Search

Your search keyword '"Knappich, Christoph"' showing total 162 results
Start Over Author "Knappich, Christoph"
162 results on '"Knappich, Christoph"'

5. Associations of Perioperative Variables With the 30-Day Risk of Stroke or Death in Carotid Endarterectomy for Symptomatic Carotid Stenosis.

Author

Knappich, Christoph, Kuehnl, Andreas, Haller, Bernhard, Salvermoser, Michael, Algra, Ale, Becquemin, Jean-Pierre, Bonati, Leo H, Bulbulia, Richard, Calvet, David, Fraedrich, Gustav, Gregson, John, Halliday, Alison, Hendrikse, Jeroen, Howard, George, Jansen, Olav, Malas, Mahmoud B, Ringleb, Peter A, Brown, Martin M, Mas, Jean-Louis, Brott, Thomas G, Morris, Dylan R, Lewis, Steff C, and Eckstein, Hans-Henning

Subjects
Humans, Carotid Stenosis, Postoperative Complications, Anesthesia, Local, Anesthesia, General, Endarterectomy, Carotid, Risk Factors, Aged, Middle Aged, Female, Male, Stroke, anesthesia, death, endarterectomy, carotid, humans, stroke, Clinical Research, Neurosciences, Brain Disorders, endarterectomy, carotid, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurology & Neurosurgery
Abstract

Background and Purpose- This analysis was performed to assess the association between perioperative and clinical variables and the 30-day risk of stroke or death after carotid endarterectomy for symptomatic carotid stenosis. Methods- Individual patient-level data from the 5 largest randomized controlled carotid trials were pooled in the Carotid Stenosis Trialists' Collaboration database. A total of 4181 patients who received carotid endarterectomy for symptomatic stenosis per protocol were included. Determinants of outcome included carotid endarterectomy technique, type of anesthesia, intraoperative neurophysiological monitoring, shunting, antiplatelet medication, and clinical variables. Stroke or death within 30 days after carotid endarterectomy was the primary outcome. Adjusted risk ratios (aRRs) were estimated in multilevel multivariable analyses using a Poisson regression model. Results- Mean age was 69.5±9.2 years (70.7% men). The 30-day stroke or death rate was 4.3%. In the multivariable regression analysis, local anesthesia was associated with a lower primary outcome rate (versus general anesthesia; aRR, 0.70 [95% CI, 0.50-0.99]). Shunting (aRR, 1.43 [95% CI, 1.05-1.95]), a contralateral high-grade carotid stenosis or occlusion (aRR, 1.58 [95% CI, 1.02-2.47]), and a more severe neurological deficit (mRS, 3-5 versus 0-2: aRR, 2.51 [95% CI, 1.30-4.83]) were associated with higher primary outcome rates. None of the other characteristics were significantly associated with the perioperative stroke or death risk. Conclusions- The current results indicate lower perioperative stroke or death rates in patients operated upon under local anesthesia, whereas a more severe neurological deficit and a contralateral high-grade carotid stenosis or occlusion were identified as potential risk factors. Despite a possible selection bias and patients not having been randomized, these findings might be useful to guide surgeons and anesthetists when treating patients with symptomatic carotid disease.

Published
2019

7. Bypass Patency and Amputation-Free Survival after Popliteal Aneurysm Exclusion Significantly Depends on Patient Age and Medical Complications: A Detailed Dual-Center Analysis of 395 Consecutive Elective and Emergency Procedures

Author

Freytag, Hannah, primary, Kapalla, Marvin, additional, Berg, Floris, additional, Stroth, Hans-Christian Arne, additional, Reisenauer, Tessa, additional, Stoklasa, Kerstin, additional, Zimmermann, Alexander, additional, Reeps, Christian, additional, Knappich, Christoph, additional, Wolk, Steffen, additional, and Busch, Albert, additional

Published
2024
Full Text
View/download PDF

8. Identification of patient characteristics that may improve procedure selection for the treatment of carotid stenosis.

Author

Kuehnl, Andreas, Knappich, Christoph, Kirchhoff, Felix, Bohmann, Bianca, Lohe, Vanessa, Naher, Shamsun, Eckstein, Hans-Henning, and Kallmayer, Michael

Subjects
*INTERNAL carotid artery, *STROKE, *CAROTID artery, *OLDER patients, *CAROTID endarterectomy, CAROTID artery stenosis
Abstract

Background Carotid endarterectomy and carotid artery stenting are common procedures for the treatment of carotid artery stenosis. The aim of this study was to identify factors that modify the effect between type of treatment and outcome, and could thus be used to refine the selection of treatment procedure. Methods All patients who underwent either carotid endarterectomy or carotid artery stenting between 2012 and 2018 in German hospitals were included. The analysis of effect modification was focused on baseline patient characteristics. The outcome was a composite of any stroke or death until discharge from hospital. For multivariable analyses, a generalized linear mixed regression model was used. Results Some 221 282 patients were included, of whom 68% were male. In patients who underwent carotid endarterectomy or carotid artery stenting, the risk of any stroke or death was 2.3% and 3.7% respectively. Patient age was statistically significantly associated with a higher risk of a composite outcome of any stroke or death (main effect of age: adjusted OR 1.21 (95% c.i. 1.17 to 1.26), P < 0.001). The age effect was stronger in patients treated with carotid artery stenting (interaction effect: adjusted OR 1.29 (95% c.i. 1.20 to 1.38), P < 0.001). Statistically significant interaction effects were identified for side of treatment, ASA grade, contralateral degree of stenosis, and the time interval between the index event and treatment. Conclusion This analysis shows that carotid artery stenting may be particularly disadvantageous in older patients, in patients with right-sided stenosis, and in symptomatic patients treated within the first 2 days after the index event. In patients with contralateral occlusion, carotid artery stenting appears equivalent to carotid endarterectomy. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

9. Association of Centre Quality Certification with Characteristics of Patients, Management, and Outcomes Following Carotid Endarterectomy or Carotid Artery Stenting.

Author

Saicic, Stefan, Knappich, Christoph, Kallmayer, Michael, Kirchhoff, Felix, Bohmann, Bianca, Lohe, Vanessa, Naher, Shamsun, Böhm, Julian, Lückerath, Sofie, Eckstein, Hans-Henning, and Kuehnl, Andreas

Subjects
*ASYMPTOMATIC patients, *CAROTID endarterectomy, *HOSPITAL admission & discharge, *STROKE units, CAROTID artery stenosis
Abstract

Background: The aim of this study was to analyze the association between center quality certifications and patients' characteristics, clinical management, and outcomes after carotid revascularization. Methods: This study is a pre-planned sub-study of the ISAR-IQ project, which analyzes data from the Bavarian subset of the nationwide German statutory quality assurance carotid database. Hospitals were classified as to whether a certified vascular center (cVC) or a certified stroke unit (cSU) was present on-site or not. The primary outcome event was any stroke or death until discharge from the hospital. Results: In total, 31,793 cases were included between 2012 and 2018. The primary outcome rate in asymptomatic patients treated by CEA ranged from 0.7% to 1.5%, with the highest rate in hospitals with cVC but without cSU. The multivariable regression analysis revealed a significantly lower primary outcome rate in centers with cSU in asymptomatic patients (aOR 0.69; 95% CI 0.56–0.86; p < 0.001). In symptomatic patients needing emergency treatment, the on-site availability of a cSU was associated with a significantly lower primary outcome rate (aOR 0.56; 95% CI 0.40–0.80; p < 0.001), whereas the presence of a cVC was associated with higher risk (aOR 3.07; 95% CI 1.65–5.72). Conclusions: This study provides evidence of statistically significant better results in some sub-cohorts in certified centers. In centers with cSU, the risk of any stroke or death was significantly lower in asymptomatic patients receiving CEA or symptomatic patients treated by emergency CEA. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

12. Der „vascular surgeon scientist“: Zentrale Rolle für die Translation zwischen Forschung und Therapie sowie für die Weiterentwicklung der Gefäßchirurgie

Author

Knappich, Christoph, Busch, Albert, Trenner, Matthias, Kühnl, Andreas, Freytag, Hanna, Zang, Lan, Tsantilas, Pavlos, Kallmayer, Michael, Schmid, Sofie, Schmidt, Sebastian, Karlas, Angelos, Langenbach, Constantin, Kirchhoff, Felix, Radu, Oksana, Dallmann-Sieber, Sabine, Schäffer, Christoph, Knipfer, Eva, Puttini, Ilaria, Wendorff, Heiko, Maegdefessel, Lars, and Eckstein, Hans-Henning

Published
2021
Full Text
View/download PDF

13. Determinants of Pre- and Post-Procedural Neurological Assessment, and Outcome of Carotid Endarterectomy or Stenting.

Author

Kallmayer, Michael, Knappich, Christoph, Kirchhoff, Felix, Bohmann, Bianca, Lohe, Vanessa, Naher, Shamsun, Eckstein, Hans-Henning, and Kuehnl, Andreas

Subjects
*NEUROLOGIC examination, *CAROTID endarterectomy, *CAROTID artery, *REGRESSION analysis, CAROTID artery stenosis
Abstract

Background: The German–Austrian guideline on the treatment of carotid stenosis recommends specialist neurological assessment (NA) before and after carotid endarterectomy (CEA) or carotid artery stenting (CAS). This study analyzes the determinants of NA and the association of NA with the perioperative rate of stroke or death. Materials and Methods: This study is a pre-planned sub-study of the ISAR-IQ project, which analyzes data from the nationwide German statutory quality assurance carotid database. Patients were classified as asymptomatic (group A), elective symptomatic (group B), and others (group C: emergency (C1), simultaneous operation (C2), and other indications (C3)). The primary outcome event (POE) of this study was any in-hospital stroke or death. Adjusted odds ratios for pre- and post-NA and the POE were calculated using multivariable regression analyses. Results: We analyzed 228,133 patients (54% asymptomatic, 68% male, mean age 72 years) undergoing CEA or CAS between 2012 and 2018. Age and sex were not associated with the likelihood of pre-NA or post-NA. The multivariable regression analysis showed an inverse association between pre-NA and POE (adjusted odds ratio (aOR) 0.47; 95% CI 0.44–0.51, p < 0.001), and a direct association of post-NA and POE (aOR 4.39; 95% CI 4.04–4.78, p < 0.001). Conclusions: Pre- and postinterventional specialist NA is strongly associated with the risk of any in-hospital stroke or death after CEA or CAS in Germany. A relevant confounding by indication or reversed causation cannot be ruled out. Nevertheless, to improve the quality assurance of treatment, the NA recommended in the guideline should be carried out consistently. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

15. Aortic Vascular Graft and Endograft Infection–Patient Outcome Cannot Be Determined Based on Pre-Operative Characteristics

Author

Puttini, Ilaria, primary, Kapalla, Marvin, additional, Braune, Anja, additional, Michler, Enrico, additional, Kröger, Joselyn, additional, Lutz, Brigitta, additional, Sakhalihasan, Natzi, additional, Trenner, Matthias, additional, Biro, Gabor, additional, Weber, Wolfgang, additional, Rössel, Thomas, additional, Reeps, Christian, additional, Eckstein, Hans-Henning, additional, Wolk, Steffen, additional, Knappich, Christoph, additional, Notohamiprodjo, Susan, additional, and Busch, Albert, additional

Published
2024
Full Text
View/download PDF

20. A Modern Series of Secondary Aortoenteric Fistula – A 19-Year Experience.

Author

Sieber, Sabine, Busch, Albert, Sargut, Mine, Knappich, Christoph, Bohmann, Bianca, Karlas, Angelos, Friess, Helmut, Eckstein, Hans-Henning, and Novotny, Alexander

Subjects
STATISTICS, AORTIC diseases, OPERATIVE surgery, RETROSPECTIVE studies, FISHER exact test, POSITRON emission tomography computed tomography, RISK assessment, TREATMENT effectiveness, INTESTINAL fistula, DESCRIPTIVE statistics, DATA analysis software, DATA analysis, DISEASE risk factors, SYMPTOMS
Abstract

Objectives: Secondary aortoenteric fistula is a rare and life-threatening condition. Clear evidence on the ideal therapeutic approach is largely missing. This study aims to analyze symptoms, etiology, risk factors, and outcomes based on procedural details. Patients and Methods: All patients with secondary aortoenteric fistula admitted between 2003 and 2021 were included. Patient characteristics, surgical procedure details, and postoperative outcomes were analyzed. Outcomes were stratified and compared according to the urgency of operation and the procedure performed. Descriptive statistics were used. The primary endpoint was in-hospital mortality. Results: A total of twentytwo patients (68% male, median age 70 years) were identified. Main symptoms were gastrointestinal bleeding, pain, and fever. From the twentytwo patients ten patients required emergency surgery and ten urgent surgery. Emergency patients were older on average (74 vs 63 years, P =.015) and had a higher risk of postoperative respiratory complications (80% vs 10%, P =.005). Primary open surgery with direct replacement of the aorta or an extra-anatomic bypass with an additional direct suture or resection of the involved bowel was performed in sixteen patients. In four patients underwent endovascular bridging treatment with the definitive approach as a second step. Other two patients died without operation (1x refusal; 1x palliative cancer history). In-hospital mortality was 27%, respectively. Compared to patients undergoing urgent surgery, those treated emergently showed significantly higher in-hospital (50% vs 0%, P =.0033) mortalities. Conclusion: Despite rapid diagnosis and treatment, secondary aortoenteric fistula remains a life-threatening condition with 27% in-hospital mortality, significantly increased upon emergency presentation. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

23. Patients with Acute Limb Ischemia Might Benefit from Endovascular Therapy—A 17-Year Retrospective Single-Center Series of 985 Patients

Author

Stoklasa, Kerstin, primary, Sieber, Sabine, additional, Naher, Shamsun, additional, Bohmann, Bianca, additional, Kuehnl, Andreas, additional, Stadlbauer, Thomas, additional, Wendorff, Heiko, additional, Biro, Gabor, additional, Kallmayer, Michael A., additional, Knappich, Christoph, additional, Busch, Albert, additional, and Eckstein, Hans-Henning, additional

Published
2023
Full Text
View/download PDF

25. Locoregional Anaesthesia and Intra-Operative Angiography in Carotid Endarterectomy: 16 Year Results of a Consecutive Single Centre Series

Author

Kirchhoff, Felix, primary, Eckstein, Hans-Henning, additional, Schmid, Sofie, additional, Schmidt, Sebastian, additional, Mergen, Julia, additional, Dridi, Sofiane, additional, Wunderlich, Silke, additional, Bohmann, Bianca, additional, Knappich, Christoph, additional, Tsantilas, Pavlos, additional, Kallmayer, Michael, additional, and Kuehnl, Andreas, additional

Published
2023
Full Text
View/download PDF

26. The circular RNA Ataxia Telangiectasia Mutated regulates oxidative stress in smooth muscle cells in expanding abdominal aortic aneurysms

Author

Fasolo, Francesca, Winski, Greg, Li, Zhaolong, Wu, Zhiyuan, Winter, Hanna, Ritzer, Julia, Glukha, Nadiya, Roy, Joy, Hultgren, Rebecka, Pauli, Jessica, Busch, Albert Franz Jakob, Sachs, Nadja, Knappich, Christoph Magnus, Eckstein, Hans-Henning, Boon, Reinier, Paloschi, Valentina, Mägdefessel, Lars, Fasolo, Francesca, Winski, Greg, Li, Zhaolong, Wu, Zhiyuan, Winter, Hanna, Ritzer, Julia, Glukha, Nadiya, Roy, Joy, Hultgren, Rebecka, Pauli, Jessica, Busch, Albert Franz Jakob, Sachs, Nadja, Knappich, Christoph Magnus, Eckstein, Hans-Henning, Boon, Reinier, Paloschi, Valentina, and Mägdefessel, Lars

Abstract

An abdominal aortic aneurysm (AAA) is a pathological widening of the aortic wall characterized by loss of smooth muscle cells (SMCs), extracellular matrix degradation, and local inflammation. This condition is often asymptomatic until rupture occurs, leading to high morbidity and mortality rates. Diagnosis is mostly accidental and the only currently available treatment option remains surgical intervention. Circular RNAs (circRNAs) represent a novel class of regulatory non-coding RNAs that originate from backsplicing. Their highly stable loop structure, combined with a remarkable enrichment in body fluids, make circRNAs promising disease biomarkers. We investigated the contribution of circRNAs to AAA pathogenesis and their potential application to improve AAA diagnostics. Gene expression analysis revealed the presence of deregulated circular transcripts stemming from AAA-relevant gene loci. Among these, the circRNA to the Ataxia Telangiectasia Mutated gene (cATM) was upregulated in human AAA specimens, in AAA-derived SMCs, and serum samples collected from aneurysm patients. In primary aortic SMCs, cATM increased upon angiotensin II and doxorubicin stimulation, while its silencing triggered apoptosis. Higher cATM levels made AAA-derived SMCs less vulnerable to oxidative stress, compared with control SMCs. These data suggest that cATM contributes to elicit an adaptive oxidative-stress response in SMCs and provides a reliable AAA disease signature.

Published
2023

35. Lenvatinib halts aortic aneurysm growth by restoring smooth muscle cell contractility

Author

Busch, Albert, primary, Pauli, Jessica, additional, Winski, Greg, additional, Bleichert, Sonja, additional, Chernogubova, Ekaterina, additional, Metschl, Susanne, additional, Winter, Hanna, additional, Trenner, Matthias, additional, Wiegering, Armin, additional, Otto, Christoph, additional, Fischer, Johannes, additional, Reiser, Judith, additional, Werner, Julia, additional, Roy, Joy, additional, Brostjan, Christine, additional, Knappich, Christoph, additional, Eckstein, Hans-Henning, additional, Paloschi, Valentina, additional, and Maegdefessel, Lars, additional

Published
2021
Full Text
View/download PDF

37. Associations of Perioperative Variables with the 30-day risk of Stroke or Death in CEA for Symptomatic Carotid Stenosis

Author

Knappich, Christoph, Kuehnl, Andreas, Haller, Bernhard, Salvermoser, Michael, Algra, Ale, Becquemin, Jean-Pierre, Bonati, Leo H., Bulbulia, Richard, Calvet, David, Fraedrich, Gustav, Gregson, John, Halliday, Alison, Hendrikse, Jeroen, Howard, George, Jansen, Olav, Malas, Mahmoud B., Ringleb, Peter A., Brown, Martin M., Mas, Jean-Louis, Brott, Thomas G., Morris, Dylan R., and Lewis, Steff C.

Subjects
Male, Stroke, Endarterectomy, Carotid, Postoperative Complications, Risk Factors, Humans, Carotid Stenosis, Female, Anesthesia, General, Middle Aged, Article, Aged, Anesthesia, Local
Abstract

Background and Purpose- This analysis was performed to assess the association between perioperative and clinical variables and the 30-day risk of stroke or death after carotid endarterectomy for symptomatic carotid stenosis. Methods- Individual patient-level data from the 5 largest randomized controlled carotid trials were pooled in the Carotid Stenosis Trialists' Collaboration database. A total of 4181 patients who received carotid endarterectomy for symptomatic stenosis per protocol were included. Determinants of outcome included carotid endarterectomy technique, type of anesthesia, intraoperative neurophysiological monitoring, shunting, antiplatelet medication, and clinical variables. Stroke or death within 30 days after carotid endarterectomy was the primary outcome. Adjusted risk ratios (aRRs) were estimated in multilevel multivariable analyses using a Poisson regression model. Results- Mean age was 69.5±9.2 years (70.7% men). The 30-day stroke or death rate was 4.3%. In the multivariable regression analysis, local anesthesia was associated with a lower primary outcome rate (versus general anesthesia; aRR, 0.70 [95% CI, 0.50-0.99]). Shunting (aRR, 1.43 [95% CI, 1.05-1.95]), a contralateral high-grade carotid stenosis or occlusion (aRR, 1.58 [95% CI, 1.02-2.47]), and a more severe neurological deficit (mRS, 3-5 versus 0-2: aRR, 2.51 [95% CI, 1.30-4.83]) were associated with higher primary outcome rates. None of the other characteristics were significantly associated with the perioperative stroke or death risk. Conclusions- The current results indicate lower perioperative stroke or death rates in patients operated upon under local anesthesia, whereas a more severe neurological deficit and a contralateral high-grade carotid stenosis or occlusion were identified as potential risk factors. Despite a possible selection bias and patients not having been randomized, these findings might be useful to guide surgeons and anesthetists when treating patients with symptomatic carotid disease.

Published
2019

40. Associations of Perioperative Variables With the 30-Day Risk of Stroke or Death in Carotid Endarterectomy for Symptomatic Carotid Stenosis

Author

Cardiovasculaire Epi Team 5, Brain, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS Radiologie, Researchgr. Neuroradiologie, Knappich, Christoph, Kuehnl, Andreas, Haller, Bernhard, Salvermoser, Michael, Algra, Ale, Becquemin, Jean Pierre, Bonati, Leo H., Bulbulia, Richard, Calvet, David, Fraedrich, Gustav, Gregson, John, Halliday, Alison, Hendrikse, Jeroen, Howard, George, Jansen, Olav, Malas, Mahmoud B., Ringleb, Peter A., Brown, Martin M., Mas, Jean Louis, Brott, Thomas G., Morris, Dylan R., Lewis, Steff C., Eckstein, Hans Henning, Cardiovasculaire Epi Team 5, Brain, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS Radiologie, Researchgr. Neuroradiologie, Knappich, Christoph, Kuehnl, Andreas, Haller, Bernhard, Salvermoser, Michael, Algra, Ale, Becquemin, Jean Pierre, Bonati, Leo H., Bulbulia, Richard, Calvet, David, Fraedrich, Gustav, Gregson, John, Halliday, Alison, Hendrikse, Jeroen, Howard, George, Jansen, Olav, Malas, Mahmoud B., Ringleb, Peter A., Brown, Martin M., Mas, Jean Louis, Brott, Thomas G., Morris, Dylan R., Lewis, Steff C., and Eckstein, Hans Henning

Published
2019

41. Association between periprocedural factors and the in-hospital risk of stroke or death after carotid endarterectomy and carotid artery stenting

Author

Knappich, Christoph Magnus, Eckstein, Hans-Henning (Prof. Dr.), and Zimmer, Claus (Prof. Dr.)

Subjects
Medizin und Gesundheit, ddc:610
Abstract

Hintergrund und Zielsetzung: In Deutschland besteht eine gesetzlich verpflichtende Dokumentation aller an der Karotis-Gabel durchgeführten chirurgischen und endovaskulären Eingriffe. Ziel dieser Sekundärdaten-Analyse war die Untersuchung der Assoziationen zwischen unterschiedlichen intra- und periprozeduralen Faktoren und dem Auftritt eines Schlaganfalls oder Todes während des Klinikaufenthalts nach Karotis-Thrombendarteriektomie (CEA) und nach Karotis-Stenting (CAS). Material und Methoden: Die Studie schloss diejenigen Patienten ein, die zwischen 2009 und 2014 elektiv aufgrund einer asymptomatischen oder symptomatischen Karotis-Stenose mittels CEA bzw. mit CAS therapiert worden waren. Alle Daten wurden der im Rahmen der gesetzlich verpflichtenden Qualitätssicherung geführten Datenbank (AQUA-Institut) entnommen. Schlaganfall oder Tod während des Klinik-Aufenthalts wurde als primärer Endpunkt definiert. Die statistische Auswertung erfolgte mittels uni- und multivariabler Regressions-Analysen. Ergebnisse 142074 elektive CEAs (mittleres Alter 70,7 Jahre, 67,8% männlich) und 13086 elektive CAS-Prozeduren (mittleres Alter 69,7 Jahre, 69,7% männlich) standen für die Analyse zur Verfügung. Der primäre Endpunkt trat in 1,8% aller Patienten nach CEA und in 2,4% aller Patienten nach CAS ein. Nach CEA zeigte die multivariable Regressions-Analyse für die folgenden Faktoren eine unabhängige Assoziation mit einem niedrigerem Risiko, den primären Endpunkt zu erreichen: Lokalanästhesie (RR 0.85, 95% CI 0.75–0.95), intraoperative morphologische Kontrolle mittels Angiographie (RR 0.80, 95% CI 0.71–0.90) oder Duplex-Sonographie (RR 0.74, 95% CI 0.63–0.88) und die Einnahme eines Thrombozytenfunktionshemmers (RR 0.83, 95% CI 0.71–0.97). Nach CAS war lediglich die Verwendung eines Embolieprotektionssystems in der multivariablen Regressions-Analyse (adj. RR 0.65, 95% CI 0.50–0.85) mit einem niedrigeren Risiko assoziiert, den primären Endpunkt zu erreichen. Zusammenfassung Intraoperative morphologische Kontrolle mittels Duplex-Sonographie oder Angiographie, Lokalanästhesie und perioperative Thrombozytenaggregationshemmung waren signifikant mit einem niedrigeren perioperativen Schlaganfall- oder Todesrisiko nach CEA assoziiert. Die Verwendung eines Embolieprotektionssystems war als einziger Faktor mit einem niedrigeren periprozeduralen Risiko nach CAS einen Schlaganfall zu erleiden oder zu versterben assoziiert. Background and object: In Germany, all open surgical and endovascular procedures on the carotid bifurcation have to be documented in a nationwide carotid registry. The object of this investigation was to analyze the association between different periprocedural variables and the in-hospital risk of stroke or death after carotid endarterectomy (CEA) and carotid artery stenting (CAS), respectively. Methods: Patients who were treated electively for asymptomatic or symptomatic carotid artery stenosis were included. Data were available for patients who underwent CEA or CAS between 2009 and 2014. All data were extracted from the statutory nationwide quality assurance databank held by the Institute for Applied Quality Improvement and Research in Health Care (AQUA Institute). Risk ratios (RR) were assessed by univariate and multivariable regression analyses. Results: A total of 142074 elective CEA (mean age 70.7 years, 67.8% male) and 13,086 CAS (mean age 69.7 years, 69.7% male) procedures were available for this analysis. The primary endpoint occurred in 1.8% of patients who underwent CEA and 2.4% of those treated with CAS. For patients treated with CEA, the multivariable analysis revealed an independent association with lower risks of in-hospital stroke or death for local anesthesia (vs. general anesthesia, RR 0.85, 95% CI 0.75–0.95), intraoperative morphological control by duplex ultrasound (RR 0.74, 95% CI 0.63–0.88) or angiography (RR 0.80, 95% CI 0.71–0.90), and perioperative antiplatelet medication (RR 0.83, 95% CI 0.71–0.97). In patients who received CAS, the multivariable analysis showed the use of an EPD to be exclusively associated with a lower rate of in-hospital stroke or death (adj. RR 0.65, 95% CI 0.50–0.85). Conclusions: This analysis shows, that local anaesthesia, intraoperative morphological control by angiography or duplex ultrasound, and perioperative antiplatelet medication in patients treated with CEA, and usage of an EPD in those treated with CAS were independently associated with lower rates of in-hospital stroke or death.

Published
2018

43. Biobanking: Objectives, Requirements, and Future Challenges—Experiences from the Munich Vascular Biobank

Author

Pelisek, Jaroslav, primary, Hegenloh, Renate, additional, Bauer, Sabine, additional, Metschl, Susanne, additional, Pauli, Jessica, additional, Glukha, Nadiya, additional, Busch, Albert, additional, Reutersberg, Benedikt, additional, Kallmayer, Michael, additional, Trenner, Matthias, additional, Wendorff, Heiko, additional, Tsantilas, Pavlos, additional, Schmid, Sofie, additional, Knappich, Christoph, additional, Schaeffer, Christoph, additional, Stadlbauer, Thomas, additional, Biro, Gabor, additional, Wertern, Uta, additional, Meisner, Franz, additional, Stoklasa, Kerstin, additional, Menges, Anna-Leonie, additional, Radu, Oksana, additional, Dallmann-Sieber, Sabine, additional, Karlas, Angelos, additional, Knipfer, Eva, additional, Reeps, Christian, additional, Zimmermann, Alexander, additional, Maegdefessel, Lars, additional, and Eckstein, Hans-Henning, additional

Published
2019
Full Text
View/download PDF

45. Assoziation periprozeduraler Faktoren mit dem Risiko, nach operativer und endovaskulärer Therapie von Karotisstenosen einen Schlaganfall zu erleiden oder zu versterben

Author

Zimmer, Claus (Prof. Dr.), Eckstein, Hans-Henning (Prof. Dr.), Knappich, Christoph Magnus, Zimmer, Claus (Prof. Dr.), Eckstein, Hans-Henning (Prof. Dr.), and Knappich, Christoph Magnus

Abstract

Hintergrund und Zielsetzung: In Deutschland besteht eine gesetzlich verpflichtende Dokumentation aller an der Karotis-Gabel durchgeführten chirurgischen und endovaskulären Eingriffe. Ziel dieser Sekundärdaten-Analyse war die Untersuchung der Assoziationen zwischen unterschiedlichen intra- und periprozeduralen Faktoren und dem Auftritt eines Schlaganfalls oder Todes während des Klinikaufenthalts nach Karotis-Thrombendarteriektomie (CEA) und nach Karotis-Stenting (CAS). Material und Methoden: Die Studie schloss diejenigen Patienten ein, die zwischen 2009 und 2014 elektiv aufgrund einer asymptomatischen oder symptomatischen Karotis-Stenose mittels CEA bzw. mit CAS therapiert worden waren. Alle Daten wurden der im Rahmen der gesetzlich verpflichtenden Qualitätssicherung geführten Datenbank (AQUA-Institut) entnommen. Schlaganfall oder Tod während des Klinik-Aufenthalts wurde als primärer Endpunkt definiert. Die statistische Auswertung erfolgte mittels uni- und multivariabler Regressions-Analysen. Ergebnisse 142074 elektive CEAs (mittleres Alter 70,7 Jahre, 67,8% männlich) und 13086 elektive CAS-Prozeduren (mittleres Alter 69,7 Jahre, 69,7% männlich) standen für die Analyse zur Verfügung. Der primäre Endpunkt trat in 1,8% aller Patienten nach CEA und in 2,4% aller Patienten nach CAS ein. Nach CEA zeigte die multivariable Regressions-Analyse für die folgenden Faktoren eine unabhängige Assoziation mit einem niedrigerem Risiko, den primären Endpunkt zu erreichen: Lokalanästhesie (RR 0.85, 95% CI 0.75–0.95), intraoperative morphologische Kontrolle mittels Angiographie (RR 0.80, 95% CI 0.71–0.90) oder Duplex-Sonographie (RR 0.74, 95% CI 0.63–0.88) und die Einnahme eines Thrombozytenfunktionshemmers (RR 0.83, 95% CI 0.71–0.97). Nach CAS war lediglich die Verwendung eines Embolieprotektionssystems in der multivariablen Regressions-Analyse (adj. RR 0.65, 95% CI 0.50–0.85) mit einem niedrigeren Risiko assoziiert, den primären Endpunkt zu erreichen. Zusammenfassung Intraoperative m, Background and object: In Germany, all open surgical and endovascular procedures on the carotid bifurcation have to be documented in a nationwide carotid registry. The object of this investigation was to analyze the association between different periprocedural variables and the in-hospital risk of stroke or death after carotid endarterectomy (CEA) and carotid artery stenting (CAS), respectively. Methods: Patients who were treated electively for asymptomatic or symptomatic carotid artery stenosis were included. Data were available for patients who underwent CEA or CAS between 2009 and 2014. All data were extracted from the statutory nationwide quality assurance databank held by the Institute for Applied Quality Improvement and Research in Health Care (AQUA Institute). Risk ratios (RR) were assessed by univariate and multivariable regression analyses. Results: A total of 142074 elective CEA (mean age 70.7 years, 67.8% male) and 13,086 CAS (mean age 69.7 years, 69.7% male) procedures were available for this analysis. The primary endpoint occurred in 1.8% of patients who underwent CEA and 2.4% of those treated with CAS. For patients treated with CEA, the multivariable analysis revealed an independent association with lower risks of in-hospital stroke or death for local anesthesia (vs. general anesthesia, RR 0.85, 95% CI 0.75–0.95), intraoperative morphological control by duplex ultrasound (RR 0.74, 95% CI 0.63–0.88) or angiography (RR 0.80, 95% CI 0.71–0.90), and perioperative antiplatelet medication (RR 0.83, 95% CI 0.71–0.97). In patients who received CAS, the multivariable analysis showed the use of an EPD to be exclusively associated with a lower rate of in-hospital stroke or death (adj. RR 0.65, 95% CI 0.50–0.85). Conclusions: This analysis shows, that local anaesthesia, intraoperative morphological control by angiography or duplex ultrasound, and perioperative antiplatelet medication in patients treated with CEA, and usage of an EPD in those treated with CAS were

Published
2018

46. Assoziation periprozeduraler Faktoren mit dem Risiko, nach operativer und endovaskulärer Therapie von Karotisstenosen einen Schlaganfall zu erleiden oder zu versterben

Author

Eckstein, Hans-Henning (Prof. Dr.), Eckstein, Hans-Henning (Prof. Dr.);Zimmer, Claus (Prof. Dr.), Knappich, Christoph Magnus, Eckstein, Hans-Henning (Prof. Dr.), Eckstein, Hans-Henning (Prof. Dr.);Zimmer, Claus (Prof. Dr.), and Knappich, Christoph Magnus

Abstract

Hintergrund und Zielsetzung: In Deutschland besteht eine gesetzlich verpflichtende Dokumentation aller an der Karotis-Gabel durchgeführten chirurgischen und endovaskulären Eingriffe. Ziel dieser Sekundärdaten-Analyse war die Untersuchung der Assoziationen zwischen unterschiedlichen intra- und periprozeduralen Faktoren und dem Auftritt eines Schlaganfalls oder Todes während des Klinikaufenthalts nach Karotis-Thrombendarteriektomie (CEA) und nach Karotis-Stenting (CAS). Material und Methoden: Die Studie schloss diejenigen Patienten ein, die zwischen 2009 und 2014 elektiv aufgrund einer asymptomatischen oder symptomatischen Karotis-Stenose mittels CEA bzw. mit CAS therapiert worden waren. Alle Daten wurden der im Rahmen der gesetzlich verpflichtenden Qualitätssicherung geführten Datenbank (AQUA-Institut) entnommen. Schlaganfall oder Tod während des Klinik-Aufenthalts wurde als primärer Endpunkt definiert. Die statistische Auswertung erfolgte mittels uni- und multivariabler Regressions-Analysen. Ergebnisse 142074 elektive CEAs (mittleres Alter 70,7 Jahre, 67,8% männlich) und 13086 elektive CAS-Prozeduren (mittleres Alter 69,7 Jahre, 69,7% männlich) standen für die Analyse zur Verfügung. Der primäre Endpunkt trat in 1,8% aller Patienten nach CEA und in 2,4% aller Patienten nach CAS ein. Nach CEA zeigte die multivariable Regressions-Analyse für die folgenden Faktoren eine unabhängige Assoziation mit einem niedrigerem Risiko, den primären Endpunkt zu erreichen: Lokalanästhesie (RR 0.85, 95% CI 0.75–0.95), intraoperative morphologische Kontrolle mittels Angiographie (RR 0.80, 95% CI 0.71–0.90) oder Duplex-Sonographie (RR 0.74, 95% CI 0.63–0.88) und die Einnahme eines Thrombozytenfunktionshemmers (RR 0.83, 95% CI 0.71–0.97). Nach CAS war lediglich die Verwendung eines Embolieprotektionssystems in der multivariablen Regressions-Analyse (adj. RR 0.65, 95% CI 0.50–0.85) mit einem niedrigeren Risiko assoziiert, den primären Endpunkt zu erreichen. Zusammenfassung Intraoperative m, Background and object: In Germany, all open surgical and endovascular procedures on the carotid bifurcation have to be documented in a nationwide carotid registry. The object of this investigation was to analyze the association between different periprocedural variables and the in-hospital risk of stroke or death after carotid endarterectomy (CEA) and carotid artery stenting (CAS), respectively. Methods: Patients who were treated electively for asymptomatic or symptomatic carotid artery stenosis were included. Data were available for patients who underwent CEA or CAS between 2009 and 2014. All data were extracted from the statutory nationwide quality assurance databank held by the Institute for Applied Quality Improvement and Research in Health Care (AQUA Institute). Risk ratios (RR) were assessed by univariate and multivariable regression analyses. Results: A total of 142074 elective CEA (mean age 70.7 years, 67.8% male) and 13,086 CAS (mean age 69.7 years, 69.7% male) procedures were available for this analysis. The primary endpoint occurred in 1.8% of patients who underwent CEA and 2.4% of those treated with CAS. For patients treated with CEA, the multivariable analysis revealed an independent association with lower risks of in-hospital stroke or death for local anesthesia (vs. general anesthesia, RR 0.85, 95% CI 0.75–0.95), intraoperative morphological control by duplex ultrasound (RR 0.74, 95% CI 0.63–0.88) or angiography (RR 0.80, 95% CI 0.71–0.90), and perioperative antiplatelet medication (RR 0.83, 95% CI 0.71–0.97). In patients who received CAS, the multivariable analysis showed the use of an EPD to be exclusively associated with a lower rate of in-hospital stroke or death (adj. RR 0.65, 95% CI 0.50–0.85). Conclusions: This analysis shows, that local anaesthesia, intraoperative morphological control by angiography or duplex ultrasound, and perioperative antiplatelet medication in patients treated with CEA, and usage of an EPD in those treated with CAS were

Published
2018

47. Risk of Inhospital Stroke or Death Is Associated With Age But Not Sex in Patients Treated With Carotid Endarterectomy for Asymptomatic or Symptomatic Stenosis in Routine Practice: Secondary Data Analysis of the Nationwide German Statutory Quality Assurance Database From 2009 to 2014

Author

Schmid, Sofie, Tsantilas, Pavlos, Knappich, Christoph, Kallmayer, Michael, König, Thomas, Breitkreuz, Thorben, Zimmermann, Alexander, Kuehnl, Andreas, and Eckstein, Hans‐Henning

Subjects
Male, Time Factors, Ultrasonography, Doppler, Transcranial, Risk Assessment, surgery, Risk Factors, Cause of Death, Germany, sex, Humans, Women, Carotid Stenosis, Hospital Mortality, Original Research, Aged, Retrospective Studies, Aged, 80 and over, Endarterectomy, Carotid, Inpatients, Ultrasonography, Doppler, Duplex, Cardiovascular Surgery, Quality and Outcomes, carotid artery, aging, stenosis, Age Factors, Quality Improvement, Stroke, Population Surveillance, Asymptomatic Diseases, Cerebrovascular Disease/Stroke, Female, Stents, Tomography, X-Ray Computed, Magnetic Resonance Angiography, Follow-Up Studies
Abstract

Background Guideline recommendations on carotid endarterectomy are based predominantly on randomized, controlled trials, in which women or elderly patients are often under‐represented. This study analyzed the association of age and sex with the risk of in‐hospital stroke or death following carotid endarterectomy under routine conditions in Germany. Methods and Results Secondary data analysis using the Statutory German Quality Assurance Database on all carotid endarterectomy procedures (n=142 074) performed between 2009 and 2014. Primary outcome was any stroke or death until discharge; secondary outcomes were any in‐hospital stroke (alone), and death (alone). Descriptive statistics and multilevel multivariable regression analyses were applied. Patients were predominately male (68%), with mean age 71 years. Carotid stenosis was symptomatic in 40%. Primary outcome occurred in 1.8% of women and 1.9% of men. Multivariable regression analysis revealed that more‐advanced age was associated with a higher primary outcome rate (relative risk [RR] per 10‐year increase: 1.19; 95% CI, 1.14–1.24). Risk of death (alone) was associated with age (RR, 1.68; 95% CI, 1.54–1.84). Age was associated with the risk of stroke (alone; RR, 1.05; 95% CI, 1.00–1.11). Sex was not associated with primary outcome rate (1.01; 95% CI, 0.93–1.10), nor did it significantly modify the age effect. Conclusions This study shows that increasing age, but not sex, is associated with a higher risk of in‐hospital stroke or death following carotid endarterectomy under everyday conditions in Germany. Whereas the risk of death (alone) is significantly associated with age, the association between age and the risk of stroke (alone) can be considered of minor importance.

Published
2017

48. Risk of Inhospital Stroke or Death Is Associated With Age But Not Sex in Patients Treated With Carotid Endarterectomy for Asymptomatic or Symptomatic Stenosis in Routine Practice: Secondary Data Analysis of the Nationwide German Statutory Quality Assurance Database From 2009 to 2014

Author

Schmid, Sofie, Tsantilas, Pavlos, Knappich, Christoph, Kallmayer, Michael, König, Thomas, Breitkreuz, Thorben, Zimmermann, Alexander, Kuehnl, Andreas, and Eckstein, Hans‐Henning

Subjects
ddc
Published
2016

Catalog

Books, media, physical & digital resources
See catalog results