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18 results on '"A. Von Hessling"'

1. A Case of Fulminant Listeria Rhombencephalitis with Brainstem Abscesses in a 37-Year-Old Immunocompetent Patient: From Vestibular Neuritis to Ondine's Curse

Author

Veronica Percuoco, Oliver Kemp, Manuel Bolognese, Alexander von Hessling, Johannes B.J. Scholte, and Ulf C. Schneider

Subjects
Surgery, Neurology (clinical)
Abstract

We present a rare case of Listeria monocytogenes (LM) rhombencephalitis with the formation of multifocal abscesses in a young immunocompetent patient. His initial symptoms of dizziness, headache, and feeling generally unwell were put down to a coincidental coinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The unfortunate rapid progression to trigeminal, hypoglossal, vagal, facial, and abducens nuclei palsies, and then an acquired central hypoventilation syndrome, known as Ondine's curse, required a prolonged intensive care unit (ICU) stay, and prolonged mechanical ventilation. As they continued to deteriorate despite targeted antibiotic treatment, surgical drainage of the abscesses was seen as the only meaningful available treatment option left to contain the disease. Postoperatively, the patient's strength rapidly improved as well as the severity of the cranial nerve palsies. After prolonged rehabilitation, at 3 months of follow-up, the patient was weaned off mechanical ventilation, independently mobile, and was left with only minor residual neurologic deficits. This case highlights a number of interesting findings only touched upon in current literature including the route of entry of LM into the central nervous system, the rare entity of acquired central hypoventilation syndrome, and finally the use of surgical intervention in cerebral LM infections.

Published
2022
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2. Technical considerations and tips for using the Tegus remote proctoring system in elective and emergency cases and in webinars

Author

Alexander von Hessling, Tomás Reyes del Castillo, Justus Erasmus Roos, and Grzegorz Marek Karwacki

Subjects
Male, COVID-19, Humans, Surgery, Neurology (clinical), General Medicine, Pandemics, Software
Abstract

Smart angiography suites (SAS) refer to the incorporation of audio-video technology and internet connectivity into the angiography suite to enable bidirectional communication for teleproctoring. Remote streaming support (RESS) is intended to increase patient safety by supporting interventionalists with limited experience or who are practicing in geographically remote areas. The aim of this review is to describe real-life experience of the Tegus system and to share practical tips concerning its use and setup. We describe the platform itself, settings and integration in our angiography suite. We provide technical tips intended to help new and potential users to achieve an optimal experience for both neurointerventionalists and proctors. We describe both elective cases that we have performed with teleproctoring and emergencies. Lastly, we describe a different room setup and software solutions used in live workshops. Use of teleproctoring enabled involvement of proctors in cases where an already experienced interventionalist needed support in the decision-making process concerning the sizing and deployment of devices with which he was familiar only on a basic level. Excellent video feed quality and instant communication enabled optimal preparation and in vivo implantation of those devices without the need for physical proctors’ presence. In emergency cases the system allowed a senior physician to offer support during cases where optimal device sizing is critical. Our usage concept of the rig permitted monitoring of thrombectomy cases by junior physicians. During webinars a remote streaming platform enabled us to conduct workshops that simulated an “on-site” experience as closely as possible during the COVID-19 pandemic.

Published
2022
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3. The Columbus steerable guidewire in neurointerventions: early clinical experience and applications

Author

Alexander von Hessling, Justus Erasmus Roos, Tomas Reyes del Castillo, and Grzegorz Karwacki

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Target vessel, Catheterization, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, Humans, Medicine, Embolization, Acute ischemic stroke, Ischemic Stroke, Thrombectomy, medicine.diagnostic_test, business.industry, Angiography, Digital Subtraction, General Medicine, Digital subtraction angiography, Neurovascular bundle, medicine.disease, Embolization, Therapeutic, Surgery, Stenosis, Female, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

ObjectiveTo report our early experience in using the steerable ‘Columbus’ guidewire, also known as ‘Drivewire’ in the USA, and its potential applications in neurovascular interventions.MethodsNeurointerventions in 36 patients (20 female, 16 male) using the steerable Columbus guidewire were recorded from August 2019 to December 2020 and included a variety of neurovascular procedures: Treatment of aneurysms (n=17), thrombectomy in acute ischemic stroke (n=12), and others (n=7), such as treatment of stenosis and embolization procedures. Immediate follow-up with digital subtraction angiography and tracking of each patient’s clinical outcome was performed.ResultsIn 35 out of 36 cases, the target vessel was reached with Columbus, including advancement of the appropriate microcatheter. In 14 cases, additional wires were used, mainly because of the nature of the procedures (eg, use of multiple wires/buddy wires or exchange maneuvers). In five cases, the Columbus wire was damaged by the operator and had to be replaced. Peri-interventional complications occurred in two patients, neither attributed to the Columbus guidewire.ConclusionsThe new Columbus neurovascular guidewire has the unique ability to be shaped within the patient. Currently available versions lack torquability compared with other available guidewires but offer tremendous support at the tip, allowing maneuvers which are impossible with other wires on the market.

Published
2021
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4. Applications of the Columbus steerable guidewire

Author

Alexander von Hessling, Tomas Reyes del Castillo, Justus Erasmus Roos, Lutz Lehmann, and Grzegorz Karwacki

Subjects
Posterior Cerebral Artery, Microsurgery, business.industry, Acoustics, General Medicine, Pericallosal Artery, Curvature, Catheterization, Medicine, Humans, Surgery, Stents, Neurology (clinical), Basilar tip aneurysm, Israel, business
Abstract

The Columbus steerable guidewire (Rapid Medical, Israel) is a 0.014 inch guidewire with a remotely controlled deflectable tip intended for neuronavigational purposes. 1 The tip can be shaped by pulling or pushing the handle. Pulling the handle decreases the radius (from 4 mm to 2 mm) and curves the tip, while pushing the handle increases the curvature radius and straightens the tip until it bends in the opposite direction. The amount of deflection is at the discretion of the operator. Video 1 The response of the Columbus guidewire to rotational movements is inferior to that of standard wires, and the tip is very soft and malleable but brings great support when bent. We present two cases where the Columbus guidewire was used. In the first case, the Columbus enabled us to probe a posterior cerebral artery arising from a giant basilar tip aneurysm without wall contact. In the second case, the Columbus was used as a secondary wire to help cannulate the pericallosal artery in a patient with a recurrent anterior complex aneurysm; this subsequently permitted successful stent-assisted coiling of the aneurysm.Video 1­

Published
2021

5. Radial Access Simulation Using Mentice

Author

Grzegorz Marek Karwacki, Tomas Reyes del Castillo, and Alexander von Hessling

Subjects
Treatment Outcome, Catheterization, Peripheral, Radial Artery, Humans, Surgery, Neurology (clinical), Coronary Angiography
Published
2022
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6. Vascular Anatomy Predicts the Risk of Cerebral Ischemia in Patients Randomized to Carotid Stenting Versus Endarterectomy

Author

Toby Richards, F.J. Ahlhelm, Aad van der Lugt, Philippe Lyrer, H. Bart van der Worp, Leo H. Bonati, Stefan T. Engelter, Alexander von Hessling, Mandy D. Müller, Martin M. Brown, Jeroen Hendrikse, Sumaira Macdonald, Paul J. Nederkoorn, D Doig, Christoph Stippich, Radiology & Nuclear Medicine, ANS - Neurovascular Disorders, Neurology, ACS - Amsterdam Cardiovascular Sciences, and ACS - Atherosclerosis & ischemic syndromes

Subjects
Male, Risk, medicine.medical_specialty, Computed Tomography Angiography, medicine.medical_treatment, Ischemia, Aorta, Thoracic, 030204 cardiovascular system & hematology, Brain Ischemia, law.invention, Brain ischemia, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, Humans, Carotid Stenosis, cardiovascular diseases, Stroke, Aged, Endarterectomy, Aged, 80 and over, Advanced and Specialized Nursing, Endarterectomy, Carotid, medicine.diagnostic_test, business.industry, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Cerebral Angiography, Surgery, Diffusion Magnetic Resonance Imaging, Outcome and Process Assessment, Health Care, Angiography, Cardiology, Female, Stents, Neurology (clinical), Carotid stenting, Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures, Carotid Artery, Internal, Magnetic Resonance Angiography, 030217 neurology & neurosurgery, Cerebral angiography
Abstract

Background and Purpose— Complex vascular anatomy might increase the risk of procedural stroke during carotid artery stenting (CAS). Randomized controlled trial evidence that vascular anatomy should inform the choice between CAS and carotid endarterectomy (CEA) has been lacking. Methods— One-hundred eighty-four patients with symptomatic internal carotid artery stenosis who were randomly assigned to CAS or CEA in the ICSS (International Carotid Stenting Study) underwent magnetic resonance (n=126) or computed tomographic angiography (n=58) at baseline and brain magnetic resonance imaging before and after treatment. We investigated the association between aortic arch configuration, angles of supra-aortic arteries, degree, length of stenosis, and plaque ulceration with the presence of ≥1 new ischemic brain lesion on diffusion-weighted magnetic resonance imaging (DWI+) after treatment. Results— Forty-nine of 97 patients in the CAS group (51%) and 14 of 87 in the CEA group (16%) were DWI+ (odds ratio [OR], 6.0; 95% confidence interval [CI], 2.9–12.4; P P =0.027) and the degree of the largest internal carotid artery angle (≥60° versus P =0.002) were both associated with DWI+, also after correction for age. No predictors for DWI+ were identified in the CEA group. The DWI+ risk in CAS increased further over CEA if the largest internal carotid artery angle was ≥60° (OR, 11.8; 95% CI, 4.1–34.1) than if it was P =0.035). Conclusions— Complex configuration of the aortic arch and internal carotid artery tortuosity increase the risk of cerebral ischemia during CAS, but not during CEA. Vascular anatomy should be taken into account when selecting patients for stenting. Clinical Trial Registration— URL: http://www.isrctn.com/ISRCTN25337470 . Unique identifier: ISRCTN25337470.

Published
2017
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7. Diagnosis and Treatment of Cervical Artery Dissection

Author

Christopher Traenka, Stefan T. Engelter, Alexander von Hessling, and Philippe Lyrer

Subjects
medicine.medical_specialty, Cervical Artery, medicine.medical_treatment, Dissection (medical), law.invention, Hematoma, Fibrinolytic Agents, Randomized controlled trial, law, Antithrombotic, medicine, Humans, cardiovascular diseases, Stroke, business.industry, Endovascular Procedures, Anticoagulants, Brain, Arteries, Thrombolysis, medicine.disease, Surgery, Aortic Dissection, Observational study, Neurology (clinical), Radiology, business
Abstract

Cervical artery dissection (CAD) is a major cause of stroke in the young. A mural hematoma is detected in most CAD patients. The intramural blood accumulation should not be considered a reason to withhold intravenous thrombolysis in patients with CAD-related stroke. Because intravenous-thrombolyzed CAD patients might not recover as well as other stroke patients, acute endovascular treatment is an alternative. Regarding the choice of antithrombotic agents, this article discusses the findings of 4 meta-analyses across observational data, the current status of 3 randomized controlled trials, and arguments and counterarguments favoring anticoagulants over antiplatelets. Furthermore, the role of stenting and surgery is addressed.

Published
2015
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8. Erratum to 'Choices of Stent and Cerebral Protection in the Ongoing ACST-2 Trial: A Descriptive Study' (European Journal of Vascular and Endovascular Surgery (2017) 53(5) (617–625) (S1078588417300424) (10.1016/j.ejvs.2016.12.034))

Author

de Waard, D. D., Halliday, A., de Borst, G. J., Bulbulia, R., Huibers, A., Casana, R., Bonati, L. H., Tolva, V., Fraedrich, G., Rantner, B., Gizewski, E., Gruber, I., Hendriks, J., Cras, P., Lauwers, P., van Scheil, P., Vermassen, F., Van Herzeele, I., Geenens, M., Hemelsoet, D., Lerut, P., Lambrecht, B., Saad, G., Peeters, A., Bosiers, M., da Silva, E., de Luccia, N., Sitrangulo, J. C., Estenssoro, A. E. V., Presti, C., Casella, I., Monteiro, J. A. T., Campos, W., Puech-Leao, P., Petrov, V., Bachvarov, C., Hill, M., Mitha, A., Wong, J., Liu, C. -W., Bao, L., Yu, C., Cvjetko, I., Vidjak, V., Fiedler, J., Ostry, S., Sterba, L., Kostal, P., Staffa, R., Vlachovsky, R., Privara, M., Kriz, Z., Vojtisek, B., Krupa, P., Reif, M., Benes, V., Buchvald, P., Endrych, L., Prochazka, V., Kuliha, M., Otahal, D., Hrbac, T., Netuka, D., Mohapl, M., Kramier, F., Eldessoki, M., Heshmat, H., Abd-Allah, F., Palmiste, V., Margus, S., Toomsoo, T., Becquemin, J. -P., Bergeron, P., Abdulamit, T., Cardon, J. -M., Debus, S., Thomalla, G., Fiehler, J., Gerloss, C., Grzyska, U., Storck, M., Lamacchia, E., Eckstein, H. H., Söllner, H., Berger, H., Kallmayer, M., Popert, H., Zimmermann, A., Guenther, A., Klingner, C., Mayer, T., Schubert, J., Zanow, J., Scheinert, D., Banning-Eichenseer, U., Bausback, Y., Branzan, D., Braünilch, S., Lenzer, J., Schidt, A., Staab, H., Ulirch, M., Barlinn, J., Haase, K., Abramyuk, A., Bodechtel, U., Gerber, J., Reeps, C., Pfeiffer, T., Torello, G., Cöster, A., Giannoukas, A., Spanos, K., Matsagkas, M., Koutias, S., Vasdekis, S., Kakisis, J., Moulakakis, K., Lazaris, A., Liapas, C., Brountzos, E., Lazarides, M., Ioannou, N., Polydorou, A., Fulop, B., Fako, E., Voros, E., Bodosi, M., Nemeth, T., Barzo, P., Pazdernyik, S., Entz, L., Szeberin, Z., Dosa, E., Nemes, B., Jaranyi, Z., Pazdernyia, S., Madhaban, P., Hoffman, A., Nikolsky, E., Beyar, R., Silingardi, R., Lauricella, A., Coppi, G., Nicoloci, E., Tusini, N., Strozzi, F., Vecchiati, E., Ferri, M., Ferrero, E., Psacharopulo, D., Gaggiano, A., Viazzo, A., Farchioni, L., Parlani, G., Caso, V., De Rangoy, P., Verzini, F., Castelli, P., Delodovici, M. L., Carrafiello, G., Ierardi, A. M., Piffaretti, G., Nano, G., Occhiuto, M. T., Malacrida, G., Tealdi, D., Steghter, S., Stella, A., Pini, R., Faggioli, G., Sacca, S., Negri, M. D., Palombo, M., Perfumo, M. C., Fadda, G. F., Kasemi, H., Cernetti, C., Tonello, D., Visonà, A., Mangialardi, N., Ronchey, S., Altavista, M. C., Michelagnoli, S., Chisci, E., Speziale, F., Capoccia, L., Veroux, P., Giaquinta, A., Patti, F., Pulli, R., Boggia, P., Angiletta, D., Amatucci, G., Spinetti, F., Mascoli, F., Tsolaki, E., Civilini, E., Reimers, B., Snoch-Ziólkiewicz, M., Gabriel, M., Odero, A., Accrocca, F., Bajardi, G., Takashi, I., Masayuki, E., Hidenori, E., Aidashova, B., Kospanov, N., Bakke, S., Skjelland, M., Czlonkowska, A., Kobayashi, A., Proczka, R., Dowzenko, A., Czepel, W., Polanski, J., Bialek, P., Ozkinis, G., Stanisic, M., Iwanowski, W., Andziak, P., Gonçalves, F. B., Starodubtsev, V., Ignatenko, P., Karpenko, A., Radak, D., Aleksic, N., Sagic, D., Davidovic, L., Koncar, I., Tomic, I., Colic, M., Bartkoy, D., Rusnak, F., Gaspirini, M., Praczek, P., Milosevic, Z., Flis, V., Bergauer, A., Kobilica, N., Miksic, K., Matela, J., Blanco, E., Guerra, M., Riambau, V., Gillgren, P., Skioldebrand, C., Nymen, N., Berg, B., Delle, M., Formgren, J., Kally, T. B., Qvarfordt, P., Plate, G., Pärson, H., Lindgren, H., Bjorses, K., Gottsäter, A., Warvsten, M., Kristmundsson, T., Forssell, C., Malina, M., Holst, J., Kuhme, T., Sonesson, B., Lindblad, B., Kolbel, T., Acosta, S., Bonati, L., Traenka, C., Mueller, M., Lattman, T., Wasner, M., Mujagic, E., Von Hessling, A., Isaak, A., Stierli, P., Eugster, T., Mariani, L., Stippich, C., Wolff, T., Kahles, T., Toorop, R., Moll, F., Lo, R., Meershoek, A., Jahrome, A. K., Vos, A. W. F., Schuiling, W., Keunen, R., Reijnen, M., Macsweeney, S., Mcconachie, N., Southam, A., Stansby, G., Lees, T., Lambert, D., Clarke, M., Wyatt, M., Kappadath, S., Wales, L., Jackson, R., Raudonaitis, A., Macdonald, S., Dunlop, P., Brown, A., Vetrivel, S., Bajoriene, M., Gopi, R., Mccollum, C., Wolowczyk, L., Ghosh, J., Seriki, D., Ashleigh, R., Butterfield, J., Welch, M., Smyth, J. V., Briley, D., Schulz, U., Perkins, J., Hands, L., Kuker, W., Darby, C., Handa, A., Sekaran, L., Poskitt, K., Morrison, J., Guyler, P., Grunwald, I., Brown, J., Jakeways, M., Tysoe, S., Hargroves, D., Gunathilagan, G., Insall, R., Senaratne, J., Beard, J., Cleveland, T., Nawaz, S., Lonsdale, R., Turner, D., Gaines, P., Nair, R., Chetter, I., Robinson, G., Akomolafe, B., Hatfield, J., Saastamoinen, K., Crinnion, J., Egun, A. A., Thomas, J., Drinkwater, S., D'Souza, S., Thomson, G., Gregory, B., Babu, S., Joseph, T., Gibbs, R., Tebit, G., Mehrzad, A., Enevoldson, P., Mendalow, D., Parry, A., Tervitt, G., Clifton, A., Nazzel, M., Peto, R., Pan, H., Potter, J., Bullbulia, R., Ashley, S., Flather, M., Mansfield, A., Simpson, D., Thomas, D., Gray, W., Farrell, B., Davies, C., Rahimi, K., Gough, M., Cao, P., Rothwell, P., Belli, A., Mafham, M., Herrington, W., Sandercock, P., Gray, R., Shearman, C., Molyneux, A., Gray, A., Clarke, A., Sneade, M., Tully, L., Brudlo, W., Lay, M., Munday, A., Berry, C., Tochlin, S., Mihaylova, B., Cox, J., Kurien, R., Chester, J. Giaquinta A., de Waard, D.D., Halliday, A., de Borst, G.J., Bulbulia, R., Huibers, A., Casana, R., Bonati, L.H., Tolva, V., Fraedrich, G., Rantner, B., Gizewski, E., Gruber, I., Hendriks, J., Cras, P., Lauwers, P., van Scheil, P., Vermassen, F., Van Herzeele, I., Geenens, M., Hemelsoet, D., Lerut, P., Lambrecht, B., Saad, G., Peeters, A., Bosiers, M., da Silva, E., de Luccia, N., Sitrangulo, J.C., Estenssoro, A.E.V., Presti, C., Casella, I., Monteiro, J.A.T., Campos, W., Puech-Leao, P., Petrov, V., Bachvarov, C., Hill, M., Mitha, A., Wong, J., Liu, C.-W., Bao, L., Yu, C., Cvjetko, I., Vidjak, V., Fiedler, J., Ostry, S., Sterba, L., Kostal, P., Staffa, R., Vlachovsky, R., Privara, M., Kriz, Z., Vojtisek, B., Krupa, P., Reif, M., Benes, V., Buchvald, P., Endrych, L., Prochazka, V., Kuliha, M., Otahal, D., Hrbac, T., Netuka, D., Mohapl, M., Kramier, F., Eldessoki, M., Heshmat, H., Abd-Allah, F., Palmiste, V., Margus, S., Toomsoo, T., Becquemin, J.-P., Bergeron, P., Abdulamit, T., Cardon, J.-M., Debus, S., Thomalla, G., Fiehler, J., Gerloss, C., Grzyska, U., Storck, M., LaMacchia, E., Eckstein, H.H., Söllner, H., Berger, H., Kallmayer, M., Popert, H., Zimmermann, A., Guenther, A., Klingner, C., Mayer, T., Schubert, J., Zanow, J., Scheinert, D., Banning-Eichenseer, U., Bausback, Y., Branzan, D., Braünilch, S., Lenzer, J., Schidt, A., Staab, H., Ulirch, M., Barlinn, J., Haase, K., Abramyuk, A., Bodechtel, U., Gerber, J., Reeps, C., Pfeiffer, T., Torello, G., Cöster, A., Giannoukas, A., Spanos, K., Matsagkas, M., Koutias, S., Vasdekis, S., Kakisis, J., Moulakakis, K., Lazaris, A., Liapas, C., Brountzos, E., Lazarides, M., Ioannou, N., Polydorou, A., Fulop, B., Fako, E., Voros, E., Bodosi, M., Nemeth, T., Barzo, P., Pazdernyik, S., Entz, L., Szeberin, Z., Dosa, E., Nemes, B., Jaranyi, Z., Pazdernyia, S., Madhaban, P., Hoffman, A., Nikolsky, E., Beyar, R., Silingardi, R., Lauricella, A., Coppi, G., Nicoloci, E., Tusini, N., Strozzi, F., Vecchiati, E., Ferri, M., Ferrero, E., Psacharopulo, D., Gaggiano, A., Viazzo, A., Farchioni, L., Parlani, G., Caso, V., De Rangoy, P., Verzini, F., Castelli, P., DeLodovici, M.L., Carrafiello, G., Ierardi, A.M., Piffaretti, G., Nano, G., Occhiuto, M.T., Malacrida, G., Tealdi, D., Steghter, S., Stella, A., Pini, R., Faggioli, G., Sacca, S., Negri, M.D., Palombo, M., Perfumo, M.C., Fadda, G.F., Kasemi, H., Cernetti, C., Tonello, D., Visonà, A., Mangialardi, N., Ronchey, S., Altavista, M.C., Michelagnoli, S., Chisci, E., Speziale, F., Capoccia, L., Veroux, P., Giaquinta, A., Patti, F., Pulli, R., Boggia, P., Angiletta, D., Amatucci, G., Spinetti, F., Mascoli, F., Tsolaki, E., Civilini, E., Reimers, B., Snoch-Ziólkiewicz, M., Gabriel, M., Odero, A., Accrocca, F., Bajardi, G., Takashi, I., Masayuki, E., Hidenori, E., Aidashova, B., Kospanov, N., Bakke, S., Skjelland, M., Czlonkowska, A., Kobayashi, A., Proczka, R., Dowzenko, A., Czepel, W., Polanski, J., Bialek, P., Ozkinis, G., Stanisic, M., Iwanowski, W., Andziak, P., Gonçalves, F.B., Starodubtsev, V., Ignatenko, P., Karpenko, A., Radak, D., Aleksic, N., Sagic, D., Davidovic, L., Koncar, I., Tomic, I., Colic, M., Bartkoy, D., Rusnak, F., Gaspirini, M., Praczek, P., Milosevic, Z., Flis, V., Bergauer, A., Kobilica, N., Miksic, K., Matela, J., Blanco, E., Guerra, M., Riambau, V., Gillgren, P., Skioldebrand, C., Nymen, N., Berg, B., Delle, M., Formgren, J., Kally, T.B., Qvarfordt, P., Plate, G., Pärson, H., Lindgren, H., Bjorses, K., Gottsäter, A., Warvsten, M., Kristmundsson, T., Forssell, C., Malina, M., Holst, J., Kuhme, T., Sonesson, B., Lindblad, B., Kolbel, T., Acosta, S., Bonati, L., Traenka, C., Mueller, M., Lattman, T., Wasner, M., Mujagic, E., Von Hessling, A., Isaak, A., Stierli, P., Eugster, T., Mariani, L., Stippich, C., Wolff, T., Kahles, T., Toorop, R., Moll, F., Lo, R., Meershoek, A., Jahrome, A.K., Vos, A.W.F., Schuiling, W., Keunen, R., Reijnen, M., Macsweeney, S., McConachie, N., Southam, A., Stansby, G., Lees, T., Lambert, D., Clarke, M., Wyatt, M., Kappadath, S., Wales, L., Jackson, R., Raudonaitis, A., MacDonald, S., Dunlop, P., Brown, A., Vetrivel, S., Bajoriene, M., Gopi, R., McCollum, C., Wolowczyk, L., Ghosh, J., Seriki, D., Ashleigh, R., Butterfield, J., Welch, M., Smyth, J.V., Briley, D., Schulz, U., Perkins, J., Hands, L., Kuker, W., Darby, C., Handa, A., Sekaran, L., Poskitt, K., Morrison, J., Guyler, P., Grunwald, I., Brown, J., Jakeways, M., Tysoe, S., Hargroves, D., Gunathilagan, G., Insall, R., Senaratne, J., Beard, J., Cleveland, T., Nawaz, S., Lonsdale, R., Turner, D., Gaines, P., Nair, R., Chetter, I., Robinson, G., Akomolafe, B., Hatfield, J., Saastamoinen, K., Crinnion, J., Egun, A.A., Thomas, J., Drinkwater, S., D'Souza, S., Thomson, G., Gregory, B., Babu, S., Joseph, T., Gibbs, R., Tebit, G., Mehrzad, A., Enevoldson, P., Mendalow, D., Parry, A., Tervitt, G., Clifton, A., Nazzel, M., Peto, R., Pan, H., Potter, J., Bullbulia, R., Ashley, S., Flather, M., Mansfield, A., Simpson, D., Thomas, D., Gray, W., Farrell, B., Davies, C., Rahimi, K., Gough, M., Cao, P., Rothwell, P., Belli, A., Mafham, M., Herrington, W., Sandercock, P., Gray, R., Shearman, C., Molyneux, A., Gray, A., Clarke, A., Sneade, M., Tully, L., Brudlo, W., Lay, M., Munday, A., Berry, C., Tochlin, S., Mihaylova, B., Cox, J., Kurien, R., and Chester, J.

Subjects
Surgery, Cardiology and Cardiovascular Medicine, Settore MED/22 - Chirurgia Vascolare
Abstract

Due to a miscommunication during the production of this article, the members of the ACST-2 Collaborative Group were not properly indexed in PubMed. This has now been corrected online. We apologize for any confusion or inconvenience that this oversight might have caused.

Published
2017

9. Erratum to “Choices of Stent and Cerebral Protection in the Ongoing ACST-2 Trial: A Descriptive Study” (European Journal of Vascular and Endovascular Surgery (2017) 53(5) (617–625) (S1078588417300424) (10.1016/j.ejvs.2016.12.034))

Author

de Waard, D. D., Halliday, A., de Borst, G. J., Bulbulia, R., Huibers, A., Casana, R., Bonati, L. H., Tolva, V., Fraedrich, G., Rantner, B., Gizewski, E., Gruber, I., Hendriks, J., Cras, P., Lauwers, P., van Scheil, P., Vermassen, F., Van Herzeele, I., Geenens, M., Hemelsoet, D., Lerut, P., Lambrecht, B., SAAD, GEORGE SAFWAT YOUSSEF, Peeters, A., Bosiers, M., COSTA DA SILVA, AMELIA ELISABETE, de Luccia, N., Sitrangulo, J. C., Estenssoro, A. E. V., PRESTI, CHIARA, Casella, I., Monteiro, J. A. T., Campos, W., Puech-Leao, P., Petrov, V., Bachvarov, C., Hill, M., Mitha, A., Wong, J., Liu, C. -W., BAO, LIYING, Yu, C., Cvjetko, I., Vidjak, V., Fiedler, J., Ostry, S., Sterba, L., Kostal, P., Staffa, R., Vlachovsky, R., Privara, M., Kriz, Z., Vojtisek, B., Krupa, P., Reif, M., Benes, V., Buchvald, P., Endrych, L., Prochazka, V., Kuliha, M., Otahal, D., Hrbac, T., Netuka, D., Mohapl, M., Kramier, F., Eldessoki, M., Heshmat, H., Abd-Allah, F., Palmiste, V., Margus, S., Toomsoo, T., Becquemin, J. -P., Bergeron, P., Abdulamit, T., Cardon, J. -M., Debus, S., Thomalla, G., Fiehler, J., Gerloss, C., Grzyska, U., Storck, M., LaMacchia, E., Eckstein, H. H., Söllner, H., Berger, H., Kallmayer, M., Popert, H., Zimmermann, A., Guenther, A., Klingner, C., Mayer, T., Schubert, J., Zanow, J., Scheinert, D., Banning-Eichenseer, U., Bausback, Y., Branzan, D., Braünilch, S., Lenzer, J., Schidt, A., Staab, H., Ulirch, M., Barlinn, J., Haase, K., Abramyuk, A., Bodechtel, U., Gerber, J., Reeps, C., Pfeiffer, T., Torello, G., Cöster, A., Giannoukas, A., Spanos, K., Matsagkas, M., Koutias, S., VASDEKIS, VASSILIS G.S., Kakisis, J., Moulakakis, K., Lazaris, A., Liapas, C., Brountzos, E., Lazarides, M., Ioannou, N., Polydorou, A., Fulop, B., Fako, E., Voros, E., Bodosi, M., Nemeth, T., Barzo, P., Pazdernyik, S., Entz, L., Szeberin, Z., Dosa, E., Nemes, B., Jaranyi, Z., Pazdernyia, S., Madhaban, P., Hoffman, A., Nikolsky, E., Beyar, R., Silingardi, R., Lauricella, A., COPPI, GIOACHINO, Nicoloci, E., Tusini, N., Strozzi, F., Vecchiati, E., Ferri, M., FERRERO, ELISA, Psacharopulo, D., Gaggiano, A., Viazzo, A., Farchioni, L., Parlani, G., Caso, V., De Rangoy, P., Verzini, F., CASTELLI, PAOLO, DeLodovici, M. L., Carrafiello, G., Ierardi, A. M., Piffaretti, G., Nano, G., Occhiuto, M. T., Malacrida, G., Tealdi, D., Steghter, S., Stella, A., Pini, R., Faggioli, G., SACCA', SALVATORE, Negri, M. D., Palombo, M., Perfumo, M. C., Fadda, G. F., Kasemi, H., CERNETTI, MARIA CHIARA, Tonello, D., Visonà, A., Mangialardi, N., Ronchey, S., Altavista, M. C., Michelagnoli, S., Chisci, E., Speziale, F., Capoccia, L., Veroux, P., Giaquinta, A., Patti, F., Pulli, R., Boggia, P., Angiletta, D., Amatucci, G., Spinetti, F., Mascoli, F., TSOLAKI, ELPINIKI, Civilini, E., Reimers, B., Setacci, C., Pogany, G., ODERO, ANDREA, Accrocca, F., Bajardi, G., Takashi, I., Masayuki, E., Hidenori, E., Aidashova, B., Kospanov, N., Bakke, S., Skjelland, M., Czlonkowska, A., Kobayashi, A., Proczka, R., Dowzenko, A., Czepel, W., Polanski, J., Bialek, P., Ozkinis, G., Snoch-Ziólkiewicz, M., Gabriel, M., Stanisic, M., Iwanowski, W., Andziak, P., Gonçalves, F. B., Starodubtsev, V., Ignatenko, P., Karpenko, A., Radak, D., Aleksic, N., Sagic, D., Davidovic, L., Koncar, I., Tomic, I., ČOLIC, MINA, Bartkoy, D., Rusnak, F., Gaspirini, M., Praczek, P., Milosevic, Z., Flis, V., Bergauer, A., Kobilica, N., Miksic, K., Matela, J., Blanco, E., Guerra, M., Riambau, V., Gillgren, P., Skioldebrand, C., Nymen, N., Berg, B., DELLE VERGINI, ANNA RITA MARIA, Formgren, J., Kally, T. B., Qvarfordt, P., Plate, G., Pärson, H., Lindgren, H., Bjorses, K., Gottsäter, A., Warvsten, M., Kristmundsson, T., Forssell, C., Malina, M., Holst, J., Kuhme, T., Sonesson, B., Lindblad, B., Kolbel, T., Acosta, S., BONATI, LISA, Traenka, C., Mueller, M., Lattman, T., Wasner, M., Mujagic, E., Von Hessling, A., Isaak, A., Stierli, P., Eugster, T., Mariani, L., Stippich, C., Wolff, T., Kahles, T., Toorop, R., Moll, F., Lo, R., Meershoek, A., Jahrome, A. K., Vos, A. W. F., Schuiling, W., Keunen, R., Reijnen, M., Macsweeney, S., McConachie, N., Southam, A., Stansby, G., Lees, T., Lambert, D., Clarke, M., Wyatt, M., Kappadath, S., Wales, L., Jackson, R., Raudonaitis, A., MacDonald, S., Dunlop, P., Brown, A., Vetrivel, S., Bajoriene, M., Gopi, R., McCollum, C., Wolowczyk, L., Ghosh, J., Seriki, D., Ashleigh, R., Butterfield, J., WELCH, MICHAEL, Smyth, J. V., Briley, D., Schulz, U., Perkins, J., Hands, L., Kuker, W., Darby, C., Handa, A., Sekaran, L., Poskitt, K., Morrison, J., Guyler, P., Grunwald, I., Brown, J., Jakeways, M., Tysoe, S., Hargroves, D., Gunathilagan, G., Insall, R., Senaratne, J., Beard, J., Cleveland, T., Nawaz, S., Lonsdale, R., Turner, D., Gaines, P., Nair, R., Chetter, I., Robinson, G., Akomolafe, B., Hatfield, J., Saastamoinen, K., Crinnion, J., Egun, A. A., Thomas, J., Drinkwater, S., D'Souza, S., Thomson, G., Gregory, B., Babu, S., Ashley, S., Joseph, T., Gibbs, R., Tebit, G., Mehrzad, A., Enevoldson, P., Mendalow, D., Parry, A., Tervitt, G., Clifton, A., Nazzel, M., Peto, R., Pan, H., Potter, J., Bullbulia, R., Bonati, L., Mihaylova, B., Flather, M., Mansfield, A., Simpson, D., Thomas, D., Gray, W., Farrell, B., Davies, C., Rahimi, K., Gough, M., Cao, P., Rothwell, P., Belli, A., Mafham, M., Herrington, W., Sandercock, P., Gray, R., Shearman, C., Molyneux, A., Gray, A., Clarke, A., Sneade, M., Tully, L., Brudlo, W., Lay, M., MUNDAY, SARA ANN, Berry, C., Tochlin, S., Cox, J., Kurien, R., Chester, J., de Waard, D. D., Halliday, A., de Borst, G. J., Bulbulia, R., Huibers, A., Casana, R., Bonati, L. H., Tolva, V., Fraedrich, G., Rantner, B., Gizewski, E., Gruber, I., Hendriks, J., Cras, P., Lauwers, P., van Scheil, P., Vermassen, F., Van Herzeele, I., Geenens, M., Hemelsoet, D., Lerut, P., Lambrecht, B., Saad, G., Peeters, A., Bosiers, M., da Silva, E., de Luccia, N., Sitrangulo, J. C., Estenssoro, A. E. V., Presti, C., Casella, I., Monteiro, J. A. T., Campos, W., Puech-Leao, P., Petrov, V., Bachvarov, C., Hill, M., Mitha, A., Wong, J., Liu, C. -W., Bao, L., Yu, C., Cvjetko, I., Vidjak, V., Fiedler, J., Ostry, S., Sterba, L., Kostal, P., Staffa, R., Vlachovsky, R., Privara, M., Kriz, Z., Vojtisek, B., Krupa, P., Reif, M., Benes, V., Buchvald, P., Endrych, L., Prochazka, V., Kuliha, M., Otahal, D., Hrbac, T., Netuka, D., Mohapl, M., Kramier, F., Eldessoki, M., Heshmat, H., Abd-Allah, F., Palmiste, V., Margus, S., Toomsoo, T., Becquemin, J. -P., Bergeron, P., Abdulamit, T., Cardon, J. -M., Debus, S., Thomalla, G., Fiehler, J., Gerloss, C., Grzyska, U., Storck, M., Lamacchia, E., Eckstein, H. H., Söllner, H., Berger, H., Kallmayer, M., Popert, H., Zimmermann, A., Guenther, A., Klingner, C., Mayer, T., Schubert, J., Zanow, J., Scheinert, D., Banning-Eichenseer, U., Bausback, Y., Branzan, D., Braünilch, S., Lenzer, J., Schidt, A., Staab, H., Ulirch, M., Barlinn, J., Haase, K., Abramyuk, A., Bodechtel, U., Gerber, J., Reeps, C., Pfeiffer, T., Torello, G., Cöster, A., Giannoukas, A., Spanos, K., Matsagkas, M., Koutias, S., Vasdekis, S., Kakisis, J., Moulakakis, K., Lazaris, A., Liapas, C., Brountzos, E., Lazarides, M., Ioannou, N., Polydorou, A., Fulop, B., Fako, E., Voros, E., Bodosi, M., Nemeth, T., Barzo, P., Pazdernyik, S., Entz, L., Szeberin, Z., Dosa, E., Nemes, B., Jaranyi, Z., Pazdernyia, S., Madhaban, P., Hoffman, A., Nikolsky, E., Beyar, R., Silingardi, R., Lauricella, A., Coppi, G., Nicoloci, E., Tusini, N., Strozzi, F., Vecchiati, E., Ferri, M., Ferrero, E., Psacharopulo, D., Gaggiano, A., Viazzo, A., Farchioni, L., Parlani, G., Caso, V., De Rangoy, P., Verzini, F., Castelli, P., Delodovici, M. L., Carrafiello, G., Ierardi, A. M., Piffaretti, G., Nano, G., Occhiuto, M. T., Malacrida, G., Tealdi, D., Steghter, S., Stella, A., Pini, R., Faggioli, G., Sacca, S., Negri, M. D., Palombo, M., Perfumo, M. C., Fadda, G. F., Kasemi, H., Cernetti, C., Tonello, D., Visonà, A., Mangialardi, N., Ronchey, S., Altavista, M. C., Michelagnoli, S., Chisci, E., Speziale, F., Capoccia, L., Veroux, P., Giaquinta, A., Patti, F., Pulli, R., Boggia, P., Angiletta, D., Amatucci, G., Spinetti, F., Mascoli, F., Tsolaki, E., Civilini, E., Reimers, B., Setacci, C., Pogany, G., Odero, A., Accrocca, F., Bajardi, G., Takashi, I., Masayuki, E., Hidenori, E., Aidashova, B., Kospanov, N., Bakke, S., Skjelland, M., Czlonkowska, A., Kobayashi, A., Proczka, R., Dowzenko, A., Czepel, W., Polanski, J., Bialek, P., Ozkinis, G., Snoch-Ziólkiewicz, M., Gabriel, M., Stanisic, M., Iwanowski, W., Andziak, P., Gonçalves, F. B., Starodubtsev, V., Ignatenko, P., Karpenko, A., Radak, D., Aleksic, N., Sagic, D., Davidovic, L., Koncar, I., Tomic, I., Colic, M., Bartkoy, D., Rusnak, F., Gaspirini, M., Praczek, P., Milosevic, Z., Flis, V., Bergauer, A., Kobilica, N., Miksic, K., Matela, J., Blanco, E., Guerra, M., Riambau, V., Gillgren, P., Skioldebrand, C., Nymen, N., Berg, B., M., Delle, Formgren, J., Kally, T. B., Qvarfordt, P., Plate, G., Pärson, H., Lindgren, H., Bjorses, K., Gottsäter, A., Warvsten, M., Kristmundsson, T., Forssell, C., Malina, M., Holst, J., Kuhme, T., Sonesson, B., Lindblad, B., Kolbel, T., Acosta, S., Bonati, L., Traenka, C., Mueller, M., Lattman, T., Wasner, M., Mujagic, E., Von Hessling, A., Isaak, A., Stierli, P., Eugster, T., Mariani, L., Stippich, C., Wolff, T., Kahles, T., Toorop, R., Moll, F., R., Lo, Meershoek, A., Jahrome, A. K., Vos, A. W. F., Schuiling, W., Keunen, R., Reijnen, M., Macsweeney, S., Mcconachie, N., Southam, A., Stansby, G., Lees, T., Lambert, D., Clarke, M., Wyatt, M., Kappadath, S., Wales, L., Jackson, R., Raudonaitis, A., Macdonald, S., Dunlop, P., Brown, A., Vetrivel, S., Bajoriene, M., Gopi, R., Mccollum, C., Wolowczyk, L., Ghosh, J., Seriki, D., Ashleigh, R., Butterfield, J., Welch, M., Smyth, J. V., Briley, D., Schulz, U., Perkins, J., Hands, L., Kuker, W., Darby, C., Handa, A., Sekaran, L., Poskitt, K., Morrison, J., Guyler, P., Grunwald, I., Brown, J., Jakeways, M., Tysoe, S., Hargroves, D., Gunathilagan, G., Insall, R., Senaratne, J., Beard, J., Cleveland, T., Nawaz, S., Lonsdale, R., Turner, D., Gaines, P., Nair, R., Chetter, I., Robinson, G., Akomolafe, B., Hatfield, J., Saastamoinen, K., Crinnion, J., Egun, A. A., Thomas, J., Drinkwater, S., D'Souza, S., Thomson, G., Gregory, B., Babu, S., Ashley, S., Joseph, T., Gibbs, R., Tebit, G., Mehrzad, A., Enevoldson, P., Mendalow, D., Parry, A., Tervitt, G., Clifton, A., Nazzel, M., Peto, R., Pan, H., Potter, J., Bullbulia, R., Mihaylova, B., Flather, M., Mansfield, A., Simpson, D., Thomas, D., Gray, W., Farrell, B., Davies, C., Rahimi, K., Gough, M., Cao, P., Rothwell, P., Belli, A., Mafham, M., Herrington, W., Sandercock, P., Gray, R., Shearman, C., Molyneux, A., Gray, A., Clarke, A., Sneade, M., Tully, L., Brudlo, W., Lay, M., Munday, A., Berry, C., Tochlin, S., Cox, J., Kurien, R., and Chester, J.

Subjects
Surgery, Cardiology and Cardiovascular Medicine
Abstract

Due to a miscommunication during the production of this article, the members of the ACST-2 Collaborative Group were not properly indexed in PubMed. This has now been corrected online. We apologize for any confusion or inconvenience that this oversight might have caused.

Published
2017

10. Teaching NeuroImages: Visual loss as a rare complication of mechanical thrombectomy

Author

Florian Jordi, Manuel Bolognese, and Alexander von Hessling

Subjects
medicine.medical_specialty, Mechanical Thrombolysis, Vision Disorders, Physical examination, Retina, 030218 nuclear medicine & medical imaging, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Retinal Diseases, Aphasia, Occlusion, Medicine, Humans, cardiovascular diseases, medicine.diagnostic_test, business.industry, Emergency department, Cerebral Infarction, Middle Aged, Trunk, nervous system diseases, Surgery, Mechanical thrombectomy, Female, Neurology (clinical), medicine.symptom, Complication, business, 030217 neurology & neurosurgery
Abstract

A 46-year-old woman was admitted to the emergency department with a severe left hemispheric syndrome (NIH Stroke Scale [NIHSS] 11). CT showed an occlusion of the left middle cerebral artery, reaching from the distal main trunk (M1) to the inferior division (M2) (figure 1). IV thrombolysis was started and mechanical thrombectomy performed successfully. Postinterventional clinical examination showed mild aphasia (NIHSS 1). However, the patient also complained about impaired (“foggy”) vision of the left eye.

Published
2018

11. Choices of stent and cerebral protection in the ongoing ACST-2 trial: a descriptive study

Author

D.D. de Waard, A. Halliday, G.J. de Borst, R. Bulbulia, A. Huibers, R. Casana, L.H. Bonati, V. Tolva, G. Fraedrich, B. Rantner, E. Gizewski, I. Gruber, J. Hendriks, P. Cras, P. Lauwers, P. van Scheil, F. Vermassen, I. Van Herzeele, M. Geenens, D. Hemelsoet, P. Lerut, B. Lambrecht, G. Saad, A. Peeters, M. Bosiers, E. da Silva, N. de Luccia, J.C. Sitrangulo, A.E.V. Estenssoro, C. Presti, I. Casella, J.A.T. Monteiro, W. Campos, P. Puech-Leao, V. Petrov, C. Bachvarov, M. Hill, A. Mitha, J. Wong, C.-W. Liu, L. Bao, C. Yu, I. Cvjetko, V. Vidjak, J. Fiedler, S. Ostry, L. Sterba, P. Kostal, R. Staffa, R. Vlachovsky, M. Privara, Z. Kriz, B. Vojtisek, P. Krupa, M. Reif, V. Benes, P. Buchvald, L. Endrych, V. Prochazka, M. Kuliha, D. Otahal, T. Hrbac, D. Netuka, M. Mohapl, F. Kramier, M. Eldessoki, H. Heshmat, F. Abd-Allah, V. Palmiste, S. Margus, T. Toomsoo, J.-P. Becquemin, P. Bergeron, T. Abdulamit, J.-M. Cardon, S. Debus, G. Thomalla, J. Fiehler, C. Gerloss, U. Grzyska, M. Storck, E. LaMacchia, H.H. Eckstein, H. Söllner, H. Berger, M. Kallmayer, H. Popert, A. Zimmermann, A. Guenther, C. Klingner, T. Mayer, J. Schubert, J. Zanow, D. Scheinert, U. Banning-Eichenseer, Y. Bausback, D. Branzan, S. Braünilch, J. Lenzer, A. Schidt, H. Staab, M. Ulirch, J. Barlinn, K. Haase, A. Abramyuk, U. Bodechtel, J. Gerber, C. Reeps, T. Pfeiffer, G. Torello, A. Cöster, A. Giannoukas, K. Spanos, M. Matsagkas, S. Koutias, S. Vasdekis, J. Kakisis, K. Moulakakis, A. Lazaris, C. Liapas, E. Brountzos, M. Lazarides, N. Ioannou, A. Polydorou, B. Fulop, E. Fako, E. Voros, M. Bodosi, T. Nemeth, P. Barzo, S. Pazdernyik, L. Entz, Z. Szeberin, E. Dosa, B. Nemes, Z. Jaranyi, S. Pazdernyia, P. Madhaban, A. Hoffman, E. Nikolsky, R. Beyar, R. Silingardi, A. Lauricella, G. Coppi, E. Nicoloci, N. Tusini, F. Strozzi, E. Vecchiati, M. Ferri, E. Ferrero, D. Psacharopulo, A. Gaggiano, A. Viazzo, L. Farchioni, G. Parlani, V. Caso, P. De Rangoy, F. Verzini, P. Castelli, M.L. DeLodovici, G. Carrafiello, A.M. Ierardi, G. Piffaretti, G. Nano, M.T. Occhiuto, G. Malacrida, D. Tealdi, S. Steghter, A. Stella, R. Pini, G. Faggioli, S. Sacca, M.D. Negri, M. Palombo, M.C. Perfumo, G.F. Fadda, H. Kasemi, C. Cernetti, D. Tonello, A. Visonà, N. Mangialardi, S. Ronchey, M.C. Altavista, S. Michelagnoli, E. Chisci, F. Speziale, L. Capoccia, P. Veroux, A. Giaquinta, F. Patti, R. Pulli, P. Boggia, D. Angiletta, G. Amatucci, F. Spinetti, F. Mascoli, E. Tsolaki, E. Civilini, B. Reimers, C. Setacci, G. Pogany, A. Odero, F. Accrocca, G. Bajardi, I. Takashi, E. Masayuki, E. Hidenori, B. Aidashova, N. Kospanov, S. Bakke, M. Skjelland, A. Czlonkowska, A. Kobayashi, R. Proczka, A. Dowzenko, W. Czepel, J. Polanski, P. Bialek, G. Ozkinis, M. Snoch-Ziólkiewicz, M. Gabriel, M. Stanisic, W. Iwanowski, P. Andziak, F.B. Gonçalves, V. Starodubtsev, P. Ignatenko, A. Karpenko, D. Radak, N. Aleksic, D. Sagic, L. Davidovic, I. Koncar, I. Tomic, M. Colic, D. Bartkoy, F. Rusnak, M. Gaspirini, P. Praczek, Z. Milosevic, V. Flis, A. Bergauer, N. Kobilica, K. Miksic, J. Matela, E. Blanco, M. Guerra, V. Riambau, P. Gillgren, C. Skioldebrand, N. Nymen, B. Berg, M. Delle, J. Formgren, T.B. Kally, P. Qvarfordt, G. Plate, H. Pärson, H. Lindgren, K. Bjorses, A. Gottsäter, M. Warvsten, T. Kristmundsson, C. Forssell, M. Malina, J. Holst, T. Kuhme, B. Sonesson, B. Lindblad, T. Kolbel, S. Acosta, L. Bonati, C. Traenka, M. Mueller, T. Lattman, M. Wasner, E. Mujagic, A. Von Hessling, A. Isaak, P. Stierli, T. Eugster, L. Mariani, C. Stippich, T. Wolff, T. Kahles, R. Toorop, F. Moll, R. Lo, A. Meershoek, A.K. Jahrome, A.W.F. Vos, W. Schuiling, R. Keunen, M. Reijnen, S. Macsweeney, N. McConachie, A. Southam, G. Stansby, T. Lees, D. Lambert, M. Clarke, M. Wyatt, S. Kappadath, L. Wales, R. Jackson, A. Raudonaitis, S. MacDonald, P. Dunlop, A. Brown, S. Vetrivel, M. Bajoriene, R. Gopi, C. McCollum, L. Wolowczyk, J. Ghosh, D. Seriki, R. Ashleigh, J. Butterfield, M. Welch, J.V. Smyth, D. Briley, U. Schulz, J. Perkins, L. Hands, W. Kuker, C. Darby, A. Handa, L. Sekaran, K. Poskitt, J. Morrison, P. Guyler, I. Grunwald, J. Brown, M. Jakeways, S. Tysoe, D. Hargroves, G. Gunathilagan, R. Insall, J. Senaratne, J. Beard, T. Cleveland, S. Nawaz, R. Lonsdale, D. Turner, P. Gaines, R. Nair, I. Chetter, G. Robinson, B. Akomolafe, J. Hatfield, K. Saastamoinen, J. Crinnion, A.A. Egun, J. Thomas, S. Drinkwater, S. D'Souza, G. Thomson, B. Gregory, S. Babu, S. Ashley, T. Joseph, R. Gibbs, G. Tebit, A. Mehrzad, P. Enevoldson, D. Mendalow, A. Parry, G. Tervitt, A. Clifton, M. Nazzel, R. Peto, H. Pan, J. Potter, R. Bullbulia, B. Mihaylova, M. Flather, A. Mansfield, D. Simpson, D. Thomas, W. Gray, B. Farrell, C. Davies, K. Rahimi, M. Gough, P. Cao, P. Rothwell, A. Belli, M. Mafham, W. Herrington, P. Sandercock, R. Gray, C. Shearman, A. Molyneux, A. Gray, A. Clarke, M. Sneade, L. Tully, W. Brudlo, M. Lay, A. Munday, C. Berry, S. Tochlin, J. Cox, R. Kurien, and J. Chester

Subjects
Plaque echolucency, Time Factors, medicine.medical_treatment, Practice Patterns, 030204 cardiovascular system & hematology, Severity of Illness Index, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Risk Factors, Occlusion, Carotid artery stenosis, Carotid Stenosis, Practice Patterns, Physicians', Stroke, Endarterectomy, Plaque, Atherosclerotic, Endarterectomy, Carotid, Endovascular Procedures, Plaque, Atherosclerotic, Treatment Outcome, Cerebrovascular Circulation, Stents, Radiology, medicine.symptom, Cardiology and Cardiovascular Medicine, Carotid artery stenting, medicine.medical_specialty, Clinical Decision-Making, education, Cerebral protection devices, Stent design, Surgery, Prosthesis Design, Asymptomatic, Embolic Protection Devices, 03 medical and health sciences, Severity of illness, medicine, Humans, Carotid, Chi-Square Distribution, Physicians', business.industry, Patient Selection, Stent, METANÁLISE, medicine.disease, Asymptomatic Diseases, Cerebrovascular Disorders, Stenosis, business, 030217 neurology & neurosurgery
Abstract

Objectives Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics. Materials and methods Trial patients who underwent CAS between 2008 and 2015 were included in this study. Chi-square statistics were used to study the effects of plaque echolucency, ipsilateral preocclusive disease (90–99%), and contralateral high-grade stenosis (>50%) or occlusion of the carotid artery on interventionalists' choice for stent and CPD. Differences in treatment preference between specialties were also analysed. Results In this study, 831 patients from 88 ACST-2 centres were included. Almost all procedures were performed by either interventional radiologists (50%) or vascular surgeons (45%). Plaque echolucency, ipsilateral preocclusive disease (90–99%), and significant contralateral stenosis (>50%) or occlusion did not affect the choice of stent or either the use of cerebral protection and type of CPD employed (i.e., filter/flow reversal). Vascular surgeons used a CPD significantly more often than interventional radiologists (98.6% vs. 76.3%; p < .001), but this choice did not appear to be dependent on patient characteristics. Conclusions In ACST-2, plaque characteristics and severity of stenosis did not primarily determine interventionalists' choice of stent or use or type of CPD, suggesting that other factors, such as vascular anatomy or personal and centre preference, may be more important. Stent and CPD use was highly heterogeneous among participating European centres.

Published
2017

12. Choices of Stent and Cerebral Protection in the Ongoing ACST-2 Trial: A Descriptive Study (vol 53, pg 617, 2017)

Author

de Waard, D. D., Halliday, A., de Borst, G. J., Bulbulia, R., Huibers, A., Casana, R., Bonati, L. H., Tolva, V., Fraedrich, G., Rantner, B., Gizewski, E., Gruber, I., Hendriks, J., Cras, P., Lauwers, P., van Scheil, P., Vermassen, F., Van Herzeele, I., Geenens, M., Hemelsoet, D., Lerut, P., Lambrecht, B., Saad, G., Peeters, A., Bosiers, M., da Silva, E., de Luccia, N., Sitrangulo, J. C., Estenssoro, A. E. V., Presti, C., Casella, I., Monteiro, J. A. T., Campos, W., Puech-Leao, P., Petrov, V., Bachvarov, C., Hill, M., Mitha, A., Wong, J., Liu, C. -W., Bao, L., Yu, C., Cvjetko, I., Vidjak, V., Fiedler, J., Ostry, S., Sterba, L., Kostal, P., Staffa, R., Vlachovsky, R., Privara, M., Kriz, Z., Vojtisek, B., Krupa, P., Reif, M., Benes, V., Buchvald, P., Endrych, L., Prochazka, V., Kuliha, M., Otahal, D., Hrbac, T., Netuka, D., Mohapl, M., Kramier, F., Eldessoki, M., Heshmat, H., Abd-Allah, F., Palmiste, V., Margus, S., Toomsoo, T., Becquemin, J. -P., Bergeron, P., Abdulamit, T., Cardon, J. -M., Debus, S., Thomalla, G., Fiehler, J., Gerloss, C., Grzyska, U., Storck, M., Lamacchia, E., Eckstein, H. H., Söllner, H., Berger, H., Kallmayer, M., Popert, H., Zimmermann, A., Guenther, A., Klingner, C., Mayer, T., Schubert, J., Zanow, J., Scheinert, D., Banning-Eichenseer, U., Bausback, Y., Branzan, D., Braünilch, S., Lenzer, J., Schidt, A., Staab, H., Ulirch, M., Barlinn, J., Haase, K., Abramyuk, A., Bodechtel, U., Gerber, J., Reeps, C., Pfeiffer, T., Torello, G., Cöster, A., Giannoukas, A., Spanos, K., Matsagkas, M., Koutias, S., Vasdekis, S., Kakisis, J., Moulakakis, K., Lazaris, A., Liapas, C., Brountzos, E., Lazarides, M., Ioannou, N., Polydorou, A., Fulop, B., Fako, E., Voros, E., Bodosi, M., Nemeth, T., Barzo, P., Pazdernyik, S., Entz, L., Szeberin, Z., Dosa, E., Nemes, B., Jaranyi, Z., Pazdernyia, S., Madhaban, P., Hoffman, A., Nikolsky, E., Beyar, R., Silingardi, R., Lauricella, A., Coppi, G., Nicoloci, E., Tusini, N., Strozzi, F., Vecchiati, E., Ferri, M., Ferrero, E., Psacharopulo, D., Gaggiano, A., Viazzo, A., Farchioni, L., Parlani, G., Caso, V., De Rangoy, P., Verzini, F., Castelli, P., Delodovici, M. L., Carrafiello, G., Ierardi, A. M., Piffaretti, G., Nano, G., Occhiuto, M. T., Malacrida, G., Tealdi, D., Steghter, S., Stella, A., Pini, R., Faggioli, G., Sacca, S., Negri, M. D., Palombo, M., Perfumo, M. C., Fadda, G. F., Kasemi, H., Cernetti, C., Tonello, D., Visonà, A., Mangialardi, N., Ronchey, S., Altavista, M. C., Michelagnoli, S., Chisci, E., Speziale, F., Capoccia, L., Veroux, P., Giaquinta, A., Patti, F., Pulli, R., Boggia, P., Angiletta, D., Amatucci, G., Spinetti, F., Mascoli, F., Tsolaki, E., Civilini, E., Reimers, B., Snoch-Ziólkiewicz, M., Gabriel, M., Odero, A., Accrocca, F., Bajardi, G., Takashi, I., Masayuki, E., Hidenori, E., Aidashova, B., Kospanov, N., Bakke, S., Skjelland, M., Czlonkowska, A., Kobayashi, A., Proczka, R., Dowzenko, A., Czepel, W., Polanski, J., Bialek, P., Ozkinis, G., Stanisic, M., Iwanowski, W., Andziak, P., Gonçalves, F. B., Starodubtsev, V., Ignatenko, P., Karpenko, A., Radak, D., Aleksic, N., Sagic, D., Davidovic, L., Koncar, I., Tomic, I., Colic, M., Bartkoy, D., Rusnak, F., Gaspirini, M., Praczek, P., Milosevic, Z., Flis, V., Bergauer, A., Kobilica, N., Miksic, K., Matela, J., Blanco, E., Guerra, M., Riambau, V., Gillgren, P., Skioldebrand, C., Nymen, N., Berg, B., Delle, M., Formgren, J., Kally, T. B., Qvarfordt, P., Plate, G., Pärson, H., Lindgren, H., Bjorses, K., Gottsäter, A., Warvsten, M., Kristmundsson, T., Forssell, C., Malina, M., Holst, J., Kuhme, T., Sonesson, B., Lindblad, B., Kolbel, T., Acosta, S., Bonati, L., Traenka, C., Mueller, M., Lattman, T., Wasner, M., Mujagic, E., Von Hessling, A., Isaak, A., Stierli, P., Eugster, T., Mariani, L., Stippich, C., Wolff, T., Kahles, T., Toorop, R., Moll, F., Lo, R., Meershoek, A., Jahrome, A. K., Vos, A. W. F., Schuiling, W., Keunen, R., Reijnen, M., Macsweeney, S., Mcconachie, N., Southam, A., Stansby, G., Lees, T., Lambert, D., Clarke, M., Wyatt, M., Kappadath, S., Wales, L., Jackson, R., Raudonaitis, A., Macdonald, S., Dunlop, P., Brown, A., Vetrivel, S., Bajoriene, M., Gopi, R., Mccollum, C., Wolowczyk, L., Ghosh, J., Seriki, D., Ashleigh, R., Butterfield, J., Welch, M., Smyth, J. V., Briley, D., Schulz, U., Perkins, J., Hands, L., Kuker, W., Darby, C., Handa, A., Sekaran, L., Poskitt, K., Morrison, J., Guyler, P., Grunwald, I., Brown, J., Jakeways, M., Tysoe, S., Hargroves, D., Gunathilagan, G., Insall, R., Senaratne, J., Beard, J., Cleveland, T., Nawaz, S., Lonsdale, R., Turner, D., Gaines, P., Nair, R., Chetter, I., Robinson, G., Akomolafe, B., Hatfield, J., Saastamoinen, K., Crinnion, J., Egun, A. A., Thomas, J., Drinkwater, S., D'Souza, S., Thomson, G., Gregory, B., Babu, S., Joseph, T., Gibbs, R., Tebit, G., Mehrzad, A., Enevoldson, P., Mendalow, D., Parry, A., Tervitt, G., Clifton, A., Nazzel, M., Peto, R., Pan, H., Potter, J., Bullbulia, R., Ashley, S., Flather, M., Mansfield, A., Simpson, D., Thomas, D., Gray, W., Farrell, B., Davies, C., Rahimi, K., Gough, M., Cao, P., Rothwell, P., Belli, A., Mafham, M., Herrington, W., Sandercock, P., Gray, R., Shearman, C., Molyneux, A., Gray, A., Clarke, A., Sneade, M., Tully, L., Brudlo, W., Lay, M., Munday, A., Berry, C., Tochlin, S., Mihaylova, B., Cox, J., Kurien, R., and Chester, J.

Subjects
Surgery, Cardiology and Cardiovascular Medicine
Published
2017

13. Pre-operative embolisation of spinal metastasis: technique, complication rate and outcome-clinical experience

Author

Patrick Cernoch, Alexander von Hessling, Lukas Hechelhammer, Fabrice Külling, Johannes Erhardt, Bernhard Jost, and Christian Spross

Subjects
Adult, Male, medicine.medical_specialty, Lung Neoplasms, medicine.medical_treatment, Blood Loss, Surgical, Breast Neoplasms, Blood loss, Medicine, Humans, Orthopedics and Sports Medicine, In patient, Complication rate, Corpectomy, Carcinoma, Renal Cell, Aged, Retrospective Studies, Aged, 80 and over, Spinal Neoplasms, business.industry, Middle Aged, Combined Modality Therapy, Embolization, Therapeutic, Pre operative, Kidney Neoplasms, Surgery, Orthopedic surgery, Etiology, Spinal metastasis, Female, business
Abstract

Pre-operative embolisation of metastatic spinal tumours has the potential to decrease intra-operative blood loss. Intra-operative blood loss is multifactorial and one factor may be the embolisation technique used. The purpose of this study was to retrospectively analyse the effect of three different pre-operative embolisation techniques on intra-operative blood loss, complication rate and tumour aetiology in patients treated with a corpectomy and dorsoventral stabilisation at our institution.We conducted a retrospective analysis of embolisation procedures for vertebral metastases performed from January 2002 to December 2011. Only pre-operatively embolised patients treated by a single-level hemicorpectomy or corpectomy procedure from T4-L5, including posterior spinal stabilisation using pedicle screws, were included. All patient charts and examinations were analysed regarding the embolisation technique, gender, age, primary tumour, time between the embolisation and surgery, intra-operative blood loss, intra-operative transfusions and complications related to embolisation.We identified a total of 46 patients, 25 male and 21 female patients. The mean age at the time of surgery was 66 years (range 39-84 years). The tumours treated were: 15 (33%) renal cell carcinomas, six (13%) breast carcinomas, five (11%) lung carcinomas, five (11%) urothelial carcinomas, four (9%) myelomas and 11 (24%) miscellaneous types including rectal carcinoma, thymoma and melanoma. Embolisation with coils was performed in 23 patients, particles were used in six and a combination of coils and particles in 18. The mean time between the embolisation and surgery was 23 hours (range 80-4,430 minutes). The median overall intra-operative estimated blood loss (EBL) was 2,300 ml (range 500-15,000 ml). In patients embolised with coils and particles, EBL was 2,200 ml compared to 1,450 ml in patients embolised with particles and 2,500 ml in the coil group. No statistically significant differences between the three groups could be detected. There were no complications related to the embolisation techniques.Pre-operative embolisation of spinal metastases using coils, particles or a combination of both is a safe and reproducible procedure. In our cohort we reported no complications during the three different embolisation techniques. No statistically significant difference regarding blood loss between the three embolisation techniques could be detected. Our data confirm existing studies concerning the control of intra-operative blood loss using different embolisation techniques. The benefit of embolisation with a combination of coils and particles compared to embolisation with particles only is questionable.

Published
2015

14. Erratum to 'Choices of Stent and Cerebral Protection in the Ongoing ACST-2 Trial: A Descriptive Study' [Eur J Vasc Endovasc Surg 53 (2017) 617–625]

Author

D.D. de Waard, A. Halliday, G.J. de Borst, R. Bulbulia, A. Huibers, R. Casana, L.H. Bonati, V. Tolva, G. Fraedrich, B. Rantner, E. Gizewski, I. Gruber, J. Hendriks, P. Cras, P. Lauwers, P. van Scheil, F. Vermassen, I. Van Herzeele, M. Geenens, D. Hemelsoet, P. Lerut, B. Lambrecht, G. Saad, A. Peeters, M. Bosiers, E. da Silva, N. de Luccia, J.C. Sitrangulo, A.E.V. Estenssoro, C. Presti, I. Casella, J.A.T. Monteiro, W. Campos, P. Puech-Leao, V. Petrov, C. Bachvarov, M. Hill, A. Mitha, J. Wong, C.-W. Liu, L. Bao, C. Yu, I. Cvjetko, V. Vidjak, J. Fiedler, S. Ostry, L. Sterba, P. Kostal, R. Staffa, R. Vlachovsky, M. Privara, Z. Kriz, B. Vojtisek, P. Krupa, M. Reif, V. Benes, P. Buchvald, L. Endrych, V. Prochazka, M. Kuliha, D. Otahal, T. Hrbac, D. Netuka, M. Mohapl, F. Kramier, M. Eldessoki, H. Heshmat, F. Abd-Allah, V. Palmiste, S. Margus, T. Toomsoo, J.-P. Becquemin, P. Bergeron, T. Abdulamit, J.-M. Cardon, S. Debus, G. Thomalla, J. Fiehler, C. Gerloss, U. Grzyska, M. Storck, E. LaMacchia, H.H. Eckstein, H. Söllner, H. Berger, M. Kallmayer, H. Popert, A. Zimmermann, A. Guenther, C. Klingner, T. Mayer, J. Schubert, J. Zanow, D. Scheinert, U. Banning-Eichenseer, Y. Bausback, D. Branzan, S. Braünilch, J. Lenzer, A. Schidt, H. Staab, M. Ulirch, J. Barlinn, K. Haase, A. Abramyuk, U. Bodechtel, J. Gerber, C. Reeps, T. Pfeiffer, G. Torello, A. Cöster, A. Giannoukas, K. Spanos, M. Matsagkas, S. Koutias, S. Vasdekis, J. Kakisis, K. Moulakakis, A. Lazaris, C. Liapas, E. Brountzos, M. Lazarides, N. Ioannou, A. Polydorou, B. Fulop, E. Fako, E. Voros, M. Bodosi, T. Nemeth, P. Barzo, S. Pazdernyik, L. Entz, Z. Szeberin, E. Dosa, B. Nemes, Z. Jaranyi, S. Pazdernyia, P. Madhaban, A. Hoffman, E. Nikolsky, R. Beyar, R. Silingardi, A. Lauricella, G. Coppi, E. Nicoloci, N. Tusini, F. Strozzi, E. Vecchiati, M. Ferri, E. Ferrero, D. Psacharopulo, A. Gaggiano, A. Viazzo, L. Farchioni, G. Parlani, V. Caso, P. De Rangoy, F. Verzini, P. Castelli, M.L. DeLodovici, G. Carrafiello, A.M. Ierardi, G. Piffaretti, G. Nano, M.T. Occhiuto, G. Malacrida, D. Tealdi, S. Steghter, A. Stella, R. Pini, G. Faggioli, S. Sacca, M.D. Negri, M. Palombo, M.C. Perfumo, G.F. Fadda, H. Kasemi, C. Cernetti, D. Tonello, A. Visonà, N. Mangialardi, S. Ronchey, M.C. Altavista, S. Michelagnoli, E. Chisci, F. Speziale, L. Capoccia, P. Veroux, A. Giaquinta, F. Patti, R. Pulli, P. Boggia, D. Angiletta, G. Amatucci, F. Spinetti, F. Mascoli, E. Tsolaki, E. Civilini, B. Reimers, C. Setacci, G. Pogany, A. Odero, F. Accrocca, G. Bajardi, I. Takashi, E. Masayuki, E. Hidenori, B. Aidashova, N. Kospanov, S. Bakke, M. Skjelland, A. Czlonkowska, A. Kobayashi, R. Proczka, A. Dowzenko, W. Czepel, J. Polanski, P. Bialek, G. Ozkinis, M. Snoch-Ziólkiewicz, M. Gabriel, M. Stanisic, W. Iwanowski, P. Andziak, F.B. Gonçalves, V. Starodubtsev, P. Ignatenko, A. Karpenko, D. Radak, N. Aleksic, D. Sagic, L. Davidovic, I. Koncar, I. Tomic, M. Colic, D. Bartkoy, F. Rusnak, M. Gaspirini, P. Praczek, Z. Milosevic, V. Flis, A. Bergauer, N. Kobilica, K. Miksic, J. Matela, E. Blanco, M. Guerra, V. Riambau, P. Gillgren, C. Skioldebrand, N. Nymen, B. Berg, M. Delle, J. Formgren, T.B. Kally, P. Qvarfordt, G. Plate, H. Pärson, H. Lindgren, K. Bjorses, A. Gottsäter, M. Warvsten, T. Kristmundsson, C. Forssell, M. Malina, J. Holst, T. Kuhme, B. Sonesson, B. Lindblad, T. Kolbel, S. Acosta, L. Bonati, C. Traenka, M. Mueller, T. Lattman, M. Wasner, E. Mujagic, A. Von Hessling, A. Isaak, P. Stierli, T. Eugster, L. Mariani, C. Stippich, T. Wolff, T. Kahles, R. Toorop, F. Moll, R. Lo, A. Meershoek, A.K. Jahrome, A.W.F. Vos, W. Schuiling, R. Keunen, M. Reijnen, S. Macsweeney, N. McConachie, A. Southam, G. Stansby, T. Lees, D. Lambert, M. Clarke, M. Wyatt, S. Kappadath, L. Wales, R. Jackson, A. Raudonaitis, S. MacDonald, P. Dunlop, A. Brown, S. Vetrivel, M. Bajoriene, R. Gopi, C. McCollum, L. Wolowczyk, J. Ghosh, D. Seriki, R. Ashleigh, J. Butterfield, M. Welch, J.V. Smyth, D. Briley, U. Schulz, J. Perkins, L. Hands, W. Kuker, C. Darby, A. Handa, L. Sekaran, K. Poskitt, J. Morrison, P. Guyler, I. Grunwald, J. Brown, M. Jakeways, S. Tysoe, D. Hargroves, G. Gunathilagan, R. Insall, J. Senaratne, J. Beard, T. Cleveland, S. Nawaz, R. Lonsdale, D. Turner, P. Gaines, R. Nair, I. Chetter, G. Robinson, B. Akomolafe, J. Hatfield, K. Saastamoinen, J. Crinnion, A.A. Egun, J. Thomas, S. Drinkwater, S. D'Souza, G. Thomson, B. Gregory, S. Babu, S. Ashley, T. Joseph, R. Gibbs, G. Tebit, A. Mehrzad, P. Enevoldson, D. Mendalow, A. Parry, G. Tervitt, A. Clifton, M. Nazzel, R. Peto, H. Pan, J. Potter, R. Bullbulia, B. Mihaylova, M. Flather, A. Mansfield, D. Simpson, D. Thomas, W. Gray, B. Farrell, C. Davies, K. Rahimi, M. Gough, P. Cao, P. Rothwell, A. Belli, M. Mafham, W. Herrington, P. Sandercock, R. Gray, C. Shearman, A. Molyneux, A. Gray, A. Clarke, M. Sneade, L. Tully, W. Brudlo, M. Lay, A. Munday, C. Berry, S. Tochlin, J. Cox, R. Kurien, and J. Chester

Subjects
medicine.medical_specialty, Surgery, Cardiology and Cardiovascular Medicine, business.industry, Published Erratum, medicine.medical_treatment, Physical therapy, medicine, MEDLINE, Stent, Descriptive research, business
Published
2017
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15. Vascular Anatomy Predicts the Risk of Cerebral Ischemia in Patients Randomized to Carotid Stenting Versus Endarterectomy

Author

M. Müller, Paul J. Nederkoorn, Sumaira Macdonald, F.J. Ahlhelm, A. von Hessling, and Philippe Lyrer

Subjects
medicine.medical_specialty, Vascular anatomy, business.industry, medicine.medical_treatment, Ischemia, medicine.disease, Surgery, Internal medicine, medicine, Cardiology, In patient, Carotid stenting, Cardiology and Cardiovascular Medicine, business, Endarterectomy
Published
2017
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16. Attenuation of blood flow pulsatility along the Atlas slope: a physiologic property of the distal vertebral artery?

Author

A. von Hessling, Tilman Schubert, Francesco Santini, S. Schaedelin, Oliver Bieri, Christoph Stippich, Michele Pansini, and Stephan G. Wetzel

Subjects
Adult, Male, medicine.medical_specialty, Lacunar stroke, Vertebral artery, Pulsatility index, Young Adult, Atlas (anatomy), medicine.artery, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Extracranial Vascular, Vertebral Artery, business.industry, Attenuation, Straight segment, Blood flow, medicine.disease, Surgery, medicine.anatomical_structure, Cerebrovascular Circulation, Pulsatile Flow, Cardiology, Vascular resistance, Female, Vascular Resistance, Neurology (clinical), business, Blood Flow Velocity, Magnetic Resonance Angiography
Abstract

BACKGROUND AND PURPOSE: Physiologic and pathologic arterial tortuosity may attenuate blood flow pulsatility. The aim of this prospective study was to assess a potential effect of the curved V3 segment (Atlas slope) of the vertebral artery on arterial flow pulsatility. The pulsatility index and resistance index were used to assess blood flow pulsatility. MATERIALS AND METHODS: Twenty-one healthy volunteers (17 men, 4 women; mean age, 32 years) were examined with a 3T MR imaging system. Blood velocities were measured at 2 locations below (I and II) and at 1 location above the V3 segment (III) of the vertebral artery by using a high-resolution 2D-phase-contrast sequence with multidirectional velocity-encoding. RESULTS: Pulsatility and resistance indices decreased along all measurement locations from proximal to distal. The pulsatility index decreased significantly from location II to III and from I to II. However, the decrease was more pronounced along the Atlas slope than in the straight-vessel section below. The decrease of the resistance index was highly significant along the Atlas slope (location II to III). The decrease from location I to II was small and not significant. CONCLUSIONS: The pronounced decrease in pulsatility and resistance indices along the interindividually uniformly bent V3 segment compared with a straight segment of the vertebral artery indicates a physiologic attenuating effect of the Atlas slope on arterial flow pulsatility. A similar effect has been described for the carotid siphon. A physiologic reduction of pulsatility in brain-supplying arteries would be in accordance with several recent publications reporting a correlation of increased arterial flow pulsatility with leukoencephalopathy and lacunar stroke.

Published
2014

18. Long-term neurological and neuropsychological outcome in patients with severe traumatic brain injury

Author

Martin Seule, Mélanie C. Huser, Stephan Bednarz, Oliver Gautschi, Gerhard Hildebrandt, Sven Maedler, Nicolas R. Smoll, Roger Lussmann, and Alexander von Hessling

Subjects
Adult, Employment, Male, medicine.medical_specialty, Pediatrics, Adolescent, Intracranial Pressure, Traumatic brain injury, medicine.medical_treatment, Glasgow Outcome Scale, Neuropsychological Tests, Logistic regression, Executive Function, Young Adult, Memory, Predictive Value of Tests, medicine, Humans, Attention, Glasgow Coma Scale, Neuropsychological assessment, Intracranial pressure, Cause of death, Aged, Rehabilitation, medicine.diagnostic_test, business.industry, Neuropsychology, General Medicine, Recovery of Function, Middle Aged, medicine.disease, Treatment Outcome, Brain Injuries, Physical therapy, Surgery, Female, Neurology (clinical), business, Psychomotor Performance, Follow-Up Studies
Abstract

Background Severe traumatic brain injury (TBI) remains a major cause of death and disability worldwide. The aim of the study was to evaluate predictors for neurological and neuropsychological long-term outcome in patients with severe TBI treated according to an intracranial pressure (ICP-) targeted therapy. Methods From 08/2005 to 12/2008, 46 patients with severe TBI and more than 12 h of intensive care treatment were included in this study. Neurological outcome was assessed with the Glasgow Outcome Scale (GOS). Neuropsychological performance assessing 9 different domains was evaluated at long-term follow-up (median 20.5 months; range 10–46). Logistic regression was used to identify favourable outcomes according to the GOS and Fisher's exact tests were used to identify predictors of severe neuropsychological impairments at follow-up. Results Twenty-nine patients were available for neuropsychological assessment at long-term follow-up. Only 2 out of 29 patients presented normal or average neuropsychological findings throughout all 9 neuropsychological domains at long-term follow-up. The percentage of a favourable outcome (GOS 4-5) increased from 13.8% at hospital discharge to 75.8% at rehabilitation discharge to 79.3% at long-term follow-up, respectively. Age ≤40 was found to be a strong predictor of favourable outcome at follow-up (OR 5.95, 95% CI 1.41 25.00, p = 0.015). The GOS at hospital discharge was not a predictor for severe impairments in any of the 9 different neuropsychological domains (all p-values were p > 0.268). In contrast, the GOS at rehabilitation discharge was found to be a predictor of severe impairments at follow-up in all but one domain assessed (all p-values less than p Conclusions The GOS at rehabilitation discharge should be regarded as a better predictor for neuropsychological impairments at long-term follow-up than the GOS at hospital discharge. Even in patients with favourable GOS after finishing a course of rehabilitation, three quarters of these patients may have at least one severe neuropsychological deficit. Therefore, it remains of paramount importance to provide long-term neuropsychological support to further improve outcome after TBI.

Published
2013

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