of effective DBS contacts with those of adjacent, but clinically ineffective, stimulation sites. RESULTS VIM stimulation resulted in decrease of tremor and improvement in quality of life. Tractography initiated from the effective stimulation site reconstructed a highly reproducible network of structural connectivity comprising motor cortical, subcortical, and cerebellar sites and the brainstem, forming the anatomic basis for remote effects of VIM stimulation. This network is congruent with functional imaging studies in humans and with thalamic projections found in the animal literature. Connectivity to the primary motor cortex seemed to play a key role in successful stimulation. CONCLUSIONS Patients undergoing DBS provide a unique opportunity to assess an electrophysiologically defined seed region in human thalamus, a technique that is usually restricted to animal research. In the future, preoperative tractography could aid with stereotactic planning of individual subcortical target points for stimulation in tremor and in other disease entities.
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Affiliation(s)
- J C Klein
- Department of Neurology, Goethe-University Frankfurt, Frankfurt Germany.
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39
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Dorn F, Stehle S, Lockau H, Zimmer C, Liebig T. Endovascular Treatment of Acute Intracerebral Artery Occlusions with the Solitaire Stent: Single-Centre Experience with 108 Recanalization Procedures. Cerebrovasc Dis 2012; 34:70-7. [PMID: 22759754 DOI: 10.1159/000338903] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 04/17/2012] [Indexed: 11/19/2022] Open
Affiliation(s)
- F Dorn
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany.
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Dorn F, Prothmann S, Wunderlich S, Liebig T. Stent angioplasty of intracranial stenosis: single center experience of 54 cases. Clin Neuroradiol 2011; 22:149-56. [PMID: 21935719 DOI: 10.1007/s00062-011-0106-1] [Citation(s) in RCA: 4] [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] [Received: 03/07/2011] [Accepted: 08/30/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of the study was to retrospectively evaluate the safety and efficacy of stent angioplasty of symptomatic intracranial stenosis in a single center experience. MATERIALS AND METHODS Between November 2006 and September 2009 a total of 54 stent angioplasties were performed in 49 patients and of these 46 were done for symptomatic intracranial high-grade (>70%) stenoses and 8 for complete vessel occlusions in acute stroke. All elective treatments were carried out with patients under antithrombotic/anticoagulant medication. Self-expandable stents were used in 42 cases and balloon-expandable stents in 12 cases. RESULTS Stent angioplasty was successful in 53 out of 54 cases (98%). Periprocedural complications occurred in 6 patients, including 2 dissections, 1 contrast-mediated toxic reaction and 1 thromboembolic event with transient neurological deficits but did not cause permanent neurological deficits, in any of the cases. Adverse events within 30 days after intervention occurred in 11 of the 49 patients (20.4%) of which 4 were scheduled patients (8.3%) and 7 were treated for acute stroke with complete vessel occlusions (87.5%). Overall there were 9 cases of restenosis (7 out of 9>90% stenoses and 2 complete vessel occlusions), 5 out of 9 were asymptomatic, 4 out of 9 had a transient ischemic attack and 1 developed a major stroke. Two complete in-stent thromboses were seen in acute stroke patients with initial complete occlusion within 24 h after recanalization. One restenosis and one complete occlusion occurred under double antiplatelet medication, 4 out of 9 restenoses occurred under aspisol medication and 3 out of 9 after antiplatelet medication was discontinued. In 2 out of 9 restenoses, balloon-expandable stents had been used, the remaining 7 had been treated with self-expanding stents, 5 out of 9 restenoses were treated by balloon-angioplasty alone, in 3 out of 9 an additional stent had to be placed and 1 asymptomatic occlusion was left untreated. CONCLUSIONS The results demonstrate the technical feasibility and satisfactory success rates of stent angioplasty in intracranial atherosclerotic stenoses. The procedural success rate was 98% and the overall rate of adverse events was 20.4%. The rate of adverse events was high in unstable patients (87.5%) treated without antiplatelet premedication, especially in the setting of an acute stroke. In stable patients the rate of adverse events was much lower (8.3%). Future development of dedicated stents and a better understanding of factors that predispose to restenosis may help to further decrease the rate of periprocedural and postprocedural adverse events thus helping to improve both short-term and long-term outcome after intracranial stent angioplasty.
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Affiliation(s)
- F Dorn
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Kerpenerstr. 62, 50937 Koeln, Germany.
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Körber F, Semler O, Demant A, Schulze-Uphoff U, Schönau E, Liebig T. Vergleichsstudie Röntgen versus Dual Energy X-Ray Absorptiometry (iDXA) – erste Ergebnisse der Wirbelkörpermorphometrie. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1286238] [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: 10/17/2022]
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42
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Körber F, Semler O, Demant A, Schulze-Uphoff U, Schönau E, Liebig T. Vergleichsstudie Röntgen versus Dual Energy X-Ray Absorptiometry (iDXA) – erste Ergebnisse der Knochenalterbestimmung an Aufnahmen der linken Hand. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1286237] [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: 10/17/2022]
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43
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Körber F, Semler O, Demant A, Schulze-Uphoff U, Schönau E, Liebig T. Quantifizierender Score zur Beurteilung der Röntgenaufnahmen der Wirbelsäule bei Kindern und Jugendlichen mit primärer Osteoporose. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1286245] [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: 10/17/2022]
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Bovenschulte H, Chang D, Michels G, Kochanek M, Liebig T, Bangard C. Technische Mitteilung: Fehlplatzierter 13F-Shaldonkatheter in der A. subclavia – kontrollierte Entfernung mit einem unterdimensionierten 8F-Kollagen-Verschlusssystem (AngioSeal®) und endovaskulärer Ballonfixation. ROFO-FORTSCHR RONTG 2011; 183:758-60. [DOI: 10.1055/s-0031-1273448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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45
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Koerber F, Semler O, Demant A, Schoenau E, Liebig T. Erste Ergebnisse einer Vergleichsstudie Röntgen versus Dual Energy X-Ray Absorptiometry (iDXA) am Beispiel der Wirbelkörpermorphometrie. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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46
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Koerber F, Semler O, Schulze Uphoff U, Schoenau E, Liebig T. Erste Ergebnisse einer Vergleichsstudie Röntgen versus Dual Energy X-Ray Absorptiometry (iDXA) am Beispiel der Knochenalterbestimmung an Aufnahmen der linken Hand. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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47
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Förschler A, Prothmann S, Zimmer C, Liebig T. Anwendung des Enterprise Stent-Systems zur Therapie intrakranieller Gefäßpathologien: Technische Erfolgsrate, periprozedurale Komplikationen und Verlauf bei 98 Patienten. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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48
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Dorn F, Muenzel D, Liebig T, Meier R, Rummeny E, Huber A. Multimodale CT in der Diagnostik des akuten Schlaganfalls: hat die Reihenfolge (CT Angiographie vor oder nach der CT Perfusion) einen Einfluss auf die Bildqualität? ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chang DH, Liebig T, Bangard C. [Closure of an iatrogenic arteriovenous fistula and an pseudoaneurysm of the lower leg with the Amplatzer vascular plug]. ROFO-FORTSCHR RONTG 2011; 183:394-6. [PMID: 21246478 DOI: 10.1055/s-0029-1245968] [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: 10/18/2022]
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Esposito L, Saam T, Heider P, Bockelbrink A, Pelisek J, Sepp D, Feurer R, Winkler C, Liebig T, Holzer K, Pauly O, Sadikovic S, Hemmer B, Poppert H. MRI plaque imaging reveals high-risk carotid plaques especially in diabetic patients irrespective of the degree of stenosis. BMC Med Imaging 2010; 10:27. [PMID: 21118504 PMCID: PMC3004802 DOI: 10.1186/1471-2342-10-27] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 11/30/2010] [Indexed: 12/03/2022] Open
Abstract
Background Plaque imaging based on magnetic resonance imaging (MRI) represents a new modality for risk assessment in atherosclerosis. It allows classification of carotid plaques in high-risk and low-risk lesion types (I-VIII). Type 2 diabetes mellitus (DM 2) represents a known risk factor for atherosclerosis, but its specific influence on plaque vulnerability is not fully understood. This study investigates whether MRI-plaque imaging can reveal differences in carotid plaque features of diabetic patients compared to nondiabetics. Methods 191 patients with moderate to high-grade carotid artery stenosis were enrolled after written informed consent was obtained. Each patient underwent MRI-plaque imaging using a 1.5-T scanner with phased-array carotid coils. The carotid plaques were classified as lesion types I-VIII according to the MRI-modified AHA criteria. For 36 patients histology data was available. Results Eleven patients were excluded because of insufficient MR-image quality. DM 2 was diagnosed in 51 patients (28.3%). Concordance between histology and MRI-classification was 91.7% (33/36) and showed a Cohen's kappa value of 0.81 with a 95% CI of 0.98-1.15. MRI-defined high-risk lesion types were overrepresented in diabetic patients (n = 29; 56.8%). Multiple logistic regression analysis revealed association between DM 2 and MRI-defined high-risk lesion types (OR 2.59; 95% CI [1.15-5.81]), independent of the degree of stenosis. Conclusion DM 2 seems to represent a predictor for the development of vulnerable carotid plaques irrespective of the degree of stenosis and other risk factors. MRI-plaque imaging represents a new tool for risk stratification of diabetic patients. See Commentary: http://www.biomedcentral.com/1741-7015/8/78/abstract
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Affiliation(s)
- L Esposito
- Department of Neurology, Klinikum rechts der Isar, Technische Universität, Munich, Germany.
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