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Van Dam-Nolen D, Truijman M, Van Der Kolk A, Liem M, Schreuder F, Boersma E, Daemen M, Mess W, Van Oostenbrugge R, Van Der Steen A, Bos D, Koudstaal P, Nederkoorn P, Hendrikse J, Van Der Lugt A, Kooi M. Carotid plaque characteristics predict recurrent ischemic stroke: The Plaque At Risk (PARISK) study. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.079] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Lukas A, Theunissen M, Boer DDKD, van Kuijk S, Van Noyen L, Magerl W, Mess W, Buhre W, Peters M. AMAZONE: prevention of persistent pain after breast cancer treatment by online cognitive behavioral therapy-study protocol of a randomized controlled multicenter trial. Trials 2022; 23:595. [PMID: 35879728 PMCID: PMC9310687 DOI: 10.1186/s13063-022-06549-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Surviving breast cancer does not necessarily mean complete recovery to a premorbid state of health. Among the multiple psychological and somatic symptoms that reduce the quality of life of breast cancer survivors, persistent pain after breast cancer treatment (PPBCT) with a prevalence of 15–65% is probably the most invalidating. Once chronic, PPBCT is difficult to treat and requires an individualized multidisciplinary approach. In the past decades, several somatic and psychological risk factors for PPBCT have been identified. Studies aiming to prevent PPBCT by reducing perioperative pain intensity have not yet shown a significant reduction of PPBCT prevalence. Only few studies have been performed to modify psychological distress around breast cancer surgery. The AMAZONE study aims to investigate the effect of online cognitive behavioral therapy (e-CBT) on the prevalence of PPBCT. Methods The AMAZONE study is a multicenter randomized controlled trial, with an additional control arm. Patients (n=138) scheduled for unilateral breast cancer surgery scoring high for surgical or cancer-related fears, general anxiety or pain catastrophizing are randomized to receive either five sessions of e-CBT or online education consisting of information about surgery and a healthy lifestyle (EDU). The first session is scheduled before surgery. In addition to the online sessions, patients have three online appointments with a psychotherapist. Patients with low anxiety or catastrophizing scores (n=322) receive treatment as usual (TAU, additional control arm). Primary endpoint is PPBCT prevalence 6 months after surgery. Secondary endpoints are PPBCT intensity, the intensity of acute postoperative pain during the first week after surgery, cessation of postoperative opioid use, PPBCT prevalence at 12 months, pain interference, the sensitivity of the nociceptive and non-nociceptive somatosensory system as measured by quantitative sensory testing (QST), the efficiency of endogenous pain modulation assessed by conditioned pain modulation (CPM) and quality of life, anxiety, depression, catastrophizing, and fear of recurrence until 12 months post-surgery. Discussion With perioperative e-CBT targeting preoperative anxiety and pain catastrophizing, we expect to reduce the prevalence and intensity of PPBCT. By means of QST and CPM, we aim to unravel underlying pathophysiological mechanisms. The online application facilitates accessibility and feasibility in a for breast cancer patients emotionally and physically burdened time period. Trial registration NTR NL9132, registered December 16 2020.
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Affiliation(s)
- Anne Lukas
- Department of Anesthesiology & Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - Maurice Theunissen
- Department of Anesthesiology & Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Dianne de Korte-de Boer
- Department of Anesthesiology & Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Lotte Van Noyen
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Walter Magerl
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Ruprecht-Karls-University Heidelberg, Medical Faculty Mannheim, Heidelberg, Germany
| | - Werner Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Wolfgang Buhre
- Department of Anesthesiology & Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Madelon Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
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Florea A, Kooi ME, Mess W, Schurgers LJ, Bucerius J, Mottaghy FM. Effects of Combined Vitamin K2 and Vitamin D3 Supplementation on Na[ 18F]F PET/MRI in Patients with Carotid Artery Disease: The INTRICATE Rationale and Trial Design. Nutrients 2021; 13:nu13030994. [PMID: 33808652 PMCID: PMC8003489 DOI: 10.3390/nu13030994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/13/2021] [Accepted: 03/17/2021] [Indexed: 11/29/2022] Open
Abstract
INTRICATE is a prospective double-blind placebo-controlled feasibility study, assessing the influence of combined vitamin K2 and vitamin D3 supplementation on micro-calcification in carotid artery disease as imaged by hybrid Sodium [18F]Fluoride (Na[18F]F) positron emission tomography (PET)/ magnetic resonance imaging (MRI). Arterial calcification is an actively regulated process and results from the imbalance between calcification promoting and inhibiting factors. Considering the recent advancements in medical imaging, ultrasound (US), PET/MRI, and computed tomography (CT) can be used for the selection and stratification of patients with atherosclerosis. Fifty-two subjects with asymptomatic carotid artery disease on at least one side of the neck will be included in the study. At baseline, an Na[18F]F PET/MRI and CT examination will be performed. Afterwards, subjects will be randomized (1:1) to a vitamin K (400 µg MK-7/day) and vitamin D3 (80 µg/day) or to placebo. At the 3-month follow-up, subjects will undergo a second Na[18F]F PET/MRI and CT scan. The primary endpoint is the change in Na[18F]F PET/MRI (baseline vs. after 3 months) in the treatment group as compared to the placebo arm. Secondary endpoints are changes in plaque composition and in blood-biomarkers. The INTRICATE trial bears the potential to open novel avenues for future large scale randomized controlled trials to intervene in the plaque development and micro-calcification progression.
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Affiliation(s)
- Alexandru Florea
- Department of Nuclear Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany;
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, 6229HX Maastricht, The Netherlands; (M.E.K.); (J.B.)
- School for Cardiovascular Diseases (CARIM), Maastricht University, 6229HX Maastricht, The Netherlands;
| | - M. Eline Kooi
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, 6229HX Maastricht, The Netherlands; (M.E.K.); (J.B.)
- School for Cardiovascular Diseases (CARIM), Maastricht University, 6229HX Maastricht, The Netherlands;
| | - Werner Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Center, 6229HX Maastricht, The Netherlands;
| | - Leon J. Schurgers
- School for Cardiovascular Diseases (CARIM), Maastricht University, 6229HX Maastricht, The Netherlands;
- Department of Biochemistry, Maastricht University, 6229HX Maastricht, The Netherlands
- Institute of Experimental Medicine and Systems Biology, RWTH Aachen University, 52074 Aachen, Germany
| | - Jan Bucerius
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, 6229HX Maastricht, The Netherlands; (M.E.K.); (J.B.)
- School for Cardiovascular Diseases (CARIM), Maastricht University, 6229HX Maastricht, The Netherlands;
- Department of Nuclear Medicine, University of Göttingen, 37075 Göttingen, Germany
| | - Felix M. Mottaghy
- Department of Nuclear Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany;
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, 6229HX Maastricht, The Netherlands; (M.E.K.); (J.B.)
- School for Cardiovascular Diseases (CARIM), Maastricht University, 6229HX Maastricht, The Netherlands;
- Correspondence: ; Tel.: +49-241-80-88741
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Maalmi H, Wouters K, Savelberg HHCM, van der Velde JHPM, Reulen JPH, Mess W, Schalkwijk CG, Stehouwer CDA, Roden M, Ziegler D, Herder C, Schaper NC. Associations of cells from both innate and adaptive immunity with lower nerve conduction velocity: the Maastricht Study. BMJ Open Diabetes Res Care 2021; 9:9/1/e001698. [PMID: 33431599 PMCID: PMC7802711 DOI: 10.1136/bmjdrc-2020-001698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Distal sensorimotor polyneuropathy (DSPN) is common in people with diabetes but is also found in pre-diabetes. Peripheral nerve myelin damage, which can be assessed by reduced nerve conduction velocity (NCV), is an essential feature of DSPN. Emerging evidence indicates that the development of DSPN may involve the activation of the immune system. However, available studies have mainly investigated circulating immune mediators, whereas the role of immune cells remains unclear. Therefore, we aimed to test whether leukocyte subsets are associated with NCV. RESEARCH DESIGN AND METHODS This cross-sectional study analyzed data from 850 individuals (of whom 252 and 118 had type 2 diabetes and pre-diabetes, respectively) of the Maastricht Study. NCV was measured in the peroneal and tibial motor nerves and the sural sensory nerve and summed to calculate a standardized NCV sum score. Associations between percentages of leukocyte subsets and NCV sum scores were estimated using linear regression models adjusted for demographic, lifestyle, metabolic and clinical covariates. RESULTS After adjustment for covariates, higher percentages of basophils and CD4+ T cells were associated with lower NCV (p=0.014 and p=0.005, respectively). The percentage of CD8+ T cells was positively associated with NCV (p=0.022). These associations were not modified by glucose metabolism status (all pinteraction >0.05). No associations were found for monocytes, eosinophils, neutrophils, lymphocytes, total T cells, Treg cells and B cells. CONCLUSIONS The associations of basophils, CD4+ and CD8+ T cells with NCV suggest that cell types from both innate and adaptive immunity may be implicated in the development of DSPN.
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Affiliation(s)
- Haifa Maalmi
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
| | - Kristiaan Wouters
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Hans H C M Savelberg
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Jeroen H P M van der Velde
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Jos P H Reulen
- Department of Clinical Neurophysiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Werner Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Casper G Schalkwijk
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Nicolaas C Schaper
- Department of Internal Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Crombag G, Schreuder F, Benali F, Dam DNV, Liem M, Lucci C, van der Steen A, Daemen M, Mess W, van der Lugt A, Nederkoorn P, Hendrikse J, Hofman P, van Oostenbrugge R, Wildberger J, Kooi E. Proximal Region of Carotid Atherosclerotic Plaque Shows More Intraplaque Hemorrhage: The Plaque at Risk (Parisk) Study. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.101] [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: 11/16/2022]
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Crombag G, Liem M, Koornstra E, Schreuder F, Dam DNV, Lucci C, van der Geest R, Daemen M, van der Steen A, Hendrikse J, Mess W, van der Lugt A, Wildberger J, van Oostenbrugge R, Nederkoorn P, Kooi E. Start of Antiplatelet Therapy Increases the Prevalence of Intraplaque Hemorrhage in Patients With Advanced Carotid Artery Lesions: A Longitudinal MR Imaging Study. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.096] [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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Crombag G, Spronk H, Nelemans P, Schreuder F, Truijman M, van Dijk A, de Rotte A, Liem M, Daemen M, van der Steen A, Mess W, Nederkoorn P, Hendrikse J, van der Lugt A, Wildberger J, ten Cate H, van Oostenbrugge R, Kooi M. No Association between Thrombin Generation and Intra-Plaque Haemorrhage in Symptomatic Carotid Atherosclerotic Plaques: The Plaque at RISK (PARISK) Study. Thromb Haemost 2018; 118:1461-1469. [DOI: 10.1055/s-0038-1666858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background Carotid atherosclerosis is an important cause of stroke. Intra-plaque haemorrhage (IPH) on magnetic resonance imaging (MRI) increases stroke risk. Development of IPH is only partly understood. Thrombin is an essential enzyme in haemostasis. Experimental animal studies have shown conflicting results on the relation between thrombin and plaque vulnerability. We hypothesize that decreased thrombin generation (TG) is associated with IPH and plaque vulnerability.
Objective This article investigates whether TG is associated with IPH and other features of plaque vulnerability in stroke patients.
Methods Recently symptomatic stroke patients underwent carotid MRI and blood sampling. MRI plaque features include plaque burden, presence of IPH, amount of lipid-rich necrotic core (LRNC), calcified tissue and fibrous tissue (% of total wall volume). TG was assessed in platelet-poor plasma and expressed as: peak height (PH) and endogenous thrombin potential (ETP). MR images could be analysed in 224 patients. Blood samples were available in 161 of 224 patients. Binary multivariate logistic and linear regression were used to investigate the association between TG and MRI plaque features.
Results IPH and LRNC were present in 65 (40%) and 102 (63%) of plaques. There were no significant associations between TG and IPH; PH odds ratio (OR) = 1, 95% confidence interval (CI): 0.76 to 1.45 and ETP OR = 1, 95% CI: 0.73 to 1.37. After correction for age, sex and hypercholesterolaemia, the association was weak but non-significant; PH: OR = 0.76, 95% CI: 0.52 to 1.10 and ETP: OR = 0.73, 95% CI: 0.53 to 1.37.
Conclusion Features of carotid plaque on MRI show no significant association with TG in stroke patients. Systemic TG does not seem to be an important factor in IPH development.
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Affiliation(s)
- Geneviève Crombag
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Henri Spronk
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Clinical Thrombosis and Haemostasis Laboratory, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Patty Nelemans
- Department of Epidemiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Floris Schreuder
- Department of Neurology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Neurophysiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Martine Truijman
- Department of Neurology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Neurophysiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Anouk van Dijk
- Department of Radiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
- Department of Neurology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
| | - Alexandra de Rotte
- Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Madieke Liem
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Mat Daemen
- Department of Pathology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton van der Steen
- Department of Biomedical Engineering, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
| | - Werner Mess
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Neurophysiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Paul Nederkoorn
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
| | - Joachim Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Hugo ten Cate
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Clinical Thrombosis and Haemostasis Laboratory, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Robert van Oostenbrugge
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - M. Kooi
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
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Leunissen T, van Vriesland D, den Ruijter H, Moll F, Mess W, de Borst GJ. Validation of the Automated Electronic Microemboli Detection System in Patients Undergoing Carotid Endarterectomy. Ultraschall in Med 2018; 39:198-205. [PMID: 28384835 DOI: 10.1055/s-0043-106737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To assess the diagnostic value of automatic embolus detection software (AEDS) in transcranial Doppler (TCD) monitoring for the detection of solid microemboli in patients at risk for perioperative stroke during carotid endarterectomy (CEA). MATERIALS AND METHODS In 50 patients undergoing CEA, perioperative TCD registration was recorded. All recorded events, identified and saved by the AEDS, were analyzed off-line doubly by two human experts (HEs) within a time frame of > 4 months. The inter- and intraobserver variability was assessed. The overall agreement with the HEs, the sensitivity, specificity, negative and positive predictive values (NPV and PPV) of the AEDS were computed for different cut-offs (patient displaying perioperative 5, 10, 20, 25, or 50 microemboli). RESULTS 77 233 events were analyzed. The inter- and intraobserver variability was good (min κ = 0.72, max κ = 0.79). AEDS and the HEs identified 760 and 470 solid emboli, respectively. The agreement between AEDS and the HEs for solid emboli detection was poor (κ = 0.24, SE = 0.016). The specificity and NPV were high (99.2 % and 99.6 %) but the sensitivity and PPV were low (30.6 % and 19.8 %). Applying a threshold of > 20 microemboli resulted in the best sensitivity (100.0 %), specificity (84.4 %), PPV (42.7 %), NPV (100.0 %) and area under the curve (0.898). However, 58.3 % of the patients were false positive as classified by AEDS. CONCLUSION In this validation cohort, AEDS has insufficient agreement with HEs in the identification of solid emboli. AEDS and HEs disagree with respect to the identification of specific patients at risk. Therefore, AEDS cannot be used as a standalone system to identify patients at risk for perioperative stroke during CEA.
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Affiliation(s)
- Tesse Leunissen
- Vascular Surgery, University Medical Center Utrecht, Netherlands
| | | | - Hester den Ruijter
- Experimental Cardiology, University Medical Center Utrecht, Netherlands
- Neurology/Clinical Neurophysiology, Academic Hospital Maastricht, Netherlands
| | - Frans Moll
- Vascular Surgery, University Medical Center Utrecht, Netherlands
| | - Werner Mess
- Neurology/Clinical Neurophysiology, Academic Hospital Maastricht, Netherlands
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Vonk T, Hermeling E, Schreuder F, Mess W, Kooi E. 3.1 STRAIN DISCONTINUITIES IN CAROTID ATHEROSCLEROTIC PLAQUES – A NOVEL MARKER FOR PLAQUE VULNERABILITY? Artery Res 2018. [DOI: 10.1016/j.artres.2018.10.032] [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: 11/26/2022] Open
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Steinbuch J, Hermeling E, Schreuder F, Truijman M, Hoeks A, Mess W. P2.6 ARTERY DISTENSION MEASURED WITH STANDARD B-MODE IMAGE ECHO-TRACKING HAS SIMILAR ABSOLUTE VALUES AND PRECISION AS MEASURED WITH RADIO-FREQUENCY PHASE-TRACKING. Artery Res 2014. [DOI: 10.1016/j.artres.2014.09.102] [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: 11/30/2022] Open
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Schurink GWH, De Haan MW, Peppelenbosch AG, Mess W, Jacobs MJ. Spinal cord function monitoring during endovascular treatment of thoracoabdominal aneurysms: implications for staged procedures. J Cardiovasc Surg (Torino) 2013; 54:117-124. [PMID: 23443596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM Spinal cord ischemia is a well-known complication in the treatment of thoracoabdominal aneurysms (TAAA). Despite the fact that endovascular treatment of TAAA is less invasive, spinal cord ischemia rate is not reduced if compared to open repair. METHODS We report the results of our experience of spinal cord function monitoring by measuring motor evoked potentials (MEP) during endovascular treatment of TAAA type II and III. Depending on the level of the MEPs the decision is made whether to stage the procedure or not. We treated ten patients according to this protocol. RESULTS In two patients, MEPs decreased 50% or more and procedures were staged. Both experienced no neurological complications after first and second procedure. No MEPs decrease was seen during the second procedures. One of the other eight patients had a temporary right lower leg pararesis. CONCLUSION In conclusion we state that our first experience demonstrates the value of assessing spinal cord function during extensive endovascular TAAA repair with subsequent strategies to prevent paraplegia.
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Affiliation(s)
- G W H Schurink
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
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Jacobs MJ, Mess W, Mochtar B, Nijenhuis RJ, Statius van Eps RG, Schurink GWH. The value of motor evoked potentials in reducing paraplegia during thoracoabdominal aneurysm repair. J Vasc Surg 2007; 43:239-46. [PMID: 16476594 DOI: 10.1016/j.jvs.2005.09.042] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.7] [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: 06/20/2005] [Accepted: 09/13/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Paraplegia after thoracoabdominal aortic aneurysm (TAAA) repair mainly occurs in patients with Crawford extent I and II. We assessed the impact of monitoring spinal cord integrity and the subsequent adjusted surgical maneuvers on neurologic outcome in repairs of type I and II TAAAs. METHODS Surgical repair of TAAAs was performed in 112 consecutive patients with extent type I (n = 42) and type II (n = 70) aneurysms. The surgical protocol included cerebrospinal fluid drainage, moderate hypothermia, and left heart bypass with selective organ perfusion. Spinal cord function was assessed by means of monitoring motor evoked potentials (MEPs). Significant decreased MEPs always generated adjustments, including raising distal aortic and mean arterial pressure, reattachment of visible intercostal arteries, or endarterectomy of the excluded aortic segment with revascularization of back bleeding intercostal arteries. RESULTS Motor evoked potential monitoring could be achieved in all patients. By maintaining a mean distal aortic pressure of 60 mm Hg, MEPs were adequate in 82% of patients. Increasing distal aortic pressure restored MEPs in all patients. In 19 patients (17%), MEPs decreased significantly during aortic cross-clamping because of critical spinal cord ischemia. MEPs returned in all patients after spinal cord blood flow was re-established except in three patients with type II TAAA in whom MEPs could not be restored, and absent MEPs at the end of the procedure corresponded with neurologic deficit. Delayed paraplegia developed in two patients owing to hemodynamic instability with insufficient mean arterial blood pressure to maintain adequate spinal cord perfusion. CONCLUSION Monitoring MEPs is a highly reliable technique to assess spinal cord ischemia during TAAA repair. A surgical protocol including cerebrospinal fluid drainage, left heart bypass, and monitoring of MEPs can reduce the paraplegia rate significantly. Adjusted hemodynamic and surgical strategies induced by changes in MEPs could restore spinal cord ischemia in most patients, preventing early and late paraplegia in all type I patients. In type II patients, early paraplegia occurred in 4.2% and delayed neurologic deficit in 2.9%. Despite all available measures, complete prevention of paraplegia in type II aneurysms seems to be unrealistic.
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Affiliation(s)
- Michael J Jacobs
- Department of Vascular Surgery, University Hospital Aachen, The Netherlands.
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Schurink GWH, Nijenhuis RJ, Backes WH, Mess W, de Haan MW, Mochtar B, Jacobs MJ. Assessment of Spinal Cord Circulation and Function in Endovascular Treatment of Thoracic Aortic Aneurysms. Ann Thorac Surg 2007; 83:S877-81; discussion S890-2. [PMID: 17257945 DOI: 10.1016/j.athoracsur.2006.11.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 10/29/2006] [Accepted: 11/02/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND In thoracic stent graft repair, the importance of segmental artery (SA) occlusion and the role of blood pressure management during the intraoperative and directly postoperative period are not clear. To study these aspects in relation to spinal cord ischemia, our protocol in the endovascular treatment of descending thoracic aneurysms covering segmental arteries T8 and lower includes preoperative assessment of the spinal cord circulation using magnetic resonance angiography, intraoperative cerebrospinal fluid drainage, and spinal cord function monitoring using motor evoked potentials (MEPs). METHODS Thirteen patients with thoracic aortic aneurysms and dissections needing stent graft coverage of T8 and lower were included. In 9 patients, spinal cord circulation was evaluated preoperatively by magnetic resonance angiography. In 12 patients, MEPs were recorded during the endovascular procedure. A combination of both techniques was used in 8 patients. RESULTS The distal stent graft landing zone covered the intercostal arteries up to T10 in 4 patients, up to T11 in 7 patients, up to T12 in 1 patient, and all SAs to the aortic bifurcation in 1 patient. In 6 patients, the SA feeding the Adamkiewicz artery was covered by the stent graft. In three patients, intersegmental collaterals were present to the SA feeding the Adamkiewicz artery. The MEPs decreased to 50% and 30% in 2 patients, recovering to levels above 50% by elevation of the mean arterial pressure. Postoperatively, no signs of paraplegia were present. CONCLUSIONS We believe that the presence of intersegmental collaterals decreases the risk of spinal cord ischemia during endovascular thoracic aortic aneurysm repair. Monitoring of MEPs during endovascular thoracic procedures shows no decrease in most cases. However, if a decrease of MEPs occurs, this can be reversed by elevation of the mean arterial pressure.
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Affiliation(s)
- Geert Willem H Schurink
- Department of Vascular Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
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Pohlmann-Eden B, Wolf T, Mess W, Diehl RR. Psychogene Blindheit. Akt Neurol 1993. [DOI: 10.1055/s-2007-1018001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Ninety-four asymptomatic patients with internal carotid artery occlusion were followed for a mean of 44 months, 16% suffered strokes and 11.7% reported transient ischemic attacks (TIA). The annual stroke and TIA rates were 4.4% and 3.2%, respectively, the annual mortality was 11.3%. In 27 asymptomatic patients progression of extracranial arterial disease to occlusion was observed: 7.4% of these patients suffered from stroke and 18.5% reported TIA's during that period. Thus the annual stroke rate was lower (1.9%) but the TIA rate higher (4.7%) than post-occlusive rates. These data reflect an increase risk in patients with progressive high-degree carotid stenosis which continues after occlusion. This may favour carotid endarterectomy for selected patients in the pre-occlusive state because medical treatment has not been shown to prevent progression of stenosis to occlusion.
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Affiliation(s)
- W Rautenberg
- Department of Neurology, Klinikum Mannheim, University of Heidelberg, F.R.G
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