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5. 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

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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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6. 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

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

Author

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

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

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

Published
2017

8. Measurement and comparison of labyrinthine structures with the digital volume tomography: ancient Egyptian mummies’ versus today’s temporal bones

Author

Carsten V. Dalchow, Adrian Muenscher, C. Schmidt, U. Grzyska, Rainald Knecht, and J. Harbort

Subjects
Adult, Male, Computed tomography, Young Adult, Temporal bone, Image Processing, Computer-Assisted, Humans, Medicine, Digital volume tomography, medicine.diagnostic_test, business.industry, Temporal Bone, Mummies, Organ Size, General Medicine, Anatomy, Middle Aged, Surgical procedures, Semicircular Canals, Cochlea, Otorhinolaryngology, Case-Control Studies, Ear, Inner, Head and neck surgery, Female, Tomography, X-Ray Computed, business
Abstract

The objective of this study was to investigate whether the labyrinthine structures of ancient Egyptian mummies differ significantly from modern labyrinths. The new technique of digital volume tomography (DVT) was used to visualize the temporal bones. To obtain standardized images and measurements, precise instructions regarding volume rotation, slicing and measurements' positioning were determined. Twenty-five dimensions were obtained. The groups were compared statistically. No significant differences could be found except one cochlear diameter which proved to be significantly larger in the control group. DVT is applicable for imaging of temporal bones. Measurements might help to increase understanding of the temporal bone's structure, to aid the diagnostics of pathologies as well as to supplement the planning of surgical procedures.

Published
2012
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9. Imaging of ancient Egyptian mummies’ temporal bones with digital volume tomography

Author

Rainald Knecht, U. Grzyska, Adrian Muenscher, Carsten V. Dalchow, C. Schmidt, and J. Harbort

Subjects
Adult, Egypt, Ancient, Imaging, Three-Dimensional, Temporal bone, Image Processing, Computer-Assisted, otorhinolaryngologic diseases, medicine, Humans, Ear canal, Tomography, History, Ancient, Ear Ossicles, Semicircular canal, Ossicles, business.industry, Temporal Bone, Mummies, General Medicine, Anatomy, Semicircular Canals, Sagittal plane, medicine.anatomical_structure, Otorhinolaryngology, Coronal plane, Middle ear, Female, sense organs, Tomography, X-Ray Computed, business
Abstract

The radiographic imaging of ancient Egyptian mummies has always been of great interest. Computed tomography is the method of choice to demonstrate bony pathologies with high quality. As digital volume tomography (DVT) is an extension of panoramic tomography with a very high resolution, its qualities were evaluated by examination of temporal bones of Egyptian mummy skulls. Ten Egyptian mummy skulls from the Zoological Collection Marburg, estimated 1,700-5,000 years of age, from Abydos, Philae, Theben-West and Sakkarah, were examined by DVT (3D Accuitomo, Morita, Japan). Through a rotation 360° of the X-ray source around the region of interest, a cylinder of 3 × 4 cm was captured as a three-dimensional volume. The gained data were analyzed with the help of special software on a PC. The angles of the axial, coronal and sagittal sections were arbitrarily changed to represent single structures with high resolution of 0.125 mm to analyze specific anatomical structures. In all skulls, conditions of the temporal bone and its anatomical structures were evaluated and normal as well as pathological findings evaluated in detail. The analysis of special landmarks such as the ossicular chain, cochlea, external, and internal auditory canal, facial nerve canal, and semicircular canals showed an intact ossicular chain in six temporal bones, while only isolated and dislocated ossicles were found in eight temporal bones. Besides one dehiscence of the superior semicircular canal in one temporal bone which might have led to vertigo and deafness at lifetime, all other findings were normal. Fragments of foreign bodies additionally found in the labyrinth, external ear canal and intracranially were attributed to postmortem damage. Digital volume tomography extends the imaging possibilities of CT for paleoradiological evaluation of temporal bones. With its high resolution, geometric accuracy, reconstruction capabilities, rapidness, and comparably low costs, even small bony pathologies are precisely demonstrated in a limited area. Investigations of larger numbers of specimen might reveal further details of ancient history for further interdisciplinary investigation of anthropologists, Egyptiologists, otolaryngologists, and radiologists.

Published
2012
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10. Duplexsonographie von A.-carotis-externa-Ästen zum Nachweis duraler AV-Fisteln

Author

U. Grzyska, C. Arning, and L. Lachenmayer

Subjects
Duplex ultrasonography, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Fistula, External carotid artery, Ultrasound, medicine.disease, Duplex (building), medicine.artery, Angiography, Medicine, Radiology, Nuclear Medicine and imaging, Occipital artery, Radiology, Common carotid artery, business
Abstract

PURPOSE To evaluate duplex ultrasonography of external carotid artery branches for the non-invasive diagnosis of dural AV fistulae (DAVFs). MATERIALS AND METHODS A total of 126 patients suffering from pulsatile tinnitus underwent duplex ultrasonography of the cervicocephalic vasculature including external carotid artery branches. DAVFs were identified by increased flow velocity and reduced pulsatility. Patients with ultrasound findings of DAVFs were considered for selective angiography. RESULTS Of the 23 patients that fulfilled the ultrasound criteria of AV fistula, 5 did not undergo angiography and were excluded from the study. The ultrasound findings of AV fistula were confirmed in all remaining patients (17 DAVFs, 1 extracranial AV fistula). Duplex ultrasound detected a DAVF of the common carotid artery in 29 %, of the external carotid artery in 65 % and of the external carotid artery branches in 100 % of the cases. CONCLUSION Duplex ultrasonography of external carotid artery branches improves the non-invasive detection of DAVFs. For the evaluation of the venous drainage, however, selective angiography is necessary.

Published
2005
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11. Schwerhörigkeit mit Tinnitus

Author

U. Grzyska, R. Leuwer, and A. Münscher

Subjects
medicine.medical_specialty, Plastic surgery, Otorhinolaryngology, business.industry, Hearing loss, Head and neck surgery, Medicine, medicine.symptom, business, Tinnitus, Surgery
Published
2004
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12. Klinische Relevanz der kranialen Computertomographie unter Notdienstbedingungen

Author

G. Adam, C. Weber, E. Lehner, and U. Grzyska

Subjects
medicine.medical_specialty, Diagnostic methods, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Gold standard (test), medicine.disease, Petrosal bone, Skull fracture, Cranial ct, Angiography, medicine, In patient, Radiology, Nuclear Medicine and imaging, Clinical significance, Radiology, Medical diagnosis, business, Craniotomy
Abstract

PURPOSE To determine the diagnostic accuracy of cranial CT under emergency conditions. MATERIAL AND METHODS Four hundred cranial CT examinations (cerebrum, petrosal bone, fascial bone, sinuses, orbita) were evaluated retrospectively and correlated with the initial neurologic examination, the discharge and surgical diagnoses, and the results of other imaging modalities (conventional X-Ray, MRI, angiography). The average age was 49 (2 to 89) years, with 42 % male and 58 % female patients. The discharge diagnosis was defined as the gold standard, assuming that clinical examinations and laboratory and imaging studies were maximized to establish the diagnosis, together with any possible surgery. RESULTS Overall sensitivity, specificity and diagnostic accuracy was 85 %, 70 % and 82 % for cranial CT, 66 %, 45 % and 61 % for the initial neurologic examination, 79 % and 29 % for acute cerebral infarction, and 65% and 13% for intracranial bleeding. Correlation of the CT diagnoses to the discharge and surgical diagnoses was high (82 % and 80 %, respectively; p 0.05). Craniotomy was performed in 47 of 400 (12%) patients after cranial CT, within 12 hours in 29, in 12 to 24 hours in 8, and after 24 hours in 10 patients. The risk for intracranial bleeding in patients with a skull fracture was increased by a factor of 3.3. CONCLUSION The high diagnostic accuracy of cranial CT in establishing a precise, timely and reproducible diagnosis confirms the important role of CT as primary diagnostic method under emergency conditions.

Published
2003
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13. [Untitled]

Author

O. Heese, Katrin Lamszus, U. Grzyska, and Manfred Westphal

Subjects
Ependymoma, Pathology, medicine.medical_specialty, business.industry, medicine.disease, Fourth ventricle, Cerebellopontine angle, Choroid plexus papilloma, Rhomboid fossa, Conus medullaris, medicine.anatomical_structure, medicine, Papilloma, Surgery, Choroid plexus, Neurology (clinical), business
Abstract

The case of a 38-year old man with a histologically benign choroid plexus papilloma arising within the fourth ventricle with en plaque growth around the brain stem and medulla is described in detail. Up to this point this particular growth pattern has not been published and is a rare presentation for this tumour. The patient presented with a 1.5 year history of headache, nausea, and vomiting in the morning. Additional symptoms like blurred vision and gait ataxia lead to hospital admission. MRI demonstrated a homogeneously contrast-enhancing tumour completely filling the fourth ventricle and subsequent obstructive hydrocephalus. In addition Gd enhancement encasing the brain stem, the lower aspect of the medulla and the conus medullaris was seen suggesting a disseminated ependymoma or medulloblastoma. An extensive resection of the tumour in the fourth ventricle and CP angle was performed. Infiltrative growth into the structures of the left CP angle and into the rhomboid fossa hampered complete removal. Surprisingly histological examination revealed a well-differentiated papillary choroid plexus papilloma without signs of anaplasia. On follow up imaging the Gd enhancement encasing the pons vanished completely. A growing cyst adjacent to a small tumour residuum left behind on the floor of the fourth ventricle led to re-operation after 8 months with complete removal. This case presents several biological, neuroradiological and surgical aspects which make it noteworthy and we hope that the informations provided add to the understanding of these tumours, expand the differential diagnostic thinking of lesions which present with diffuse arachnoid Gd enhancement upon first presentation.

Published
2002
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14. Erratum to 'Choices of Stent and Cerebral Protection in the Ongoing ACST-2 Trial: A Descriptive Study' [Eur J Vasc Endovasc Surg 53 (2017) 617–625]

Author

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

Subjects
medicine.medical_specialty, Surgery, Cardiology and Cardiovascular Medicine, business.industry, Published Erratum, medicine.medical_treatment, Physical therapy, medicine, MEDLINE, Stent, Descriptive research, business
Published
2017
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16. Laterale kraniale Durafistel

Author

U. Grzyska, L. Lachenmayer, and C. Arning

Subjects
medicine.medical_specialty, business.industry, Fistula, medicine.medical_treatment, Vertebral artery, Dura mater, Ultrasound, External carotid artery, Arteriovenous fistula, General Medicine, medicine.disease, Psychiatry and Mental health, medicine.anatomical_structure, Neurology, medicine.artery, cardiovascular system, medicine, Neurology (clinical), Radiology, Occipital artery, Embolization, business
Abstract

Cranial dural fistulae are rare; when they occur, it is usually difficult to detect them at an early stage. With a view to the question of possible progress in diagnosis we now report on seven patients with lateral dural fistulae fed by branches of the external carotid artery. The examination was carried out before selective arteriography using cw-Doppler sonography and colour coded duplex sonography in combination. Sonographic criteria for detection of hyperperfusion take account of flow velocity as well as pulsatility. In all cases hyperperfusion of the external carotid artery was detected. In most of these cases pathologic findings were also observed at the occipital artery, and more rarely in the contralateral external carotid artery or the ipsilateral vertebral artery, in addition. A possible source of error arising from confusion of blood vessels was present with the cw-Doppler sonography, but not for colour coded duplex sonography. Therefore, cranial dural fistulae characterized by a high shunt volume can be diagnosed correctly by indirect Doppler sonographic criteria using cw-Doppler and duplex sonography. Direct visualization of the fistula and its nidus requires additional selective arteriography, in the course of which endovascular embolization may be performed.

Published
1997
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18. How to deal with incompletely treated AVMs: experience of 67 cases and review of the literature

Author

M, Reitz, N O, Schmidt, Z, Vukovic, U, Grzyska, H, Zeumer, M, Westphal, and J, Regelsberger

Subjects
Adult, Male, Adolescent, Neurosurgery, Angiography, Digital Subtraction, Middle Aged, Embolization, Therapeutic, Magnetic Resonance Imaging, Arteriovenous Malformations, Young Adult, Treatment Outcome, Humans, Female, Child, Retrospective Studies
Abstract

Despite the availability of multimodal treatment options, some arteriovenous malformations remain difficult to treat, either for intrinsic reasons at initial presentation or for reasons evolving during the course of treatment. Frequently, such cases can be easily resolved with further therapy, but some become a continuously growing treatment dilemma while exhausting dwindling therapeutic options.A retrospective analysis was performed to identify patients with cerebral AVM who were treated unsuccessfully. Treatment was termed "not successful" if (1) postoperative angiography showed a residual AVM or missing flow reduction after palliative embolization, (2) therapy was associated with a substantial deterioration of existing neurological deficits or death, or (3) rebleeding from residual AVM occurred after therapy. Special interest was focused on the angiographic appearance of residual AVMs, their characteristic features, and their follow-up regarding second and third therapies.According to these criteria we identified 46 internal patients from our own series of 474 patients and 21 external patients who were referred from other institutions or sought a second opinion after incomplete treatment elsewhere. Out of those 67 cases, 50 patients (74.6%) were diagnosed with a residual AVM. Eleven patients (16.4%) experienced a deterioration of their clinical condition under therapy. Six patients did not show a flow reduction after palliative embolization. Twenty-five of the 67 patients were readmitted because of an ICH, either originating from an AVM residual or under palliative embolization. Thus, an increased risk of re-hemorrhage was found for palliative embolization (n = 16) in partially treated lesions (n = 10) and in patients with AVM grade IV and V located in eloquent regions (n = 22). In dealing with residual AVMs, microsurgical resection alone or in combination was found to be the most efficient therapeutic option, being successful in 58.9% of cases.An estimated 10% of AVM treatments may fail because of inadequate selection of either patients or management. Besides, for thorough decision-making, angiographic follow-up in all AVM patients is mandatory to allow an early identification of patients with an incompletely treated AVM requiring a second attempt. Major attention should be focused especially on high-risk subgroups with complex AVMs, partially treated AVMs, or those treated by only a palliative regimen.

Published
2011

19. [Certified quality management according to DIN ISO 9001 in a radiology department at a university hospital: measurable changes in academic quality indicators?]

Author

J, Lorenzen, C, Habermann, C, Utler, U, Grzyska, C, Weber, G, Adam, and A, Koops

Subjects
Publishing, Certification, Radiology Department, Hospital, Waiting Lists, Health Plan Implementation, Guidelines as Topic, Reference Standards, Hospitals, University, Education, Medical, Graduate, Germany, Surveys and Questionnaires, Humans, Education, Medical, Continuing, Radiology, Referral and Consultation, Quality Indicators, Health Care, Total Quality Management
Abstract

To evaluate the changes in academic quality indicators after implementation of a quality management system according to DIN ISO 9001:2000.After implementation and certification of a quality management system, the actual state based on quality indicators from the fields of student teaching, research, continuing education and the satisfaction of referring physician was determined. After implementation of an action plan for the individual areas, the temporal changes in the ratios were documented in the follow-up.The evaluation of teaching performance obtained by questionnaire among the students of the radiology course showed a steady increase in satisfaction (mean value 2003: 2.7; 2007: 3.9). In the field of research an increase in scientific output was achieved based on the number of an internal publication score (2002: 99 points; 2006: 509). Repeated opinion surveys among our referring physicians found improvements in indicators for the appointment of investigations, consulting service and waiting times for the investigation, while the waiting times for internal transport service did not improve. Exemplary measurements of the success of the advanced training of the staff demonstrated the need for continuing education for quality improvement.The evaluation of quality indicators showed over time a measurable positive impact on processes of a radiological University Hospital after implementation of a QM system according to DIN ISO 9001:2000.

Published
2009

20. [Long-term outcome after endovascular treatment of high-risk patients with recurrently symptomatic intracranial stenoses of the posterior circulation]

Author

O, Wittkugel, M, Rosenkranz, D, Burckhardt, W D, Niessen, T, Espersen, H, Zeumer, J, Fiehler, and U, Grzyska

Subjects
Adult, Male, Posterior Cerebral Artery, Ultrasonography, Doppler, Transcranial, Anticoagulants, Middle Aged, Intracranial Arteriosclerosis, Brain Ischemia, Cerebral Angiography, Stroke, Survival Rate, Recurrence, Vertebrobasilar Insufficiency, Humans, Female, Stents, Ultrasonography, Doppler, Color, Tomography, X-Ray Computed, Angioplasty, Balloon, Magnetic Resonance Angiography, Platelet Aggregation Inhibitors, Aged, Follow-Up Studies
Abstract

We present long-term clinical and duplex data from high-risk patients with severe, recurrent symptomatic stenoses of the vertebrobasilar circulation. We hypothesized that despite the greater risk of periprocedural complications in this patient group, interventional treatment would reduce the risk of recurrent strokes relative to the expected natural risk. We also predicted that the long-term treatment outcome would be positively influenced by the use of stents and by the periprocedural technical success rate.An analysis of our patient data base yielded 45 cases of stenosis of the vertebrobasilar circulation treated endovascularly in 42 patients between 1998 and 2006. Clinical and vascular diagnostic tests, both periinterventionally and during follow-up, were performed independently by experienced neurologists.The technical success rate was 93%. Stents were used in 67% of the procedures. After 30 days, 24% of the patients showed post-procedural clinical deterioration. After an average period of 26.3 months, 17.8 % of the patients had deteriorated. 11.1% of the patients suffered severe permanent damage as a result of the procedure (mRs 3 - 6). Restenosis was found in 9.5% of the cases. There were no instances of a recurrent stroke during follow-up.For this population of high-risk patients with recurrently symptomatic intracranial stenoses of the vertebrobasilar axis, endovascular treatment reduced the risk of stroke and death relative to the expected natural risk. The use of stents had no significant effect on the long-term results.

Published
2009

21. Navigation-assisted resection of a primary extraocular melanoma of the orbit

Author

R E, Friedrich, U, Grzyska, H, Schäfer, and L, Li

Subjects
Adult, Male, Monitoring, Intraoperative, Humans, Orbital Neoplasms, Ophthalmologic Surgical Procedures, Immunohistochemistry, Magnetic Resonance Imaging, Melanoma
Abstract

A 22-year-old male presented with proptosis of the right eye and diplopia. On magnetic resonance images (MRI), a well-delineated orbital tumor medio-distal to the eye was detected, respecting the eye-ball and the orbital walls. The aim of navigation-assisted surgery was to excise the progressive tumor while maintaining vision. A modified latero-cranial orbitotomy was used to approach the tumor. Microscopic analysis of the resection specimen revealed a melanoma. The patient's postoperative course was uneventful. The diplopia improved rapidly. Two further eye-saving second-look revisions of the tumor site excluded further melanoma infiltrates and revealed melanophages in scar tissue. Intraoperative navigation was used during all procedures. The tumor showed some interesting features concerning its histopathological appearance and magnetic resonance imaging. Detailed histopathological investigations supported the decision for organ-saving surgery. Follow-up MRI and positron emission tomograms up to 14 months later showed neither local tumor recurrence nor distant spread.In the presented case with the incidental finding of orbital melanoma without invasion of the globe or orbital walls, navigation-assisted surgery supported the eye-saving operating procedures.

Published
2007

25. [Duplex ultrasound of external carotid artery branches for the detection of dural arteriovenous fistulae]

Author

C, Arning, U, Grzyska, and L, Lachenmayer

Subjects
Adult, Aged, 80 and over, Male, Ultrasonography, Doppler, Duplex, Carotid Artery, Common, Middle Aged, Diagnosis, Differential, Tinnitus, Arteriovenous Fistula, Carotid Artery, External, Humans, Female, Dura Mater, Aged
Abstract

To evaluate duplex ultrasonography of external carotid artery branches for the non-invasive diagnosis of dural AV fistulae (DAVFs).A total of 126 patients suffering from pulsatile tinnitus underwent duplex ultrasonography of the cervicocephalic vasculature including external carotid artery branches. DAVFs were identified by increased flow velocity and reduced pulsatility. Patients with ultrasound findings of DAVFs were considered for selective angiography.Of the 23 patients that fulfilled the ultrasound criteria of AV fistula, 5 did not undergo angiography and were excluded from the study. The ultrasound findings of AV fistula were confirmed in all remaining patients (17 DAVFs, 1 extracranial AV fistula). Duplex ultrasound detected a DAVF of the common carotid artery in 29 %, of the external carotid artery in 65 % and of the external carotid artery branches in 100 % of the cases.Duplex ultrasonography of external carotid artery branches improves the non-invasive detection of DAVFs. For the evaluation of the venous drainage, however, selective angiography is necessary.

Published
2005

26. [Deafness with tinnitus]

Author

A, Münscher, U, Grzyska, and R, Leuwer

Subjects
Diagnostic Imaging, Tinnitus, Otoscopes, Meningeal Neoplasms, Humans, Female, Cerebellopontine Angle, Deafness, Middle Aged, Meningioma, Ear Neoplasms
Published
2004

27. Vaskuläre Krankheiten und interventionelle Therapie

Author

U. Grzyska, H. Zeumer, and M. Schöning

Abstract

Nach neuropathologischer Einteilung werden folgende zerebrale Gefasmalformationen unterschieden: 1. arteriovenose Malformationen (V.-Galeni-Malformation und V.-Galeni-Dilatation als Sonderformen), 2. kavernose Angiome oder Kavernome, 3. sog. venose Angiome und 4. kapillare Teleangiektasien.

Published
2003
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28. Diffuse arachnoidal enhancement of a well differentiated choroid plexus papilloma

Author

O, Heese, K, Lamszus, U, Grzyska, and M, Westphal

Subjects
Adult, Diagnosis, Differential, Male, Reoperation, Fourth Ventricle, Neoplasm, Residual, Choroid Plexus, Humans, Neoplasm Invasiveness, Papilloma, Choroid Plexus, Arachnoid, Image Enhancement, Magnetic Resonance Imaging
Abstract

The case of a 38-year old man with a histologically benign choroid plexus papilloma arising within the fourth ventricle with en plaque growth around the brain stem and medulla is described in detail. Up to this point this particular growth pattern has not been published and is a rare presentation for this tumour.The patient presented with a 1.5 year history of headache, nausea, and vomiting in the morning. Additional symptoms like blurred vision and gait ataxia lead to hospital admission. MRI demonstrated a homogeneously contrast-enhancing tumour completely filling the fourth ventricle and subsequent obstructive hydrocephalus. In addition Gd enhancement encasing the brain stem, the lower aspect of the medulla and the conus medullaris was seen suggesting a disseminated ependymoma or medulloblastoma.An extensive resection of the tumour in the fourth ventricle and CP angle was performed. Infiltrative growth into the structures of the left CP angle and into the rhomboid fossa hampered complete removal. Surprisingly histological examination revealed a well-differentiated papillary choroid plexus papilloma without signs of anaplasia. On follow up imaging the Gd enhancement encasing the pons vanished completely. A growing cyst adjacent to a small tumour residuum left behind on the floor of the fourth ventricle led to re-operation after 8 months with complete removal.This case presents several biological, neuroradiological and surgical aspects which make it noteworthy and we hope that the informations provided add to the understanding of these tumours, expand the differential diagnostic thinking of lesions which present with diffuse arachnoid Gd enhancement upon first presentation.

Published
2002

29. Krankheiten des Nervensystems

Author

F. J. Schulte, M. Blasius, A. Ritz, Th. Voit, F. Hanefeld, I. Krägeloh-Mann, U. Grzyska, M. Schöning, Th. Rosenbaum, H. Zeumer, D. Nadal, F. Vassella, Rudolf Korinthenberg, G. Neuhäuser, K. Müller, S. Ziegler, and H. Schneble

Abstract

Fehlbildungen (Misbildungen, Anomalien) sind pranatal durch Anlagefehler entstandene Formabweichungen von Organen oder Korperteilen bei sonst normalen Geweben. Als Dysplasien werden morphologische Anomalien bezeichnet, die durch fehlerhafte Organisation und/oder Funktion von Gewebe oder Gewebekomponenten zustande kommen Von primaren Fehlbildungen sind sekundare Formabweichungen zu unterscheiden: Disruptionen (Defekte eines ursprunglich sich normal entwickelnden Organs, Organ- oder Korperteils), Deformitaten (durch mechanische Einflusse hervorgerufene Form- oder Lageanomalien eines Organs, Organ- oder Korperteils), Degeneration oder Deterioration. Kombinierte Anomalien (multiple Defekte) treten auf, wenn ein Entwicklungsfeld betroffen ist (polytope Felddefekte) oder pathogenetische Sequenzen entstehen (z.B. Potter-Sequenz bei Oligohydramnion). Fehlbildungssyndrome sind Muster angeborener Anomalien, die in ihrer Pathogenese sicher oder vermutlich zusammenhangen und nicht auf einen einzelnen morphologischen Defekt zuruckgefuhrt werden konnen, auch nicht Teil eines embryonalen Entwicklungsfeldes sind. Sie konnen Ausdruck pleiotroper Wirkung von Genmutationen sein und durch Chromosomenanomalien oder Teratogene hervorgerufen werden. Man unterscheidet sie von Assoziationen, die durch eine Storung in der fruhen Blastogenese entstehen, sowie von einem zufalligen Zusammentreffen verschiedener Anomalien, die sich in ihrer Pathogenese (noch) nicht verbinden lassen (Syntropie).

Published
2001
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30. [Spontaneous vertebral arteriovenous fistula. Detection and treatment follow-up with color-coded duplex ultrasound]

Author

C, Arning, U, Grzyska, E, Hammer, and L, Lachenmayer

Subjects
Male, Treatment Outcome, Arteriovenous Fistula, Cervical Vertebrae, Vertebrobasilar Insufficiency, Humans, Ultrasonography, Doppler, Color, Embolization, Therapeutic, Vertebral Artery, Aged, Follow-Up Studies, Veins
Abstract

Spontaneous or traumatic arteriovenous fistulae between vertebral artery and the surrounding venous plexus may cause vertebrobasilar hypoperfusion by steal effects. We report on a 71-year-old man presenting with vertigo. Duplex sonography revealed a vertebral arteriovenous fistula at the C4/5 level with the typical perivascular color Doppler artifact and hyperperfusion in the supplying arteries and draining veins. Angiography confirmed the findings; the consequently performed endovascular embolization using platin coils and silicon balloon removed the symptoms immediately. Ultrasonographic follow-up examinations within 5 months demonstrated the success of therapy showing only low-flow fistula yet. This case demonstrates that early detection of a vertebral arteriovenous fistula by duplex sonography is highly beneficial because efficient treatment modalities are available.

Published
1999

31. [Lateral cranial dural fistula. Detection with Doppler and duplex ultrasound]

Author

C, Arning, U, Grzyska, and L, Lachenmayer

Subjects
Adult, Aged, 80 and over, Carotid Artery Diseases, Ultrasonography, Doppler, Transcranial, Cranial Sinuses, Middle Aged, Embolization, Therapeutic, Diagnosis, Differential, Pulsatile Flow, Arteriovenous Fistula, Carotid Artery, External, Humans, Female, Dura Mater, Ultrasonography, Doppler, Color, Blood Flow Velocity, Aged
Abstract

Cranial dural fistulae are rare; when they occur, it is usually difficult to detect them at an early stage. With a view to the question of possible progress in diagnosis we now report on seven patients with lateral dural fistulae fed by branches of the external carotid artery. The examination was carried out before selective arteriography using cw-Doppler sonography and colour coded duplex sonography in combination. Sonographic criteria for detection of hyperperfusion take account of flow velocity as well as pulsatility. In all cases hyperperfusion of the external carotid artery was detected. In most of these cases pathologic findings were also observed at the occipital artery, and more rarely in the contralateral external carotid artery or the ipsilateral vertebral artery, in addition. A possible source of error arising from confusion of blood vessels was present with the cw-Doppler sonography, but not for colour coded duplex sonography. Therefore, cranial dural fistulae characterized by a high shunt volume can be diagnosed correctly by indirect Doppler sonographic criteria using cw-Doppler and duplex sonography. Direct visualization of the fistula and its nidus requires additional selective arteriography, in the course of which endovascular embolization may be performed.

Published
1997

32. [Asymptomatic cerebral aneurysms--surgical and endovascular therapy options]

Author

F, Schröder, J, Regelsberger, M, Westphal, N, Freckmann, U, Grzyska, and H D, Herrmann

Subjects
Adult, Male, Microsurgery, Intracranial Aneurysm, Cerebral Infarction, Middle Aged, Embolization, Therapeutic, Cerebral Angiography, Survival Rate, Postoperative Complications, Treatment Outcome, Humans, Female, Tomography, X-Ray Computed, Aged, Follow-Up Studies
Abstract

Aneurysmal subarachnoid hemorrhage carries a risk of 50% mortality. Therefore it is recommended to also treat asymptomatic, previously unruptured aneurysms. Deciding whether to treat or to observe depends on the consideration of risk of hemorrhage and the surgical risk. Such decision could be facilitated if predisposing factors affecting the outcome were known. 15 Patients with 19 unruptured aneurysms managed in a period when both, surgical and endovascular treatment options were available, were selected from a group of 47 asymptomatic patients documented since 1984. The patients were either operated (n = 9) or were treated by endovascular occlusion with GDC coils (n = 6). In most cases, a long history of headaches eventually lead to a CT-scan or MRI in which a suspicious abnormality was found. Upon subsequent angiography, 8 middle cerebral, 6 carotid, 3 basilar and 1 pericallosal, and ophthalmic artery aneurysm(s), respectively, were found. The aneurysms varied from 4 to 30 mm in diameter. The patients were followed between 9 months and 2.5 years. Treatment results in this small series were independent from size, location, age or sex of the patient. The initial, mostly unrelated symptoms persisted after treatment in most cases. The morbidity according to GOS in this small series (3 out of 19 patients deteriorated) is not representative of the complete series where morbidity and mortality was 5.4% and 1.2% respectively). In agreement with the literature reviewed herein, we recommend surgical treatment of previously unruptured aneurysms, especially when the patients are below 60 years of age. In patients with posterior circulation aneurysms, endovascular coil occlusion is a valid alternative, especially in older patients with concurrent medical problems.

Published
1997

33. [Cranial dural arteriovenous fistulas--current status of therapy]

Author

E, Neumaier Probst, C, Koch, and U, Grzyska

Subjects
Microsurgery, Treatment Outcome, Arteriovenous Fistula, Humans, Dura Mater, Tomography, X-Ray Computed, Embolization, Therapeutic, Cerebral Angiography
Abstract

Spontaneous dural arteriovenous fistulas (DAVF) are abnormal arteriovenous shunts with a nidus within the dura mater. The exact etiology of the spontaneous DAVFs remains uncertain. Arterial inflow is from the meningeal branches in the region, which can be from an extracranial or an intracranial source. The venous drainage is through the dural sinuses, although cortical or deep venous drainage may be recruited. The critical symptoms are highly dependent on the venous drainage. Computed tomography and/or magnetic resonance imaging demonstrates the epiphenomena rather than the DAVF itself. Angiography is the most important modality in evaluating a DAVF. Based on the patterns of the venous drainage, a classification of the DAVF is possible. This classification enables decision-making about the appropriate therapy. Also the risk of each DAVF may be determined.

Published
1997

34. [Intraspinal metastasis of stage I anaplastic Wilms tumor]

Author

T, Wiegel, U, Grzyska, R, Schwarz, and G, Escherich

Subjects
Spinal Neoplasms, Time Factors, Humans, Female, Radiotherapy Dosage, Child, Magnetic Resonance Imaging, Nephrectomy, Spinal Cord Compression, Wilms Tumor, Kidney Neoplasms
Abstract

Intraspinal metastasis of Wilms' tumors is a rare event with only 6 cases documented in the literature.We report a case of an intraspinal metastasis by a young child with anaplastic Wilms' tumor (stage I). A 9-year-old girl developed 8 months following nephrectomy and pre-operative chemotherapy strong back pain. Within 2 weeks signs of beginning of spinal cord compression were obtained. The magnetic resonance imaging showed a spinal cord compression with an intraspinal tumor mass Th 8 to 10.The child underwent immediate spinal cord decompression followed by chemotherapy and an additional radiotherapy of the metastatic region up to 30 Gy with most of neurologic recovery within 6 weeks.The case illustrates the importance of rapidly responding neurologic complications in patients with Wilms' tumor, even in stage I.

Published
1995

35. [Traumatic dislocations of the cranial spine in childhood. Clinical description of 2 cases]

Author

M, Dallek, N M, Meenen, K H, Jungbluth, K H, Bentele, and U, Grzyska

Subjects
Male, Atlanto-Occipital Joint, Fatal Outcome, Atlanto-Axial Joint, Child, Preschool, Image Processing, Computer-Assisted, Joint Dislocations, Humans, Infant, Tomography, X-Ray Computed, Magnetic Resonance Imaging, Spinal Cord Injuries
Abstract

Case reports are presented on 2 children who had suffered traumatic luxations in the region of the cranial cervical spine. In both children, there was interruption of spinal cord continuity by severance with respiratory arrest and tetraplegia. As a rule, death occurs immediately at the site of accident. With a well-developed emergency ambulance system in conurbations, however, such cases may be admitted to hospital after resuscitation. After 16 hours, a child admitted to hospital died of a progressive bradycardia with subsequent asystole in respiratory paralysis. The second child survived for 10 months until it died of pneumonia.

Published
1995

36. Transient brainstem ischemia and recurrent syncope caused by a dural arteriovenous fistula

Author

G. Schwendemann, M. Ebke, Jürgen Kraus, U. Grzyska, M. Lanz, and U. Thiemann

Subjects
Ataxia, Ischemia, Arteriovenous fistula, Neurological disorder, Syncope, Central nervous system disease, Recurrence, Dural arteriovenous fistulas, Diplopia, medicine, Humans, Aged, Central Nervous System Vascular Malformations, Muscle Weakness, Vascular disease, business.industry, Dysarthria, medicine.disease, Embolization, Therapeutic, Magnetic Resonance Imaging, Cerebral Angiography, Ischemic Attack, Transient, Anesthesia, Female, Neurology (clinical), medicine.symptom, business, Brain Stem
Abstract

Dural arteriovenous fistulas (DAVFs) are direct artery-to-cerebral venous sinus shunts. Because of their relative rarity, diagnosis of DAVF is often delayed especially if symptoms are of infratentorial or spinal localization. Here we report a case of DAVF leading to transient brainstem ischemia and recurrent syncope. A 68-year-old right-handed white woman had recurrent, fully reversible episodes of diplopia and dysarthria for 1 year. These episodes were sometimes accompanied by transient acute weakness of her legs lasting up to 3 minutes and unrelated to posture or activity. She also had a history of recurrent syncope accompanied by a cessation of spontaneous breathing and palpable pulses resolving spontaneously within few seconds. There was a single episode of acute respiratory failure leading to resuscitation with no evidence of obstructive or infectious pulmonary disease or lung edema. Repeated cardiac workup did not reveal any disease. When admitted for acute dysarthria, the neurologic examination also disclosed a mild left hemiparesis, ataxia of her right upper extremity, increased reflexes …

Published
2003
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37. [Initial experiences with the use of gadolinium DTPA in infants and children under 2 years of age]

Author

R, Maas, U, Grzyska, N, Lausch, and E, Bücheler

Subjects
Central Nervous System Neoplasms, Gadolinium DTPA, Male, Organometallic Compounds, Contrast Media, Humans, Infant, Female, Pentetic Acid, Magnetic Resonance Imaging
Abstract

The use of Gadolinium-DTPA as a paramagnetic contrast agent in MRI with adults and juveniles concerning brain and spinal cord pathology is well proven since years. Tolerance and safety were excellent. In the FRG it is only introduced for children over two years of age. Therefore this report deals with the experience in four infants and small children under the age of two, who received gadolinium-DTPA for diagnostic purposes in pre- or post-operative circumstances. They all were suffering from neurological tumors and got additional diagnostic information in three cases. Clinical side-effects like urticaria, vomiting or convulsions had not been observed nor had pathologic changes of the biochemical parameters been noticed.

Published
1991

39. Selective cerebral intraarterial DSA. Complication rate and control of risk factors

Author

Hermann Zeumer, U Grzyska, and J Freitag

Subjects
Adult, medicine.medical_specialty, Neurology, Time Factors, Iohexol, Contrast Media, Risk Factors, Medicine, Fluoroscopy, Humans, Radiology, Nuclear Medicine and imaging, Risk factor, Neuroradiology, Aged, medicine.diagnostic_test, business.industry, Brain Neoplasms, Angiography, Digital Subtraction, Middle Aged, Cerebral Angiography, Cerebrovascular Disorders, Injections, Intra-Arterial, Anesthesia, Neurology (clinical), Neurosurgery, Clinical Competence, Cardiology and Cardiovascular Medicine, business, Complication, medicine.drug, Cerebral angiography
Abstract

In 1095 patients 2770 brain supplying arteries have been studied by i.a.-DSA. Definitive neurological deficits occurred in 0.09%, transient deficits were observed in 0.45%. The reduced complication rate in comparison to former studies seems to be a continued effect of technical progress (DSA) and the use of new isoosmotic contrast media. In order to reduce the "training hospital effect" as to complication rate careful supervision of trainees is necessary. The average fluoroscopy time per vessel is proposed as an objective measure of the investigational skill of a neuroradiologist.

Published
1990

40. Heating of Large Endovascular Stents and Stent Grafts in Magnetic Particle Imaging-Influence of Measurement Parameters and Isocenter Distance.

Author

Wegner F, von Gladiss A, Wei H, Behrends A, Grzyska U, Sieren MM, Haegele J, Graeser M, Buzug TM, Barkhausen J, and Friedrich T

Subjects
Humans, Magnetic Phenomena, Endovascular Aneurysm Repair, Heating, Stents, Tomography, Endovascular Procedures
Abstract

Purpose: Magnetic particle imaging (MPI) is a tomographic imaging modality with the potential for cardiovascular applications. In this context, the extent to which stents are heated should be estimated from safety perspective. Furthermore, the influence of the measurement parameters and stent distance to the isocenter of the MPI scanner on stent heating were evaluated., Materials and Methods: Nine different endovascular stents and stent grafts were tested in polyvinyl-chloride tubes. The stents had diameters from 10 to 31 mm, lengths between 25 and 100 mm and were made from stainless steel, nitinol or cobalt-chromium. The temperature differences were recorded with fiber-optic thermometers. All measurements were performed in a preclinical commercial MPI scanner. The measurement parameters were varied (drive field strengths: 3, 6, 9, 12 mT and selection field gradients: 0, 1.25 and 2.5 T/m). Furthermore, measurements with different distances to the scanner's isocenter were performed (100 to 0 mm)., Results: All stents showed heating (maximum 53.1 K, minimum 4.6 K). The stent diameter directly correlated with the temperature increase. The drive field strength influenced the heating of the stents, whereas the selection field gradient had no detectable impact. The heating of the stents decreased with increasing distance from the scanner's isocenter and thus correlated with the loss of the scanner's magnetic field., Conclusion: Stents can cause potentially harmful heating in MPI. In addition to the stent diameter and design, the drive field strength and the distance to the MPI scanner's isocenter must be kept in mind as influencing parameters., (© 2022. The Author(s).)

Published
2023
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41. Retrograde Revascularization of Tibial Arteries in Patients with Critical Limb Ischemia: Plantar-Arch Versus Transpedal Approach.

Author

Stahlberg E, Stroth A, Haenel A, Grzyska U, Wegner F, Sieren M, Horn M, Barkhausen J, and Goltz JP

Subjects
Chronic Limb-Threatening Ischemia, Humans, Ischemia diagnostic imaging, Ischemia therapy, Limb Salvage, Retrospective Studies, Treatment Outcome, Peripheral Arterial Disease diagnostic imaging, Peripheral Arterial Disease therapy, Tibial Arteries diagnostic imaging
Abstract

Purpose: To compare retrograde plantar-arch and transpedal-access approach for revascularization of below-the-knee (BTK) arteries in patients with critical limb ischemia (CLI) after a failed antegrade approach., Materials and Methods: Retrospectively we identified 811 patients who underwent BTK revascularization between 1/2014 and 1/2020. In 115/811 patients (14.2%), antegrade revascularization of at least 1 tibial artery had failed. In 67/115 (58.3%), patients retrograde access to the target vessel was achieved via the femoral access and the plantar-arch (PLANTAR-group); and in 48/115 patients (41.7%) retrograde revascularization was performed by an additional retrograde puncture (TRANSPEDAL-group). Comorbidities, presence of calcification at pedal-plantar-loop/transpedal-access-site, and tibial-target-lesion was recorded. Endpoints were technical success (PLANTAR-group: crossing the plantar-arch; TRANSPEDAL-group: intravascular placement of the pedal access sheath), procedural success [residual stenosis <30% after plain old balloon angioplasty (POBA)], and procedural complications limb salvage and survival. Correlations between calcification at access site/tibial-target-lesion and technical/procedural-success were tested., Results: Technical success was achieved in 50/67 (75%) patients of the PLANTAR-group and in 39/48 (81%) patients of the TRANSPEDAL-group (p=0.1). Procedural success was obtained in 23/67 (34%) patients of the PLANTAR-group and in 25/48 (52%) patients of the TRANSPEDAL-group (p=0.04). In 14/49 (29%) cases with calcification at the pedal-plantar loop, technical success was not achieved (p=0.04), and in 33/44 (75%) patients with calcification at the tibial-target-lesion, procedural success was not attained (PLANTAR-group) (p=0.026). In the TRANSPEDAL-group, correlations between calcification at access site/tibial-target-lesion and technical/procedural-success were not observed (p=0.2/p=0.4). In the PLANTAR-group, minor complications occurred in 13/67 (19%) and in the TRANSPEDAL-group in 4/48 patients (8%) (p=0.08). Limb salvage at 12 (18) months was 90% (82%) (PLANTAR-group; 95%CI 15.771-18.061) and 84% (76%) (TRANSPEDAL-group; 95%CI 14.475-17.823) (Log-rank p=0.46). Survival at 12 (18) months was 94% (86%) (PLANTAR-group; 95%CI 16.642-18.337) and 85% (77%) (TRANSPEDAL; 95%CI 14.296-17.621) (Log-rank p=0.098)., Conclusion: Procedural success was significantly higher using the transpedal-access approach. Calcifications at pedal-plantar loop and target-lesion significantly influenced technical/procedural failure using the plantar-arch approach. No significant difference between both retrograde techniques in terms of feasibility, safety, and limb salvage/survival was found.

Published
2022
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42. Serum Troponin T Concentrations Are Frequently Elevated in Advanced Skin Cancer Patients Prior to Immune Checkpoint Inhibitor Therapy: Experience From a Single Tertiary Referral Center.

Author

Kurzhals JK, Graf T, Boch K, Grzyska U, Frydrychowicz A, Zillikens D, Terheyden P, and Langan EA

Abstract

Immune checkpoint inhibitor (ICI) therapy has revolutionized the treatment of several human malignancies, particularly metastatic skin cancer. However, immune-related myocarditis (irM), an immune-mediated adverse event (irAE), is often fatal. In the absence of a reliable biomarker, measurement of pre-ICI therapy serum troponin concentration has been proposed to identify patients at risk of developing irM, although real-world studies examining this strategy are lacking. Thus, we retrospectively analyzed the case records of all patients who commenced ICI therapy between January 2018 and December 2019 in a single university skin cancer center ( n = 121) to (i) determine the incidence of irM, (ii) establish the frequency of pretreatment serum hsTnT elevations, and (iii) to establish whether this identified patients who subsequently developed irM. Only one patient developed irM, resulting in an overall incidence of 0.8%. Pretreatment hsTnT was measured in 47 patients and was elevated in 13 (28%). Elevated serum hsTnT concentrations were associated with chronic renal failure ( p = 0.02) and diabetes ( p < 0.0002). Pretreatment hsTnT was not elevated in the patient who developed fulminant irM. Pre-immunotherapy serum hsTnT concentrations were often asymptomatically elevated in patients with advanced skin cancer, none of whom subsequently developed irM during ICI therapy. However, large studies are required to assess the positive and negative predictive values of hsTnT for the development of irM. In the meantime, elevated hsTnT concentrations should be investigated before initiation of immunotherapy and closely monitored during early treatment cycles, where the risk of irM is greatest., Competing Interests: EL reports personal fees and non-financial support from Bristol Myers Squibb, personal fees and non-financial support from Novartis, Meeting and travel support from Curevac, and advisory board fees from Sun Pharma. PT speaker's honoraria from BMS, Novartis, MSD, Pierre-Fabre, CureVac, and Roche, consultant's honoraria from BMS, Novartis, Pierre-Fabre, Merck Serono, Sanofi, and Roche and travel support from BMS, Pierre-Fabre, and Roche. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Kurzhals, Graf, Boch, Grzyska, Frydrychowicz, Zillikens, Terheyden and Langan.)

Published
2021
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43. Heating of an Aortic Stent for Coarctation Treatment During Magnetic Particle Imaging and Magnetic Resonance Imaging-A Comparative In Vitro Study.

Author

Grzyska U, Friedrich T, Sieren MM, Stahlberg E, Oechtering TH, Ahlborg M, Buzug TM, Frydrychowicz A, Barkhausen J, Haegele J, and Wegner F

Subjects
Aortic Coarctation diagnosis, Humans, Treatment Outcome, Aortic Coarctation surgery, Blood Vessel Prosthesis Implantation methods, Heating methods, Magnetic Resonance Imaging methods, Phantoms, Imaging, Stents
Abstract

Purpose: To evaluate heating of a redilatable stent for the treatment of aortic coarctation in neonates and small children in the new imaging modality magnetic particle imaging and established magnetic resonance imaging., Materials and Methods: The cobalt-chromium stent (BabyStent, OSYPKA AG, Rheinfelden, Germany) has a stent design which allows for redilatation and adjustment of the diameter from 6 to 16 mm for a use in aortic coarctation. The stent loses its radial integrity while opening at predetermined breaking points at a diameter of 14 mm or 16 mm, respectively. We measured the temperature increase in the stent at different diameters during 7-min magnetic particle imaging and magnetic resonance imaging scans with fiber optic thermometers under static conditions surrounded by air. In magnetic particle imaging, stents with diameters from 6 to 16 mm were tested while in magnetic resonance imaging only stents with diameters of 6 mm and 14 mm were investigated exemplarily., Result: In magnetic particle imaging, the measured temperature differences increased up to 4.7 K with growing diameters, whereas the opened stents with discontinuous struts at 14 and 16 mm showed only minimal heating of max. 0.5 K. In contrast to magnetic particle imaging, our measurements showed no heating of the stents during magnetic resonance imaging under identical conditions., Conclusion: The BabyStent did show only slight heating in magnetic particle imaging and no detectable temperature increase in magnetic resonance imaging.

Published
2021
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44. Internal carotid artery false aneurysm as a fatal complication of transsphenoidal surgery.

Author

Sumislawski P, Ludwig C, Rotermund R, Grzyska U, and Flitsch J

Abstract

False aneurysm of internal carotid artery (ICA) is a rare but serious vascular complication observed after transsphenoidal pituitary surgery. Here, we present a 41-year-old woman with a pseudoaneurysm in the ophthalmic 1 segment of the left ICA after exoscopic transsphenoidal pituitary surgery. The initially uneventful procedure was complicated by a subarachnoidal hemorrhage 10 days after the surgery, which was confirmed by cranial computed tomography scan. The emergency angiography revealed a pseudoaneurysm of the ophthalmic 1 part of the left ICA. Despite repeated endovascular treatments with a flow diverter and coiling, the patient experienced a re-bleeding with consecutive vasospasms, occlusion hydrocephalus and finally bifrontal intracerebral hemorrhage with fatal outcome. As a conclusion in irregular post-operative courses with for example headache, a post-operative magnetic resonance imaging with vessel presentation using TOF sequence and contrast-enhanced MRA might be recommended in order to detect a possible pseudoaneurysm in an early stage., (Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2021.)

Published
2021
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45. Magnetic Particle Imaging: In vitro Signal Analysis and Lumen Quantification of 21 Endovascular Stents.

Author

Wegner F, von Gladiss A, Haegele J, Grzyska U, Sieren MM, Stahlberg E, Oechtering TH, Lüdtke-Buzug K, Barkhausen J, Buzug TM, and Friedrich T

Subjects
Artifacts, Humans, Magnetic Resonance Imaging, Phantoms, Imaging, Signal-To-Noise Ratio, Tomography, X-Ray Computed, Endovascular Procedures, Magnetic Phenomena, Signal Processing, Computer-Assisted, Stents
Abstract

Purpose: Endovascular stents are medical devices, which are implanted in stenosed blood vessels to ensure sufficient blood flow. Due to a high rate of in-stent re-stenoses, there is the need of a noninvasive imaging method for the early detection of stent occlusion. The evaluation of the stent lumen with computed tomography (CT) and magnetic resonance imaging (MRI) is limited by material-induced artifacts. The purpose of this work is to investigate the potential of the tracer-based modality magnetic particle imaging (MPI) for stent lumen visualization and quantification., Methods: In this in vitro study, 21 endovascular stents were investigated in a preclinical MPI scanner. Therefore, the stents were implanted in vessel phantoms. For the signal analysis, the phantoms were scanned without tracer material, and the signal-to-noise-ratio was analyzed. For the evaluation of potential artifacts and the lumen quantification, the phantoms were filled with diluted tracer agent. To calculate the stent lumen diameter a calibrated threshold value was applied., Results: We can show that it is possible to visualize the lumen of a variety of endovascular stents without material induced artifacts, as the stents do not generate sufficient signals in MPI. The stent lumen quantification showed a direct correlation between the calculated and nominal diameter (r = 0.98)., Conclusion: In contrast to MRI and CT, MPI is able to visualize and quantify stent lumina very accurately., Competing Interests: Dr Franz Wegner and Dr Thomas Friedrich report grants from German Federal Ministry of Education and Research, during the conduct of the study. The authors report no other conflicts of interest in this work., (© 2021 Wegner et al.)

Published
2021
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46. Major central nervous system complications after allogeneic stem cell transplantation: A large retrospective study on 888 consecutive adult patients.

Author

Mannina D, Berneking L, Both A, Timm W, Urbanowicz T, Wolschke C, Ayuketang Ayuk F, Fischer N, Fiehler J, Grzyska U, Rösner S, Choe CU, Kröger N, and Christopeit M

Subjects
Adult, Central Nervous System Diseases diagnosis, Disease Susceptibility, Female, Hematopoietic Stem Cell Transplantation methods, Hematopoietic Stem Cell Transplantation statistics & numerical data, Humans, Incidence, Male, Morbidity, Mortality, Prognosis, Recurrence, Retrospective Studies, Risk Factors, Transplantation, Homologous, Central Nervous System Diseases epidemiology, Central Nervous System Diseases etiology, Hematopoietic Stem Cell Transplantation adverse effects
Abstract

Objectives: Major complications affecting the central nervous system (CNS) present a challenge after allogeneic stem cell transplantation (allo-SCT)., Methods: Incidence, risk factors, and outcome were retrospectively analyzed in 888 patients in a monocentric study., Results: Cumulative incidence (CI) of major CNS complications at 1 year was 14.8% (95%CI 12.3%-17.2%). Median follow-up is 11 months. CNS complications were documented in 132 patients: in 36 cases, classified metabolic; 26, drug-related neurotoxicity (14 attributed to cyclosporine A, 4 to antilymphocyte globulin); 11, cerebrovascular (ischemic n = 8, bleeding n = 3); 9, infections; 9, psychiatric; and 9, malignant. The cause of CNS symptoms remained unclear for 37 patients (28%). Multivariate analysis demonstrated an association of CNS complication with patient age (P < .001). The estimated OS of patients with any CNS complication was significantly lower than in patients without neurological complications (P < .001), and the CI of non-relapse mortality (NRM) was higher for patients with CNS complication (P < .001). A significant negative impact on survival can only be demonstrated for metabolic CNS complications and CNS infections (NRM, P < .0001 and P = .0003, respectively), and relapse (P < .0001)., Conclusion: CNS complications after allo-SCT are frequent events with a major contribution to morbidity and mortality. In particular, the situations of unclear neurological complications need to be clarified by intensive research., (© 2020 The Authors. European Journal of Haematology published by John Wiley & Sons Ltd.)

Published
2020
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47. Symptomatic Intraosseous Vascular Malformation of Infraorbital Rim: A Case Report With Literature Survey.

Author

Friedrich RE, Grzyska U, Kohlrusch FK, VON Kroge S, Vollkommer T, and Luebke AM

Subjects
Female, Humans, Immunohistochemistry, Middle Aged, Orbital Neoplasms pathology, Orbital Neoplasms blood supply, Vascular Malformations etiology
Abstract

Background/aim: Intraosseous orbital hemangiomas or vascular malformations (VM) are rare. This report is intended to complement the experience of diagnosing and treating a rare vascular lesion at this site. Special attention is paid to three-dimensional imaging and the morphological distinction between the two entities in this location., Case Report: A 54-year-old female was examined and surgically treated for an exophytic firm mass of the infraorbital, which had become palpable as a hard mass due to growth in size. At first, a bone tumor, for example, an osteoma, was suspected. Intraoperatively, an osseous expansion with distinct fenestrations of the newly grown bone's surface, was detected. The lesion was firmly attaching to the orbital rim. The densely vascularized tumor was well defined to the soft tissues but had grown in continuity from the orbital floor and rim. Vascularized cavities caused the tumor to have a slightly reddish color. The histological examination confirmed the suspicion of the lesion's vascular origin. The lesion's immunohistochemical expression profile approved the final diagnosis of intraosseous VM., Conclusion: The symptoms of intraosseous vascular lesions of the orbit are determined by location and size. Modern imaging techniques facilitate the estimation of tumor-like expansion of lesions. However, the imaging characteristics of intraosseous vascular lesions are very variable. The symptoms of the patient presented herein show that growth phases of a vascular orbital malformation can occur in later stages of life and are initially indistinguishable from a neoplasm. In individual cases, patient care necessitates advanced diagnostic measures to establish the diagnosis and determine surgical therapy., (Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Published
2020
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48. Vestiges of Ossified Spheno-occipital Suture in an Elderly Patient With Down Syndrome and Lateral Skull Base Fracture.

Author

Friedrich RE, Kohlrusch FK, and Grzyska U

Subjects
Aged, Humans, Male, Tomography, X-Ray Computed, Down Syndrome complications, Osteogenesis, Skull Fracture, Basilar complications, Skull Fracture, Basilar diagnosis
Abstract

Background/aim: Down syndrome (DS) patients often show characteristic changes in the skull, e.g. short cranial base. The synchondroses of the skull base have a significant influence on the shape of the skull. The sphenooccipital synchondrosis (SOS) is the last of the basal synchondroses to ossify. This report is about residual ossification of SOS in an elderly patient with DS., Case Report: The 65-year-old DS patient was polytraumatized by a fall. In the course of treatment, a purulent otitis externa on the right side was diagnosed, which had developed as a result of the fracture of the fossa glenoidalis. Computed tomograms of the skull base showed the fracture of the mandibular condyle, glenoid fossa and vestiges of SOS., Conclusion: The coincidental finding of vestiges of SOS in an elderly patient with DS raises the question of whether cross-sectional skull base images can show differences in the ossification of SOS between DS patients and a normal population., (Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Published
2020
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49. Magnetic Particle Imaging: Artifact-Free Metallic Stent Lumen Imaging in a Phantom Study.

Author

Wegner F, Friedrich T, von Gladiss A, Grzyska U, Sieren MM, Lüdtke-Buzug K, Frydrychowicz A, Buzug TM, Barkhausen J, and Haegele J

Subjects
Magnetic Resonance Imaging methods, Tomography, X-Ray Computed methods, Artifacts, Image Processing, Computer-Assisted methods, Magnetite Nanoparticles, Phantoms, Imaging, Stents, Tomography methods
Abstract

Purpose: To illustrate the potential of magnetic particle imaging (MPI) for stent lumen imaging in comparison with clinical computed tomography (CT) and magnetic resonance imaging (MRI)., Materials and Methods: Imaging of eight tracer-filled, stented vessel phantoms and a tracer-filled, non-stented reference phantom for each diameter was performed on a preclinical MPI scanner: eight commercially available coronary stents of different dimensions (diameter: 3-4 mm; length: 11-38 mm) and materials (stainless steel, platinum-chromium) were implanted into silicone vessel phantoms. For comparison, all vessel phantoms were also visualized by MRI and CT. Two radiologists assessed the images regarding stent-induced artifacts using a 5-point grading scale., Results: The visualization of all stented vessel phantoms was achieved without stent-induced artifacts with MPI. In contrast, MRI and CT images revealed multiform stent-induced artifacts., Conclusion: Given its clinical introduction, MPI has the potential to overcome the disadvantages of MRI and CT concerning the visualization of the stent lumen.

Published
2020
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