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1. How much of the variance in functional outcome related to intracerebral hemorrhage volume is already apparent in neurological status at admission?

Author

Geest, Vincent, Oblak, Janja Pretnar, Popović, Katarina Šurlan, Nawabi, Jawed, Elsayed, Sarah, Friedrich, Constanze, Böhmer, Maik, Akkurt, Burak, Sporns, Peter, Morotti, Andrea, Schlunk, Frieder, Steffen, Paul, Broocks, Gabriel, Meyer, Lukas, Hanning, Uta, Thomalla, Götz, Gellissen, Susanne, Fiehler, Jens, Frol, Senta, and Kniep, Helge

Published
2024
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2. Endovascular thrombectomy for acute ischaemic stroke with established large infarct (TENSION): 12-month outcomes of a multicentre, open-label, randomised trial

Author

Aamodt, Anne Hege, Adamczewski, Olaf, Alektoror, Kirill, Alexander, März, Alexandrou, Maria, Alias, Quentin, Al-Kuzae, Fadha Elawi, Allard, Julien, Al-Schameri, Rahman, Álvarez, Alberto, Andersen, Grethe, AnkerlundBlaufeldt, Rolf, Antje, Riedel, Appelbohm, Hannes, Argren, Maria, Assmann, Anne, Augustin, Michael, Bach, Elke, Bar, Michal, Barleben, Maria, Baronnet, Flore, Barrios, Andrés, Bavúzová, Xénia, BayThomsen, Rikke, Becker, Sandra, Beer, Sylvia, Behme, Daniel, Bellut, Maximilian, Bendszus, Martin, Berkefeld, Joachim, Bester, Maximillian, Bode, Felix J., Boehme, Christian, Boese, Ramona, Bohmann, Ferdinand, Bonekamp, Susanne, Borggrefe, Jan, Boss, Erendira Gabriela, Boutchakova, Maria, Boxhammer, Elfi, Brandhofe, Annemarie, Breckwoldt, Michael, Brekenfeld, Casper, Brehm, Alex, Brem, Christian, Breuer, Stella, Breyer, Tobias, Brodová, Petra, Broocks, Gabriel, Brosinski, Christoph, Bubel, Nele, Búřil, Jiří, Čábal, Martin, Casado, Laura, de Celis, Elena, Chabert, Emmanuel, Charisse, Daniel, Cheng, Bastian, Chovanec, Vendelín, Cidlinsky, Peter, Cisár, Juraj, Clarençon, Fréderic, Crozier, Sophie, Čurdová, Nina, Damaskinos, Michele, Damgaard, Dorte, Daniš, Martin, Dazinger, Florian, Deb-Chatterji, Milani, Delalic, Asima, Delekta, Agnieszka, Delorme, Stephen, Deutschmann, Hannes, Diamandis, Elie, Diedrichsen, Tove, Doležalová, Irena, Dorn, Franziska, du Mesnil de Rochemont, Richard, DupontHougaard, Kristina, Ebrahimi, Taraneh, Eff, Florian, Eliášová, Ilona, Enriquez, Brian, Ergawy, Mostafa, Essig, Fabian, Falkesgaard, Maiken, Fandler-Höfler, Simon, Fernández, Andrés, Ferré, Jean-Christophe, Ferrier, Anna, Fiehler, Jens, Figlewski, Krystian, Fischer, Sebastian, Fischer, Urs, Flottmann, Fabian, Forbrig, Robert, Förch, Christian, Fromm, Annette, Fuentes, Blanca, Gaedke, Ines, Galczak, Romana, Galijasevic, Malik, Ganser, Bernhard, Gattringer, Thomas, Gawlitza, Matthias, Gelhard, Sarah, Gellißen, Susanne, Gerber, Johannes, Giannakakis, Michail Panagiotis, Gindlhuber, Karin, Gizewski, Elke R., Glodny, Bernhard, Godel, Tim, Goebell, Einar, Goldemund, David, Görtler, Michael, Goyal, Mayank, Grams, Astrid E., Gruber, Joachim, Gruber, Katharina, Günthner-Lengsfeld, Thomas, Haase, Kathrin, Hacker-Ivan, Floriana, Hallerstig, Erika, Hametner, Christian, Hanning, Uta, Haring, Jozef, Haršány, Michal, Haršány, Ján, Hartmann, Christian, Hassler, Eva Maria, Hauptmann, Kristina, Haeusler, Karl Georg, Hecker, Constantin, Hellstern, Victoria, Henkes, Hans, Hernández, Victoria, Herweh, Christian, Hilgenfeld, Tim, Hill, Michael D., Hjort, Niels, HjortJensen, Nina, Hoelter, Maya, Hoffmann, Karl-Titus, Holst, Brigitte, Holtmannspoetter, Markus, Hopf-Jensen, Silke, Hoppe, Julia, Horner, Susanne, HougaardSoerensen, Leif, Hua, Vi Tuan, Hubert, Alexander, Hurtíková, Eva, Jakubíček, Stanislava, Janjic, Tanja, Jaramillo, Kirsten, Jedlitschka, Angela, Jensen, Schiela, Jensen, Märit, Jesser, Jessica, Jestaedt, Leonie, Johnson, Sabine, Jonszta, Tomáš, Kalmar, Peter, Karabegovic, Sanja, Karen, Kollo, Kastrup, Andreas, Katja, Hopp, Keeba, Natalia, Keese, Petra, Kefaloykos, Christina, Keil, Fee, Kellert, Lars, Kellinghaus, Christoph, Kestner, Roxane-Isabelle, Kiechl, Stefan, Killer-Oberpfalzer, Monika, Klepanec, Andrej, Knispel, Casjupea, Knoflach, Michael, Kohler, Sabine, Kohlhase, Konstantin, Kollikowski, Alexander Marco, Kovář, Martin, Krajina, Antonín, Kral, Michael, Krastev, Georgi, Krause, Lars Udo, Kreidenhuber, Rudolf, Křivka, Tomáš, Krkoška, Adam, Kröger, Jan Robert, Kronlage, Moritz, Krukowski, Pawel, Kühn, Julia, Kurča, Egon, Kurka, Natalia, Kuschnerow, Michael, Lachmund, Rita, Lamprecht, Susanne, Lange, Rüdiger, Lauer, Monika, de Leciñana, Alonso, Leder, Sara, Leger, Anne, Lehnen, Nils, Lehrieder, Dominik, Leißner, Maximilian, Leitinger, Markus, Leitner, Ursula, Lenck, Stéphanie, Lenzenweger, Eva, Liebig, Thomas, Lowens, Stephan, Lunzer, Manuel, Maegerlein, Christian, Magyar, Marton, Marques, Leonardo, Matyáš, David, Maurer, Gabriele, Mauritz, Matthias, Maximilian, Thormann, Mayer-Süß, Lukas, Meckel, Stephan, Medek, Oldřich, Meissner, Julius N., Mencl, Pavel, Merkle, Andrea, Mesche, Birte, Michalski, Dominik, Mikulík, Robert, Modrau, Boris, Möhlenbruch, Markus A., Mohr, Alexander, Mönninghoff, Christoph, Moser, Tobias, Mücke, Ramona, Müller-Hülsbeck, Stefan, Müller-Thies-Broussalis, Erasmia, Mutzenbach, Sebastian, Navia, Pedro, Neuberger, Ulf, Neugebauer, Hermann, Neumann, Jens, Nguyên, Anh, Niederkorn, Kurt, Nosál', Vladimír, Novobilský, Richard, Ntoulias, Nikos, Nussbaum, Lukas, Oder, Joanna, Oldag, Andreas, Ondrejkovič, Marián, Otto, Ferdinand, Otto, Dagmar, Paech, Daniel, Pagano, Paolo, Pallesen, Lars-Peder, Panský, Michal, Papanagiotou, Panagiotis, Patrick, Samp, Paukisch, Harald, Pelz, Johann, Petersen, Inga, Petersen, Martina, Petzold, Gabor C., Pfaff, Johannes, Pfeilschifter, Waltraud, Pham, Mirko, Pichler, Alexander, Pierot, Laurent, Pikija, Slaven, PlougmannPovlsen, Jan, Polkowski, Christoph, Polomac, Nenad, Portugaller, Rupert Horst, Poulsen, Marika, Preiß, Michael, Premat, Kévin, Prestsæter, Sjur, Prieto-Pérez, Rocio, Psychogios, Marios, Puetz, Volker, Purrucker, Jan, Rai, Heike, Rauch, Maximilian, Raupach, Jan, Reimann, Gernot, Reimann, Georg, Reitz, Sarah, Renc, Ondřej, Retzlaff, Jasmin, Rigual, Ricardo, Ringleb, Peter Arthur, Rivera-Bengoa, Carlota, Rodríguez, Jorge, Rohde, Stefan, Rohler, Siegfried, Rosso, Charlotte, Roth, Christian, Röttcher, Thomas, Roubec, Martin, Roztočilová, Milada, Rudnicka, Svetlana, Ruiz, Gerardo, Ryan, Stephen, Ryckborst, Karla J., Sandvik, Simen, Schäfer, Jan-Hendrik, Schaller-Paule, Martin, Schell, Maximillian, Schellinger, Peter, Schlemm, Eckhard, Schmid, Florian, Schmidt, Christoph, Schmitz, Marie Louise, Schneider, Claus, Scholtz, Jan-Erik, Schönenberger, Silvia, Schröter, Andreas, Schwarz, Daniel, Schwarz, Stephan, Schwarzenhofer, Daniel, Seifert-Held, Thomas, Seiler, Alexander, Seker, Fatih, Shotar, Eimad, Simonsen, Claus Z., Simonsen, Maria Theresa, Sivák, Jozef, Skagen, Karolina, Skjelland, Mona, Šnajdrová, Alena, Solymosi, Lazlo, Sømark, Jesper, Sonnberger, Michael, Soršák, Jakub, Sourour, Nader, Søyland, Jogrim, Spitzer, Daniel, Sporns, Peter, Städt, Michael, Steidl, Eike, Størdal, Anne Margrethe Kaalaas, Stösser, Sebastian, Strickmann, Sarah, Strýček, Ondřej, Suškevič, Igor, Sýkora, Jan, Tennøe, Bjørn, Thaler, Daniela, Theisen, Sara, Thomalla, Götz, Trendafilov, Petar, Trenkler, Johannes, Trumm, Christoph, Tsogkas, Ioannis, Tunold, Jon-Anders, Tveit, Lars, Ulfert, Christian, Vališ, Kateřina, Vaníček, Jiří, Vassilev, Christine, Vítková, Eva, Voit-Höhne, Heinz-Leonhard, Vojtíšek, Bohuslav, Volderauer, Karoline, Vollherbst, Dominik, Vollmuth, Christoph, Volna, Kamila, Volný, Ondřej, VonWeitzel-Mudersbach, Poul, Vorčák, Martin, Wagner, Marlies, Wathle, Gaute Kjellevold, Weber, Werner, Weber, Anushe, Weiss, Viktor, Weller, Johannes M., Wenger-Alakmeh, Katharina, Weyland, Cyrill, Weymayr, Friedrich, Wießpeiner, Ulrike, Willeit, Johannes, Wittwer, Aymeric, Wollenweber, Frank, Wortmann, Ginette, Wunderlich, Silke, Xiong, Yanyan, You, Se-Jong, ZachoSpeiser, Lasse, Zamani, Mahtab, Zelenak, Kamil, Zeleňáková, Jana, Zubel, Seraphine, Subtil, Fabien, Gizewski, Elke R, Hill, Michael D, Krajina, Antonin, Simonsen, Claus Z, Zeleňák, Kamil, Blauenfeldt, Rolf A, Denis, Angélique, Gerber, Johannes C, Keil, Christiane Fee, Mikkelsen, Ronni, Möhlenbruch, Markus, Münnich, Nico, Petzold, Gabor C, Schell, Maximilian, Vollherbst, Dominik F, and Wick, Wolfgang

Published
2024
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4. Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomised trial

Author

Aamodt, Anne Hege, Adamczewski, Olaf, Alektoror, Kirill, Alexander, März, Alexandrou, Maria, Alias, Quentin, Al-Kuzae, Fadha Elawi, Allard, Julien, Al-Schameri, Rahman, Álvarez, Alberto, Andersen, Grethe, AnkerlundBlaufeldt, Rolf, Antje, Riedel, Appelbohm, Hannes, Argren, Maria, Assmann, Anne, Augustin, Michael, Bach, Elke, Bar, Michal, Barleben, Maria, Baronnet, Flore, Barrios, Andrés, Bavúzová, Xénia, BayThomsen, Rikke, Becker, Sandra, Beer, Sylvia, Behme, Daniel, Bellut, Maximilian, Bendszus, Martin, Berkefeld, Joachim, Bester, Maximillian, Bode, Felix J., Boehme, Christian, Boese, Ramona, Bohmann, Ferdinand, Bonekamp, Susanne, Borggrefe, Jan, Boss, Erendira Gabriela, Boutchakova, Maria, Boxhammer, Elfi, Brandhofe, Annemarie, Breckwoldt, Michael, Brekenfeld, Casper, Brehm, Alex, Brem, Christian, Breuer, Stella, Breyer, Tobias, Brodová, Petra, Broocks, Gabriel, Brosinski, Christoph, Bubel, Nele, Búřil, Jiří, Čábal, Martin, Casado, Laura, Celis, Elena de, Chabert, Emmanuel, Charisse, Daniel, Cheng, Bastian, Chovanec, Vendelín, Cidlinsky, Peter, Cisár, Juraj, Clarençon, Fréderic, Crozier, Sophie, Čurdová, Nina, Damaskinos, Michele, Damgaard, Dorte, Daniš, Martin, Dazinger, Florian, Deb-Chatterji, Milani, Delalic, Asima, Delekta, Agnieszka, Delorme, Stephen, Deutschmann, Hannes, Diamandis, Elie, Diedrichsen, Tove, Doležalová, Irena, Dorn, Franziska, du Mesnil de Rochemont, Richard, DupontHougaard, Kristina, Ebrahimi, Taraneh, Eff, Florian, Eliášová, Ilona, Enriquez, Brian, Ergawy, Mostafa, Essig, Fabian, Falkesgaard, Maiken, Fandler-Höfler, Simon, Fernández, Andrés, Ferré, Jean-Christophe, Ferrier, Anna, Fiehler, Jens, Figlewski, Krystian, Fischer, Sebastian, Fischer, Urs, Flottmann, Fabian, Forbig, Robert, Förch, Christian, Fromm, Annette, Fuentes, Blanca, Gaedke, Ines, Galczak, Romana, Galijasevic, Malik, Ganser, Bernhard, Gattringer, Thomas, Gawlitza, Matthias, Gelhard, Sarah, Gellißen, Susanne, Gerber, Johannes, Giannakakis, Michail Panagiotis, Gindlhuber, Karin, Gizewski, Elke R., Glodny, Bernhard, Godel, Tim, Goebell, Einar, Goldemund, David, Görtler, Michael, Goyal, Mayank, Grams, Astrid E., Gruber, Joachim, Gruber, Katharina, Günthner-Lengsfeld, Thomas, Haase, Kathrin, Hacker-Ivan, Floriana, Hallerstig, Erika, Hanning, Uta, Haring, Jozef, Haršány, Michal, Haršány, Ján, Hartmann, Christian, Hassler, Eva Maria, Hauptmann, Kristina, Häusler, Karl Georg, Hecker, Constantin, Hellstern, Victoria, Henkes, Hans, Hernández, Victoria, Herweh, Christian, Hilgenfeld, Tim, Hill, Michael D., Hjort, Niels, HjortJensen, Nina, Hoelter, Maya, Hoffmann, Karl-Titus, Holst, Brigitte, Holtmannspoetter, Markus, Hopf-Jensen, Silke, Hoppe, Julia, Horner, Susanne, HougaardSoerensen, Leif, Hua, Vi Tuan, Hubert, Alexander, Hurtíková, Eva, Jakubíček, Stanislava, Janjic, Tanja, Jaramillo, Kirsten, Jedlitschka, Angela, Jensen, Schiela, Jensen, Märit, Jesser, Jessica, Jestaedt, Leonie, Johnson, Sabine, Jonszta, Tomáš, Kalmar, Peter, Karabegovic, Sanja, Karen, Kollo, Kastrup, Andreas, Katja, Hopp, Keeba, Natalia, Keese, Petra, Kefalaykos, Christina, Keil, Fee, Kellert, Lars, Kellinghaus, Christoph, Kestner, Roxane-Isabelle, Kiechl, Stefan, Killer-Oberpfalzer, Monika, Klepanec, Andrej, Knispel, Casjupea, Knoflach, Michael, Kohler, Sabine, Kohlhase, Konstantin, Kollikowski, Alexander Marco, Kovář, Martin, Krajina, Antonín, Kral, Michael, Krastev, Georgi, Krause, Lars Udo, Kreidenhuber, Rudolf, Křivka, Tomáš, Krkoška, Adam, Kröger, Jan Robert, Kronlage, Moritz, Krukowski, Pawel, Kühn, Julia, Kurča, Egon, Kurka, Natalia, Kuschnerow, Michael, Lachmund, Rita, Lamprecht, Susanne, Lange, Rüdiger, Lauer, Monika, Leciñana, Alonso de, Leder, Sara, Leger, Anne, Lehnen, Nils, Lehrieder, Dominik, Leißner, Maximilian, Leitinger, Markus, Leitner, Ursula, Lenck, Stéphanie, Lenzenweger, Eva, Liebig, Thomas, Lowens, Stephan, Lunzer, Manuel, Maegerlein, Christian, Magyar, Marton, Marques, Leonardo, Matyáš, David, Maurer, Gabriele, Mauritz, Matthias, Maximilian, Thormann, Mayer-Süß, Lukas, Meckel, Stephan, Medek, Oldřich, Meissner, Julius N., Mencl, Pavel, Merkle, Andrea, Mesche, Birte, Michalski, Dominik, Mikulík, Robert, Modrau, Boris, Möhlenbruch, Markus A., Mohr, Alexander, Mönninghoff, Christoph, Moser, Tobias, Mücke, Ramona, Müller-Hülsbeck, Stefan, Müller-Thies-Broussalis, Erasmia, Mutzenbach, Sebastian, Navia, Pedro, Neuberger, Ulf, Neugebauer, Hermann, Neumann, Jens, Nguyên, Anh, Niederkorn, Kurt, Nosál', Vladimír, Novobilský, Richard, Ntoulias, Nikos, Nussbaum, Lukas, Oder, Joanna, Oldag, Andreas, Ondrejkovič, Marián, Otto, Ferdinand, Otto, Dagmar, Paech, Daniel, Pagano, Paolo, Pallesen, Lars-Peder, Panský, Michal, Papanagiotou, Panagiotis, Patrick, Samp, Paukisch, Harald, Pelz, Johann, Petersen, Inga, Petersen, Martina, Petzold, Gabor C., Pfaff, Johannes, Pfeilschifter, Waltraud, Pham, Mirko, Pichler, Alexander, Pierot, Laurent, Pikija, Slaven, PlougmannPovlsen, Jan, Polkowski, Christoph, Polomac, Nenad, Portugaller, Rupert Horst, Poulsen, Marika, Preiß, Michael, Premat, Kévin, Prestsæter, Sjur, Prieto-Pérez, Rocio, Psychogios, Marios, Puetz, Volker, Purrucker, Jan, Rai, Heike, Rauch, Maximilian, Raupach, Jan, Reimann, Gernot, Reimann, Georg, Reitz, Sarah, Renc, Ondřej, Retzlaff, Jasmin, Rigual, Ricardo, Ringleb, Peter Arthur, Rivera-Bengoa, Carlota, Rodríguez, Jorge, Rohde, Stefan, Rohler, Siegfried, Rosso, Charlotte, Roth, Christian, Röttcher, Thomas, Roubec, Martin, Roztočilová, Milada, Rudnicka, Svetlana, Ruiz, Gerardo, Ryan, Stephen, Ryckborst, Karla J., Sandvik, Simen, Schäfer, Jan-Hendrik, Schaller-Paule, Martin, Schell, Maximillian, Schellinger, Peter, Schlemm, Eckhard, Schmid, Florian, Schmidt, Christoph, Schmitz, Marie Louise, Schneider, Claus, Scholtz, Jan-Erik, Schönenberger, Silvia, Schröter, Andreas, Schwarz, Daniel, Schwarz, Stephan, Schwarzenhofer, Daniel, Seifert-Held, Thomas, Seiler, Alexander, Seker, Fatih, Shotar, Eimad, Simonsen, Claus Z., Simonsen, Maria Theresa, Sivák, Jozef, Skagen, Karolina, Skjelland, Mona, Šnajdrová, Alena, Solymosi, Lazlo, Sømark, Jesper, Sonnberger, Michael, Soršák, Jakub, Sourour, Nader, Søyland, Jogrim, Spitzer, Daniel, Sporns, Peter, Städt, Michael, Steidl, Eike, Størdal, Anne Margrethe Kaalaas, Stösser, Sebastian, Strickmann, Sarah, Strýček, Ondřej, Suškevič, Igor, Sýkora, Jan, Tennøe, Bjørn, Thaler, Daniela, Theisen, Sara, Thomalla, Götz, Trendafilov, Petar, Trenkler, Johannes, Trumm, Christoph, Tsogkas, Ioannis, Tunold, Jon-Anders, Tveit, Lars, Ulfert, Christian, Vališ, Kateřina, Vaníček, Jiří, Vassilev, Christine, Vítková, Eva, Voit-Höhne, Heinz-Leonhard, Vojtíšek, Bohuslav, Volderauer, Karoline, Vollherbst, Dominik, Vollmuth, Christoph, Volna, Kamila, Volný, Ondřej, VonWeitzel-Mudersbach, Poul, Vorčák, Martin, Wagner, Marlies, Wathle, Gaute Kjellevold, Weber, Werner, Weber, Anushe, Weiss, Viktor, Weller, Johannes M., Wenger-Alakmeh, Katharina, Weyland, Cyrill, Weymayr, Friedrich, Wießpeiner, Ulrike, Willeit, Johannes, Wittwer, Aymeric, Wollenweber, Frank, Wortmann, Ginette, Wunderlich, Silke, Xiong, Yanyan, You, Se-Jong, ZachoSpeiser, Lasse, Zelenak, Kamil, Zeleňáková, Jana, Zubel, Seraphine, Subtil, Fabien, Gizewski, Elke R, Hill, Michael D, Krajina, Antonin, Simonsen, Claus Z, Zeleňák, Kamil, Blauenfeldt, Rolf A, Denis, Angélique, Gerber, Johannes C, Keil, Christiane Fee, Mikkelsen, Ronni, Möhlenbruch, Markus, Münnich, Nico, Petzold, Gabor C, Schell, Maximilian, Vollherbst, Dominik F, and Wick, Wolfgang

Published
2023
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8. Thrombectomy for M2 Occlusions: Predictors of Successful and Futile Recanalization

Author

Kniep, Helge, Meyer, Lukas, Broocks, Gabriel, Bechstein, Matthias, Heitkamp, Christian, Winkelmeier, Laurens, Faizy, Tobias, Brekenfeld, Caspar, Flottmann, Fabian, Deb-Chatterji, Milani, Alegiani, Anna, Hanning, Uta, Thomalla, Götz, Fiehler, Jens, Gellißen, Susanne, Röther, Joachim, Eckert, Bernd, Braun, Michael, Hamann, Gerhard F., Siebert, Eberhard, Nolte, Christian, Zweynert, Sarah, Bohner, Georg, Berrouschot, Jörg, Bormann, Albrecht, Kraemer, Christoffer, Leischner, Hannes, Hattingen, Jörg, Petersen, Martina, Stögbauer, Florian, Boeckh-Behrens, Tobias, Wunderlich, Silke, Ludolph, Alexander, Henn, Karl-Heinz, Gerloff, Christian, Schell, Maximilian, Reich, Arno, Nikoubashman, Omid, Dorn, Franziska, Petzold, Gabor, Liman, Jan, Schäfer, Jan Hendrik, Keil, Fee, Gröschel, Klaus, Uphaus, Timo, Schellinger, Peter, Borggrefe, Jan, Tiedt, Steffen, Kellert, Lars, Trumm, Christoph, Ernemann, Ulrike, Poli, Sven, Riedel, Christian, and Ernst, Marielle Sophie

Published
2023
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9. Prediction of tissue outcome in acute ischemic stroke based on single-phase CT angiography at admission

Author

Palsson, Frosti, primary, Forkert, Nils D., additional, Meyer, Lukas, additional, Broocks, Gabriel, additional, Flottmann, Fabian, additional, Maros, Máté E., additional, Bechstein, Matthias, additional, Winkelmeier, Laurens, additional, Schlemm, Eckhard, additional, Fiehler, Jens, additional, Gellißen, Susanne, additional, and Kniep, Helge C., additional

Published
2024
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10. Thrombectomy in ischemic stroke patients with large core but minor ischemic changes on non-enhanced computed tomography.

Author

Broocks, Gabriel, Kniep, Helge, McDonough, Rosalie, Bechstein, Matthias, Heitkamp, Christian, Winkelmeier, Laurens, Klapproth, Susan, Faizy, Tobias D, Schell, Maximilian, Schön, Gerhard, Hanning, Uta, Gellißen, Susanne, Kemmling, Andre, Papanagiotou, Panagiotis, Fiehler, Jens, and Meyer, Lukas

Abstract

Purpose: The Alberta Stroke Program Early CT Score (ASPECTS) is regularly used to guide patient selection for mechanical thrombectomy (MT). Similarly, penumbral imaging based on computed tomography perfusion (CTP) may serve as neuroimaging tool to guide treatment. Yet, patients with a large ischemic core on CTP may show only minor ischemic changes resulting in a high ASPECTS. Aim: We hypothesized twofold: (1) the treatment effect of vessel recanalization in patients with core volume > 50 mL but ASPECTS ⩾ 6 is not different compared to high ASPECTS patients with core volume < 50 mL, and (2) recanalization is associated with core overestimation. Methods: We conducted an observational study analyzing ischemic stroke patients consecutively treated with MT after triage by multimodal CT. Functional endpoint was the rate of functional independence at Day 90 defined as modified Rankin Scale (mRS) 0–2. Imaging endpoint was core overestimation, which was considered when CTP-derived core was larger than the final infarct volume assessed on follow-up imaging. Recanalization was evaluated with the extended Thrombolysis in Cerebral Infarction (eTICI) scale. Multivariable logistic regression analysis and propensity score matching (PSM) were used to assess the association of recanalization (eTICI ⩾ 2b) with functional outcome and core overestimation. Results: Of 630 patients with ASPECTS ⩾ 6, 91 patients (14.4%) had a large ischemic core. Following 1:1 PSM, the treatment effect of recanalization was not different in patients with large core and ASPECTS ⩾ 6 (+ 25.8%, 95% CI: 16.3–35.4, p < 0.001) compared to patients with ASPECTS ⩾ 6 and core volume < 50 mL (+ 14.9%, 95% CI: 5.7–24.1, p = 0.002). Recanalization (aOR: 3.46, 95% CI: 1.85–6.47, p < 0.001) and higher core volume (aOR: 1.03, 95% CI: 1.02–1.04, p < 0.001) were significantly associated with core overestimation. Conclusion: In patients with ASPECTS ⩾ 6, core volumes did not significantly modify outcomes following recanalization. Reperfusion and higher core volume were significantly associated with core overestimation which may explain the treatment effect of MT for patients with a large ischemic core but minor ischemic changes on non-enhanced CT. Data access statement: The data analyzed in this study will be available and shared on reasonable request from any qualified researcher for the purpose of replicating the results after clearance by the local ethics committee. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Predictors of aneurysm occlusion after treatment with flow diverters: a systematic literature review.

Author

Meyer, Lukas, Stracke, Christian Paul, Bester, Maxim, Kallmes, Kevin M., Zeleňák, Kamil, Rouchaud, Aymeric, Martínez-Galdámez, Mario, Jabbour, Pascal, Thanh N. Nguyen, Siddiqui, Adnan H., Fiehler, Jens, and Gellissen, Susanne

Subjects
INTRACRANIAL aneurysms, THERAPEUTIC embolization, LOGISTIC regression analysis, SEX distribution, SURGICAL stents, TREATMENT effectiveness, MULTIVARIATE analysis, AGE distribution, SYSTEMATIC reviews, MEDLINE, ONLINE information services, CONFIDENCE intervals
Abstract

Background Flow diverters (FDs) have become an integral part of treatment for brain aneurysms. Aim To summarize available evidence of factors associated with aneurysm occlusion (AO) after treatment with a FD. Methods References were identified using the Nested Knowledge AutoLit semi-automated review platform between January 1, 2008 and August 26, 2022. The review focuses on preprocedural and postprocedural factors associated with AO identified in logistic regression analysis. Studies were included if they met the inclusion criteria of study details (ie, study design, sample size, location, (pre)treatment aneurysm details). Evidence levels were classified by variability and significancy across studies (eg, low variability ≥5 studies and significance in ≥60% throughout reports). Results Overall, 2.03% (95% CI 1.22 to 2.82; 24/1184) of screened studies met the inclusion criteria for predictors of AO based on logistic regression analysis. Predictors of AO with low variability in multivariable logistic regression analysis included aneurysm characteristics (aneurysm diameter), particularly complexity (absence of branch involvement) and younger patient age. Predictors of moderate evidence for AO included aneurysm characteristics (neck width), patient characteristics (absence of hypertension), procedural (adjunctive coiling) and post-deployment variables (longer follow-up; direct postprocedural satisfactory occlusion). Variables with a high variability in predicting AO following FD treatment were gender, FD as re-treatment strategy, and aneurysm morphology (eg, fusiform or blister). Conclusion Evidence of predictors for AO after FD treatment is sparse. Current literature suggests that absence of branch involvement, younger age, and aneurysm diameter have the highest impact on AO following FD treatment. Large studies investigating high-quality data with well-defined inclusion criteria are needed for greater insight into FD effectiveness. [ABSTRACT FROM AUTHOR]

Published
2024
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12. How much of the outcome improvement after successful recanalization is explained by follow-up infarct volume reduction?

Author

Kniep, Helge, Meyer, Lukas, Broocks, Gabriel, Bechstein, Matthias, Austein, Friederike, McDonough, Rosalie V., Brekenfeld, Caspar, Flottmann, Fabian, Deb-Chatterji, Milani, Alegiani, Anna, Hanning, Uta, Thomalla, Goetz, Fiehler, Jens, and Gellissen, Susanne

Subjects
NIH Stroke Scale, INTRACRANIAL hemorrhage, STATISTICAL models, LOGISTIC regression analysis, HYPERTENSION, TREATMENT effectiveness, DESCRIPTIVE statistics, ODDS ratio, REOPERATION, ISCHEMIC stroke, THROMBECTOMY, CEREBRAL infarction, STROKE patients, CONFIDENCE intervals, FACTOR analysis, PATIENT aftercare
Abstract

Background Follow-up infarct volume (FIV) is used as surrogate for treatment efficiency in mechanical thrombectomy (MT). However, previous works suggest that MT-related FIV reduction has only limited association with outcome comparing MT independently of recanalization success versus medical care. It remains unclear to what extent the relationship between successful recanalization versus persistent occlusion and functional outcome is explained by FIV reduction. Objective To determine whether FIV mediates the relationship between successful recanalization and functional outcome. Methods All patients from our institution enrolled in the German Stroke Registry (May 2015-December 2019) with anterior circulation stroke; availability of the relevant clinical data, and follow-up-CT were analyzed. The effect of FIV reduction on functional outcome (90-day modified Rankin Scale (mRS) score ≤2) after successful recanalization (Thrombolysis in Cerebral Infarction ≥2b) was quantified using mediation analysis. Results 429 patients were included, of whom, 309 (72 %) had successful recanalization and 127 (39%) had good functional outcome. Good outcome was associated with age (0R=0.89, P<0.001), pre-stroke mRS score (0R=0.38, P<0.001), FIV (0R=0.98, P<0.001), hypertension (0R=2.08, P<0.05), and successful recanalization (0R=3.57, P<0.01). Using linear regression in the mediator pathway, FIV was associated with Alberta Stroke program Early CT Score (coefficient (Co)=-26.13, P<0.001), admission National Institutes of Health Stroke Scale score (Co=3.69, P<0.001), age (Co=-1.18, P<0.05), and successful recanalization (Co=-85.22, P<0.001). Successful recanalization increased the probability of good outcome by 23 percentage points (pp) (95% CI 16pp to 29pp). 56% (95% CI 38% to 78%) of the improvement in good outcome was explained by FIV reduction. Conclusion 56% (95% CI 38% to 78%) of outcome improvement after successful recanalization was explained by FIV reduction. Results corroborate pathophysiological assumptions and confirm the value of FIV as an imaging endpoint in clinical trials. 44% (95% CI 22% to 62%) of the improvement in outcome was not explained by FIV reduction and reflects the remaining mismatch between radiological and clinical outcome measures. [ABSTRACT FROM AUTHOR]

Published
2024
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13. Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomised trial

Author

Bendszus, Martin, primary, Fiehler, Jens, additional, Subtil, Fabien, additional, Bonekamp, Susanne, additional, Aamodt, Anne Hege, additional, Fuentes, Blanca, additional, Gizewski, Elke R, additional, Hill, Michael D, additional, Krajina, Antonin, additional, Pierot, Laurent, additional, Simonsen, Claus Z, additional, Zeleňák, Kamil, additional, Blauenfeldt, Rolf A, additional, Cheng, Bastian, additional, Denis, Angélique, additional, Deutschmann, Hannes, additional, Dorn, Franziska, additional, Flottmann, Fabian, additional, Gellißen, Susanne, additional, Gerber, Johannes C, additional, Goyal, Mayank, additional, Haring, Jozef, additional, Herweh, Christian, additional, Hopf-Jensen, Silke, additional, Hua, Vi Tuan, additional, Jensen, Märit, additional, Kastrup, Andreas, additional, Keil, Christiane Fee, additional, Klepanec, Andrej, additional, Kurča, Egon, additional, Mikkelsen, Ronni, additional, Möhlenbruch, Markus, additional, Müller-Hülsbeck, Stefan, additional, Münnich, Nico, additional, Pagano, Paolo, additional, Papanagiotou, Panagiotis, additional, Petzold, Gabor C, additional, Pham, Mirko, additional, Puetz, Volker, additional, Raupach, Jan, additional, Reimann, Gernot, additional, Ringleb, Peter Arthur, additional, Schell, Maximilian, additional, Schlemm, Eckhard, additional, Schönenberger, Silvia, additional, Tennøe, Bjørn, additional, Ulfert, Christian, additional, Vališ, Kateřina, additional, Vítková, Eva, additional, Vollherbst, Dominik F, additional, Wick, Wolfgang, additional, Thomalla, Götz, additional, Adamczewski, Olaf, additional, Alektoror, Kirill, additional, Alexander, März, additional, Alexandrou, Maria, additional, Alias, Quentin, additional, Al-Kuzae, Fadha Elawi, additional, Allard, Julien, additional, Al-Schameri, Rahman, additional, Álvarez, Alberto, additional, Andersen, Grethe, additional, AnkerlundBlaufeldt, Rolf, additional, Antje, Riedel, additional, Appelbohm, Hannes, additional, Argren, Maria, additional, Assmann, Anne, additional, Augustin, Michael, additional, Bach, Elke, additional, Bar, Michal, additional, Barleben, Maria, additional, Baronnet, Flore, additional, Barrios, Andrés, additional, Bavúzová, Xénia, additional, BayThomsen, Rikke, additional, Becker, Sandra, additional, Beer, Sylvia, additional, Behme, Daniel, additional, Bellut, Maximilian, additional, Bendszus, Martin, additional, Berkefeld, Joachim, additional, Bester, Maximillian, additional, Bode, Felix J., additional, Boehme, Christian, additional, Boese, Ramona, additional, Bohmann, Ferdinand, additional, Borggrefe, Jan, additional, Boss, Erendira Gabriela, additional, Boutchakova, Maria, additional, Boxhammer, Elfi, additional, Brandhofe, Annemarie, additional, Breckwoldt, Michael, additional, Brekenfeld, Casper, additional, Brehm, Alex, additional, Brem, Christian, additional, Breuer, Stella, additional, Breyer, Tobias, additional, Brodová, Petra, additional, Broocks, Gabriel, additional, Brosinski, Christoph, additional, Bubel, Nele, additional, Búřil, Jiří, additional, Čábal, Martin, additional, Casado, Laura, additional, Celis, Elena de, additional, Chabert, Emmanuel, additional, Charisse, Daniel, additional, Chovanec, Vendelín, additional, Cidlinsky, Peter, additional, Cisár, Juraj, additional, Clarençon, Fréderic, additional, Crozier, Sophie, additional, Čurdová, Nina, additional, Damaskinos, Michele, additional, Damgaard, Dorte, additional, Daniš, Martin, additional, Dazinger, Florian, additional, Deb-Chatterji, Milani, additional, Delalic, Asima, additional, Delekta, Agnieszka, additional, Delorme, Stephen, additional, Diamandis, Elie, additional, Diedrichsen, Tove, additional, Doležalová, Irena, additional, du Mesnil de Rochemont, Richard, additional, DupontHougaard, Kristina, additional, Ebrahimi, Taraneh, additional, Eff, Florian, additional, Eliášová, Ilona, additional, Enriquez, Brian, additional, Ergawy, Mostafa, additional, Essig, Fabian, additional, Falkesgaard, Maiken, additional, Fandler-Höfler, Simon, additional, Fernández, Andrés, additional, Ferré, Jean-Christophe, additional, Ferrier, Anna, additional, Figlewski, Krystian, additional, Fischer, Sebastian, additional, Fischer, Urs, additional, Forbig, Robert, additional, Förch, Christian, additional, Fromm, Annette, additional, Gaedke, Ines, additional, Galczak, Romana, additional, Galijasevic, Malik, additional, Ganser, Bernhard, additional, Gattringer, Thomas, additional, Gawlitza, Matthias, additional, Gelhard, Sarah, additional, Gerber, Johannes, additional, Giannakakis, Michail Panagiotis, additional, Gindlhuber, Karin, additional, Gizewski, Elke R., additional, Glodny, Bernhard, additional, Godel, Tim, additional, Goebell, Einar, additional, Goldemund, David, additional, Görtler, Michael, additional, Grams, Astrid E., additional, Gruber, Joachim, additional, Gruber, Katharina, additional, Günthner-Lengsfeld, Thomas, additional, Haase, Kathrin, additional, Hacker-Ivan, Floriana, additional, Hallerstig, Erika, additional, Hanning, Uta, additional, Haršány, Michal, additional, Haršány, Ján, additional, Hartmann, Christian, additional, Hassler, Eva Maria, additional, Hauptmann, Kristina, additional, Häusler, Karl Georg, additional, Hecker, Constantin, additional, Hellstern, Victoria, additional, Henkes, Hans, additional, Hernández, Victoria, additional, Hilgenfeld, Tim, additional, Hill, Michael D., additional, Hjort, Niels, additional, HjortJensen, Nina, additional, Hoelter, Maya, additional, Hoffmann, Karl-Titus, additional, Holst, Brigitte, additional, Holtmannspoetter, Markus, additional, Hoppe, Julia, additional, Horner, Susanne, additional, HougaardSoerensen, Leif, additional, Hubert, Alexander, additional, Hurtíková, Eva, additional, Jakubíček, Stanislava, additional, Janjic, Tanja, additional, Jaramillo, Kirsten, additional, Jedlitschka, Angela, additional, Jensen, Schiela, additional, Jesser, Jessica, additional, Jestaedt, Leonie, additional, Johnson, Sabine, additional, Jonszta, Tomáš, additional, Kalmar, Peter, additional, Karabegovic, Sanja, additional, Karen, Kollo, additional, Katja, Hopp, additional, Keeba, Natalia, additional, Keese, Petra, additional, Kefalaykos, Christina, additional, Keil, Fee, additional, Kellert, Lars, additional, Kellinghaus, Christoph, additional, Kestner, Roxane-Isabelle, additional, Kiechl, Stefan, additional, Killer-Oberpfalzer, Monika, additional, Knispel, Casjupea, additional, Knoflach, Michael, additional, Kohler, Sabine, additional, Kohlhase, Konstantin, additional, Kollikowski, Alexander Marco, additional, Kovář, Martin, additional, Krajina, Antonín, additional, Kral, Michael, additional, Krastev, Georgi, additional, Krause, Lars Udo, additional, Kreidenhuber, Rudolf, additional, Křivka, Tomáš, additional, Krkoška, Adam, additional, Kröger, Jan Robert, additional, Kronlage, Moritz, additional, Krukowski, Pawel, additional, Kühn, Julia, additional, Kurka, Natalia, additional, Kuschnerow, Michael, additional, Lachmund, Rita, additional, Lamprecht, Susanne, additional, Lange, Rüdiger, additional, Lauer, Monika, additional, Leciñana, Alonso de, additional, Leder, Sara, additional, Leger, Anne, additional, Lehnen, Nils, additional, Lehrieder, Dominik, additional, Leißner, Maximilian, additional, Leitinger, Markus, additional, Leitner, Ursula, additional, Lenck, Stéphanie, additional, Lenzenweger, Eva, additional, Liebig, Thomas, additional, Lowens, Stephan, additional, Lunzer, Manuel, additional, Maegerlein, Christian, additional, Magyar, Marton, additional, Marques, Leonardo, additional, Matyáš, David, additional, Maurer, Gabriele, additional, Mauritz, Matthias, additional, Maximilian, Thormann, additional, Mayer-Süß, Lukas, additional, Meckel, Stephan, additional, Medek, Oldřich, additional, Meissner, Julius N., additional, Mencl, Pavel, additional, Merkle, Andrea, additional, Mesche, Birte, additional, Michalski, Dominik, additional, Mikulík, Robert, additional, Modrau, Boris, additional, Möhlenbruch, Markus A., additional, Mohr, Alexander, additional, Mönninghoff, Christoph, additional, Moser, Tobias, additional, Mücke, Ramona, additional, Müller-Thies-Broussalis, Erasmia, additional, Mutzenbach, Sebastian, additional, Navia, Pedro, additional, Neuberger, Ulf, additional, Neugebauer, Hermann, additional, Neumann, Jens, additional, Nguyên, Anh, additional, Niederkorn, Kurt, additional, Nosál', Vladimír, additional, Novobilský, Richard, additional, Ntoulias, Nikos, additional, Nussbaum, Lukas, additional, Oder, Joanna, additional, Oldag, Andreas, additional, Ondrejkovič, Marián, additional, Otto, Ferdinand, additional, Otto, Dagmar, additional, Paech, Daniel, additional, Pallesen, Lars-Peder, additional, Panský, Michal, additional, Patrick, Samp, additional, Paukisch, Harald, additional, Pelz, Johann, additional, Petersen, Inga, additional, Petersen, Martina, additional, Petzold, Gabor C., additional, Pfaff, Johannes, additional, Pfeilschifter, Waltraud, additional, Pichler, Alexander, additional, Pikija, Slaven, additional, PlougmannPovlsen, Jan, additional, Polkowski, Christoph, additional, Polomac, Nenad, additional, Portugaller, Rupert Horst, additional, Poulsen, Marika, additional, Preiß, Michael, additional, Premat, Kévin, additional, Prestsæter, Sjur, additional, Prieto-Pérez, Rocio, additional, Psychogios, Marios, additional, Purrucker, Jan, additional, Rai, Heike, additional, Rauch, Maximilian, additional, Reimann, Georg, additional, Reitz, Sarah, additional, Renc, Ondřej, additional, Retzlaff, Jasmin, additional, Rigual, Ricardo, additional, Rivera-Bengoa, Carlota, additional, Rodríguez, Jorge, additional, Rohde, Stefan, additional, Rohler, Siegfried, additional, Rosso, Charlotte, additional, Roth, Christian, additional, Röttcher, Thomas, additional, Roubec, Martin, additional, Roztočilová, Milada, additional, Rudnicka, Svetlana, additional, Ruiz, Gerardo, additional, Ryan, Stephen, additional, Ryckborst, Karla J., additional, Sandvik, Simen, additional, Schäfer, Jan-Hendrik, additional, Schaller-Paule, Martin, additional, Schell, Maximillian, additional, Schellinger, Peter, additional, Schmid, Florian, additional, Schmidt, Christoph, additional, Schmitz, Marie Louise, additional, Schneider, Claus, additional, Scholtz, Jan-Erik, additional, Schröter, Andreas, additional, Schwarz, Daniel, additional, Schwarz, Stephan, additional, Schwarzenhofer, Daniel, additional, Seifert-Held, Thomas, additional, Seiler, Alexander, additional, Seker, Fatih, additional, Shotar, Eimad, additional, Simonsen, Claus Z., additional, Simonsen, Maria Theresa, additional, Sivák, Jozef, additional, Skagen, Karolina, additional, Skjelland, Mona, additional, Šnajdrová, Alena, additional, Solymosi, Lazlo, additional, Sømark, Jesper, additional, Sonnberger, Michael, additional, Soršák, Jakub, additional, Sourour, Nader, additional, Søyland, Jogrim, additional, Spitzer, Daniel, additional, Sporns, Peter, additional, Städt, Michael, additional, Steidl, Eike, additional, Størdal, Anne Margrethe Kaalaas, additional, Stösser, Sebastian, additional, Strickmann, Sarah, additional, Strýček, Ondřej, additional, Suškevič, Igor, additional, Sýkora, Jan, additional, Thaler, Daniela, additional, Theisen, Sara, additional, Trendafilov, Petar, additional, Trenkler, Johannes, additional, Trumm, Christoph, additional, Tsogkas, Ioannis, additional, Tunold, Jon-Anders, additional, Tveit, Lars, additional, Vaníček, Jiří, additional, Vassilev, Christine, additional, Voit-Höhne, Heinz-Leonhard, additional, Vojtíšek, Bohuslav, additional, Volderauer, Karoline, additional, Vollherbst, Dominik, additional, Vollmuth, Christoph, additional, Volna, Kamila, additional, Volný, Ondřej, additional, VonWeitzel-Mudersbach, Poul, additional, Vorčák, Martin, additional, Wagner, Marlies, additional, Wathle, Gaute Kjellevold, additional, Weber, Werner, additional, Weber, Anushe, additional, Weiss, Viktor, additional, Weller, Johannes M., additional, Wenger-Alakmeh, Katharina, additional, Weyland, Cyrill, additional, Weymayr, Friedrich, additional, Wießpeiner, Ulrike, additional, Willeit, Johannes, additional, Wittwer, Aymeric, additional, Wollenweber, Frank, additional, Wortmann, Ginette, additional, Wunderlich, Silke, additional, Xiong, Yanyan, additional, You, Se-Jong, additional, ZachoSpeiser, Lasse, additional, Zelenak, Kamil, additional, Zeleňáková, Jana, additional, and Zubel, Seraphine, additional

Published
2023
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14. Comparison of Thrombolysis In Cerebral Infarction (TICI) 2b and TICI 3 reperfusion in endovascular therapy for large ischemic anterior circulation strokes

Author

Winkelmeier, Laurens, primary, Faizy, Tobias D, additional, Brekenfeld, Caspar, additional, Heitkamp, Christian, additional, Broocks, Gabriel, additional, Bechstein, Matthias, additional, Steffen, Paul, additional, Schell, Maximilian, additional, Gellissen, Susanne, additional, Kniep, Helge, additional, Thomalla, Goetz, additional, Fiehler, Jens, additional, and Flottmann, Fabian, additional

Published
2023
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15. O20/181 Early reperfusion or complete reperfusion TICI 3: determinants of improve outcome after first pass recanalization in mechanical thrombectomy

Author

Kniep, Helge, primary, Meyer, Lukas, additional, Bechstein, Matthias, additional, Winkelmeier, Laurens, additional, Faizy, Tobias, additional, Brekenfeld, Caspar, additional, Flottmann, Fabian, additional, Paula Hanning, Uta Meta, additional, Thomalla, Götz, additional, Fiehler, Jens, additional, and Gellißen, Susanne, additional

Published
2023
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16. P159/213 Early clinical surrogates for functional outcome after mechanical thrombectomy in M2 occlusions compared to M1 occlusions

Author

Kniep, Helge, primary, Meyer, Lukas, additional, Broocks, Gabriel, additional, Bechstein, Matthias, additional, Winkelmeier, Laurens, additional, Faizy, Tobias, additional, Brekenfeld, Caspar, additional, Flottmann, Fabian, additional, Paula Hanning, Uta Meta, additional, Thomalla, Götz, additional, Fiehler, Jens, additional, and Gellißen, Susanne, additional

Published
2023
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17. P152/178 Safety and efficiency of bridging i.v. thrombolysis in M2 occlusions: a propensity-score-matched registry cohort study

Author

Kniep, Helge, primary, Meyer, Lukas, additional, Broocks, Gabriel, additional, Bechstein, Matthias, additional, Faizy, Tobias, additional, Winkelmeier, Laurens, additional, Brekenfeld, Caspar, additional, Flottmann, Fabian, additional, Paula Hanning, Uta Meta, additional, Thomalla, Götz, additional, Fiehler, Jens, additional, and Gellißen, Susanne, additional

Published
2023
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18. Thrombectomy in M2 occlusion compared to M1 occlusion: treatment effects of Thrombolysis In Cerebral Infarction (TICI) 2b and TICI 3 recanalization on functional outcome.

Author

Kniep, Helge, Meyer, Lukas, Broocks, Gabriel, Faizy, Tobias D., Bechstein, Matthias, Brekenfeld, Caspar, Flottmann, Fabian, van Horn, Noel, Geest, Vincent, Winkelmeier, Laurens, Alegiani, Anna, Deb-Chatterji, Milani, Hanning, Uta, Thomalla, Goetz, Fiehler, Jens, and Gellissen, Susanne

Subjects
CEREBRAL artery surgery, ARTERIAL occlusions, STROKE, CEREBRAL infarction, TREATMENT effectiveness, COMPARATIVE studies, THROMBECTOMY, DESCRIPTIVE statistics
Abstract

Background Emerging data suggest that mechanical thrombectomy (MT) might also be safe and efficient for medium and distal occlusions. This study aims to compare average treatment effects on functional outcome of different degrees of recanalization after MT in patients with M2 occlusion and M1 occlusion. Methods All patients enrolled in the German Stroke Registry (GSR) between June 2015 and December 2021 were analyzed. Inclusion criteria were stroke with primary M1 occlusion or M2 occlusion, and availability of relevant clinical data. 4259 patients were included, thereof 1353 with M2 occlusion and 2906 with M1 occlusion. Treatment effects were analyzed using double-robust inverse-probability-weighted regression-adjustment (IPWRA) estimators to control for confounding covariates. Binarized endpoint metrics were defined as good outcome with modified Rankin Scale (mRS) ≤2 at 90 days, and linearized endpoint metrics were defined as mRS shift pre-stroke to 90 days. Effects were evaluated for near complete recanalization (Thrombolysis In Cerebral Infarction scale (TICI) 2b) and complete recanalization (TICI 3). results Treatment effect estimation for TICI ≥2b versus TICI <2b in M2 occlusions showed an increase in the probability of a good outcome from 27% to 47% with a number-needed-to-treat (NNT) of 5. For M1 occlusions the probability of a good outcome increased from 16% to 38% with NNT 4.5. TICI 3 versus TICI 2b increased the probability of a good outcome by 7 percentage points in M1 occlusions; for M2 occlusions the beneficial effect was not significant. Conclusions Results suggest that successful recanalization with TICI ≥2b versus TICI <2b after MT in M2 occlusions provides significant patient benefit with treatment effects comparable to M1 occlusions. The probability of functional independence increased by 20 percentage points (NNT 5) and stroke-related mRS increase was reduced by 0.9 mRS points. In contrast to M1 occlusions, complete recanalization TICI 3 versus TICI 2b had lower additional beneficial effect. [ABSTRACT FROM AUTHOR]

Published
2023
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19. How much of the outcome improvement after successful recanalization is explained by follow-up infarct volume reduction?

Author

Kniep, Helge, primary, Meyer, Lukas, additional, Broocks, Gabriel, additional, Bechstein, Matthias, additional, Austein, Friederike, additional, McDonough, Rosalie V, additional, Brekenfeld, Caspar, additional, Flottmann, Fabian, additional, Deb-Chatterji, Milani, additional, Alegiani, Anna, additional, Hanning, Uta, additional, Thomalla, Goetz, additional, Fiehler, Jens, additional, and Gellissen, Susanne, additional

Published
2023
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20. Discordant and Converting Receptor Expressions in Brain Metastases from Breast Cancer: MRI-Based Non-Invasive Receptor Status Tracking

Author

Heitkamp, Alexander, primary, Madesta, Frederic, additional, Amberg, Sophia, additional, Wahaj, Schohla, additional, Schröder, Tanja, additional, Bechstein, Matthias, additional, Meyer, Lukas, additional, Broocks, Gabriel, additional, Hanning, Uta, additional, Gauer, Tobias, additional, Werner, René, additional, Fiehler, Jens, additional, Gellißen, Susanne, additional, and Kniep, Helge C., additional

Published
2023
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22. Comparison of Thrombolysis In Cerebral Infarction (TICI) 2b and TICI 3 reperfusion in endovascular therapy for large ischemic anterior circulation strokes

Author

Winkelmeier, Laurens, Faizy, Tobias D, Brekenfeld, Caspar, Heitkamp, Christian, Broocks, Gabriel, Bechstein, Matthias, Steffen, Paul, Schell, Maximilian, Gellissen, Susanne, Kniep, Helge, Thomalla, Goetz, Fiehler, Jens, and Flottmann, Fabian

Abstract

BackgroundLandmark thrombectomy trials have provided evidence that selected patients with large ischemic stroke benefit from successful endovascular therapy, commonly defined as incomplete (modified Thrombolysis In Cerebral Infarction (mTICI) 2b) or complete reperfusion (mTICI 3). We aimed to investigate whether mTICI 3 improves functional outcomes compared with mTICI 2b in large ischemic strokes.MethodsThis retrospective multicenter cohort study was conducted to compare mTICI 2b versus mTICI 3 in large ischemic strokes in the anterior circulation. Patients enrolled in the German Stroke Registry between 2015–2021 were analyzed. Large ischemic stroke was defined as an Alberta Stroke Program Early CT Score (ASPECTS) of 3–5. Patients were matched by final mTICI grade using propensity score matching. Primary outcome was the 90-day modified Rankin Scale (mRS) score.ResultsAfter matching, 226 patients were included. Baseline and imaging characteristics were balanced between mTICI 2b and mTICI 3 patients. There was no shift on the mRS favoring mTICI 3 compared with mTICI 2b in large ischemic strokes (adjusted common odds ratio (acOR) 1.12, 95% confidence interval (95% CI) 0.64 to 1.94, P=0.70). The rate of symptomatic intracranial hemorrhage was higher in mTICI 2b than in mTICI 3 patients (12.6% vs 4.5%, P=0.03). Mortality at 90 days did not differ between mTICI 3 and mTICI 2b (33.6% vs 37.2%; adjusted OR 0.69, 95% CI 0.33 to 1.45, P=0.33).ConclusionsIn endovascular therapy for large ischemic strokes, mTICI 3 was not associated with better 90-day functional outcomes compared with mTICI 2b. This study suggests that mTICI 2b might be warranted as the final angiographic result, questioning the benefit/risk ratio of additional maneuvers to seek for mTICI 3 in large ischemic strokes.Trial registration numberNCT03356392.

Published
2024
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23. How Much of the Outcome Improvement after Successful Recanalization is Explained by Follow-up Infarct Volume Reduction?

Author

Kniep, Helge C, primary, Meyer, Lukas, additional, Broocks, Gabriel, additional, Bechstein, Matthias, additional, Austein, Friederike, additional, McDonough, Rosalie V, additional, Brekenfeld, Caspar, additional, Flottmann, Fabian Alexander, additional, Deb-Chatterji, Milani, additional, Alegiani, Anna Christina, additional, Hanning, Uta, additional, Thomalla, Götz, additional, Fiehler, Jens, additional, and Gellissen, Susanne, additional

Published
2023
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24. How Much of the Thrombectomy Related Improvement in Functional Outcome Is Already Apparent at 24 Hours and at Hospital Discharge?

Author

Kniep, Helge, primary, Meyer, Lukas, additional, Bechstein, Matthias, additional, Broocks, Gabriel, additional, Guerreiro, Helena, additional, van Horn, Noel, additional, Brekenfeld, Caspar, additional, Flottmann, Fabian, additional, Deb-Chatterji, Milani, additional, Alegiani, Anna, additional, Thomalla, Götz, additional, Hanning, Uta, additional, Fiehler, Jens, additional, Gellißen, Susanne, additional, Reich, PD Arno, additional, Nikoubashman, Omid, additional, Röther, Joachim, additional, Eckert, Bernd, additional, Braun, Michael, additional, Hamann, Gerhard F., additional, Siebert, PD Eberhard, additional, Nolte, Christian, additional, Zweynert, Sarah, additional, Bohner, Georg, additional, Borggrefe, Jan, additional, Schellinger, Peter, additional, Berrouschot, Jörg, additional, Bormann, Albrecht, additional, Kraemer, Christoffer, additional, Leischner, Hannes, additional, Hattingen, Jörg, additional, Petersen, Martina, additional, Stögbauer, Florian, additional, Boeckh-Behrens, PD, additional, Wunderlich, Silke, additional, Ludolph, Alexander, additional, Henn, Karl-Heinz, additional, Gerloff, Christian, additional, Dorn, PD Franziska, additional, Petzold, Gabor, additional, Schäfer, Jan Hendrik, additional, Keil, Fee, additional, Tiedt, Steffen, additional, Kellert, PD Lars, additional, Trumm, PD Christoph, additional, Ernemann, Ulrike, additional, Poli, PD Sven, additional, Liman, Jan, additional, Ernst, PD Marielle, additional, Gröschel, Klaus, additional, and Uphaus, Timo, additional

Published
2022
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25. Common data elements reported on middle meningeal artery embolization in chronic subdural hematoma: an interactive systematic review of recent trials

Author

Adusumilli, Gautam, primary, Ghozy, Sherief, additional, Kallmes, Kevin M, additional, Hardy, Nicole, additional, Tarchand, Ranita, additional, Zinn, Caleb, additional, Lamar, Duncan, additional, Singeltary, Emily, additional, Siegel, Lauren, additional, Kallmes, David F, additional, Arthur, Adam S, additional, Gellissen, Susanne, additional, Fiehler, Jens, additional, and Heit, Jeremy J, additional

Published
2022
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27. Early surrogates of outcome after thrombectomy in posterior circulation stroke.

Author

Kniep, Helge, Bechstein, Matthias, Broocks, Gabriel, Brekenfeld, Caspar, Flottmann, Fabian, van Horn, Noel, Geest, Vincent, Faizy, Tobias D., Deb‐Chatterji, Milani, Alegiani, Anna, Thomalla, Götz, Gellißen, Susanne, Fiehler, Jens, Hanning, Uta, and Meyer, Lukas

Subjects
BASILAR artery, THROMBECTOMY, LOGISTIC regression analysis, VERTEBRAL artery, ARTERIAL occlusions, ODDS ratio
Abstract

Background: Early surrogates for functional outcome in anterior circulation stroke have been described with the National Institute of Health Stroke Scale (NIHSS) at 24 h being reported as the most accurate metric. We compare discriminatory power of established definitions of early neurological improvement (ENI) and NIHSS scores at admission and 24 h to predict functional outcome at 90 days after thrombectomy in posterior circulation stroke (PCS). Methods: All patients enrolled in the German Stroke Registry (June 2015–December 2019) with PCS and at least vertebral or basilar artery occlusions were included. NIHSS admission, 24 h and ENI definitions (improvement of 8/10 NIHSS points or 0/1 NIHSS points at 24 h) were compared for predicting functional outcome at 90 days. Favourable and good outcome were defined as modified Rankin Scale (mRS) 0–2 and 0–3. Multivariable logistic regression analysis was conducted to identify factors impairing predictive power. Results: Three hundred and eighty‐seven patients were included. NIHSS 24 h had the highest discriminative power with receiver operator characteristics area under the curve of 0.87 (95% confidence interval: 0.83; 0.90) for good and 0.89 (0.85; 0.92) for favourable outcome; optimal cut‐off values were ≤9 and ≤5. Higher age (odds ratio = 1.10 [1.05; 1.16]), adverse events during treatment (9.46 [1.52; 72.5]) and until discharge (18.34 [2.33; 172]) and high NIHSS scores at 24 h (1.29 [1.10; 1.53]) were independent predictors for turning the outcome prognosis from good (mRS ≤3) to poor (mRS ≥4). Conclusions: NIHSS 24 h ≤9 points serves best as surrogate for good functional outcome after thrombectomy in PCS. Advanced age, severe neurological symptoms at admission and adverse events decrease its predictive value. [ABSTRACT FROM AUTHOR]

Published
2022
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28. Endovascular thrombectomy for acute ischaemic stroke with established large infarct (TENSION): 12-month outcomes of a multicentre, open-label, randomised trial.

Author

Thomalla, Götz, Fiehler, Jens, Subtil, Fabien, Bonekamp, Susanne, Aamodt, Anne Hege, Fuentes, Blanca, Gizewski, Elke R, Hill, Michael D, Krajina, Antonin, Pierot, Laurent, Simonsen, Claus Z, Zeleňák, Kamil, Blauenfeldt, Rolf A, Cheng, Bastian, Denis, Angélique, Deutschmann, Hannes, Dorn, Franziska, Flottmann, Fabian, Gellißen, Susanne, and Gerber, Johannes C

Subjects
*ENDOVASCULAR surgery, *ISCHEMIC stroke, *STROKE, *MENTAL depression, *THERAPEUTICS
Abstract

Long-term data showing the benefits of endovascular thrombectomy for stroke with large infarct are scarce. The TENSION trial showed the safety and efficacy of endovascular thrombectomy in patients with ischaemic stroke and large infarct at 90 days. We aimed to investigate the safety and efficacy at 12 months of endovascular thrombectomy in patients who were enrolled in the TENSION trial. TENSION was an open-label, blinded endpoint, randomised trial done at 40 hospitals across Europe and one hospital in Canada. We included patients (aged ≥18 years) with acute ischaemic stroke due to large vessel occlusion in the anterior circulation and who had a large infarct, as indicated by an Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) of 3–5 on standard-of-care stroke imaging. We randomly assigned patients (1:1) to receive either endovascular thrombectomy with medical treatment or medical treatment only up to 12 h from stroke onset. The primary outcome was functional outcome across the entire range of the modified Rankin Scale at 90 days. Here, we report the prespecified 12-month follow-up analyses for functional outcome (using the simplified modified Rankin Scale questionnaire), quality of life (using the Patient-Reported Outcomes Measurement Information System 10-item [PROMIS-10] and EQ-5D questionnaires), post-stroke anxiety and depression (using the Patient Health Questionnaire-4 [PHQ-4]), and overall survival. Outcomes (except survival) were assessed in the intention-to-treat population; the survival analysis was based on treatment received. This trial is registered with ClinicalTrials.gov , NCT03094715 , and is completed. We enrolled patients between July 17, 2018, and Feb 21, 2023, when the trial was stopped early for efficacy. 253 patients were randomly assigned, 125 (49%) to endovascular thrombectomy and 128 (51%) to medical treatment only. Median follow-up was 8·36 months (IQR 0·02–12·00). Endovascular thrombectomy was associated with a shift in the distribution of scores on the modified Rankin Scale towards better functional outcome at 12 months (adjusted common odds ratio 2·39 [95% CI 1·47–3·90]). Endovascular thrombectomy was also associated with a better quality of life compared with medical treatment only, as reflected by median scores on the EQ-5D questionnaire index (0·7 [IQR 0·4–0·9] vs 0·4 [0·2–0·7]), median scores for health status on the EQ-5D questionnaire visual analogue scale (50 [IQR 35–70] vs 30 [5–60]), and median global physical health scores on the PROMIS-10 questionnaire (T-score 39·8 [IQR 37·4–50·8] vs 37·4 [32·4–44·9]); although there was not enough evidence to suggest a difference between groups in global mental health scores on PROMIS-10 (41·1 [IQR 36·3–48·3] vs 38·8 [31·3–44·7]) or the numbers of patients reporting anxiety (13 [22%] of 58 vs 15 [42%] of 36) and depression (18 [31%] vs 18 [50%]) on PHQ-4. Overall survival was slightly better in the endovascular thrombectomy group compared with medical treatment only (adjusted hazard ratio 0·70 [95% CI 0·50–0·99]). In patients with acute ischaemic stroke from large vessel occlusion with established large infarct, compared with medical treatment only, endovascular thrombectomy was associated at 12 months after stroke with better functional outcome, quality of life, and overall survival. These findings suggest that the benefits of endovascular thrombectomy in patients with an ischaemic stroke and a large infarct are sustained in the long term and support the use of endovascular thrombectomy in these patients. European Union Horizon 2020 Research and Innovation Programme. [ABSTRACT FROM AUTHOR]

Published
2024
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29. Early stopping versus continued retrievals after failed recanalization: associated factors and implications for outcome.

Author

Kniep HC, Meyer L, Broocks G, Bechstein M, Heitkamp C, Winkelmeier L, Geest V, Faizy TD, Feyen L, Brekenfeld C, Flottmann F, McDonough RV, Maros M, Schell M, Hanning U, Thomalla G, Fiehler J, and Gellissen S

Abstract

Background: Successful recanalization defined as modified Thrombolysis in Cerebral Infarction Score (mTICI) ≥2b is not achieved in 15%-20% of patients with acute ischemic stroke. This study aims to identify patient-specific factors associated with early stopping without successful recanalization. We hypothesized that the probability of the decision for early stopping during mechanical thrombectomy (MT) is higher in patients with an unfavorable prognosis., Methods: All patients enrolled in the German Stroke Registry (GSR) between June 2015 and December 2021 were screened. Inclusion criteria were stroke in the anterior circulation and availability of relevant clinical data. For each retrieval attempt 1-3, patients with stopping and failed reperfusion (mTICI <2b) were compared with all patients with continued retrieval attempts using descriptive statistics and multivariable logistic regression., Results: Our study included 2977 patients, 350 (12%) of which had early stopping. Higher pre-stroke Modified Rankin Scale (mRS) score (adjusted odds ratio (aOR) =1.20 (95% confidence interval (CI): 1.09; 1.32), P<0.001), higher age (aOR=1.01 (1.00; 1.02), P=0.017) and distal occlusions (aOR=1.93 (1.50; 2.47), P<0.001) as well as intraprocedural dissections/perforations (aOR=4.61 (2.95; 7.20), P<0.001) and extravasation (aOR=2.43 (1.55;3.82), P<0.001) were associated with early stopping. In patients with unsuccessful recanalization (n=622), the number of retrieval attempts (aOR=1.05 (0.94; 1.18), p=0.405) was not associated with unfavorable outcomes (90d-mRS>3)., Conclusion: The probability of early stopping was higher in patients with clinical conditions associated with: a) Favorable prognosis and assumed lower impact of recanalization success on functional status, such as distal occlusions; and b) Unfavorable prognosis, such as higher age and reduced pre-stroke functional status. Adverse events during the procedure increased the probability of early stopping. The number of recanalization attempts did not increase the risk of unfavorable outcome for patients with persistent occlusion, supporting the decision for continuation of retrieval attempts., Competing Interests: Competing interests: HK and FF are consultants for Eppdata GmbH. HK is shareholder of Eppdata GmbH. GT received consultancy fees from Acandis, Boehringer Ingelheim, Bayer, and Portola, and fees as lecturer from Acandis, Alexion, Amarin, Bayer, Boehringer-Ingelheim, BMS/Pfizer, Daiichii Sankyo and Portola. He serves in the board of the TEA Stroke Study and of ESO. JF is consultant for Cerenovus, Medtronic, Microvention, Penumbra, Phenox, Roche and Tonbridge. He serves on the advisory board of Stryker and Phenox. He is a stock holder of Tegus Medical, Eppdata and Vastrax. He serves as Associate Editor at JNIS., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2024
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