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Diestro JDB, Adeeb N, Musmar B, Salim H, Aslan A, Cancelliere NM, McLellan RM, Algin O, Ghozy S, Lay SV, Guenego A, Renieri L, Carnevale J, Saliou G, Mastorakos P, El Naamani K, Shotar E, Premat K, Möhlenbruch M, Kral M, Bernstock JD, Doron O, Chung C, Salem MM, Lylyk I, Foreman PM, Vachhani JA, Shaikh H, Župančić V, Hafeez MU, Catapano J, Waqas M, Ibrahim MK, Mohammed MA, Imamoglu C, Bayrak A, Rabinov JD, Ren Y, Schirmer CM, Piano M, Kühn AL, Michelozzi C, Elens S, Starke RM, Hassan AE, Ogilvie M, Nguyen A, Jones J, Brinjikji W, Nawka MT, Psychogios M, Ulfert C, Pukenas B, Burkhardt JK, Huynh T, Martinez-Gutierrez JC, Essibayi MA, Sheth SA, Spiegel G, Tawk RG, Lubicz B, Panni P, Puri AS, Pero G, Nossek E, Raz E, Killer-Oberpfalzer M, Griessenauer CJ, Asadi H, Siddiqui A, Brook AL, Altschul D, Spears J, Marotta TR, Ducruet AF, Albuquerque FC, Regenhardt RW, Stapleton CJ, Kan P, Kalousek V, Lylyk P, Boddu S, Knopman J, Aziz-Sultan MA, Tjoumakaris SI, Jabbour PM, Clarençon F, Limbucci N, Cuellar-Saenz HH, Mendes Pereira V, Patel AB, Dmytriw AA. Association of preprocedural antiplatelet use with decreased thromboembolic complications for intracranial aneurysms undergoing intrasaccular flow disruption. J Neurosurg 2024:1-8. [PMID: 38701528 DOI: 10.3171/2024.2.jns232918] [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: 12/20/2023] [Accepted: 02/23/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE This study was conducted to investigate the impact of antiplatelet administration in the periprocedural period on the occurrence of thromboembolic complications (TECs) in patients undergoing treatment using the Woven EndoBridge (WEB) device for intracranial wide-necked bifurcation aneurysms. The primary objective was to assess whether the use of antiplatelets in the pre- and postprocedural phases reduces the likelihood of developing TECs, considering various covariates. METHODS A retrospective multicenter observational study was conducted within the WorldWideWEB Consortium and comprised 38 academic centers with endovascular treatment capabilities. Univariable and multivariable logistic regression analyses were performed to determine the association between antiplatelet use and TECs, adjusting for covariates. Missing predictor data were addressed using multiple imputation. RESULTS The study comprised two cohorts: one addressing general thromboembolic events and consisting of 1412 patients, among whom 103 experienced TECs, and another focusing on symptomatic thromboembolic events and comprising 1395 patients, of whom 50 experienced symptomatic TECs. Preprocedural antiplatelet use was associated with a reduced likelihood of overall TECs (OR 0.32, 95% CI 0.19-0.53, p < 0.001) and symptomatic TECs (OR 0.49, 95% CI 0.25-0.95, p = 0.036), whereas postprocedural antiplatelet use showed no significant association with TECs. The study also revealed additional predictors of TECs, including stent use (overall: OR 4.96, 95% CI 2.38-10.3, p < 0.001; symptomatic: OR 3.24, 95% CI 1.26-8.36, p = 0.015), WEB single-layer sphere (SLS) type (overall: OR 0.18, 95% CI 0.04-0.74, p = 0.017), and posterior circulation aneurysm location (symptomatic: OR 18.43, 95% CI 1.48-230, p = 0.024). CONCLUSIONS The findings of this study suggest that the preprocedural administration of antiplatelets is associated with a reduced likelihood of TECs in patients undergoing treatment with the WEB device for wide-necked bifurcation aneurysms. However, postprocedural antiplatelet use did not show a significant impact on TEC occurrence.
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Affiliation(s)
- Jose Danilo Bengzon Diestro
- 1Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Nimer Adeeb
- 2Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, Louisiana
| | - Basel Musmar
- 2Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, Louisiana
| | - Hamza Salim
- 2Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, Louisiana
| | - Assala Aslan
- 2Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, Louisiana
| | - Nicole M Cancelliere
- 1Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Rachel M McLellan
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Oktay Algin
- 4Ankara University, Medical Faculty, Department of Radiology, Ankara, Turkey
| | | | - Sovann V Lay
- 6Service de Neuroradiologie Diagnostique et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Adrien Guenego
- 7Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Bruxelles, Belgique
| | - Leonardo Renieri
- 8Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Joseph Carnevale
- 9Neurosurgery & Interventional Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York
| | - Guillaume Saliou
- 10Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Panagiotis Mastorakos
- 11Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kareem El Naamani
- 11Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Eimad Shotar
- 12Département de Neuroradiologie, Hôpital Pitié-Salpêtrière, Université Sorbonne, Paris, France
| | - Kevin Premat
- 12Département de Neuroradiologie, Hôpital Pitié-Salpêtrière, Université Sorbonne, Paris, France
| | - Markus Möhlenbruch
- 13Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Germany
| | - Michael Kral
- 14Department of Neurosurgery, Christian Doppler University Hospital and Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Joshua D Bernstock
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Omer Doron
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Charlotte Chung
- Departments of15Radiology and
- 39Neurosurgery, NYU Langone Health Center, New York, New York
| | - Mohamed M Salem
- 16Department of Neurosurgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Ivan Lylyk
- 17Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Paul M Foreman
- 18Department of Neurosurgery, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, Florida
| | - Jay A Vachhani
- 18Department of Neurosurgery, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, Florida
| | - Hamza Shaikh
- Departments of19Radiology and
- 40Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Vedran Župančić
- 20Department of Radiology, Subdivision of Interventional Neuroradiology, Clinical Hospital Center Sisters of Mercy, Zagreb, Croatia
| | - Muhammad U Hafeez
- 21Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, Texas
| | - Joshua Catapano
- 22Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Muhammad Waqas
- 23Department of Neurosurgery, State University of New York at Buffalo, New York
| | - Mohamed K Ibrahim
- Departments of5Radiology and
- 38Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Marwa A Mohammed
- Departments of5Radiology and
- 38Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Cetin Imamoglu
- 37Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital of the Ministry of Health, Ankara, Turkey
| | - Ahmet Bayrak
- 37Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital of the Ministry of Health, Ankara, Turkey
| | - James D Rabinov
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Yifan Ren
- 24Department of Radiology, Interventional Radiology and Neurointerventional Services, Austin Health, Melbourne, Victoria, Australia
| | - Clemens M Schirmer
- Departments of25Neurosurgery and
- 41Radiology, Geisinger Hospital, Danville, Pennsylvania
| | - Mariangela Piano
- 26Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milano, Italy
| | - Anna L Kühn
- 27Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, Massachusetts
| | | | - Stéphanie Elens
- 8Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | | | - Ameer E Hassan
- 30Department of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, Texas
| | - Mark Ogilvie
- Departments of31Neurosurgery and
- 42Radiology, University of Alabama at Birmingham, Alabama
| | - Anh Nguyen
- 32Department of Neuroradiology, University Hospital of Basel, Switzerland
| | - Jesse Jones
- Departments of31Neurosurgery and
- 42Radiology, University of Alabama at Birmingham, Alabama
| | - Waleed Brinjikji
- Departments of5Radiology and
- 38Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Marie T Nawka
- 33Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios Psychogios
- 32Department of Neuroradiology, University Hospital of Basel, Switzerland
| | - Christian Ulfert
- 13Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Germany
| | - Bryan Pukenas
- 16Department of Neurosurgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Jan-Karl Burkhardt
- 16Department of Neurosurgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Thien Huynh
- Departments of34Radiology and
- 43Neurosurgery, Mayo Clinic, Jacksonville, Florida
| | | | - Muhammed Amir Essibayi
- 36Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; and
| | - Sunil A Sheth
- Departments of35Radiology
- 44Neurology, and
- 45Neurosurgery, University of Texas Health Science Center at Houston, Texas
| | - Gary Spiegel
- Departments of35Radiology
- 44Neurology, and
- 45Neurosurgery, University of Texas Health Science Center at Houston, Texas
| | - Rabih G Tawk
- Departments of34Radiology and
- 43Neurosurgery, Mayo Clinic, Jacksonville, Florida
| | - Boris Lubicz
- 8Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Pietro Panni
- 28Interventistica Neurovascolare, Ospedale San Raffaele, Milano, Italy
| | - Ajit S Puri
- 27Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, Massachusetts
| | - Guglielmo Pero
- 26Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milano, Italy
| | - Erez Nossek
- Departments of15Radiology and
- 39Neurosurgery, NYU Langone Health Center, New York, New York
| | - Eytan Raz
- Departments of15Radiology and
- 39Neurosurgery, NYU Langone Health Center, New York, New York
| | - Monika Killer-Oberpfalzer
- 14Department of Neurosurgery, Christian Doppler University Hospital and Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Christoph J Griessenauer
- 14Department of Neurosurgery, Christian Doppler University Hospital and Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Hamed Asadi
- Departments of15Radiology and
- 39Neurosurgery, NYU Langone Health Center, New York, New York
| | - Adnan Siddiqui
- 23Department of Neurosurgery, State University of New York at Buffalo, New York
| | - Allan L Brook
- 36Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; and
| | - David Altschul
- 36Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; and
| | - Julian Spears
- 1Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Thomas R Marotta
- 1Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Andrew F Ducruet
- 22Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Robert W Regenhardt
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Christopher J Stapleton
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Peter Kan
- 21Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, Texas
| | - Vladimir Kalousek
- 20Department of Radiology, Subdivision of Interventional Neuroradiology, Clinical Hospital Center Sisters of Mercy, Zagreb, Croatia
| | - Pedro Lylyk
- 17Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Srikanth Boddu
- 10Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jared Knopman
- 9Neurosurgery & Interventional Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York
| | - Mohammad A Aziz-Sultan
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | | | - Pascal M Jabbour
- 11Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Frédéric Clarençon
- 12Département de Neuroradiologie, Hôpital Pitié-Salpêtrière, Université Sorbonne, Paris, France
| | - Nicola Limbucci
- 9Neurosurgery & Interventional Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York
| | - Hugo H Cuellar-Saenz
- 1Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- 1Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Aman B Patel
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Adam A Dmytriw
- 3Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
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2
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Diestro JDB, Dibas M, Adeeb N, Regenhardt RW, Vranic JE, Guenego A, Lay SV, Renieri L, Balushi AA, Shotar E, Premat K, Namaani KE, Saliou G, Möhlenbruch MA, Lylyk I, Foreman PM, Vachhani JA, Župančić V, Hafeez MU, Rutledge C, Rai H, Tutino VM, Mirshahi S, Ghozy S, Harker P, Alotaibi NM, Rabinov JD, Ren Y, Schirmer CM, Goren O, Piano M, Kühn AL, Michelozzi C, Elens S, Starke RM, Hassan AE, Salehani A, Nguyen A, Jones J, Psychogios M, Spears J, Marotta T, Pereira V, Parra-Fariñas C, Bres-Bullrich M, Mayich M, Salem MM, Burkhardt JK, Jankowitz BT, Domingo RA, Huynh T, Tawk R, Ulfert C, Lubicz B, Panni P, Puri AS, Pero G, Griessenauer CJ, Asadi H, Siddiqui A, Ducruet AF, Albuquerque FC, Patel N, Kan P, Kalousek V, Lylyk P, Boddu S, Stapleton CJ, Knopman J, Jabbour P, Tjoumakaris S, Clarençon F, Limbucci N, Aziz-Sultan MA, Cuellar-Saenz HH, Cognard C, Patel AB, Dmytriw AA. Stent-assisted Woven EndoBridge device for the treatment of intracranial aneurysms: an international multicenter study. J Neurosurg 2024; 140:1071-1079. [PMID: 37862717 DOI: 10.3171/2023.8.jns235] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 08/14/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE The Woven EndoBridge (WEB) device is an intrasaccular flow disruptor designed for wide-necked bifurcation aneurysms. These aneurysms may require the use of a concomitant stent. The objective of this study was to determine the clinical and radiological outcomes of patients undergoing stent-assisted WEB treatment. In addition, the authors also sought to determine the predictors of a concomitant stent in aneurysms treated with the WEB device. METHODS The data for this study were taken from the WorldWideWEB Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups based on treatment: stent-assisted WEB and WEB device alone. The authors compared clinical and radiological outcomes of both groups. Univariable and multivariable binary logistic regression analyses were performed to determine factors that predispose to stent use. RESULTS The study included 691 intracranial aneurysms (31 with stents and 660 without stents) treated with the WEB device. The adequate occlusion status did not differ between the two groups at the latest follow-up (83.3% vs 85.6%, p = 0.915). Patients who underwent stenting had more thromboembolic (32.3% vs 6.5%, p < 0.001) and procedural (16.1% vs 3.0%, p < 0.001) complications. Aneurysms treated with a concomitant stent had wider necks, greater heights, and lower dome-to-neck ratios. Increasing neck size was the only significant predictor for stent use. CONCLUSIONS This study demonstrates that there is no difference in the degree of aneurysm occlusion between the two groups; however, complications were more frequent in the stent group. In addition, a wider aneurysm neck predisposes to stent assistance in WEB-treated aneurysms.
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Affiliation(s)
- Jose Danilo Bengzon Diestro
- 1Department of Radiology, Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Mahmoud Dibas
- 2Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nimer Adeeb
- 3Department of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, Louisiana
| | - Robert W Regenhardt
- 4Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Justin E Vranic
- 4Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Adrien Guenego
- 5Interventional Neuroradiology Department, Erasmus University Hospital, Brussels, Belgium
| | - Sovann V Lay
- 6Diagnostic and Therapeutic Neuroradiology Department, Toulouse Hospital Center, Purpan Hospital, Toulouse, France
| | - Leonardo Renieri
- 7Neurovascular Intervention, Careggi Hospital of Florence, Florence, Italy
| | - Ali Al Balushi
- 8Neurosurgery & Interventional Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York
| | - Eimad Shotar
- 9Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France
| | - Kévin Premat
- 9Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France
| | - Kareem El Namaani
- 10Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Guillaume Saliou
- 11Department of diagnostic Radiology and Interventional Radiology, Vaudois Hospital Center of Lausanne, Lausanne, Switzerland
| | - Markus A Möhlenbruch
- 12Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ivan Lylyk
- 13Endovascular Neurosurgery and Interventional Radiology Team, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | - Paul M Foreman
- 14Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, Florida
| | - Jay A Vachhani
- 14Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, Florida
| | - Vedran Župančić
- 15Department of Radiology, Subdivision of Interventional Neuroradiology, Clinical Hospital Center "Sisters of Mercy", Zagreb, Croatia
| | - Muhammad U Hafeez
- 16Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, Texas
| | - Caleb Rutledge
- 17Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Hamid Rai
- 18Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York
| | - Vincent M Tutino
- 18Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York
| | - Shervin Mirshahi
- 2Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sherief Ghozy
- 19Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota
| | - Pablo Harker
- 4Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Naif M Alotaibi
- 4Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - James D Rabinov
- 4Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Yifan Ren
- 20Department of Radiology, Interventional Radiology and Neurointerventional Services, Austin Health, Melbourne, Australia
| | | | - Oded Goren
- 22Department of Neurosurgery, Geisinger, Danville, Pennsylvania
| | - Mariangela Piano
- 23Neuroradiology, ASST Great Metropolitan Hospital, Niguarda, Milan, Italy
| | - Anna L Kühn
- 24Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, Massachusetts
| | | | - Stéphanie Elens
- 5Interventional Neuroradiology Department, Erasmus University Hospital, Brussels, Belgium
| | | | - Ameer E Hassan
- 27Department of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, Texas
| | - Arsalaan Salehani
- 28Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Anh Nguyen
- 29Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Switzerland
| | - Jesse Jones
- 28Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Marios Psychogios
- 29Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Switzerland
| | - Julian Spears
- 1Department of Radiology, Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Thomas Marotta
- 1Department of Radiology, Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Vitor Pereira
- 1Department of Radiology, Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Carmen Parra-Fariñas
- 1Department of Radiology, Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Maria Bres-Bullrich
- 30Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Michael Mayich
- 31Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mohamed M Salem
- 32Department of Neurosurgery, University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania
| | - Jan-Karl Burkhardt
- 32Department of Neurosurgery, University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania
| | - Brian T Jankowitz
- 32Department of Neurosurgery, University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania
| | - Ricardo A Domingo
- 33Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Thien Huynh
- 33Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Rabih Tawk
- 33Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Christian Ulfert
- 12Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Boris Lubicz
- 5Interventional Neuroradiology Department, Erasmus University Hospital, Brussels, Belgium
| | - Pietro Panni
- 25Neurovascular Intervention, San Raffaele Hospital, Milan, Italy
| | - Ajit S Puri
- 24Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, Massachusetts
| | - Guglielmo Pero
- 34Neurovascular Intervention, Niguarda Cà Granda Hospital, Milano, Italy
| | - Christoph J Griessenauer
- 35Department of Neurosurgery, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria; and
- 36Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Hamed Asadi
- 20Department of Radiology, Interventional Radiology and Neurointerventional Services, Austin Health, Melbourne, Australia
| | - Adnan Siddiqui
- 18Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York
| | - Andrew F Ducruet
- 17Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Nirav Patel
- 2Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peter Kan
- 16Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, Texas
| | - Vladimir Kalousek
- 15Department of Radiology, Subdivision of Interventional Neuroradiology, Clinical Hospital Center "Sisters of Mercy", Zagreb, Croatia
| | - Pedro Lylyk
- 13Endovascular Neurosurgery and Interventional Radiology Team, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | - Srikanth Boddu
- 8Neurosurgery & Interventional Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York
| | - Christopher J Stapleton
- 4Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Jared Knopman
- 8Neurosurgery & Interventional Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York
| | - Pascal Jabbour
- 10Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Frédéric Clarençon
- 9Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France
| | - Nicola Limbucci
- 7Neurovascular Intervention, Careggi Hospital of Florence, Florence, Italy
| | - Mohammad A Aziz-Sultan
- 2Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hugo H Cuellar-Saenz
- 3Department of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, Louisiana
| | - Christophe Cognard
- 6Diagnostic and Therapeutic Neuroradiology Department, Toulouse Hospital Center, Purpan Hospital, Toulouse, France
| | - Aman B Patel
- 4Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Adam A Dmytriw
- 2Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- 4Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
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Dittrich TD, von Streng T, Toebak AM, Zietz A, Wagner B, Hänsel M, Sutter R, Katan M, Peters N, Michels L, Kulcsár Z, Karwacki GM, Pileggi M, Cereda CW, Wegener S, Bonati LH, Psychogios M, De Marchis GM. Absent leptomeningeal collateralization is associated with greatest benefit from mechanical thrombectomy in the 6-24 hour time window. Eur Stroke J 2024:23969873241239208. [PMID: 38497536 DOI: 10.1177/23969873241239208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION The impact of leptomeningeal collateralization on the efficacy of mechanical thrombectomy (MT) in patients with anterior circulation large vessel occlusion (aLVO) presenting in the 6-24 h time window remains poorly elucidated. PATIENTS AND METHODS Retrospective multicenter study of aLVO patients presenting between 6 and 24 h after stroke onset who received MT plus Best Medical Treatment (BMT) or BMT alone. Leptomeningeal collateralization was assessed using single-phase computed tomography angiography (grade 0: no filling; grade 1: filling ⩽50%; grade 2: filling >50% but <100%; grade 3: filling 100% of the occluded territory). Inverse probability of treatment weighted ordinal regression was performed to assess the association between treatment and shift of the modified Rankin Scale (mRS) score toward lower categories at 3 months. We used interaction analysis to explore differential treatment effects on functional outcomes (probabilities for each mRS subcategory at 3 months) at different collateral grades. RESULTS Among 363 included patients, 62% received MT + BMT. Better collateralization was associated with better functional outcomes at 3 months in the BMT alone group (collateral grade 1 vs 0: acOR 5.06, 95% CI 2.33-10.99). MT + BMT was associated with higher odds of favorable functional outcome at 3 months (acOR 1.70, 95% CI 1.11-2.62) which was consistent after adjustment for collateral status (acOR 1.54, 95% CI 1.01-2.35). Regarding treatment effect modification, patients with absent collateralization had higher probabilities for a mRS of 0-4 and a lower mortality at 3 months for the MT + BMT group. DISCUSSION AND CONCLUSION In the 6-to-24-h time window, aLVO patients with absent leptomeningeal collateralization benefit most from MT + BMT, indicating potential advantages for this group despite their poorer baseline prognosis.
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Affiliation(s)
- Tolga D Dittrich
- Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Tennessee von Streng
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Anna M Toebak
- Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Annaelle Zietz
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Benjamin Wagner
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Martin Hänsel
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Raoul Sutter
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Intensive Care Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Medical Faculty, University Hospital Basel, Basel, Switzerland
| | - Mira Katan
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Medical Faculty, University Hospital Basel, Basel, Switzerland
| | - Nils Peters
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Neurology and Stroke Center, Hirslanden Hospital Zurich, Zurich, Switzerland
| | - Lars Michels
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Zsolt Kulcsár
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Grzegorz M Karwacki
- Department of Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Marco Pileggi
- Department of Neuroradiology EOC, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Carlo W Cereda
- Department of Neurology and Stroke Center EOC, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Rheinfelden Rehabilitation Clinic, Rheinfelden, Switzerland
| | - Marios Psychogios
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Medical Faculty, University Hospital Basel, Basel, Switzerland
- Department of Neuroradiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Medical Faculty, University Hospital Basel, Basel, Switzerland
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4
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Dmytriw AA, Salim H, Musmar B, Aslan A, Cancelliere NM, McLellan RM, Algin O, Ghozy S, Dibas M, Lay SV, Guenego A, Renieri L, Carnevale J, Saliou G, Mastorakos P, Naamani KE, Shotar E, Premat K, Möhlenbruch M, Kral M, Doron O, Chung C, Salem MM, Lylyk I, Foreman PM, Vachhani JA, Shaikh H, Župančić V, Hafeez MU, Catapano J, Waqas M, Tutino VM, Ibrahim MK, Mohammed MA, Imamoglu C, Bayrak A, Rabinov JD, Ren Y, Schirmer CM, Piano M, Kühn AL, Michelozzi C, Elens S, Starke RM, Hassan AE, Ogilvie M, Sporns P, Jones J, Brinjikji W, Nawka MT, Psychogios M, Ulfert C, Diestro JDB, Pukenas B, Burkhardt JK, Huynh T, Martinez-Gutierrez JC, Essibayi MA, Sheth SA, Spiegel G, Tawk R, Lubicz B, Panni P, Puri AS, Pero G, Nossek E, Raz E, Killer-Oberfalzer M, Griessenauer CJ, Asadi H, Siddiqui A, Brook AL, Altschul D, Ducruet AF, Albuquerque FC, Regenhardt RW, Stapleton CJ, Kan P, Kalousek V, Lylyk P, Boddu S, Knopman J, Aziz-Sultan MA, Tjoumakaris SI, Clarençon F, Limbucci N, Cuellar-Saenz HH, Jabbour PM, Pereira VM, Patel AB, Adeeb N. Dual Layer vs Single Layer Woven EndoBridge Device in the Treatment of Intracranial Aneurysms: A Propensity Score-Matched Analysis. Neurosurg Rev 2024; 47:116. [PMID: 38483647 DOI: 10.1007/s10143-024-02341-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/26/2024] [Accepted: 03/03/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND The Woven EndoBridge (WEB) devices have been used for treating wide neck bifurcation aneurysms (WNBAs) with several generational enhancements to improve clinical outcomes. The original device dual-layer (WEB DL) was replaced by a single-layer (WEB SL) device in 2013. This study aimed to compare the effectiveness and safety of these devices in managing intracranial aneurysms. METHODS A multicenter cohort study was conducted, and data from 1,289 patients with intracranial aneurysms treated with either the WEB SL or WEB DL devices were retrospectively analyzed. Propensity score matching was utilized to balance the baseline characteristics between the two groups. Outcomes assessed included immediate occlusion rate, complete occlusion at last follow-up, retreatment rate, device compaction, and aneurysmal rupture. RESULTS Before propensity score matching, patients treated with the WEB SL had a significantly higher rate of complete occlusion at the last follow-up and a lower rate of retreatment. After matching, there was no significant difference in immediate occlusion rate, retreatment rate, or device compaction between the WEB SL and DL groups. However, the SL group maintained a higher rate of complete occlusion at the final follow-up. Regression analysis showed that SL was associated with higher rates of complete occlusion (OR: 0.19; CI: 0.04 to 0.8, p = 0.029) and lower rates of retreatment (OR: 0.12; CI: 0 to 4.12, p = 0.23). CONCLUSION The WEB SL and DL devices demonstrated similar performances in immediate occlusion rates and retreatment requirements for intracranial aneurysms. The SL device showed a higher rate of complete occlusion at the final follow-up.
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Affiliation(s)
- Adam A Dmytriw
- Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA.
| | - Hamza Salim
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Basel Musmar
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Assala Aslan
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Nicole M Cancelliere
- Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Rachel M McLellan
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Oktay Algin
- Medical Faculty, Department of Radiology, Ankara University, Ankara, Turkey
| | - Sherief Ghozy
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Mahmoud Dibas
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Sovann V Lay
- Service de Neuroradiologie Diagnostique Et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Adrien Guenego
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Brussels, Belgique
| | - Leonardo Renieri
- Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy
| | - Joseph Carnevale
- Neurosurgery & Interventional Neuroradiology, Weill Cornell School of Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Guillaume Saliou
- Service de Radiodiagnostic Et Radiologie Interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland
| | | | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eimad Shotar
- Department de Neuroradiologie, Hôpital Pitié-Salpêtrière. Université Sorbonne, Paris, France
| | - Kevin Premat
- Department de Neuroradiologie, Hôpital Pitié-Salpêtrière. Université Sorbonne, Paris, France
| | - Markus Möhlenbruch
- Sektion Vaskuläre Und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Michael Kral
- Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Omer Doron
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Charlotte Chung
- Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA
| | - Mohamed M Salem
- Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania, PA, USA
| | - Ivan Lylyk
- Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Paul M Foreman
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA
| | - Jay A Vachhani
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA
| | - Hamza Shaikh
- Departments of Radiology & Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Vedran Župančić
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Muhammad U Hafeez
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, USA
| | - Joshua Catapano
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Muhammad Waqas
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Vincent M Tutino
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Mohamed K Ibrahim
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Marwa A Mohammed
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Cetin Imamoglu
- Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital of the Ministry of Health, Ankara, Turkey
| | - Ahmet Bayrak
- Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital of the Ministry of Health, Ankara, Turkey
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Yifan Ren
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, VIC, Australia
| | - Clemens M Schirmer
- Department of Neurosurgery and Radiology, Geisinger Health System, Danville, PA, USA
| | - Mariangela Piano
- Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Anna L Kühn
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA, USA
| | | | - Stéphanie Elens
- Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy
| | - Robert M Starke
- Deparment of Neurosurgery, University of Miami, Miami, FL, USA
| | - Ameer E Hassan
- Deparment of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX, USA
| | - Mark Ogilvie
- Deparments of Neurosurgery and Radiology, University of Alabama, Birmingham, AL, USA
| | - Peter Sporns
- Department of Interventional Neuroradiology, Interventional Neuroradiology, University Hospital of Basel, Basel, Switzerland
| | - Jesse Jones
- Deparments of Neurosurgery and Radiology, University of Alabama, Birmingham, AL, USA
| | - Waleed Brinjikji
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Marie T Nawka
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios Psychogios
- Department of Interventional Neuroradiology, Interventional Neuroradiology, University Hospital of Basel, Basel, Switzerland
| | - Christian Ulfert
- Sektion Vaskuläre Und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jose Danilo Bengzon Diestro
- Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Bryan Pukenas
- Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania, PA, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University of Pennsylvania Medical Center, Pennsylvania, PA, USA
| | - Thien Huynh
- Departments of Radiology and Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Juan Carlos Martinez-Gutierrez
- Departments of Radiology, Neurology, and Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Muhammed Amir Essibayi
- Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sunil A Sheth
- Departments of Radiology, Neurology, and Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gary Spiegel
- Departments of Radiology, Neurology, and Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rabih Tawk
- Departments of Radiology and Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Boris Lubicz
- Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy
| | - Pietro Panni
- Interventistica Neurovascolare, Ospedale San Raffaele Milano, Milan, Italy
| | - Ajit S Puri
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA, USA
| | - Guglielmo Pero
- Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Erez Nossek
- Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA
| | - Eytan Raz
- Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA
| | - Monika Killer-Oberfalzer
- Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Christoph J Griessenauer
- Department of Neurosurgery, Christian Doppler University Hospital & Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Hamed Asadi
- Departments of Radiology & Neurosurgery, NYU Langone Health Center, New York, NY, USA
| | - Adnan Siddiqui
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Allan L Brook
- Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David Altschul
- Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | | | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Peter Kan
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, USA
| | - Vladimir Kalousek
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Pedro Lylyk
- Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Srikanth Boddu
- Service de Radiodiagnostic Et Radiologie Interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland
| | - Jared Knopman
- Neurosurgery & Interventional Neuroradiology, Weill Cornell School of Medicine, New York Presbyterian Hospital, New York, NY, USA
| | | | | | - Frédéric Clarençon
- Department de Neuroradiologie, Hôpital Pitié-Salpêtrière. Université Sorbonne, Paris, France
| | - Nicola Limbucci
- Neurosurgery & Interventional Neuroradiology, Weill Cornell School of Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Hugo H Cuellar-Saenz
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
| | - Pascal M Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vitor Mendes Pereira
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA
| | - Nimer Adeeb
- Departement of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, LA, USA
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Sporns PB, Psychogios M, Blackham K, Zech C, Wildgruber M, Takes M. Ultrasonography-guided radiofrequency ablation of vascular malformations-The moving shot technique. Front Med (Lausanne) 2024; 10:1345904. [PMID: 38283038 PMCID: PMC10811020 DOI: 10.3389/fmed.2023.1345904] [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: 11/28/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024] Open
Abstract
Purpose To describe a novel ultrasound-guided technique for percutaneous radiofrequency ablation of vascular malformations-the "moving shot technique." Methods Preliminary observational cohort study, conducted from June 1, 2019, to January 31, 2021, including all consecutive patients diagnosed with vascular malformations who were treated with ultrasound-guided radiofrequency ablation using the moving shot technique. Only patients who had undergone at least one unsuccessful previous treatment were included (sclerotherapy with ethanol/aethoxysklerol or embolization/surgery). Results Eight patients with a median age of 22 years (interquartile range, 13-31) were included. Patients had different vascular malformations consisting of 1 arteriovenous malformation, 4 venous malformations, and 1 each a mixed venous-lymphatic malformation, a glomuvenous malformation and a FAVA (fibroadipose vascular anomaly). Malformations were located at the limbs in 5 patients (62.5%), the subcutaneous/intramuscular tissue of the body in 2 patients (25%) and at the chin in 1 patient (12.5%). Clinical symptoms were pain in 8 patients (100%), swelling in 6 patients (75%), and partial immobility in 4 patients (50%). All patients showed an improvement of clinical symptoms after treatment with 7 (87.5%) being completely asymptomatic and 1 (12.5%) showing improvement of immobility and pain. No procedural complications, such as nerve damage or skin burns occurred. Conclusion The moving shot technique using ultrasonography-guided radiofrequency ablation is a promising technique for the interventional treatment of vascular malformations and should be validated in multicenter-approaches.
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Affiliation(s)
- Peter B. Sporns
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Radiology and Neuroradiology, Stadtspital Zürich, Zürich, Switzerland
| | - Marios Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristine Blackham
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Zech
- Department of Interventional Radiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Moritz Wildgruber
- Department of Radiology, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Martin Takes
- Department of Interventional Radiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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6
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Goeldlin MB, Mueller M, Siepen BM, Zhang W, Ozkan H, Locatelli M, Du Y, Valenzuela W, Radojewski P, Hakim A, Kaesmacher J, Meinel TR, Clénin L, Branca M, Strambo D, Fischer T, Medlin F, Peters N, Carrera E, Lovblad KO, Karwacki GM, Cereda CW, Niederhauser J, Mono ML, Mueller A, Wegener S, Sartoretti S, Polymeris AA, Altersberger V, Katan M, Psychogios M, Sturzenegger R, Nauer C, Schaerer M, Buitrago Tellez C, Renaud S, Minkner Klahre K, Z'Graggen WJ, Bervini D, Bonati LH, Wiest R, Arnold M, Simister RJ, Wilson D, Jäger HR, Fischer U, Werring DJ, Seiffge DJ. CADMUS: A Novel MRI-Based Classification of Spontaneous Intracerebral Hemorrhage Associated With Cerebral Small Vessel Disease. Neurology 2024; 102:e207977. [PMID: 38165372 PMCID: PMC10834115 DOI: 10.1212/wnl.0000000000207977] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/04/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cerebral small vessel disease (SVD) is the major cause of intracerebral hemorrhage (ICH). There is no comprehensive, easily applicable classification of ICH subtypes according to the presumed underlying SVD using MRI. We developed an MRI-based classification for SVD-related ICH. METHODS We performed a retrospective study in the prospectively collected Swiss Stroke Registry (SSR, 2013-2019) and the Stroke InvestiGation in North And central London (SIGNAL) cohort. Patients with nontraumatic, SVD-related ICH and available MRI within 3 months were classified as Cerebral Amyloid angiopathy (CAA), Deep perforator arteriopathy (DPA), Mixed CAA-DPA, or Undetermined SVD using hemorrhagic and nonhemorrhagic MRI markers (CADMUS classification). The primary outcome was inter-rater reliability using Gwet's AC1. Secondary outcomes were recurrent ICH/ischemic stroke at 3 months according to the CADMUS phenotype. We performed Firth penalized logistic regressions and competing risk analyses. RESULTS The SSR cohort included 1,180 patients (median age [interquartile range] 73 [62-80] years, baseline NIH Stroke Scale 6 [2-12], 45.6% lobar hematoma, systolic blood pressure on admission 166 [145-185] mm Hg). The CADMUS phenotypes were as follows: mixed CAA-DPA (n = 751 patients, 63.6%), undetermined SVD (n = 203, 17.2%), CAA (n = 154, 13.1%), and DPA (n = 72, 6.3%), with a similar distribution in the SIGNAL cohort (n = 313). Inter-rater reliability was good (Gwet's AC1 for SSR/SIGNAL 0.69/0.74). During follow-up, 56 patients had 57 events (28 ICH, 29 ischemic strokes). Three-month event rates were comparable between the CADMUS phenotypes. DISCUSSION CADMUS, a novel MRI-based classification for SVD-associated ICH, is feasible and reproducible and may improve the classification of ICH subtypes in clinical practice and research.
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Affiliation(s)
- Martina B Goeldlin
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Madlaine Mueller
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Bernhard M Siepen
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Wenpeng Zhang
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Hatice Ozkan
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Martina Locatelli
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Yang Du
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Waldo Valenzuela
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Piotr Radojewski
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Arsany Hakim
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Johannes Kaesmacher
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Thomas R Meinel
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Leander Clénin
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Mattia Branca
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Davide Strambo
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Tim Fischer
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Friedrich Medlin
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Nils Peters
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Emmanuel Carrera
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Karl-Olof Lovblad
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Grzegorz M Karwacki
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Carlo W Cereda
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Julien Niederhauser
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Marie-Luise Mono
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Achim Mueller
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Susanne Wegener
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Sabine Sartoretti
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Alexandros A Polymeris
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Valerian Altersberger
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Mira Katan
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Marios Psychogios
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Rolf Sturzenegger
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Claude Nauer
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Michael Schaerer
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Carlos Buitrago Tellez
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Susanne Renaud
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Katharina Minkner Klahre
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Werner J Z'Graggen
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - David Bervini
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Leo H Bonati
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Roland Wiest
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Marcel Arnold
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Robert J Simister
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Duncan Wilson
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Hans Rolf Jäger
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Urs Fischer
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - David J Werring
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - David J Seiffge
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
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Dmytriw AA, Dibas M, Ghozy S, Adeeb N, Diestro JDB, Phan K, Cuellar-Saenz HH, Sweid A, Lay SV, Guenego A, Renieri L, Al Balushi A, Saliou G, Möhlenbruch M, Regenhardt RW, Vranic JE, Lylyk I, Foreman PM, Vachhani JA, Župančić V, Hafeez MU, Rutledge C, Waqas M, Tutino VM, Rabinov JD, Ren Y, Schirmer CM, Piano M, Kühn AL, Michelozzi C, Elens S, Starke RM, Hassan A, Salehani A, Sporns P, Jones J, Psychogios M, Spears J, Lubicz B, Panni P, Puri AS, Pero G, Griessenauer CJ, Asadi H, Stapleton CJ, Siddiqui A, Ducruet AF, Albuquerque FC, Du R, Kan P, Kalousek V, Lylyk P, Boddu S, Tjoumakaris S, Jared Knopman, Aziz-Sultan MA, Limbucci N, Jabbour P, Cognard C, Patel AB. Correction to: The Woven EndoBridge (WEB) Device for the Treatment of Intracranial Aneurysms: Ten Years of Lessons Learned and Adjustments in Practice from the WorldWideWEB Consortium. Transl Stroke Res 2023; 14:1005-1006. [PMID: 36168083 DOI: 10.1007/s12975-022-01086-5] [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: 11/24/2022]
Affiliation(s)
- Adam A Dmytriw
- Neurointerventional Program, Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada.
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA.
| | - Mahmoud Dibas
- Neurointerventional Program, Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
| | - Sherief Ghozy
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
| | - Nimer Adeeb
- Departement of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, LA, USA
| | - Jose Danilo Bengzon Diestro
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Kevin Phan
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, VIC, Australia
| | - Hugo H Cuellar-Saenz
- Departement of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, LA, USA
| | - Ahmad Sweid
- Department of Neurosurgery, Thomas Jeferson University, Philadelphia, PA, USA
| | - Sovann V Lay
- Service de Neuroradiologie Diagnostique Et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Adrien Guenego
- Department of Neurosurgery, Thomas Jeferson University, Philadelphia, PA, USA
| | - Leonardo Renieri
- Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy
| | - Ali Al Balushi
- Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, NY, USA
| | - Guillaume Saliou
- Service de Radiodiagnostic Et Radiologie Interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland
| | - Markus Möhlenbruch
- Sektion Vaskuläre Und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Justin E Vranic
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Ivan Lylyk
- Equipo de Neurocirugía Endovascular Y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Paul M Foreman
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA
| | - Jay A Vachhani
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA
| | - Vedran Župančić
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Muhammad U Hafeez
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, USA
| | - Caleb Rutledge
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Muhammad Waqas
- Department of Neurosurgery, State University of New York at Bufalo, Bufalo, NY, USA
| | - Vincent M Tutino
- Department of Neurosurgery, State University of New York at Bufalo, Bufalo, NY, USA
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Yifan Ren
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, VIC, Australia
| | - Clemens M Schirmer
- Department of Neurosurgery and Radiology, Geisinger Hospital, Danville, PA, USA
| | - Mariangela Piano
- Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Anna L Kühn
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA, USA
| | | | - Stéphanie Elens
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Brussels, Belgium
| | - Robert M Starke
- Deparment of Neurosurgery, University of Miami, Miami, FL, USA
| | - Ameer Hassan
- Deparment of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX, USA
| | - Arsalaan Salehani
- Deparments of Neurosurgery and Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter Sporns
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jesse Jones
- Deparments of Neurosurgery and Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marios Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Spears
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Boris Lubicz
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Brussels, Belgium
| | - Pietro Panni
- Interventistica Neurovascolare, Ospedale San Rafaele Milano, Milan, Italy
| | - Ajit S Puri
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA, USA
| | - Guglielmo Pero
- Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Christoph J Griessenauer
- Department of Neurosurgery and Radiology, Geisinger Hospital, Danville, PA, USA
- Department of Neurosurgery, Christian Doppler University Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria
- Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Hamed Asadi
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, VIC, Australia
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Adnan Siddiqui
- Department of Neurosurgery, State University of New York at Bufalo, Bufalo, NY, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | | | - Rose Du
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Peter Kan
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, USA
| | - Vladimir Kalousek
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Pedro Lylyk
- Equipo de Neurocirugía Endovascular Y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Srikanth Boddu
- Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, NY, USA
| | | | - Jared Knopman
- Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, NY, USA
| | - Mohammad A Aziz-Sultan
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Nicola Limbucci
- Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jeferson University, Philadelphia, PA, USA
| | - Christophe Cognard
- Service de Neuroradiologie Diagnostique Et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
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8
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Palaiodimou L, Sarraj A, Safouris A, Magoufis G, Lemmens R, Sandset EC, Turc G, Psychogios M, Tsivgoulis G. Endovascular treatment for large-core ischaemic stroke: a meta-analysis of randomised controlled clinical trials. J Neurol Neurosurg Psychiatry 2023; 94:781-785. [PMID: 37451694 DOI: 10.1136/jnnp-2023-331513] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 03/21/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND PURPOSE Current guidelines recommend endovascular treatment (EVT) for acute ischaemic stroke (AIS), due to large-vessel occlusion and an Alberta Stroke Program Early CT Score (ASPECTS) of ≥6. High-quality evidence resulting from randomised controlled clinical trials (RCTs) regarding EVT among large-core AIS has recently become available, justifying an updated meta-analysis aiming to evaluate efficacy and safety of EVT in this clinical setting. METHODS We conducted a systematic review and meta-analysis including all available RCTs that compared EVT in addition to best medical treatment (BMT) versus BMT alone for large-core AIS (defined by ASPECTS 2-5 or volumetric methods). The primary outcome was reduced disability at 3 months (≥1-point reduction across all Modified Rankin Scale (mRS) grades). Secondary outcomes included independent ambulation at 3 months (mRS score 0-3), good functional outcome at 3 months (mRS score 0-2), excellent functional outcome at 3 months (mRS score 0-1), symptomatic intracranial haemorrhage (sICH) and any intracranial haemorrhage (ICH) and mortality at 3 months. The random-effects model was used. RESULTS Four RCTs were included comprising a total of 662 patients treated with EVT vs 649 patients treated with BMT. Compared with BMT, EVT was significantly associated with reduced disability (common OR 1.70, 95% CI 1.39 to 2.07; I2=0%), independent ambulation (risk ratio (RR) 1.69, 95% CI 1.33 to 2.14; I2=39%) and good functional outcome (RR 2.33, 95% CI 1.76 to 3.10; I2=0%), but not with excellent functional outcome (RR 1.46, 95% CI 0.91 to 2.33; I2=39%) at 3 months. Although rates of sICH (RR 1.98, 95% CI 1.07 to 3.68; I2=0%) and any ICH (RR 2.13, 95% CI 1.70 to 2.66; I2=37%) were higher in the EVT group, 3-month mortality (RR 0.98, 95% CI 0.83 to 1.15; I2=0%) did not differ between the two groups. CONCLUSION EVT appears to be effective and safe and may be considered for the treatment of large-core AIS, as assessed by ASPECTS of 2-5 or volumetric methods. PROSPERO REGISTRATION NUMBER CRD42022334417.
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Affiliation(s)
- Lina Palaiodimou
- Second Department of Neurology, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Amrou Sarraj
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Apostolos Safouris
- Second Department of Neurology, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Stroke Unit, Metropolitan Hospital, Piraeus, Greece
- National Institute of Mental Health, Neurology and Neurosurgery, Department Section of Neurointervention, Semmelweis University, Budapest, Hungary
| | - Georgios Magoufis
- Neuroradiology Department, Metropolitan Hospital, Piraeus, Greece
- Interventional Radiology Department, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Robin Lemmens
- Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences Division of Experimental Neurology, KU Leuven, Leuven, Belgium
| | - Else Charlotte Sandset
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Norwegian Air Ambulance Foundation, Bodo, Norway
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Department of Neurology, Université Paris Cité, Paris, France
- Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Department of Neurology, FHU NeuroVasc, Paris, France
| | - Marios Psychogios
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, Universität Basel, Basel, Switzerland
| | - Georgios Tsivgoulis
- Second Department of Neurology, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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9
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Bilgin C, Ibrahim M, Azzam AY, Ghozy S, Elswedy A, Kobeissi H, Sobhi Jabal M, Kadirvel R, Boulouis G, Naggara O, Fiehler J, Psychogios M, Lee S, Wildgruber M, Kemmling A, Al-Mufti F, Kossorotoff M, Sporns PB, Kallmes DF. Mechanical Thrombectomy for Pediatric Large Vessel Occlusions : A Systematic Review and Meta-analysis. Clin Neuroradiol 2023; 33:635-644. [PMID: 36592199 DOI: 10.1007/s00062-022-01246-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/22/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Acute intracranial large vessel occlusion (LVO) is an important cause of morbidity and mortality among children; however, unlike in adults, no clinical trial has investigated the benefit of mechanical thrombectomy (MT) in pediatric LVO. Thus, MT remains an off-label procedure for pediatric stroke. PURPOSE To investigate the efficacy and safety of MT in pediatric LVO. METHODS A systematic literature search was conducted in Ovid MEDLINE, Ovid Embase, Scopus, Web of Science, and Cochrane Central Register of Clinical Trials databases. Studies reporting safety and efficacy outcomes for endovascular treatment of pediatric LVO were included. Data regarding recanalization, functional outcome, symptomatic intracranial hemorrhage (sICH), and mortality were extracted from the included studies. Functional outcome was assessed with the modified Rankin scale (mRS). A fixed or random-effects model was used to calculate pooled event rates and 95% confidence intervals (CI). RESULTS In this study 11 studies comprising 215 patients were included. The successful recanalization rate was 90.3% (95% CI = 85.77-95.11%), and complete recanalization was achieved in 52.7% (95% CI = 45.09-61.62%) of the cases. The favorable (mRS = 0-2) and excellent (mRS = 0-1) outcome rates were 83.3% (95% CI = 73.54-94.50%) and 59.5% (95% CI = 44.24-80.06%), respectively. The overall sICH prevalence was 0.59% (95% CI = 0-3.30%) and mortality rate was 3.2% (95% CI = 0.55-7.38%). CONCLUSION In our meta-analysis, MT demonstrated a promising safety and efficacy profile for pediatric patients, with consistently high efficacy outcomes and low complication rates. Our results support the utilization of MT in pediatric LVOs; however, prospective studies are still needed to further establish the role of pediatric MT as a first-line treatment strategy.
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Affiliation(s)
- Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
| | | | - Ahmed Y Azzam
- Faculty of Medicine, October 6 University, 6th of October City, Egypt
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Adam Elswedy
- Uppsala University Faculty of Medicine, Uppsala, Sweden
| | - Hassan Kobeissi
- College of Medicine, Central Michigan University, Mt. Pleasant, MI, USA
| | | | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Grégoire Boulouis
- Department of Neuroradiology, Université de Tours, CHRU Bretonneau, Tours, France
- French Center for Pediatric Stroke, Pediatric Neurology, APHP-University Hospital Necker-Enfants malades, Paris, France
| | - Olivier Naggara
- Department of Neuroradiology, Université de Paris City, INSERM U1266, GHU Paris, Sainte-Anne Hospital, Paris, France
- French Center for Pediatric Stroke, Pediatric Neurology, APHP-University Hospital Necker-Enfants malades, Paris, France
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios Psychogios
- Department of Radiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Sarah Lee
- Stanford Stroke Center, Stanford University, Palo Alto, CA, USA
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - André Kemmling
- Department of Neuroradiology, University Hospital Marburg, Marburg, Germany
| | - Fawaz Al-Mufti
- Department of Neurology, Westchester Medical Center, Valhalla, NY, USA
| | - Manoelle Kossorotoff
- French Center for Pediatric Stroke, Pediatric Neurology, APHP-University Hospital Necker-Enfants malades, Paris, France
| | - Peter B Sporns
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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10
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Diestro JDB, Dibas M, Adeeb N, Regenhardt RW, Vranic JE, Guenego A, Lay SV, Renieri L, Al Balushi A, Shotar E, Premat K, El Naamani K, Saliou G, Möhlenbruch MA, Lylyk I, Foreman PM, Vachhani JA, Župančić V, Hafeez MU, Rutledge C, Rai H, Tutino VM, Mirshani S, Ghozy S, Harker P, Alotaibi NM, Rabinov JD, Ren Y, Schirmer CM, Goren O, Piano M, Kuhn AL, Michelozzi C, Elens S, Starke RM, Hassan A, Salehani A, Nguyen A, Jones J, Psychogios M, Spears J, Parra-Fariñas C, Bres Bullrich M, Mayich M, Salem MM, Burkhardt JK, Jankowitz BT, Domingo RA, Huynh T, Tawk R, Ulfert C, Lubicz B, Panni P, Puri AS, Pero G, Griessenauer CJ, Asadi H, Siddiqui A, Ducruet AF, Albuquerque FC, Du R, Kan P, Kalousek V, Lylyk P, Boddu SR, Stapleton CJ, Knopman J, Jabbour P, Tjoumakaris S, Clarençon F, Limbucci N, Aziz-Sultan MA, Cuellar-Saenz HH, Cognard C, Patel AB, Dmytriw AA. Intrasaccular flow disruption for ruptured aneurysms: an international multicenter study. J Neurointerv Surg 2023; 15:844-850. [PMID: 35868856 DOI: 10.1136/jnis-2022-019153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/12/2022] [Accepted: 07/01/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Woven EndoBridge (WEB) device is a novel intrasaccular flow disruptor tailored for bifurcation aneurysms. We aim to describe the degree of aneurysm occlusion at the latest follow-up, and the rate of complications of aneurysms treated with the WEB device stratified according to rupture status. METHODS Our data were taken from the WorldWideWeb Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups: ruptured and unruptured. We compared clinical and radiologic outcomes of both groups. Propensity score matching (PSM) was done to match according to age, gender, bifurcation, location, prior treatment, neck, height, dome width, daughter sac, incorporated branch, pretreatment antiplatelets, and last imaging follow-up. RESULTS The study included 676 patients with 691 intracranial aneurysms (529 unruptured and 162 ruptured) treated with the WEB device. The PSM analysis had 55 pairs. In both the unmatched (85.8% vs 84.3%, p=0.692) and matched (94.4% vs 83.3%, p=0.066) cohorts there was no significant difference in the adequate occlusion rate at the last follow-up. Likewise, there were no significant differences in both ischemic and hemorrhagic complications between the two groups. There was no documented aneurysm rebleeding after WEB device implantation. CONCLUSION There was no significant difference in both the radiologic outcomes and complications between unruptured and ruptured aneurysms. Our findings support the feasibility of treatment of ruptured aneurysms with the WEB device.
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Affiliation(s)
- Jose Danilo Bengzon Diestro
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mahmoud Dibas
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nimer Adeeb
- Department of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, Louisiana, USA
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin E Vranic
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adrien Guenego
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Bruxelles, Belgique
| | - Sovann V Lay
- Service de Neuroradiologie Diagnostique et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Leonardo Renieri
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Ali Al Balushi
- Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York, USA
| | - Eimad Shotar
- Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France
| | - Kevin Premat
- Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Guillaume Saliou
- Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland
| | | | - Ivan Lylyk
- Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Paul M Foreman
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, Florida, USA
| | - Jay A Vachhani
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, Florida, USA
| | - Vedran Župančić
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Muhammad U Hafeez
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, Texas, USA
| | - Caleb Rutledge
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Hamid Rai
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York, USA
| | - Vincent M Tutino
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York, USA
| | - Shervin Mirshani
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sherief Ghozy
- Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pablo Harker
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Naif M Alotaibi
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yifan Ren
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Melbourne, Victoria, Australia
| | | | - Oded Goren
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA
| | - Mariangela Piano
- Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Anna Luisa Kuhn
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, Massachusetts, USA
| | | | - Stephanie Elens
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Bruxelles, Belgique
| | - Robert M Starke
- Deparment of Neurosurgery, University of Miami, Miami, Florida, USA
| | - Ameer Hassan
- Deparment of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, Texas, USA
| | - Arsalaan Salehani
- Deparments of Neurosurgery and Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anh Nguyen
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Jesse Jones
- Deparments of Neurosurgery and Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marios Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Julian Spears
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Division of Neurosurgery, University of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Carmen Parra-Fariñas
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Maria Bres Bullrich
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Michael Mayich
- Departments of Medical Imaging, and Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mohamed M Salem
- Department of Neurosurgery, University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Ricardo A Domingo
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Thien Huynh
- Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Rabih Tawk
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Christian Ulfert
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Boris Lubicz
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Bruxelles, Belgique
| | - Pietro Panni
- Interventistica Neurovascolare, Ospedale San Raffaele, Milano, Italy
| | - Ajit S Puri
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, Massachusetts, USA
| | - Guglielmo Pero
- Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milano, Italy
| | - Christoph J Griessenauer
- Department of Neurosurgery, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria, Salzburg, Austria
- Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Hamed Asadi
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Melbourne, Victoria, Australia
| | - Adnan Siddiqui
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Rose Du
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, Canada
| | - Peter Kan
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, Texas, USA
| | - Vladimir Kalousek
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Pedro Lylyk
- Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Srikanth Reddy Boddu
- Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York, USA
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jared Knopman
- Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Frédéric Clarençon
- Department of Interventional Neuroradiology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Nicola Limbucci
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Mohammad A Aziz-Sultan
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hugo H Cuellar-Saenz
- Department of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, Louisiana, USA
| | - Christophe Cognard
- Service de Neuroradiologie Diagnostique et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adam A Dmytriw
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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11
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Todea AR, Melie-Garcia L, Barakovic M, Cagol A, Rahmanzadeh R, Galbusera R, Lu PJ, Weigel M, Ruberte E, Radue EW, Schaedelin S, Benkert P, Oezguer Y, Sinnecker T, Müller S, Achtnichts L, Vehoff J, Disanto G, Findling O, Chan A, Salmen A, Pot C, Lalive P, Bridel C, Zecca C, Derfuss T, Remonda L, Wagner F, Vargas M, Du Pasquier R, Pravata E, Weber J, Gobbi C, Leppert D, Wuerfel J, Kober T, Marechal B, Corredor-Jerez R, Psychogios M, Lieb J, Kappos L, Cuadra MB, Kuhle J, Granziera C. A Multicenter Longitudinal MRI Study Assessing LeMan-PV Software Accuracy in the Detection of White Matter Lesions in Multiple Sclerosis Patients. J Magn Reson Imaging 2023; 58:864-876. [PMID: 36708267 DOI: 10.1002/jmri.28618] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/24/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Detecting new and enlarged lesions in multiple sclerosis (MS) patients is needed to determine their disease activity. LeMan-PV is a software embedded in the scanner reconstruction system of one vendor, which automatically assesses new and enlarged white matter lesions (NELs) in the follow-up of MS patients; however, multicenter validation studies are lacking. PURPOSE To assess the accuracy of LeMan-PV for the longitudinal detection NEL white-matter MS lesions in a multicenter clinical setting. STUDY TYPE Retrospective, longitudinal. SUBJECTS A total of 206 patients with a definitive MS diagnosis and at least two follow-up MRI studies from five centers participating in the Swiss Multiple Sclerosis Cohort study. Mean age at first follow-up = 45.2 years (range: 36.9-52.8 years); 70 males. FIELD STRENGTH/SEQUENCE Fluid attenuated inversion recovery (FLAIR) and T1-weighted magnetization prepared rapid gradient echo (T1-MPRAGE) sequences at 1.5 T and 3 T. ASSESSMENT The study included 313 MRI pairs of datasets. Data were analyzed with LeMan-PV and compared with a manual "reference standard" provided by a neuroradiologist. A second rater (neurologist) performed the same analysis in a subset of MRI pairs to evaluate the rating-accuracy. The Sensitivity (Se), Specificity (Sp), Accuracy (Acc), F1-score, lesion-wise False-Positive-Rate (aFPR), and other measures were used to assess LeMan-PV performance for the detection of NEL at 1.5 T and 3 T. The performance was also evaluated in the subgroup of 123 MRI pairs at 3 T. STATISTICAL TESTS Intraclass correlation coefficient (ICC) and Cohen's kappa (CK) were used to evaluate the agreement between readers. RESULTS The interreader agreement was high for detecting new lesions (ICC = 0.97, Pvalue < 10-20 , CK = 0.82, P value = 0) and good (ICC = 0.75, P value < 10-12 , CK = 0.68, P value = 0) for detecting enlarged lesions. Across all centers, scanner field strengths (1.5 T, 3 T), and for NEL, LeMan-PV achieved: Acc = 61%, Se = 65%, Sp = 60%, F1-score = 0.44, aFPR = 1.31. When both follow-ups were acquired at 3 T, LeMan-PV accuracy was higher (Acc = 66%, Se = 66%, Sp = 66%, F1-score = 0.28, aFPR = 3.03). DATA CONCLUSION In this multicenter study using clinical data settings acquired at 1.5 T and 3 T, and variations in MRI protocols, LeMan-PV showed similar sensitivity in detecting NEL with respect to other recent 3 T multicentric studies based on neural networks. While LeMan-PV performance is not optimal, its main advantage is that it provides automated clinical decision support integrated into the radiological-routine flow. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Alexandra Ramona Todea
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Lester Melie-Garcia
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Muhamed Barakovic
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Alessandro Cagol
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Reza Rahmanzadeh
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Riccardo Galbusera
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Po-Jui Lu
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Matthias Weigel
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Division of Radiological Physics, Department of Radiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Esther Ruberte
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Ernst-Wilhelm Radue
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sabine Schaedelin
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Pascal Benkert
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Yaldizli Oezguer
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Tim Sinnecker
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Medical Image Analysis Center (MIAC) and qbig, Department of Biomedical Engineering, University Basel, Basel, Switzerland
| | - Stefanie Müller
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Lutz Achtnichts
- Department of Neurology, Cantonal Hospital Aarau, Switzerland
| | - Jochen Vehoff
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Giulio Disanto
- Department of Neurology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
| | - Oliver Findling
- Department of Neurology, Cantonal Hospital Aarau, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Caroline Pot
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Patrice Lalive
- Department of Clinical Neurosciences, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Claire Bridel
- Department of Clinical Neurosciences, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Chiara Zecca
- Department of Neurology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Tobias Derfuss
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Luca Remonda
- Department of Radiology, Cantonal Hospital Aarau, Switzerland
| | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Maria Vargas
- Department of Radiology, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Renaud Du Pasquier
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Emanuele Pravata
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Johannes Weber
- Department of Radiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Claudio Gobbi
- Department of Neurology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - David Leppert
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center (MIAC) and qbig, Department of Biomedical Engineering, University Basel, Basel, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthineers International, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique FÉdÉrale de Lausanne (EPFL), Lausanne, Switzerland
| | - Benedicte Marechal
- Advanced Clinical Imaging Technology, Siemens Healthineers International, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique FÉdÉrale de Lausanne (EPFL), Lausanne, Switzerland
| | - Ricardo Corredor-Jerez
- Advanced Clinical Imaging Technology, Siemens Healthineers International, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique FÉdÉrale de Lausanne (EPFL), Lausanne, Switzerland
| | - Marios Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland
| | - Johanna Lieb
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Meritxell Bach Cuadra
- CIBM Center for Biomedical Imaging, Radiology Department, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
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12
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Dmytriw AA, Dibas M, Ghozy S, Adeeb N, Diestro JDB, Phan K, Cuellar-Saenz HH, Sweid A, Lay SV, Guenego A, Renieri L, Al Balushi A, Saliou G, Möhlenbruch M, Regenhardt RW, Vranic JE, Lylyk I, Foreman PM, Vachhani JA, Župančić V, Hafeez MU, Rutledge C, Waqas M, Tutino VM, Rabinov JD, Ren Y, Schirmer CM, Piano M, Kühn AL, Michelozzi C, Elens S, Starke RM, Hassan A, Salehani A, Sporns P, Jones J, Psychogios M, Spears J, Lubicz B, Panni P, Puri AS, Pero G, Griessenauer CJ, Asadi H, Stapleton CJ, Siddiqui A, Ducruet AF, Albuquerque FC, Du R, Kan P, Kalousek V, Lylyk P, Boddu S, Tjoumakaris S, Knopman J, Aziz-Sultan MA, Limbucci N, Jabbour P, Cognard C, Patel AB. The Woven EndoBridge (WEB) Device for the Treatment of Intracranial Aneurysms: Ten Years of Lessons Learned and Adjustments in Practice from the WorldWideWEB Consortium. Transl Stroke Res 2023; 14:455-464. [PMID: 36066701 DOI: 10.1007/s12975-022-01072-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/27/2022] [Accepted: 07/25/2022] [Indexed: 10/14/2022]
Abstract
Several studies have shown promising outcomes of the Woven EndoBridge (WEB) device for the treatment of wide-necked intracranial bifurcation aneurysms. This is a multicenter study attempts to explore the changes in trends and treatment outcomes over time for WEB embolization of intracranial aneurysms. The WorldWideWEB consortium is a retrospective multicenter collaboration of data from international centers spanning from January 2011 and June 2021, with no limitations on aneurysm location or rupture status. Both bifurcation and sidewall aneurysms were included. These patients were stratified based on treatment year into five treatment intervals: 2011-2015 (N = 66), 2016-2017 (N = 77), 2018 (N = 66), 2019 (N = 300), and 2020-2021 (N = 173). Patient characteristics and angiographic and clinical outcomes were compared between these time intervals. This study comprised 671 patients (median age 61.4 years; 71.2% female) with 682 intracranial aneurysms. Over time, we observed an increasing tendency to treat patients presenting with ruptured aneurysms and aneurysms with smaller neck, diameter, and dome widths. Furthermore, we observed a trend towards more off-label use of the WEB for sidewall aneurysms and increased adoption of transradial access for WEB deployment. Moreover, the proportion of patients with adequate WEB occlusion immediately and at last follow-up was significantly higher in more recent year cohorts, as well as lower rates of compaction and retreatment. Mortality and complications did not differ over time. This learning curve study suggests improved experience using the WEB for the treatment of intracranial aneurysms and has yielded higher rates of adequate occlusion over time.
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Affiliation(s)
- Adam A Dmytriw
- Neurointerventional Program, Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada.
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA.
| | - Mahmoud Dibas
- Neurointerventional Program, Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
| | - Sherief Ghozy
- Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA
| | - Nimer Adeeb
- Departement of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, LA, USA
| | - Jose Danilo Bengzon Diestro
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Kevin Phan
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Hugo H Cuellar-Saenz
- Departement of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, LA, USA
| | - Ahmad Sweid
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sovann V Lay
- Service de Neuroradiologie Diagnostique Et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Adrien Guenego
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Leonardo Renieri
- Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy
| | - Ali Al Balushi
- Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, NY, USA
| | - Guillaume Saliou
- Service de Radiodiagnostic Et Radiologie Interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland
| | - Markus Möhlenbruch
- Sektion Vaskuläre Und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Justin E Vranic
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Ivan Lylyk
- Equipo de Neurocirugía Endovascular Y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Paul M Foreman
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA
| | - Jay A Vachhani
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA
| | - Vedran Župančić
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Muhammad U Hafeez
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, USA
| | - Caleb Rutledge
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Muhammad Waqas
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Vincent M Tutino
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Yifan Ren
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Clemens M Schirmer
- Department of Neurosurgery and Radiology, Geisinger Hospital, Danville, PA, USA
| | - Mariangela Piano
- Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Anna L Kühn
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA, USA
| | | | - Stéphanie Elens
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Brussels, Belgium
| | - Robert M Starke
- Deparment of Neurosurgery, University of Miami, Miami, FL, USA
| | - Ameer Hassan
- Deparment of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX, USA
| | - Arsalaan Salehani
- Deparments of Neurosurgery and Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter Sporns
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jesse Jones
- Deparments of Neurosurgery and Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marios Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Spears
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Boris Lubicz
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Brussels, Belgium
| | - Pietro Panni
- Interventistica Neurovascolare, Ospedale San Raffaele Milano, Milan, Italy
| | - Ajit S Puri
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA, USA
| | - Guglielmo Pero
- Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Christoph J Griessenauer
- Department of Neurosurgery and Radiology, Geisinger Hospital, Danville, PA, USA
- Department of Neurosurgery, Christian Doppler University Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria
- Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Hamed Asadi
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Adnan Siddiqui
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | | | - Rose Du
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Peter Kan
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX, USA
| | - Vladimir Kalousek
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Pedro Lylyk
- Equipo de Neurocirugía Endovascular Y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Srikanth Boddu
- Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, NY, USA
| | | | - Jared Knopman
- Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, NY, USA
| | - Mohammad A Aziz-Sultan
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Nicola Limbucci
- Interventistica Neurovascolare, Ospedale Careggi Di Firenze, Florence, Italy
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christophe Cognard
- Service de Neuroradiologie Diagnostique Et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
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13
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Dittrich TD, Aujesky M, Rudin S, Zietz A, Wagner B, Polymeris A, Altersberger VL, Sinnecker T, Gensicke H, Engelter ST, Lyrer P, Hess V, Sutter R, Nickel CH, Bonati LH, Fischer U, Psychogios M, Katan M, De Marchis GM. Apical pulmonary lesions suspected of malignancy visible on neck CT angiography performed for acute stroke: Prevalence, treatment, and clinical implications - the PLEURA study. Eur Stroke J 2023; 8:549-556. [PMID: 37231698 PMCID: PMC10334179 DOI: 10.1177/23969873231151488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/30/2022] [Indexed: 12/13/2023] Open
Abstract
BACKGROUND Computed tomography angiography (CTA) of the supraaortic arteries is commonly used for acute stroke workup and may reveal apical pulmonary lesions (APL). AIM To determine the prevalence, follow-up algorithms, and in-hospital outcomes of stroke patients with APL on CTA. METHODS We retrospectively included consecutive adult patients with ischemic stroke, transient ischemic attack, or intracerebral hemorrhage and available CTA at a tertiary hospital between January 2014 and May 2021. We reviewed all CTA reports for the presence of APL. APL were classified as malignancy suspicious or benign appearing based on radiological-morphological criteria. We performed regression analyses to investigate the impact of malignancy suspicious APL on different in-hospital outcome parameters. RESULTS Among 2715 patients, APL on CTA were found in 161 patients (5.9% [95%CI: 5.1-6.9]; 161/2715). Suspicion of malignancy was present in one third of patients with APL (36.0% [95%CI: 29.0-43.7]; 58/161), 42 of whom (72.4% [95%CI: 60.0-82.2]; 42/58) had no history of lung cancer or metastases. When performed, further investigations confirmed primary or secondary pulmonary malignancy in three-quarters (75.0% [95%CI: 50.5-89.8]; 12/16), with two patients (16.7% [95%CI: 4.7-44.8]; 2/12) receiving de novo oncologic therapy. In multivariable regression, the presence of radiologically malignancy suspicious APL was associated with higher NIHSS scores at 24 h (beta = 0.67, 95%CI: 0.28-1.06, p = 0.001) and all-cause in-hospital mortality (aOR = 3.83, 95%CI: 1.29-9.94, p = 0.01). CONCLUSIONS One in seventeen patients shows APL on CTA, of which one-third is malignancy suspicious. Further work-up confirmed pulmonary malignancy in a substantial number of patients triggering potentially life-saving oncologic therapy.
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Affiliation(s)
- Tolga D Dittrich
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Mara Aujesky
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Salome Rudin
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Annaelle Zietz
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Benjamin Wagner
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Alexandros Polymeris
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Valerian L Altersberger
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Tim Sinnecker
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Stefan T Engelter
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Philippe Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Viviane Hess
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Oncology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Raoul Sutter
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Intensive Care Medicine, University Hospital and University of Basel, Basel, Switzerland
| | - Christian H Nickel
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Emergency Department, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Rehabilitation Clinic, Rheinfelden, Switzerland
| | - Urs Fischer
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Marios Psychogios
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Neuroradiology, University Hospital and University of Basel, Basel, Switzerland
| | - Mira Katan
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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14
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Ning S, Chautems C, Kim Y, Rice H, Hanning U, Al Kasab S, Meyer L, Psychogios M, Zaidat OO, Hassan AE, Masoud HE, Mujanovic A, Kaesmacher J, Dhillon PS, Ma A, Kaliaev A, Nguyen TN, Abdalkader M. Robotic Interventional Neuroradiology: Progress, Challenges, and Future Prospects. Semin Neurol 2023; 43:432-438. [PMID: 37562456 DOI: 10.1055/s-0043-1771298] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Advances in robotic technology have improved standard techniques in numerous surgical and endovascular specialties, offering more precision, control, and better patient outcomes. Robotic-assisted interventional neuroradiology is an emerging field at the intersection of interventional neuroradiology and biomedical robotics. Endovascular robotics can automate maneuvers to reduce procedure times and increase its safety, reduce occupational hazards associated with ionizing radiations, and expand networks of care to reduce gaps in geographic access to neurointerventions. To date, many robotic neurointerventional procedures have been successfully performed, including cerebral angiography, intracranial aneurysm embolization, carotid stenting, and epistaxis embolization. This review aims to provide a survey of the state of the art in robotic-assisted interventional neuroradiology, consider their technical and adoption limitations, and explore future developments critical for the widespread adoption of robotic-assisted neurointerventions.
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Affiliation(s)
- Shen Ning
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
- Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | | | - Yoonho Kim
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Hal Rice
- Neurointerventional Section, Gold Coast University Hospital, Queensland, Australia
| | - Uta Hanning
- Klinik und Poliklinik für Interventionelle Neuroradiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Lukas Meyer
- Klinik und Poliklinik für Interventionelle Neuroradiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Marios Psychogios
- Department of Radiology, Basel University Hospital, University of Basel, Switzerland
| | - Osama O Zaidat
- Department of Neurology, Mercy Vincent Hospital, Toledo, Ohio
| | - Ameer E Hassan
- Department of Neurology, Valley Baptist Medical Center, University of Texas Rio Grande Valley, Harlingen, Texas
| | - Hesham E Masoud
- Division of Cerebrovascular, Department of Neurology, Upstate University Hospital, Syracuse, New York
| | - Adnan Mujanovic
- Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric Radiology and Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric Radiology and Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Permesh S Dhillon
- Interventional Neuroradiology, University of Nottingham, Nottingham, United Kingdom
| | - Alice Ma
- Department of Neurosurgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Artem Kaliaev
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Thanh N Nguyen
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
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15
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Nguyen TN, Qureshi MM, Strambo D, Strbian D, Räty S, Herweh C, Abdalkader M, Olive-Gadea M, Ribo M, Psychogios M, Fischer U, Nguyen A, Kuramatsu JB, Haupenthal D, Köhrmann M, Deuschl C, Kühne Escola J, Yaghi S, Shu L, Puetz V, Kaiser DPO, Kaesmacher J, Mujanovic A, Marterstock DC, Engelhorn T, Klein P, Haussen DC, Mohammaden MH, Abdelhamid H, Souza Viana L, Cunha B, Fragata I, Romoli M, Diana F, Virtanen P, Lappalainen K, Clark J, Matsoukas S, Fifi JT, Sheth SA, Salazar-Marioni S, Marto JP, Ramos JN, Miszczuk M, Riegler C, Jadhav AP, Desai SM, Maus V, Kaeder M, Siddiqui AH, Monteiro A, Masoud HE, Suryadevara N, Mokin M, Thanki S, Siegler JE, Khalife J, Linfante I, Dabus G, Asdaghi N, Saini V, Nolte CH, Siebert E, Meinel TR, Finitsis S, Möhlenbruch MA, Ringleb PA, Berberich A, Nogueira RG, Hanning U, Meyer L, Michel P, Nagel S. Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study. Stroke 2023. [PMID: 37222709 DOI: 10.1161/strokeaha.123.042674] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND The optimal management of patients with isolated posterior cerebral artery occlusion is uncertain. We compared clinical outcomes for endovascular therapy (EVT) versus medical management (MM) in patients with isolated posterior cerebral artery occlusion. METHODS This multinational case-control study conducted at 27 sites in Europe and North America included consecutive patients with isolated posterior cerebral artery occlusion presenting within 24 hours of time last well from January 2015 to August 2022. Patients treated with EVT or MM were compared with multivariable logistic regression and inverse probability of treatment weighting. The coprimary outcomes were the 90-day modified Rankin Scale ordinal shift and ≥2-point decrease in the National Institutes of Health Stroke Scale. RESULTS Of 1023 patients, 589 (57.6%) were male with median (interquartile range) age of 74 (64-82) years. The median (interquartile range) National Institutes of Health Stroke Scale was 6 (3-10). The occlusion segments were P1 (41.2%), P2 (49.2%), and P3 (7.1%). Overall, intravenous thrombolysis was administered in 43% and EVT in 37%. There was no difference between the EVT and MM groups in the 90-day modified Rankin Scale shift (aOR, 1.13 [95% CI, 0.85-1.50]; P=0.41). There were higher odds of a decrease in the National Institutes of Health Stroke Scale by ≥2 points with EVT (aOR, 1.84 [95% CI, 1.35-2.52]; P=0.0001). Compared with MM, EVT was associated with a higher likelihood of excellent outcome (aOR, 1.50 [95% CI, 1.07-2.09]; P=0.018), complete vision recovery, and similar rates of functional independence (modified Rankin Scale score, 0-2), despite a higher rate of SICH and mortality (symptomatic intracranial hemorrhage, 6.2% versus 1.7%; P=0.0001; mortality, 10.1% versus 5.0%; P=0.002). CONCLUSIONS In patients with isolated posterior cerebral artery occlusion, EVT was associated with similar odds of disability by ordinal modified Rankin Scale, higher odds of early National Institutes of Health stroke scale improvement, and complete vision recovery compared with MM. There was a higher likelihood of excellent outcome in the EVT group despite a higher rate of symptomatic intracranial hemorrhage and mortality. Continued enrollment into ongoing distal vessel occlusion randomized trials is warranted.
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Affiliation(s)
- Thanh N Nguyen
- Neurology, Boston Medical Center, MA. (T.N.N., J.C.)
- Radiology, Boston Medical Center, MA. (T.N.N., M.M.Q., M.A., P.K.)
| | - Muhammad M Qureshi
- Radiology, Boston Medical Center, MA. (T.N.N., M.M.Q., M.A., P.K.)
- Radiation Oncology, Boston Medical Center, MA. (M.M.Q.)
| | - Davide Strambo
- Neurology Service, Lausanne University Hospital, University of Lausanne, Switzerland (D. Strambo, P.M.)
| | - Daniel Strbian
- Neurology, Helsinki University Hospital, Finland. (D. Strbian, S.R.)
| | - Silja Räty
- Neurology, Helsinki University Hospital, Finland. (D. Strbian, S.R.)
| | - Christian Herweh
- Neuroradiology, Heidelberg University Hospital, Germany. (C.H., M. Moehlenbruch)
| | | | - Marta Olive-Gadea
- Neurology, Hospital Universitario Vall d'Hebron, Barcelona, Spain. (M.O.-G., M. Ribo)
| | - Marc Ribo
- Neurology, Hospital Universitario Vall d'Hebron, Barcelona, Spain. (M.O.-G., M. Ribo)
| | - Marios Psychogios
- Neurology Service, Lausanne University Hospital, University of Lausanne, Switzerland (D. Strambo, P.M.)
| | - Urs Fischer
- Neurology, Basel University Hospital, University of Basel, Switzerland. (U.F.)
- Neurology, Bern University Hospital, University of Bern, Switzerland (T.R.M., U.F.)
| | - Anh Nguyen
- Radiology, Basel University Hospital, University of Basel, Switzerland. (A.N, M.P.)
| | - Joji B Kuramatsu
- Neurology, University of Erlangen-Nuremberg, Germany. (J.B.K., D.H.)
| | - David Haupenthal
- Neurology, University of Erlangen-Nuremberg, Germany. (J.B.K., D.H.)
| | - Martin Köhrmann
- Neurology, Universitätsklinikum Essen, Germany. (M. Köhrmann, J.K.E.)
| | | | | | - Shadi Yaghi
- Neurology, Rhode Island Hospital, Brown University Medical School, Providence, RI (S.Y., L.S.)
| | - Liqi Shu
- Neurology, Rhode Island Hospital, Brown University Medical School, Providence, RI (S.Y., L.S.)
| | - Volker Puetz
- Radiology, Helsinki University Hospital, Finland. (P.V., K.L.)
- Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany. (V.P.)
| | - Daniel P O Kaiser
- Neuroradiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany. (D.P.O.K.)
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Switzerland (J. Kaesmacher, A. Mujanovic)
| | - Adnan Mujanovic
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Switzerland (J. Kaesmacher, A. Mujanovic)
| | | | - Tobias Engelhorn
- Neuroradiology, University of Erlangen-Nuremberg, Germany. (D.C.M., T.E.)
| | - Piers Klein
- Radiology, Boston Medical Center, MA. (T.N.N., M.M.Q., M.A., P.K.)
| | - Diogo C Haussen
- Neurology, Grady Memorial Hospital, Atlanta, GA (D.C.H., M.H.M., H.A., L.S.V.)
| | | | - Hend Abdelhamid
- Neurology, Grady Memorial Hospital, Atlanta, GA (D.C.H., M.H.M., H.A., L.S.V.)
| | - Lorena Souza Viana
- Neurology, Grady Memorial Hospital, Atlanta, GA (D.C.H., M.H.M., H.A., L.S.V.)
| | - Bruno Cunha
- Neuroradiology, Centro Hospitalar Universitario de Lisboa Central, Portugal (B.C., I.F.)
| | - Isabel Fragata
- Neuroradiology, Centro Hospitalar Universitario de Lisboa Central, Portugal (B.C., I.F.)
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy (M. Romoli)
| | - Francesco Diana
- Interventional Neuroradiology, Hospital Universitario Vall d'Hebron, Barcelona, Spain. (F.D.)
| | - Pekka Virtanen
- Radiology, Helsinki University Hospital, University of Helsinki, Finland (P.V., K.L.)
| | - Kimmo Lappalainen
- Radiology, Helsinki University Hospital, Finland. (P.V., K.L.)
- Radiology, Helsinki University Hospital, University of Helsinki, Finland (P.V., K.L.)
| | - Judith Clark
- Neurology, Boston Medical Center, MA. (T.N.N., J.C.)
| | - Stavros Matsoukas
- Neurosurgery, Mount Sinai Health System, New York City, NY (S.M., J.T.F.)
| | - Johanna T Fifi
- Neurosurgery, Mount Sinai Health System, New York City, NY (S.M., J.T.F.)
| | - Sunil A Sheth
- Neurology, McGovern Medical School at UTHealth, TX (S.A.S., S.S.-M.)
| | | | - João Pedro Marto
- Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal. (J.P.M.)
| | - João Nuno Ramos
- Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal. (J.N.R.)
| | - Milena Miszczuk
- Neuroradiology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, Germany. (M. Miszczuk, E.S.)
| | - Christoph Riegler
- Neurology, Experimental Neurology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, Germany. (C.R., C.H.N.)
| | - Ashutosh P Jadhav
- Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J., S.M.D.)
| | - Shashvat M Desai
- Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J., S.M.D.)
| | - Volker Maus
- Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Germany (V.M., M. Kaeder)
| | - Maximilian Kaeder
- Radiology, Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum, Germany (V.M., M. Kaeder)
| | | | - Andre Monteiro
- Neurosurgery, University of Buffalo, NY (A.H.S., A. Monteiro)
| | - Hesham E Masoud
- Neurology, New York Upstate Medical University, Syracuse, NY (H.E.M.)
| | | | - Maxim Mokin
- Neurosurgery, University of South Florida, Tampa (M. Mokin, S.T.)
| | - Shail Thanki
- Neurosurgery, University of South Florida, Tampa (M. Mokin, S.T.)
| | - James E Siegler
- Cooper Neurological Institute, Camden, NJ (J.E.S., J. Khalife)
| | - Jane Khalife
- Cooper Neurological Institute, Camden, NJ (J.E.S., J. Khalife)
| | | | | | - Negar Asdaghi
- Neurology, University of Miami Miller School of Medicine, FL (N.A., V.S.)
| | - Vasu Saini
- Neurology, University of Miami Miller School of Medicine, FL (N.A., V.S.)
| | - Christian H Nolte
- Neurology, Experimental Neurology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, Germany. (C.R., C.H.N.)
| | - Eberhard Siebert
- Neuroradiology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin Berlin, Germany. (M. Miszczuk, E.S.)
| | - Thomas R Meinel
- Neurology, Bern University Hospital, University of Bern, Switzerland (T.R.M., U.F.)
| | | | - Markus A Möhlenbruch
- Neuroradiology, Heidelberg University Hospital, Germany. (C.H., M. Moehlenbruch)
| | - Peter A Ringleb
- Neurology, Heidelberg University Hospital, Germany. (P.A.R., S.N.)
| | | | - Raul G Nogueira
- Neurology, University of Pittsburgh Medical Center, PA (R.G.N., N.S.)
| | - Uta Hanning
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H., L.M.)
| | - Lukas Meyer
- Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (U.H., L.M.)
| | - Patrik Michel
- Radiology, Basel University Hospital, University of Basel, Switzerland. (A.N, M.P.)
| | - Simon Nagel
- Neurology, Heidelberg University Hospital, Germany. (P.A.R., S.N.)
- Neurology, University of Pittsburgh Medical Center, PA (R.G.N., N.S.)
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16
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Traenka C, Lorscheider J, Hametner C, Baumgartner P, Gralla J, Magoni M, Martinez-Majander N, Casolla B, Feil K, Pascarella R, Papanagiotou P, Nordanstig A, Padjen V, Cereda CW, Psychogios M, Nolte CH, Zini A, Michel P, Béjot Y, Kastrup A, Zedde M, Kägi G, Kellert L, Henon H, Curtze S, Pezzini A, Arnold M, Wegener S, Ringleb P, Tatlisumak T, Nederkoorn PJ, Engelter ST, Gensicke H. Recanalization Therapies for Large Vessel Occlusion Due to Cervical Artery Dissection: A Cohort Study of the EVA-TRISP Collaboration. J Stroke 2023; 25:272-281. [PMID: 37282374 DOI: 10.5853/jos.2022.03370] [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: 10/26/2022] [Accepted: 02/27/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND AND PURPOSE This study aimed to investigate the effect of endovascular treatment (EVT, with or without intravenous thrombolysis [IVT]) versus IVT alone on outcomes in patients with acute ischemic stroke (AIS) and intracranial large vessel occlusion (LVO) attributable to cervical artery dissection (CeAD). METHODS This multinational cohort study was conducted based on prospectively collected data from the EVA-TRISP (EndoVAscular treatment and ThRombolysis for Ischemic Stroke Patients) collaboration. Consecutive patients (2015-2019) with AIS-LVO attributable to CeAD treated with EVT and/or IVT were included. Primary outcome measures were (1) favorable 3-month outcome (modified Rankin Scale score 0-2) and (2) complete recanalization (thrombolysis in cerebral infarction scale 2b/3). Odds ratios with 95% confidence intervals (OR [95% CI]) from logistic regression models were calculated (unadjusted, adjusted). Secondary analyses were performed in the patients with LVO in the anterior circulation (LVOant) including propensity score matching. RESULTS Among 290 patients, 222 (76.6%) had EVT and 68 (23.4%) IVT alone. EVT-treated patients had more severe strokes (National Institutes of Health Stroke Scale score, median [interquartile range]: 14 [10-19] vs. 4 [2-7], P<0.001). The frequency of favorable 3-month outcome did not differ significantly between both groups (EVT: 64.0% vs. IVT: 86.8%; ORadjusted 0.56 [0.24-1.32]). EVT was associated with higher rates of recanalization (80.5% vs. 40.7%; ORadjusted 8.85 [4.28-18.29]) compared to IVT. All secondary analyses showed higher recanalization rates in the EVT-group, which however never translated into better functional outcome rates compared to the IVT-group. CONCLUSION We observed no signal of superiority of EVT over IVT regarding functional outcome in CeAD-patients with AIS and LVO despite higher rates of complete recanalization with EVT. Whether pathophysiological CeAD-characteristics or their younger age might explain this observation deserves further research.
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Affiliation(s)
- Christopher Traenka
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Johannes Lorscheider
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Christian Hametner
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Philipp Baumgartner
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology University Hospital Bern, University of Bern, Bern, Switzerland
| | - Mauro Magoni
- ASST Spedali Civili, Neurologia Vascolare, Brescia, Italy
| | | | - Barbara Casolla
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
- Stroke Unit, UR2CA-URRIS Neurology, CHU Pasteur 2, Nice Cote d'Azur University, Nice, France
| | - Katharina Feil
- Department of Neurology, Ludwig Maximilian University (LMU), Munich, Germany
- Department of Neurology, University Hospital Tübingen, Tübingen, Germany
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Annika Nordanstig
- Department of Neurology, Sahlgrenska University Hospital and Department of Clinical Neuroscience Institute for Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Visnja Padjen
- University of Belgrade, Faculty of Medicine, Neurology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Carlo W Cereda
- Stroke Center, Department of Neurology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Marios Psychogios
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Christian H Nolte
- Klinik für Neurologie mit experimenteller Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Germany
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - Patrik Michel
- Stroke Service, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Yannick Béjot
- Department of Neurology, University Hospital Dijon, Dijon, France
| | - Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lars Kellert
- Department of Neurology, Ludwig Maximilian University (LMU), Munich, Germany
| | - Hilde Henon
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Sami Curtze
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Susanne Wegener
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Peter Ringleb
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital and Department of Clinical Neuroscience Institute for Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Stefan T Engelter
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
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17
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Jensen-Kondering U, Maurer CJ, Brudermann HCB, Ernst M, Sedaghat S, Margraf NG, Bahmer T, Jansen O, Nawabi J, Vogt E, Büttner L, Siebert E, Bartl M, Maus V, Werding G, Schlamann M, Abdullayev N, Bender B, Richter V, Mengel A, Göpel S, Berlis A, Grams A, Ladenhauf V, Gizewski ER, Kindl P, Schulze-Zachau V, Psychogios M, König IR, Sondermann S, Wallis S, Brüggemann N, Schramm P, Neumann A. Patterns of acute ischemic stroke and intracranial hemorrhage in patients with COVID-19 : Results of a retrospective multicenter neuroimaging-based study from three central European countries. J Neurol 2023; 270:2349-2359. [PMID: 36820915 PMCID: PMC9947908 DOI: 10.1007/s00415-023-11608-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is an infection which can affect the central nervous system. In this study, we sought to investigate associations between neuroimaging findings with clinical, demographic, blood and cerebrospinal fluid (CSF) parameters, pre-existing conditions and the severity of acute COVID-19. MATERIALS AND METHODS Retrospective multicenter data retrieval from 10 university medical centers in Germany, Switzerland and Austria between February 2020 and September 2021. We included patients with COVID-19, acute neurological symptoms and cranial imaging. We collected demographics, neurological symptoms, COVID-19 severity, results of cranial imaging, blood and CSF parameters during the hospital stay. RESULTS 442 patients could be included. COVID-19 severity was mild in 124 (28.1%) patients (moderate n = 134/30.3%, severe n = 43/9.7%, critical n = 141/31.9%). 220 patients (49.8%) presented with respiratory symptoms, 167 (37.8%) presented with neurological symptoms first. Acute ischemic stroke (AIS) was detected in 70 (15.8%), intracranial hemorrhage (IH) in 48 (10.9%) patients. Typical risk factors were associated with AIS; extracorporeal membrane oxygenation therapy and invasive ventilation with IH. No association was found between the severity of COVID-19 or blood/CSF parameters and the occurrence of AIS or IH. DISCUSSION AIS was the most common finding on cranial imaging. IH was more prevalent than expected but a less common finding than AIS. Patients with IH had a distinct clinical profile compared to patients with AIS. There was no association between AIS or IH and the severity of COVID-19. A considerable proportion of patients presented with neurological symptoms first. Laboratory parameters have limited value as a screening tool.
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Affiliation(s)
- Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, UKSH, Campus Kiel, Kiel, Germany.
- Department of Neuroradiology, UKSH, Campus Lübeck, Lübeck, Germany.
| | - Christoph J Maurer
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Hanna C B Brudermann
- Institute of Medical Biometry and Statistics (IMBS), UKSH, Campus Lübeck, Lübeck, Germany
| | - Marielle Ernst
- Institute of Diagnostic and Interventional Neuroradiology, University Medical Center, Göttingen, Germany
| | - Sam Sedaghat
- Department of Radiology and Neuroradiology, UKSH, Campus Kiel, Kiel, Germany
- Department of Radiology, University of California San Diego, San Diego, USA
| | - Nils G Margraf
- Department of Neurology, UKSH, Campus Kiel, Kiel, Germany
| | - Thomas Bahmer
- Department of Internal Medicine, UKSH, Campus Kiel, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, UKSH, Campus Kiel, Kiel, Germany
| | - Jawed Nawabi
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte (CCM), Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany
| | - Estelle Vogt
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte (CCM), Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Berlin, Germany
| | - Laura Büttner
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte (CCM), Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Berlin, Germany
| | - Eberhard Siebert
- Institute of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Bartl
- Department of Neurology, University Medical Center, Göttingen, Germany
| | - Volker Maus
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, University Medical Center Knappschaftskrankenhaus, Bochum, Germany
| | - Gregor Werding
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, University Medical Center Knappschaftskrankenhaus, Bochum, Germany
| | - Marc Schlamann
- Department of Radiology, Neuroradiology Division, University of Cologne, Cologne, Germany
| | - Nuran Abdullayev
- Department of Radiology, Neuroradiology Division, University of Cologne, Cologne, Germany
- GFO Clinics Troisdorf, Radiology and Neuroradiologie, Troisdorf, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Vivien Richter
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Annerose Mengel
- Department of Neurology and Stroke, University Hospital Tübingen, Tübingen, Germany
| | - Siri Göpel
- Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Astrid Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Valentin Ladenhauf
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke R Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Kindl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Marios Psychogios
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Inke R König
- Institute of Medical Biometry and Statistics (IMBS), UKSH, Campus Lübeck, Lübeck, Germany
| | | | - Sönke Wallis
- Department of Internal Medicine, UKSH, Campus Lübeck, Lübeck, Germany
| | | | - Peter Schramm
- Department of Neuroradiology, UKSH, Campus Lübeck, Lübeck, Germany
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Altersberger VL, Sibolt G, Enz LS, Hametner C, Scheitz JF, Henon H, Bigliardi G, Strambo D, Martinez-Majander N, Stolze LJ, Heldner MR, Grisendi I, Jovanovic DR, Bejot Y, Pezzini A, Leker RR, Kägi G, Wegener S, Cereda CW, Ntaios G, De Marchis GM, Bonati LH, Psychogios M, Lyrer P, Räty S, Tiainen M, Wouters A, Caparros F, Heyse M, Erdur H, Padjen V, Zedde M, Arnold M, Nederkoorn PJ, Michel P, Zini A, Cordonnier C, Nolte CH, Ringleb PA, Curtze S, Engelter ST, Gensicke H. Intravenous Thrombolysis 4.5-9 Hours After Stroke Onset - a Cohort Study from the TRISP Collaboration. Ann Neurol 2023. [PMID: 37114466 DOI: 10.1002/ana.26669] [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: 03/09/2022] [Revised: 03/27/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To investigate the safety and effectiveness of intravenous thrombolysis (IVT) >4.5-9 hours after stroke onset and the relevance of advanced neuroimaging for patient selection. METHODS Prospective multicenter cohort study from the ThRombolysis in Ischemic Stroke Patients (TRISP) collaboration. Outcomes were symptomatic intracranial hemorrhage (sICH), poor 3-month functional outcome (mRS 3-6) and mortality. We compared (i) IVT >4.5-9 hours versus 0-4.5 hours after stroke onset and (ii) within the >4.5-9 hours-group baseline advanced neuroimaging (CT perfusion, MR perfusion or MR DWI/FLAIR) versus non-advanced neuroimaging. RESULTS Of 15'827 patients, 663 (4.2%) received IVT >4.5-9 hours and 15'164 (95.8%) within 4.5 hours after stroke onset. The main baseline characteristics were evenly distributed between both groups. Time of stroke onset was known in 74.9% of patients treated between >4.5-9 hours. Using propensity score weighted binary logistic regression analysis (OTT >4.5-9 hours vs. OTT 0-4.5 hours), the probability of sICH (ORadjusted 0.80[0.53-1.17]), poor functional outcome (ORadjusted 1.01[0.83-1.22]) and mortality (ORadjusted 0.80[0.61-1.04]) did not differ significantly between both groups. In patients treated between >4.5-9 hours, the use of advanced neuroimaging was associated with a 50% lower mortality compared to non-advanced imaging only (9.9% vs 19.7%; ORadjusted 0.51[0.33-0.79]). INTERPRETATION This study showed no evidence in difference of sICH, poor outcome and mortality in selected stroke patients treated with IVT between >4.5-9 hours after stroke onset compared to those treated within 4.5 hours. Advanced neuroimaging for patient selection was associated with lower mortality. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Valerian L Altersberger
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Gerli Sibolt
- Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Lukas S Enz
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | | | - Jan F Scheitz
- Klinik Neurologie mit Experimenteller Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Germany
| | - Hilde Henon
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Guido Bigliardi
- Stroke Unit, Department of Neuroscience, Ospedale Civile di Baggiovara, Modena University Hospital, Modena, Italy
| | - Davide Strambo
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Lotte J Stolze
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Ilaria Grisendi
- Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Dejana R Jovanovic
- Neurology Clinic, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Yannick Bejot
- Department of Neurology, University Hospital Dijon, France
| | - Alessandro Pezzini
- Neurology Clinic, Department of Clinical and Experimental Sciences, University of Brescia, Italy
- Department of Neurological Sciences and Vision, ASST Spedali Civili, Brescia, Italy
| | - Ronen R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Carlo W Cereda
- Stroke Center and department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Georges Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Gian Marco De Marchis
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Leo H Bonati
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Marios Psychogios
- Department of Neuroradiology, University Hospital Basel and University of Basel, Switzerland
| | - Philippe Lyrer
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Silja Räty
- Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Marjaana Tiainen
- Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Anke Wouters
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - François Caparros
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Miriam Heyse
- Department of Neurology, University Hospital Heidelberg, Germany
| | - Hebun Erdur
- Klinik Neurologie mit Experimenteller Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Germany
| | - Visnja Padjen
- Neurology Clinic, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marialuisa Zedde
- Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Christian H Nolte
- Klinik Neurologie mit Experimenteller Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Germany
| | - Peter A Ringleb
- Department of Neurology, University Hospital Heidelberg, Germany
| | - Sami Curtze
- Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Stefan T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
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Kurmann CC, Kaesmacher J, Cooke DL, Psychogios M, Weber J, Lopes DK, Albers GW, Mordasini P. Evaluation of time-resolved whole brain flat panel detector perfusion imaging using RAPID ANGIO in patients with acute stroke: comparison with CT perfusion imaging. J Neurointerv Surg 2023; 15:387-392. [PMID: 35396333 PMCID: PMC10086455 DOI: 10.1136/neurintsurg-2021-018464] [Citation(s) in RCA: 1] [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: 11/29/2021] [Accepted: 03/23/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND In contrast to conventional CT perfusion (CTP) imaging, flat panel detector CT perfusion (FD-CTP) imaging can be acquired directly in the angiosuite. OBJECTIVE To evaluate time-resolved whole brain FD-CTP imaging and assess clinically important qualitative and quantitative perfusion parameters in correlation with previously acquired conventional CTP using the new RAPID for ANGIO software. METHODS We included patients with internal carotid artery occlusions and M1 or M2 occlusions from six centers. All patients underwent mechanical thrombectomy (MT) with preinterventional conventional CTP and FD-CTP imaging. Quantitative performance was determined by comparing volumes of infarct core, penumbral tissue, and mismatch. Eligibility for MT according to the perfusion imaging criteria of DEFUSE 3 was determined for each case from both conventional CTP and FD-CTP imaging. RESULTS A total of 20 patients were included in the final analysis. Conventional relative cerebral blood flow (rCBF) <30% and FD-CTP rCBF <45% showed good correlation (R2=0.84). Comparisons of conventional CTP Tmax >6 s versus FD-CTP Tmax >6 s and CTP mismatch versus FD-CTP mismatch showed more variability (R2=0.57, and R2=0.33, respectively). Based on FD-CTP, 16/20 (80%) patients met the inclusion criteria for MT according to the DEFUSE 3 perfusion criteria, in contrast to 18/20 (90%) patients based on conventional CTP. The vessel occlusion could be correctly extrapolated from the hypoperfusion in 18/20 cases (90%). CONCLUSIONS In our multicenter study, time-resolved whole brain FD-CTP was technically feasible, and qualitative and quantitative perfusion results correlated with those obtained with conventional CTP.
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Affiliation(s)
- Christoph C Kurmann
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Daniel L Cooke
- Department of Radiology and Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Marios Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Johannes Weber
- Clinic of Radiology and Nuclear Medicine, Diagnostic and Interventional Neuroradiology, Kantonsspital St Gallen, St. Gallen, Switzerland
| | - Demetrius K Lopes
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory W Albers
- Department of Neurology and Neurosurgery, Stanford University, Stanford, California, USA
| | - Pasquale Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, Switzerland
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20
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Saad HW, Eshraghi S, Howard BM, Buster BE, Akbik F, Maier I, Goyal N, Starke RM, Rai A, Fargen KM, Psychogios M, Jabbour P, DeLeacy R, Dumont TM, Kan P, Arthur AS, Crosa R, Gory B, Spiotta AM, Alawieh AM, Grossberg JA. 476 Technical and Clinical Outcomes in Concurrent Multivessel Occlusions Treated With Mechanical Thrombectomy: Insights from the STAR Collaboration. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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Desai SM, Psychogios M, Khatri P, Jovin TG, Jadhav AP. Direct Transfer to the Neuroangiography Suite for Patients With Stroke. Stroke 2023; 54:1674-1684. [PMID: 36999410 DOI: 10.1161/strokeaha.122.033447] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
The therapeutic focus in acute ischemic stroke over the last 2.5 decades has been to balance the benefits of rapid reperfusion therapy with the risks of treatment-related complications. Both intravenous thrombolytics and endovascular thrombectomy are proven to substantially improve outcomes in a time-dependent manner. Each minute saved in achieving successful reperfusion grants an additional week of healthy life and may salvage up to 27 million neurons. The current approach to patient triage is inherited from the preendovascular thrombectomy era of stroke care. Current workflow concentrates on stabilization, diagnosis, and decision-making in the emergency department, followed by thrombolysis if eligible and subsequent transfer to the angiography suite as needed for further treatment. Multiple efforts have been directed toward minimizing the time from first medical contact to reperfusion therapy including prehospital triage and intrahospital workflow. Novel approaches for stroke patient triage such as the direct to angio approach, (also referred to as One Stop Management) are currently in development. The concept was initially introduced as several single-center experiences. In this narrative review article, we will consider various definitions of direct to angio and its variants, discuss its rationale, review its safety and efficacy, assess its feasibility, and delineate its limitations. Further, we will address methods to overcome these limitations and the potential impact of emerging data and new technologies on the direct-to-angio approach.
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Affiliation(s)
- Shashvat M Desai
- HonorHealth Research and Innovation Institute, Scottsdale, AZ (S.M.D.)
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22
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Lee S, Mlynash M, Christensen S, Jiang B, Wintermark M, Sträter R, Broocks G, Grams A, Nikoubashman O, Morotti A, Trenkler J, Möhlenbruch M, Fiehler J, Wildgruber M, Kemmling A, Psychogios M, Sporns PB. Hyperacute Perfusion Imaging Before Pediatric Thrombectomy: Analysis of the Save ChildS Study. Neurology 2023; 100:e1148-e1158. [PMID: 36543574 PMCID: PMC10074461 DOI: 10.1212/wnl.0000000000201687] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Perfusion imaging can identify adult patients with salvageable brain tissue who would benefit from thrombectomy in later time windows. The feasibility of obtaining hyperacute perfusion sequences in pediatric stroke is unknown. The aim of this study was to determine whether contrast perfusion imaging delayed time to treatment and to assess perfusion profiles in children with large vessel occlusion stroke. METHODS The Save ChildS retrospective cohort study (January 2000-December 2018) enrolled children (1 month-18 years) with stroke who underwent thrombectomy from 27 European and U.S. stroke centers. This secondary analysis included patients with anterior circulation occlusion and available imaging for direct review by the neuroimaging core laboratory. Between-group comparisons were performed using the Wilcoxon rank-sum exact test for continuous variables or Fisher exact test for binary variables. Given the small number of patients, evaluation of perfusion imaging parameters was performed descriptively only. RESULTS Of 33 patients with available neuroimaging, 15 (45.4%) underwent perfusion (CT perfusion n = 6; MR perfusion n = 9); all were technically adequate. The median time from onset to recanalization did not differ between groups {4 hours (interquartile range [IQR] 4-7.5) perfusion+; 3.4 hours (IQR 2.5-6.5) perfusion-, p = 0.158}. Target mismatch criteria were met by 10/15 (66.7%) patients and did not correlate with reperfusion status or functional outcome. The hypoperfusion intensity ratio (HIR) was favorable in 11/15 patients and correlated with older age but not NIHSS, time to recanalization, or stroke etiology. Favorable HIR was associated with better functional outcome at 6 months (Pediatric Stroke Outcome Measure 1.0 [IQR 0.5-2.0] vs 2.0 [1.5-3.0], p = 0.026) and modified Rankin Scale 1.0 [0-1] vs 2.0 [1.5-3.5], p = 0.048) in this small sample. DISCUSSION Automated perfusion imaging is feasible to obtain acutely in children and does not delay time to recanalization. Larger prospective studies are needed to determine biomarkers of favorable outcome in pediatric ischemic stroke and to establish core and penumbral thresholds in children.
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Affiliation(s)
- Sarah Lee
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland.
| | - Michael Mlynash
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Soren Christensen
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Bin Jiang
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Max Wintermark
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Ronald Sträter
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Gabriel Broocks
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Astrid Grams
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Omid Nikoubashman
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Andrea Morotti
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Johannes Trenkler
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Markus Möhlenbruch
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Jens Fiehler
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Moritz Wildgruber
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Andre Kemmling
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Marios Psychogios
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Peter B Sporns
- From the Department of Neurology and Neurological Sciences (S.L., M.M., S.C.), Stanford Stroke Center, Stanford University School of Medicine, CA; Division of Child Neurology (S.L.), Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA; Division of Neuroradiology (B.J.), Department of Radiology, Stanford University School of Medicine, CA; Department of Neuroradiology (M.W.), University of Texas MD Anderson, Houston, TX; Department of Pediatrics (R.S.), University Hospital of Muenster; Department of Diagnostic and Interventional Neuroradiology (G.B., J.F.), University Medical Center Hamburg-Eppendorf, Germany; Department of Neuroradiology (A.G.), Medical University of Innsbruck, Austria; Department of Neuroradiology (O.N.), RWTH Aachen University, Germany; Department of Neurological Sciences and Vision (A.M.), Neurology Unit, ASST Spedali Civili, Brescia, Italy; Department of Neuroradiology (J.T.), Kepler University Hospital, Johannes Kepler University Linz, Austria; Department of Neuroradiology (M.M.), Heidelberg University Hospital; Department of Radiology (M.W.), University Hospital, LMU Munich; Department of Neuroradiology (A.K.), Marburg University Hospital, Germany; Department of Neuroradiology (M.P., P.B.S.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
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23
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Dittrich TD, Sporns PB, Kriemler LF, Rudin S, Nguyen A, Zietz A, Polymeris AA, Tränka C, Thilemann S, Wagner B, Altersberger VL, Piot I, Barinka F, Müller S, Hänsel M, Gensicke H, Engelter ST, Lyrer PA, Sutter R, Nickel CH, Katan M, Peters N, Kulcsár Z, Karwacki GM, Pileggi M, Cereda C, Wegener S, Bonati LH, Fischer U, Psychogios M, De Marchis GM. Mechanical Thrombectomy Versus Best Medical Treatment in the Late Time Window in Non-DEFUSE-Non-DAWN Patients: A Multicenter Cohort Study. Stroke 2023; 54:722-730. [PMID: 36718751 PMCID: PMC10561685 DOI: 10.1161/strokeaha.122.039793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/21/2022] [Accepted: 10/21/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND We assessed the efficacy and safety of mechanical thrombectomy (MT) in adult stroke patients with anterior circulation large vessel occlusion presenting in the late time window not fulfilling the DEFUSE-3 (Thrombectomy for Stroke at 6 to 16 Hours With Selection by Perfusion Imaging trial) and DAWN (Thrombectomy 6 to 24 Hours After Stroke With a Mismatch Between Deficit and Infarct trial) inclusion criteria. METHODS Cohort study of adults with anterior circulation large vessel occlusion admitted between 6 and 24 hours after last-seen-well at 5 participating Swiss stroke centers between 2014 and 2021. Mismatch was assessed by computer tomography or magnetic resonance imaging perfusion with automated software (RAPID or OLEA). We excluded patients meeting DEFUSE-3 and DAWN inclusion criteria and compared those who underwent MT with those receiving best medical treatment alone by inverse probability of treatment weighting using the propensity score. The primary efficacy end point was a favorable functional outcome at 90 days, defined as a modified Rankin Scale score shift toward lower categories. The primary safety end point was symptomatic intracranial hemorrhage within 7 days of stroke onset; the secondary was all-cause mortality within 90 days. RESULTS Among 278 patients with anterior circulation large vessel occlusion presenting in the late time window, 190 (68%) did not meet the DEFUSE-3 and DAWN inclusion criteria and thus were included in the analyses. Of those, 102 (54%) received MT. In the inverse probability of treatment weighting analysis, patients in the MT group had higher odds of favorable outcomes compared with the best medical treatment alone group (modified Rankin Scale shift: acOR, 1.46 [1.02-2.10]; P=0.04) and lower odds of all-cause mortality within 90 days (aOR, 0.59 [0.37-0.93]; P=0.02). There were no significant differences in symptomatic intracranial hemorrhage (MT versus best medical treatment alone: 5% versus 2%, P=0.63). CONCLUSIONS Two out of 3 patients with anterior circulation large vessel occlusion presenting in the late time window did not meet the DEFUSE-3 and DAWN inclusion criteria. In these patients, MT was associated with higher odds of favorable functional outcomes without increased rates of symptomatic intracranial hemorrhage. These findings support the enrollment of patients into ongoing randomized trials on MT in the late window with more permissive inclusion criteria.
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Affiliation(s)
- Tolga D Dittrich
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Peter B Sporns
- Department of Neuroradiology, University Hospital Basel, Switzerland (P.B.S., A.N., M.P.)
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (P.B.S.)
| | - Lilian F Kriemler
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
- Clinic for Internal Medicine, Cantonal Hospital Schaffhausen, Switzerland (L.F.K.)
| | - Salome Rudin
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Anh Nguyen
- Department of Neuroradiology, University Hospital Basel, Switzerland (P.B.S., A.N., M.P.)
| | - Annaelle Zietz
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Alexandros A Polymeris
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Christopher Tränka
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Sebastian Thilemann
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Benjamin Wagner
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Valerian L Altersberger
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Ines Piot
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Filip Barinka
- Department of Neurology and Stroke Center, Hirslanden Hospital Zurich, Switzerland (F.B., N.P.)
| | - Susanne Müller
- Department of Neuroradiology, University Hospital Zurich, Switzerland (S.M.)
| | - Martin Hänsel
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland (M.H., S.W.)
| | - Henrik Gensicke
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland (H.G., S.T.E.)
| | - Stefan T Engelter
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland (H.G., S.T.E.)
| | - Philippe A Lyrer
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Raoul Sutter
- Department of Intensive Care Medicine, University Hospital Basel, Switzerland (R.S.)
| | - Christian H Nickel
- Emergency Department University Hospital Basel and University of Basel, Switzerland (C.H.N.)
| | - Mira Katan
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Nils Peters
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
- Department of Neurology and Stroke Center, Hirslanden Hospital Zurich, Switzerland (F.B., N.P.)
| | - Zsolt Kulcsár
- Department of Neuroradiology, University Hospital Zurich, Switzerland (Z.K.)
| | - Grzegorz M Karwacki
- Department of Radiology and Nuclear Medicine, Cantonal Hospital of Lucerne, Switzerland (G.M.K.)
| | - Marco Pileggi
- Department of Neuroradiology, University Hospital Basel, Switzerland (P.B.S., A.N., M.P.)
| | - Carlo Cereda
- Department of Neurology and Stroke Center, EOC Neurocenter of Southern Switzerland, Lugano, Switzerland (C.C.)
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland (M.H., S.W.)
| | - Leo H Bonati
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
- Rheinfelden Rehabilitation Clinic, Switzerland (L.H.B.)
| | - Urs Fischer
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
| | - Marios Psychogios
- Department of Neuroradiology, EOC Neurocenter of Southern Switzerland, Lugano, Switzerland (M.P.)
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (T.D.D., L.F.K., S.R., A.Z., A.A.P., C.T., S.T., B.W., V.L.A., I.P., H.G., S.T.E., P.A.L., M.K., N.P., L.H.B., U.F., G.M.D.M.)
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24
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Hanning U, Bechstein M, Kaesmacher J, Boulouis G, Chapot R, Andersson T, Boccardi E, Psychogios M, Cognard C, de Dios Lascuevas M, Rodrigues M, Rodriguez Caamaño I, Gargalas S, Simonato D, Zupancic V, Daller C, Meyer L, Broocks G, Guerreiro H, Fiehler J, Martínez-Galdamez M, Kalousek V. Remote Training of Neurointerventions by Audiovisual Streaming : Experiences from the European ESMINT-EYMINT E-Fellowship Program. Clin Neuroradiol 2023; 33:137-145. [PMID: 35829740 PMCID: PMC9277595 DOI: 10.1007/s00062-022-01192-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Remote access of trainees to training centers via video streaming (tele-observership, e‑fellowship) emerges as an alternative to acquire knowledge in endovascular interventions. Situational awareness is a summary term that is also used in surgical procedures for perceiving and understanding the situation and projecting what will happen next. A high situational awareness would serve as prerequisite for meaningful learning success during tele-observerships. We hypothesized that live perception of the angiographical procedures using streaming technology is feasible and sufficient to gain useful situational awareness of the procedure. METHODS During a European tele-observership organized by the European Society of Minimally Invasive Neurological Therapy (ESMINT) and its trainee association (EYMINT), a total of six neurointerventional fellows in five countries observed live cases performed by experienced neurointerventionalists (mentors) in six different high-volume neurovascular centers across Europe equipped with live-streaming technology (Tegus Medical, Hamburg, Germany). Cases were prospectively evaluated during a 12-month period, followed by a final questionnaire after completion of the course. RESULTS A total of 102/161 (63%) cases with a 1:1 allocation of fellow and mentor were evaluated during a 12-month period. Most frequent conditions were ischemic stroke (27.5%), followed by embolization of unruptured aneurysms (25.5%) and arteriovenous malformations (AVMs) (15.7%). A high level of situational awareness was reported by fellows in 75.5% of all cases. After finishing the program, the general improvement of neurointerventional knowledge was evaluated to be extensive (1/6 fellows), substantial (3/6), and moderate (2/6). The specific fields of improvement were procedural knowledge (6/6 fellows), technical knowledge (3/6) and complication management (2/6). CONCLUSION Online streaming technology facilitates location-independent training of complex neurointerventional procedures through high levels of situational awareness and can therefore supplement live hands-on-training. In addition, it leads to a training effect for fellows with a perceived improvement of their neurointerventional knowledge.
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Affiliation(s)
- Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Johannes Kaesmacher
- Department of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology Department, Institut national de la santé et de la recherche médicale (INSERM) Team 1253 iBrain, Tours University Hospital, Tours, Centre Val de Loire Region, France
| | - René Chapot
- Department of Neuroradiology, Alfried Krupp Krankenhaus, Essen, Germany
| | - Tommy Andersson
- Department of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| | - Edoardo Boccardi
- Department of Diagnostic and Interventional Neuroradiology, Niguarda Hospital, Milan, Italy
| | - Marios Psychogios
- Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland
| | - Christophe Cognard
- Neuroradiology Department, Pierre-Paul-Riquet/Purpan University Hospital, Toulouse, France
| | | | - Marta Rodrigues
- Neuroradiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Sergios Gargalas
- Diagnostic and Interventional Neuroradiology Department, John Radcliffe Hospital, Oxford, UK
| | - Davide Simonato
- Interventional Neuroradiology Department, University Hospital of Padua, Padua, Italy
| | - Vedran Zupancic
- Department of Radiology, Clinical Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Cornelia Daller
- Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Helena Guerreiro
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Mario Martínez-Galdamez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Vladimir Kalousek
- Department of Radiology, Clinical Hospital Center Sestre Milosrdnice, Zagreb, Croatia
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Meyer L, Stracke P, Broocks G, Elsharkawy M, Sporns P, Piechowiak EI, Kaesmacher J, Maegerlein C, Hernandez Petzsche MR, Zimmermann H, Naziri W, Abdullayev N, Kabbasch C, Diamandis E, Thormann M, Maus V, Fischer S, Möhlenbruch M, Weyland CS, Ernst M, Jamous A, Meila D, Miszczuk M, Siebert E, Lowens S, Krause LU, Yeo L, Tan B, Gopinathan A, Arenillas-Lara JF, Navia P, Raz E, Shapiro M, Arnberg F, Zeleňák K, Martínez-Galdámez M, Alexandrou M, Kastrup A, Papanagiotou P, Kemmling A, Dorn F, Psychogios M, Andersson T, Chapot R, Fiehler J, Hanning U. Thrombectomy versus Medical Management for Isolated Anterior Cerebral Artery Stroke: An International Multicenter Registry Study. Radiology 2023; 307:e220229. [PMID: 36786705 DOI: 10.1148/radiol.220229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Background Evidence supporting a potential benefit of thrombectomy for distal medium vessel occlusions (DMVOs) of the anterior cerebral artery (ACA) is, to the knowledge of the authors, unknown. Purpose To compare the clinical and safety outcomes between mechanical thrombectomy (MT) and best medical treatment (BMT) with or without intravenous thrombolysis for primary isolated ACA DMVOs. Materials and Methods Treatment for Primary Medium Vessel Occlusion Stroke, or TOPMOST, is an international, retrospective, multicenter, observational registry of patients treated for DMVO in daily practice. Patients treated with thrombectomy or BMT alone for primary ACA DMVO distal to the A1 segment between January 2013 and October 2021 were analyzed and compared by one-to-one propensity score matching (PSM). Early outcome was measured by the median improvement of National Institutes of Health Stroke Scale (NIHSS) scores at 24 hours. Favorable functional outcome was defined as modified Rankin scale scores of 0-2 at 90 days. Safety was assessed by the occurrence of symptomatic intracerebral hemorrhage and mortality. Results Of 154 patients (median age, 77 years; quartile 1 [Q1] to quartile 3 [Q3], 66-84 years; 80 men; 94 patients with MT; 60 patients with BMT) who met the inclusion criteria, 110 patients (median age, 76 years; Q1-Q3, 67-83 years; 50 men; 55 patients with MT; 55 patients with BMT) were matched. DMVOs were in A2 (82 patients; 53%), A3 (69 patients; 45%), and A3 (three patients; 2%). After PSM, the median 24-hour NIHSS point decrease was -2 (Q1-Q3, -4 to 0) in the thrombectomy and -1 (Q1-Q3, -4 to 1.25) in the BMT cohort (P = .52). Favorable functional outcome (MT vs BMT, 18 of 37 [49%] vs 19 of 39 [49%], respectively; P = .99) and mortality (MT vs BMT, eight of 37 [22%] vs 12 of 39 [31%], respectively; P = .36) were similar in both groups. Symptomatic intracranial hemorrhage occurred in three (2%) of 154 patients. Conclusion Thrombectomy appears to be a safe and technically feasible treatment option for primary isolated anterior cerebral artery occlusions in the A2 and A3 segment with clinical outcomes similar to best medical treatment with and without intravenous thrombolysis. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Zhu and Wang in this issue.
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Affiliation(s)
- Lukas Meyer
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Paul Stracke
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Gabriel Broocks
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Mohamed Elsharkawy
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Peter Sporns
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Eike I Piechowiak
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Johannes Kaesmacher
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Christian Maegerlein
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Moritz Roman Hernandez Petzsche
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Hanna Zimmermann
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Weis Naziri
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Nuran Abdullayev
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Christoph Kabbasch
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Elie Diamandis
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Maximilian Thormann
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Volker Maus
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Sebastian Fischer
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Markus Möhlenbruch
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Charlotte S Weyland
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Marielle Ernst
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Ala Jamous
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Dan Meila
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Milena Miszczuk
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Eberhard Siebert
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Stephan Lowens
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Lars Udo Krause
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Leonard Yeo
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Benjamin Tan
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Anil Gopinathan
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Juan F Arenillas-Lara
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Pedro Navia
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Eytan Raz
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Maksim Shapiro
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Fabian Arnberg
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Kamil Zeleňák
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Mario Martínez-Galdámez
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Maria Alexandrou
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Andreas Kastrup
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Panagiotis Papanagiotou
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - André Kemmling
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Franziska Dorn
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Marios Psychogios
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Tommy Andersson
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - René Chapot
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Jens Fiehler
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | - Uta Hanning
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
| | -
- From the Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany (L.M., P.S., G.B., P.S., J.F., U.H.); Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany (P.S., M.E.); Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Essen, Germany (R.C.); Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland (P.S., M.P.); Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (E.I.P., J.K.); Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.); Institute of Neuroradiology, University Hospitals, LMU Munich, Munich, Germany (H.Z., F.D.); Department of Neuroradiology, University of Cologne, Cologne, Germany (N.A., C.K.); Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany (E.D., M.T.); Department of Diagnostic Radiology and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Bochum Germany (V.M., S.F.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M. Möhlenbruch, C.S.W.); Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Goettingen, Goettingen, Germany (M.E., A.J.); Department of Interventional Neuroradiology, Johanna Étienne Hospital, Neuss, Germany (D.M.); Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Berlin, Germany (M. Miszczuk, E.S.); Department of Radiology, Klinikum Osnabrück, Osnabrück, Germany (S.L.); Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany (L.U.K.); Division of Neurology, Department of Medicine, National University Health System, Singapore (L.Y., B.T.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.Y., B.T., A.G.); Division of Interventional Radiology, Department of Diagnostic imaging, National University Health System, Singapore (A.G.); Department of Neuroradiology, University Hospital Bonn, Bonn, Germany (F.D.); Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (M.M.G.); Department of Radiology, New York Langone Medical Center, New York, NY (E.R., M.S.); Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.); Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.); Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany (A. Kastrup); Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany (M.A., P.P.); Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece (P.P.); Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.); Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.); Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.); Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.); Department of Neuroradiology, University Hospital Marburg, Marburg, Germany (A. Kemmling); and Stroke Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain (J.F.A.L.)
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Essibayi MA, Anadani M, Almallouhi E, Yaghi S, Maier I, Jabbour PM, Kim JT, Wolfe SQ, Rai A, Starke R, Psychogios M, Shaban A, Arthur AS, Yoshimura S, Howard B, Alawieh A, Fragata I, Cuellar H, Polifka A, Mascitelli J, Osbun J, Matouk C, Park MS, Levitt M, Dumont T, Williamson R, Altschul D, Spiotta AM, Al Kasab S. Abstract WP164: Acute Carotid Stenting Versus Conservative Management For Tandem Carotid Occlusions: Insights From STAR. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
Management of anterior circulation emergent large vessel occlusion with tandem carotid occlusion (TCO) remains a challenge during mechanical thrombectomy (MT). To day, there is no consensus regarding emergent carotid stenting (ECS) in the setting of MT with TCO. We aimed to compare the outcomes of ECS versus conservative management (MT alone) among patients with TCO.
Methods:
Data from the Stroke Thrombectomy and Aneurysm Registry between 2010 and 2022 was interrogated. Only patients with concomitant occlusions of cervical carotid and proximal ipsilateral intracranial segments of the ICA or MCA were included in the analyses. We compared baseline, procedural charecteristics, successful reperfusion (mTICI 2b-3), favorable 90-day good outcomes (mRS 0-2), intravenous tPA administration and symptomatic ICH between patients who did or did not undergo ECS. Multivariate regression was performed adjusting for variables of clinical importance. Propensity score matching for IV tPA use was performed to explore its safety with stenting.
Results:
Among 9812 thrombectomy patients, 688 patients had TCO; 132 underwent emergent stenting and 444 had MT alone. Patients who did not undergo ECS had a higher prevalence of atrial fibrillation (33.9% Vs 9.2%, P<.001), higher admission NIHSS scores (18 Vs 14, P<.001), shorter time from symptom onset to puncture (275 minutes Vs 333 minutes, P=0.029), and were predominantly women (59.2% Vs 33.6%, P<0.001).Patients with stenting had lower mortality rates ( 17.5% Vs 29.6%, P=0.009), and higher rates of successful reperfusion (83% Vs 95%, P=0.001). No difference in mRS 0-2 (37.5% Vs 30.4%, P=0.178) or sICH were seen (11.1% Vs 15.4%, P=0.219). Propensity score matching analysis (n=129 in each group) demonstrated better rates of reperfusion (94.8 Vs 84.4%, P=0.011) in the stenting group. Advanced age, higher admission NIHSS and lower ASPECT scores were associated with worse clinical outcomes.
Conclusion:
ECS during MT for TCO appears to be safe and is associated with better clinical and angiographic outcomes compared to conservative management.
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Affiliation(s)
| | | | | | | | | | | | - Joon-Tae Kim
- Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | | | | | | | | | | | | | | | | | | | - Isabel Fragata
- Cntr Hospar Universitário de Lisboa Central, Lisbon, Portugal
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Shoskes A, Shu L, Nguyen TN, Giles J, Siegler JE, Henninger N, Al Kasab S, Klein P, Heldner MR, Psychogios M, Liebeskind DS, Abdalkader M, Starke RM, Morcos JJ, Romano JG, Yaghi S, Asdaghi N. Abstract 54: Incidence And Predictors Of Dural Arteriovenous Fistulae After Cerebral Venous Sinus Thrombosis: Analysis Of ACTION-CVT. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background:
Intracranial dural arteriovenous fistulae (DAVF) are uncommon vascular anomalies with a reported incidence of 0.2 per 100,000 person years. An association between cerebral venous thrombosis (CVT) and DAVF has been reported; however, the direction of causality between the two remains uncertain. We aimed to identify the incidence and predictors of development of DAVF among patients with CVT.
Methods:
This is a post-hoc analysis of Anticoagulation in the Treatment of Cerebral Venous Thrombosis (ACTION-CVT), a multicenter retrospective study comparing outcomes of CVT patients treated with warfarin versus direct oral anticoagulants (DOACs) from 2015 to 2020. Patients were included in this analysis if they did not have DAVF on initial imaging and had follow-up vascular imaging during the study. Clinical, imaging, and anticoagulation characteristics of patients who developed DAVF were compared to those who did not. Stepwise binary logistic regression including important variables (achieving p<0.1 on univariate analyses) was used to determine predictors of DAVF development.
Results:
A total of 751 patients (median age 43, 66% female) met inclusion criteria of whom 13 (1.7%) developed DAVF with an estimated rate of 2.40 per 100 patient years. Patients with DAVF were less likely to have headache at presentation (53.8% vs 79.3%, p=0.037), but more likely to have no venous recanalization on follow-up imaging (46.2% vs 14.8%, p=0.008), baseline cortical vein thrombosis (15.4% vs 2.7%, p=0.053), and received warfarin (vs. DOACs) as initial oral anticoagulant (84.6% vs 58.7%, p=0.085) but the latter two missed the statistical significance threshold. In stepwise binary logistic regression analysis, cortical vein thrombosis (OR 7.98, 95% CI 1.40-45.35, p=0.02) and lack of venous recanalization (OR 4.93, 95% CI 1.48-16.39, p=0.01) were associated with development of DAVF.
Conclusion:
In this large multicenter study of CVT, the incidence of DAVF development was higher than the previously reported rate in the general population. The presence of cortical vein thrombosis and lack of venous recanalization were associated with increased risk of development of DAVF.
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Affiliation(s)
| | - Liqi Shu
- Dept of Neurology, Brown Univ, Providence, RI
| | - Thanh N Nguyen
- Dept of Neurology, Boston Univ Sch of Medicine, Boston, MA
| | - James Giles
- Dept of Neurology, Washington Univ, St. Louis, MO
| | | | | | - Sami Al Kasab
- Dept of Neurology, Med Univ of South Carolin, Charleston, SC
| | | | | | - Marios Psychogios
- Dept of Interventional and Diagnostic Neuroradiology, Univ Hosp Basel, Basel, Switzerland
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Almallouhi E, Al Kasab S, Maier I, Jabbour PM, Kim JT, Quintero Wolfe SC, rai A, Starke R, Psychogios M, Samaniego EA, Arthur AS, Yoshimura S, Grossberg JA, Alawieh A, Fragata I, Cuellar H, Polifka A, Mascitelli J, Osbun J, Matouk C, Park MS, Levitt M, Dumont T, Williamson R, Spiotta AM, Grandhi R. Abstract 48: Outcomes And Risk Of Hemorrhagic Transformation Following Mechanical Thrombectomy In Primary Distal Posterior Cerebral Artery Occlusions-subgroup Analysis From STAR. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background:
While mechanical thrombectomy (MT) has become the standard of care for acute stroke patients presenting with large vessel occlusion (LVO) and salvageable brain tissue, limited data is currently available regarding the benefits of MT in patents with medium vessel occlusions (MeVO) especially in the posterior circulation (P2 occlusions).
Methods:
We used the Stroke Thrombectomy and Aneurysm registry (STAR) which included data from 35 stroke centers in North America, Europe, Asia, and South America. We included patients who presented with MeVO in the M2, M3 or P2 segments and underwent MT. We used a Generalized Linear Model to assess the relationship between location of occlusion and outcomes.
Results:
9812 patients were included in STAR at the time of this analysis; 43 underwent MT for P2 occlusion, 130 underwent MT for M3 occlusion; and 1273 underwent MT for M2 occlusion. There was no difference in age, sex, race, rate of IV-tPA and stroke severity between patients in all 3 groups (Table 1). There was a trend toward lower rate of atrial fibrillation in patients with P2 and M3 occlusions. Patients with P2 occlusions were less likely to achieve successful recanalization (modified treatment in cerebral infarction score≥2b); intraarterial thrombolysis was used less in P2 occlusions (4.7% compared to 16.2% in M3 occlusions and 10.1% in M2 occlusions). However, there was no difference in the rate of successful first pass. On multivariable analysis, P2 occlusions were not associated with hemorrhagic transformation (OR 2.0, 95% CI 0.7-5.7, P 0.186), 90-day mortality (OR 0.5, 95% CI 0.2-1.4, P 0.183), or 90-day favorable outcome (OR 2.0, 95% CI 0.9-4.4, P 0.084).
Conclusions:
In this multicenter study, there was no significant difference in safety and efficacy of MT in patients with MeVOs in posterior circulation (P2 occlusions) compared to M2 and M3 occlusions. Improved techniques for successful recanalization are needed for posterior circulation MeVOs.
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Affiliation(s)
| | | | | | | | - Joon-Tae Kim
- Chonnam National Univ Hosp, Gwangju, Korea, Republic of
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van der Geest Y, Disanto G, Bianco G, Sihabdeen S, Pileggi M, Strambo D, Michel P, Kahles T, Nedeltchev K, Fischer U, Bonati L, Kaegi G, Escribano JB, Carrera E, Nyffeler T, Bolognese M, Wegener S, Luft A, Medlin F, Renaud S, Mono ML, Remonda L, Machi P, Psychogios M, Kaesmacher J, Wardlaw JM, Cereda CW. Abstract TP150: Outcome Of Patients With Lacunar Strokes In The Era Of Thrombectomy. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tp150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
Endovascular treatment (EVT), in particular mechanical thrombectomy, has dramatically improved the clinical outcome of patients with large vessels occlusion (LVO) of the anterior circulation. In contrast, the benefits of EVT cannot be applied to lacunar strokes (LS). The absence of a LVO in LS has been historically associated with a more favorable outcome, but in the new era of EVT, this assumption may not be correct anymore. We aimed to test the general assumption that LS have a better prognosis than other stroke subtypes, and analyze the outcome of LS treated with IVT as compared to strokes with LVO treated with IVT and/or mechanical thrombectomy in the multicentric Swiss Stroke Registry.
Methods:
retrospective propensity score matching analysis of patients from the Swiss stroke registry (SSR) with lacunar stroke treated with thrombolysis versus LVO of the medial cerebral artery treated with EVT (with or without thrombolysis). Primary endpoint was a shift analysis of mRs at 90 days after stroke. Secondary outcomes were favorable functional outcome (mRS 0-1), independence (mRS 0-2), survival with high disability (mRS 3-5) and mortality (mRS 6) at 90 days.
Results:
From 13'227 patients, the propensity score method matched (sex, age, NIHSS, time to treatment, prior anticoagulation, pre-stroke modified Rankin Score, mRs) 538 patients (269 in each group. There was no difference between groups in mRs shift analysis at 90 days after stroke (OR=0.99, 95%CI=0.73-1.35, p=0.952). There was also no significant difference in mRS 0-1 (59.9% vs 55.8% respectively; OR=0.79, 95%CI=0.55-1.16, p=0.75). LS+IVT patients showed a non-significant trend towards mRS 3-5 (OR=1.23, 95%CI=0.78-1.94, p=0.38), while patients treated with EVT had a slightly, non-significant, higher mortality (6.3% vs 1.9%, p=0.38).
Conclusions:
Lacunar strokes - which cannot directly benefit from thrombectomy therapy - when treated with IVT and matched on key prognostic variables, seem to have similar outcomes as LVO strokes treated with EVT. This observation confirms that lacunar stroke is not a benign entity and therefore suggests that reperfusion therapy should be addressed with the same intensity as LVO stroke.
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Affiliation(s)
- Yael van der Geest
- Facoltà di Scienze Biomediche, Università della Svizzera italiana (USI), Lugano, Switzerland
| | | | | | | | | | | | | | | | | | | | - Leo Bonati
- Neurology, Univ Hosp, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | | - Luca Remonda
- Radiology, Cantonal Hosp Aarau, Aarau, Switzerland
| | - Paolo Machi
- Neuroradiology, Univ Hosp, Geneva, Switzerland
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30
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Almallouhi E, Anadani M, Al Kasab S, Maier I, Jabbour PM, Kim JT, Quintero Wolfe SC, rai A, Starke R, Psychogios M, Samaniego EA, Arthur AS, Yoshimura S, Grossberg JA, Alawieh A, Fragata I, Cuellar H, Polifka A, Mascitelli J, Osbun J, Matouk C, Park MS, Levitt M, Dumont T, Williamson R, Spiotta AM. Abstract 98: The Impact Of Aspiration Catheter Size On Thrombectomy Outcomes Using Adapt Technique-analysis From The STAR Registry. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introductions:
Clinical trials have shown that aspiration thrombectomy is as safe and effective as stent-retriever thrombectomy. Multiple improvements have been made to the aspiration technique over the last few years. In this study, we aim to assess the effect of aspiration catheter bore size on the outcomes of A direct aspiration first pass technique (ADAPT) thrombectomy.
Methods:
We included patients who underwent ADAPT thrombectomy for M1 or internal carotid artery terminus (ICA-T) occlusions in the Stroke Thrombectomy and Aneurysm (STAR) database. Patients included between July 2016 and July 2022. We compared baseline characteristics, procedural metrics and outcomes between patients who underwent thrombectomy using small bore (0.035”-0.060”), medium bore (0.062”-0.068”) and large bore (0.070”-0.074”) catheters.
Results:
A total of 1158 patients were included; 576 (49.7%) females, 645 (70%) White, and 464 (40.6%) received IV-tPA. No difference was noticed in age, sex, and vascular risk factors between the 3 different groups. There was higher rate of IV-tPA in the small-bore catheter group (48.8%) compared to the medium and large bore catheter groups (38.4% and 36.7%, respectively) (P=0.03). Procedure duration was shorter when using medium (20 min) and large (18 min) compared to small bore catheters (30 min) (P=0.01). Both medium and large bore catheters were associated with higher rate of successful recanalization (88.9% and 87.9%, respectively) compared to small bore catheters (81.6%) (P=0.010). However, the difference in successful recanalization or procedure duration between medium and large bore catheters was not significant. No difference was noted in the rate of symptomatic hemorrhagic transformation (sICH) (4.7%, 5.3%, and 7.1%; P=0.345), 90-day favorable outcome (modified Rankin Scale 0-2) (41.8%, 39.3%, 40.8%; P=0.766) or 90-day mortality (18.1%, 23.5%, 24.4%; P=0.111) between the groups.
Conclusions:
Higher rate of successful recanalization and shorter procedure duration were observed when using medium and large bore aspiration catheters compared with small bore catheters in ADAPT technique. However, these procedural benefits were not observed when comparing large bore to medium bore catheters.
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Affiliation(s)
| | | | | | | | | | - Joon-Tae Kim
- Chonnam National Univ Hosp, Gwangju, Korea, Republic of
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31
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Essibayi MA, Anadani M, Almallouhi E, Yaghi S, Lajthia O, Maier I, Jabbour PM, Kim JT, Quintero Wolfe S, rai A, Starke R, Psychogios M, Shaban A, Arthur AS, Yoshimura S, Howard B, Alawieh A, Fragata I, Cuellar H, Polifka A, Mascitelli J, Osbun J, Matouk C, Park MS, Levitt M, Dumont T, Williamson R, Altschul D, Spiotta AM, Al Kasab S. Abstract TP154: Outcomes Of Acute Carotid Stenting With Or Without Intravenous Thrombolysis Among Patients With Acute Tandem Occlusion: Insights From STAR. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tp154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
Emergency carotid artery stenting during mechanical thrombectomy has emerged as an effective emergent treatment for tandem carotid occlusions. Nevertheless, scarce evidence is available about the safety of this procedure in patients who received intravenous tPA before thrombectomy. Herein, we investigate the safety of acute carotid stenting among patients who received intravenous tPA in a large international multicenter registry.
Methods:
Patients from the Stroke Thrombectomy and Aneurysm Registry between 2010 and 2022 were analyzed. Only patients with concomitant occlusions of cervical carotid and proximal ipsilateral intracranial segments of the internal carotid or middle cerebral artery were included in the final analyses. Patients were divided into two groups, depending on tPA administration. The primary outcome was 90-day good clinical outcome (mRS 0-2), and the primary safety outcome was symptomatic intracranial hemorrhage. Univariate and multivariate regressions were performed adjusting for variables of clinical importance.
Results:
Among 9812 with acute ischemic stroke in the registry, 132 patients had acute tandem occlusion and underwent carotid stenting; of those, 60 patients received IV tPA. Compared to non-intravenous thrombolytics, patients with IV tPA had a higher male prevalence (78.3% Vs 54.4%, P=0.005) and better ASPECT scores (9 Vs 8, P=0.022) with a shorter time from onset to puncture (241 Vs 672 minutes, P<0.001). There was no difference in rates of successful revascularization (94% Vs 95.5%, P=NS), good clinical outcome (50.8% Vs 61.4%, P=NS), symptomatic intracranial hemorrhage (15.3% Vs 14.5%, P=NS) or procedural complications (15% Vs 11.6%, P=NS) between the tPA and non-tPA groups.
Conclusion:
The use of IV tPA did not affect the safety or efficacy of emergent carotid stenting in the setting of acute tandem occlusion.
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Affiliation(s)
| | | | | | | | | | | | | | - Joon-Tae Kim
- Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | | | | | | | | | | | | | | | | | | | - Isabel Fragata
- Cntr Hospar Universitário de Lisboa Central, Lisbon, Portugal
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32
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Roethlisberger M, Aghlmandi S, Rychen J, Chiappini A, Zumofen DW, Bawarjan S, Stienen MN, Fung C, D'Alonzo D, Maldaner N, Steinsiepe VK, Corniola MV, Goldberg J, Cianfoni A, Robert T, Maduri R, Saliou G, Starnoni D, Weber J, Seule MA, Gralla J, Bervini D, Kulcsar Z, Burkhardt JK, Bozinov O, Remonda L, Marbacher S, Lövblad KO, Psychogios M, Bucher HC, Mariani L, Bijlenga P, Blackham KA, Guzman R. Impact of Very Small Aneurysm Size and Anterior Communicating Segment Location on Outcome after Aneurysmal Subarachnoid Hemorrhage. Neurosurgery 2023; 92:370-381. [PMID: 36469672 DOI: 10.1227/neu.0000000000002212] [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: 12/21/2021] [Accepted: 08/31/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Very small anterior communicating artery aneurysms (vsACoA) of <5 mm in size are detected in a considerable number of patients with aneurysmal subarachnoid hemorrhage (aSAH). Single-center studies report that vsACoA harbor particular risks when treated. OBJECTIVE To assess the clinical and radiological outcome(s) of patients with aSAH diagnosed with vsACoA after aneurysm treatment and at discharge. METHODS Information on n = 1868 patients was collected in the Swiss Subarachnoid Hemorrhage Outcome Study registry between 2009 and 2014. The presence of a new focal neurological deficit at discharge, functional status (modified Rankin scale), mortality rates, and procedural complications (in-hospital rebleeding and presence of a new stroke on computed tomography) was assessed for vsACoA and compared with the results observed for aneurysms in other locations and with diameters of 5 to 25 mm. RESULTS This study analyzed n = 1258 patients with aSAH, n = 439 of which had a documented ruptured ACoA. ACoA location was found in 38% (n = 144/384) of all very small ruptured aneurysms. A higher in-hospital bleeding rate was found in vsACoA compared with non-ACoA locations (2.8 vs 2.1%), especially when endovascularly treated (2.1% vs 0.5%). In multivariate analysis, aneurysm size of 5 to 25 mm, and not ACoA location, was an independent risk factor for a new focal neurological deficit and a higher modified Rankin scale at discharge. Neither very small aneurysm size nor ACoA location was associated with higher mortality rates at discharge or the occurrence of a peri-interventional stroke. CONCLUSION Very small ruptured ACoA have a higher in-hospital rebleeding rate but are not associated with worse morbidity or mortality.
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Affiliation(s)
- Michel Roethlisberger
- Departments of Neurosurgery and Interventional Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jonathan Rychen
- Departments of Neurosurgery and Interventional Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alessio Chiappini
- Departments of Neurosurgery and Interventional Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel W Zumofen
- Department of Neurological Surgery, Maimonides Medical Center, New York, USA
| | - Schatlo Bawarjan
- Department of Neurosurgery, University Hospital of Göttingen, Göttingen, Germany
| | - Martin N Stienen
- Department of Neurosurgery and Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland.,Departments of Neurosurgery and Neuroradiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christian Fung
- Department of Neurosurgery, University Hospital of Freiburg, Freiburg Germany.,Departments of Neurosurgery and Neuroradiology, University Hospital of Bern, Bern Switzerland
| | - Donato D'Alonzo
- Departments of Neurosurgery and Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery and Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Valentin K Steinsiepe
- Departments of Neurosurgery and Neuroradiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marco V Corniola
- Departments of Neurosurgery and Neuroradiology, University Hospital of Geneva, Geneva Switzerland
| | - Johannes Goldberg
- Departments of Neurosurgery and Neuroradiology, University Hospital of Bern, Bern Switzerland
| | - Alessandro Cianfoni
- Departments of Neurosurgery and Neuroradiology, Neurocenter of Southern Switzerland, Ospedale regionale, Lugano, Switzerland
| | - Thomas Robert
- Departments of Neurosurgery and Neuroradiology, Neurocenter of Southern Switzerland, Ospedale regionale, Lugano, Switzerland
| | - Rodolfo Maduri
- Clinique de Genolier, Swiss Medical Network, Genolier, Switzerland
| | - Guillaume Saliou
- Departments of Neurosurgery and Neuroradiology, University Hospital of Lausanne, Switzerland
| | - Daniele Starnoni
- Departments of Neurosurgery and Neuroradiology, University Hospital of Lausanne, Switzerland
| | - Johannes Weber
- Departments of Neurosurgery and Neuroradiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Martin A Seule
- Departments of Neurosurgery and Neuroradiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jan Gralla
- Departments of Neurosurgery and Neuroradiology, University Hospital of Bern, Bern Switzerland
| | - David Bervini
- Departments of Neurosurgery and Neuroradiology, University Hospital of Bern, Bern Switzerland
| | - Zsolt Kulcsar
- Department of Neurosurgery and Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Oliver Bozinov
- Department of Neurosurgery and Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland.,Departments of Neurosurgery and Neuroradiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Luca Remonda
- Departments of Neurosurgery and Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Serge Marbacher
- Departments of Neurosurgery and Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Karl-Olof Lövblad
- Departments of Neurosurgery and Neuroradiology, University Hospital of Geneva, Geneva Switzerland
| | - Marios Psychogios
- Departments of Neurosurgery and Interventional Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Luigi Mariani
- Departments of Neurosurgery and Interventional Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philippe Bijlenga
- Departments of Neurosurgery and Neuroradiology, University Hospital of Geneva, Geneva Switzerland
| | - Kristine A Blackham
- Departments of Neurosurgery and Interventional Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Raphael Guzman
- Departments of Neurosurgery and Interventional Neuroradiology, University Hospital Basel, University of Basel, Basel, Switzerland
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Feil K, Berndt MT, Wunderlich S, Maegerlein C, Bernkopf K, Zimmermann H, Herzberg M, Tiedt S, Küpper C, Wischmann J, Schönecker S, Dimitriadis K, Liebig T, Dieterich M, Zimmer C, Kellert L, Boeckh-Behrens T, Boeckh-Behrens T, Wunderlich S, Ludolph A, Henn KH, Reich A, Nikoubashman O, Wiesmann M, Ernemann U, Poli S, Nolte CH, Siebert E, Zweynert S, Bohner G, Solymosi L, Petzold G, Pfeilschifter W, Keil F, Röther J, Eckert B, Berrouschot J, Bormann A, Alegiani A, Fiehler J, Gerloff C, Thomalla G, Thonke S, Bangard C, Kraemer C, Dichgans M, Psychogios M, Liman J, Petersen M, Stögbauer F, Kraft P, Pham M, Braun M, Hamann GF, Roth C, Gröschel K, Uphaus T, Limmroth V. Endovascular thrombectomy for basilar artery occlusion stroke: Analysis of the German Stroke Registry-Endovascular Treatment. Eur J Neurol 2023; 30:1293-1302. [PMID: 36692229 DOI: 10.1111/ene.15694] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 12/06/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Acute ischemic stroke due to basilar artery occlusion (BAO) causes the most severe strokes and has a poor prognosis. Data regarding efficacy of endovascular thrombectomy in BAO are sparse. Therefore, in this study, we performed an analysis of the therapy of patients with BAO in routine clinical practice. METHODS Patients enrolled between June 2015 and December 2019 in the German Stroke Registry-Endovascular Treatment (GSR-ET) were analyzed. Primary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] score of 2b-3), substantial neurological improvement (≥8-point National Institute of Health Stroke Scale [NIHSS] score reduction from admission to discharge or NIHSS score at discharge ≤1), and good functional outcome at 3 months (modified Rankin Scale [mRS] score of 0-2). RESULTS Out of 6635 GSR-ET patients, 640 (9.6%) patients (age 72.2 ± 13.3, 43.3% female) experienced BAO (median [interquartile range] NIHSS score 17 [8, 27]). Successful reperfusion was achieved in 88.4%. Substantial neurological improvement at discharge was reached by 45.5%. At 3-month follow-up, good clinical outcome was observed in 31.1% of patients and the mortality rate was 39.2%. Analysis of mTICI3 versus mTICI2b groups showed considerable better outcome in those with mTICI3 (38.9% vs. 24.4%; p = 0.005). The strongest predictors of good functional outcome were intravenous thrombolysis (IVT) treatment (odds ratio [OR] 3.04, 95% confidence interval [CI] 1.76-5.23) and successful reperfusion (OR 4.92, 95% CI 1.15-21.11), while the effect of time between symptom onset and reperfusion seemed to be small. CONCLUSIONS Acute reperfusion strategies in BAO are common in daily practice and can achieve good rates of successful reperfusion, neurological improvement and good functional outcome. Our data suggest that, in addition to IVT treatment, successful and, in particular, complete reperfusion (mTICI3) strongly predicts good outcome, while time from symptom onset seemed to have a lower impact.
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Affiliation(s)
- Katharina Feil
- Department of Neurology, Ludwig Maximilians Universität (LMU), Munich, Germany.,Department of Neurology and Stroke, Eberhard-Karls University Tübingen/Universitätsklinikum Tübingen (UKT), Tübingen, Germany
| | - Maria Teresa Berndt
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Silke Wunderlich
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kathleen Bernkopf
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Moriz Herzberg
- Institute of Neuroradiology, LMU, Munich, Germany.,Department of Radiology, University Hospital, Würzburg, Germany
| | - Steffen Tiedt
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Clemens Küpper
- Department of Neurology, Ludwig Maximilians Universität (LMU), Munich, Germany
| | - Johannes Wischmann
- Department of Neurology, Ludwig Maximilians Universität (LMU), Munich, Germany
| | - Sonja Schönecker
- Department of Neurology, Ludwig Maximilians Universität (LMU), Munich, Germany
| | - Konstantin Dimitriadis
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | | | - Marianne Dieterich
- Department of Neurology, Ludwig Maximilians Universität (LMU), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.,German Center for Vertigo and Balance Disorders, LMU, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lars Kellert
- Department of Neurology, Ludwig Maximilians Universität (LMU), Munich, Germany
| | - Tobias Boeckh-Behrens
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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Sporns PB, Rusche T, Lee S, Hanning U, Meyer L, Faizy T, Fiehler J, Psychogios M, Kemmling A, Broocks G. Impact of edema formation on functional outcome in pediatric stroke patients. Eur J Neurol 2023; 30:150-154. [PMID: 36168926 DOI: 10.1111/ene.15576] [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: 08/18/2022] [Accepted: 09/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Quantitative lesion net water uptake (NWU) has been described as an imaging biomarker reflecting vasogenic edema as an early indicator of infarct progression. We hypothesized that edema formation measured by NWU is higher in children compared to adults but despite this functional outcome may be better in children. METHODS This study analyzed children enrolled in the Save ChildS Study who had baseline and follow-up computed tomography available and the data were compared to adult patients. RESULTS Some 207 patients, of whom 13 were children and 194 were adults, were analyzed. Median NWU at baseline was 7.8% (IQR: 4.3-11.3), and there were no significant differences between children and adults (7.5% vs. 7.8%; p = 0.87). The early edema progression rate was 3.0%/h in children and 2.3%/h in adults. Median ΔNWU was 15.1% in children and 10.5% in adults. Children had significantly more often excellent (mRS 0-1; children 10/13 = 77% vs. adults 28/196 = 14%; p < 0.0001) and favorable clinical outcomes (mRS 0-2, 12/13 = 92% vs. 39/196 = 20%; p < 0.0001). CONCLUSIONS In this study, clinical outcomes in children with large vessel occlusion strokes were better than in adults despite similar clinical and imaging characteristics and similar edema formation. This may be impacted by the generally better outcomes of children after strokes but may demonstrate that the degree of early ischemic changes using Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and edema progression rate may not be a reason for exclusion from endovascular thrombectomy.
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Affiliation(s)
- Peter B Sporns
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thilo Rusche
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios Psychogios
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Andre Kemmling
- Department of Neuroradiology, University Hospital Marburg, Marburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Shu L, Bakradze E, Omran SS, Giles J, Amar J, Henninger N, Elnazeir M, Liberman A, Moncrieffe K, Rotblat J, Sharma R, Cheng Y, Zubair AS, Simpkins A, Li G, Kung J, Perez D, Heldner MR, Scutelnic A, von Martial R, Siepen B, Rothstein A, Khazaal O, Do D, Al Kasab S, Rahman LA, Mistry EA, Kerrigan D, Lafever H, Nguyen TN, Klein P, Aparicio HJ, Frontera JA, Kuohn L, Agarwal S, Stretz C, Kala N, ElJamal S, Chang A, Cutting S, Indraswari F, de Havenon A, Muddasani V, Wu T, Wilson D, Nouh A, Asad D, Qureshi A, Moore J, Khatri P, Aziz Y, Casteigne B, Khan M, Cheng Y, Grory BM, Weiss M, Ryan D, Vedovati MC, Paciaroni M, Siegler J, Kamen S, Yu S, Guerrero CL, Atallah E, De Marchis GM, Brehm A, Dittrich T, Psychogios M, Alvarado-Dyer R, Kass-Hout T, Prabhakaran S, Honda T, Liebeskind D, Furie K, Yaghi S. Predictors of Recurrent Venous Thrombosis After Cerebral Venous Thrombosis: Analysis of the ACTION-CVT Study. Neurology 2022; 99:e2368-e2377. [PMID: 36123126 PMCID: PMC9687409 DOI: 10.1212/wnl.0000000000201122] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Cerebral venous thrombosis (CVT) is a rare cause of stroke carrying a nearly 4% risk of recurrence after 1 year. There are limited data on predictors of recurrent venous thrombosis in patients with CVT. In this study, we aim to identify those predictors. METHODS This is a secondary analysis of the ACTION-CVT study which is a multicenter international study of consecutive patients hospitalized with a diagnosis of CVT over a 6-year period. Patients with cancer-associated CVT, CVT during pregnancy, or CVT in the setting of known antiphospholipid antibody syndrome were excluded per the ACTION-CVT protocol. The study outcome was recurrent venous thrombosis defined as recurrent venous thromboembolism (VTE) or de novo CVT. We compared characteristics between patients with vs without recurrent venous thrombosis during follow-up and performed adjusted Cox regression analyses to determine important predictors of recurrent venous thrombosis. RESULTS Nine hundred forty-seven patients were included with a mean age of 45.2 years, 63.9% were women, and 83.6% had at least 3 months of follow-up. During a median follow-up of 308 (interquartile range 120-700) days, there were 5.05 recurrent venous thromboses (37 VTE and 24 de novo CVT) per 100 patient-years. Predictors of recurrent venous thrombosis were Black race (adjusted hazard ratio [aHR] 2.13, 95% CI 1.14-3.98, p = 0.018), history of VTE (aHR 3.40, 95% CI 1.80-6.42, p < 0.001), and the presence of one or more positive antiphospholipid antibodies (aHR 3.85, 95% CI 1.97-7.50, p < 0.001). Sensitivity analyses including events only occurring on oral anticoagulation yielded similar findings. DISCUSSION Black race, history of VTE, and the presence of one or more antiphospholipid antibodies are associated with recurrent venous thrombosis among patients with CVT. Future studies are needed to validate our findings to better understand mechanisms and treatment strategies in patients with CVT.
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Affiliation(s)
- Liqi Shu
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Ekaterina Bakradze
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Setareh Salehi Omran
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - James Giles
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Jordan Amar
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Nils Henninger
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Marwa Elnazeir
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Ava Liberman
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Khadean Moncrieffe
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Jenny Rotblat
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Richa Sharma
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Yee Cheng
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Adeel S Zubair
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Alexis Simpkins
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Grace Li
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Justin Kung
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Dezaray Perez
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Mirjam R Heldner
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Adrian Scutelnic
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Rascha von Martial
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Bernhard Siepen
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Aaron Rothstein
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Ossama Khazaal
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - David Do
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Sami Al Kasab
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Line Abdul Rahman
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Eva A Mistry
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Deborah Kerrigan
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Hayden Lafever
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Thanh N Nguyen
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Piers Klein
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Hugo J Aparicio
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Jennifer A Frontera
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Lindsey Kuohn
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Shashank Agarwal
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Christoph Stretz
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Narendra Kala
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Sleiman ElJamal
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Allison Chang
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Shawna Cutting
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Fransisca Indraswari
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Adam de Havenon
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Varsha Muddasani
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Teddy Wu
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Duncan Wilson
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Amre Nouh
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Daniyal Asad
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Abid Qureshi
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Justin Moore
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Pooja Khatri
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Yasmin Aziz
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Bryce Casteigne
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Muhib Khan
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Yao Cheng
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Brian Mac Grory
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Martin Weiss
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Dylan Ryan
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Maria Cristina Vedovati
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Maurizio Paciaroni
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - James Siegler
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Scott Kamen
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Siyuan Yu
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Christopher Leon Guerrero
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Eugenie Atallah
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Gian Marco De Marchis
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Alex Brehm
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Tolga Dittrich
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Marios Psychogios
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Ronald Alvarado-Dyer
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Tareq Kass-Hout
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Shyam Prabhakaran
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Tristan Honda
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - David Liebeskind
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Karen Furie
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles
| | - Shadi Yaghi
- From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles.
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36
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Grossberg JA, Chalhoub RM, Al Kasab S, Pullmann D, Jabbour P, Psychogios M, Starke RM, Arthur AS, Fargen KM, De Leacy R, Kan P, Dumont T, Rai A, Crosa RJ, Naamani KE, Maier I, Goyal N, Wolfe SQ, Michael Cawley C, Mocco J, Hafeez M, Howard BM, Dimisko L, Saad H, Ogilvy CS, Webster Crowley R, Mascitelli J, Fragata I, Levitt M, Spiotta AM, Alawieh AM. Multicenter investigation of technical and clinical outcomes after thrombectomy for Proximal Medium Vessel Occlusion (pMeVO) by frontline technique. Interv Neuroradiol 2022:15910199221138139. [PMID: 36377352 DOI: 10.1177/15910199221138139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Endovascular thrombectomy(EVT) is the standard of care for large vessel occlusion(LVO) stroke. Data on technical and clinical outcome in proximal medium vessel occlusions(pMeVOs) comparing frontline techniques remain limited. METHODS We report an international multicenter retrospective study of patients undergoing EVT for stroke at 32 centers between 2015-2021. Patients were divided into LVOs(ICA/M1/Vertebrobasilar) or pMeVOs(M2/A1/P1) and categorized by thrombectomy technique. Primary outcome was 90-day good functional outcome(mRS ≤ 2). Multivariate logistic regressions were used to evaluate the impact of technical variables on clinical outcomes. Propensity score matching was used to compare outcome in patients with pMeVO treated with aspiration versus stent-retriever. RESULTS In the cohort of 5977 LVO and 1287 pMeVO patients, pMeVO did not independently predict good-outcome(p = 0.55). In pMeVO patients, successful recanalization irrespective of frontline technique(aOR = 3.2,p < 0.05), procedure time ≤ 1-h(aOR = 2.2,p < 0.05), and thrombectomy attempts ≤ 4(aOR = 2.8,p < 0.05) were independent predictors of good-outcomes.In a propensity-matched cohort of aspiration versus stent-retriever pMeVO patients, there was no difference in good-outcomes. The rates of hemorrhage were higher(9%vs.4%,p < 0.01) and procedure time longer(51-min vs. 33-min,p < 0.01) with stent-retriever, while the number of attempts was higher with aspiration(2.5vs.2,p < 0.01). Rates of hemorrhage and good-outcome showed an exponential relationship to procedural metrics, and were more dependent on time in the aspiration group compared to attempts in the stent-retriever group. CONCLUSIONS Clinical outcomes following EVT for pMeVO are comparable to those in LVOs. The golden hour or 3-pass rules in LVO thrombectomy still apply to pMeVO thrombectomy. Different techniques may exhibit different futility metrics; SR thrombectomy was more influenced by attempts whereas aspiration was more dependent on procedure time.
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Affiliation(s)
- Jonathan A Grossberg
- Department of Neurosurgery, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Reda M Chalhoub
- Department of Neurosurgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Sami Al Kasab
- Department of Neurosurgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Dominika Pullmann
- Department of Neurosurgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Robert M Starke
- Department of Neurosurgery, University of Miami Health System, Miami, FL, USA
| | - Adam S Arthur
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kyle M Fargen
- Department of Neurosurgery, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Reade De Leacy
- Department of Neurosurgery, Mount Sinai Hospital, New York, NY, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor University, Houston, TX, USA
| | - Travis Dumont
- Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Ansaar Rai
- Department of Radiology, West Virginia School of Medicine, Morgantown, WV, USA
| | - Roberto J Crosa
- Department of Neurosurgery, Centro Endovascular Neurologico Medica Uruguaya, Montevideo, Uruguay
| | - Kareem E Naamani
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ilko Maier
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - C Michael Cawley
- Department of Neurosurgery, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - J Mocco
- Department of Neurosurgery, Mount Sinai Hospital, New York, NY, USA
| | - Muhammad Hafeez
- Department of Neurosurgery, Baylor University, Houston, TX, USA
| | - Brian M Howard
- Department of Neurosurgery, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Laurie Dimisko
- Department of Neurosurgery, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Hassan Saad
- Department of Neurosurgery, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Christopher S Ogilvy
- Department of Neurosurgery, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Justin Mascitelli
- Department of Neurosurgery, University of Texas San Antonio, San Antonio, TX, USA
| | - Isabel Fragata
- Neuroradiology Department, Hospital São José, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Michael Levitt
- Department of Neurosurgery, University of Washington, Seattle, WA, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Ali M Alawieh
- Department of Neurosurgery, 12239Emory University School of Medicine, Atlanta, GA, USA
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37
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Dittrich TD, Sporns P, Kriemler L, Rudin S, Nguyen A, Zietz A, Polymeris AA, Tränka C, Thilemann S, Wagner B, Altersberger V, Piot I, Barinka F, Hänsel M, Gensicke H, Engelter S, Lyrer PA, Sutter R, Nickel C, Katan M, Peter N, Michels L, Kulcsar Z, Karwacki G, Pileggi M, Cereda CW, Wegener S, Bonati L, Fischer U, Psychogios M, De Marchis GM. Mechanical Thrombectomy For Large Vessel Occlusion Between 6 And 24 Hours: Outcome Comparison Of Defuse-3/Dawn Eligible Versus Non-Eligible Patients. Int J Stroke 2022:17474930221140793. [DOI: 10.1177/17474930221140793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: The DEFUSE-3 and DAWN trials showed that mechanical thrombectomy (MT) improves the outcome of selected patients with large vessel occlusions in the anterior circulation (LVO) up to 24 hours of stroke onset. However, it is unknown whether only those patients fulfilling the trial inclusion criteria benefit, or whether benefit is seen in a broader range of patients presenting between 6 and 24 hours. Aims: We determined whether fulfilling the DEFUSE-3 and DAWN selection criteria affects outcomes in MT patients in clinical practice. Methods: We reviewed adult patients with LVO treated with MT between 6 and 24 hours after stroke onset at five Swiss stroke centers between 2014 and 2021. We compared two groups: (1) patients who satisfied neither DEFUSE-3 nor DAWN criteria (NDND); and (2) those who satisfied DEFUSE-3 or DAWN criteria (DOD). We used logistic regression to examine the impact of trial eligibility on two safety outcomes (symptomatic intracranial hemorrhage [sICH] and all-cause mortality at three months) and two efficacy outcomes (modified Rankin Score [mRS] shift toward lower categories and mRS of 0-2 at three months). Results: Of 174 patients who received MT, 102 (59%) belonged to the NDND group. Rates of sICH were similar between the NDND group and the DOD group (3% vs. 4%, p=1.00). Multivariable regression revealed no differences in 3-month all-cause mortality (aOR 2.07, 95%CI 0.64-6.84, p=0.23) or functional outcomes (mRS shift: acOR 0.81, 95%CI 0.37-1.79, p=0.60; mRS 0-2: aOR 0.91, 95%CI 0.31-2.57, p=0.85). Conclusion: Among adult patients with LVO treated with MT between 6 and 24 hours, safety and efficacy outcomes were similar between DEFUSE-3/DAWN eligible vs. ineligible patients. Our data provide a compelling rationale for randomized trials with broader inclusion criteria for MT.
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Affiliation(s)
- Tolga Daniel Dittrich
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Peter Sporns
- Department of Neuroradiology, University Hospital Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Lilian Kriemler
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland
- Clinic for Internal Medicine, Cantonal Hospital Schaffhausen, Switzerland
| | - Salome Rudin
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Anh Nguyen
- Department of Neuroradiology, University Hospital Basel, Switzerland
| | - Annaelle Zietz
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | | | - Christopher Tränka
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Sebastian Thilemann
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Benjamin Wagner
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Valerian Altersberger
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Ines Piot
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Filip Barinka
- Department of Neurology and Stroke Center, Hirslanden Hospital Zurich, Switzerland
| | - Martin Hänsel
- Department of Neurology, University Hospital and University of Zurich, Switzerland
| | - Henrik Gensicke
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Switzerland
| | - Stefan Engelter
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Switzerland
| | - Philippe A Lyrer
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Raoul Sutter
- Department of Intensive Care Medicine, University Hospital Basel and University of Basel, Switzerland
| | - Christian Nickel
- Emergency Department, University Hospital Basel and University of Basel, Switzerland
| | - Mira Katan
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland
- Department of Neurology, University Hospital and University of Zurich, Switzerland
| | - Nils Peter
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland
- Department of Neurology and Stroke Center, Hirslanden Hospital Zurich, Switzerland
| | - Lars Michels
- Department of Neuroradiology, University Hospital Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, University Hospital Zurich, Switzerland
| | - Grzegorz Karwacki
- Department of Radiology and Nuclear Medicine, Cantonal Hospital of Lucerne, Switzerland
| | - Marco Pileggi
- Department of Neuroradiology, EOC Neurocenter of Southern Switzerland, Switzerland
| | - Carlo W. Cereda
- Department of Neurology and Stroke Center, EOC Neurocenter of Southern Switzerland, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital and University of Zurich, Switzerland
| | - Leo Bonati
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland
- Rheinfelden Rehabilitation Clinic, Switzerland
| | - Urs Fischer
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Marios Psychogios
- Department of Neuroradiology, University Hospital Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland
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Dibas M, Adeeb N, Diestro JDB, Cuellar HH, Sweid A, Lay SV, Guenego A, Aslan A, Renieri L, Sundararajan SH, Saliou G, Möhlenbruch M, Regenhardt RW, Vranic JE, Lylyk I, Foreman PM, Vachhani JA, Župančić V, Hafeez MU, Rutledge C, Waqas M, Tutino VM, Rabinov JD, Ren Y, Schirmer CM, Piano M, Kühn AL, Michelozzi C, Elens S, Starke RM, Hassan AE, Salehani A, Sporns P, Jones J, Psychogios M, Spears J, Lubicz B, Panni P, Puri AS, Pero G, Griessenauer CJ, Asadi H, Stapleton CJ, Siddiqui A, Ducruet AF, Albuquerque FC, Kan P, Kalousek V, Lylyk P, Boddu S, Knopman J, Aziz-Sultan MA, Limbucci N, Jabbour P, Cognard C, Patel AB, Dmytriw AA. Transradial versus transfemoral access for embolization of intracranial aneurysms with the Woven EndoBridge device: a propensity score-matched study. J Neurosurg 2022; 137:1064-1071. [PMID: 35120326 DOI: 10.3171/2021.12.jns212293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/27/2021] [Accepted: 12/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Transradial access (TRA) is commonly utilized in neurointerventional procedures. This study compared the technical and clinical outcomes of the use of TRA versus those of transfemoral access (TFA) for intracranial aneurysm embolization with the Woven EndoBridge (WEB) device. METHODS This is a secondary analysis of the Worldwide WEB Consortium, which comprises multicenter data related to adult patients with intracranial aneurysms who were managed with the WEB device. These aneurysms were categorized into two groups: those who were treated with TRA or TFA. Patient and aneurysm characteristics and technical and clinical outcomes were compared between groups. Propensity score matching (PSM) was used to match groups according to the following baseline characteristics: age, sex, subarachnoid hemorrhage, aneurysm location, bifurcation aneurysm, aneurysm with incorporated branch, neck width, aspect ratio, dome width, and elapsed time since the last follow-up imaging evaluation. RESULTS This study included 682 intracranial aneurysms (median [interquartile range] age 61.3 [53.0-68.0] years), of which 561 were treated with TFA and 121 with TRA. PSM resulted in 65 matched pairs. After PSM, both groups had similar characteristics, angiographic and functional outcomes, and rates of retreatment, thromboembolic and hemorrhagic complications, and death. TFA was associated with longer procedure length (median 96.5 minutes vs 72.0 minutes, p = 0.006) and fluoroscopy time (28.2 minutes vs 24.8 minutes, p = 0.037) as compared with TRA. On the other hand, deployment issues were more common in those treated with TRA, but none resulted in permanent complications. CONCLUSIONS TRA has comparable outcomes, with shorter procedure and fluoroscopy time, to TFA for aneurysm embolization with the WEB device.
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Affiliation(s)
- Mahmoud Dibas
- 1Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nimer Adeeb
- 2Department of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, LA
| | - Jose Danilo Bengzon Diestro
- 3Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Hugo H Cuellar
- 2Department of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, LA
| | - Ahmad Sweid
- 4Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA
| | - Sovann V Lay
- 5Service de Neuroradiologie Diagnostique et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Adrien Guenego
- 4Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA
| | - Assala Aslan
- 2Department of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, LA
| | - Leonardo Renieri
- 6Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Sri Hari Sundararajan
- 7Neurosurgery & Interventional Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell School of Medicine, New York, NY
| | - Guillaume Saliou
- 8Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland
| | - Markus Möhlenbruch
- 9Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Robert W Regenhardt
- 10Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA
| | - Justin E Vranic
- 10Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA
| | - Ivan Lylyk
- 11Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Paul M Foreman
- 12Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL
| | - Jay A Vachhani
- 12Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL
| | - Vedran Župančić
- 13Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center "Sisters of Mercy," Zagreb, Croatia
| | - Muhammad U Hafeez
- 14Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX
| | - Caleb Rutledge
- 15Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ
| | - Muhammad Waqas
- 16Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY
| | - Vincent M Tutino
- 16Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY
| | - James D Rabinov
- 10Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA
| | - Yifan Ren
- 17Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Clemens M Schirmer
- 18Department of Neurosurgery and Radiology, Geisinger Hospital, Danville, PA
| | - Mariangela Piano
- 19Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milano, Italy
| | - Anna L Kühn
- 20Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA
| | | | - Stéphanie Elens
- 22Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Brussels, Belgium
| | - Robert M Starke
- 23Department of Neurosurgery, University of Miami, Miami, FL
| | - Ameer E Hassan
- 24Department of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX
| | - Arsalaan Salehani
- 25Department of Neurosurgery, University of Alabama at Birmingham, AL; and
| | - Peter Sporns
- 26Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jesse Jones
- 25Department of Neurosurgery, University of Alabama at Birmingham, AL; and
| | - Marios Psychogios
- 26Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Spears
- 3Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Boris Lubicz
- 22Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Brussels, Belgium
| | - Pietro Panni
- 21Interventistica Neurovascolare, Ospedale San Raffaele, Milano, Italy
| | - Ajit S Puri
- 20Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, MA
| | - Guglielmo Pero
- 19Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milano, Italy
| | | | - Hamed Asadi
- 17Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | | | - Adnan Siddiqui
- 16Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY
| | - Andrew F Ducruet
- 15Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ
| | | | - Peter Kan
- 14Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX
| | - Vladimir Kalousek
- 13Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center "Sisters of Mercy," Zagreb, Croatia
| | - Pedro Lylyk
- 11Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Srikanth Boddu
- 7Neurosurgery & Interventional Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell School of Medicine, New York, NY
| | - Jared Knopman
- 7Neurosurgery & Interventional Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell School of Medicine, New York, NY
| | - Mohammad A Aziz-Sultan
- 2Department of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, LA
| | - Nicola Limbucci
- 6Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Pascal Jabbour
- 4Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA
| | - Christophe Cognard
- 5Service de Neuroradiologie Diagnostique et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Aman B Patel
- 10Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA
| | - Adam A Dmytriw
- 1Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- 10Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA
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Klein P, Shu L, Nguyen TN, Siegler JE, Omran SS, Simpkins AN, Heldner M, de Havenon A, Aparicio HJ, Abdalkader M, Psychogios M, Vedovati MC, Paciaroni M, von Martial R, Liebeskind DS, de Sousa DA, Coutinho JM, Yaghi S. Outcome Prediction in Cerebral Venous Thrombosis: The IN-REvASC Score. J Stroke 2022; 24:404-416. [PMID: 36221944 PMCID: PMC9561213 DOI: 10.5853/jos.2022.01606] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/11/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We identified risk factors, derived and validated a prognostic score for poor neurological outcome and death for use in cerebral venous thrombosis (CVT). METHODS We performed an international multicenter retrospective study including consecutive patients with CVT from January 2015 to December 2020. Demographic, clinical, and radiographic characteristics were collected. Univariable and multivariable logistic regressions were conducted to determine risk factors for poor outcome, mRS 3-6. A prognostic score was derived and validated. RESULTS A total of 1,025 patients were analyzed with median 375 days (interquartile range [IQR], 180 to 747) of follow-up. The median age was 44 (IQR, 32 to 58) and 62.7% were female. Multivariable analysis revealed the following factors were associated with poor outcome at 90- day follow-up: active cancer (odds ratio [OR], 11.20; 95% confidence interval [CI], 4.62 to 27.14; P<0.001), age (OR, 1.02 per year; 95% CI, 1.00 to 1.04; P=0.039), Black race (OR, 2.17; 95% CI, 1.10 to 4.27; P=0.025), encephalopathy or coma on presentation (OR, 2.71; 95% CI, 1.39 to 5.30; P=0.004), decreased hemoglobin (OR, 1.16 per g/dL; 95% CI, 1.03 to 1.31; P=0.014), higher NIHSS on presentation (OR, 1.07 per point; 95% CI, 1.02 to 1.11; P=0.002), and substance use (OR, 2.34; 95% CI, 1.16 to 4.71; P=0.017). The derived IN-REvASC score outperformed ISCVT-RS for the prediction of poor outcome at 90-day follow-up (area under the curve [AUC], 0.84 [95% CI, 0.79 to 0.87] vs. AUC, 0.71 [95% CI, 0.66 to 0.76], χ2 P<0.001) and mortality (AUC, 0.84 [95% CI, 0.78 to 0.90] vs. AUC, 0.72 [95% CI, 0.66 to 0.79], χ2 P=0.03). CONCLUSIONS Seven factors were associated with poor neurological outcome following CVT. The INREvASC score increased prognostic accuracy compared to ISCVT-RS. Determining patients at highest risk of poor outcome in CVT could help in clinical decision making and identify patients for targeted therapy in future clinical trials.
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Affiliation(s)
- Piers Klein
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Liqi Shu
- Department of Neurology, Brown University, Providence, RI, USA
| | - Thanh N. Nguyen
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - James E. Siegler
- Department of Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA
| | - Setareh Salehi Omran
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Mirjam Heldner
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Adam de Havenon
- Department of Neurology, Yale University, New Haven, CT, USA
| | - Hugo J. Aparicio
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Mohamad Abdalkader
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Marios Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | | | | | - Rascha von Martial
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - David S. Liebeskind
- Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Diana Aguiar de Sousa
- Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria/CHULN, University of Lisbon, Lisbon, Portugal
| | - Jonathan M. Coutinho
- Department of Neurology, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Shadi Yaghi
- Department of Neurology, Brown University, Providence, RI, USA
- Correspondence: Shadi Yaghi Department of Neurology, Warren Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, USA Tel: +1-401-444-8806 Fax: +1-401-444-8781 E-mail:
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40
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Psychogios M, Brehm A, López-Cancio E, Marco De Marchis G, Meseguer E, Katsanos AH, Kremer C, Sporns P, Zedde M, Kobayashi A, Caroff J, Bos D, Lémeret S, Lal A, Arenillas JF. European Stroke Organisation guidelines on treatment of patients with intracranial atherosclerotic disease. Eur Stroke J 2022; 7:III-IV. [PMID: 36082254 PMCID: PMC9446330 DOI: 10.1177/23969873221099715] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 04/07/2022] [Accepted: 04/22/2022] [Indexed: 07/22/2023] Open
Abstract
The aim of the present European Stroke Organisation guideline is to provide clinically useful evidence-based recommendations on the management of patients with intracranial atherosclerotic disease (ICAD). The guidelines were prepared following the Standard Operational Procedure of the European Stroke Organisation guidelines and according to GRADE methodology. ICAD represents a major cause of ischemic stroke worldwide, and patients affected by this condition are exposed to a high risk for future strokes and other major cardiovascular events, despite best medical therapy available. We identified 11 relevant clinical problems affecting ICAD patients and formulated the corresponding Population Intervention Comparator Outcomes (PICO) questions. The first two questions refer to the asymptomatic stage of the disease, which is being increasingly detected thanks to the routine use of noninvasive vascular imaging. We were not able to provide evidence-based recommendations regarding the optimal detection strategy and management of asymptomatic ICAD, and further research in the field is encouraged as subclinical ICAD may represent a big opportunity to improve primary stroke prevention. The second block of PICOs (3-5) is dedicated to the management of acute large vessel occlusion (LVO) ischemic stroke caused by ICAD, a clinical presentation of this disease that is becoming increasingly relevant and problematic, since it is associated with more refractory endovascular reperfusion procedures. An operational definition of probable ICAD-related LVO is proposed in the guideline. Despite the challenging context, no dedicated randomized clinical trials (RCTs) were identified, and therefore the guideline can only provide with suggestions derived from observational studies and our expert consensus, such as the escalated use of glycoprotein IIb-IIIa inhibitors and angioplasty/stenting in cases of refractory thrombectomies due to underlying ICAD. The last block of PICOs is devoted to the secondary prevention of patients with symptomatic ICAD. Moderate-level evidence was found to recommend against the use of oral anticoagulation as preferred antithrombotic drug, in favor of antiplatelets. Low-level evidence based our recommendation in favor of double antiplatelet as the antithrombotic treatment of choice in symptomatic ICAD patients, which we suggest to maintain during 90 days as per our expert consensus. Endovascular therapy with intracranial angioplasty and or stenting is not recommended as a treatment of first choice in high-grade symptomatic ICAD (moderate-level evidence). Regarding neurosurgical interventions, the available evidence does not support their use as front line therapies in patients with high-grade ICAD. There is not enough evidence as to provide any specific recommendation regarding the use of remote ischemic conditioning in ICAD patients, and further RCTs are needed to shed light on the utility of this promising therapy. Finally, we dedicate the last PICO to the importance of aggressive vascular risk factor management in ICAD, although the evidence derived from RCTs specifically addressing this question is still scarce.
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Affiliation(s)
- Marios Psychogios
- Department of Neuroradiology,
University Hospital Basel, Basel, Switzerland
| | - Alex Brehm
- Department of Neuroradiology,
University Hospital Basel, Basel, Switzerland
| | - Elena López-Cancio
- Department of Neurology, Hospital
Universitario Central de Asturias, Oviedo, Spain
| | - Gian Marco De Marchis
- Department of Neurology and Stroke
Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Elena Meseguer
- Department of Neurology and Stroke
Center, Assistance Publique Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Aristeidis H Katsanos
- Division of Neurology, McMaster
University and Population Health Research Institute, Hamilton, ON, Canada
| | - Christine Kremer
- Department of Neurology, Skåne
University Hospital, Malmö, Department of Clinical Sciences Lund University, Lund,
Sweden
| | - Peter Sporns
- Department of Neuroradiology,
University Hospital Basel, Basel, Switzerland
- Department of Neuroradiology,
University Clinic Hamburg Eppendorf, Hamburg, Germany
| | - Marialuisa Zedde
- Neurology Unit, Department of
Neuromotor Physiology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio
Emilia, Italy
- Neurology Unit, Stroke Unit, Azienda
Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy
| | - Adam Kobayashi
- Department of Pharmacology and
Clinical Pharmacology, Institute of Medical Sciences, Faculty of Medicine –
Collegium Medicum Cardinal Stefan Wyszynski University in Warsaw, Poland
- Department of Neurology and Stroke
Unit, Mazovian Voivodeship Hospital in Siedlce, Poland
| | - Jildaz Caroff
- Department of Interventional
Neuroradiology – NEURI Brain Vascular Center, Bicêtre Hospital, Assistance Publique
Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Daniel Bos
- Department of Radiology and Nuclear
Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus
MC, Rotterdam, The Netherlands
| | | | - Avtar Lal
- European Stroke Organisation, Basel,
Switzerland
| | - Juan F Arenillas
- Stroke Program, Department of
Neurology, Hospital Clínico Universitario de Valladolid, Spain
- Clinical Neurosciences Research
Group, Department of Medicine, University of Valladolid, Spain
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41
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Siegler JE, Shu L, Yaghi S, Salehi Omran S, Elnazeir M, Bakradze E, Psychogios M, De Marchis GM, Yu S, Klein P, Abdalkader M, Nguyen TN. Endovascular Therapy for Cerebral Vein Thrombosis: A Propensity-Matched Analysis of Anticoagulation in the Treatment of Cerebral Venous Thrombosis. Neurosurgery 2022; 91:749-755. [PMID: 36001776 DOI: 10.1227/neu.0000000000002098] [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: 02/23/2022] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endovascular treatment (EVT) for cerebral vein thrombosis (CVT) has not been proven to be more effective than anticoagulation based on recent results of the Thrombolysis or Anticoagulation for Cerebral Venous Thrombosis (TO-ACT) randomized clinical trial. OBJECTIVE To compare outcomes of EVT vs medical management in CVT. METHODS We compared EVT vs medical management in a retrospective multinational cohort of consecutive patients with CVT across 4 countries (USA, Italy, Switzerland, and New Zealand) and 27 sites (2015-2020), using propensity score matching (PSM) and inverse probability treatment weighting (IPTW), and meta-analyzed these results with the TO-ACT trial. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] 0-1) at 90 days. RESULTS Of the 987 patients, the mean age was 45.7 ± 16.9 years and 79 (8%) underwent EVT. With PSM (n = 124), there were no major differences in clinical or imaging features between groups other than a higher proportion of female patients receiving EVT (81% vs 65%, P = .04). There was no difference in the primary outcome with PSM (odds ratio [OR] 1.48, 95% CI, 0.55-3.96) or IPTW (OR 1.02, 95% CI, 0.34-3.06). EVT was associated with a higher 90-day shift in modified Rankin Scale (OR 2.00, 95% CI, 1.01-3.98) and mortality with IPTW (OR 4.60, 95% CI, 1.10-19.23) but no other differences in secondary outcomes with PSM or IPTW. A meta-analysis of primary and secondary outcomes from TO-ACT and PSM patients from anticoagulation in the treatment of cerebral venous thrombosis also showed no significant association with EVT in primary or secondary outcomes. CONCLUSION In this large observational cohort, there was no evidence of benefit with EVT for CVT. These findings corroborate the results from the TO-ACT trial.
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Affiliation(s)
- James E Siegler
- Department of Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | - Liqi Shu
- Department of Neurology, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Shadi Yaghi
- Department of Neurology, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Setareh Salehi Omran
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Marwa Elnazeir
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ekaterina Bakradze
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marios Psychogios
- Department of Neuroradiology & Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology & Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Siyuan Yu
- Department of Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | - Piers Klein
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
| | - Mohamad Abdalkader
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
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42
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Mujanovic A, Kurmann CC, Dobrocky T, Olivé-Gadea M, Maegerlein C, Pierot L, Mendes Pereira V, Costalat V, Psychogios M, Michel P, Beyeler M, Piechowiak EI, Seiffge DJ, Mordasini P, Arnold M, Gralla J, Fischer U, Kaesmacher J, Meinel TR. Bridging intravenous thrombolysis in patients with atrial fibrillation. Front Neurol 2022; 13:945338. [PMID: 35989924 PMCID: PMC9382124 DOI: 10.3389/fneur.2022.945338] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background and purpose 40% of acute ischemic stroke patients treated by mechanical thrombectomy (MT) have a clinical history of atrial fibrillation (AF). The safety of bridging intravenous thrombolysis (IVT) (MT + IVT) is currently being discussed. We aimed to analyze the interaction between oral anticoagulation (OAC) status or AF with bridging IVT, regarding the occurrence of symptomatic intracranial hemorrhage (sICH) and functional outcome. Materials and Methods Multicentric observational cohort study (BEYOND-SWIFT registry) of consecutive patients undergoing MT between 2010 and 2018 (n = 2,941). Multinomial regression models were adjusted for prespecified baseline and plausible pathophysiological covariates identified on a univariate analysis to assess the association of AF and OAC status with sICH and good outcomes (90-day modified Rankin Scale score 0–2). Results In the total cohort (median age 74, 50.6% women), 1,347 (45.8%) patients had AF. Higher admission National Institutes of Health Stroke Scale (NIHSS) score (aOR 1.04 [95% 1.02–1.06], per point of increase) and prior medication with Vitamin K antagonists (VKA) (aOR 2.19 [95% 1.27–3.66]) were associated with sICH. Neither AF itself (aOR 0.71 [95% 0.41–1.24]) nor bridging IVT (aOR 1.08 [0.67–1.75]) were significantly associated with increased sICH. Receiving bridging IVT (aOR 1.61 [95% 1.24–2.11]) was associated with good 90-day outcome, with no interaction between AF and IVT (p = 0.92). Conclusion Bridging IVT appears to be a reasonable clinical option in selected patients with AF. Given the increased sICH risk in patients with VKA, subgroup analysis of the randomized controlled trials should analyze whether patients with VKA might benefit from withholding bridging IVT. Registration clinicaltrials.gov; Unique identifier: NCT03496064.
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Affiliation(s)
- Adnan Mujanovic
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland
| | - Christoph C. Kurmann
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland
| | - Tomas Dobrocky
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland
| | - Marta Olivé-Gadea
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Laurent Pierot
- Department of Neuroradiology, University Hospital Reims, Reims, France
| | - Vitor Mendes Pereira
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, ON, Canada
| | - Vincent Costalat
- Department of Neuroradiology, University Hospital Montpellier, Montpellier, France
| | - Marios Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Patrik Michel
- Department of Neurology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Morin Beyeler
- Department of Neurology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland
| | - Eike I. Piechowiak
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland
| | - David J. Seiffge
- Department of Neurology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland
| | - Jan Gralla
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland
| | - Thomas R. Meinel
- Department of Neurology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland
- *Correspondence: Thomas R. Meinel
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Adeeb N, Dibas M, Diestro JDB, Cuellar-Saenz HH, Sweid A, Kandregula S, Lay SV, Guenego A, Renieri L, Sundararajan SH, Saliou G, Aslan A, Möhlenbruch M, Vranic JE, Regenhardt RW, Savardekar A, Mamilly A, Lylyk I, Foreman PM, Vachhani JA, Župančić V, Hafeez MU, Rutledge C, Waqas M, Parra Farinas C, Tutino VM, Inoue Y, Mirshahi S, Rabinov JD, Ren Y, Schirmer CM, Piano M, Kühn AL, Michelozzi C, Elens S, Starke RM, Hassan A, Salehani A, Sporns P, Brehm A, Jones J, Psychogios M, Spears J, Lubicz B, Panni P, Puri AS, Pero G, Griessenauer CJ, Asadi H, Stapleton CJ, Siddiqui A, Ducruet AF, Albuquerque FC, Kan P, Kalousek V, Lylyk P, Boddu S, Knopman J, Aziz-Sultan MA, Limbucci N, Jabbour P, Cognard C, Patel AB, Dmytriw AA. Multicenter Study for the Treatment of Sidewall versus Bifurcation Intracranial Aneurysms with Use of Woven EndoBridge (WEB). Radiology 2022; 304:372-382. [DOI: 10.1148/radiol.212006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Grand T, Dargazanli C, Papagiannaki C, Bruggeman A, Maurer C, Gascou G, Fauche C, Bourcier R, Tessier G, Blanc R, Machaa MB, Marnat G, Barreau X, Ognard J, Gentric JC, Barbier C, Gory B, Rodriguez C, Boulouis G, Eugène F, Thouant P, Ricolfi F, Janot K, Herbreteau D, Eker OF, Cappucci M, Dobrocky T, Möhlenbruch M, Demerath T, Psychogios M, Fischer S, Cianfoni A, Majoie C, Emmer B, Marquering H, Valter R, Lenck S, Premat K, Cortese J, Dormont D, Sourour NA, Shotar E, Samson Y, Clarençon F. Benefit of mechanical thrombectomy in acute ischemic stroke related to calcified cerebral embolus. J Neuroradiol 2022; 49:317-323. [PMID: 35183595 DOI: 10.1016/j.neurad.2022.02.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/13/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Mechanical thrombectomies (MT) in patients with large vessel occlusion (LVO) related to calcified cerebral embolus (CCE) have been reported, through small case series, being associated with low reperfusion rate and worse outcome, compared to regular MT. The purpose of the MASC (Mechanical Thrombectomy in Acute Ischemic Stroke Related to Calcified Cerebral Embolus) study was to evaluate the incidence of CCEs treated by MT and the effectiveness of MT in this indication. METHODS The MASC study is a retrospective multicentric (n = 37) national study gathering the cases of adult patients who underwent MT for acute ischemic stroke with LVO related to a CCE in France from January 2015 to November 2019. Reperfusion rate (mTICI ≥ 2B), complication rate and 90-day mRS were systematically collected. We then conducted a systematic review by searching for articles in PubMed, Cochrane Library, Embase and Google Scholar from January 2015 to March 2020. A meta-analysis was performed to estimate clinical outcome at 90 days, reperfusion rate and complications. RESULTS We gathered data from 35 patients. Reperfusion was obtained in 57% of the cases. Good clinical outcome was observed in 28% of the patients. The meta-analysis retrieved 136 patients. Reperfusion and good clinical outcome were obtained in 50% and 29% of the cases, respectively. CONCLUSION The MASC study found worse angiographic and clinical outcomes compared to regular thrombectomies. Individual patient-based meta-analysis including the MASC findings shows a 50% reperfusion rate and a 29% of good clinical outcome.
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Affiliation(s)
- Téodor Grand
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | | | | | - Agnetha Bruggeman
- Departments of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, NETHERLANDS
| | - Christoph Maurer
- Department of Neuroradiology, Klinikum Augsburg, Augsburg, GERMANY
| | | | - Cédric Fauche
- Department of Neuroradiology, CHU de Poitiers, FRANCE
| | - Romain Bourcier
- Department of Neuroradiology, Hôpital Nord Laennec, Nantes, FRANCE
| | | | - Raphaël Blanc
- Department of Neuroradiology, Fondation Rothschild, Paris, FRANCE
| | - Malek Ben Machaa
- Department of Neuroradiology, Fondation Rothschild, Paris, FRANCE
| | | | | | | | | | | | - Benjamin Gory
- Department of Neuroradiology, Centre Hospitalier Régional et Universitaire, Nancy, FRANCE
| | | | | | | | | | | | - Kevin Janot
- Department of Neuroradiology, CHU de Tours, France
| | | | | | | | - Tomas Dobrocky
- Department of Neuroradiology, Universitätsspital Bern, Bern, SWITZERLAND
| | - Markus Möhlenbruch
- Department of Neurology, University Heidelberg Medical Center, Heidelberg, GERMANY
| | - Theo Demerath
- Department of Neurology, University Freiburg Medical Center, Freiburg, GERMANY
| | - Marios Psychogios
- Department of Neurology, University Basel Medical Center, Basel, SWITZERLAND
| | - Sebastian Fischer
- Department of Neurology, University Bochum Medical Center, Bochum, GERMANY
| | - Alessandro Cianfoni
- Department of Neurology, University Lugano Medical Center, Lugano, SWITZERLAND
| | - Charles Majoie
- Departments of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, NETHERLANDS
| | - Bart Emmer
- Departments of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, NETHERLANDS
| | - Henk Marquering
- Departments of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, NETHERLANDS
| | - Rémi Valter
- Department of Public Health, Hôpital Henri Mondor, Créteil, FRANCE
| | - Stéphanie Lenck
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Kévin Premat
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Jonathan Cortese
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Didier Dormont
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne University, Paris, FRANCE
| | | | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Yves Samson
- Department of Vascular Neurology, Pitié-Salpêtrière Hospital, Paris, FRANCE
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne University, Paris, FRANCE; GRC Biofast, Paris, FRANCE.
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Fischer U, Branca M, Bonati LH, Carrera E, Vargas MI, Platon A, Kulcsar Z, Wegener S, Luft A, Seiffge DJ, Arnold M, Michel P, Strambo D, Dunet V, De Marchis GM, Schelosky L, Andreisek G, Barinka F, Peters N, Fisch L, Nedeltchev K, Cereda CW, Kägi G, Bolognese M, Salmen S, Sturzenegger R, Medlin F, Berger C, Renaud S, Bonvin C, Schaerer M, Mono ML, Rodic B, Psychogios M, Mordasini P, Gralla J, Kaesmacher J, Meinel TR. MRI or CT for Suspected Acute Stroke: Association of Admission Image Modality with Acute Recanalization Therapies, Workflow Metrics and Outcomes. Ann Neurol 2022; 92:184-194. [PMID: 35599442 PMCID: PMC9545922 DOI: 10.1002/ana.26413] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/23/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022]
Abstract
Objective To examine rates of intravenous thrombolysis (IVT), mechanical thrombectomy (MT), door‐to‐needle (DTN) time, door‐to‐puncture (DTP) time, and functional outcome between patients with admission magnetic resonance imaging (MRI) versus computed tomography (CT). Methods An observational cohort study of consecutive patients using a target trial design within the nationwide Swiss‐Stroke‐Registry from January 2014 to August 2020 was carried out. Exclusion criteria included MRI contraindications, transferred patients, and unstable or frail patients. Multilevel mixed‐effects logistic regression with multiple imputation was used to calculate adjusted odds ratios with 95% confidence intervals for IVT, MT, DTN, DTP, and good functional outcome (mRS 0–2) at 90 days. Results Of the 11,049 patients included (mean [SD] age, 71 [15] years; 4,811 [44%] women; 69% ischemic stroke, 16% transient ischemic attack, 8% stroke mimics, 6% intracranial hemorrhage), 3,741 (34%) received MRI and 7,308 (66%) CT. Patients undergoing MRI had lower National Institutes of Health Stroke Scale (median [interquartile range] 2 [0–6] vs 4 [1–11]), and presented later after symptom onset (150 vs 123 min, p < 0.001). Admission MRI was associated with: lower adjusted odds of IVT (aOR 0.83, 0.73–0.96), but not with MT (aOR 1.11, 0.93–1.34); longer adjusted DTN (+22 min [13–30]), but not with longer DTP times; and higher adjusted odds of favorable outcome (aOR 1.54, 1.30–1.81). Interpretation We found an association of MRI with lower rates of IVT and a significant delay in DTN, but not in DTP and rates of MT. Given the delays in workflow metrics, prospective trials are required to show that tissue‐based benefits of baseline MRI compensate for the temporal benefits of CT. ANN NEUROL 2022;92:184–194
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Affiliation(s)
- Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland.,Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland
| | | | | | - Emmanuel Carrera
- Department of Neurology, Neuroradiology, Radiology, HUG, Geneva, Switzerland
| | - Maria I Vargas
- Department of Neurology, Neuroradiology, Radiology, HUG, Geneva, Switzerland
| | - Alexandra Platon
- Department of Neurology, Neuroradiology, Radiology, HUG, Geneva, Switzerland
| | - Zsolt Kulcsar
- Department of Neurology, Neuroradiology, University Hospital Zurich, Switzerland & Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Susanne Wegener
- Department of Neurology, Neuroradiology, University Hospital Zurich, Switzerland & Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Andreas Luft
- Department of Neurology, Neuroradiology, University Hospital Zurich, Switzerland & Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - David J Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Davide Strambo
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Vincent Dunet
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Ludwig Schelosky
- Department of Neurology, Institute for Radiology, Cantonal Hospital Muensterlingen, Switzerland
| | - Gustav Andreisek
- Department of Neurology, Institute for Radiology, Cantonal Hospital Muensterlingen, Switzerland
| | - Filip Barinka
- Stroke Center, Hirslanden Hospital Zurich, Switzerland
| | - Nils Peters
- Stroke Center, Hirslanden Hospital Zurich, Switzerland
| | | | | | - Carlo W Cereda
- Stroke Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
| | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, Switzerland
| | | | - Stephan Salmen
- Department of Neurology, Spitalzentrum Biel, Switzerland
| | | | - Friedrich Medlin
- Stroke and Neurology Unit, Cantonal Hospital Fribourg, Switzerland
| | | | | | | | | | | | | | - Marios Psychogios
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Pasquale Mordasini
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric Radiology and Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Thomas R Meinel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
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Adeeb N, Dibas M, Diestro JDB, Phan K, Cuellar-Saenz HH, Sweid A, Lay SV, Guenego A, Aslan A, Renieri L, Sundararajan SH, Saliou G, Möhlenbruch M, Regenhardt RW, Vranic JE, Lylyk I, Foreman PM, Vachhani JA, Župančić V, Hafeez MU, Rutledge C, Waqas M, Tutino VM, Rabinov JD, Ren Y, Schirmer CM, Piano M, Kuhn AL, Michelozzi C, Elens S, Starke RM, Hassan A, Salehani A, Brehm A, MohammedAli M, Jones J, Psychogios M, Spears J, Lubicz B, Panni P, Puri AS, Pero G, Griessenauer CJ, Asadi H, Siddiqui A, Ducruet A, Albuquerque FC, Du R, Kan P, Kalousek V, Lylyk P, Stapleton CJ, Boddu S, Knopman J, Aziz-Sultan MA, Limbucci N, Jabbour P, Cognard C, Patel AB, Dmytriw AA. Comparing treatment outcomes of various intracranial bifurcation aneurysms locations using the Woven EndoBridge (WEB) device. J Neurointerv Surg 2022; 15:558-565. [PMID: 35483912 DOI: 10.1136/neurintsurg-2022-018694] [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: 01/25/2022] [Accepted: 04/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Woven EndoBridge (WEB) device has Food and Drug Administration approval for treatment of wide-necked intracranial bifurcation aneurysms. The WEB device has been shown to result in adequate occlusion in bifurcation aneurysms overall, but its usefulness in the individual bifurcation locations has been evaluated separately only in few case series, which were limited by small sample sizes. OBJECTIVE To compare angiographic and clinical outcomes after treatment of bifurcation aneurysms at various locations, including anterior communicating artery (AComA), anterior cerebral artery (ACA) bifurcation distal to AComA, basilar tip, internal carotid artery (ICA) bifurcation, and middle cerebral artery (MCA) bifurcation aneurysms using the WEB device. METHODS A retrospective cohort analysis was conducted at 22 academic institutions worldwide to compare treatment outcomes of patients with intracranial bifurcation aneurysms using the WEB device. Data include patient and aneurysm characteristics, procedural details, angiographic and functional outcomes, and complications. RESULTS A total of 572 aneurysms were included. MCA (36%), AComA (35.7%), and basilar tip (18.9%) aneurysms were most common. The rate of adequate aneurysm occlusion was significantly higher for basilar tip (91.6%) and ICA bifurcation (96.7%) aneurysms and lower for ACA bifurcation (71.4%) and AComA (80.6%) aneurysms (p=0.04). CONCLUSION To our knowledge, this is the most extensive study to date that compares the treatment of different intracranial bifurcation aneurysms using the WEB device. Basilar tip and ICA bifurcation aneurysms showed significantly higher rates of aneurysm occlusion than other locations.
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Affiliation(s)
- Nimer Adeeb
- Departments of Neurosurgery and Neurointerventional Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Mahmoud Dibas
- Neuroradiology and Neurosurgical Services, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jose Danilo Bengzon Diestro
- Department of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Phan
- Neuroradiology and Neurosurgical Services, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hugo H Cuellar-Saenz
- Departments of Neurosurgery and Neurointerventional Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Sovann V Lay
- Interventional Neuroradiology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Adrien Guenego
- Interventional Neuroradiology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Assala Aslan
- Departments of Neurosurgery and Neurointerventional Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Leonardo Renieri
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Sri Hari Sundararajan
- Neurosurgery and Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York, USA
| | - Guillaume Saliou
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland
| | - Markus Möhlenbruch
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Justin E Vranic
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Ivan Lylyk
- Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Paul M Foreman
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA
| | - Jay A Vachhani
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, FL, USA
| | - Vedran Župančić
- Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Muhammad U Hafeez
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX
| | - Caleb Rutledge
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Muhammad Waqas
- Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Vincent M Tutino
- Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Yifan Ren
- Neurointervention Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Clemens M Schirmer
- Departments of Neurosurgery and Radiology, Geisinger Hospital, Danville, Virginia, USA
| | - Mariangela Piano
- Department of Neuroradiology, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Anna L Kuhn
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Stephanie Elens
- Department of Interventional Neuroradiology, Erasmus Hospital, Bruxelles, Bruxelles, Belgium
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ameer Hassan
- Deparment of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX, USA
| | | | - Alex Brehm
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - MajdEddin MohammedAli
- Departments of Neurosurgery and Neurointerventional Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Jesse Jones
- Department of Neurosurgery, UAB Hospital, Birmingham, Alabama, USA
| | - Marios Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Julian Spears
- Department of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Boris Lubicz
- Department of Interventional Neuroradiology, Erasmus Hospital, Bruxelles, Bruxelles, Belgium
| | - Pietro Panni
- Interventistica Neurovascolare, Ospedale San Raffaele, Milano, Italy
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Guglielmo Pero
- Department of Neuroradiology, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Christoph J Griessenauer
- Departments of Neurosurgery and Radiology, Geisinger Hospital, Danville, Virginia, USA.,Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Hamed Asadi
- Neurointervention Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Adnan Siddiqui
- Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Andrew Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Rose Du
- Neuroradiology and Neurosurgical Services, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Kan
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, TX
| | - Vladimir Kalousek
- Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Pedro Lylyk
- Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Srikanth Boddu
- Neurosurgery and Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York, USA
| | - Jared Knopman
- Neurosurgery and Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York, USA
| | - Mohammad A Aziz-Sultan
- Neuroradiology and Neurosurgical Services, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicola Limbucci
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Christophe Cognard
- Interventional Neuroradiology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Adam A Dmytriw
- Neuroradiology and Neurosurgical Services, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
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Altersberger VL, Wright PR, Schaedelin SA, De Marchis GM, Gensicke H, Engelter ST, Psychogios M, Kahles T, Goeldlin M, Meinel TR, Mordasini P, Kaesmacher J, von Hessling A, Vehoff J, Weber J, Wegener S, Salmen S, Sturzenegger R, Medlin F, Berger C, Schelosky L, Renaud S, Niederhauser J, Bonvin C, Schaerer M, Mono ML, Rodic B, Schwegler G, Peters N, Bolognese M, Luft AR, Cereda CW, Kägi G, Michel P, Carrera E, Arnold M, Fischer U, Nedeltchev K, Bonati LH. Effect of admission time on provision of acute stroke treatment at stroke units and stroke centers—An analysis of the Swiss Stroke Registry. Eur Stroke J 2022; 7:117-125. [DOI: 10.1177/23969873221094408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/29/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction: Rapid treatment of acute ischemic stroke (AIS) depends on sufficient staffing which differs between Stroke Centers and Stroke Units in Switzerland. We studied the effect of admission time on performance measures of AIS treatment and related temporal trends over time. Patients and methods: We compared treatment rates, door-to-image-time, door-to-needle-time, and door-to-groin-puncture-time in stroke patients admitted during office hours (Monday–Friday 8:00–17:59) and non-office hours at all certified Stroke Centers and Stroke Units in Switzerland, as well as secular trends thereof between 2014 and 2019, using data from the Swiss Stroke Registry. Secondary outcomes were modified Rankin Scale and mortality at 3 months. Results: Data were eligible for analysis in 31,788 (90.2%) of 35,261 patients. Treatment rates for IVT/EVT were higher during non-office hours compared with office hours in Stroke Centers (40.8 vs 36.5%) and Stroke Units (21.8 vs 18.5%). Door-to-image-time and door-to-needle-time increased significantly during non-office hours. Median (IQR) door-to-groin-puncture-time at Stroke Centers was longer during non-office hours compared to office hours (84 (59–116) vs 95 (66–130) minutes). Admission during non-office hours was independently associated with worse functional outcome (1.11 [95%CI: 1.04–1.18]) and increased mortality (1.13 [95%CI: 1.01–1.27]). From 2014 to 2019, median door-to-groin-puncture-time improved and the treatment rate for wake-up strokes increased. Discussion and Conclusion: Despite differences in staffing, patient admission during non-office hours delayed IVT to a similar, modest degree at Stroke Centers and Stroke Units. A larger delay of EVT was observed during non-office hours, but Stroke Centers sped up delivery of EVT over time. Patients admitted during non-office hours had worse functional outcomes, which was not explained by treatment delays.
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Affiliation(s)
- Valerian L Altersberger
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Patrick R Wright
- Clinical Trial Unit, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sabine A Schaedelin
- Clinical Trial Unit, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurorehabilitation, University of Basel and University Department of Geriatic Medicine FELIX PLATTER, University of Basel, Switzerland
| | - Stefan T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurorehabilitation, University of Basel and University Department of Geriatic Medicine FELIX PLATTER, University of Basel, Switzerland
| | - Marios Psychogios
- Department of Neuroradiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Timo Kahles
- Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
| | - Martina Goeldlin
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Thomas R Meinel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology and University Institute of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital Inselspital Bern, and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- University Institute of Diagnostic and Interventional Neuroradiology and University Institute of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital Inselspital Bern, and University of Bern, Bern, Switzerland
| | | | - Jochen Vehoff
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Johannes Weber
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stephan Salmen
- Department of Neurology, Spitalzentrum Biel, Biel, Switzerland
| | | | - Friedrich Medlin
- Department of Internal Medicine, Stroke Unit and Division of Neurology, HFR Fribourg, Cantonal Hospital, Fribourg, Switzerland
| | | | | | - Susanne Renaud
- Stroke Unit and Division of Neurology, Neuchatel Hospital Network, Neuchatel, Switzerland
| | | | | | | | | | - Biljana Rodic
- Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Nils Peters
- Stroke Center, Hirslanden Hospital Zurich, Zurich, Switzerland
| | | | - Andreas R Luft
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Weggis, Switzerland
| | - Carlo W Cereda
- Stroke Center and Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Georg Kägi
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Patrick Michel
- Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | | | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Urs Fischer
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | - Leo H Bonati
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
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Meyer L, Stracke P, Wallocha M, Broocks G, Sporns P, Piechowiak EI, Kaesmacher J, Maegerlein C, Hernandez Petzsche MR, Dorn F, Zimmermann H, Naziri W, Abdullayev N, Kabbasch C, Behme D, Jamous A, Maus V, Fischer S, Möhlenbruch M, Weyland CS, Langner S, Meila D, Miszczuk M, Siebert E, Lowens S, Krause LU, Yeo L, Tan B, Gopinathan A, Gory B, Galván-Fernández J, Schüller M, Navia P, Raz E, Shapiro M, Arnberg F, Zeleňák K, Martínez-Galdámez M, Kastrup A, Papanagiotou P, Kemmling A, Psychogios M, Andersson T, Chapot R, Fiehler J, Hanning U. Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study. Stroke 2022; 53:2449-2457. [PMID: 35443785 DOI: 10.1161/strokeaha.121.037792] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The optimal endovascular strategy for reperfusing distal medium-vessel occlusions (DMVO) remains unknown. This study evaluates angiographic and clinical outcomes of thrombectomy strategies in DMVO stroke of the posterior circulation. METHODS TOPMOST (Treatment for Primary Medium Vessel Occlusion Stroke) is an international, retrospective, multicenter, observational registry of patients treated for DMVO between January 2014 and June 2020. This study analyzed endovascularly treated isolated primary DMVO of the posterior cerebral artery in the P2 and P3 segment. Technical feasibility was evaluated with the first-pass effect defined as a modified Thrombolysis in Cerebral Infarction Scale score of 3. Rates of early neurological improvement and functional modified Rankin Scale scores at 90 days were compared. Safety was assessed by the occurrence of symptomatic intracranial hemorrhage and intervention-related serious adverse events. RESULTS A total of 141 patients met the inclusion criteria and were treated endovascularly for primary isolated DMVO in the P2 (84.4%, 119) or P3 segment (15.6%, 22) of the posterior cerebral artery. The median age was 75 (IQR, 62-81), and 45.4% (64) were female. The initial reperfusion strategy was aspiration only in 29% (41) and stent retriever in 71% (100), both achieving similar first-pass effect rates of 53.7% (22) and 44% (44; P=0.297), respectively. There were no significant differences in early neurological improvement (aspiration: 64.7% versus stent retriever: 52.2%; P=0.933) and modified Rankin Scale rates (modified Rankin Scale score 0-1, aspiration: 60.5% versus stent retriever 68.6%; P=0.4). In multivariable logistic regression analysis, the time from groin puncture to recanalization was associated with the first-pass effect (adjusted odds ratio, 0.97 [95% CI, 0.95-0.99]; P<0.001) that in turn was associated with early neurological improvement (aOR, 3.27 [95% CI, 1.16-9.21]; P<0.025). Symptomatic intracranial hemorrhage occurred in 2.8% (4) of all cases. CONCLUSIONS Both first-pass aspiration and stent retriever thrombectomy for primary isolated posterior circulation DMVO seem to be safe and technically feasible leading to similar favorable rates of angiographic and clinical outcome.
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Affiliation(s)
- Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.)
| | - Paul Stracke
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.).,Department of Interventional Neuroradiology, University Hospital Muenster, Germany (P.S.).,Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Switzerland (P.S., M.P.)
| | - Marta Wallocha
- Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Germany (M.W., R.C.)
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.)
| | - Peter Sporns
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.)
| | - Eike I Piechowiak
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (E.I.P., J.K.)
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (E.I.P., J.K.).,Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (J.K.)
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.)
| | - Moritz Roman Hernandez Petzsche
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany (C.M., M.R.H.P.)
| | - Franziska Dorn
- Institute of Neuroradiology, University Hospitals, LMU Munich, Germany (F.D., H.Z.)
| | - Hanna Zimmermann
- Institute of Neuroradiology, University Hospitals, LMU Munich, Germany (F.D., H.Z.)
| | - Weis Naziri
- Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany (W.N.).,Department of Neuroradiology, University Hospital Luebeck, Germany (W.N.)
| | - Nuran Abdullayev
- Department of Neuroradiology, University of Cologne, Germany (N.A., C.K.)
| | - Christoph Kabbasch
- Department of Neuroradiology, University of Cologne, Germany (N.A., C.K.)
| | - Daniel Behme
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital Goettingen, Germany (D.B., A.J.)
| | - Ala Jamous
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital Goettingen, Germany (D.B., A.J.)
| | - Volker Maus
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Germany (V.M., S.F.)
| | - Sebastian Fischer
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, Germany (V.M., S.F.)
| | - Markus Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Germany (M.M., C.S.W.)
| | - Charlotte S Weyland
- Department of Neuroradiology, Heidelberg University Hospital, Germany (M.M., C.S.W.)
| | - Sönke Langner
- Institute for Diagnostic and Interventional Radiology, Pediatric and Neuroradiology, University Hospital Rostock, Germany (S.L.)
| | - Dan Meila
- Department of Interventional Neuroradiology, Johanna-Étienne-Hospital, Neuss, Germany (D.M.)
| | - Milena Miszczuk
- Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Germany (M.M., E.S.)
| | - Eberhard Siebert
- Institute of Neuroradiology, Charité Universitätsmedizin Berlin, Germany (M.M., E.S.)
| | - Stephan Lowens
- Department of Radiology, Klinikum Osnabrück, Germany. (S.L.)
| | - Lars Udo Krause
- Department of Neurology, Klinikum Osnabrück, Germany. (L.U.K.)
| | - Leonard Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore. (L.Y., B.T.).,Yong Loo Lin School of Medicine, National University of Singapore (L.Y., B.T., A.G.)
| | - Benjamin Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore. (L.Y., B.T.).,Yong Loo Lin School of Medicine, National University of Singapore (L.Y., B.T., A.G.)
| | - Anil Gopinathan
- Department of Diagnostic imaging, National University Health System, Singapore. (A.G.)
| | - Benjamin Gory
- Yong Loo Lin School of Medicine, National University of Singapore (L.Y., B.T., A.G.).,Université de Lorraine, CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, France (B.G.).,Université de Lorraine, IADI, INSERM U1254, F-54000 Nancy, France (B.G.)
| | - Jorge Galván-Fernández
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Spain (J.G.-F., M.S., M.M.-G.)
| | - Miguel Schüller
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Spain (J.G.-F., M.S., M.M.-G.)
| | - Pedro Navia
- Department of Neuroradiology, Hospital Universitario La Paz, Madrid, Spain (P.N.)
| | - Eytan Raz
- Department of Radiology, New York Langone Medical Center (E.R., M.S.)
| | - Maksim Shapiro
- Department of Radiology, New York Langone Medical Center (E.R., M.S.)
| | - Fabian Arnberg
- Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.)
| | - Kamil Zeleňák
- Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.)
| | - Mario Martínez-Galdámez
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Spain (J.G.-F., M.S., M.M.-G.)
| | - Andreas Kastrup
- Department of Neurology, Hospital Bremen-Mitte, Germany (A.K.)
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Germany (P.P.).,Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Greece (P.P.)
| | - André Kemmling
- Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.).,Department of Neuroradiology, University Hospital Marburg, Germany (A.K.)
| | - Marios Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Switzerland (P.S., M.P.)
| | - Tommy Andersson
- Department of Neuroradiology, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (F.A., T.A.).,Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium (T.A.)
| | - Rene Chapot
- Department of Endovascular Therapy, Alfried-Krupp Hospital Essen, Germany (M.W., R.C.)
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.)
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.M., P.S., G.B., P.S., J.F., U.H.)
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Wagner B, Lorscheider J, Wiencierz A, Blackham K, Psychogios M, Bolliger D, De Marchis GM, Engelter ST, Lyrer P, Wright PR, Fischer U, Mordasini P, Nannoni S, Puccinelli F, Kahles T, Bianco G, Carrera E, Luft AR, Cereda CW, Kägi G, Weber J, Nedeltchev K, Michel P, Gralla J, Arnold M, Bonati LH. Endovascular Treatment for Acute Ischemic Stroke With or Without General Anesthesia: A Matched Comparison. Stroke 2022; 53:1520-1529. [PMID: 35341319 PMCID: PMC10082068 DOI: 10.1161/strokeaha.121.034934] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endovascular treatment in large artery occlusion stroke reduces disability. However, the impact of anesthesia type on clinical outcomes remains uncertain. METHODS We compared consecutive patients in the Swiss Stroke Registry with anterior circulation stroke receiving endovascular treatment with or without general anesthesia (GA). The primary outcome was disability on the modified Rankin Scale after 3 months, analyzed with ordered logistic regression. Secondary outcomes included dependency or death (modified Rankin Scale score ≥3), National Institutes of Health Stroke Scale after 24 hours, symptomatic intracranial hemorrhage with ≥4 points worsening on National Institutes of Health Stroke Scale within 7 days, and mortality. Coarsened exact matching and propensity score matching were performed to adjust for indication bias. RESULTS One thousand two hundred eighty-four patients (GA: n=851, non-GA: n=433) from 8 Stroke Centers were included. Patients treated with GA had higher modified Rankin Scale scores after 3 months than patients treated without GA, in the unmatched (odds ratio [OR], 1.75 [1.42-2.16]; P<0.001), the coarsened exact matching (n=332-524, using multiple imputations of missing values; OR, 1.60 [1.08-2.36]; P=0.020), and the propensity score matching analysis (n=568; OR, 1.61 [1.20-2.15]; P=0.001). In the coarsened exact matching analysis, there were no significant differences in National Institutes of Health Stroke Scale after 1 day (estimated coefficient 2.61 [0.59-4.64]), symptomatic intracranial hemorrhage (OR, 1.06 [0.30-3.75]), dependency or death (OR, 1.42 [0.91-2.23]), or mortality (OR, 1.65 [0.94-2.89]). In the propensity score matching analysis, National Institutes of Health Stroke Scale after 24 hours (estimated coefficient, 3.40 [1.76-5.04]), dependency or death (OR, 1.49 [1.07-2.07]), and mortality (OR, 1.65 [1.11-2.45]) were higher in the GA group, whereas symptomatic intracranial hemorrhage did not differ significantly (OR, 1.77 [0.73-4.29]). CONCLUSIONS This large study showed worse functional outcome after endovascular treatment of anterior circulation stroke with GA than without GA in a real-world setting. This finding appears to be independent of known differences in patient characteristics between groups.
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Affiliation(s)
- Benjamin Wagner
- Department of Neurology (B.W., J.L., G.M.D.M., S.T.E., P.L., L.H.B.), University Hospital Basel and University of Basel, Switzerland
| | - Johannes Lorscheider
- Department of Neurology (B.W., J.L., G.M.D.M., S.T.E., P.L., L.H.B.), University Hospital Basel and University of Basel, Switzerland
| | - Andrea Wiencierz
- Clinical Trial Unit (A.W., P.R.W.), University Hospital Basel and University of Basel, Switzerland
| | - Kristine Blackham
- Institute of Diagnostic and Interventional Neuroradiology (K.B., M.P.), University Hospital Basel and University of Basel, Switzerland
| | - Marios Psychogios
- Institute of Diagnostic and Interventional Neuroradiology (K.B., M.P.), University Hospital Basel and University of Basel, Switzerland
| | - Daniel Bolliger
- Department of Anesthesiology (D.B.), University Hospital Basel and University of Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology (B.W., J.L., G.M.D.M., S.T.E., P.L., L.H.B.), University Hospital Basel and University of Basel, Switzerland
| | - Stefan T Engelter
- Department of Neurology (B.W., J.L., G.M.D.M., S.T.E., P.L., L.H.B.), University Hospital Basel and University of Basel, Switzerland.,Neurology and Neurorehabilitation, University Department of Geriatic Medicine FELIX PLATTER and Department of Clinical Research, University of Basel, Switzerland (S.T.E.)
| | - Philippe Lyrer
- Department of Neurology (B.W., J.L., G.M.D.M., S.T.E., P.L., L.H.B.), University Hospital Basel and University of Basel, Switzerland
| | - Patrick R Wright
- Clinical Trial Unit (A.W., P.R.W.), University Hospital Basel and University of Basel, Switzerland
| | - Urs Fischer
- Department of Neurology (U.F., M.A.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Stefania Nannoni
- Department of Neurology, Lausanne University Hospital, Switzerland (S.N., F.P., P.M.)
| | - Francesco Puccinelli
- Department of Neurology, Lausanne University Hospital, Switzerland (S.N., F.P., P.M.)
| | - Timo Kahles
- Department of Neurology, Cantonal Hospital Aarau, Switzerland (T.K., K.N.)
| | - Giovanni Bianco
- Stroke Center EOC, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano (G.B., C.W.C.)
| | - Emmanuel Carrera
- Department of Neurology, University Hospital Geneva, Switzerland (E.C.)
| | - Andreas R Luft
- Department of Neurology, University Hospital Zurich, Switzerland (A.R.L.).,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.R.L.)
| | - Carlo W Cereda
- Stroke Center EOC, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano (G.B., C.W.C.)
| | - Georg Kägi
- Department of Neurology (G.K.), Cantonal Hospital St. Gallen, Switzerland
| | - Johannes Weber
- Institute of Diagnostic and Interventional Neuroradiology (J.W.), Cantonal Hospital St. Gallen, Switzerland
| | - Krassen Nedeltchev
- Department of Neurology, Cantonal Hospital Aarau, Switzerland (T.K., K.N.)
| | - Patrik Michel
- Institute of Diagnostic and Interventional Neuroradiology (P.M., J.G.), Inselspital, Bern University Hospital, University of Bern, Switzerland.,Department of Neurology, Lausanne University Hospital, Switzerland (S.N., F.P., P.M.)
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology (P.M., J.G.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology (U.F., M.A.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Leo H Bonati
- Department of Neurology (B.W., J.L., G.M.D.M., S.T.E., P.L., L.H.B.), University Hospital Basel and University of Basel, Switzerland.,Research Department, Reha Rheinfelden, Switzerland (L.H.B.)
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50
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Yaghi S, Shu L, Bakradze E, Salehi Omran S, Giles JA, Amar JY, Henninger N, Elnazeir M, Liberman AL, Moncrieffe K, Lu J, Sharma R, Cheng Y, Zubair AS, Simpkins AN, Li GT, Kung JC, Perez D, Heldner M, Scutelnic A, Seiffge D, Siepen B, Rothstein A, Khazaal O, Do D, Kasab SA, Rahman LA, Mistry EA, Kerrigan D, Lafever H, Nguyen TN, Klein P, Aparicio H, Frontera J, Kuohn L, Agarwal S, Stretz C, Kala N, El Jamal S, Chang A, Cutting S, Xiao H, de Havenon A, Muddasani V, Wu T, Wilson D, Nouh A, Asad SD, Qureshi A, Moore J, Khatri P, Aziz Y, Casteigne B, Khan M, Cheng Y, Mac Grory B, Weiss M, Ryan D, Vedovati MC, Paciaroni M, Siegler JE, Kamen S, Yu S, Leon Guerrero CR, Atallah E, De Marchis GM, Brehm A, Dittrich T, Psychogios M, Alvarado-Dyer R, Kass-Hout T, Prabhakaran S, Honda T, Liebeskind DS, Furie K. Direct Oral Anticoagulants Versus Warfarin in the Treatment of Cerebral Venous Thrombosis (ACTION-CVT): A Multicenter International Study. Stroke 2022; 53:728-738. [PMID: 35143325 DOI: 10.1161/strokeaha.121.037541] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A small randomized controlled trial suggested that dabigatran may be as effective as warfarin in the treatment of cerebral venous thrombosis (CVT). We aimed to compare direct oral anticoagulants (DOACs) to warfarin in a real-world CVT cohort. METHODS This multicenter international retrospective study (United States, Europe, New Zealand) included consecutive patients with CVT treated with oral anticoagulation from January 2015 to December 2020. We abstracted demographics and CVT risk factors, hypercoagulable labs, baseline imaging data, and clinical and radiological outcomes from medical records. We used adjusted inverse probability of treatment weighted Cox-regression models to compare recurrent cerebral or systemic venous thrombosis, death, and major hemorrhage in patients treated with warfarin versus DOACs. We performed adjusted inverse probability of treatment weighted logistic regression to compare recanalization rates on follow-up imaging across the 2 treatments groups. RESULTS Among 1025 CVT patients across 27 centers, 845 patients met our inclusion criteria. Mean age was 44.8 years, 64.7% were women; 33.0% received DOAC only, 51.8% received warfarin only, and 15.1% received both treatments at different times. During a median follow-up of 345 (interquartile range, 140-720) days, there were 5.68 recurrent venous thrombosis, 3.77 major hemorrhages, and 1.84 deaths per 100 patient-years. Among 525 patients who met recanalization analysis inclusion criteria, 36.6% had complete, 48.2% had partial, and 15.2% had no recanalization. When compared with warfarin, DOAC treatment was associated with similar risk of recurrent venous thrombosis (aHR, 0.94 [95% CI, 0.51-1.73]; P=0.84), death (aHR, 0.78 [95% CI, 0.22-2.76]; P=0.70), and rate of partial/complete recanalization (aOR, 0.92 [95% CI, 0.48-1.73]; P=0.79), but a lower risk of major hemorrhage (aHR, 0.35 [95% CI, 0.15-0.82]; P=0.02). CONCLUSIONS In patients with CVT, treatment with DOACs was associated with similar clinical and radiographic outcomes and favorable safety profile when compared with warfarin treatment. Our findings need confirmation by large prospective or randomized studies.
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Affiliation(s)
- Shadi Yaghi
- Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)
| | - Liqi Shu
- Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)
| | | | - Setareh Salehi Omran
- Department of Neurology, University of Colorado School of Medicine, Aurora (S.S.O.)
| | - James A Giles
- Department of Neurology, Washington University, Saint Louis, MO (J.A.G., J.Y.A.)
| | - Jordan Y Amar
- Department of Neurology, Washington University, Saint Louis, MO (J.A.G., J.Y.A.)
| | - Nils Henninger
- Department of Neurology, University of Massachusetts, Worcester. (N.H., M.E.).,Department of Psychiatry, University of Massachusetts, Worcester. (N.H.)
| | - Marwa Elnazeir
- Department of Neurology, University of Massachusetts, Worcester. (N.H., M.E.)
| | - Ava L Liberman
- Department of Neurology, Weill Cornell Medical Center, NY (A.L.L.)
| | | | - Jenny Lu
- Department of Neurology, Montefiore Medical Center, NY (K.M., J.L.)
| | - Richa Sharma
- Department of Neurology, Yale University, New Haven, CT (R.S., Y.C., A.S.Z., A.d.H.)
| | - Yee Cheng
- Department of Neurology, Yale University, New Haven, CT (R.S., Y.C., A.S.Z., A.d.H.)
| | - Adeel S Zubair
- Department of Neurology, Yale University, New Haven, CT (R.S., Y.C., A.S.Z., A.d.H.)
| | - Alexis N Simpkins
- Department of Neurology, University of Florida, Gainesville (A.N.S., G.T.L., J.C.K., D.P.)
| | - Grace T Li
- Department of Neurology, University of Florida, Gainesville (A.N.S., G.T.L., J.C.K., D.P.)
| | - Justin Chi Kung
- Department of Neurology, University of Florida, Gainesville (A.N.S., G.T.L., J.C.K., D.P.)
| | - Dezaray Perez
- Department of Neurology, University of Florida, Gainesville (A.N.S., G.T.L., J.C.K., D.P.)
| | - Mirjam Heldner
- Department of Neurology, Inselspital Universitätsspital, Bern, Switzerland (M.H., A.S., D.S., B.S.)
| | - Adrian Scutelnic
- Department of Neurology, Inselspital Universitätsspital, Bern, Switzerland (M.H., A.S., D.S., B.S.)
| | - David Seiffge
- Department of Neurology, Inselspital Universitätsspital, Bern, Switzerland (M.H., A.S., D.S., B.S.)
| | - Bernhard Siepen
- Department of Neurology, Inselspital Universitätsspital, Bern, Switzerland (M.H., A.S., D.S., B.S.)
| | - Aaron Rothstein
- Department of Neurology, University of Pennsylvania, Philadelphia, PA (A.R., O.K., D.D.)
| | - Ossama Khazaal
- Department of Neurology, University of Pennsylvania, Philadelphia, PA (A.R., O.K., D.D.)
| | - David Do
- Department of Neurology, University of Pennsylvania, Philadelphia, PA (A.R., O.K., D.D.)
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston (S.A.K., L.A.R.).,Department of Neurosurgery, Medical University of South Carolina, Charleston (S.A.K.)
| | - Line Abdul Rahman
- Department of Neurology, Medical University of South Carolina, Charleston (S.A.K., L.A.R.)
| | - Eva A Mistry
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati (E.A.M., P.K., Y.A., B.C.)
| | - Deborah Kerrigan
- Department of Neurology, Vanderbilt University, Nashville, TN (D.K., H.L.)
| | - Hayden Lafever
- Department of Neurology, Vanderbilt University, Nashville, TN (D.K., H.L.)
| | - Thanh N Nguyen
- Department of Neurology, Boston University School of Medicine, MA (T.N.N., P.K., H.A.)
| | - Piers Klein
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati (E.A.M., P.K., Y.A., B.C.).,Department of Neurology, Boston University School of Medicine, MA (T.N.N., P.K., H.A.)
| | - Hugo Aparicio
- Department of Neurology, Boston University School of Medicine, MA (T.N.N., P.K., H.A.)
| | | | - Lindsey Kuohn
- Department of Neurology, New York University, NY (J.F., L.K., S.A.)
| | - Shashank Agarwal
- Department of Neurology, New York University, NY (J.F., L.K., S.A.)
| | - Christoph Stretz
- Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)
| | - Narendra Kala
- Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)
| | - Sleiman El Jamal
- Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)
| | - Alison Chang
- Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)
| | - Shawna Cutting
- Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)
| | - Han Xiao
- Department of Biostatistics, University of California Santa Barbara (H.X.)
| | - Adam de Havenon
- Department of Neurology, Yale University, New Haven, CT (R.S., Y.C., A.S.Z., A.d.H.)
| | - Varsha Muddasani
- Department of Neurology, University of Utah, Salt Lake City (V.M.)
| | - Teddy Wu
- Department of Neurology, Christchurch hospital, New Zealand (T.W., D.W.)
| | - Duncan Wilson
- Department of Neurology, Christchurch hospital, New Zealand (T.W., D.W.)
| | - Amre Nouh
- Department of Neurology, Hartford Hospital, CT (A.N., S.D.A.)
| | | | - Abid Qureshi
- Department of Neurology, University of Kansas, Kansas City (A.Q., J.M.)
| | - Justin Moore
- Department of Neurology, University of Kansas, Kansas City (A.Q., J.M.)
| | | | - Yasmin Aziz
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati (E.A.M., P.K., Y.A., B.C.)
| | - Bryce Casteigne
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati (E.A.M., P.K., Y.A., B.C.)
| | - Muhib Khan
- Department of Neurology, Spectrum Health, Michigan State University, Grand Rapids (M.K., Y.C.)
| | - Yao Cheng
- Department of Neurology, Spectrum Health, Michigan State University, Grand Rapids (M.K., Y.C.)
| | - Brian Mac Grory
- Department of Neurology, Duke University, Durham, NC (B.M.G., M.W., D.R.)
| | - Martin Weiss
- Department of Neurology, Duke University, Durham, NC (B.M.G., M.W., D.R.)
| | - Dylan Ryan
- Department of Neurology, Duke University, Durham, NC (B.M.G., M.W., D.R.)
| | | | | | - James E Siegler
- Department of Neurology, Cooper University, Camden, NJ (J.E.S., S.K., S.Y.)
| | - Scott Kamen
- Department of Neurology, Cooper University, Camden, NJ (J.E.S., S.K., S.Y.)
| | - Siyuan Yu
- Department of Neurology, Cooper University, Camden, NJ (J.E.S., S.K., S.Y.)
| | | | - Eugenie Atallah
- Department of Neurology, George Washington University, District of Columbia (C.R.L.G., E.A.)
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.D.)
| | - Alex Brehm
- Department of interventional and diagnostic Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland (A.B., M.P.)
| | - Tolga Dittrich
- Department of Neurology, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.D.)
| | - Marios Psychogios
- Department of interventional and diagnostic Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland (A.B., M.P.)
| | | | - Tareq Kass-Hout
- Department of Neurology, University of Chicago, IL (R.A.-D., T.K.-H., S.P.)
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago, IL (R.A.-D., T.K.-H., S.P.)
| | - Tristan Honda
- Department of Neurology, University of California at Los Angeles (T.H., D.S.L.)
| | - David S Liebeskind
- Department of Neurology, University of California at Los Angeles (T.H., D.S.L.)
| | - Karen Furie
- Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)
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