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1. Poor grade subarachnoid hemorrhage: Treatment decisions and timing influence outcome. Should we, and when should we treat these patients?

Author

N. Brawanski, D. Dubinski, M. Bruder, J. Berkefeld, E. Hattingen, C. Senft, V. Seifert, and J. Konczalla

Subjects
Outcome, Prognostic factors, Poor grade subarachnoid hemorrhage, Time of treatment, Neurophysiology and neuropsychology, QP351-495
Abstract

Background: A poor admission status (World Federation of Neurosurgical Science (WFNS) IV-V) after aneurysmal subarachnoid hemorrhage (SAH) is well known as a negative prognostic factor for the future outcome of patients. In this retrospective study, we examine the factors that can be influenced by the treating doctors in this highly affected patient group. Methods: Patients with SAH were prospectively entered into a database, and outcome and prognostic factors were reviewed. Outcome was assessed using the modified Rankin Scale (mRS: favorable (mRS 0–2) vs. unfavorable (mRS 3–6)), six months after SAH. Results: A total of 1003 patients were selected, of whom 449 (44.8%) patients showed a poor admission status. Multivariate analysis showed the following independent, poor prognostic factors for a later unfavorable outcome: a concomitant intracerebral hemorrhage (ICH), delayed cerebral ischemia (DCI), and an untreated ruptured aneurysm. Additionally, early treatment (within 12 h of ictus) showed a notable effect on a favorable patient outcome (46%). Overall, 39% of patients with WFNS IV-V showed a favorable outcome. Conclusion: Patients with WFNS IV-V often have an unfavorable outcome (61% overall). Significant factors influencing the outcome of patients with WFNS IV-V are, ICH, and DCI. As the non-treatment of aneurysm is the only parameter that can be influenced, SAH patients will benefit from aneurysm treatment and, especially, from treatment in the first 12 h after ictus. In cases of early treatment, the number of patients with a favorable outcome increases to 46%.

Published
2021
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2. 4D Flat Panel Conebeam CTA for Analysis of the Angioarchitecture of Cerebral AVMs with a Novel Software Prototype

Author

F. Keil, A. Bergkemper, A. Birkhold, M. Kowarschik, S. Tritt, and J. Berkefeld

Subjects
Intracranial Arteriovenous Malformations, Interventional, Microvessels, Angiography, Digital Subtraction, Humans, Radiology, Nuclear Medicine and imaging, Neurology (clinical), Software
Abstract

BACKGROUND AND PURPOSE: Time-resolved 3DRA (4D-DSA) and flat panel conebeam CTA are new methods for visualizing the microangioarchitecture of cerebral AVMs. We applied a 4D software prototype to a series of cases of AVMs to assess the utility of this method in relation to treatment planning. MATERIALS AND METHODS: In 33 patients with AVMs, 4D volumes and flat panel conebeam CTA images were recalculated from existing 3D rotational angiography data. The multiplanar reconstructions were used to determine intranidal arteriovenous branching patterns, categorize them according to common classifications of AVM angioarchitecture, and compare the results with those from 2D-DSA. RESULTS: 4D flat panel conebeam CTA showed angioarchitectural features equal to or better than those of 2D-DSA in 30 of 33 cases. In particular, the reconstructions helped in understanding the intranidal microvasculature. Fistulous direct arteriovenous connections with a low degree of arterial branching (n = 22) could be distinguished from plexiform arterial networks before the transition to draining veins (n = 11). We identified AVMs with a single draining vein (n = 20) or multiple draining veins (n = 10). Arteriovenous shunts in the lateral wall of the draining veins (n = 22) could be distinguished from cases with increased venous branching and shunts between corresponding intranidal arteries and veins (n = 11). Limitations were the time-consuming postprocessing and the difficulties in correctly tracing intranidal vessels in larger and complex AVMs. CONCLUSIONS: 4D flat panel conebeam CTA reconstructions allow detailed analysis of the nidal angioarchitecture of AVMs. However, further improvements in temporal resolution and automated reconstruction techniques are needed to use the method generally in clinical practice.

Published
2022
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3. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data

Author

Bruce C V Campbell, Charles B L M Majoie, Gregory W Albers, Bijoy K Menon, Nawaf Yassi, Gagan Sharma, Wim H van Zwam, Robert J van Oostenbrugge, Andrew M Demchuk, Francis Guillemin, Philip White, Antoni Dávalos, Aad van der Lugt, Kenneth S Butcher, Aboubaker Cherifi, Henk A Marquering, Geoffrey Cloud, Juan M Macho Fernández, Jeremy Madigan, Catherine Oppenheim, Geoffrey A Donnan, Yvo B W E M Roos, Jai Shankar, Hester Lingsma, Alain Bonafé, Hélène Raoult, María Hernández-Pérez, Aditya Bharatha, Reza Jahan, Olav Jansen, Sébastien Richard, Elad I Levy, Olvert A Berkhemer, Marc Soudant, Lucia Aja, Stephen M Davis, Timo Krings, Marie Tisserand, Luis San Román, Alejandro Tomasello, Debbie Beumer, Scott Brown, David S Liebeskind, Serge Bracard, Keith W Muir, Diederik W J Dippel, Mayank Goyal, Jeffrey L Saver, Tudor G Jovin, Michael D Hill, Peter J Mitchell, Puck SS Fransen, Lucie A van den Berg, Hester F Lingsma, Albert J Yoo, Wouter J Schonewille, Jan Albert Vos, Paul J Nederkoorn, Marieke JH Wermer, Marianne AA van Walderveen, Julie Staals, Jeannette Hofmeijer, Jacques A. van Oostayen, Geert J. Lycklama à Nijeholt, Jelis Boiten, Patrick A. Brouwer, Bart J. Emmer, Sebastiaan F. de Bruijn, Lukas C. van Dijk, Jaap Kappelle, Rob H Lo, Ewoud J. van Dijk, Joost de Vries, Paul L.M. de Kort, Willem Jan J. van Rooij, Jan S.P. van den Berg, Boudewijn A.A.M. van Hasselt, Leo A.M. Aerden, René J. Dallinga, Marieke C. Visser, Joseph C.J. Bot, Patrick C. Vroomen, Omid Eshghi, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Alexander V. Tielbeek, Heleen M. den Hertog, Dick G. Gerrits, Renske M. van den Berg-Vos, Giorgos B. Karas, Ewout W. Steyerberg, Zwenneke Flach, Henk A. Marquering, Marieke E.S. Sprengers, Sjoerd F.M. Jenniskens, Ludo F.M. Beenen, René van den Berg, Peter J. Koudstaal, Wim H. van Zwam, Yvo B.W.E.M. Roos, Robert J. van Oostenbrugge, Charles B.L.M. Majoie, Diederik W.J. Dippel, Martin M. Brown, Thomas Liebig, Theo Stijnen, Tommy Andersson, Heinrich Mattle, Nils Wahlgren, Esther van der Heijden, Naziha Ghannouti, Nadine Fleitour, Imke Hooijenga, Corina Puppels, Wilma Pellikaan, Annet Geerling, Annemieke Lindl-Velema, Gina van Vemde, Ans de Ridder, Paut Greebe, José de Bont-Stikkelbroeck, Joke de Meris, Kirsten Janssen, Willy Struijk, Silvan Licher, Nikki Boodt, Adriaan Ros, Esmee Venema, Ilse Slokkers, Raymie-Jayce Ganpat, Maxim Mulder, Nawid Saiedie, Alis Heshmatollah, Stefanie Schipperen, Stefan Vinken, Tiemen van Boxtel, Jeroen Koets, Merel Boers, Emilie Santos, Jordi Borst, Ivo Jansen, Manon Kappelhof, Marit Lucas, Ralph Geuskens, Renan Sales Barros, Roeland Dobbe, Marloes Csizmadia, MD Hill, M Goyal, AM Demchuk, BK Menon, M Eesa, KJ Ryckborst, MR Wright, NR Kamal, L Andersen, PA Randhawa, T Stewart, S Patil, P Minhas, M Almekhlafi, S Mishra, F Clement, T Sajobi, A Shuaib, WJ Montanera, D Roy, FL Silver, TG Jovin, DF Frei, B Sapkota, JL Rempel, J Thornton, D Williams, D Tampieri, AY Poppe, D Dowlatshahi, JH Wong, AP Mitha, S Subramaniam, G Hull, MW Lowerison, M Salluzzi, M Maxwell, S Lacusta, E Drupals, K Armitage, PA Barber, EE Smith, WF Morrish, SB Coutts, C Derdeyn, B Demaerschalk, D Yavagal, R Martin, R Brant, Y Yu, RA Willinsky, A Weill, C Kenney, H Aram, PK Stys, TW Watson, G Klein, D Pearson, P Couillard, A Trivedi, D Singh, E Klourfeld, O Imoukhuede, D Nikneshan, S Blayney, R Reddy, P Choi, M Horton, T Musuka, V Dubuc, TS Field, J Desai, S Adatia, A Alseraya, V Nambiar, R van Dijk, NJ Newcommon, B Schwindt, KS Butcher, T Jeerakathil, B Buck, K Khan, SS Naik, DJ Emery, RJ Owen, TB Kotylak, RA Ashforth, TA Yeo, D McNally, M Siddiqui, M Saqqur, D Hussain, H Kalashyan, A Manosalva, M Kate, L Gioia, S Hasan, A Mohammad, M Muratoglu, A Cullen, P Brennan, A O'Hare, S Looby, D Hyland, S Duff, M McCusker, B Hallinan, S Lee, J McCormack, A Moore, M O'Connor, C Donegan, L Brewer, A Martin, S Murphy, K O'Rourke, S Smyth, P Kelly, T Lynch, T Daly, P O'Brien, A O'Driscoll, M Martin, R Collins, T Coughlan, D McCabe, D O'Neill, M Mulroy, O Lynch, T Walsh, M O'Donnell, T Galvin, J Harbison, P McElwaine, K Mulpeter, C McLoughlin, M Reardon, E Harkin, E Dolan, M Watts, N Cunningham, C Fallon, S Gallagher, P Cotter, M Crowe, R Doyle, I Noone, M Lapierre, VA Coté, S Lanthier, C Odier, A Durocher, J Raymond, N Daneault, Y Deschaintre, B Jankowitz, L Baxendell, L Massaro, C Jackson-Graves, S Decesare, P Porter, K Armbruster, A Adams, J Billigan, J Oakley, A Ducruet, A Jadhav, D-V Giurgiutiu, A Aghaebrahim, V Reddy, M Hammer, M Starr, V Totoraitis, L Wechsler, S Streib, S Rangaraju, D Campbell, M Rocha, D Gulati, T Krings, L Kalman, A Cayley, J Williams, R Wiegner, LK Casaubon, C Jaigobin, JM del Campo, E Elamin, JD Schaafsma, R Agid, R Farb, K ter Brugge, BL Sapkoda, BW Baxter, K Barton, A Knox, A Porter, A Sirelkhatim, T Devlin, C Dellinger, N Pitiyanuvath, J Patterson, J Nichols, S Quarfordt, J Calvert, H Hawk, C Fanale, A Bitner, A Novak, D Huddle, R Bellon, D Loy, J Wagner, I Chang, E Lampe, B Spencer, R Pratt, R Bartt, S Shine, G Dooley, T Nguyen, M Whaley, K McCarthy, J Teitelbaum, W Poon, N Campbell, M Cortes, C Lum, R Shamloul, S Robert, G Stotts, M Shamy, N Steffenhagen, D Blacquiere, M Hogan, M AlHazzaa, G Basir, H Lesiuk, D Iancu, M Santos, H Choe, DC Weisman, K Jonczak, A Blue-Schaller, Q Shah, L MacKenzie, B Klein, K Kulandaivel, O Kozak, DJ Gzesh, LJ Harris, JS Khoury, J Mandzia, D Pelz, S Crann, L Fleming, K Hesser, B Beauchamp, B Amato-Marzialli, M Boulton, P Lopez- Ojeda, M Sharma, S Lownie, R Chan, R Swartz, P Howard, D Golob, D Gladstone, K Boyle, M Boulos, J Hopyan, V Yang, L Da Costa, CA Holmstedt, AS Turk, R Navarro, E Jauch, S Ozark, R Turner, S Phillips, J Shankar, J Jarrett, G Gubitz, W Maloney, R Vandorpe, M Schmidt, J Heidenreich, G Hunter, M Kelly, R Whelan, L Peeling, PA Burns, A Hunter, I Wiggam, E Kerr, M Watt, A Fulton, P Gordon, I Rennie, P Flynn, G Smyth, S O'Leary, N Gentile, G Linares, P McNelis, K Erkmen, P Katz, A Azizi, M Weaver, C Jungreis, S Faro, P Shah, H Reimer, V Kalugdan, G Saposnik, A Bharatha, Y Li, P Kostyrko, T Marotta, W Montanera, D Sarma, D Selchen, J Spears, JH Heo, K Jeong, DJ Kim, BM Kim, YD Kim, D Song, K-J Lee, J Yoo, OY Bang, S Rho, J Lee, P Jeon, KH Kim, J Cha, SJ Kim, S Ryoo, MJ Lee, S-I Sohn, C-H Kim, H-G Ryu, J-H Hong, H-W Chang, C-Y Lee, J Rha, Bruce CV Campbell, Leonid Churilov, Bernard Yan, Richard Dowling, Thomas J Oxley, Teddy Y Wu, Gabriel Silver, Amy McDonald, Rachael McCoy, Timothy J Kleinig, Rebecca Scroop, Helen M Dewey, Marion Simpson, Mark Brooks, Bronwyn Coulton, Martin Krause, Timothy J Harrington, Brendan Steinfort, Kenneth Faulder, Miriam Priglinger, Susan Day, Thanh Phan, Winston Chong, Michael Holt, Ronil V Chandra, Henry Ma, Dennis Young, Kitty Wong, Tissa Wijeratne, Hans Tu, Elizabeth Mackay, Sherisse Celestino, Christopher F Bladin, Poh Sien Loh, Amanda Gilligan, Zofia Ross, Skye Coote, Tanya Frost, Mark W Parsons, Ferdinand Miteff, Christopher R Levi, Timothy Ang, Neil Spratt, Lara Kaauwai, Monica Badve, Henry Rice, Laetitia de Villiers, P. Alan Barber, Ben McGuinness, Ayton Hope, Maurice Moriarty, Patricia Bennett, Andrew Wong, Alan Coulthard, Andrew Lee, Jim Jannes, Deborah Field, Simon Salinas, Elise Cowley, Barry Snow, John Kolbe, Richard Stark, John King, Richard Macdonnell, John Attia, Cate D'Este, Hans-Christoph Diener, Elad I. Levy, Vitor Mendes Pereira, Gregory W. Albers, Christophe Cognard, David J. Cohen, Werner Hacke, Tudor G. Jovin, Heinrich P. Mattle, Raul G. Nogueira, Adnan H. Siddiqui, Dileep R. Yavagal, Rüdiger von Kummer, Wade Smith, Francis Turjman, Scott Hamilton, Richard Chiacchierini, Arun Amar, Nerses Sanossian, Yince Loh, B Baxter, VK Reddy, A Horev, M Star, A Siddiqui, LN Hopkins, K Snyder, R Sawyer, S Hall, V Costalat, C Riquelme, P Machi, E Omer, C Arquizan, I Mourand, M Charif, X Ayrignac, N Menjot de Champfleur, N Leboucq, G Gascou, M Moynier, R du Mesnil de Rochemont, O Singer, J Berkefeld, C Foerch, M Lorenz, W Pfeilschifer, E Hattingen, M Wagner, SJ You, S Lescher, H Braun, S Dehkharghani, SR Belagaje, A Anderson, A Lima, M Obideen, D Haussen, R Dharia, M Frankel, V Patel, K Owada, A Saad, L Amerson, C Horn, S Doppelheuer, K Schindler, DK Lopes, M Chen, R Moftakhar, C Anton, M Smreczak, JS Carpenter, S Boo, A Rai, T Roberts, A Tarabishy, L Gutmann, C Brooks, J Brick, J Domico, G Reimann, K Hinrichs, M Becker, E Heiss, C Selle, A Witteler, S Al-Boutros, M-J Danch, A Ranft, S Rohde, K Burg, C Weimar, V Zegarac, C Hartmann, M Schlamann, S Göricke, A Ringlestein, I Wanke, C Mönninghoff, M Dietzold, R Budzik, T Davis, G Eubank, WJ Hicks, P Pema, N Vora, J Mejilla, M Taylor, W Clark, A Rontal, J Fields, B Peterson, G Nesbit, H Lutsep, H Bozorgchami, R Priest, O Ologuntoye, S Barnwell, A Dogan, K Herrick, C Takahasi, N Beadell, B Brown, S Jamieson, MS Hussain, A Russman, F Hui, D Wisco, K Uchino, Z Khawaja, I Katzan, G Toth, E Cheng-Ching, M Bain, S Man, A Farrag, P George, S John, L Shankar, A Drofa, R Dahlgren, A Bauer, A Itreat, A Taqui, R Cerejo, A Richmond, P Ringleb, M Bendszus, M Möhlenbruch, T Reiff, H Amiri, J Purrucker, C Herweh, M Pham, O Menn, I Ludwig, I Acosta, C Villar, W Morgan, C Sombutmai, F Hellinger, E Allen, M Bellew, R Gandhi, E Bonwit, J Aly, RD Ecker, D Seder, J Morris, M Skaletsky, J Belden, C Baker, LS Connolly, P Papanagiotou, C Roth, A Kastrup, M Politi, F Brunner, M Alexandrou, H Merdivan, C Ramsey, C Given II, S Renfrow, V Deshmukh, K Sasadeusz, F Vincent, JT Thiesing, J Putnam, A Bhatt, A Kansara, D Caceves, T Lowenkopf, L Yanase, J Zurasky, S Dancer, B Freeman, T Scheibe-Mirek, J Robison, J Roll, D Clark, M Rodriguez, B-FM Fitzsimmons, O Zaidat, JR Lynch, M Lazzaro, T Larson, L Padmore, E Das, A Farrow-Schmidt, A Hassan, W Tekle, C Cate, O Jansen, C Cnyrim, F Wodarg, C Wiese, A Binder, C Riedel, A Rohr, N Lang, H Laufs, S Krieter, L Remonda, M Diepers, J Añon, K Nedeltchev, T Kahles, S Biethahn, M Lindner, V Chang, C Gächter, C Esperon, M Guglielmetti, JF Arenillas Lara, M Martínez Galdámez, AI Calleja Sanz, E Cortijo Garcia, P Garcia Bermejo, S Perez, P Mulero Carrillo, E Crespo Vallejo, M Ruiz Piñero, L Lopez Mesonero, FJ Reyes Muñoz, C Brekenfeld, J-H Buhk, A Krützelmann, G Thomalla, B Cheng, C Beck, J Hoppe, E Goebell, B Holst, U Grzyska, G Wortmann, S Starkman, G Duckwiler, R Jahan, N Rao, S Sheth, K Ng, A Noorian, V Szeder, M Nour, M McManus, J Huang, J Tarpley, S Tateshima, N Gonzalez, L Ali, D Liebeskind, J Hinman, M Calderon-Arnulphi, C Liang, J Guzy, S Koch, K DeSousa, G Gordon-Perue, M Elhammady, E Peterson, V Pandey, S Dharmadhikari, P Khandelwal, A Malik, R Pafford, P Gonzalez, K Ramdas, G Andersen, D Damgaard, P Von Weitzel-Mudersbach, C Simonsen, N Ruiz de Morales Ayudarte, M Poulsen, L Sørensen, S Karabegovich, M Hjørringgaard, N Hjort, T Harbo, K Sørensen, E Deshaies, D Padalino, A Swarnkar, JG Latorre, E Elnour, Z El-Zammar, M Villwock, H Farid, A Balgude, L Cross, K Hansen, M Holtmannspötter, D Kondziella, J Hoejgaard, S Taudorf, H Soendergaard, A Wagner, M Cronquist, T Stavngaard, M Cortsen, LH Krarup, T Hyldal, H-P Haring, S Guggenberger, M Hamberger, J Trenkler, M Sonnberger, K Nussbaumer, C Dominger, E Bach, BD Jagadeesan, R Taylor, J Kim, K Shea, R Tummala, H Zacharatos, D Sandhu, M Ezzeddine, A Grande, D Hildebrandt, K Miller, J Scherber, A Hendrickson, M Jumaa, S Zaidi, T Hendrickson, V Snyder, M Killer-Oberpfalzer, J Mutzenbach, F Weymayr, E Broussalis, K Stadler, A Jedlitschka, A Malek, N Mueller-Kronast, P Beck, C Martin, D Summers, J Day, I Bettinger, W Holloway, K Olds, S Arkin, N Akhtar, C Boutwell, S Crandall, M Schwartzman, C Weinstein, B Brion, S Prothmann, J Kleine, K Kreiser, T Boeckh-Behrens, H Poppert, S Wunderlich, ML Koch, V Biberacher, A Huberle, G Gora-Stahlberg, B Knier, T Meindl, D Utpadel-Fischler, M Zech, M Kowarik, C Seifert, B Schwaiger, A Puri, S Hou, A Wakhloo, M Moonis, N Henninger, R Goddeau, F Massari, A Minaeian, JD Lozano, M Ramzan, C Stout, A Patel, A Tunguturi, S Onteddu, R Carandang, M Howk, M Ribó, E Sanjuan, M Rubiera, J Pagola, A Flores, M Muchada, P Meler, E Huerga, S Gelabert, P Coscojuela, A Tomasello, D Rodriguez, E Santamarina, O Maisterra, S Boned, L Seró, A Rovira, CA Molina, M Millán, L Muñoz, N Pérez de la Ossa, M Gomis, L Dorado, E López-Cancio, E Palomeras, J Munuera, P García Bermejo, S Remollo, C Castaño, R García-Sort, P Cuadras, P Puyalto, M Hernández-Pérez, M Jiménez, A Martínez-Piñeiro, G Lucente, A Dávalos, A Chamorro, X Urra, V Obach, A Cervera, S Amaro, L Llull, J Codas, M Balasa, J Navarro, H Ariño, A Aceituno, S Rudilosso, A Renu, JM Macho, L San Roman, J Blasco, A López, N Macías, P Cardona, H Quesada, F Rubio, L Cano, B Lara, MA de Miquel, L Aja, J Serena, E Cobo, Kennedy R Lees, J Arenillas, R Roberts, F Al-Ajlan, L Zimmel, S Patel, J Martí-Fàbregas, M Salvat-Plana, S Bracard, Xavier Ducrocq, René Anxionnat, Pierre-Alexandre Baillot, Charlotte Barbier, Anne-Laure Derelle, Jean-Christophe Lacour, Yves Samson, Nader Sourour, Flore Baronnet-Chauvet, Frédéric Clarencon, Sophie Crozier, Sandrine Deltour, Federico Di Maria, Raphael Le Bouc, Anne Leger, Gurkan Mutlu, Charlotte Rosso, Zoltan Szatmary, Marion Yger, Chiara Zavanone, Serge Bakchine, Laurent Pierot, Nathalie Caucheteux, Laurent Estrade, Krzysztof Kadziolka, Alexandre Leautaud, Céline Renkes, Isabelle Serre, Hubert Desal, Benoît Guillon, Claire Boutoleau-Bretonniere, Benjamin Daumas-Duport, Solène De Gaalon, Pascal Derkinderen, Sarah Evain, Fanny Herisson, David-Axel Laplaud, Thibaud Lebouvier, Alina Lintia-Gaultier, Hélène Pouclet-Courtemanche, Tiphaine Rouaud, Violaine Rouaud Jaffrenou, Aurélia Schunck, Mathieu Sevin-Allouet, Frederique Toulgoat, Sandrine Wiertlewski, Jean-Yves Gauvrit, Thomas Ronziere, Vincent Cahagne, Jean-Christophe Ferre, Jean-François Pinel, Jean-Louis Mas, Jean-François Meder, Amen-Adam Al Najjar-Carpentier, Julia Birchenall, Eric Bodiguel, David Calvet, Valérie Domigo, Sylvie Godon-Hardy, Vincent Guiraud, Catherine Lamy, Loubna Majhadi, Ludovic Morin, Olivier Naggara, Denis Trystram, Guillaume Turc, Jérôme Berge, Igor Sibon, Patrice Menegon, Xavier Barreau, François Rouanet, Sabrina Debruxelles, Annabelle Kazadi, Pauline Renou, Olivier Fleury, Anne Pasco-Papon, Frédéric Dubas, Jildaz Caroff, Sophie Godard Ducceschi, Marie-Aurélie Hamon, Alderic Lecluse, Guillaume Marc, Maurice Giroud, Frédéric Ricolfi, Yannick Bejot, Adrien Chavent, Arnaud Gentil, Apolline Kazemi, Guy-Victor Osseby, Charlotte Voguet, Marie-Hélène Mahagne, Jacques Sedat, Yves Chau, Laurent Suissa, Sylvain Lachaud, Emmanuel Houdart, Christian Stapf, Frédérique Buffon Porcher, Hugues Chabriat, Pierre Guedin, Dominique Herve, Eric Jouvent, Jérôme Mawet, Jean-Pierre Saint-Maurice, Hans-Martin Schneble, Norbert Nighoghossian, Nadia-Nawel Berhoune, Françoise Bouhour, Tae-Hee Cho, Laurent Derex, Sandra Felix, Hélène Gervais-Bernard, Benjamin Gory, Luis Manera, Laura Mechtouff, Thomas Ritzenthaler, Roberto Riva, Fabrizio Salaris Silvio, Caroline Tilikete, Raphael Blanc, Michaël Obadia, Mario Bruno Bartolini, Antoine Gueguen, Michel Piotin, Silvia Pistocchi, Hocine Redjem, Jacques Drouineau, Jean-Philippe Neau, Gaelle Godeneche, Matthias Lamy, Emilia Marsac, Stephane Velasco, Pierre Clavelou, Emmanuel Chabert, Nathalie Bourgois, Catherine Cornut-Chauvinc, Anna Ferrier, Jean Gabrillargues, Betty Jean, Anna-Raquel Marques, Nicolas Vitello, Olivier Detante, Marianne Barbieux, Kamel Boubagra, Isabelle Favre Wiki, Katia Garambois, Florence Tahon, Vasdev Ashok, Oguzhan Coskun, Georges Rodesch, Bertrand Lapergue, Frédéric Bourdain, Serge Evrard, Philippe Graveleau, Jean Pierre Decroix, Adrien Wang, François Sellal, Guido Ahle, Gabriela Carelli, Marie-Hélène Dugay, Claude Gaultier, Ariel Pablo Lebedinsky, Lavinia Lita, Raul Mariano Musacchio, Catherine Renglewicz-Destuynder, Alain Tournade, Françis Vuillemet, Francisco Macian Montoro, Charbel Mounayer, Frederic Faugeras, Laetitia Gimenez, Catherine Labach, Géraldine Lautrette, Christian Denier, Guillaume Saliou, Olivier Chassin, Claire Dussaule, Elsa Melki, Augustin Ozanne, Francesco Puccinelli, Marina Sachet, Mariana Sarov, Jean-François Bonneville, Thierry Moulin, Alessandra Biondi, Elisabeth De Bustos Medeiros, Fabrice Vuillier, Patrick Courtheoux, Fausto Viader, Marion Apoil-Brissard, Mathieu Bataille, Anne-Laure Bonnet, Julien Cogez, Emmanuel Touze, Xavier Leclerc, Didier Leys, Mohamed Aggour, Pierre Aguettaz, Marie Bodenant, Charlotte Cordonnier, Dominique Deplanque, Marie Girot, Hilde Henon, Erwah Kalsoum, Christian Lucas, Jean-Pierre Pruvo, Paolo Zuniga, Caroline Arquizan, Vincent Costalat, Paolo Machi, Isabelle Mourand, Carlos Riquelme, Pierre Bounolleau, Charles Arteaga, Anthony Faivre, Marc Bintner, Patrice Tournebize, Cyril Charlin, Françoise Darcel, Pascale Gauthier-Lasalarie, Marcia Jeremenko, Servane Mouton, Jean-Baptiste Zerlauth, Chantal Lamy, Deramond Hervé, Hosseini Hassan, André Gaston, Francis-Guy Barral, Pierre Garnier, Rémy Beaujeux, Valérie Wolff, Denis Herbreteau, Séverine Debiais, Alicia Murray, Gary Ford, Andy Clifton, Janet Freeman, Ian Ford, Hugh Markus, Joanna Wardlaw, Andy Molyneux, Thompson Robinson, Steff Lewis, John Norrie, Fergus Robertson, Richard Perry, Anand Dixit, Andrew Clifton, Christine Roffe, Sanjeev Nayak, Kyriakos Lobotesis, Craig Smith, Amit Herwadkar, Naga Kandasamy, Tony Goddard, John Bamford, Ganesh Subramanian, Rob Lenthall, Edward Littleton, Sal Lamin, Kelley Storey, Rita Ghatala, Azra Banaras, John Aeron-Thomas, Bath Hazel, Holly Maguire, Emelda Veraque, Louise Harrison, Rekha Keshvara, James Cunningham, Clinical Neurophysiology, Weimar, Christian (Beitragende*r), Radiology and nuclear medicine, Rheumatology, ACS - Atherosclerosis & ischemic syndromes, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, MUMC+: MA AIOS Neurologie (9), The Royal Melbourne Hospital, Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA), Stanford University, University of Calgary, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University [Maastricht], Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute of Neuroscience [Newcastle] (ION), Newcastle University [Newcastle], Universitat Autònoma de Barcelona (UAB), Erasmus University Medical Center [Rotterdam] (Erasmus MC), University of Alberta, Centre d'Investigation Clinique - Innovation Technologique [Nancy] (CIC-IT), Monash University [Melbourne], St George’s University Hospitals, Institut de psychiatrie et neurosciences (U894 / UMS 1266), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Dalhousie University [Halifax], Neuroradiologie [Hôpital Gui de Chauliac], Hôpital Gui de Chauliac [Montpellier], Service de Neuroradiologie [Rennes], CHU Pontchaillou [Rennes], St. Michael's Hospital, University of California [Los Angeles] (UCLA), University of California, University Medical Center of Schleswig–Holstein = Universitätsklinikum Schleswig-Holstein (UKSH), Kiel University, Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de neurologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), University at Buffalo [SUNY] (SUNY Buffalo), State University of New York (SUNY), Toronto Western Hospital, Hôpital Foch [Suresnes], Vall d'Hebron University Hospital [Barcelona], Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), University of Glasgow, Queen Elizabeth University Hospital (Glasgow), David Geffen School of Medicine [Los Angeles], University of California-University of California, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Radiology & Nuclear Medicine, Public Health, Neurology, Radiology and Nuclear Medicine, ACS - Microcirculation, ANS - Neurovascular Disorders, ACS - Amsterdam Cardiovascular Sciences, Graduate School, ACS - Pulmonary hypertension & thrombosis, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, ARD - Amsterdam Reproduction and Development, Biomedical Engineering and Physics, APH - Personalized Medicine, APH - Quality of Care, and AMS - Restoration & Development

Subjects
SELECTION, COMPUTED TOMOGRAPHIC PERFUSION, Medizin, Perfusion scanning, 030204 cardiovascular system & hematology, Brain Ischemia, 0302 clinical medicine, Modified Rankin Scale, REPERFUSION, Stroke, ComputingMilieux_MISCELLANEOUS, Thrombectomy, Aged, 80 and over, medicine.diagnostic_test, Penumbra, Endovascular Procedures, Brain, Middle Aged, Magnetic Resonance Imaging, 3. Good health, Treatment Outcome, Cerebral blood flow, Tissue Plasminogen Activator, INFARCT, Cardiology, Female, TRIAL, CT, medicine.medical_specialty, Perfusion Imaging, Neuroimaging, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 03 medical and health sciences, Fibrinolytic Agents, ALTEPLASE, Internal medicine, medicine, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, Aged, business.industry, MECHANICAL THROMBECTOMY, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Magnetic resonance imaging, Odds ratio, medicine.disease, Neurology (clinical), business, Tomography, X-Ray Computed, 030217 neurology & neurosurgery, Fibrinolytic agent, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Background CT perfusion (CTP) and diffusion or perfusion MRI might assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of irreversibly injured ischaemic core and potentially salvageable penumbra volumes were associated with functional outcome and whether they interacted with the treatment effect of endovascular thrombectomy on functional outcome.Methods In this systematic review and meta-analysis, the HERMES collaboration pooled patient-level data from all randomised controlled trials that compared endovascular thrombectomy (predominantly using stent retrievers) with standard medical therapy in patients with anterior circulation ischaemic stroke, published in PubMed from Jan 1,2010, to May 31, 2017. The primary endpoint was functional outcome, assessed by the modified Rankin Scale (mRS) at 90 days after stroke. Ischaemic core was estimated, before treatment with either endovascular thrombectomy or standard medical therapy, by CTP as relative cerebral blood flow less than 30% of normal brain blood flow or by MRI as an apparent diffusion coefficient less than 620 mu m(2)/s. Critically hypoperfused tissue was estimated as the volume of tissue with a CTP time to maximum longer than 6 s. Mismatch volume (ie, the estimated penumbral volume) was calculated as critically hypoperfused tissue volume minus ischaemic core volume. The association of ischaemic core and penumbral volumes with 90-day mRS score was analysed with multivariable logistic regression (functional independence, defined as mRS score 0-2) and ordinal logistic regression (functional improvement by at least one mRS category) in all patients and in a subset of those with more than 50% endovascular reperfusion, adjusted for baseline prognostic variables. The meta-analysis was prospectively designed by the HERMES executive committee, but not registered.Findings We identified seven studies with 1764 patients, all of which were included in the meta-analysis. CTP was available and assessable for 591 (34%) patients and diffusion MRI for 309 (18%) patients. Functional independence was worse in patients who had CTP versus those who had diffusion MRI, after adjustment for ischaemic core volume (odds ratio [OR] 0.47 [95% CI 0.30-0.72], p=0.0007), so the imaging modalities were not pooled. Increasing ischaemic core volume was associated with reduced likelihood of functional independence (CTP OR 0.77 [0.69-0.86] per 10 mL, p(interaction)=0.29; diffusion MRI OR 0.87 [0.81-0.94] per 10 mL, p(interaction)=0.94). Mismatch volume, examined only in the CTP group because of the small numbers of patients who had perfusion MRI, was not associated with either functional independence or functional improvement. In patients with CTP with more than 50% endovascular reperfusion (n=186), age, ischaemic core volume, and imaging-to-reperfusion time were independently associated with functional improvement. Risk of bias between studies was generally low.Interpretation Estimated ischaemic core volume was independently associated with functional independence and functional improvement but did not modify the treatment benefit of endovascular thrombectomy over standard medical therapy for improved functional outcome. Combining ischaemic core volume with age and expected imagingto-reperfusion time will improve assessment of prognosis and might inform endovascular thrombectomy treatment decisions. Copyright (C) 2018 Elsevier Ltd. All rights reserved.

Published
2019
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4. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

Author

Bruce C V Campbell, Wim H van Zwam, Mayank Goyal, Bijoy K Menon, Diederik W J Dippel, Andrew M Demchuk, Serge Bracard, Philip White, Antoni Dávalos, Charles B L M Majoie, Aad van der Lugt, Gary A Ford, Natalia Pérez de la Ossa, Michael Kelly, Romain Bourcier, Geoffrey A Donnan, Yvo B W E M Roos, Oh Young Bang, Raul G Nogueira, Thomas G Devlin, Lucie A van den Berg, Frédéric Clarençon, Paul Burns, Jeffrey Carpenter, Olvert A Berkhemer, Dileep R Yavagal, Vitor Mendes Pereira, Xavier Ducrocq, Anand Dixit, Helena Quesada, Jonathan Epstein, Stephen M Davis, Olav Jansen, Marta Rubiera, Xabier Urra, Emilien Micard, Hester F Lingsma, Olivier Naggara, Scott Brown, Francis Guillemin, Keith W Muir, Robert J van Oostenbrugge, Jeffrey L Saver, Tudor G Jovin, Michael D Hill, Peter J Mitchell, Puck SS Fransen, Debbie Beumer, Albert J Yoo, Wouter J Schonewille, Jan Albert Vos, Paul J Nederkoorn, Marieke JH Wermer, Marianne AA van Walderveen, Julie Staals, Jeannette Hofmeijer, Jacques A. van Oostayen, Geert J. Lycklama à Nijeholt, Jelis Boiten, Patrick A. Brouwer, Bart J. Emmer, Sebastiaan F. de Bruijn, Lukas C. van Dijk, Jaap Kappelle, Rob H Lo, Ewoud J. van Dijk, Joost de Vries, Paul L.M. de Kort, Willem Jan J. van Rooij, Jan S.P. van den Berg, Boudewijn A.A.M. van Hasselt, Leo A.M. Aerden, René J. Dallinga, Marieke C. Visser, Joseph C.J. Bot, Patrick C. Vroomen, Omid Eshghi, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Alexander V. Tielbeek, Heleen M. den Hertog, Dick G. Gerrits, Renske M. van den Berg-Vos, Giorgos B. Karas, Ewout W. Steyerberg, Zwenneke Flach, Henk A. Marquering, Marieke E.S. Sprengers, Sjoerd F.M. Jenniskens, Ludo F.M. Beenen, René van den Berg, Peter J. Koudstaal, Wim H. van Zwam, Yvo B.W.E.M. Roos, Robert J. van Oostenbrugge, Charles B.L.M. Majoie, Diederik W.J. Dippel, Martin M. Brown, Thomas Liebig, Theo Stijnen, Tommy Andersson, Heinrich Mattle, Nils Wahlgren, Esther van der Heijden, Naziha Ghannouti, Nadine Fleitour, Imke Hooijenga, Corina Puppels, Wilma Pellikaan, Annet Geerling, Annemieke Lindl-Velema, Gina van Vemde, Ans de Ridder, Paut Greebe, José de Bont-Stikkelbroeck, Joke de Meris, Kirsten Janssen, Willy Struijk, Silvan Licher, Nikki Boodt, Adriaan Ros, Esmee Venema, Ilse Slokkers, Raymie-Jayce Ganpat, Maxim Mulder, Nawid Saiedie, Alis Heshmatollah, Stefanie Schipperen, Stefan Vinken, Tiemen van Boxtel, Jeroen Koets, Merel Boers, Emilie Santos, Jordi Borst, Ivo Jansen, Manon Kappelhof, Marit Lucas, Ralph Geuskens, Renan Sales Barros, Roeland Dobbe, Marloes Csizmadia, MD Hill, M Goyal, AM Demchuk, BK Menon, M Eesa, KJ Ryckborst, MR Wright, NR Kamal, L Andersen, PA Randhawa, T Stewart, S Patil, P Minhas, M Almekhlafi, S Mishra, F Clement, T Sajobi, A Shuaib, WJ Montanera, D Roy, FL Silver, TG Jovin, DF Frei, B Sapkota, JL Rempel, J Thornton, D 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Alan Barber, Ben McGuinness, Ayton Hope, Maurice Moriarty, Patricia Bennett, Andrew Wong, Alan Coulthard, Andrew Lee, Jim Jannes, Deborah Field, Gagan Sharma, Simon Salinas, Elise Cowley, Barry Snow, John Kolbe, Richard Stark, John King, Richard Macdonnell, John Attia, Cate D'Este, Hans-Christoph Diener, Elad I. Levy, Alain Bonafé, Reza Jahan, Gregory W. Albers, Christophe Cognard, David J. Cohen, Werner Hacke, Tudor G. Jovin, Heinrich P. Mattle, Raul G. Nogueira, Adnan H. Siddiqui, Dileep R. 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J Codas, M Balasa, J Navarro, H Ariño, A Aceituno, S Rudilosso, A Renu, JM Macho, L San Roman, J Blasco, A López, N Macías, P Cardona, H Quesada, F Rubio, L Cano, B Lara, MA de Miquel, L Aja, J Serena, E Cobo, Gregory W Albers, Kennedy R Lees, J Arenillas, R Roberts, F Al-Ajlan, L Zimmel, S Patel, J Martí-Fàbregas, M Salvat-Plana, S Bracard, René Anxionnat, Pierre-Alexandre Baillot, Charlotte Barbier, Anne-Laure Derelle, Jean-Christophe Lacour, Sébastien Richard, Yves Samson, Nader Sourour, Flore Baronnet-Chauvet, Frédéric Clarencon, Sophie Crozier, Sandrine Deltour, Federico Di Maria, Raphael Le Bouc, Anne Leger, Gurkan Mutlu, Charlotte Rosso, Zoltan Szatmary, Marion Yger, Chiara Zavanone, Serge Bakchine, Laurent Pierot, Nathalie Caucheteux, Laurent Estrade, Krzysztof Kadziolka, Alexandre Leautaud, Céline Renkes, Isabelle Serre, Hubert Desal, Benoît Guillon, Claire Boutoleau-Bretonniere, Benjamin Daumas-Duport, Solène De Gaalon, Pascal Derkinderen, Sarah Evain, Fanny Herisson, David-Axel Laplaud, Thibaud Lebouvier, Alina Lintia-Gaultier, Hélène Pouclet-Courtemanche, Tiphaine Rouaud, Violaine Rouaud Jaffrenou, Aurélia Schunck, Mathieu Sevin-Allouet, Frederique Toulgoat, Sandrine Wiertlewski, Jean-Yves Gauvrit, Thomas Ronziere, Vincent Cahagne, Jean-Christophe Ferre, Jean-François Pinel, Hélène Raoult, Jean-Louis Mas, Jean-François Meder, Amen-Adam Al Najjar-Carpentier, Julia Birchenall, Eric Bodiguel, David Calvet, Valérie Domigo, Sylvie Godon-Hardy, Vincent Guiraud, Catherine Lamy, Loubna Majhadi, Ludovic Morin, Denis Trystram, Guillaume Turc, Jérôme Berge, Igor Sibon, Patrice Menegon, Xavier Barreau, François Rouanet, Sabrina Debruxelles, Annabelle Kazadi, Pauline Renou, Olivier Fleury, Anne Pasco-Papon, Frédéric Dubas, Jildaz Caroff, Sophie Godard Ducceschi, Marie-Aurélie Hamon, Alderic Lecluse, Guillaume Marc, Maurice Giroud, Frédéric Ricolfi, Yannick Bejot, Adrien Chavent, Arnaud Gentil, Apolline Kazemi, Guy-Victor Osseby, Charlotte Voguet, Marie-Hélène Mahagne, Jacques Sedat, Yves Chau, Laurent Suissa, Sylvain Lachaud, Emmanuel Houdart, Christian Stapf, Frédérique Buffon Porcher, Hugues Chabriat, Pierre Guedin, Dominique Herve, Eric Jouvent, Jérôme Mawet, Jean-Pierre Saint-Maurice, Hans-Martin Schneble, Norbert Nighoghossian, Nadia-Nawel Berhoune, Françoise Bouhour, Tae-Hee Cho, Laurent Derex, Sandra Felix, Hélène Gervais-Bernard, Benjamin Gory, Luis Manera, Laura Mechtouff, Thomas Ritzenthaler, Roberto Riva, Fabrizio Salaris Silvio, Caroline Tilikete, Raphael Blanc, Michaël Obadia, Mario Bruno Bartolini, Antoine Gueguen, Michel Piotin, Silvia Pistocchi, Hocine Redjem, Jacques Drouineau, Jean-Philippe Neau, Gaelle Godeneche, Matthias Lamy, Emilia Marsac, Stephane Velasco, Pierre Clavelou, Emmanuel Chabert, Nathalie Bourgois, Catherine Cornut-Chauvinc, Anna Ferrier, Jean Gabrillargues, Betty Jean, Anna-Raquel Marques, Nicolas Vitello, Olivier Detante, Marianne Barbieux, Kamel Boubagra, Isabelle Favre Wiki, Katia Garambois, Florence Tahon, Vasdev Ashok, Oguzhan Coskun, Georges Rodesch, Bertrand Lapergue, Frédéric Bourdain, Serge Evrard, Philippe Graveleau, Jean Pierre Decroix, Adrien Wang, François Sellal, Guido Ahle, Gabriela Carelli, Marie-Hélène Dugay, Claude Gaultier, Ariel Pablo Lebedinsky, Lavinia Lita, Raul Mariano Musacchio, Catherine Renglewicz-Destuynder, Alain Tournade, Françis Vuillemet, Francisco Macian Montoro, Charbel Mounayer, Frederic Faugeras, Laetitia Gimenez, Catherine Labach, Géraldine Lautrette, Christian Denier, Guillaume Saliou, Olivier Chassin, Claire Dussaule, Elsa Melki, Augustin Ozanne, Francesco Puccinelli, Marina Sachet, Mariana Sarov, Jean-François Bonneville, Thierry Moulin, Alessandra Biondi, Elisabeth De Bustos Medeiros, Fabrice Vuillier, Patrick Courtheoux, Fausto Viader, Marion Apoil-Brissard, Mathieu Bataille, Anne-Laure Bonnet, Julien Cogez, Emmanuel Touze, Xavier Leclerc, Didier Leys, Mohamed Aggour, Pierre Aguettaz, Marie Bodenant, Charlotte Cordonnier, Dominique Deplanque, Marie Girot, Hilde Henon, Erwah Kalsoum, Christian Lucas, Jean-Pierre Pruvo, Paolo Zuniga, Caroline Arquizan, Vincent Costalat, Paolo Machi, Isabelle Mourand, Carlos Riquelme, Pierre Bounolleau, Charles Arteaga, Anthony Faivre, Marc Bintner, Patrice Tournebize, Cyril Charlin, Françoise Darcel, Pascale Gauthier-Lasalarie, Marcia Jeremenko, Servane Mouton, Jean-Baptiste Zerlauth, Chantal Lamy, Deramond Hervé, Hosseini Hassan, André Gaston, Francis-Guy Barral, Pierre Garnier, Rémy Beaujeux, Valérie Wolff, Denis Herbreteau, Séverine Debiais, Alicia Murray, Gary Ford, Martin M Brown, Andy Clifton, Janet Freeman, Ian Ford, Hugh Markus, Joanna Wardlaw, Andy Molyneux, Thompson Robinson, Steff Lewis, John Norrie, Fergus Robertson, Richard Perry, Geoffrey Cloud, Andrew Clifton, Jeremy Madigan, Christine Roffe, Sanjeev Nayak, Kyriakos Lobotesis, Craig Smith, Amit Herwadkar, Naga Kandasamy, Tony Goddard, John Bamford, Ganesh Subramanian, Rob Lenthall, Edward Littleton, Sal Lamin, Kelley Storey, Rita Ghatala, Azra Banaras, John Aeron-Thomas, Bath Hazel, Holly Maguire, Emelda Veraque, Louise Harrison, Rekha Keshvara, James Cunningham, University of Melbourne, University of Calgary, Erasmus University Medical Center [Rotterdam] (Erasmus MC), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), University of Amsterdam [Amsterdam] (UvA), Universitat Autònoma de Barcelona (UAB), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, ACS - Amsterdam Cardiovascular Sciences, Neurology, Graduate School, Other Research, APH - Personalized Medicine, APH - Quality of Care, Biomedical Engineering and Physics, ARD - Amsterdam Reproduction and Development, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ACS - Microcirculation, ACS - Atherosclerosis & ischemic syndromes, ACS - Pulmonary hypertension & thrombosis, Radiology & Nuclear Medicine, Public Health, Weimar, Christian (Beitragende*r), Molecular cell biology and Immunology, Pathology, Radiology and nuclear medicine, Amsterdam Neuroscience - Neurovascular Disorders, Rheumatology, Beeldvorming, RS: CARIM - R3.03 - Cerebral small vessel disease, RS: CARIM - R3.11 - Imaging, MUMC+: DA BV Medisch Specialisten Radiologie (9), Klinische Neurowetenschappen, and MUMC+: MA Neurologie (3)

Subjects
Male, medicine.medical_specialty, Sedation, Medizin, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 030204 cardiovascular system & hematology, Anesthesia, General, CONTROLLED-TRIAL, THERAPY, law.invention, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, All institutes and research themes of the Radboud University Medical Center, Randomized controlled trial, law, Modified Rankin Scale, Journal Article, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Medicine, Humans, General anaesthesia, Stroke, Aged, Randomized Controlled Trials as Topic, Thrombectomy, Aged, 80 and over, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Odds ratio, MR, Middle Aged, Outcome and Process Assessment (Health Care), medicine.disease, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], 3. Good health, Surgery, Outcome and Process Assessment, Health Care, Meta-analysis, Observational study, Female, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Meta-Analysis
Abstract

BACKGROUND: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care.METHODS: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered.FINDINGS: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09-2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75-3·10, pINTERPRETATION: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons.FUNDING: Medtronic.

Published
2018
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7. S3-Leitlinie Extracranielle Carotisstenose

Author

A. Kühnl, R. Langhoff, Martin Storck, M. Görtler, Dirk Sander, Arnd Dörfler, J. Berkefeld, Peter A. Ringleb, Holger Lawall, R. Diel, D. G. Nabavi, I. Kopp, C. Arning, and Hans-Henning Eckstein

Subjects
Gynecology, medicine.medical_specialty, business.industry, Medicine, Surgery, Cardiology and Cardiovascular Medicine, business
Published
2012
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9. S3-Leitlinie Extracranielle Carotisstenose

Author

Arnd Dörfler, Martin Storck, Dirk Sander, M. Goertler, J. Berkefeld, Peter A. Ringleb, R. Langhoff, Hans-Henning Eckstein, I. Kopp, R. Diel, Holger Lawall, and A. Kühnl

Subjects
Gynecology, medicine.medical_specialty, business.industry, Medicine, Surgery, Cardiology and Cardiovascular Medicine, business
Published
2012
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10. S3-Leitlinie Extracranielle Carotisstenose

Author

Hans-Henning Eckstein, Martin Storck, Holger Lawall, R. Diel, J. Berkefeld, Arnd Dörfler, Peter A. Ringleb, R. Langhoff, Dirk Sander, Curt Diehm, I. Kopp, and A. Kühnl

Subjects
Gynecology, medicine.medical_specialty, business.industry, Medicine, Surgery, Cardiology and Cardiovascular Medicine, business
Published
2012
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12. Mechanische Rekanalisationstherapien beim akuten Schlaganfall

Author

J. S. Becktepe, J. Berkefeld, and O. C. Singer

Subjects
Neurology (clinical), Family Practice
Abstract

ZusammenfassungNeben der seit 2002 zur Behandlung des akuten ischämischen Schlaganfalles in Deutschland zugelassenen systemischen Thrombolyse mit rekombinantem Gewebeplasminogenaktivator (rtPA) werden vermehrt endovaskuläre Rekanalisationstherapien sowohl in wissenschaftlichen Studien als auch in der klinischen Routine eingesetzt. Hierbei werden in erster Linie klinisch schwer betroffene Patienten mit einem akuten Verschluss eines großen hirnversorgenden Gefäßes (Hauptstamm der A. cerebri media, intrakranielle A. carotis interna, A. basilaris) behandelt. Obwohl die angiografischen Daten, insbesondere die Rekanalisationsraten überzeugend sind und in Einzelfällen dramatische klinische Verbesserungen zu erzielen sind, ist der klinische Nutzen der endovaskulären Schlaganfalltherapie noch nicht abschließend geklärt. Dieser Übersichtsartikel informiert über gängige Indikationen, Verfahren und prozedurale Aspekte der mechanischen Rekanalisationstherapie.

Published
2012
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13. [Not Available]

Author

J, Berkefeld

Subjects
Neurology, Germany, Neuroradiography, Practice Guidelines as Topic, Radiology, Societies, Medical
Published
2015

15. Stent Treatment of Arterial Dissection

Author

J. Berkefeld

Subjects
medicine.medical_specialty, Subarachnoid hemorrhage, Radiological and Ultrasound Technology, Arterial dissection, business.industry, medicine.medical_treatment, Vertebral artery dissection, Cerebral arteries, Stent, medicine.disease, Surgery, Carotid artery dissection, Antithrombotic, Occlusion, Medicine, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Neurology (clinical), Radiology, business
Abstract

Dissections of cerebral arteries are most often treated in a conservative manner with the use of antithrombotic drugs. This is justified by the relatively benign cause of the disease after the initial event. However, there are some exceptions from this rule: Stent treatment of stenotic dissections should be considered in patients who are hemodynamically compromised or recurrently symptomatic. Dissecting pseudoaneurysms must be treated after subarachnoid hemorrhage or in traumatic cases. Parent vessel occlusion is still the best option in this condition. Coiling with soft coils or stenting + coiling may be an alternative in cases without sufficient collaterals or in unruptured dissecting aneurysms.

Published
2005
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21. The Influence of Stent Design on Recanalization Results at the Carotid Bifurcation

Author

J. B. Martin, Daniel A. Rüfenacht, N. Tanaka, Friedhelm E. Zanella, J. Berkefeld, and S. Rohde

Subjects
medicine.medical_specialty, Radiological and Ultrasound Technology, business.industry, medicine.medical_treatment, Stent, Surgery, chemistry.chemical_compound, Silicone, chemistry, medicine, Carotid bifurcation, Radiology, Nuclear Medicine and imaging, Neurology (clinical), Radiology, business, Stent design
Published
2003
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25. [Diagnosis of cerebral ischemia: when CT and when MRI?]

Author

J, Berkefeld and T, Neumann-Haefelin

Subjects
Brain, Humans, Image Enhancement, Tomography, X-Ray Computed, Magnetic Resonance Imaging, Brain Ischemia
Abstract

Rapid and effective diagnostic imaging is important for decision-making concerning thrombolysis in patients with acute ischemic stroke. Apart from excluding intracranial hemorrhage, CT and MRI provide multiple methodological options to define the extent of ischemic brain damage and the underlying vascular pathology. The aim of this article is to discuss the value of CT and MRI from a neurologicalneuroradiological point of view and to discuss which of the available imaging tools are really relevant for clinical decision making.

Published
2009

26. [Stroke MRI for risk assessment of intracerebral hemorrhage associated with thrombolytic therapy]

Author

O C, Singer, J, Fiehler, J, Berkefeld, and T, Neumann-Haefelin

Subjects
Stroke, Diffusion Magnetic Resonance Imaging, Fibrinolytic Agents, Risk Factors, Patient Selection, Humans, Thrombolytic Therapy, Risk Assessment, Magnetic Resonance Angiography, Cerebral Hemorrhage
Abstract

This article summarizes recent developments concerning MRI-based risk assessment of symptomatic intracerebral hemorrhage (sICH) associated with thrombolytic therapy for acute stroke. Special attention is paid to three imaging parameters: cerebral microangiopathy, lesion size on diffusion weighted imaging (DWI), and the role of cerebral microbleeds. Both severe cerebral microangiopathy and increasing lesion size on DWI are now established risk factors for sICH following thrombolysis, while the presence of a single or few microbleeds is not associated with a substantially elevated sICH risk.

Published
2009

27. [Presaccal stenosis as a cause of epiphora]

Author

M, Lüchtenberg, J, Berkefeld, and A, Bink

Subjects
Imaging, Three-Dimensional, Lacrimal Apparatus Diseases, Lacrimal Duct Obstruction, Image Processing, Computer-Assisted, Angiography, Digital Subtraction, Humans, Nasolacrimal Duct, Sensitivity and Specificity
Abstract

Dacryocystographic evaluation of the location of stenoses of the lacrimal pathways was carried out in patients with epiphora to define the frequency and morphology of canalicular stenosis.Digital subtraction angiography (DSA) dacryocystograms of 55 consecutive patients with severe epiphora and stenoses of the lacrimal draining system were reviewed in a consensus between three evaluators to determine radiomorphologic criteria for the diagnosis of canalicular stenosis. In 9 cases 3D rotational dacryocystography was additionally used.A total of 80 stenotic lesions were detected including 19 (24%) canalicular, 26 (32%) saccal and 35 (44%) ductal stenoses. In 9 of the patients 3D rotational dacryocystography was used to differentiate between canalicular (n=4) and saccal (n=5) stenosis. Increased resistance during continuous injection of contrast material and lack of distension of the distal ductal system were the main criteria for diagnosis of canalicular stenosis.Presaccal stenoses accounted for nearly 25% of the stenoses found in this study. This type of stenosis occurs frequently and should not be overlooked on dacryocystography. 3D rotational dacryocystography may be helpful in unclear cases.

Published
2008

28. [Importance of imaging diagnostics and interventional therapy for diseases of the lacrimal drainage canals]

Author

A, Bink, M, Lüchtenberg, and J, Berkefeld

Subjects
Adult, Male, Lacrimal Apparatus Diseases, Angiography, Digital Subtraction, Contrast Media, Endoscopy, Middle Aged, Magnetic Resonance Imaging, Sensitivity and Specificity, Catheterization, Dacryocystitis, Imaging, Three-Dimensional, Lacrimal Duct Obstruction, Image Processing, Computer-Assisted, Humans, Female, Tomography, Spiral Computed, Aged
Abstract

Epiphora (continuous watering of the eyes) is frequently caused by obstruction of the lacrimal draining system. Radiographic imaging of the tear ducts after contrast injection with the DSA (digital subtraction angiography) dacryocystography technique is still the gold standard in patients with severe epiphora which does not respond to conservative therapy. Recent techniques, such as 3D rotational dacryocystography, MRI and CT are able to show the anatomic surroundings in addition to the ductal structures and are especially useful for planning endoscopic operations. Dacryocystographically assisted interventions, such as balloon dilatation or stenting of tear duct stenoses are technically feasible. Balloon dacryocystoplasty is especially successful in patients with incomplete or short distance obstructions of the nasolacrimal duct. Stenting may improve procedural success and patency rates. Minimally invasive interventional therapy is useful as an initial treatment in selected cases, however, long-term success rates may be limited and operative dacryocystorhinostomy still plays an important role. Comparative studies for evaluation of different therapeutic options are necessary.

Published
2008

31. [Endovascular treatment for intracranial stenoses. A common statement by neurologists and neuroradiologists]

Author

J, Berkefeld, G F, Hamann, R, du Mesnil, W, Kurre, H, Steinmetz, F E, Zanella, and M, Sitzer

Subjects
Cerebral Infarction, Intracranial Arteriosclerosis, Magnetic Resonance Imaging, Cerebral Angiography, Treatment Outcome, Intracranial Embolism, Recurrence, Risk Factors, Image Processing, Computer-Assisted, Humans, Stents, Algorithms, Angioplasty, Balloon, Platelet Aggregation Inhibitors, Follow-Up Studies
Abstract

Intracranial stenoses cause 5-10% of all strokes and are increasingly detected by means of modern imaging methods. The stroke danger of high-grade symptomatic stenoses is relatively high, with an annual risk of approximately 10% under medical treatment. Coumadin increases the risk of hemorrhage, and after risk/benefit considerations, antiplatelets should be preferred for antithrombotic therapy. Despite optimized medical treatment, a small group of patients with recurrent symptoms or symptomatic stenoses without adequate collateral supply probably carry higher spontaneous stroke risk and may be considered for intracranial stenting, which itself is associated with procedural risks of up to 10%. Currently published case series show relatively high complication rates as a major drawback of endovascular treatment, mainly strokes after occlusion of perforating branches extending from the stenotic vessel segment or hemorrhagic complications. According to data from smaller feasibility studies, stroke rates in follow-up after successful stenting seem to be low. The average rate of high-grade restenosis with possible indication for reintervention is 10%. Improvements in endovascular treatment aim at reducing vessel wall trauma during balloon angioplasty by underdilatation or the use of self-expanding stents. Until complication rates are dependably reduced to values of 5-6%, indication for endovascular treatment should be restricted to patients without therapeutic alternatives. According to limited data with large variation between different studies, a prospective multicentric registry is proposed for systematic evaluation and further development of the method.

Published
2006

32. [Clinical and histopathological results after local chemoembolization of oral and oropharyngeal carcinoma--comparison with intraarterial chemoperfusion]

Author

S, Rohde, B, Turowski, J, Berkefeld, A F, Kovács, and A, Kovács

Subjects
Male, Antineoplastic Agents, Middle Aged, Oropharyngeal Neoplasms, Treatment Outcome, Injections, Intra-Arterial, Germany, Outcome Assessment, Health Care, Humans, Female, Mouth Neoplasms, Chemoembolization, Therapeutic, Cisplatin, Retrospective Studies
Abstract

Retrospective analysis of clinical and histopathological results after neoadjuvant intraarterial chemoembolization (iaCE) as compared to intraarterial chemoperfusion (iaCP) in patients with oral and oropharyngeal squamous cell cancer (SCC).289 patients (mean age 60 years, 68 % male) with SCC of the oral cavity or the oropharynx (WHO stage I-IV) received (1) neoadjuvant iaCE (n = 103) with a crystalline suspension of cisplatin (150 mg/m(2), solution ratio 5 mg cisplatin ad 1 ml NaCl 0.9 %, total volume 40 - 60 ml) or (2) iaCP (n = 186) using high-dose cisplatin infusions (150 mg/m(2), 1 mg cisplatin ad 1 ml NaCl 0.9 %, 400 - 500 ml). The decision for iaCE or iaCP was made individually for each patient based on tumor localization and expected vascular supply. Four weeks after local chemotherapy, the treatment response was evaluated according (1) to WHO criteria and (2) to histopathological TNM-grading after tumor resection.The overall treatment response was 72.5 % after iaCE and 47 % after iaCP (p0.001). A stable disease was found in 24 % and 48 %, respectively, and tumor progression was found in 3 % for both modalities. Histopathological examination of resected tumors revealed complete remission in 20 % after iaCE and 13 % after iaCP. The percentage of complete remissions was highest in local T1 and T2 tumors after iaCE (42.9 versus 22.4 % after iaCP, p = 0.031). Local side effects were significantly more frequent after iaCE than after iaCP (p0.001), especially in obese patients with extended carcinoma of the oral floor or the tongue base.Compared to iaCP, clinical and histopathological remission rates are significantly higher after iaCE, especially in early stages of local tumor growth. However, in view of the higher risk of regional complications, indication for iaCE should be considered cautiously and its application should be limited to small tumors of the oral floor and the oral tongue.

Published
2006

33. Traumatic rupture of the intracranial vertebral artery due to rotational acceleration

Author

Hansjürgen Bratzke, A. Schnabel, J. Berkefeld, and Ch. Kaiser

Subjects
Adult, Male, medicine.medical_specialty, Vertebral artery, Autopsy, Pathology and Forensic Medicine, Pseudoaneurysm, Blunt, medicine.artery, Head Injuries, Closed, Medicine, Humans, Forensic Pathology, Orbital Fractures, Vertebral Artery, Intracranial pressure, Rupture, medicine.diagnostic_test, business.industry, Vascular disease, Subarachnoid Hemorrhage, medicine.disease, Hematoma, Subdural, Blunt trauma, Angiography, Radiology, Intracranial Hypertension, business, Tomography, X-Ray Computed, Law, Aneurysm, False, Dilatation, Pathologic
Abstract

The reason for blunt forces against the head to rupture the basal brain arteries has been discussed in forensic and trauma research. However, well-documented case reports demonstrating the mechanism of injury, the clinical course and the forensic work up are rare. We present the case of a 40-year-old man, who was assaulted with blunt force to the head resulting in death 34 h later from a longitudinal rupture of the distal left vertebral artery. Computer tomography of the brain and the face demonstrated a basal subarachnoidal haemorrhage, signs of increased intracranial pressure and a fracture of the right orbital bone. Angiography showed a long fusiform dilatation of both intracranial vertebral arteries with an active pseudoaneurysm on the left side. At autopsy signs of a blunt trauma to the head, extensive basal subarachnoidal haemorrhage and a minor subdural haemorrhage were found. Histological examination revealed a transmural longitudinal rupture of the left vertebral artery with vital reaction and no signs of preexisting vascular disease. We discuss the current literature regarding traumatic basal brain artery rupture, important clinical decision making processes as well as pitfalls in the forensic work up. In addition, this singular well-documented case gives new insights in the underlying pathophysiological mechanisms of traumatic basal artery rupture.

Published
2006

34. Conformability of balloon-expandable stents to the carotid siphon: an in vitro study

Author

R, du Mesnil de Rochemont, B, Yan, F E, Zanella, D A, Rüfenacht, and J, Berkefeld

Subjects
Interventional, Models, Cardiovascular, Silicones, Angiography, Digital Subtraction, Equipment Design, In Vitro Techniques, equipment and supplies, Brain Ischemia, Equipment Failure Analysis, surgical procedures, operative, Imaging, Three-Dimensional, cardiovascular system, Humans, Carotid Stenosis, Stents, cardiovascular diseases, Angioplasty, Balloon, Carotid Artery, Internal
Abstract

BACKGROUND AND PURPOSE: Endovascular placement of coronary balloon-expandable stents in patients with recurrent cerebral ischemia has emerged as a treatment option for intracranial arterial occlusive disease. We have developed an in vitro model matching the tortuous curve of the carotid siphon that allows the assessment of apposition of stents to a curved vessel wall. METHODS: Six types of balloon-expandable coronary stents were implanted in a silicone model of the carotid siphon. Digital radiographs and 3D rotational angiograms were obtained. Stent morphology was evaluated and the degree of apposition between stent and wall of the model was measured on a digital workstation. RESULTS: All 6 stents showed lack of apposition between stent and the wall at the convexity of the anterior segment of the carotid siphon and the wall at the concavity at both extremities of the stent. In and around the curve, the modules of the stents did not expand completely to their nominal diameter and were distorted to an oval shape. CONCLUSION: The tested coronary balloon-expandable stents did not completely conform to the vessel wall of the model of the carotid siphon and further development is needed to approach the goal of an “ideal intracranial stent.”

Published
2006

35. [Long term follow-up after intracranial vertebro-basilar artery stenting]

Author

R, du Mesnil de Rochemont, J, Berkefeld, M, Buchkremer, H, Arndt, T, Neumann-Haefelin, O, Singer, H, Steinmetz, F, Zanella, and M, Sitzer

Subjects
Male, Radiography, Time Factors, Treatment Outcome, Vertebrobasilar Insufficiency, Humans, Female, Stents, Middle Aged, Aged, Follow-Up Studies, Retrospective Studies
Abstract

Recurrent ischemic symptoms attributable to intracranial high-grade vertebrobasilar artery stenoses are associated with a high risk of ischemic stroke, particularly if these occur in spite of aggressive medical treatment. Long term efficacy data for endovascular stent angioplasty of symptomatic intracranial stenoses are lacking. The purpose of this prospective study is to determine the rates of deaths, of ischemic events and of restenosis during long-term follow-up.Between June 2001 and February 2004 twelve patients (11 male, 1 female; median 63 yrs; range, 46 - 75 yrs) with recurrent ischemic symptoms attributed toor = 70 % intracranial vertebro-basilar artery stenoses, who had failed aggressive medical treatment, were included. Median follow-up was 24 months (range: 6 to 36 months). Intracranial stenoses were measured using 3D rotation angiography data sets and treated with balloon expandable stents. All patients were scheduled for follow-up including clinical (Barthel Index) and transcranial Doppler examinations and intraarterial angiography at 6 months after intervention. Clinical outcome was defined as the rate of stroke in any vascular territory or death during follow-up. Vascular outcome was determined by the rate of in-stent restenosis 50 % on follow-up as examined by intraarterial angiography at 6 months or by transcranial color-coded duplex sonography.Stent placement was technically successful in all patients. No patient had further cerebral ischemic symptoms; two patients died (1 myocardial infarct, 1 sudden death) during follow-up of median 24 months. The degree of stenoses was reduced from median 81 % (range 69 - 94 %) to 19 % (range 10 - 36 %) immediately after stent placement and to 32 % (range 22 - 48 %) after 6 months. No restenosisor = 50 % occurred during follow-up.Based on this limited series, we believe that in patients, with recurrent symptoms despite aggressive medical treatment, endovascular stent placement in intracranial high-grade vertebrobasilar artery stenoses can be an effective and safe treatment option.

Published
2006

36. Leukoaraiosis is a risk factor for symptomatic intracerebral haemorrhage after thrombolysis for acute stroke

Author

Joachim Röther, S. Hölig, Achim Gass, B. Yan, Jens Fiehler, J. L. Saver, O. Lecei, Y. Samson, T. Kucinski, D. S. Liebeskind, Andreas Kastrup, J. Berkefeld, and Tobias Neumann-Haefelin

Subjects
medicine.medical_specialty, business.industry, Internal medicine, medicine.medical_treatment, medicine, Cardiology, Leukoaraiosis, Neurology (clinical), Thrombolysis, Risk factor, business, Surgery, Acute stroke
Published
2006
Full Text
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38. [Interventional endovascular therapy (stenting) for residual stenosis after lysis of the basilar artery]

Author

S, Boy, K, Isenhardt, K, Gardill, B, Kapp, R, Schneider, and J, Berkefeld

Subjects
Male, Reoperation, Treatment Outcome, Basilar Artery, Vertebrobasilar Insufficiency, Humans, Stents, Thrombolytic Therapy, Intracranial Thrombosis, Middle Aged, Vascular Surgical Procedures, Blood Vessel Prosthesis
Abstract

Despite the introduction of local thrombolytic therapy, there is still a very high mortality rate in basilar thrombosis. We report three cases of successful intra-arterial thrombolysis of acute basilar artery occlusion and consecutive interventional endovascular therapy. In all cases, the acute thrombosis of the basilar artery probably developed from preexisting atherosclerotic stenoses. The clinical outcomes were excellent. We discuss early consecutive stenting as a possible therapeutic option in cases of residual stenosis after successful intra-arterial lysis of basilar artery occlusion.

Published
2005

39. [Local chemotherapy for squamous cell cancer of the oral cavity and oropharynx]

Author

S, Rohde, A F, Kovács, F E, Zanella, J, Berkefeld, and B, Turowski

Subjects
Adult, Aged, 80 and over, Male, Dose-Response Relationship, Drug, Antineoplastic Agents, Middle Aged, Combined Modality Therapy, Disease-Free Survival, Neoadjuvant Therapy, Oropharyngeal Neoplasms, Chemotherapy, Adjuvant, Lymphatic Metastasis, Carcinoma, Squamous Cell, Humans, Infusions, Intra-Arterial, Female, Mouth Neoplasms, Radiotherapy, Adjuvant, Cisplatin, Neoplasm Recurrence, Local, Aged
Abstract

Modern treatment concepts for patients suffering from oral and oropharyngeal cancer include more and more adjuvant therapeutic options. Local chemotherapy offers the possibility to apply an extremely high drug concentration at the tumor site while minimizing possible side effects by systemic neutralization at the same time.A total of 289 patients with histologically proven carcinoma of the oral cavity and the oropharynx underwent neoadjuvant intra-arterial chemotherapy with high-dosage cisplatin within a multimodal therapeutic setting. Concerning the TNM classification, more than 70% of the patients were classified as stages III and IV. The mean age at the time of intervention was 60 years, and 71% of the patients were male.After the first cycle 19.3% of the patients presented with complete remission (grade I); 35.4% and 41.5% showed partial remissions (grade II) or stable disease (grade III), respectively. The mean observation time after treatment was 28 months (median: 24.2 months). Of the 137 patients who completed the full multimodal therapeutic scheme, 11% developed local recurrence, and 12.4% developed lymph node or distant metastasis. At the time of evaluation, 72.5% of these patients were still alive.Intra-arterial chemotherapy is a safe and highly effective procedure that should be considered as an important option in multimodal therapeutic concepts for oral and oropharyngeal cancer.

Published
2005

40. [Mechanical recanalization in acute stroke treatment]

Author

J, Berkefeld, R, du Mesnil de Rochemont, M, Sitzer, and F E, Zanella

Subjects
Stroke, Treatment Outcome, Critical Care, Acute Disease, Practice Guidelines as Topic, Humans, Thrombolytic Therapy, Intracranial Thrombosis, Practice Patterns, Physicians', Vascular Surgical Procedures, Catheterization, Thrombectomy
Abstract

The development of endovascular techniques for the treatment of acute stroke began with the introduction of local intra-arterial fibrinolysis. In parallel to designing new systemic therapy approaches, catheter systems for loosening, disintegrating, or removing cerebral thrombi have undergone assessment in recent years to serve as alternatives or supplements to fibrinolytic treatment. Mechanical alteration of intracranial thrombi with balloon catheters, manipulations with the guide wire, or ultrasound waves transmitted into the vascular system as well as techniques for thrombus aspiration, snare extraction, or more complex hydrodynamic or laser-guided thrombectomy systems have been tested in feasibility studies, which evidenced basic functionality and relative safety. Broad clinical applications outside of the clinical trial setting cannot yet be recommended since the new catheter systems are still in early phase clinical testing.

Published
2005

41. [Stenting in acute stroke]

Author

R, du Mesnil de Rochemont, M, Sitzer, F E, Zanella, and J, Berkefeld

Subjects
Aged, 80 and over, Male, Cerebral Revascularization, Critical Care, Middle Aged, Blood Vessel Prosthesis, Stroke, Treatment Outcome, Acute Disease, Humans, Carotid Stenosis, Female, Stents, Aged, Retrospective Studies
Abstract

Hemodynamic impairment caused by pseudo-occlusion or occlusion of the internal carotid artery (ICA) is a rare etiology of stroke. Acute revascularization of the vessel can restore the flow to the brain. This retrospective study shows that ICA stenting with proximal and distal protection devices in patients with acute stroke and pseudo-occlusion or occlusion of the ICA is technically feasible and can prevent further hemodynamic strokes. In contrast, selected patients have a high risk of reperfusion syndrome with intracranial hemorrhage and peri-interventional monitoring of blood pressure in an ICU is recommended.

Published
2005

43. [Distal protection devices in carotid stent]

Author

J, Berkefeld, R, du Mesnil de Rochemont, M, Sitzer, and F E, Zanella

Subjects
Intracranial Embolism, Humans, Carotid Stenosis, Stents, Equipment Design, Balloon Occlusion, Angioplasty, Balloon, Filtration, Randomized Controlled Trials as Topic
Abstract

Endovascular treatment of carotid stenoses is increasingly used. Frequently temporary occlusion balloons or filters are placed distal to the stenosis to gain additional protection against cerebral emboli. There is still a scientific debate about the usefulness of such distal protection devices. The following contribution reviews existing techniques and their clinical results and should allow for a critical discussion and selection of current techniques and materials.

Published
2004

45. [Stents in the treatment of intracranial atherosclerotic stenoses]

Author

R, du Mesnil de Rochemont, M, Sitzer, F E, Zanella, and J, Berkefeld

Subjects
Imaging, Three-Dimensional, Image Processing, Computer-Assisted, Angiography, Digital Subtraction, Humans, Stents, Cerebral Infarction, Balloon Occlusion, Intracranial Arteriosclerosis, Angioplasty, Balloon, Magnetic Resonance Angiography, Brain Ischemia
Abstract

The treatment of intracranial atherosclerotic stenoses, which account for 10-15% of all ischemic strokes, is technically feasible for few years by the use of new flexible stent devices. Especially patients who fail best medical treatment have a poor prognosis and stenting becomes a reasonable treatment option. Herein we discuss treatment concepts and the principles of stent placement against the background of epidemiology and pathophysiologic basics.

Published
2004

46. [A new possibility for imaging the lacrimal draining system. Three-dimensional rotation dacryocystography]

Author

M, Lüchtenberg, L-O, Hattenbach, and J, Berkefeld

Subjects
Radiographic Image Enhancement, User-Computer Interface, Imaging, Three-Dimensional, Lacrimal Apparatus Diseases, Iohexol, Lacrimal Duct Obstruction, Image Processing, Computer-Assisted, Contrast Media, Humans, Endoscopy
Abstract

The aim was to investigate the applicability of a 3D rotation angiography system for imaging lesions of the lacrimal draining system.Five patients with stenosis of the lacrimal system were enrolled in this pilot project to undergo a distension dacryocystography as 3D rotation angiography. The 3D reconstructions are derived from 100 radiographic projection images, which are obtained during a 240 degrees rotation of an angiographic C-arm. Volume-rendering techniques show plastic representations of the contrast-enhanced ductal system with the possibility of additional virtual dacryoendoscopy. The adjacent bony structures and the nasal cavity can also be visualized by special window settings and cuts through the 3D data set. Exact calibration of the X-ray system allows for precise measurements of distances. A sufficient 3D representation needs permanent injection of contrast material for about 5.5 s. Outpatient examination under surface anesthesia is well tolerated.The high-resolution 3D reconstructions show detailed images of lesions of the endoluminal surface and give a plastic impression of the site of obstructions. In contrast to normal DSA dacryocystography, the contrast-enhanced ductal system, the adjacent bone, and even the soft tissues of the nasal cavity are demonstrated simultaneously. A disadvantage is an incomplete representation of the residual lumen of subtotal stenoses and the one and one-half times higher radiation dose compared to normal dacryocystography.Dacryocystography with 3D rotation angiography opens a new dimension of minimally invasive imaging of the lacrimal drainage system, which may be helpful for exact planning of dacryocystorhinostomy procedures.

Published
2004

47. Geometric Effects of Carotid Stents

Author

J Berkefeld, S Rohde, J. B. Martin, N. Tanaka, J Théron, and D Rüfenacht

Subjects
medicine.medical_specialty, business.industry, Medicine, Radiology, business, Carotid stents
Published
2004
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