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1. Flat-panel Detector Perfusion Imaging and Conventional Multidetector Perfusion Imaging in Patients with Acute Ischemic Stroke: A Comparative Study

Author

Serrallach, Bettina L., Mujanovic, Adnan, Ntoulias, Nikolaos, Manhart, Michael, Branca, Mattia, Brehm, Alex, Psychogios, Marios-Nikos, Kurmann, Christoph C., Piechowiak, Eike I., Pilgram-Pastor, Sara, Meinel, Thomas, Seiffge, David, Mordasini, Pasquale, Gralla, Jan, Dobrocky, Tomas, and Kaesmacher, Johannes

Published
2024
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2. Correction to: Flat-panel Detector Perfusion Imaging and Conventional Multidetector Perfusion Imaging in Patients with Acute Ischemic Stroke

Author

Serrallach, Bettina L., Mujanovic, Adnan, Ntoulias, Nikolaos, Manhart, Michael, Branca, Mattia, Brehm, Alex, Psychogios, Marios-Nikos, Kurmann, Christoph C., Piechowiak, Eike I., Pilgram-Pastor, Sara, Meinel, Thomas, Seiffge, David, Mordasini, Pasquale, Gralla, Jan, Dobrocky, Tomas, and Kaesmacher, Johannes

Published
2024
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7. Association of Intravenous Thrombolysis with Delayed Reperfusion After Incomplete Mechanical Thrombectomy

Author

Mujanovic, Adnan, Kammer, Christoph, Kurmann, Christoph C., Grunder, Lorenz, Beyeler, Morin, Lang, Matthias F., Piechowiak, Eike I., Meinel, Thomas R., Jung, Simon, Almiri, William, Pilgram-Pastor, Sara, Hoffmann, Angelika, Seiffge, David J., Heldner, Mirjam R., Dobrocky, Tomas, Mordasini, Pasquale, Arnold, Marcel, Gralla, Jan, Fischer, Urs, and Kaesmacher, Johannes

Published
2023
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9. Development of a Score for Prediction of Occult Malignancy in Stroke Patients (Occult-5 Score)

Author

Beyeler, Morin, Birner, Barbara, Branca, Mattia, Meinel, Thomas, Vynckier, Jan, Buffle, Eric, Scutelnic, Adrian, Heldner, Mirjam R., Bücke, Philipp, Seiffge, David, Mordasini, Pascale, Dobrocky, Tomas, Piechowiak, Eike I., Kaesmacher, Johannes, Gralla, Jan, Mattle, Heinrich P., Arnold, Marcel, Fischer, Urs, Pabst, Thomas, Berger, Martin D., and Jung, Simon

Published
2022
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12. Connecting the DOTs: a novel imaging sign on flatpanel detector CT indicating distal vessel occlusions after thrombectomy.

Author

Mujanovic, Adnan, Windecker, Daniel, Serrallach, Bettina L., Kurmann, Christoph C., Almiri, William, Meinel, Thomas R., Seiffge, David J., Piechowiak, Eike I., Dobrocky, Tomas, Gralla, Jan, Fischer, Urs, Dorn, Franziska, Chapot, René, Pilgram-Pastor, Sara, and Kaesmacher, Johannes

Abstract

Background Immediate non-contrast post-interventional flat-panel detector CT (FPDCT) has been suggested as an imaging tool to assess complications after endovascular therapy (EVT). We systematically investigated a new imaging finding of focal hyperdensities correlating with remaining distal vessel occlusion after EVT. Methods A single-center retrospective analysis was conducted for all acute ischemic stroke patients admitted between July 2020 and December 2022 who underwent EVT and immediate post-interventional FPDCT. A blinded core lab performed reperfusion grading on post-interventional digital subtraction angiography (DSA) images and evaluated focal hyperdensities on FPDCT (here called the distal occlusion tracker (DOT) sign). DOT sign was defined as a tubular or punctiform, vessel confined, hyperdense signal within the initial occlusion target territory. We assessed sensitivity and specificity of the DOT sign when compared with DSA findings. Results The median age of the cohort (n=215) was 74 years (IQR 63-82) and 58.6% were male. The DOT sign was positive in half of the cohort (51%, 110/215). The DOT sign had high specificity (85%, 95% CI 72% to 93%), but only moderate sensitivity (63%, 95% CI 55% to 70%) for detection of residual vessel occlusions. In comparison to the core lab, operators overestimated complete reperfusion in a quarter of the entire cohort (25%, 53/215). In more than half of these cases (53%, 28/53) there was a positive DOT sign, which could have mitigated this overestimation. Conclusion The DOT sign appears to be a frequent finding on immediate post-interventional FPDCT. It correlates strongly with incomplete reperfusion and indicates residual distal vessel occlusions. In the future, it may be used to complement grading of reperfusion success and may help mitigating overestimation of reperfusion in the acute setting. [ABSTRACT FROM AUTHOR]

Published
2025
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13. Spinal CSF Leaks: The Neuroradiologist Transforming Care.

Author

Mamlouk, Mark D., Callen, Andrew L., Madhavan, Ajay A., Lützen, Niklas, Jones, Lalani Carlton, Mark, Ian T., Brinjikji, Waleed, Benson, John C., Verdoorn, Jared T., Kim, D. K., Amrhein, Timothy J., Gray, Linda, Dillon, William P., Maya, Marcel M., Huynh, Thien J., Shah, Vinil N., Dobrocky, Tomas, Piechowiak, Eike I., Chazen, Joseph Levi, and Malinzak, Michael D.

Published
2024
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16. Connecting the DOTs: a novel imaging sign on flat-panel detector CT indicating distal vessel occlusions after thrombectomy

Author

Mujanovic, Adnan, Windecker, Daniel, Serrallach, Bettina L, Kurmann, Christoph C, Almiri, William, Meinel, Thomas R, Seiffge, David J, Piechowiak, Eike I, Dobrocky, Tomas, Gralla, Jan, Fischer, Urs, Dorn, Franziska, Chapot, René, Pilgram-Pastor, Sara, and Kaesmacher, Johannes

Abstract

BackgroundImmediate non-contrast post-interventional flat-panel detector CT (FPDCT) has been suggested as an imaging tool to assess complications after endovascular therapy (EVT). We systematically investigated a new imaging finding of focal hyperdensities correlating with remaining distal vessel occlusion after EVT.MethodsA single-center retrospective analysis was conducted for all acute ischemic stroke patients admitted between July 2020 and December 2022 who underwent EVT and immediate post-interventional FPDCT. A blinded core lab performed reperfusion grading on post-interventional digital subtraction angiography (DSA) images and evaluated focal hyperdensities on FPDCT (here called the distal occlusion tracker (DOT) sign). DOT sign was defined as a tubular or punctiform, vessel confined, hyperdense signal within the initial occlusion target territory. We assessed sensitivity and specificity of the DOT sign when compared with DSA findings.ResultsThe median age of the cohort (n=215) was 74 years (IQR 63–82) and 58.6% were male. The DOT sign was positive in half of the cohort (51%, 110/215). The DOT sign had high specificity (85%, 95% CI 72% to 93%), but only moderate sensitivity (63%, 95% CI 55% to 70%) for detection of residual vessel occlusions. In comparison to the core lab, operators overestimated complete reperfusion in a quarter of the entire cohort (25%, 53/215). In more than half of these cases (53%, 28/53) there was a positive DOT sign, which could have mitigated this overestimation.ConclusionThe DOT sign appears to be a frequent finding on immediate post-interventional FPDCT. It correlates strongly with incomplete reperfusion and indicates residual distal vessel occlusions. In the future, it may be used to complement grading of reperfusion success and may help mitigating overestimation of reperfusion in the acute setting.

Published
2025
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22. Time to Treatment With Intravenous Thrombolysis Before Thrombectomy and Functional Outcomes in Acute Ischemic Stroke: A Meta-Analysis

Author

Kaesmacher, Johannes, Cavalcante, Fabiano, Kappelhof, Manon, Treurniet, Kilian M, Rinkel, Leon, Liu, Jianmin, Yan, Bernard, Zi, Wenjie, Kimura, Kazumi, Eker, Omer F, Zhang, Yongwei, Piechowiak, Eike I, van Zwam, Wim, Liu, Sheng, Strbian, Daniel, Uyttenboogaart, Maarten, Dobrocky, Tomas, Miao, Zhongrong, Suzuki, Kentaro, Zhang, Lei, van Oostenbrugge, Robert, Meinel, Thomas R, Guo, Changwei, Seiffge, David, Yin, Congguo, Bütikofer, Lukas, Lingsma, Hester, Nieboer, Daan, Yang, Pengfei, Mitchell, Peter, Majoie, Charles, Fischer, Urs, Roos, Yvo, Gralla, Jan, IRIS Collaborators, Kaesmacher, Johannes, Cavalcante, Fabiano, Kappelhof, Manon, Treurniet, Kilian M, Rinkel, Leon, Liu, Jianmin, Yan, Bernard, Zi, Wenjie, Kimura, Kazumi, Eker, Omer F, Zhang, Yongwei, Piechowiak, Eike I, van Zwam, Wim, Liu, Sheng, Strbian, Daniel, Uyttenboogaart, Maarten, Dobrocky, Tomas, Miao, Zhongrong, Suzuki, Kentaro, Zhang, Lei, van Oostenbrugge, Robert, Meinel, Thomas R, Guo, Changwei, Seiffge, David, Yin, Congguo, Bütikofer, Lukas, Lingsma, Hester, Nieboer, Daan, Yang, Pengfei, Mitchell, Peter, Majoie, Charles, Fischer, Urs, Roos, Yvo, Gralla, Jan, and IRIS Collaborators

Abstract

IMPORTANCE: The benefit of intravenous thrombolysis (IVT) for acute ischemic stroke declines with longer time from symptom onset, but it is not known whether a similar time dependency exists for IVT followed by thrombectomy. OBJECTIVE: To determine whether the benefit associated with IVT plus thrombectomy vs thrombectomy alone decreases with treatment time from symptom onset. DESIGN, SETTING, AND PARTICIPANTS: Individual participant data meta-analysis from 6 randomized clinical trials comparing IVT plus thrombectomy vs thrombectomy alone. Enrollment was between January 2017 and July 2021 at 190 sites in 15 countries. All participants were eligible for IVT and thrombectomy and presented directly at thrombectomy-capable stroke centers (n?=?2334). For this meta-analysis, only patients with an anterior circulation large-vessel occlusion were included (n?=?2313). EXPOSURE: Interval from stroke symptom onset to expected administration of IVT and treatment with IVT plus thrombectomy vs thrombectomy alone. MAIN OUTCOMES AND MEASURES: The primary outcome analysis tested whether the association between the allocated treatment (IVT plus thrombectomy vs thrombectomy alone) and disability at 90 days (7-level modified Rankin Scale [mRS] score range, 0 [no symptoms] to 6 [death]; minimal clinically important difference for the rates of mRS scores of 0-2: 1.3%) varied with times from symptom onset to expected administration of IVT. RESULTS: In 2313 participants (1160 in IVT plus thrombectomy group vs 1153 in thrombectomy alone group; median age, 71 [IQR, 62 to 78] years; 44.3% were female), the median time from symptom onset to expected administration of IVT was 2 hours 28 minutes (IQR, 1 hour 46 minutes to 3 hours 17 minutes). There was a statistically significant interaction between the time from symptom onset to expected administration of IVT and the association of allocated treatment with functional outcomes (ratio of adjusted common odds ratio [OR] per 1-hour delay, 0.84 [95%

Published
2024

24. Connecting the DOTs: a novel imaging sign on flat-panel detector CT indicating distal vessel occlusions after thrombectomy

Author

Mujanovic, Adnan, primary, Windecker, Daniel, additional, Serrallach, Bettina L, additional, Kurmann, Christoph C, additional, Almiri, William, additional, Meinel, Thomas R, additional, Seiffge, David J, additional, Piechowiak, Eike I, additional, Dobrocky, Tomas, additional, Gralla, Jan, additional, Fischer, Urs, additional, Dorn, Franziska, additional, Chapot, René, additional, Pilgram-Pastor, Sara, additional, and Kaesmacher, Johannes, additional

Published
2024
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25. Value of Immediate Flat Panel Perfusion Imaging after Endovascular Therapy (AFTERMATH): A Proof of Concept Study

Author

Mujanovic, Adnan, primary, Kurmann, Christoph C., additional, Manhart, Michael, additional, Piechowiak, Eike I., additional, Pilgram-Pastor, Sara M., additional, Serrallach, Bettina L., additional, Boulouis, Gregoire, additional, Meinel, Thomas R., additional, Seiffge, David J., additional, Jung, Simon, additional, Arnold, Marcel, additional, Nguyen, Thanh N., additional, Fischer, Urs, additional, Gralla, Jan, additional, Dobrocky, Tomas, additional, Mordasini, Pasquale, additional, and Kaesmacher, Johannes, additional

Published
2024
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26. External Validation of a Model for Persistent Perfusion Deficit in Patients With Incomplete Reperfusion After Thrombectomy: EXTEND-PROCEED.

Author

Mujanovic, Adnan, Ng, Felix C., Branca, Mattia, Deutschmann, Hannes A., Meinel, Thomas R., Churilov, Leonid, Nistl, Oliver, Mitchell, Peter J., Yassi, Nawaf, Parsons, Mark W., Sharma, Gagan J., Gattringer, Thomas, Arnold, Marcel, Cavalcante, Fabiano, Piechowiak, Eike I., Kleinig, Timothy J., Seiffge, David J., Dobrocky, Tomas, Gralla, Jan, and Fischer, Urs

Published
2024
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27. Value of intravenous alteplase before thrombectomy among patients with tandem lesions and emergent carotid artery stenting: A subgroup analysis of the SWIFT DIRECT trial.

Author

Mujanovic, Adnan, Dobrocky, Tomas, Pfeilschifter, Waltraud, Remonda, Luca, Caroff, Jildaz, Behme, Daniel, Seiffge, David J., Cereda, Carlo W., Kägi, Georg, Leyon, Joe, Piechowiak, Eike I., Costalat, Vincent, Wagner, Judith, Chabert, Emmanuel, Meinel, Thomas R., Jansen, Olav, Alonso, Angelika, Loehr, Christian, Liebeskind, David S., and Gralla, Jan

Subjects
CAROTID artery, TREATMENT effect heterogeneity, INTERNAL carotid artery, THROMBECTOMY, SUBGROUP analysis (Experimental design), ENDARTERECTOMY
Abstract

Background and purpose: The value of intravenous thrombolysis (IVT) in eligible tandem lesion patients undergoing endovascular treatment (EVT) is unknown. We investigated treatment effect heterogeneity of EVT + IVT versus EVT‐only in tandem lesion patients. Additional analyses were performed for patients undergoing emergent internal carotid artery (ICA) stenting. Methods: SWIFT DIRECT randomized IVT‐eligible patients to either EVT + IVT or EVT‐only. Primary outcome was 90‐day functional independence (modified Rankin Scale score 0–2) after the index event. Secondary endpoints were reperfusion success, 24 h intracranial hemorrhage rate, and 90‐day all‐cause mortality. Interaction models were fitted for all predefined outcomes. Results: Among 408 included patients, 63 (15.4%) had a tandem lesion and 33 (52.4%) received IVT. In patients with tandem lesions, 20 had undergone emergent ICA stenting (EVT + IVT: 9/33, 27.3%; EVT: 11/30, 36.7%). Tandem lesion did not show treatment effect modification of IVT on rates of functional independence (tandem lesion EVT + IVT vs. EVT: 63.6% vs. 46.7%, non‐tandem lesion EVT + IVT vs. EVT: 65.6% vs. 58.2%; p for interaction = 0.77). IVT also did not increase the risk of intracranial hemorrhage among tandem lesion patients (tandem lesion EVT + IVT vs. EVT: 34.4% vs. 46.7%, non‐tandem lesion EVT + IVT vs. EVT: 33.5% vs. 26.3%; p for interaction = 0.15). No heterogeneity was noted for other endpoints (p for interaction > 0.05). Conclusions: No treatment effect heterogeneity of EVT + IVT versus EVT‐only was observed among tandem lesion patients. Administering IVT in patients with anticipated emergent ICA stenting seems safe, and the latter should not be a factor to consider when deciding to administer IVT before EVT. [ABSTRACT FROM AUTHOR]

Published
2024
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30. Effect of Pre- and In-Hospital Delay on Reperfusion in Acute Ischemic Stroke Mechanical Thrombectomy

Author

Kaesmacher, Johannes, Maamari, Basel, Meinel, Thomas R., Piechowiak, Eike I., Mosimann, Pascal J., Mordasini, Pasquale, Goeldlin, Martina, Arnold, Marcel, Dobrocky, Tomas, Boeckh-Behrens, Tobias, Berndt, Maria, Michel, Patrik, Requena, Manuel, Benali, Amel, Pierot, Laurent, Mendes Pereira, Vitor, Boulouis, Grégoire, Brehm, Alex, Sporns, Peter B., Ospel, Johanna M., Gralla, Jan, and Fischer, Urs

Published
2020
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32. Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery.

Author

Meyer, Lukas, Stracke, Christian Paul, Broocks, Gabriel, Wallocha, Marta, Elsharkawy, Mohamed, Sporns, Peter B., Piechowiak, Eike I., Kaesmacher, Johannes, and Maegerlein, Christian

Subjects
INTRACRANIAL hemorrhage, CONSCIOUS sedation, PATIENT safety, LOCAL anesthesia, ANTERIOR cerebral artery, TREATMENT effectiveness, RETROSPECTIVE studies, DESCRIPTIVE statistics, POSTERIOR cerebral artery, ANESTHETICS, THROMBECTOMY, STROKE, COMPARATIVE studies, GENERAL anesthesia
Abstract

Background Numerous questions regarding procedural details of distal stroke thrombectomy remain unanswered. This study assesses the effect of anesthetic strategies on procedural, clinical and safety outcomes following thrombectomy for distal medium vessel occlusions (DMVOs). Methods Patients with isolated DMVO stroke from the TOPMOST registry were analyzed with regard to anesthetic strategies (ie, conscious sedation (CS), local (LA) or general anesthesia (GA)). Occlusions were in the P2/P3 or A2-A4 segments of the posterior and anterior cerebral arteries (PCA and ACA), respectively. The primary endpoint was the rate of complete reperfusion (modified Thrombolysis in Cerebral Infarction score 3) and the secondary endpoint was the rate of modified Rankin Scale score 0-1. Safety endpoints were the occurrence of symptomatic intracranial hemorrhage and mortality. Results Overall, 233 patients were included. The median age was 75 years (range 64-82), 50.6% (n=118) were female, and the baseline National Institutes of Health Stroke Scale score was 8 (IQR 4-12). DMVOs were in the PCA in 59.7% (n=139) and in the ACA in 40.3% (n=94). Thrombectomy was performed under LA±CS (51.1%, n=119) and GA (48.9%, n=114). Complete reperfusion was reached in 73.9% (n=88) and 71.9% (n=82) in the LA±CS and GA groups, respectively (P=0.729). In subgroup analysis, thrombectomy for ACA DMVO favored GA over LA±CS (aOR 3.07, 95% CI 1.24 to 7.57, P=0.015). Rates of secondary and safety outcomes were similar in the LA±CS and GA groups. Conclusion LA±CS compared with GA resulted in similar reperfusion rates after thrombectomy for DMVO stroke of the ACA and PCA. GA may facilitate achieving complete reperfusion in DMVO stroke of the ACA. Safety and functional long-term outcomes were comparable in both groups. [ABSTRACT FROM AUTHOR]

Published
2024
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33. No-reflow phenomenon in stroke patients: a systematic literature review and meta-analysis of clinical data

Author

Mujanovic, Adnan, primary, Ng, Felix Chun Fai, additional, Meinel, Thomas, additional, Dobrocky, Thomas, additional, Piechowiak, Eike I, additional, Kurmann, Christoph, additional, Seiffge, David J, additional, Wegener, Susanne, additional, Wiest, Roland, additional, Meyer, Lukas, additional, Fiehler, Jens, additional, Olivot, Jean-Marc, additional, Ribo, Marc, additional, Nguyen, Thanh N, additional, Gralla, Jan, additional, Campbell, Bruce, additional, Fischer, Urs, additional, and Kaesmacher, Johannes, additional

Published
2023
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34. Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery

Author

Meyer, Lukas, primary, Stracke, Christian Paul, additional, Broocks, Gabriel, additional, Wallocha, Marta, additional, Elsharkawy, Mohamed, additional, Sporns, Peter B, additional, Piechowiak, Eike I, additional, Kaesmacher, Johannes, additional, Maegerlein, Christian, additional, Hernandez Petzsche, Moritz Roman, additional, Zimmermann, Hanna, additional, Naziri, Weis, additional, Abdullayev, Nuran, additional, Kabbasch, Christoph, additional, Behme, Daniel, additional, Thormann, Maximilian, additional, Maus, Volker, additional, Fischer, Sebastian, additional, Möhlenbruch, Markus A, additional, Weyland, Charlotte Sabine, additional, Langner, Soenke, additional, Ernst, Marielle, additional, Jamous, Ala, additional, Meila, Dan, additional, Miszczuk, Milena, additional, Siebert, Eberhard, additional, Lowens, Stephan, additional, Krause, Lars Udo, additional, Yeo, Leonard LL, additional, Tan, Benjamin Y Q, additional, Gopinathan, Anil, additional, Gory, Benjamin, additional, Galvan Fernandez, Jorge, additional, Schüller Arteaga, Miguel, additional, Navia, Pedro, additional, Raz, Eytan, additional, Shapiro, Maksim, additional, Arnberg, Fabian, additional, Zeleňák, Kamil, additional, Martínez-Galdámez, Mario, additional, Alexandrou, Maria, additional, Kastrup, Andreas, additional, Papanagiotou, Panagiotis, additional, Dorn, Franziska, additional, Kemmling, André, additional, Psychogios, Marios-Nikos, additional, Andersson, Tommy, additional, Chapot, René, additional, Fiehler, Jens, additional, and Hanning, Uta, additional

Published
2023
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35. No-reflow phenomenon in stroke patients: A systematic literature review and meta-analysis of clinical data.

Author

Mujanovic, Adnan, Ng, Felix, Meinel, Thomas R, Dobrocky, Tomas, Piechowiak, Eike I, Kurmann, Christoph C, Seiffge, David J, Wegener, Susanne, Wiest, Roland, Meyer, Lukas, Fiehler, Jens, Olivot, Jean Marc, Ribo, Marc, Nguyen, Thanh N, Gralla, Jan, Campbell, Bruce CV, Fischer, Urs, and Kaesmacher, Johannes

Subjects
STROKE patients, STROKE, CEREBRAL infarction, MYOCARDIAL infarction
Abstract

Background: The no-reflow phenomenon refers to the absence of microvascular reperfusion despite macrovascular reperfusion. Aim: The aim of this analysis was to summarize the available clinical evidence on no-reflow in patients with acute ischemic stroke. Methods: A systematic literature review and a meta-analysis of clinical data on definition, rates, and impact of the no-reflow phenomenon after reperfusion therapy was carried out. A predefined research strategy was formulated according to the Population, Intervention, Comparison, and Outcome (PICO) model and was used to screen for articles in PubMed, MEDLINE, and Embase up to 8 September 2022. Whenever possible, quantitative data were summarized using a random-effects model. Results: Thirteen studies with a total of 719 patients were included in the final analysis. Most studies (n = 10/13) used variations of the Thrombolysis in Cerebral Infarction scale to evaluate macrovascular reperfusion, whereas microvascular reperfusion and no-reflow were mostly assessed on perfusion maps (n = 9/13). In one-third of stroke patients with successful macrovascular reperfusion (29%, 95% confidence interval (CI), 21–37%), the no-reflow phenomenon was observed. Pooled analysis showed that no-reflow was consistently associated with reduced rates of functional independence (odds ratio (OR), 0.21, 95% CI, 0.15–0.31). Conclusion: The definition of no-reflow varied substantially across studies, but it appears to be a common phenomenon. Some of the no-reflow cases may simply represent remaining vessel occlusions, and it remains unclear whether no-reflow is an epiphenomenon of the infarcted parenchyma or causes infarction. Future studies should focus on standardizing the definition of no-reflow with more consistent definitions of successful macrovascular reperfusion and experimental set-ups that could detect the causality of the observed findings. [ABSTRACT FROM AUTHOR]

Published
2024
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36. Prediction of delayed reperfusion in patients with incomplete reperfusion following thrombectomy

Author

Mujanovic, Adnan, primary, Brigger, Robin, additional, Kurmann, Christoph C, additional, Ng, Felix, additional, Branca, Mattia, additional, Dobrocky, Tomas, additional, Meinel, Thomas R, additional, Windecker, Daniel, additional, Almiri, William, additional, Grunder, Lorenz, additional, Beyeler, Morin, additional, Seiffge, David J, additional, Pilgram-Pastor, Sara, additional, Arnold, Marcel, additional, Piechowiak, Eike I, additional, Campbell, Bruce, additional, Gralla, Jan, additional, Fischer, Urs, additional, and Kaesmacher, Johannes, additional

Published
2023
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37. Absence of susceptibility vessel sign and hyperdense vessel sign in patients with cancer-related stroke

Author

Beyeler, Morin, primary, Grunder, Lorenz, additional, Göcmen, Jayan, additional, Steinauer, Fabienne, additional, Belachew, Nebiyat F., additional, Kielkopf, Moritz, additional, Clénin, Leander, additional, Mueller, Madlaine, additional, Silimon, Norbert, additional, Kurmann, Christoph, additional, Meinel, Thomas, additional, Bücke, Philipp, additional, Seiffge, David, additional, Dobrocky, Tomas, additional, Piechowiak, Eike I., additional, Pilgram-Pastor, Sara, additional, Mattle, Heinrich P., additional, Navi, Babak B., additional, Arnold, Marcel, additional, Fischer, Urs, additional, Pabst, Thomas, additional, Gralla, Jan, additional, Berger, Martin D., additional, Jung, Simon, additional, and Kaesmacher, Johannes, additional

Published
2023
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38. Abstract Number ‐ 184: Prediction Model For Medical Rescue Treatment Strategies In Patients With Incomplete Reperfusion

Author

Mujanovic, Adnan, primary, Kurmann, Christoph, additional, Dobrocky, Tomas, additional, Meinel, Thomas, additional, Grunder, Lorenz, additional, Beyeler, Morin, additional, Lang, Matthias F, additional, Jung, Simon, additional, Klail, Tomas, additional, Hoffmann, Angelika, additional, Seiffge, David J, additional, Heldner, Mirjam, additional, Pilgram‐Pastor, Sara, additional, Mordasini, Pasquale, additional, Arnold, Marcel, additional, Piechowiak, Eike I, additional, Gralla, Jan, additional, Fischer, Urs, additional, and Kaesmacher, Johannes, additional

Published
2023
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39. Thrombectomy versus Medical Management for Isolated Anterior Cerebral Artery Stroke: An International Multicenter Registry Study

Author

Meyer, Lukas, Stracke, Paul, Broocks, Gabriel, Elsharkawy, Mohamed, Sporns, Peter, Piechowiak, Eike I, Kaesmacher, Johannes, Maegerlein, Christian, Hernandez Petzsche, Moritz Roman, Zimmermann, Hanna, Naziri, Weis, Abdullayev, Nuran, Kabbasch, Christoph, Diamandis, Elie, Thormann, Maximilian, Maus, Volker, Fischer, Sebastian, Möhlenbruch, Markus, Weyland, Charlotte S, Ernst, Marielle, Jamous, Ala, Meila, Dan, Miszczuk, Milena, Siebert, Eberhard, Lowens, Stephan, Krause, Lars Udo, Yeo, Leonard, Tan, Benjamin, Gopinathan, Anil, Arenillas-Lara, Juan F, Navia, Pedro, Raz, Eytan, Shapiro, Maksim, Arnberg, Fabian, Zeleňák, Kamil, Martínez-Galdámez, Mario, Alexandrou, Maria, Kastrup, Andreas, Papanagiotou, Panagiotis, Kemmling, André, Dorn, Franziska, Psychogios, Marios, Andersson, Tommy, Chapot, René, Fiehler, Jens, and Hanning, Uta

Subjects
610 Medizin und Gesundheit
Abstract

Background Evidence supporting a potential benefit of thrombectomy for distal medium vessel occlusions (DMVOs) of the anterior cerebral artery (ACA) is, to the knowledge of the authors, unknown. Purpose To compare the clinical and safety outcomes between mechanical thrombectomy (MT) and best medical treatment (BMT) with or without intravenous thrombolysis for primary isolated ACA DMVOs. Materials and Methods Treatment for Primary Medium Vessel Occlusion Stroke, or TOPMOST, is an international, retrospective, multicenter, observational registry of patients treated for DMVO in daily practice. Patients treated with thrombectomy or BMT alone for primary ACA DMVO distal to the A1 segment between January 2013 and October 2021 were analyzed and compared by one-to-one propensity score matching (PSM). Early outcome was measured by the median improvement of National Institutes of Health Stroke Scale (NIHSS) scores at 24 hours. Favorable functional outcome was defined as modified Rankin scale scores of 0-2 at 90 days. Safety was assessed by the occurrence of symptomatic intracerebral hemorrhage and mortality. Results Of 154 patients (median age, 77 years; quartile 1 [Q1] to quartile 3 [Q3], 66-84 years; 80 men; 94 patients with MT; 60 patients with BMT) who met the inclusion criteria, 110 patients (median age, 76 years; Q1-Q3, 67-83 years; 50 men; 55 patients with MT; 55 patients with BMT) were matched. DMVOs were in A2 (82 patients; 53%), A3 (69 patients; 45%), and A3 (three patients; 2%). After PSM, the median 24-hour NIHSS point decrease was -2 (Q1-Q3, -4 to 0) in the thrombectomy and -1 (Q1-Q3, -4 to 1.25) in the BMT cohort (P = .52). Favorable functional outcome (MT vs BMT, 18 of 37 [49%] vs 19 of 39 [49%], respectively; P = .99) and mortality (MT vs BMT, eight of 37 [22%] vs 12 of 39 [31%], respectively; P = .36) were similar in both groups. Symptomatic intracranial hemorrhage occurred in three (2%) of 154 patients. Conclusion Thrombectomy appears to be a safe and technically feasible treatment option for primary isolated anterior cerebral artery occlusions in the A2 and A3 segment with clinical outcomes similar to best medical treatment with and without intravenous thrombolysis. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Zhu and Wang in this issue.

Published
2023
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40. sj-docx-1-eso-10.1177_23969873231164274 – Supplemental material for Prediction of delayed reperfusion in patients with incomplete reperfusion following thrombectomy

Author

Mujanovic, Adnan, Brigger, Robin, Kurmann, Christoph C, Ng, Felix, Branca, Mattia, Dobrocky, Tomas, Meinel, Thomas R, Windecker, Daniel, Almiri, William, Grunder, Lorenz, Beyeler, Morin, Seiffge, David J, Pilgram-Pastor, Sara, Arnold, Marcel, Piechowiak, Eike I, Campbell, Bruce, Gralla, Jan, Fischer, Urs, and Kaesmacher, Johannes

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110904 Neurology and Neuromuscular Diseases
Abstract

Supplemental material, sj-docx-1-eso-10.1177_23969873231164274 for Prediction of delayed reperfusion in patients with incomplete reperfusion following thrombectomy by Adnan Mujanovic, Robin Brigger, Christoph C Kurmann, Felix Ng, Mattia Branca, Tomas Dobrocky, Thomas R Meinel, Daniel Windecker, William Almiri, Lorenz Grunder, Morin Beyeler, David J Seiffge, Sara Pilgram-Pastor, Marcel Arnold, Eike I Piechowiak, Bruce Campbell, Jan Gralla, Urs Fischer and Johannes Kaesmacher in European Stroke Journal

Published
2023
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41. sj-pdf-1-wso-10.1177_17474930231180434 – Supplemental material for No-reflow phenomenon in stroke patients: A systematic literature review and meta-analysis of clinical data

Author

Mujanovic, Adnan, Ng, Felix, Meinel, Thomas R, Dobrocky, Tomas, Piechowiak, Eike I, Kurmann, Christoph C, Seiffge, David J, Wegener, Susanne, Wiest, Roland, Meyer, Lukas, Fiehler, Jens, Olivot, Jean Marc, Ribo, Marc, Nguyen, Thanh N, Gralla, Jan, Campbell, Bruce CV, Fischer, Urs, and Kaesmacher, Johannes

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110904 Neurology and Neuromuscular Diseases
Abstract

Supplemental material, sj-pdf-1-wso-10.1177_17474930231180434 for No-reflow phenomenon in stroke patients: A systematic literature review and meta-analysis of clinical data by Adnan Mujanovic, Felix Ng, Thomas R Meinel, Tomas Dobrocky, Eike I Piechowiak, Christoph C Kurmann, David J Seiffge, Susanne Wegener, Roland Wiest, Lukas Meyer, Jens Fiehler, Jean Marc Olivot, Marc Ribo, Thanh N Nguyen, Jan Gralla, Bruce CV Campbell, Urs Fischer and Johannes Kaesmacher in International Journal of Stroke

Published
2023
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42. sj-pdf-2-eso-10.1177_23969873231164274 – Supplemental material for Prediction of delayed reperfusion in patients with incomplete reperfusion following thrombectomy

Author

Mujanovic, Adnan, Brigger, Robin, Kurmann, Christoph C, Ng, Felix, Branca, Mattia, Dobrocky, Tomas, Meinel, Thomas R, Windecker, Daniel, Almiri, William, Grunder, Lorenz, Beyeler, Morin, Seiffge, David J, Pilgram-Pastor, Sara, Arnold, Marcel, Piechowiak, Eike I, Campbell, Bruce, Gralla, Jan, Fischer, Urs, and Kaesmacher, Johannes

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110904 Neurology and Neuromuscular Diseases
Abstract

Supplemental material, sj-pdf-2-eso-10.1177_23969873231164274 for Prediction of delayed reperfusion in patients with incomplete reperfusion following thrombectomy by Adnan Mujanovic, Robin Brigger, Christoph C Kurmann, Felix Ng, Mattia Branca, Tomas Dobrocky, Thomas R Meinel, Daniel Windecker, William Almiri, Lorenz Grunder, Morin Beyeler, David J Seiffge, Sara Pilgram-Pastor, Marcel Arnold, Eike I Piechowiak, Bruce Campbell, Jan Gralla, Urs Fischer and Johannes Kaesmacher in European Stroke Journal

Published
2023
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43. Importance of Delayed Reperfusions in Patients With Incomplete Thrombectomy

Author

Mujanovic, Adnan, primary, Jungi, Noel, additional, Kurmann, Christoph C., additional, Dobrocky, Tomas, additional, Meinel, Thomas R., additional, Almiri, William, additional, Grunder, Lorenz, additional, Beyeler, Morin, additional, Lang, Matthias F., additional, Jung, Simon, additional, Klail, Tomas, additional, Hoffmann, Angelika, additional, Seiffge, David J., additional, Heldner, Mirjam R., additional, Pilgram-Pastor, Sara, additional, Mordasini, Pasquale, additional, Arnold, Marcel, additional, Piechowiak, Eike I., additional, Gralla, Jan, additional, Fischer, Urs, additional, and Kaesmacher, Johannes, additional

Published
2022
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44. Bridging intravenous thrombolysis in patients with atrial fibrillation

Author

Mujanovic, Adnan, Kurmann, Christoph C, Dobrocky, Tomas, Olivé-Gadea, Marta, Maegerlein, Christian, Pierot, Laurent, Mendes Pereira, Vitor, Costalat, Vincent, Psychogios, Marios, Michel, Patrik, Beyeler, Morin, Piechowiak, Eike I, Seiffge, David J, Mordasini, Pasquale, Arnold, Marcel, Gralla, Jan, Fischer, Urs, Kaesmacher, Johannes, and Meinel, Thomas R

Subjects
Neurology, 610 Medicine & health, Neurology (clinical)
Abstract

Background and purpose 40% of acute ischemic stroke patients treated by mechanical thrombectomy (MT) have a clinical history of atrial fibrillation (AF). The safety of bridging intravenous thrombolysis (IVT) (MT + IVT) is currently being discussed. We aimed to analyze the interaction between oral anticoagulation (OAC) status or AF with bridging IVT, regarding the occurrence of symptomatic intracranial hemorrhage (sICH) and functional outcome. Materials and Methods Multicentric observational cohort study (BEYOND-SWIFT registry) of consecutive patients undergoing MT between 2010 and 2018 (n = 2,941). Multinomial regression models were adjusted for prespecified baseline and plausible pathophysiological covariates identified on a univariate analysis to assess the association of AF and OAC status with sICH and good outcomes (90-day modified Rankin Scale score 0-2). Results In the total cohort (median age 74, 50.6% women), 1,347 (45.8%) patients had AF. Higher admission National Institutes of Health Stroke Scale (NIHSS) score (aOR 1.04 [95% 1.02-1.06], per point of increase) and prior medication with Vitamin K antagonists (VKA) (aOR 2.19 [95% 1.27-3.66]) were associated with sICH. Neither AF itself (aOR 0.71 [95% 0.41-1.24]) nor bridging IVT (aOR 1.08 [0.67-1.75]) were significantly associated with increased sICH. Receiving bridging IVT (aOR 1.61 [95% 1.24-2.11]) was associated with good 90-day outcome, with no interaction between AF and IVT (p = 0.92). Conclusion Bridging IVT appears to be a reasonable clinical option in selected patients with AF. Given the increased sICH risk in patients with VKA, subgroup analysis of the randomized controlled trials should analyze whether patients with VKA might benefit from withholding bridging IVT. Registration clinicaltrials.gov; Unique identifier: NCT03496064.

Published
2022
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45. Safety and Efficacy of Carotid Artery Stenting with the CGuard Double-layer Stent in Acute Ischemic Stroke

Author

Klail, Tomas, primary, Kurmann, Christoph, additional, Kaesmacher, Johannes, additional, Mujanovic, Adnan, additional, Piechowiak, Eike I., additional, Dobrocky, Tomas, additional, Pilgram-Pastor, Sara, additional, Scutelnic, Adrian, additional, Heldner, Mirjam R., additional, Gralla, Jan, additional, and Mordasini, Pasquale, additional

Published
2022
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46. Epidural Blood Patching in Spontaneous Intracranial Hypotension—Do we Really Seal the Leak?

Author

Piechowiak, Eike I., primary, Aeschimann, Benjamin, additional, Häni, Levin, additional, Kaesmacher, Johannes, additional, Mordasini, Pasquale, additional, Jesse, Christopher Marvin, additional, Schankin, Christoph J., additional, Raabe, Andreas, additional, Schär, Ralph T., additional, Gralla, Jan, additional, Beck, Jürgen, additional, and Dobrocky, Tomas, additional

Published
2022
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47. Absence of Susceptibility Vessel Sign in Patients With Malignancy-Related Acute Ischemic Stroke Treated With Mechanical Thrombectomy

Author

Beyeler, Morin, primary, Belachew, Nebiyat F., additional, Kielkopf, Moritz, additional, Aleman, Enrique B., additional, León Betancourt, Alejandro Xavier, additional, Genceviciute, Kotryna, additional, Kurmann, Christoph, additional, Grunder, Lorenz, additional, Birner, Barbara, additional, Meinel, Thomas R., additional, Scutelnic, Adrian, additional, Bücke, Philipp, additional, Seiffge, David J., additional, Dobrocky, Tomas, additional, Piechowiak, Eike I., additional, Pilgram-Pastor, Sara, additional, Mattle, Heinrich P., additional, Mordasini, Pasquale, additional, Arnold, Marcel, additional, Fischer, Urs, additional, Pabst, Thomas, additional, Gralla, Jan, additional, Berger, Martin D., additional, Jung, Simon, additional, and Kaesmacher, Johannes, additional

Published
2022
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48. Association of Intravenous Thrombolysis with Delayed Reperfusion After Incomplete Mechanical Thrombectomy

Author

Mujanovic, Adnan, primary, Kammer, Christoph, additional, Kurmann, Christoph C., additional, Grunder, Lorenz, additional, Beyeler, Morin, additional, Lang, Matthias F., additional, Piechowiak, Eike I., additional, Meinel, Thomas R., additional, Jung, Simon, additional, Almiri, William, additional, Pilgram-Pastor, Sara, additional, Hoffmann, Angelika, additional, Seiffge, David J., additional, Heldner, Mirjam R., additional, Dobrocky, Tomas, additional, Mordasini, Pasquale, additional, Arnold, Marcel, additional, Gralla, Jan, additional, Fischer, Urs, additional, and Kaesmacher, Johannes, additional

Published
2022
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49. Association of the 24‐Hour National Institutes of Health Stroke Scale After Mechanical Thrombectomy With Early and Long‐Term Survival

Author

Kurmann, Christoph C., primary, Beyeler, Morin, additional, Grunder, Lorenz, additional, Lang, Matthias F., additional, Piechowiak, Eike I., additional, Meinel, Thomas R., additional, Jung, Simon, additional, Hoffmann, Angelika, additional, Seiffge, David J., additional, Heldner, Mirjam R., additional, Dobrocky, Tomas, additional, Mordasini, Pasquale, additional, Arnold, Marcel, additional, Gralla, Jan, additional, Fischer, Urs, additional, and Kaesmacher, Johannes, additional

Published
2022
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50. Role of Conventional Dynamic Myelography for Detection of High-Flow Cerebrospinal Fluid Leaks

Author

Piechowiak, Eike I., Pospieszny, Katarzyna, Haeni, Levin, Jesse, Christopher M., Peschi, Giovanni, Mosimann, Pascal J., Kaesmacher, Johannes, Mordasini, Pasquale, Raabe, Andreas, Ulrich, Christian T., Beck, Jürgen, Gralla, Jan, and Dobrocky, Tomas

Subjects
Conventional dynamic myelography, Cerebrospinal Fluid Leak, Spontaneous intracranial hypotension, Intracranial Hypotension, Humans, Original Article, CSF leak, Middle Aged, Myelography, Spine, Retrospective Studies
Abstract

Background Spinal imaging is essential to identify and localize cerebrospinal fluid (CSF) leaks in spontaneous intracranial hypotension (SIH) patients when targeted treatment is necessary. Purpose Provide an in-depth presentation of the conventional dynamic myelography (CDM) technique for localizing spinal CSF leaks in SIH patients. Material and Methods Consecutive SIH patients with a CSF leak confirmed on CDM and postmyelography computed tomography (CT) investigated at our institution between 2013 and 2019 were retrospectively analyzed. Intraoperative reports were reviewed to confirm the accuracy of CDM. Results In total, 62 patients (mean age 45 years) were included; 48 with a ventral dural tear, 12 with a meningeal diverticulum, and in 2 patients positive for spinal longitudinal extradural CSF collection the site remained unclear. The leak was identified during the first and the second CDM in 43 and 17 patients, respectively. The use of CDM correctly identified the site of the CSF leak in all but one patient undergoing surgical closure (45/46, 98%). The mean fluoroscopy time was 7.8 min (range 1.8–14.4 min) with a radiation dose for a single examination of 310 mGy (range 28–1237 mGy). Conclusion The CDM procedure has a high accuracy for spinal CSF leak localization including dural tears and spinal nerve diverticula. It is the technique with the highest temporal resolution, is robust to breathing artifacts, allows great flexibility regarding patient positioning, compares favorably to other dynamic examinations with respect to the radiation dose and does not require general anesthesia. For CSF venous fistulas, however, other dynamic examinations, such as digital subtraction myelography, seem more appropriate. Video online The online version of this article contains 4 videos. The article and the videos are online available (10.1007/s00062-020-00943-w). The videos can be found in the article back matter as “Electronic Supplementary Material”.

Published
2020

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