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Kuehnl A, Kallmayer M, Bohmann B, Lohe V, Moser R, Naher S, Kirchhoff F, Eckstein HH, Knappich C. Association between hospital ownership and patient selection, management, and outcomes after carotid endarterectomy or carotid artery stenting : - Secondary data analysis of the Bavarian statutory quality assurance database. BMC Surg 2024; 24:158. [PMID: 38760789 PMCID: PMC11100040 DOI: 10.1186/s12893-024-02448-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND This study analyses the association between hospital ownership and patient selection, treatment, and outcome of carotid endarterectomy (CEA) or carotid artery stenting (CAS). METHODS The analysis is based on the Bavarian subset of the nationwide German statutory quality assurance database. All patients receiving CEA or CAS for carotid artery stenosis between 2014 and 2018 were included. Hospitals were subdivided into four groups: university hospitals, public hospitals, hospitals owned by charitable organizations, and private hospitals. The primary outcome was any stroke or death until discharge from hospital. Research was funded by Germany's Federal Joint Committee Innovation Fund (01VSF19016 ISAR-IQ). RESULTS In total, 22,446 patients were included. The majority of patients were treated in public hospitals (62%), followed by private hospitals (17%), university hospitals (16%), and hospitals under charitable ownership (6%). Two thirds of patients were male (68%), and the median age was 72 years. CAS was most often applied in university hospitals (25%) and most rarely used in private hospitals (9%). Compared to university hospitals, patients in private hospitals were more likely asymptomatic (65% vs. 49%). In asymptomatic patients, the risk of stroke or death was 1.3% in university hospitals, 1.5% in public hospitals, 1.0% in hospitals of charitable owners, and 1.2% in private hospitals. In symptomatic patients, these figures were 3.0%, 2.5%, 3.4%, and 1.2% respectively. Univariate analysis revealed no statistically significant differences between hospital groups. In the multivariable analysis, compared to university hospitals, the odds ratio of stroke or death in asymptomatic patients treated by CEA was significantly lower in charitable hospitals (OR 0.19 [95%-CI 0.07-0.56, p = 0.002]) and private hospitals (OR 0.47 [95%-CI 0.23-0.98, p = 0.043]). In symptomatic patients (elective treatment, CEA), patients treated in private or public hospitals showed a significantly lower odds ratio compared to university hospitals (0.36 [95%-CI 0.17-0.72, p = 0.004] and 0.65 [95%-CI 0.42-1.00, p = 0.048], respectively). CONCLUSIONS Hospital ownership was related to patient selection and treatment, but not generally to outcomes. The lower risk of stroke or death in the subgroup of electively treated patients in private hospitals might be due to the right timing, the choice of treatment modality or actually to better structural and process quality.
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Affiliation(s)
- Andreas Kuehnl
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bianca Bohmann
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Vanessa Lohe
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Rebecca Moser
- Landesarbeitsgemeinschaft zur datengestützten, einrichtungsübergreifenden Qualitätssicherung in Bayern, Munich, Germany
| | - Shamsun Naher
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Felix Kirchhoff
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christoph Knappich
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Knappich C, Bohmann B, Kirchhoff F, Lohe V, Naher S, Kallmayer M, Eckstein HH, Kuehnl A. Intraoperative Completion Studies and their Associations with Carotid Endarterectomy Outcomes. Ann Surg 2024:00000658-990000000-00823. [PMID: 38545778 DOI: 10.1097/sla.0000000000006284] [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: 04/04/2024]
Abstract
OBJECTIVE This study aimed at assessing outcomes after carotid endarterectomy (CEA) in dependence of center policy with respect to imaging intraoperative completion study (ICS i ) usage. SUMMARY BACKGROUND DATA Although randomized controlled studies are missing, a beneficial effect was shown for ICS i techniques (i.e., angiography and intraoperative duplex ultrasound) after CEA. METHODS This secondary data analysis is based on the German statutory quality assurance database. Research was funded by Germany's Federal Joint Committee Innovation Fund (G-BA Innovationsfonds, 01VSF19016 ISAR-IQ). According to their ICS i policy, hospitals were categorized as routine ICSi (>90%), selective ICSi (10-90%), or sporadic ICSi (<10%) centers . Primary study outcome was in-hospital stroke or death. Multivariable regression analyses were performed. RESULTS Between 2012 and 2016, a total of 119,800 patients underwent CEA. In-hospital stroke or death rates were lower in routine ICSicenters (1.7%) compared to selective (2.1%) and sporadic ICSicenters (2.0%). The multivariable regression analysis showed, that in routine ICSicenters , ICS i use was associated with lower rates of stroke or death (aOR 0.64; 95% CI 0.44-0.93). In selective ICSicenters , ICS i was not associated with the occurrence of either of the assessed outcomes. In sporadic ICSicenters , ICS i was associated with higher rates of stroke or death (aOR 1.91; 95% CI 1.26-2.91). CONCLUSIONS Lowest in-hospital stroke or death rates are achieved in r outine ICSicenters . While ICS i is associated with a lower perioperative risk in r outine ICSicenters , it might act as a surrogate marker for worse outcomes due to intraoperative irregularities in sporadic ICSicenters . Routine use of ICS i is advisable.
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Affiliation(s)
- Christoph Knappich
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Schmitzer L, Kaczmarz S, Göttler J, Hoffmann G, Kallmayer M, Eckstein HH, Hedderich DM, Kufer J, Zimmer C, Preibisch C, Hyder F, Sollmann N. Macro- and microvascular contributions to cerebral structural alterations in patients with asymptomatic carotid artery stenosis. J Cereb Blood Flow Metab 2024:271678X241238935. [PMID: 38506325 DOI: 10.1177/0271678x241238935] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Atherosclerosis can underly internal carotid artery stenosis (ICAS), a major risk factor for ischemic stroke, as well as small vessel disease (SVD). This study aimed to investigate hemodynamics and structural alterations associated with SVD in ICAS patients. 28 patients with unilateral asymptomatic ICAS and 30 age-matched controls underwent structural (T1-/T2-weighted and diffusion tensor imaging [DTI]) and hemodynamic (pseudo-continuous arterial spin labeling and dynamic susceptibility contrast) magnetic resonance imaging. SVD-related alterations were assessed using free water (FW), FW-corrected DTI, and peak-width of skeletonized mean diffusivity (PSMD). Furthermore, cortical thickness, cerebral blood flow (CBF), and capillary transit time heterogeneity (CTH) were analyzed. Ipsilateral to the stenosis, cortical thickness was significantly decreased in the posterior dorsal cingulate cortex (p = 0.024) and temporal pole (p = 0.028). ICAS patients exhibited elevated PSMD (p = 0.005), FW (p < 0.001), and contralateral alterations in FW-corrected DTI metrics. We found significantly lateralized CBF (p = 0.011) and a tendency for lateralized CTH (p = 0.067) in the white matter (WM) related to ICAS. Elevated PSMD and FW may indicate a link between SVD and WM changes. Contralateral alterations were seen in FW-corrected DTI, whereas hemodynamic and cortical changes were mainly ipsilateral, suggesting SVD might influence global brain changes concurrent with ICAS-related hemodynamic alterations.
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Affiliation(s)
- Lena Schmitzer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiology & Biomedical Imaging, Magnetic Resonance Research Center (MRRC), Yale University, New Haven, CT, USA
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephan Kaczmarz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiology & Biomedical Imaging, Magnetic Resonance Research Center (MRRC), Yale University, New Haven, CT, USA
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Philips GmbH Market DACH, Hamburg, Germany
| | - Jens Göttler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiology & Biomedical Imaging, Magnetic Resonance Research Center (MRRC), Yale University, New Haven, CT, USA
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gabriel Hoffmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dennis Martin Hedderich
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan Kufer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiology & Biomedical Imaging, Magnetic Resonance Research Center (MRRC), Yale University, New Haven, CT, USA
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christine Preibisch
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Neurology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Fahmeed Hyder
- Department of Radiology & Biomedical Imaging, Magnetic Resonance Research Center (MRRC), Yale University, New Haven, CT, USA
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
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Graf M, Gassert FG, Marka AW, Gassert FT, Ziegelmayer S, Makowski M, Kallmayer M, Nadjiri J. Spectral computed tomography angiography using a gadolinium-based contrast agent for imaging of pathologies of the aorta. Int J Cardiovasc Imaging 2024:10.1007/s10554-024-03074-2. [PMID: 38421538 DOI: 10.1007/s10554-024-03074-2] [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] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES Especially patients with aortic aneurysms and multiple computed tomography angiographies (CTA) might show medical conditions which oppose the use of iodine-based contrast agents. CTA using monoenergetic reconstructions from dual layer CT and gadolinium (Gd-)based contrast agents might be a feasible alternative in these patients. Therefore, the purpose of this study was to evaluate the feasibility of clinical spectral CTA with a Gd-based contrast agent in patients with aortic aneurysms. METHODS Twenty-one consecutive scans in 15 patients with and without endovascular aneurysm repair showing contraindications for iodine-based contrast agents were examined using clinical routine doses (0.2 mmol/kg) of Gd-based contrast agent with spectral CT. Monoenergetic reconstructions of the spectral data set were computed. RESULTS There was a significant increase in the intravascular attenuation of the aorta between pre- and post-contrast images for the MonoE40 images in the thoracic and the abdominal aorta (p < 0.001 for both). Additionally, the ratio between pre- and post-contrast images was significantly higher in the MonoE40 images as compared to the conventional images with a factor of 6.5 ± 4.5 vs. 2.4 ± 0.5 in the thoracic aorta (p = 0.003) and 4.1 ± 1.8 vs. 1.9 ± 0.5 in the abdominal aorta (p < 0.001). CONCLUSIONS To conclude, our study showed that Gd-CTA is a valid and reliable alternative for diagnostic imaging of the aorta for clinical applications. Monoenergetic reconstructions of computed tomography angiographies using gadolinium based contrast agents may be a useful alternative in patients with aortic aneurysms and contraindications for iodine based contrast agents.
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Affiliation(s)
- Markus Graf
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Felix G Gassert
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Alexander W Marka
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Florian T Gassert
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Sebastian Ziegelmayer
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Marcus Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Michael Kallmayer
- Department of Vascular and Endovascular Surgery, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Jonathan Nadjiri
- Department of Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
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Knappich C, Kirchhoff F, Fritsche MK, Egert-Schwender S, Wendorff H, Kallmayer M, Haller B, Hyhlik-Duerr A, Reeps C, Eckstein HH, Trenner M. Endovascular aortic repair with sac embolization for the prevention of type II endoleaks (the EVAR-SE study): study protocol for a randomized controlled multicentre study in Germany. Trials 2024; 25:17. [PMID: 38167068 PMCID: PMC10759747 DOI: 10.1186/s13063-023-07888-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Beyond a certain threshold diameter, abdominal aortic aneurysms (AAA) are to be treated by open surgical or endovascular aortic aneurysm repair (EVAR). In a quarter of patients who undergo EVAR, inversion of blood flow in the inferior mesenteric artery or lumbar arteries may lead to type II endoleak (T2EL), which is associated with complications (e.g. AAA growth, secondary type I endoleak, rupture). As secondary interventions to treat T2EL often fail and may be highly invasive, prevention of T2EL is desirable. The present study aims to assess the efficacy of sac embolization (SE) with metal coils during EVAR to prevent T2EL in patients at high risk. METHODS Over a 24-month recruitment period, a total of 100 patients undergoing EVAR in four vascular centres (i.e. Klinikum rechts der Isar of the Technical University of Munich, University Hospital Augsburg, University Hospital Dresden, St. Joseph's Hospital Wiesbaden) are to be included in the present study. Patients at high risk for T2EL (i.e. ≥ 5 efferent vessels covered by endograft or aneurysmal thrombus volume <40%) are randomized to one group receiving standard EVAR and another group receiving EVAR with SE. Follow-up assessments postoperatively, after 30 days, and 6 months involve contrast-enhanced ultrasound scans (CEUS) and after 12 months an additional computed tomography angiography (CTA) scan. The presence of T2EL detected by CEUS or CTA after 12 months is the primary endpoint. Secondary endpoints comprise quality of life (quantified by the SF-36 questionnaire), reintervention rate, occurrence of type I/III endoleak, aortic rupture, death, alteration of aneurysm volume, or diameter. Standardized evaluation of CTA scans happens through a core lab. The study will be terminated after the final follow-up visit of the ultimate patient. DISCUSSION Although preexisting studies repeatedly indicated a beneficial effect of SE on T2EL rates after EVAR, patient relevant outcomes have not been assessed until now. The present study is the first randomized controlled multicentre study to assess the impact of SE on quality of life. Further unique features include employment of easily assessable high-risk criteria, a contemporary follow-up protocol, and approval to use any commercially available coil material. Overcoming limitations of previous studies might help SE to be implemented in daily practice and to enhance patient safety. TRIAL REGISTRATION ClinicalTrials.gov NCT05665101. Registered on 23 December 2022.
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Affiliation(s)
- Christoph Knappich
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany.
| | - Felix Kirchhoff
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Marie-Kristin Fritsche
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Silvia Egert-Schwender
- Münchner Studienzentrum, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Heiko Wendorff
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Bernhard Haller
- Klinikum rechts der Isar, Institute of AI and Informatics in Medicine, Technical University of Munich, Munich, Germany
| | | | - Christian Reeps
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Matthias Trenner
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
- Division of Vascular Medicine, St. Josefs Hospital, Wiesbaden, Germany
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Karlas A, Katsouli N, Fasoula NA, Bariotakis M, Chlis NK, Omar M, He H, Iakovakis D, Schäffer C, Kallmayer M, Füchtenbusch M, Ziegler A, Eckstein HH, Hadjileontiadis L, Ntziachristos V. Dermal features derived from optoacoustic tomograms via machine learning correlate microangiopathy phenotypes with diabetes stage. Nat Biomed Eng 2023; 7:1667-1682. [PMID: 38049470 PMCID: PMC10727986 DOI: 10.1038/s41551-023-01151-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/24/2023] [Indexed: 12/06/2023]
Abstract
Skin microangiopathy has been associated with diabetes. Here we show that skin-microangiopathy phenotypes in humans can be correlated with diabetes stage via morphophysiological cutaneous features extracted from raster-scan optoacoustic mesoscopy (RSOM) images of skin on the leg. We obtained 199 RSOM images from 115 participants (40 healthy and 75 with diabetes), and used machine learning to segment skin layers and microvasculature to identify clinically explainable features pertaining to different depths and scales of detail that provided the highest predictive power. Features in the dermal layer at the scale of detail of 0.1-1 mm (such as the number of junction-to-junction branches) were highly sensitive to diabetes stage. A 'microangiopathy score' compiling the 32 most-relevant features predicted the presence of diabetes with an area under the receiver operating characteristic curve of 0.84. The analysis of morphophysiological cutaneous features via RSOM may allow for the discovery of diabetes biomarkers in the skin and for the monitoring of diabetes status.
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Affiliation(s)
- Angelos Karlas
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Nikoletta Katsouli
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Nikolina-Alexia Fasoula
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Michail Bariotakis
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Nikolaos-Kosmas Chlis
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Murad Omar
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Hailong He
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios Iakovakis
- Department of Biomedical Engineering, Healthcare Engineering Innovation Center (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christoph Schäffer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | | | - Annette Ziegler
- Forschergruppe Diabetes e.V., Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg, Germany
- Forschergruppe Diabetes, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Leontios Hadjileontiadis
- Department of Biomedical Engineering, Healthcare Engineering Innovation Center (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilis Ntziachristos
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany.
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
- Munich Institute of Robotics and Machine Intelligence (MIRMI), Technical University of Munich, Munich, Germany.
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Karlas A, Fasoula NA, Kallmayer M, Schäffer C, Angelis G, Katsouli N, Reidl M, Duelmer F, Al Adem K, Hadjileontiadis L, Eckstein HH, Ntziachristos V. Optoacoustic biomarkers of lipids, hemorrhage and inflammation in carotid atherosclerosis. Front Cardiovasc Med 2023; 10:1210032. [PMID: 38028502 PMCID: PMC10666780 DOI: 10.3389/fcvm.2023.1210032] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Imaging plays a critical role in exploring the pathophysiology and enabling the diagnostics and therapy assessment in carotid artery disease. Ultrasonography, computed tomography, magnetic resonance imaging and nuclear medicine techniques have been used to extract of known characteristics of plaque vulnerability, such as inflammation, intraplaque hemorrhage and high lipid content. Despite the plethora of available techniques, there is still a need for new modalities to better characterize the plaque and provide novel biomarkers that might help to detect the vulnerable plaque early enough and before a stroke occurs. Optoacoustics, by providing a multiscale characterization of the morphology and pathophysiology of the plaque could offer such an option. By visualizing endogenous (e.g., hemoglobin, lipids) and exogenous (e.g., injected dyes) chromophores, optoacoustic technologies have shown great capability in imaging lipids, hemoglobin and inflammation in different applications and settings. Herein, we provide an overview of the main optoacoustic systems and scales of detail that enable imaging of carotid plaques in vitro, in small animals and humans. Finally, we discuss the limitations of this novel set of techniques while investigating their potential to enable a deeper understanding of carotid plaque pathophysiology and possibly improve the diagnostics in future patients with carotid artery disease.
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Affiliation(s)
- Angelos Karlas
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Nikolina-Alexia Fasoula
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Christoph Schäffer
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Georgios Angelis
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Nikoletta Katsouli
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Mario Reidl
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Felix Duelmer
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
- Chair for Computer Aided Medical Procedures and Augmented Reality, Department of Informatics, Technical University of Munich, Munich, Germany
| | - Kenana Al Adem
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Leontios Hadjileontiadis
- Department of Biomedical Engineering, Healthcare Engineering Innovation Center (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Vasilis Ntziachristos
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
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8
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Schneider SC, Kaczmarz S, Göttler J, Kufer J, Zott B, Priller J, Kallmayer M, Zimmer C, Sorg C, Preibisch C. Stronger influence of systemic than local hemodynamic-vascular factors on resting-state BOLD functional connectivity. Neuroimage 2023; 281:120380. [PMID: 37741595 DOI: 10.1016/j.neuroimage.2023.120380] [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: 04/06/2023] [Revised: 08/28/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023] Open
Abstract
Correlated fluctuations in the blood oxygenation level dependent (BOLD) signal of resting-state functional MRI (i.e., BOLD-functional connectivity, BOLD-FC) reflect a spectrum of neuronal and non-neuronal processes. In particular, there are multiple hemodynamic-vascular influences on BOLD-FC on both systemic (e.g., perfusion delay) and local levels (e.g., neurovascular coupling). While the influence of individual factors has been studied extensively, combined and comparative studies of systemic and local hemodynamic-vascular factors on BOLD-FC are scarce, notably in humans. We employed a multi-modal MRI approach to investigate and compare distinct hemodynamic-vascular processes and their impact on homotopic BOLD-FC in healthy controls and patients with unilateral asymptomatic internal carotid artery stenosis (ICAS). Asymptomatic ICAS is a cerebrovascular disorder, in which neuronal functioning is largely preserved but hemodynamic-vascular processes are impaired, mostly on the side of stenosis. Investigated indicators for local hemodynamic-vascular processes comprise capillary transit time heterogeneity (CTH) and cerebral blood volume (CBV) from dynamic susceptibility contrast (DSC) MRI, and cerebral blood flow (CBF) from pseudo-continuous arterial spin labeling (pCASL). Indicators for systemic processes are time-to-peak (TTP) from DSC MRI and BOLD lags from functional MRI. For each of these parameters, their influence on BOLD-FC was estimated by a comprehensive linear mixed model. Equally across groups, we found that individual mean BOLD-FC, local (CTH, CBV, and CBF) and systemic (TTP and BOLD lag) hemodynamic-vascular factors together explain 40.7% of BOLD-FC variance, with 20% of BOLD-FC variance explained by hemodynamic-vascular factors, with an about two-times larger contribution of systemic versus local factors. We conclude that regional differences in blood supply, i.e., systemic perfusion delays, exert a stronger influence on BOLD-FC than impairments in local neurovascular coupling.
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Affiliation(s)
- Sebastian C Schneider
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Clinic for Psychiatry, Ismaningerstr. 22, 81675 Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675 Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675 Munich, Munich, Germany.
| | - Stephan Kaczmarz
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675 Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675 Munich, Munich, Germany; Philips GmbH Market DACH, Hamburg, Germany
| | - Jens Göttler
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675 Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675 Munich, Munich, Germany
| | - Jan Kufer
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675 Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675 Munich, Munich, Germany; Department of Radiology & Biomedical Imaging, Yale University, New Haven, CT, United States of America
| | - Benedikt Zott
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675 Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675 Munich, Munich, Germany
| | - Josef Priller
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Clinic for Psychiatry, Ismaningerstr. 22, 81675 Munich, Germany
| | - Michael Kallmayer
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Clinic for vascular surgery, Ismaningerstr. 22, 81675 Munich, Munich, Germany
| | - Claus Zimmer
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675 Munich, Munich, Germany
| | - Christian Sorg
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Clinic for Psychiatry, Ismaningerstr. 22, 81675 Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675 Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675 Munich, Munich, Germany
| | - Christine Preibisch
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675 Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675 Munich, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Clinic for Neurology, Ismaningerstr. 22, 81675 Munich, Munich, Germany
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9
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He H, Fasoula NA, Karlas A, Omar M, Aguirre J, Lutz J, Kallmayer M, Füchtenbusch M, Eckstein HH, Ziegler A, Ntziachristos V. Opening a window to skin biomarkers for diabetes stage with optoacoustic mesoscopy. Light Sci Appl 2023; 12:231. [PMID: 37718348 PMCID: PMC10505608 DOI: 10.1038/s41377-023-01275-3] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/10/2023] [Accepted: 08/28/2023] [Indexed: 09/19/2023]
Abstract
Being the largest and most accessible organ of the human body, the skin could offer a window to diabetes-related complications on the microvasculature. However, skin microvasculature is typically assessed by histological analysis, which is not suited for applications to large populations or longitudinal studies. We introduce ultra-wideband raster-scan optoacoustic mesoscopy (RSOM) for precise, non-invasive assessment of diabetes-related changes in the dermal microvasculature and skin micro-anatomy, resolved with unprecedented sensitivity and detail without the need for contrast agents. Providing unique imaging contrast, we explored a possible role for RSOM as an investigational tool in diabetes healthcare and offer the first comprehensive study investigating the relationship between different diabetes complications and microvascular features in vivo. We applied RSOM to scan the pretibial area of 95 participants with diabetes mellitus and 48 age-matched volunteers without diabetes, grouped according to disease complications, and extracted six label-free optoacoustic biomarkers of human skin, including dermal microvasculature density and epidermal parameters, based on a novel image-processing pipeline. We then correlated these biomarkers to disease severity and found statistically significant effects on microvasculature parameters as a function of diabetes complications. We discuss how label-free RSOM biomarkers can lead to a quantitative assessment of the systemic effects of diabetes and its complications, complementing the qualitative assessment allowed by current clinical metrics, possibly leading to a precise scoring system that captures the gradual evolution of the disease.
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Affiliation(s)
- Hailong He
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Nikolina-Alexia Fasoula
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Angelos Karlas
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Murad Omar
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Juan Aguirre
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Jessica Lutz
- Diabetes Center at Marienplatz, Munich, Germany
- Forschergruppe Diabetes e.V., Helmholtz Zentrum München, Neuherberg, Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Martin Füchtenbusch
- Diabetes Center at Marienplatz, Munich, Germany
- Forschergruppe Diabetes e.V., Helmholtz Zentrum München, Neuherberg, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Annette Ziegler
- Forschergruppe Diabetes e.V., Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg, Germany
| | - Vasilis Ntziachristos
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany.
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
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10
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Karlas A, Bariotakis M, Kallmayer M, Hadjileontiadis L, Wildgruber M. Editorial: Research topic for frontiers in cardiovascular medicine: non-invasive sensing and imaging techniques for cardiometabolic diseases. Front Cardiovasc Med 2023; 10:1178101. [PMID: 37255706 PMCID: PMC10225729 DOI: 10.3389/fcvm.2023.1178101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/21/2023] [Indexed: 06/01/2023] Open
Affiliation(s)
- A. Karlas
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - M. Bariotakis
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
| | - M. Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - L. Hadjileontiadis
- Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Healthcare Innovation Center, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - M. Wildgruber
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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11
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Haertl J, Renz M, Wunderlich S, Hemmer B, Hofauer B, Gempt J, Kallmayer M, Boeckh-Behrens T, Kirschke JS, Ikenberg BD. Bony Stroke: Ischemic Stroke Caused by Mechanical Stress on Brain Supplying Arteries From Anatomical Bone or Cartilage Anomalies. Stroke 2023; 54:1246-1256. [PMID: 37051911 DOI: 10.1161/strokeaha.122.041946] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Bone or cartilage anomalies with affection of brain supplying arteries are a potential structural cause for ischemic stroke. In the following, we termed this entity bony stroke. Due to rarity of their description, there is no standardized workup and therapy for bony strokes. METHODS Retrospectively, we extracted diagnostic and therapeutic workup of all patients considered to have had a bony stroke between January 2017 to March 2022 at our comprehensive care center. RESULTS In total, 6 patients classified as a bony stroke were identified among 4200 acute patients with ischemic stroke treated during the study period. Each patient had recurrent ischemic strokes in the dependent vascular territory before diagnosis. Diagnosis was achieved by a combination of imaging devices, including sonography, computed tomography, and magnetic resonance imaging. In addition to conventional static imaging, the application of dynamic imaging modalities with the patients' head in rotation or reclination confirmed a vessel affection following head movements in 3 patients (50%). Treatment options were interdisciplinary assessed and included the following: conservative treatment (n=1), endovascular stenting (n=2) or occlusion (n=2), surgical removal of bone/ cartilage (n=2), and surgical bypass treatment (n=1). In follow-up (mean 11.7 months), no patient experienced further ischemia. CONCLUSIONS As a differential diagnosis, bony strokes may be considered in patients with recurrent ischemic stroke of unknown cause in one dependent vascular territory. Interdisciplinary evaluation and treatment may eliminate risk of stroke recurrence.
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Affiliation(s)
- Johanna Haertl
- Department of Neurology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany. (J.H., S.W., B. Hemmer, B.D.I.)
| | - Martin Renz
- Department of Diagnostic und Interventional Neuroradiology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany. (M.R., T.B.-B., J.S.K.)
| | - Silke Wunderlich
- Department of Neurology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany. (J.H., S.W., B. Hemmer, B.D.I.)
| | - Bernhard Hemmer
- Department of Neurology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany. (J.H., S.W., B. Hemmer, B.D.I.)
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (B. Hemmer)
| | - Benedikt Hofauer
- Department of Otorhinolaryngology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany. (B. Hofauer)
| | - Jens Gempt
- Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany. (J.G.)
| | - Michael Kallmayer
- Department of Vascular and Endovascular Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany. (M.K.)
| | - Tobias Boeckh-Behrens
- Department of Diagnostic und Interventional Neuroradiology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany. (M.R., T.B.-B., J.S.K.)
| | - Jan S Kirschke
- Department of Diagnostic und Interventional Neuroradiology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany. (M.R., T.B.-B., J.S.K.)
| | - Benno David Ikenberg
- Department of Neurology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany. (J.H., S.W., B. Hemmer, B.D.I.)
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12
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Karlas A, Fasoula NA, Katsouli N, Kallmayer M, Sieber S, Schmidt S, Liapis E, Halle M, Eckstein HH, Ntziachristos V. Skeletal muscle optoacoustics reveals patterns of circulatory function and oxygen metabolism during exercise. Photoacoustics 2023; 30:100468. [PMID: 36950518 PMCID: PMC10025091 DOI: 10.1016/j.pacs.2023.100468] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Imaging skeletal muscle function and metabolism, as reported by local hemodynamics and oxygen kinetics, can elucidate muscle performance, severity of an underlying disease or outcome of a treatment. Herein, we used multispectral optoacoustic tomography (MSOT) to image hemodynamics and oxygen kinetics within muscle during exercise. Four healthy volunteers underwent three different hand-grip exercise challenges (60s isometric, 120s intermittent isometric and 60s isotonic). During isometric contraction, MSOT showed a decrease of HbO2, Hb and total blood volume (TBV), followed by a prominent increase after the end of contraction. Corresponding hemodynamic behaviors were recorded during the intermittent isometric and isotonic exercises. A more detailed analysis of MSOT readouts revealed insights into arteriovenous oxygen differences and muscle oxygen consumption during all exercise schemes. These results demonstrate an excellent capability of visualizing both circulatory function and oxygen metabolism within skeletal muscle under exercise, with great potential implications for muscle research, including relevant disease diagnostics.
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Affiliation(s)
- Angelos Karlas
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Nikolina-Alexia Fasoula
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Nikoletta Katsouli
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sabine Sieber
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Schmidt
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Evangelos Liapis
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
| | - Martin Halle
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Vasilis Ntziachristos
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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13
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Fasoula NA, Karlas A, Prokopchuk O, Katsouli N, Bariotakis M, Liapis E, Goetz A, Kallmayer M, Reber J, Novotny A, Friess H, Ringelhan M, Schmid R, Eckstein HH, Hofmann S, Ntziachristos V. Non-invasive multispectral optoacoustic tomography resolves intrahepatic lipids in patients with hepatic steatosis. Photoacoustics 2023; 29:100454. [PMID: 36794122 PMCID: PMC9922962 DOI: 10.1016/j.pacs.2023.100454] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Hepatic steatosis is characterized by intrahepatic lipid accumulation and may lead to irreversible liver damage if untreated. Here, we investigate whether multispectral optoacoustic tomography (MSOT) can offer label-free detection of liver lipid content to enable non-invasive characterization of hepatic steatosis by analyzing the spectral region around 930 nm, where lipids characteristically absorb. In a pilot study, we apply MSOT to measure liver and surrounding tissues in five patients with liver steatosis and five healthy volunteers, revealing significantly higher absorptions at 930 nm in the patients, while no significant difference was observed in the subcutaneous adipose tissue of the two groups. We further corroborated the human observations with corresponding MSOT measurements in high fat diet (HFD) - and regular chow diet (CD)-fed mice. This study introduces MSOT as a potential non-invasive and portable technique for detecting/monitoring hepatic steatosis in clinical settings, providing justification for larger studies.
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Affiliation(s)
- Nikolina-Alexia Fasoula
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Angelos Karlas
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner Site Munich Heart Alliance, Munich, Germany
| | - Olga Prokopchuk
- Department of Visceral Surgery, Klinikum rechts der Isar, Munich, Germany
| | - Nikoletta Katsouli
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Michail Bariotakis
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Evangelos Liapis
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Anna Goetz
- Institute for Diabetes and Regeneration Research, Helmholtz Zentrum München, Neuherberg, Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Josefine Reber
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Alexander Novotny
- Department of Visceral Surgery, Klinikum rechts der Isar, Munich, Germany
| | - Helmut Friess
- Department of Visceral Surgery, Klinikum rechts der Isar, Munich, Germany
| | - Marc Ringelhan
- Department of Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roland Schmid
- Department of Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner Site Munich Heart Alliance, Munich, Germany
| | - Susanna Hofmann
- Institute for Diabetes and Regeneration Research, Helmholtz Zentrum München, Neuherberg, Germany
- Department of Internal Medicine IV, Klinikum der Ludwig Maximilian University of Munich, Munich, Germany
| | - Vasilis Ntziachristos
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- DZHK (German Centre for Cardiovascular Research), partner Site Munich Heart Alliance, Munich, Germany
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14
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Kampaktsis PN, Emfietzoglou M, Al Shehhi A, Fasoula NA, Bakogiannis C, Mouselimis D, Tsarouchas A, Vassilikos VP, Kallmayer M, Eckstein HH, Hadjileontiadis L, Karlas A. Artificial intelligence in atherosclerotic disease: Applications and trends. Front Cardiovasc Med 2023; 9:949454. [PMID: 36741834 PMCID: PMC9896100 DOI: 10.3389/fcvm.2022.949454] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the most common cause of death globally. Increasing amounts of highly diverse ASCVD data are becoming available and artificial intelligence (AI) techniques now bear the promise of utilizing them to improve diagnosis, advance understanding of disease pathogenesis, enable outcome prediction, assist with clinical decision making and promote precision medicine approaches. Machine learning (ML) algorithms in particular, are already employed in cardiovascular imaging applications to facilitate automated disease detection and experts believe that ML will transform the field in the coming years. Current review first describes the key concepts of AI applications from a clinical standpoint. We then provide a focused overview of current AI applications in four main ASCVD domains: coronary artery disease (CAD), peripheral arterial disease (PAD), abdominal aortic aneurysm (AAA), and carotid artery disease. For each domain, applications are presented with refer to the primary imaging modality used [e.g., computed tomography (CT) or invasive angiography] and the key aim of the applied AI approaches, which include disease detection, phenotyping, outcome prediction, and assistance with clinical decision making. We conclude with the strengths and limitations of AI applications and provide future perspectives.
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Affiliation(s)
- Polydoros N. Kampaktsis
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY, United States,*Correspondence: Polydoros N. Kampaktsis,
| | - Maria Emfietzoglou
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Aamna Al Shehhi
- Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Nikolina-Alexia Fasoula
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany,School of Medicine, Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
| | - Constantinos Bakogiannis
- Third Department of Cardiology, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Mouselimis
- Third Department of Cardiology, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tsarouchas
- Third Department of Cardiology, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios P. Vassilikos
- Third Department of Cardiology, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Leontios Hadjileontiadis
- Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates,Healthcare Innovation Center, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates,Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angelos Karlas
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany,School of Medicine, Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany,Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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15
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Gleißner C, Kaczmarz S, Kufer J, Schmitzer L, Kallmayer M, Zimmer C, Wiestler B, Preibisch C, Göttler J. Hemodynamic MRI parameters to predict asymptomatic unilateral carotid artery stenosis with random forest machine learning. Front Neuroimaging 2023; 1:1056503. [PMID: 37555162 PMCID: PMC10406220 DOI: 10.3389/fnimg.2022.1056503] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/20/2022] [Indexed: 08/10/2023]
Abstract
BACKGROUND Internal carotid artery stenosis (ICAS) can cause stroke and cognitive decline. Associated hemodynamic impairments, which are most pronounced within individual watershed areas (iWSA) between vascular territories, can be assessed with hemodynamic-oxygenation-sensitive MRI and may help to detect severely affected patients. We aimed to identify the most sensitive parameters and volumes of interest (VOI) to predict high-grade ICAS with random forest machine learning. We hypothesized an increased predictive ability considering iWSAs and a decreased cognitive performance in correctly classified patients. MATERIALS AND METHODS Twenty-four patients with asymptomatic, unilateral, high-grade carotid artery stenosis and 24 age-matched healthy controls underwent MRI comprising pseudo-continuous arterial spin labeling (pCASL), breath-holding functional MRI (BH-fMRI), dynamic susceptibility contrast (DSC), T2 and T2* mapping, MPRAGE and FLAIR. Quantitative maps of eight perfusion, oxygenation and microvascular parameters were obtained. Mean values of respective parameters within and outside of iWSAs split into gray (GM) and white matter (WM) were calculated for both hemispheres and for interhemispheric differences resulting in 96 features. Random forest classifiers were trained on whole GM/WM VOIs, VOIs considering iWSAs and with additional feature selection, respectively. RESULTS The most sensitive features in decreasing order were time-to-peak (TTP), cerebral blood flow (CBF) and cerebral vascular reactivity (CVR), all of these inside of iWSAs. Applying iWSAs combined with feature selection yielded significantly higher receiver operating characteristics areas under the curve (AUC) than whole GM/WM VOIs (AUC: 0.84 vs. 0.90, p = 0.039). Correctly predicted patients presented with worse cognitive performances than frequently misclassified patients (Trail-making-test B: 152.5s vs. 94.4s, p = 0.034). CONCLUSION Random forest classifiers trained on multiparametric MRI data allow identification of the most relevant parameters and VOIs to predict ICAS, which may improve personalized treatments.
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Affiliation(s)
- Carina Gleißner
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Kaczmarz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- Philips GmbH Market DACH, Hamburg, Germany
- TUM Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan Kufer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lena Schmitzer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Michael Kallmayer
- Department of Vascular and Endovascular Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christine Preibisch
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
- Clinic for Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jens Göttler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
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16
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Fedchenko O, Šmejkal L, Kallmayer M, Lytvynenko Y, Medjanik K, Babenkov S, Vasilyev D, Kläui M, Demsar J, Schönhense G, Jourdan M, Sinova J, Elmers HJ. Direct observation of antiferromagnetic parity violation in the electronic structure of Mn 2Au. J Phys Condens Matter 2022; 34:425501. [PMID: 35940170 DOI: 10.1088/1361-648x/ac87e6] [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] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
Using momentum microscopy with sub-µm spatial resolution, allowing momentum resolved photoemission on individual antiferromagnetic domains, we observe an asymmetry in the electronic band structure,E(k)≠E(-k), in Mn2Au. This broken band structure parity originates from the combined time and parity symmetry,PT, of the antiferromagnetic order of the Mn moments, in connection with spin-orbit coupling. The spin-orbit interaction couples the broken parity to the Néel order parameter direction. We demonstrate a novel tool to image the Néel vector direction,N, by combining spatially resolved momentum microscopy withab-initiocalculations that correlate the broken parity with the vectorN.
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Affiliation(s)
- O Fedchenko
- Institut für Physik, Johannes Gutenberg-Universität Mainz, Staudingerweg 7, D-55099 Mainz, Germany
| | - L Šmejkal
- Institut für Physik, Johannes Gutenberg-Universität Mainz, Staudingerweg 7, D-55099 Mainz, Germany
- Institute of Physics Academy of Sciences of the Czech Republic, Cukrovarnická 10, Praha 6, Czech Republic
| | - M Kallmayer
- Surface Concept GmbH, Am Sägewerk 23A, D-55124 Mainz, Germany
| | - Ya Lytvynenko
- Institut für Physik, Johannes Gutenberg-Universität Mainz, Staudingerweg 7, D-55099 Mainz, Germany
- Institute of Magnetism of the National Academy of Science and MES of Ukraine, Vernadsky Blvd, 36b, 03142 Kyiv, Ukraine
| | - K Medjanik
- Institut für Physik, Johannes Gutenberg-Universität Mainz, Staudingerweg 7, D-55099 Mainz, Germany
| | - S Babenkov
- Institut für Physik, Johannes Gutenberg-Universität Mainz, Staudingerweg 7, D-55099 Mainz, Germany
| | - D Vasilyev
- Institut für Physik, Johannes Gutenberg-Universität Mainz, Staudingerweg 7, D-55099 Mainz, Germany
| | - M Kläui
- Institut für Physik, Johannes Gutenberg-Universität Mainz, Staudingerweg 7, D-55099 Mainz, Germany
| | - J Demsar
- Institut für Physik, Johannes Gutenberg-Universität Mainz, Staudingerweg 7, D-55099 Mainz, Germany
| | - G Schönhense
- Institut für Physik, Johannes Gutenberg-Universität Mainz, Staudingerweg 7, D-55099 Mainz, Germany
| | - M Jourdan
- Institut für Physik, Johannes Gutenberg-Universität Mainz, Staudingerweg 7, D-55099 Mainz, Germany
| | - J Sinova
- Institut für Physik, Johannes Gutenberg-Universität Mainz, Staudingerweg 7, D-55099 Mainz, Germany
- Institute of Physics Academy of Sciences of the Czech Republic, Cukrovarnická 10, Praha 6, Czech Republic
| | - H J Elmers
- Institut für Physik, Johannes Gutenberg-Universität Mainz, Staudingerweg 7, D-55099 Mainz, Germany
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17
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Schneider SC, Archila-Meléndez ME, Göttler J, Kaczmarz S, Zott B, Priller J, Kallmayer M, Zimmer C, Sorg C, Preibisch C. Resting-state BOLD functional connectivity depends on the heterogeneity of capillary transit times in the human brain A combined lesion and simulation study about the influence of blood flow response timing. Neuroimage 2022; 255:119208. [PMID: 35427773 DOI: 10.1016/j.neuroimage.2022.119208] [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: 11/04/2021] [Revised: 02/23/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022] Open
Abstract
Functional connectivity (FC) derived from blood oxygenation level dependent (BOLD) functional magnetic resonance imaging at rest (rs-fMRI), is commonly interpreted as indicator of neuronal connectivity. In a number of brain disorders, however, metabolic, vascular, and hemodynamic impairments can be expected to alter BOLD-FC independently from neuronal activity. By means of a neurovascular coupling (NVC) model of BOLD-FC, we recently demonstrated that aberrant timing of cerebral blood flow (CBF) responses may influence BOLD-FC. In the current work, we support and extend this finding by empirically linking BOLD-FC with capillary transit time heterogeneity (CTH), which we consider as an indicator of delayed and broadened CBF responses. We assessed 28 asymptomatic patients with unilateral high-grade internal carotid artery stenosis (ICAS) as a hemodynamic lesion model with largely preserved neurocognitive functioning and 27 age-matched healthy controls. For each participant, we obtained rs-fMRI, arterial spin labeling, and dynamic susceptibility contrast MRI to study the dependence of left-right homotopic BOLD-FC on local perfusion parameters. Additionally, we investigated the dependency of BOLD-FC on CBF response timing by detailed simulations. Homotopic BOLD-FC was negatively associated with increasing CTH differences between homotopic brain areas. This relation was more pronounced in asymptomatic ICAS patients even after controlling for baseline CBF and relative cerebral blood volume influences. These findings match simulation results that predict an influence of delayed and broadened CBF responses on BOLD-FC. Results demonstrate that increasing CTH differences between homotopic brain areas lead to BOLD-FC reductions. Simulations suggest that CTH increases correspond to broadened and delayed CBF responses to fluctuations in ongoing neuronal activity.
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Affiliation(s)
- Sebastian C Schneider
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675, Munich, Germany
| | - Mario E Archila-Meléndez
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675, Munich, Germany
| | - Jens Göttler
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675, Munich, Germany
| | - Stephan Kaczmarz
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675, Munich, Germany; Philips GmbH Market DACH, Hamburg, Germany
| | - Benedikt Zott
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675, Munich, Germany
| | - Josef Priller
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Psychiatry, Ismaningerstr. 22, 81675, Munich, Munich, Germany
| | - Michael Kallmayer
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Vascular and Endovascular Surgery, Ismaningerstr. 22, 81675, Munich, Munich, Germany
| | - Claus Zimmer
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675, Munich, Germany
| | - Christian Sorg
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675, Munich, Germany
| | - Christine Preibisch
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Ismaningerstr. 22, 81675, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Ismaningerstr. 22, 81675, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Neurology, Ismaningerstr. 22, 81675, Munich, Munich, Germany.
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18
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Mantzaris MD, Siogkas PK, Tsakanikas VD, Potsika VT, Pleouras DS, Sakellarios AI, Karagiannis G, Galyfos G, Sigala F, Liasis N, Jovanovic M, Koncar IB, Kallmayer M, Fotiadis DI. Computational modeling of atherosclerotic plaque progression in carotid lesions with moderate degree of stenosis . Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:4209-4212. [PMID: 34892152 DOI: 10.1109/embc46164.2021.9630376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Carotid atherosclerotic plaque growth leads to the progressive luminal stenosis of the vessel, which may erode or rupture causing thromboembolism and cerebral infarction, manifested as stroke. Carotid atherosclerosis is considered the major cause of ischemic stroke in Europe and thus new imaging-based computational tools that can improve risk stratification and management of carotid artery disease patients are needed. In this work, we present a new computational approach for modeling atherosclerotic plaque progression in real patient-carotid lesions, with moderate to severe degree of stenosis (>50%). The model incorporates for the first time, the baseline 3D geometry of the plaque tissue components (e.g. Lipid Core) identified by MR imaging, in which the major biological processes of atherosclerosis are simulated in time. The simulated plaque tissue production results in the inward remodeling of the vessel wall promoting luminal stenosis which in turn predicts the region of the actual stenosis progression observed at the follow-up visit. The model aims to support clinical decision making, by identifying regions prone to plaque formation, predict carotid stenosis and plaque burden progression, and provide advice on the optimal time for patient follow-up screening.
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19
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Schönhense G, Medjanik K, Fedchenko O, Zymaková A, Chernov S, Kutnyakhov D, Vasilyev D, Babenkov S, Elmers HJ, Baumgärtel P, Goslawski P, Öhrwall G, Grunske T, Kauerhof T, von Volkmann K, Kallmayer M, Ellguth M, Oelsner A. Time-of-flight photoelectron momentum microscopy with 80-500 MHz photon sources: electron-optical pulse picker or bandpass pre-filter. J Synchrotron Radiat 2021; 28:1891-1908. [PMID: 34738944 PMCID: PMC8570213 DOI: 10.1107/s1600577521010511] [Citation(s) in RCA: 3] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/10/2021] [Indexed: 06/13/2023]
Abstract
The small time gaps of synchrotron radiation in conventional multi-bunch mode (100-500 MHz) or laser-based sources with high pulse rate (∼80 MHz) are prohibitive for time-of-flight (ToF) based photoelectron spectroscopy. Detectors with time resolution in the 100 ps range yield only 20-100 resolved time slices within the small time gap. Here we present two techniques of implementing efficient ToF recording at sources with high repetition rate. A fast electron-optical beam blanking unit with GHz bandwidth, integrated in a photoelectron momentum microscope, allows electron-optical `pulse-picking' with any desired repetition period. Aberration-free momentum distributions have been recorded at reduced pulse periods of 5 MHz (at MAX II) and 1.25 MHz (at BESSY II). The approach is compared with two alternative solutions: a bandpass pre-filter (here a hemispherical analyzer) or a parasitic four-bunch island-orbit pulse train, coexisting with the multi-bunch pattern on the main orbit. Chopping in the time domain or bandpass pre-selection in the energy domain can both enable efficient ToF spectroscopy and photoelectron momentum microscopy at 100-500 MHz synchrotrons, highly repetitive lasers or cavity-enhanced high-harmonic sources. The high photon flux of a UV-laser (80 MHz, <1 meV bandwidth) facilitates momentum microscopy with an energy resolution of 4.2 meV and an analyzed region-of-interest (ROI) down to <800 nm. In this novel approach to `sub-µm-ARPES' the ROI is defined by a small field aperture in an intermediate Gaussian image, regardless of the size of the photon spot.
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Affiliation(s)
- G. Schönhense
- Institut für Physik, Johannes Gutenberg Universität, 55128 Mainz, Germany
| | - K. Medjanik
- Institut für Physik, Johannes Gutenberg Universität, 55128 Mainz, Germany
| | - O. Fedchenko
- Institut für Physik, Johannes Gutenberg Universität, 55128 Mainz, Germany
| | - A. Zymaková
- Institut für Physik, Johannes Gutenberg Universität, 55128 Mainz, Germany
| | - S. Chernov
- Institut für Physik, Johannes Gutenberg Universität, 55128 Mainz, Germany
| | - D. Kutnyakhov
- Institut für Physik, Johannes Gutenberg Universität, 55128 Mainz, Germany
| | - D. Vasilyev
- Institut für Physik, Johannes Gutenberg Universität, 55128 Mainz, Germany
| | - S. Babenkov
- Institut für Physik, Johannes Gutenberg Universität, 55128 Mainz, Germany
| | - H. J. Elmers
- Institut für Physik, Johannes Gutenberg Universität, 55128 Mainz, Germany
| | | | - P. Goslawski
- BESSY II, Helmholtz-Zentrum, 12489 Berlin, Germany
| | - G. Öhrwall
- MAX IV Laboratory, Lund University, PO Box 118, SE-221 00 Lund, Sweden
| | | | | | | | | | - M. Ellguth
- Surface Concept GmbH, 55128 Mainz, Germany
| | - A. Oelsner
- Surface Concept GmbH, 55128 Mainz, Germany
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20
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Karlas A, Kallmayer M, Bariotakis M, Fasoula NA, Liapis E, Hyafil F, Pelisek J, Wildgruber M, Eckstein HH, Ntziachristos V. Multispectral optoacoustic tomography of lipid and hemoglobin contrast in human carotid atherosclerosis. Photoacoustics 2021; 23:100283. [PMID: 34381689 PMCID: PMC8340302 DOI: 10.1016/j.pacs.2021.100283] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 05/09/2023]
Abstract
Several imaging techniques aim at identifying features of carotid plaque instability but come with limitations, such as the use of contrast agents, long examination times and poor portability. Multispectral optoacoustic tomography (MSOT) employs light and sound to resolve lipid and hemoglobin content, both features associated with plaque instability, in a label-free, fast and highly portable way. Herein, 5 patients with carotid atherosclerosis, 5 healthy volunteers and 2 excised plaques, were scanned with handheld MSOT. Spectral unmixing allowed visualization of lipid and hemoglobin content within three ROIs: whole arterial cross-section, plaque and arterial lumen. Calculation of the fat-blood-ratio (FBR) value within the ROIs enabled the differentiation between patients and healthy volunteers (P = 0.001) and between plaque and lumen in patients (P = 0.04). Our results introduce MSOT as a tool for molecular imaging of human carotid atherosclerosis and open new possibilities for research and clinical assessment of carotid plaques.
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Affiliation(s)
- Angelos Karlas
- Chair of Biological Imaging, Central Institute for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Helmholtz Zentrum München, Institute of Biological and Medical Imaging, Neuherberg, Germany
- Clinic for Vascular and Endovascular Surgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Kallmayer
- Clinic for Vascular and Endovascular Surgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Michael Bariotakis
- Chair of Biological Imaging, Central Institute for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Helmholtz Zentrum München, Institute of Biological and Medical Imaging, Neuherberg, Germany
| | - Nikolina-Alexia Fasoula
- Chair of Biological Imaging, Central Institute for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Helmholtz Zentrum München, Institute of Biological and Medical Imaging, Neuherberg, Germany
| | - Evangelos Liapis
- Chair of Biological Imaging, Central Institute for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Helmholtz Zentrum München, Institute of Biological and Medical Imaging, Neuherberg, Germany
| | - Fabien Hyafil
- INSERM U1148, Laboratory for Vascular Translational Science (LVTS), DHU FIRE, University de Paris, Paris, France
- Department of Nuclear Medicine, Bichat University Hospital, Assistance-Publique-Hôpitaux de Paris, Paris, France
| | - Jaroslav Pelisek
- Clinic for Vascular and Endovascular Surgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Clinic for Vascular and Endovascular Surgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Vasilis Ntziachristos
- Chair of Biological Imaging, Central Institute for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Helmholtz Zentrum München, Institute of Biological and Medical Imaging, Neuherberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Corresponding author at: Chair of Biological Imaging, Central Institute for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany.
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21
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Knappich C, Lang T, Tsantilas P, Schmid S, Kallmayer M, Haller B, Eckstein HH. Intraoperative completion studies in carotid endarterectomy: systematic review and meta-analysis of techniques and outcomes. Ann Transl Med 2021; 9:1201. [PMID: 34430642 PMCID: PMC8350645 DOI: 10.21037/atm-20-2931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022]
Abstract
Background Declining perioperative stroke and death rates over the past 3 decades have been paralleled by an increasing use of intraoperative completion studies (ICS) following carotid endarterectomy (CEA). Techniques applied include angiography, intraoperative duplex ultrasound (IDUS), flowmetry, and angioscopy. This systematic review and meta-analysis is aiming on providing an overview of techniques and corresponding outcomes. Methods A PubMed based systematic literature review comprising the years 1980 through 2020 was performed using predefined keywords to identify articles on different ICS techniques. Pooled analyses and meta-analyses estimating risk ratios (RR) and 95% confidence intervals (CI) were performed to compare outcomes of different ICS modes to nonapplication of any ICS. I2 values were assessed to quantify study heterogeneities. Results Identification of 34 studies including patients undergoing CEA with angiography (n=53,218), IDUS (n=20,030), flowmetry (n=16,812), and angioscopy (n=2,291). Corresponding rates of perioperative stroke were 1.5%, 1.8%, 3.6%, and 1.5%, perioperative stroke or death occurred in 1.7%, 1.9%, 2.2%, and 2.0%. Intraoperative surgical revision rates were 6.2%, 5.9%, and 7.9% after CEA with angiography, IDUS, and angioscopy, respectively. Compared to nonapplication of any ICS, the pooled analysis revealed angiography to be significantly associated with lower rates of stroke (RR 0.47; 95% CI, 0.36–0.62; P<0.0001) and stroke or death (RR 0.76; 95% CI, 0.70–0.83; P<0.0001). IDUS was significantly associated with lower rates of stroke (RR 0.56; 95% CI, 0.43–0.73; P<0.0001) and stroke or death (RR 0.83; 95% CI, 0.74–0.93; P=0.0018), whereas angioscopy showed a significant association with a lower stroke rate (RR 0.48; 95% CI, 0.033–0.68; P=0.0001), but no effect on the combined stroke or death rate. Angioscopy was associated with a higher intraoperative revision rate compared to angiography (RR 1.29; 95% CI, 1.07–1.54; P=0.006). The meta-analyses confirmed lower perioperative stroke or death rates for angiography (RR 0.83; 95% CI, 0.76–0.91) and IDUS (RR 0.86; 95% CI, 0.76–0.98) compared to non-application of any ICS, whereas flowmetry showed no significant association. Conclusions This study represents the first systematic literature review and meta-analysis on usage of ICSs in CEA. Data strongly indicate a significant beneficial effect of angiography, IDUS, and angioscopy on perioperative CEA outcomes. Any carotid surgeon should consider implementation of ICSs in his routine armamentarium.
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Affiliation(s)
- Christoph Knappich
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Lang
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Pavlos Tsantilas
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sofie Schmid
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Schmitzer L, Sollmann N, Kufer J, Kallmayer M, Eckstein HH, Zimmer C, Preibisch C, Kaczmarz S, Göttler J. Decreasing Spatial Variability of Individual Watershed Areas by Revascularization Therapy in Patients With High-Grade Carotid Artery Stenosis. J Magn Reson Imaging 2021; 54:1878-1889. [PMID: 34145686 DOI: 10.1002/jmri.27788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Carotid artery stenosis can impair cerebral hemodynamics especially within watershed areas (WSAs) between vascular territories. WSAs can shift because of collateral flow, which may be an indicator for increased hemodynamic implications and hence higher risk for ischemic stroke. However, whether revascularization treatment can reverse the spatial displacement of individual WSAs (iWSAs) and impaired hemodynamics remains unknown. HYPOTHESIS That iWSAs spatially normalize because of hemodynamic improvement resulting from revascularization treatment. STUDY TYPE Prospective. POPULATION Sixteen patients with unilateral, high-grade carotid artery stenosis confirmed by duplex ultrasonography and 17 healthy controls. FIELD STRENGTH/SEQUENCES A 3 T-magnetization-prepared rapid acquisition gradient echo (MPRAGE), gradient-echo echo planar dynamic susceptibility contrast (DSC), and fluid-attenuated inversion recovery (FLAIR) sequences. Additionally, contrast-enhanced 3D gradient echo magnetic resonance angiography (MRA) and diffusion-tensor imaging (DTI) spin-echo echo planar imaging were performed. ASSESSMENT iWSAs were delineated by a recently proposed procedure based on time-to-peak maps from DSC perfusion MRI, which were also used to evaluate perfusion delay. We spatially compared iWSAs and perfusion delay before and after treatment (endarterectomy or stenting). Additionally, the Circle of Willis collateralization status was evaluated, and basic cognitive testing was conducted. STATISTICAL TESTS Statistical tests included two-sample t-tests and Chi-squared tests. A P value < 0.05 was considered to be statistically significant. RESULTS After revascularization, patients showed a significant spatial shift of iWSAs and significantly reduced perfusion delay ipsilateral to the stenosis. Spatial shift of iWSA (P = 0.007) and cognitive improvement (P = 0.013) were more pronounced in patients with poor pre-existing collateralization. Controls demonstrated stable spatial extent of iWSAs (P = 0.437) and symmetric perfusion delays between hemispheres over time (P = 0.773). DATA CONCLUSION These results demonstrate the normalization of iWSA and impaired hemodynamics after revascularization in patients with high-grade carotid artery stenosis. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Lena Schmitzer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich (TUM), Germany.,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich (TUM), Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich (TUM), Germany.,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich (TUM), Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Jan Kufer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich (TUM), Germany.,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich (TUM), Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, School of Medicine, Technical University of Munich (TUM), Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, School of Medicine, Technical University of Munich (TUM), Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich (TUM), Germany.,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich (TUM), Germany
| | - Christine Preibisch
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich (TUM), Germany.,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich (TUM), Germany.,Department of Neurology, School of Medicine, Technical University of Munich (TUM), Germany
| | - Stephan Kaczmarz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich (TUM), Germany.,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich (TUM), Germany
| | - Jens Göttler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich (TUM), Germany.,TUM-Neuroimaging Center, School of Medicine, Technical University of Munich (TUM), Germany
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23
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Knappich C, Tsantilas P, Salvermoser M, Schmid S, Kallmayer M, Trenner M, Eckstein HH, Kuehnl A. Editor's Choice - Distribution of Care and Hospital Incidence of Carotid Endarterectomy and Carotid Artery Stenting: A Secondary Analysis of German Hospital Episode Data. Eur J Vasc Endovasc Surg 2021; 62:167-176. [PMID: 33966984 DOI: 10.1016/j.ejvs.2021.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 03/10/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This is a description of the German healthcare landscape regarding carotid artery disease, assessment of hospital incidence time courses for carotid endarterectomy (CEA) and carotid artery stenting (CAS), and simulation of potential effects of minimum hospital caseload requirements for CEA and CAS. METHODS The study is a secondary data analysis of diagnosis related group statistics data (2005-2016), provided by the German Federal Statistical Office. Cases encoded by German operation procedure codes for CEA or CAS and by International Classification of Diseases (ICD-10) codes for carotid artery disease were included. Hospitals were categorised into quartiles according to annual caseloads. Linear distances to the closest hospital fulfilling hypothetical caseload requirements were calculated. RESULTS A total of 132 411 and 33 709 patients treated with CEA and CAS from 2012 to 2016 were included. CEA patients had lower rates of myocardial infarction (1.4% vs. 1.8%) and death (1.2% vs. 4.0%), and CAS patients were more often treated after emergency admission (38.1% vs. 27.1%). Age standardised annual hospital incidences were 67.2 per 100 000 inhabitants for CEA and 16.3 per 100 000 inhabitants for CAS. The incidence for CEA declined from 2005 to 2016, with CAS rising again until 2016 after having declined from 2010 to 2013. Regarding distance from home to hospital, centres offering CEA are distributed more homogeneously across Germany, compared with those performing CAS. Hypothetical introduction of minimum annual caseloads (> 20 for CEA; > 10 for CAS) imply that 75% of the population would reach their hospital after travelling 45 km for CEA and 70 km for CAS. CONCLUSION Differences in spatial distribution mean that statutory minimum annual caseloads would have a greater impact on CAS accessibility than CEA in Germany. Presumably because of a decline in carotid artery disease and a transition towards individualised therapy for asymptomatic patients, hospital incidence for CEA has been declining.
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Affiliation(s)
- Christoph Knappich
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Pavlos Tsantilas
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Salvermoser
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sofie Schmid
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Trenner
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas Kuehnl
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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Fasoula NA, Karlas A, Kallmayer M, Milik AB, Pelisek J, Eckstein HH, Klingenspor M, Ntziachristos V. Multicompartmental non-invasive sensing of postprandial lipemia in humans with multispectral optoacoustic tomography. Mol Metab 2021; 47:101184. [PMID: 33549846 PMCID: PMC7918675 DOI: 10.1016/j.molmet.2021.101184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Postprandial lipid profiling (PLP), a risk indicator of cardiometabolic disease, is based on frequent blood sampling over several hours after a meal, an approach that is invasive and inconvenient. Non-invasive PLP may offer an alternative for disseminated human monitoring. Herein, we investigate the use of clinical multispectral optoacoustic tomography (MSOT) for non-invasive, label-free PLP via direct lipid-sensing in human vasculature and soft tissues. METHODS Four (n = 4) subjects (3 females and 1 male, age: 28 ± 7 years) were enrolled in the current pilot study. We longitudinally measured the lipid signals in arteries, veins, skeletal muscles, and adipose tissues of all participants at 30-min intervals for 6 h after the oral consumption of a high-fat meal. RESULTS Optoacoustic lipid-signal analysis showed on average a 63.4% intra-arterial increase at ~ 4 h postprandially, an 83.9% intra-venous increase at ~ 3 h, a 120.8% intra-muscular increase at ~ 3 h, and a 32.8% subcutaneous fat increase at ~ 4 h. CONCLUSION MSOT provides the potential to study lipid metabolism that could lead to novel diagnostics and prevention strategies by label-free, non-invasive detection of tissue biomarkers implicated in cardiometabolic diseases.
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Affiliation(s)
- Nikolina-Alexia Fasoula
- Technical University of Munich, School of Medicine, Chair of Biological Imaging, Germany; Helmholtz Zentrum München, Neuherberg, Institute of Biological and Medical Imaging, Germany
| | - Angelos Karlas
- Technical University of Munich, School of Medicine, Chair of Biological Imaging, Germany; Helmholtz Zentrum München, Neuherberg, Institute of Biological and Medical Imaging, Germany; Clinic of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Munich, Germany
| | - Michael Kallmayer
- Clinic of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Munich, Germany
| | - Anamaria Beatrice Milik
- Technical University of Munich, School of Medicine, Chair of Biological Imaging, Germany; Helmholtz Zentrum München, Neuherberg, Institute of Biological and Medical Imaging, Germany
| | - Jaroslav Pelisek
- Clinic of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Munich, Germany; Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Hans-Henning Eckstein
- Clinic of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Munich, Germany
| | - Martin Klingenspor
- Chair of Molecular Nutritional Medicine, TUM School of Life Sciences Weihenstephan, Technical University of Munich, Freising, Germany; EKFZ-Else Kröner-Fresenius Zentrum for Nutritional Medicine, Technical University of Munich, Freising, Germany; ZIEL-Institute for Food &Health, Technical University of Munich, Freising, Germany
| | - Vasilis Ntziachristos
- Technical University of Munich, School of Medicine, Chair of Biological Imaging, Germany; Helmholtz Zentrum München, Neuherberg, Institute of Biological and Medical Imaging, Germany.
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25
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Menges AL, Reutersberg B, Busch A, Salvermoser M, Feith M, Trenner M, Kallmayer M, Zimmermann A, Eckstein HH. Early and Midterm Outcomes of Open and Endovascular Revascularization of Chronic Mesenteric Ischemia. World J Surg 2021; 44:2804-2812. [PMID: 32328781 PMCID: PMC7326829 DOI: 10.1007/s00268-020-05513-2] [Citation(s) in RCA: 6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Revascularization strategies for chronic mesenteric ischemia (CMI) include open (OR) and endovascular (ER) modalities. The primary objective of this study was to analyze the safety and effectiveness of OR and ER and the impact of clinical and morphological variables on early and midterm outcomes in a consecutive series of CMI patients in a tertiary referral center. Patients and methods From 2004 to 2017, all CMI patients treated with OR and ER were retrospectively identified. Patient records, preoperative imaging, as well as peri- and postoperative outcomes were analyzed. Univariable and multivariable analysis was performed to identify clinical or morphological variables affecting reintervention rates within 2 years. Results In total, 63 patients (33% male; mean age 71, range 60–76 years) were treated by ER (41 patients) or OR (22 patients) for CMI. Mean follow-up was 26 (10–71) months. 30-day mortality was 0.0% after ER and 4.5% after OR (p = 0.069); 30-day morbidity was 9.8% vs. 31.8%, respectively (p = 0.030). Length of stay was significantly longer after OR (14 vs. 4 days; p < 0.001). Freedom from reintervention rate after 2 years was 82% after OR and 73% after ER (p = 0.14). Overall survival did not differ after 2 years (OR 85% vs. ER 86%; p = 0.35). Multivariable analysis revealed that smoking was associated with higher risk of reintervention (hazard ratio, HR: 4.14; 95% confidence interval, CI 1.11–15.53; p = 0.03). Additionally, a nonsignificant trend of lower reintervention rates after OR was detected (HR 0.23 95% CI 0.05–1.08; p = 0.06). Conclusion Due to a lower invasiveness, despite the higher reintervention rate, an “endovascular first” strategy is justified and recommended.
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Affiliation(s)
- Anna-Leonie Menges
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Albert Busch
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Salvermoser
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marcus Feith
- Department of Surgery, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Trenner
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany.
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Karlas A, Masthoff M, Kallmayer M, Helfen A, Bariotakis M, Fasoula NA, Schäfers M, Seidensticker M, Eckstein HH, Ntziachristos V, Wildgruber M. Multispectral optoacoustic tomography of peripheral arterial disease based on muscle hemoglobin gradients-a pilot clinical study. Ann Transl Med 2021; 9:36. [PMID: 33553329 PMCID: PMC7859778 DOI: 10.21037/atm-20-3321] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Current imaging assessment of peripheral artery disease (PAD) relies on anatomical cross-sectional visualizations of the affected arteries. Multispectral optoacoustic tomography (MSOT) is a novel molecular imaging technique that provides direct and label-free visualizations of soft tissue perfusion and oxygenation. Methods MSOT was prospectively assessed in a pilot trial in healthy volunteers (group n1=4, mean age 31, 50% male and group n3=4, mean age 37.3, 75% male) and patients with intermittent claudication (group n2=4, mean age 72, 75% male, PAD stage IIb). We conducted cuff-induced ischemia (group n1) and resting state measurements (groups n2 and n3) over the calf region. Spatially resolved mapping of oxygenated (HbO2), deoxygenated (Hb) and total (THb) hemoglobin, as well as oxygen saturation (SO2), were measured via hand-held hybrid MSOT-Ultrasound based purely on hemoglobin contrast. Results Calf measurements in healthy volunteers revealed distinct dynamics for HbO2, Hb, THb and SO2 under cuff-induced ischemia. HbO2, THb and SO2 levels were significantly impaired in PAD patients compared to healthy volunteers (P<0.05 for all parameters). Revascularization led to significant improvements in HbO2 of the affected limb. Conclusions Clinical MSOT allows for non-invasive, label-free and real-time imaging of muscle oxygenation in health and disease with implications for diagnostics and therapy assessment in PAD.
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Affiliation(s)
- Angelos Karlas
- Chair of Biological Imaging, School of Medicine, Technical University of Munich, Munich, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum München (GmbH), Neuherberg, Germany.,Clinic of Vascular and Endovascular Surgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Max Masthoff
- Department for Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Michael Kallmayer
- Clinic of Vascular and Endovascular Surgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Anne Helfen
- Department for Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Michail Bariotakis
- Chair of Biological Imaging, School of Medicine, Technical University of Munich, Munich, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum München (GmbH), Neuherberg, Germany
| | - Nikolina Alexia Fasoula
- Chair of Biological Imaging, School of Medicine, Technical University of Munich, Munich, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum München (GmbH), Neuherberg, Germany
| | - Michael Schäfers
- Department for Nuclear Medicine and European Institute for Molecular Imaging, University Hospital Münster, Münster, Germany
| | - Max Seidensticker
- Department for Radiology, University Hospital, LMU Munich, München, Germany
| | - Hans-Henning Eckstein
- Clinic of Vascular and Endovascular Surgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Vasilis Ntziachristos
- Chair of Biological Imaging, School of Medicine, Technical University of Munich, Munich, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum München (GmbH), Neuherberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Moritz Wildgruber
- Department for Clinical Radiology, University Hospital Münster, Münster, Germany.,Department for Radiology, University Hospital, LMU Munich, München, Germany
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Timmerman N, Galyfos G, Sigala F, Thanopoulou K, de Borst GJ, Davidovic L, Eckstein HH, Filipovic N, Grugni R, Kallmayer M, de Kleijn DPV, Koncar I, Mantzaris MD, Marchal E, Matsagkas M, Mutavdzic P, Palombo D, Pasterkamp G, Potsika VT, Andreakos E, Fotiadis DI. The TAXINOMISIS Project: A multidisciplinary approach for the development of a new risk stratification model for patients with asymptomatic carotid artery stenosis. Eur J Clin Invest 2020; 50:e13411. [PMID: 32954520 PMCID: PMC7757200 DOI: 10.1111/eci.13411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/21/2020] [Accepted: 08/23/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Asymptomatic carotid artery stenosis (ACAS) may cause future stroke and therefore patients with ACAS require best medical treatment. Patients at high risk for stroke may opt for additional revascularization (either surgery or stenting) but the future stroke risk should outweigh the risk for peri/post-operative stroke/death. Current risk stratification for patients with ACAS is largely based on outdated randomized-controlled trials that lack the integration of improved medical therapies and risk factor control. Furthermore, recent circulating and imaging biomarkers for stroke have never been included in a risk stratification model. The TAXINOMISIS Project aims to develop a new risk stratification model for cerebrovascular complications in patients with ACAS and this will be tested through a prospective observational multicentre clinical trial performed in six major European vascular surgery centres. METHODS AND ANALYSIS The risk stratification model will compromise clinical, circulating, plaque and imaging biomarkers. The prospective multicentre observational study will include 300 patients with 50%-99% ACAS. The primary endpoint is the three-year incidence of cerebrovascular complications. Biomarkers will be retrieved from plasma samples, brain MRI, carotid MRA and duplex ultrasound. The TAXINOMISIS Project will serve as a platform for the development of new computer tools that assess plaque progression based on radiology images and a lab-on-chip with genetic variants that could predict medication response in individual patients. CONCLUSION Results from the TAXINOMISIS study could potentially improve future risk stratification in patients with ACAS to assist personalized evidence-based treatment decision-making.
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Affiliation(s)
- Nathalie Timmerman
- Department of Vascular Surgery, Division of Surgical Specialties, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - George Galyfos
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Fragiska Sigala
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliopi Thanopoulou
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Gert J de Borst
- Department of Vascular Surgery, Division of Surgical Specialties, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lazar Davidovic
- Clinic for Vascular and Endovascular Surgery, Serbian Clinical Center, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Hans-Henning Eckstein
- Clinic and Policlinik for vascular and endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Nenad Filipovic
- BioIRC, Research and Development Center for Bioengieering, Kragujevac, Serbia.,Faculty of Engineering, University of Kragujevac, Kragujevac, Serbia
| | | | - Michael Kallmayer
- Clinic and Policlinik for vascular and endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Dominique P V de Kleijn
- Department of Vascular Surgery, Division of Surgical Specialties, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Igor Koncar
- Clinic for Vascular and Endovascular Surgery, Serbian Clinical Center, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Michalis D Mantzaris
- Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
| | | | - Miltiadis Matsagkas
- Department of Vascular Surgery, Faculty of Medicine, University of Thessaly, Thessaly, Greece
| | - Perica Mutavdzic
- Clinic for Vascular and Endovascular Surgery, Serbian Clinical Center, Belgrade, Serbia
| | - Domenico Palombo
- Division of Vascular and Endovascular Surgery, IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Gerard Pasterkamp
- Division Laboratories and Pharmacy, Laboratory of Clinical Chemistry and Hematology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Vassiliki T Potsika
- Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
| | - Evangelos Andreakos
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Dimitrios I Fotiadis
- Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece.,Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas (FORTH), Ioannina, Greece
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Chlis NK, Karlas A, Fasoula NA, Kallmayer M, Eckstein HH, Theis FJ, Ntziachristos V, Marr C. A sparse deep learning approach for automatic segmentation of human vasculature in multispectral optoacoustic tomography. Photoacoustics 2020; 20:100203. [PMID: 33194545 PMCID: PMC7644749 DOI: 10.1016/j.pacs.2020.100203] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/20/2020] [Accepted: 07/26/2020] [Indexed: 05/02/2023]
Abstract
Multispectral Optoacoustic Tomography (MSOT) resolves oxy- (HbO2) and deoxy-hemoglobin (Hb) to perform vascular imaging. MSOT suffers from gradual signal attenuation with depth due to light-tissue interactions: an effect that hinders the precise manual segmentation of vessels. Furthermore, vascular assessment requires functional tests, which last several minutes and result in recording thousands of images. Here, we introduce a deep learning approach with a sparse-UNET (S-UNET) for automatic vascular segmentation in MSOT images to avoid the rigorous and time-consuming manual segmentation. We evaluated the S-UNET on a test-set of 33 images, achieving a median DICE score of 0.88. Apart from high segmentation performance, our method based its decision on two wavelengths with physical meaning for the task-at-hand: 850 nm (peak absorption of oxy-hemoglobin) and 810 nm (isosbestic point of oxy-and deoxy-hemoglobin). Thus, our approach achieves precise data-driven vascular segmentation for automated vascular assessment and may boost MSOT further towards its clinical translation.
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Affiliation(s)
- Nikolaos-Kosmas Chlis
- Institute of Computational Biology, Helmholtz Center Munich, Neuherberg, Germany
- Institute of Biological and Medical Imaging, Helmholtz Center Munich, Neuherberg, Germany
- Roche Pharma Research and Early Development, Large Molecule Research, Roche Innovation Center Munich, Penzberg 82377, Germany
| | - Angelos Karlas
- Institute of Biological and Medical Imaging, Helmholtz Center Munich, Neuherberg, Germany
- Chair of Biological Imaging and Center for Translational Cancer Research (TranslaTUM), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Clinic for Vascular and Endovascular Surgery, Rechts Der Isar Hospital, Munich, Germany
| | - Nikolina-Alexia Fasoula
- Institute of Biological and Medical Imaging, Helmholtz Center Munich, Neuherberg, Germany
- Chair of Biological Imaging and Center for Translational Cancer Research (TranslaTUM), Munich, Germany
| | - Michael Kallmayer
- Clinic for Vascular and Endovascular Surgery, Rechts Der Isar Hospital, Munich, Germany
| | - Hans-Henning Eckstein
- Clinic for Vascular and Endovascular Surgery, Rechts Der Isar Hospital, Munich, Germany
| | - Fabian J. Theis
- Institute of Computational Biology, Helmholtz Center Munich, Neuherberg, Germany
- Department of Mathematics, Technical University of Munich, Munich, Germany
| | - Vasilis Ntziachristos
- Institute of Biological and Medical Imaging, Helmholtz Center Munich, Neuherberg, Germany
- Chair of Biological Imaging and Center for Translational Cancer Research (TranslaTUM), Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Carsten Marr
- Institute of Computational Biology, Helmholtz Center Munich, Neuherberg, Germany
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Menges AL, Trenner M, Radu O, Beddoe D, Kallmayer M, Zimmermann A, Eckstein HH. Lack of durability after transarterial ethylene-vinyl alcohol copolymer-embolization of type II endoleak following endovascular abdominal aortic aneurysm repair. VASA 2020; 49:483-491. [PMID: 33103625 DOI: 10.1024/0301-1526/a000905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/19/2022]
Abstract
Background: Type II endoleak (T2EL) after endovascular aortic repair is associated with AAA sac enlargements in up to 25%, reduction of attachment zones and rarely with aortic rupture. Indications for therapy and efficacy of interventions of T2EL are not clearly established. Transarterial embolization with application of ethylene-vinyl alcohol copolymer has been described with varying outcomes. Aim of this study is to evaluate durability of OnyxTM embolization (OE) in T2EL in a consecutive series at a single tertiary vascular center. Patients and methods: Demographic data, technical success, pre- and postoperative aneurysm growth, morbidity, mortality and reintervention rates during hospital stay as well as in follow up were recorded in patients treated with OE for T2EL between 01/2015 and 12/2017. The primary endpoint was defined as persistence or reoccurrence of T2EL (durability of OE). Results: In total 15 patients (78 ± 6 years, 13 men) were treated with OE because of sac enlargement (average growth of 12 ± 8%, n = 12), persistent bleeding after AAA rupture (n = 2) or persistent T2EL with stable but large aneurysm diameter (n = 1). Mean length of stay was 8 ± 11 days. Technical success was 93.3% (n = 14). Inhospital-morbidity was 26.7%, in-hospital- and 1-year-mortality rate were 6.6% (n = 1) and 20.0% (n = 3). T2EL persisted in 20.0% (n = 3) despite of OE. Re-EL-II occurred after 40 (30-114) days in 33.3% (n = 5). Reintervention rate was 13.3% (n = 2, at day 48 and 319). Altogether clinical success with stable aneurysm diameter was achieved in 80.0% (n = 12), but durable elimination of EL was only achieved in 46.7% of patients (n = 7). Conclusions: OE is technically possible in more than 90% of patients but might be associated with severe complications. Durability of this treatment is low, since T2EL persist or reoccur in more than 50% of all patients. OE of T2EL should be reserved for few selected cases.
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Affiliation(s)
- Anna-Leonie Menges
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Trenner
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Oksana Radu
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daisy Beddoe
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander Zimmermann
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
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30
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Karlas A, Kallmayer M, Fasoula NA, Liapis E, Bariotakis M, Krönke M, Anastasopoulou M, Reber J, Eckstein HH, Ntziachristos V. Multispectral optoacoustic tomography of muscle perfusion and oxygenation under arterial and venous occlusion: A human pilot study. J Biophotonics 2020; 13:e201960169. [PMID: 32134550 DOI: 10.1002/jbio.201960169] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/26/2020] [Accepted: 02/11/2020] [Indexed: 05/21/2023]
Abstract
Perfusion and oxygenation are critical parameters of muscle metabolism in health and disease. They have been both the target of many studies, in particular using near-infrared spectroscopy (NIRS). However, difficulties with quantifying NIRS signals have limited a wide dissemination of the method to the clinics. Our aim was to investigate whether clinical multispectral optoacoustic tomography (MSOT) could enable the label-free imaging of muscle perfusion and oxygenation under clinically relevant challenges: the arterial and venous occlusion. We employed a hybrid clinical MSOT/ultrasound system equipped with a hand-held scanning probe to visualize hemodynamic and oxygenation changes in skeletal muscle under arterial and venous occlusions. Four (N = 4) healthy volunteers were scanned over the forearm for both 3-minute occlusion challenges. MSOT-recorded pathophysiologically expected results during tests of disturbed blood flow with high resolution and without the need for contrast agents. During arterial occlusion, MSOT-extracted Hb-values showed an increase, while HbO2 - and total blood volume (TBV)-values remained roughly steady, followed by a discrete increase during the hyperemic period after cuff deflation. During venous occlusion, results showed a clear increase in intramuscular HbO2 , Hb and TBV within the segmented muscle area. MSOT was found to be capable of label-free non-invasive imaging of muscle hemodynamics and oxygenation under arterial and venous occlusion. We introduce herein MSOT as a novel modality for the assessment of vascular disorders characterized by disturbed blood flow, such as acute limb ischemia and venous thrombosis.
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Affiliation(s)
- Angelos Karlas
- Chair for Biological Imaging, Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Helmholtz Zentrum München, Institute of Biological and Medical Imaging, Neuherberg, Germany
- Clinic of Vascular and Endovascular Surgery, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Kallmayer
- Clinic of Vascular and Endovascular Surgery, Technical University of Munich, Munich, Germany
| | - Nikolina-Alexia Fasoula
- Chair for Biological Imaging, Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Helmholtz Zentrum München, Institute of Biological and Medical Imaging, Neuherberg, Germany
| | - Evangelos Liapis
- Chair for Biological Imaging, Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Helmholtz Zentrum München, Institute of Biological and Medical Imaging, Neuherberg, Germany
| | - Michail Bariotakis
- Chair for Biological Imaging, Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Helmholtz Zentrum München, Institute of Biological and Medical Imaging, Neuherberg, Germany
| | - Markus Krönke
- Clinic of Nuclear Medicine, Technical University of Munich, Klinikum Rechts der Isar, Germany
| | - Maria Anastasopoulou
- Chair for Biological Imaging, Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Helmholtz Zentrum München, Institute of Biological and Medical Imaging, Neuherberg, Germany
| | - Josefine Reber
- Chair for Biological Imaging, Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Helmholtz Zentrum München, Institute of Biological and Medical Imaging, Neuherberg, Germany
| | - Hans-Henning Eckstein
- Clinic of Vascular and Endovascular Surgery, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Vasilis Ntziachristos
- Chair for Biological Imaging, Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
- Helmholtz Zentrum München, Institute of Biological and Medical Imaging, Neuherberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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31
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Knappich C, Schmid S, Tsantilas P, Kallmayer M, Salvermoser M, Zimmermann A, Eckstein HH. Prospective Comparison of Duplex Ultrasound and Angiography for Intra-operative Completion Studies after Carotid Endarterectomy. Eur J Vasc Endovasc Surg 2020; 59:881-889. [PMID: 32197998 DOI: 10.1016/j.ejvs.2020.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 02/02/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The application of intra-operative completion studies may have contributed to the ongoing improvement of peri-operative outcomes in carotid surgery. METHODS This prospective study aimed to compare angiography and duplex ultrasound (IDUS) as intra-operative completion studies after carotid endarterectomy (CEA) with respect to differences in the rating of vessel wall defects and interobserver reliability. Patients undergoing CEA for symptomatic or asymptomatic carotid stenosis were included. After CEA, angiography and IDUS were performed. Intra-operatively obtained video footage was evaluated at a later date by three independent and blinded raters with different levels of clinical experience. Rating was done according to a four step rating scale, with higher grades representing more severe defects. Standard statistical methods (Pearson's chi square test; permutation test; Wilcoxon signed rank test; Kendall's coefficient of concordance, Wt) were applied. RESULTS In total, 150 patients (mean ± standard deviation age 72 ± 7 years, 68.7% male, 33.3% symptomatic) were enrolled between March 2016 and September 2017. Significantly more defects requiring intra-operative revision (grades 3 and 4 on rating scale) were detected by IDUS, which, in part, remained undetected by angiography: 22 (14.7%) vs. 10 (6.7%) (p = .040). Defects were also judged to be more severe with IDUS than with angiography: median rating grade 1: 74 (49.3%) vs. 102 (68.0%); grade 2: 54 (36.0%) vs. 38 (25.3%); grade 3: 21 (14.0%) vs. 9 (6.0%); grade 4: 1 (0.7%) vs.1 (0.7%) (p < .001). Furthermore, Wt was significantly higher for IDUS compared with angiography (0.70 vs. 0.57; p = .003). CONCLUSION IDUS revealed more defects after CEA than angiography. Despite both techniques only showing moderate interobserver reliability, IDUS is less dependent on the surgeon's subjectivity than angiography. Taking into account the absence of procedure associated risks (i.e., adverse effects of iodinated contrast media and Xray), IDUS could be considered as an alternative intra-operative morphological assessment tool in carotid surgery.
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Affiliation(s)
- Christoph Knappich
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sofie Schmid
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Pavlos Tsantilas
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Salvermoser
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander Zimmermann
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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32
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Göttler J, Kaczmarz S, Nuttall R, Griese V, Napiórkowski N, Kallmayer M, Wustrow I, Eckstein HH, Zimmer C, Preibisch C, Finke K, Sorg C. The stronger one-sided relative hypoperfusion, the more pronounced ipsilateral spatial attentional bias in patients with asymptomatic carotid stenosis. J Cereb Blood Flow Metab 2020; 40:314-327. [PMID: 30480463 PMCID: PMC7370612 DOI: 10.1177/0271678x18815790] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/05/2018] [Accepted: 10/23/2018] [Indexed: 11/16/2022]
Abstract
Patients with asymptomatic, high-grade internal carotid artery stenosis often suffer from subtle cognitive impairments with unclear underlying neuro-cognitive mechanisms. Thus, we hypothesized that stenosis-related unilateral cerebral hypoperfusion leads to an ipsilateral attentional bias; 22 patients with asymptomatic, one-sided high-grade carotid stenosis and 24 age-matched healthy controls underwent pseudo-continuous arterial spin labeling to assess brain perfusion in the territory of the carotid arteries. Furthermore, a parametric assessment of attention functions was carried out on the basis of the computational Theory of Visual Attention. Both patients' perfusion and spatial attention were significantly more lateralized than those of healthy controls. Critically, both asymmetry indices were significantly correlated in patients, i.e. the stronger one-sided relative hypoperfusion, the stronger ipsilateral bias of attention. This association was specifically pronounced in parietal cortices and independent of white matter hyperintensities as a surrogate for cerebrovascular brain damage. Results provide evidence for a link between lateralized hypoperfusion and lateralized attentional weighting in asymptomatic, high-grade carotid stenosis. Data suggest that lateralized hypoperfusion with simultaneous spatial attentional bias might serve as a potential therapeutic target in one-sided carotid stenosis.
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Affiliation(s)
- Jens Göttler
- Department of Diagnostic and
Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität
München, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC),
Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Department of Diagnostic and
Interventional Radiology, Klinikum rechts der Isar, Technische Universität München,
Munich, Germany
- Magnetic Resonance Research Center, Yale
University, New Haven, CT, USA
| | - Stephan Kaczmarz
- Department of Diagnostic and
Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität
München, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC),
Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Magnetic Resonance Research Center, Yale
University, New Haven, CT, USA
| | - Rachel Nuttall
- Department of Diagnostic and
Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität
München, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC),
Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Vanessa Griese
- Department of Diagnostic and
Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität
München, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC),
Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Natan Napiórkowski
- Department of Psychology,
Ludwig-Maximilians-Universität München, Munich, Germany
- Graduate School of Systemic
Neurosciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michael Kallmayer
- Department of Vascular and Endovascular
Surgery, Klinikum rechts der Isar, Technische Universität München, Munich,
Germany
| | - Isabel Wustrow
- I. Medizinische Klinik und Poliklinik,
Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Hans-Henning Eckstein
- Department of Vascular and Endovascular
Surgery, Klinikum rechts der Isar, Technische Universität München, Munich,
Germany
| | - Claus Zimmer
- Department of Diagnostic and
Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität
München, Munich, Germany
| | - Christine Preibisch
- Department of Diagnostic and
Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität
München, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC),
Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Clinic for Neurology, Klinikum rechts
der Isar, Technische Universität München, Munich, Germany
| | - Kathrin Finke
- Department of Psychology,
Ludwig-Maximilians-Universität München, Munich, Germany
- Hans-Berger-Department of Neurology,
Jena University Hospital, Jena, Germany
| | - Christian Sorg
- Department of Diagnostic and
Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität
München, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC),
Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Department of Psychiatry, Klinikum
rechts der Isar, Technische Universität München, Munich, Germany
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Storck M, Noppeney T, Kallmayer M, Eckstein HH. German Carotid National Registry – Value and Limitations. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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34
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Göttler J, Kaczmarz S, Kallmayer M, Wustrow I, Eckstein HH, Zimmer C, Sorg C, Preibisch C, Hyder F. Flow-metabolism uncoupling in patients with asymptomatic unilateral carotid artery stenosis assessed by multi-modal magnetic resonance imaging. J Cereb Blood Flow Metab 2019; 39:2132-2143. [PMID: 29968499 PMCID: PMC6827123 DOI: 10.1177/0271678x18783369] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Oxygen extraction (OEF), oxidative metabolism (CMRO2), and blood flow (CBF) in the brain, as well as the coupling between CMRO2 and CBF due to cerebral autoregulation are fundamental to brain's health. We used a clinically feasible MRI protocol to assess impairments of these parameters in the perfusion territories of stenosed carotid arteries. Twenty-nine patients with unilateral high-grade carotid stenosis and thirty age-matched healthy controls underwent multi-modal MRI scans. Pseudo-continuous arterial spin labeling (pCASL) yielded absolute CBF, whereas multi-parametric quantitative blood oxygenation level dependent (mqBOLD) modeling allowed imaging of relative OEF and CMRO2. Both CBF and CMRO2 were significantly reduced in the stenosed territory compared to the contralateral side, while OEF was evenly distributed across both hemispheres similarly in patients and controls. The CMRO2-CBF coupling was significantly different between both hemispheres in patients, i.e. significant interhemispheric flow-metabolism uncoupling was observed in patients compared to controls. Given that CBF and CMRO2 are intimately linked to brain function in health and disease, the proposed easily applicable MRI protocol of pCASL and mqBOLD imaging might serve as a valuable tool for early diagnosis of potentially harmful cerebral hemodynamic and metabolic states with the final aim to select clinically asymptomatic patients who would benefit from carotid revascularization therapy.
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Affiliation(s)
- Jens Göttler
- Department of Radiology & Biomedical Imaging, Magnetic Resonance Research Center, Yale University, New Haven, CT, USA.,Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technische Universität München, Klinikum rechts der Isar, Munich, Germany.,Department of Diagnostic and Interventional Radiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Stephan Kaczmarz
- Department of Radiology & Biomedical Imaging, Magnetic Resonance Research Center, Yale University, New Haven, CT, USA.,Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Michael Kallmayer
- Department of Vascular and Endovascular Surgery, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Isabel Wustrow
- I. Medizinische Klinik und Poliklinik, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Hans-Henning Eckstein
- Department of Vascular and Endovascular Surgery, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Christian Sorg
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technische Universität München, Klinikum rechts der Isar, Munich, Germany.,Department of Psychiatry, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Christine Preibisch
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technische Universität München, Klinikum rechts der Isar, Munich, Germany.,Clinic for Neurology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Fahmeed Hyder
- Department of Radiology & Biomedical Imaging, Magnetic Resonance Research Center, Yale University, New Haven, CT, USA.,Department of Biomedical Engineering, Yale University, New Haven, CT, USA
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35
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Tsantilas P, Knappich C, Schmid S, Kallmayer M, Breitkreuz T, Zimmermann A, Eckstein HH, Kuehnl A. Last neurologic event is associated with risk of in-hospital stroke or death after carotid endarterectomy or carotid artery stenting: Secondary data analysis of the German statutory quality assurance database. J Vasc Surg 2019; 70:1488-1498. [DOI: 10.1016/j.jvs.2019.02.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/16/2019] [Indexed: 10/26/2022]
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36
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Pauli J, Tsantilas P, Kallmayer M, Maegdefessel L, Eckstein H, Pelisek J. Time-Dependent Biopathological Alternations In Carotid Atherosclerotic Plaques From Symptomatic Patients. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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37
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Karlas A, Fasoula NA, Paul-Yuan K, Reber J, Kallmayer M, Bozhko D, Seeger M, Eckstein HH, Wildgruber M, Ntziachristos V. Cardiovascular optoacoustics: From mice to men - A review. Photoacoustics 2019; 14:19-30. [PMID: 31024796 PMCID: PMC6476795 DOI: 10.1016/j.pacs.2019.03.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 05/04/2023]
Abstract
Imaging has become an indispensable tool in the research and clinical management of cardiovascular disease (CVD). An array of imaging technologies is considered for CVD diagnostics and therapeutic assessment, ranging from ultrasonography, X-ray computed tomography and magnetic resonance imaging to nuclear and optical imaging methods. Each method has different operational characteristics and assesses different aspects of CVD pathophysiology; nevertheless, more information is desirable for achieving a comprehensive view of the disease. Optoacoustic (photoacoustic) imaging is an emerging modality promising to offer novel information on CVD parameters by allowing high-resolution imaging of optical contrast several centimeters deep inside tissue. Implemented with illumination at several wavelengths, multi-spectral optoacoustic tomography (MSOT) in particular, is sensitive to oxygenated and deoxygenated hemoglobin, water and lipids allowing imaging of the vasculature, tissue oxygen saturation and metabolic or inflammatory parameters. Progress with fast-tuning lasers, parallel detection and advanced image reconstruction and data-processing algorithms have recently transformed optoacoustics from a laboratory tool to a promising modality for small animal and clinical imaging. We review progress with optoacoustic CVD imaging, highlight the research and diagnostic potential and current applications and discuss the advantages, limitations and possibilities for integration into clinical routine.
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Affiliation(s)
- Angelos Karlas
- Chair of Biological Imaging, TranslaTUM, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Clinic for Vascular and Endovascular Surgery, University Hospital rechts der Isar, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Nikolina-Alexia Fasoula
- Chair of Biological Imaging, TranslaTUM, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Korbinian Paul-Yuan
- Chair of Biological Imaging, TranslaTUM, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Josefine Reber
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Michael Kallmayer
- Clinic for Vascular and Endovascular Surgery, University Hospital rechts der Isar, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Dmitry Bozhko
- Chair of Biological Imaging, TranslaTUM, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Markus Seeger
- Chair of Biological Imaging, TranslaTUM, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Hans-Henning Eckstein
- Clinic for Vascular and Endovascular Surgery, University Hospital rechts der Isar, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Moritz Wildgruber
- Institute for Diagnostic and Interventional Radiology, University Hospital rechts der Isar, Munich, Germany
- Institute for Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Vasilis Ntziachristos
- Chair of Biological Imaging, TranslaTUM, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
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Pelisek J, Hegenloh R, Bauer S, Metschl S, Pauli J, Glukha N, Busch A, Reutersberg B, Kallmayer M, Trenner M, Wendorff H, Tsantilas P, Schmid S, Knappich C, Schaeffer C, Stadlbauer T, Biro G, Wertern U, Meisner F, Stoklasa K, Menges AL, Radu O, Dallmann-Sieber S, Karlas A, Knipfer E, Reeps C, Zimmermann A, Maegdefessel L, Eckstein HH. Biobanking: Objectives, Requirements, and Future Challenges-Experiences from the Munich Vascular Biobank. J Clin Med 2019; 8:jcm8020251. [PMID: 30781475 PMCID: PMC6406278 DOI: 10.3390/jcm8020251] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 01/09/2019] [Revised: 02/01/2019] [Accepted: 02/12/2019] [Indexed: 12/13/2022] Open
Abstract
Collecting biological tissue samples in a biobank grants a unique opportunity to validate diagnostic and therapeutic strategies for translational and clinical research. In the present work, we provide our long-standing experience in establishing and maintaining a biobank of vascular tissue samples, including the evaluation of tissue quality, especially in formalin-fixed paraffin-embedded specimens (FFPE). Our Munich Vascular Biobank includes, thus far, vascular biomaterial from patients with high-grade carotid artery stenosis (n = 1567), peripheral arterial disease (n = 703), and abdominal aortic aneurysm (n = 481) from our Department of Vascular and Endovascular Surgery (January 2004–December 2018). Vascular tissue samples are continuously processed and characterized to assess tissue morphology, histological quality, cellular composition, inflammation, calcification, neovascularization, and the content of elastin and collagen fibers. Atherosclerotic plaques are further classified in accordance with the American Heart Association (AHA), and plaque stability is determined. In order to assess the quality of RNA from FFPE tissue samples over time (2009–2018), RNA integrity number (RIN) and the extent of RNA fragmentation were evaluated. Expression analysis was performed with two housekeeping genes—glyceraldehyde 3-phosphate dehydrogenase (GAPDH) and beta-actin (ACTB)—using TaqMan-based quantitative reverse-transcription polymerase chain reaction (qRT)-PCR. FFPE biospecimens demonstrated unaltered RNA stability over time for up to 10 years. Furthermore, we provide a protocol for processing tissue samples in our Munich Vascular Biobank. In this work, we demonstrate that biobanking is an important tool not only for scientific research but also for clinical usage and personalized medicine.
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Affiliation(s)
- Jaroslav Pelisek
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, 80636 Munich, Germany.
| | - Renate Hegenloh
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Sabine Bauer
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Susanne Metschl
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Jessica Pauli
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Nadiya Glukha
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Albert Busch
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Benedikt Reutersberg
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Michael Kallmayer
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Matthias Trenner
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Heiko Wendorff
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Pavlos Tsantilas
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Sofie Schmid
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Christoph Knappich
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Christoph Schaeffer
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Thomas Stadlbauer
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Gabor Biro
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Uta Wertern
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Franz Meisner
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Kerstin Stoklasa
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Anna-Leonie Menges
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Oksana Radu
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Sabine Dallmann-Sieber
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Angelos Karlas
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Eva Knipfer
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Christian Reeps
- University Centre for Vascular Medicine and Department of Vascular Surgery, University Hospital Carl Gustav Carus, Dresden University of Technology, 01307 Dresden, Germany.
| | - Alexander Zimmermann
- Department of Vascular and Endovascular Surgery, Technische Universität München, 81675 Munich, Germany.
| | - Lars Maegdefessel
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, 80636 Munich, Germany.
| | - Hans-Henning Eckstein
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, 80636 Munich, Germany.
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Zimmermann A, Knappich C, Tsantilas P, Kallmayer M, Schmid S, Breitkreuz T, Storck M, Kuehnl A, Eckstein HH. Different perioperative antiplatelet therapies for patients treated with carotid endarterectomy in routine practice. J Vasc Surg 2018; 68:1753-1763. [DOI: 10.1016/j.jvs.2018.01.063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/27/2018] [Indexed: 11/17/2022]
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Eckstein HH, Tsantilas P, Kühnl A, Haller B, Breitkreuz T, Zimmermann A, Kallmayer M. Surgical and Endovascular Treatment of Extracranial Carotid Stenosis. Dtsch Arztebl Int 2018; 114:729-736. [PMID: 29143732 DOI: 10.3238/arztebl.2017.0729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 03/16/2017] [Accepted: 07/19/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) and carotid artery stenting (CAS) can be used to prevent stroke due to arteriosclerotic lesions of the carotid artery. In Germany, legally mandated quality assurance (QA) enables the evaluation of outcome quality after CEA and CAS performed under routine conditions. METHODS We analyzed data on all elective CEA and CAS procedures performed over the periods 2009-2014 and 2012-2014, respectively. The endpoints of the study were the combined in-hospital stroke and death rate, stroke rate and mortality separately, local complications, and other complications. We analyzed the raw data with descriptive statistics and carried out a risk-adjusted analysis of the association of clinically unalterable variables with the risk of stroke and death. All analyses were performed separately for CEA and CAS. RESULTS Data were analyzed from 142 074 CEA procedures (67.8% of them in men) and 13 086 CAS procedures (69.7% in men). The median age was 72 years (CEA) and 71 years (CAS). The periprocedural rate of stroke and death after CEA was 1.4% for asymptomatic and 2.5% for symptomatic stenoses; the corresponding rates for CAS were 1.7% and 3.7%. Variables associated with increased risk included older age, higher ASA class (ASA = American Society of Anesthesiologists), symptomatic vs. asymptomatic stenosis, 50-69% stenosis, and contralateral carotid occlusion (for CEA only). CONCLUSION These data reveal a low periprocedural rate of stroke or death for both CEA and CAS. This study does however not permit any conclusions as to the superiority or inferiority of CEA and CAS.
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Affiliation(s)
- Hans-Henning Eckstein
- Department of Vascular and Endovascular Surgery/Vascular Center, Klinikum rechts der Isar der Technischen Universität München; Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München; AQUA-Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen
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Knappich C, Kuehnl A, Tsantilas P, Schmid S, Breitkreuz T, Kallmayer M, Zimmermann A, Eckstein HH. Patient characteristics and in-hospital outcomes of emergency carotid endarterectomy and carotid stenting after stroke in evolution. J Vasc Surg 2018; 68:436-444.e6. [DOI: 10.1016/j.jvs.2017.10.085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022]
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Storck M, Kallmayer M, Noppeney T, Berkefeld J, Schmitz-Rixen T, Eckstein HH. IF02. In-Hospital Outcome of Carotid Endarterectomy and Carotid Artery Stenting in the German National Carotid Registry (2014-2016). J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Tsantilas P, Knappich C, Schmid S, Kallmayer M, Breitkreuz T, Zimmermann A, Kuehnl A, Eckstein HH. Abstract 347: Significant Association Between the Qualifying Neurologic Event and the In-hospital Risk of Stroke or Death Following Carotid Endarterectomy and Carotid Artery Stenting. Arterioscler Thromb Vasc Biol 2018. [DOI: 10.1161/atvb.38.suppl_1.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:
The purpose of this observational study was to analyze the association between the initial neurological status and the risk of any in-hospital stroke or death in patients treated with carotid endarterectomy (CEA) or carotid artery stenting (CAS) under routine conditions in Germany.
Methods:
Secondary data analysis based on the German statutory quality assurance database for carotid procedures between 2009-2014. The primary outcome was any periprocedural stroke or all-cause death until discharge. To analyze the association between initial neurological status and outcome, a multilevel multivariable regression analyses adjusting for confounders was performed.
Results:
From a total of 182,033 patients documented between 2009 and 2014, 144,347 patients treated with CEA and 14,794 patients treated with CAS were included in the analysis. In total, there 68% were men and the mean age of the cohort was 70.5±9.1 years. The risk of any in-hospital stroke or death in patients treated with CEA was 2.0% (n=2923/144,347). The raw risk of any in-hospital stroke or death was 1.4% in asymptomatic patients and 3.0% in symptomatic patients treated with CEA. Within the group of symptomatic patients, risk of any in-hospital stroke or death after CEA increased from 1.2% (amaurosis fugax, AFX), 2.3% (TIA), 2.8% (minor stroke), 4.4% (major stroke), 4.8% (crescendo TIA, cTIA) to 9.0% (stroke in evolution, SIE). The risk of any in-hospital stroke or death in patients treated with CAS was 3.6% (n=538/14,794). The raw risk of any in-hospital stroke or death was 1.7% in asymptomatic patients and 6.1% in symptomatic patients treated with CAS. Within the group of symptomatic patients, risk of any in-hospital stroke or death increased from 1.0% (AFX), 4.1% (TIA), 4.1% (minor stroke), 5.4% (major stroke), 5.2% (cTIA) to 11.7% (SIE). Regression analysis revealed that the severity of initial neurologic symptoms was associated with an increased risk of any in-hospital stroke or death in both patients treated for CEA and CAS.
Conclusion:
Periprocedural risk for any stroke or death did not significantly differ between asymptomatic patients and patients with AFX but between asymptomatic patients and patients with TIA, stroke, cTIA or SIE.
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Affiliation(s)
- Pavlos Tsantilas
- Div of Vascular Surgery, Stanford Univ Sch of Medicine, Stanford, CA
| | - Christoph Knappich
- Dept of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical Univ of Munich, Munich, Germany
| | - Sofie Schmid
- Dept of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical Univ of Munich, Munich, Germany
| | - Michael Kallmayer
- Dept of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical Univ of Munich, Munich, Germany
| | - Thorben Breitkreuz
- aQua – Institute for Applied Quality Improvement and Rsch in Health GmbH, Göttingen, Germany
| | - Alexander Zimmermann
- Dept of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical Univ of Munich, Munich, Germany
| | - Andreas Kuehnl
- Dept of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical Univ of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Dept of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical Univ of Munich, Munich, Germany
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Tsantilas P, Kuehnl A, Kallmayer M, Knappich C, Schmid S, Breitkreuz T, Zimmermann A, Eckstein HH. Risk of Stroke or Death Is Associated With the Timing of Carotid Artery Stenting for Symptomatic Carotid Stenosis: A Secondary Data Analysis of the German Statutory Quality Assurance Database. J Am Heart Assoc 2018; 7:e007983. [PMID: 29588311 PMCID: PMC5907586 DOI: 10.1161/jaha.117.007983] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/06/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Subgroup analyses from randomized trials indicate that the time interval between the neurologic index event and carotid artery stenting is associated with periprocedural stroke and death rates in patients with symptomatic carotid stenosis. The aim of this article is to analyze whether this observation holds true under routine conditions in Germany. METHODS AND RESULTS Secondary data analysis was done on 4717 elective carotid artery stenting procedures that were performed for symptomatic carotid stenosis. The patient cohort was divided into 4 groups according to the time interval between the index event and intervention (group I 0-2, II 3-7, III 8-14, and IV 15-180 days). Primary outcome was any in-hospital stroke or death. For risk-adjusted analyses, a multilevel multivariable regression model was used. The in-hospital stroke or death rate was 3.7% in total and 6.0%, 4.4%, 2.4%, and 3.0% in groups I, II, III, and IV, respectively. Adjusted analysis showed a decreased risk for any stroke or death in group III, a decreased risk for any major stroke or death in groups III and IV, and a decreased risk for any death in groups II and III compared to the reference group I. CONCLUSIONS A short time interval between the neurologic index event and carotid artery stenting of up to 7 days is associated with an increased risk for stroke or death under routine conditions in Germany. Although results cannot prove causal relationships, carotid artery stenting may be accompanied by an increased risk of stroke or death during the early period after the index event.
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Affiliation(s)
- Pavlos Tsantilas
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Andreas Kuehnl
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Michael Kallmayer
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Christoph Knappich
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Sofie Schmid
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Thorben Breitkreuz
- aQua-Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany
| | - Alexander Zimmermann
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Hans-Henning Eckstein
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
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Merckelbach S, van der Vorst E, Kallmayer M, Rischpler C, Burgkart R, Döring Y, de Borst GJ, Schwaiger M, Eckstein HH, Weber C, Pelisek J. Expression and Cellular Localization of CXCR4 and CXCL12 in Human Carotid Atherosclerotic Plaques. Thromb Haemost 2018; 118:195-206. [DOI: 10.1160/th17-04-0271] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background and Aims The CXCR4/CXCL12 complex has already been associated with progression of atherosclerosis; however, its exact role is yet unknown. The aim of this study was to analyse the expression and cellular localization of CXCL12 and its receptor CXCR4 in human carotid atherosclerotic plaques.
Methods Carotid plaques (n = 58; 31 stable, 27 unstable, based on histological characterization of plaque morphology) were obtained during carotid endarterectomy, and 10 healthy vessels were used as a control. Expression of cxcr4, cxcr7, cxcl12, ccl2/ccr2 and csf1/csf1r was analysed at mRNA, and level expression of CXCR4, CXCR7 and CXCL12 was analysed at protein level. Cellular localization was determined using consecutive and double immunohistochemical (IHC) staining and microdissection.
Results At mRNA level, cxcr4, cxcr7 and cxcl12 were significantly higher expressed in stable carotid plaques compared with controls (p = 0.011, p < 0.001 and p < 0.001). Cxcl12 mRNA expression was successively augmented toward unstable plaques (p < 0.001). At protein level, CXCR4, CXCR7 and CXCL12 expression was significantly increased in both stable (p = 0.001, p < 0.001 and p = 0.035, respectively) and unstable (p = 0.003, p < 0.001 and p = 0.045, respectively) plaques compared with controls. Using IHC, CXCR4 was particularly localized in macrophages and small neovessels. Microdissection confirmed strongest expression of cxcr4 in macrophages within atherosclerotic plaques. Leukocytes and smooth muscle cells showed cxcr4 expression as well. For cxcl12, only microdissected areas with macrophages were positive.
Conclusion Expression of CXCR4 and CXCL12 was significantly increased in both stable and unstable carotid atherosclerotic plaques compared with healthy vessels, both at mRNA and protein level. CXCR4 and CXCL12 were localized particularly in macrophages.
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Kaczmarz S, Griese V, Preibisch C, Kallmayer M, Helle M, Wustrow I, Petersen ET, Eckstein HH, Zimmer C, Sorg C, Göttler J. Increased variability of watershed areas in patients with high-grade carotid stenosis. Neuroradiology 2018; 60:311-323. [PMID: 29299616 DOI: 10.1007/s00234-017-1970-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/19/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Watershed areas (WSAs) of the brain are most susceptible to acute hypoperfusion due to their peripheral location between vascular territories. Additionally, chronic WSA-related vascular processes underlie cognitive decline especially in patients with cerebral hemodynamic compromise. Despite of high relevance for both clinical diagnostics and research, individual in vivo WSA definition is fairly limited to date. Thus, this study proposes a standardized segmentation approach to delineate individual WSAs by use of time-to-peak (TTP) maps and investigates spatial variability of individual WSAs. METHODS We defined individual watershed masks based on relative TTP increases in 30 healthy elderly persons and 28 patients with unilateral, high-grade carotid stenosis, being at risk for watershed-related hemodynamic impairment. Determined WSA location was confirmed by an arterial transit time atlas and individual super-selective arterial spin labeling. We compared spatial variability of WSA probability maps between groups and assessed TTP differences between hemispheres in individual and group-average watershed locations. RESULTS Patients showed significantly higher spatial variability of WSAs than healthy controls. Perfusion on the side of the stenosis was delayed within individual watershed masks as compared to a watershed template derived from controls, being independent from the grade of the stenosis and collateralization status of the circle of Willis. CONCLUSION Results demonstrate feasibility of individual WSA delineation by TTP maps in healthy elderly and carotid stenosis patients. Data indicate necessity of individual segmentation approaches especially in patients with hemodynamic compromise to detect critical regions of impaired hemodynamics.
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Affiliation(s)
- Stephan Kaczmarz
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Vanessa Griese
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christine Preibisch
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- Clinic for Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Michael Kallmayer
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Michael Helle
- Research Laboratories, Philips GmbH Innovative Technologies, Hamburg, Germany
| | - Isabel Wustrow
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Esben Thade Petersen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
- Center for Magnetic Resonance, Department of Electrical Engineering, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Hans-Henning Eckstein
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christian Sorg
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jens Göttler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
- TUM Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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Tsantilas P, Kühnl A, Maegdefessel L, König T, Breitkreuz T, Knappich C, Schmid S, Kallmayer M, Zimmermann A, Eckstein HH. Abstract 124: Safety of Carotid Endarterectomy and Carotid Stenting in the Early Period After the Neurologic Index Event - Results From the German Quality Assurance Registry on > 50,000 Patients. Arterioscler Thromb Vasc Biol 2017. [DOI: 10.1161/atvb.37.suppl_1.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:
Current guidelines recommend that carotid endarterectomy (CEA) should be performed within two weeks after the neurologic index event in patients with a 50-99% symptomatic carotid artery stenosis (sCS). Safety of early CEA and early carotid artery stenting (CAS) within those two weeks remains unclair. This study aims to analyze the safety of CEA and CAS in sCS in Germany.
Methods:
By German law all extracranial carotid procedures have to be documented prospectively in a nationwide quality assurance registry. We analysed data on 56,336 CEAs (68% male, mean age 71 years (SD ± 9.6) and 4,726 CAS (68% male, median age 70 years (SD ± 9.8) treated between 2009-2014 for sCS. The patient cohort was divided into four time interval groups (I: 0-2 days, II: 3-7 days, III: 8-14 days and IV: 14-180 days respectively). Primary endpoint was the combined in-hospital stroke and mortality rate. We excluded all emergency CEAs (stroke-in-evolution, acute occlusion) and all procedures for recurrent carotid stenosis from this analysis. We performed chi-squared tests and a multivariable multilevel Poisson-regression analysis to estimate adjusted risk ratios (RR).
Results:
The procedural combined stroke and mortality rate was 3.0% (157 of 5198)/6.0% (33 of 550) in group I, 2.5% (480 of 19,117)/4.4% (70 of 1579) in group II, 2.6% (427 of 16,205)/2.4% (30 of 1244) in group III and 2.3% (370 of 15,759)/3.0% (40 of 1344) in group IV respectively. In the multivariable regression analysis the time interval was no independent risk factor for patients treated by CEA. However, CAS was associated with a decreased periprocedural risk when performed 8-14 days (group III) after the index event vs. group I (0-2 days) (RR 0.47, 95% CI 0.28-0.79). No significance was found comparing time group II vs. I (RR 0.80, 95% CI0.52-1.24) and IV vs. I (RR 0.64, 95% CI 0.39-1.05).
Conclusion:
Time interval between neurologic event and CEA has no significant influence on the perioperative stroke and mortality rate. CAS was associated with a higher risk when performed early. In accordance with the guidelines, CEA remains to be the treatment of choice in the early period after cerebral ischemia.
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Affiliation(s)
- Pavlos Tsantilas
- Klinikum Rechts der Isar, Technical Univ of Munich, Munich, Germany
| | - Andreas Kühnl
- Klinikum Rechts der Isar, Technical Univ of Munich, Munich, Germany
| | | | - Thomas König
- AQUA - Institute for Applied Quality Improvement and Rsch in Health GmbH, Göttingen, Germany
| | - Thorben Breitkreuz
- AQUA - Institute for Applied Quality Improvement and Rsch in Health GmbH, Göttingen, Germany
| | | | - Sofie Schmid
- Klinikum Rechts der Isar, Technical Univ of Munich, Munich, Germany
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Knappich C, Kuehnl A, Tsantilas P, Schmid S, Breitkreuz T, Kallmayer M, Zimmermann A, Eckstein HH. Intraoperative Completion Studies, Local Anesthesia, and Antiplatelet Medication Are Associated With Lower Risk in Carotid Endarterectomy. Stroke 2017; 48:955-962. [DOI: 10.1161/strokeaha.116.014869] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/21/2017] [Accepted: 01/27/2017] [Indexed: 01/05/2023]
Abstract
Background and Purpose—
In Germany, all surgical and endovascular procedures on the carotid bifurcation must be documented in a statutory nationwide quality assurance database. We aimed to analyze the association between procedural and perioperative variables and in-hospital stroke or death rates after carotid endarterectomy.
Methods—
Between 2009 and 2014, overall 142 074 elective carotid endarterectomy procedures for asymptomatic or symptomatic carotid artery stenosis were documented in the database. The primary outcome of this secondary data analysis was in-hospital stroke or death. Major stroke or death, stroke, and death, each until discharge were secondary outcomes. Adjusted relative risks (RRs) were assessed by multivariable multilevel regression analyses.
Results—
The primary outcome occurred in 1.8% of patients, with a rate of 1.4% in asymptomatic and 2.5% in symptomatic patients, respectively. In the multivariable analysis, lower risks of stroke or death were independently associated with local anesthesia (versus general anesthesia: RR, 0.85; 95% confidence interval [CI], 0.75–0.95), carotid endarterectomy with patch plasty compared with primary closure (RR, 0.71; 95% CI, 0.52–0.97), intraoperative completion studies by duplex ultrasound (RR, 0.74; 95% CI, 0.63–0.88) or angiography (RR, 0.80; 95% CI, 0.71–0.90), and perioperative antiplatelet medication (RR, 0.83; 95% CI, 0.71–0.97). No shunting and a short cross-clamp time were also associated with lower risks; however, these are suspected to be confounded.
Conclusions—
Local anesthesia, patch plasty compared with primary closure, intraoperative completion studies by duplex ultrasound or angiography, and perioperative antiplatelet medication were independently associated with lower in-hospital stroke or death rates after carotid endarterectomy.
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Affiliation(s)
- Christoph Knappich
- From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (C.K., A.K., P.T., S.S., M.K., A.Z., H.-H.E.); and AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany (T.B.)
| | - Andreas Kuehnl
- From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (C.K., A.K., P.T., S.S., M.K., A.Z., H.-H.E.); and AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany (T.B.)
| | - Pavlos Tsantilas
- From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (C.K., A.K., P.T., S.S., M.K., A.Z., H.-H.E.); and AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany (T.B.)
| | - Sofie Schmid
- From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (C.K., A.K., P.T., S.S., M.K., A.Z., H.-H.E.); and AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany (T.B.)
| | - Thorben Breitkreuz
- From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (C.K., A.K., P.T., S.S., M.K., A.Z., H.-H.E.); and AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany (T.B.)
| | - Michael Kallmayer
- From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (C.K., A.K., P.T., S.S., M.K., A.Z., H.-H.E.); and AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany (T.B.)
| | - Alexander Zimmermann
- From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (C.K., A.K., P.T., S.S., M.K., A.Z., H.-H.E.); and AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany (T.B.)
| | - Hans-Henning Eckstein
- From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany (C.K., A.K., P.T., S.S., M.K., A.Z., H.-H.E.); and AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany (T.B.)
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Schmid S, Tsantilas P, Knappich C, Kallmayer M, König T, Breitkreuz T, Zimmermann A, Kuehnl A, Eckstein HH. Risk of Inhospital Stroke or Death Is Associated With Age But Not Sex in Patients Treated With Carotid Endarterectomy for Asymptomatic or Symptomatic Stenosis in Routine Practice: Secondary Data Analysis of the Nationwide German Statutory Quality Assurance Database From 2009 to 2014. J Am Heart Assoc 2017; 6:JAHA.116.004764. [PMID: 28288976 PMCID: PMC5524011 DOI: 10.1161/jaha.116.004764] [Citation(s) in RCA: 28] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Guideline recommendations on carotid endarterectomy are based predominantly on randomized, controlled trials, in which women or elderly patients are often under‐represented. This study analyzed the association of age and sex with the risk of in‐hospital stroke or death following carotid endarterectomy under routine conditions in Germany. Methods and Results Secondary data analysis using the Statutory German Quality Assurance Database on all carotid endarterectomy procedures (n=142 074) performed between 2009 and 2014. Primary outcome was any stroke or death until discharge; secondary outcomes were any in‐hospital stroke (alone), and death (alone). Descriptive statistics and multilevel multivariable regression analyses were applied. Patients were predominately male (68%), with mean age 71 years. Carotid stenosis was symptomatic in 40%. Primary outcome occurred in 1.8% of women and 1.9% of men. Multivariable regression analysis revealed that more‐advanced age was associated with a higher primary outcome rate (relative risk [RR] per 10‐year increase: 1.19; 95% CI, 1.14–1.24). Risk of death (alone) was associated with age (RR, 1.68; 95% CI, 1.54–1.84). Age was associated with the risk of stroke (alone; RR, 1.05; 95% CI, 1.00–1.11). Sex was not associated with primary outcome rate (1.01; 95% CI, 0.93–1.10), nor did it significantly modify the age effect. Conclusions This study shows that increasing age, but not sex, is associated with a higher risk of in‐hospital stroke or death following carotid endarterectomy under everyday conditions in Germany. Whereas the risk of death (alone) is significantly associated with age, the association between age and the risk of stroke (alone) can be considered of minor importance.
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Affiliation(s)
- Sofie Schmid
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar Technical University of Munich, Germany
| | - Pavlos Tsantilas
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar Technical University of Munich, Germany
| | - Christoph Knappich
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar Technical University of Munich, Germany
| | - Michael Kallmayer
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar Technical University of Munich, Germany
| | - Thomas König
- AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany
| | - Thorben Breitkreuz
- AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany
| | - Alexander Zimmermann
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar Technical University of Munich, Germany
| | - Andreas Kuehnl
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar Technical University of Munich, Germany
| | - Hans-Henning Eckstein
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar Technical University of Munich, Germany
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Tsantilas P, Kühnl A, Kallmayer M, Pelisek J, Poppert H, Schmid S, Zimmermann A, Eckstein HH. A short time interval between the neurologic index event and carotid endarterectomy is not a risk factor for carotid surgery. J Vasc Surg 2016; 65:12-20.e1. [PMID: 27838111 DOI: 10.1016/j.jvs.2016.07.116] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/17/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Current guidelines recommend that carotid endarterectomy (CEA) be performed as early as possible after the neurologic index event in patients with 50% to 99% carotid artery stenosis. However, recent registry data showed that patients treated ≤48 hours had a significantly increased perioperative risk. Therefore, the aim of this single-center study was to determine the effect of the time interval between the neurologic index event and CEA on the periprocedural complication rate at our institution. METHODS Prospectively collected data for 401 CEAs performed between 2004 and 2014 for symptomatic carotid stenosis were analyzed. Patients were divided into four groups according to the interval between the last neurologic event and surgery: group I, 0 to 2 days; group II, 3 to 7 days; group III, 8 to 14 days; and group IV, 15 to 180 days. The primary end point was the combined rate of in-hospital stroke or mortality. Data were analyzed by way of χ2 tests and multivariable regression analysis. RESULTS The patients (68% men) had a median age of 70 years (interquartile range, 63-76 years). The index events included transient ischemic attack in 43.4%, amaurosis fugax in 25.4%, and an ipsilateral stroke in 31.2%. CEA was performed using the eversion technique in 61.1% of patients, and 50.1% were treated under locoregional anesthesia. The perioperative combined stroke and mortality rate was 2.5% (10 of 401), representing a perioperative mortality rate of 1.0% and stroke rate of 1.5%. Overall, myocardial infarction, cranial nerve injuries, and postoperative bleeding occurred in 0.7%, 2.2%, and 1.7%, respectively. We detected no significant differences for the combined stroke and mortality rate by time interval: 3% in group I, 3% in group II, 2% in group III, and 2% in group IV. Multivariable regression analysis showed no significant effect of the time interval on the primary end point. CONCLUSIONS The combined mortality and stroke rate was 2.5% and did not differ significantly between the four different time interval groups. CEA was safe in our cohort, even when performed as soon as possible after the index event.
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Affiliation(s)
- Pavlos Tsantilas
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas Kühnl
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Kallmayer
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jaroslav Pelisek
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Holger Poppert
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sofie Schmid
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander Zimmermann
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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