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Effect of thrombectomy on oedema progression and clinical outcome in patients with a poor collateral profile

Stroke & Vascular Neurology 2021年第2期6卷 222-229页

作者： Gabriel Broocks Andre Kemmling Tobias Faizy Rosalie McDonough Noel Van Horn Matthias Bechstein Lukas Meyer Gerhard Schon Jawed Nawabi Jens Fiehler Helge Kniep Uta Hanning Department of Diagnostic and Interventional neuroradiology University Medical Center Hamburg-EppendorfHamburgGermany Institute of neuroradiology University Hospital of LuebeckLuebeckGermany neuroradiology WestpfalzklinikumKaiserslauternGermany Department of Diagnostic and Interventional neuroradiology Stanford UniversityStanfordCaliforniaUSA Department of Medical Biometry and Epidemiology University Medical Center Hamburg EppendorfHamburgGermany Department of Radiology CharitéUniversitätsmedizin BerlinBerlinGermany

Background and purpose The impact of the cerebral collateral circulation on lesion progression and clinical outcome in ischaemic stroke is well ***,collateral status modifies the effect of endovascular treatment and was therefore used to select patients for therapy in prior *** purpose of this study was to quantify the effect of vessel recanalisation on lesion pathophysiology and clinical outcome in patients with a poor collateral *** and methods 129 patients who had an ischaemic stroke with large vessel occlusion in the anterior circulation and a collateral score(CS)of 0-2 were *** profile was defined using an established 5-point scoring system in CT *** progression was determined using quantitative lesion water uptake measurements on admission and follow-up CT(FCT),and clinical outcome was assessed using modified Rankin Scale(mRS)scores after 90 *** Oedema formation in FCT was significantly lower in patients with vessel recanalisation compared with patients with persistent vessel occlusion(mean 19.5%,95%CI:17%to 22%vs mean 27%,95%CI:25%to 29%;p<0.0001).In a multivariable linear regression analysis,vessel recanalisation was significantly associated with oedema formation in FCT(ß=−7.31,SD=0.015,p<0.0001),adjusted for CS,age and Alberta Stroke Program Early CT Score(ASPECTS).Functional outcome was significantly better in patients following successful recanalisation(mRS at day 90:4.5,IQR:2-6 vs 5,IQR:5-6,p<0.001).Conclusion Although poor collaterals are known to be associated with poor outcome,endovascular recanalisation was still associated with significant oedema reduction and comparably better outcome in this patient *** with poor collaterals should not generally be excluded from thrombectomy.

关键词： collateral patients edema

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Treatment practice of vasospasm during endovascular thrombectomy: an international survey

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Stroke & Vascular Neurology 2024年第5期9卷 490-496页

作者： Jessica Jesser Thanh Nguyen Adam A Dmytriw Hiroshi Yamagami Zhongrong Miao Louisa Johanna Sommer Andrea Stockero Johannes Alex Rolf Pfaff Johanna Ospel Mayank Goyal Aman B Patel Vitor Mendes Pereira Uta Hanning Lukas Meyer Wim H van Zwam Martin Bendszus Martin Wiesmann Markus Möhlenbruch Charlotte Sabine Weyland neuroradiology University Hospital HeidelbergHeidelbergGermany Neurology Boston University School of MedicineBostonMassachusettsUSA St.Michael's Hospital Departments of Medical Imaging and NeurosurgeryNeurovascular CenterUniversity of TorontoTorontoOntarioCanada Neuroendovascular Program Harvard Medical SchoolMassachusetts General HospitalBostonMassachusettsUSA Stroke Neurology National Hospital Organization Osaka National HospitalOsakaJapan Department of Interventional neuroradiology Beijing Tiantan HospitalBeijingChina neuroradiology University Hospital AachenAachenGermany university insitute for neuroradiology at pmu Uniklinikum Salzburg—Christian-Doppler-KlinikSalzburgAustria Departments of Diagnostic Imaging and Clinical Neurosciences University of CalgaryCalgaryAlbertaCanada Neuroendovascular Program Massachusetts General HospitalBostonMassachusettsUSA Department of Neurosurgery Unity Health TorontoTorontoOntarioCanada Universitatsklinikum Hamburg Eppendorf Klinik und Poliklinik fur Neuroradiologische Diagnostik und Intervention HamburgGermany Diagnostic and Interventional neuroradiology Universitatsklinikum Hamburg Eppendorf Klinik und Poliklinik fur Neuroradiologische Diagnostik und InterventionHamburgGermany Radiology Maastricht University Medical CenterMaastrichtThe Netherlands

Background and aim The clinical importance and management of vasospasm as a complication during endovascular stroke treatment(EVT)has not been well *** sought to investigate current expert opinions in neurointervention and therapeutic strategies of iatrogenic vasospasm during *** We conducted an anonymous international online survey(4 April 2023 to 15 May 2023)addressing treatment standards of neurointerventionalists(NIs)practising *** illustrative cases of patients with vasospasm during EVT were *** study groups were compared according to the NI’s opinion regarding the potential influence of vasospasm on patient outcome after EVT using descriptive *** In total,534 NI from 56 countries responded,of whom 51.5%had performed>200 *** was considered a complication potentially influencing the patient’s outcome by 52.6%(group 1)whereas 47.4%did not(group 2).Physicians in group 1 more often added vasodilators to their catheter flushes during EVT routinely(43.7%vs 33.9%,p=0.033)and more often treated severe large-vessel vasospasm with vasodilators(75.3%vs 55.9%;p<0.001),as well as extracranial vasospasm(61.4%vs 36.5%,p<0.001)and intracranial medium-vessel vasospasm(27.1%vs 11.2%,p<0.001),compared with group *** case of a large-vessel vasospasm and residual and amenable medium-vessel occlusion during EVT,the study groups showed different treatment *** 2 continued the EVT immediately more often,without initiating therapy to treat the vasospasm first(9.6%vs 21.1%,p<0.001).Conclusion There is disagreement among NIs about the clinical relevance of vasospasm during EVT and its *** was a higher likelihood of use of preventive and active vasodilator treatment in the group that perceived vasospasm as a relevant complication as well as differing interventional strategies for continuing an EVT in the presence of a large-vessel vasospasm.

关键词： survey continued routine

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Differentiation of periapical granulomas and cysts by using dental MRI: a pilot study

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International Journal of Oral Science 2018年第3期10卷 152-159页

作者： Alexander Juerchott Thorsten Pfefferle Christa Flechtenmacher Johannes Mente Martin Bendszus Sabine Heiland Tim Hilgenfeld Department of neuroradiology Heidelberg University Hospital Division of Endodontics and Dental Traumatology Department of Conservative Dentistry Heidelberg University Hospital Institute of Pathology Heidelberg University Hospital Division of Experimental Radiology Department of Neuroradiology Heidelberg University Hospital

The purpose of this pilot study was to evaluate whether periapical granulomas can be differentiated from periapical cysts in vivo by using dental magnetic resonance imaging(MRI). Prior to apicoectomy, 11 patients with radiographically confirmed periapical lesions underwent dental MRI, including fat-saturated T2-weighted(T2 wFS) images, non-contrast-enhanced T1-weighted images with and without fat saturation(T1 w/T1 wFS), and contrast-enhanced fat-saturated T1-weighted(T1 wFS+C) images. Two independent observers performed structured image analysis of MRI datasets twice. A total of 15 diagnostic MRI criteria were evaluated, and histopathological results(6 granulomas and 5 cysts) were compared with MRI characteristics. Statistical analysis was performed using intraclass correlation coefficient(ICC), Cohen’s kappa(κ), Mann–Whitney U-test and Fisher’s exact test. Lesion identification and consecutive structured image analysis was possible on T2 wFS and T1 wFS+C MRI images. A high reproducibility was shown for MRI measurements of the maximum lesion diameter(intraobserver ICC = 0.996/0.998; interobserver ICC = 0.997), for the "peripheral rim" thickness(intraobserver ICC = 0.988/0.984; interobserver ICC = 0.970), and for all non-quantitative MRI criteria(intraobserver-κ = 0.990/0.995; interobserver-κ = 0.988). In accordance with histopathological results, six MRI criteria allowed for a clear differentiation between cysts and granulomas:(1) outer margin of lesion,(2) texture of "peripheral rim" in T1 wFS+C,(3)texture of "lesion center" in T2 wFS,(4) surrounding tissue involvement in T2 wFS,(5) surrounding tissue involvement in T1 wFS+C and(6) maximum "peripheral rim" thickness(all: P < 0.05). In conclusion, this pilot study indicates that radiation-free dental MRI enables a reliable differentiation between periapical cysts and granulomas in vivo. Thus, MRI may substantially improve treatment strategies and help to avoid unnecessary surgery in apical periodontitis.

关键词： Differentiation of periapical granulomas and cysts by using dental MRI a pilot study

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A comparison between acute large vessel occlusion in the posterior circulation and anterior circulation after endovascular treatment:the ANGEL-ACT registry experience

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Stroke & Vascular Neurology 2022年第4期7卷 285-293,I0001-I0004页

作者： Xuan Sun Jingyu Zhang Xu Tong Baixue Jia Dapeng Mo Ning Ma Feng Gao Lian Liu Xiaochuan Huo Ligang Song Yiming Deng Zhongrong Miao Interventional neuroradiology Center Beijing Tiantan HospitalCapital Medical UniversityBeijingChina

Background and purpose Endovascular treatment(EVT)has shown an overwhelming benefit for acute anterior circulation artery occlusion(ACO).Whether it can achieve the same outcomes in posterior circulation artery occlusion(PCO)has not been well *** aimed to evaluate the characteristics and prognosis of ACO and PCO after EVT in a nationwide *** The present analysis was based on the prospective ANGEL-ACT Registry in China between November 2017 and March *** data,periprocedural times,recanalisation rate,intracranial haemorrhage(ICH)and 90-day functional outcomes were compared between the ACO and PCO *** A total of 1793 patients were analysed including 397(22.1%)consecutive patients with PCO and 1396(77.9%)patients with ACO treated with EVT.A larger proportion of patients with PCO had intracranial atherosclerotic disease and received extra angioplasty during *** recanalisation and 90-day favourable functional outcomes did not differ significantly between the two *** with PCO showed lower 24-hour ICH and symptomatic ICH *** was a trend towards higher mortality rate in the PCO group(22.09%vs 14.44%;adjusted OR 1.286(95%CI 0.820 to 2.017),p=0.2731),especially when the onset to puncture time was over 6 hours(30.77%vs 11.13%;adjusted OR 2.673(95%CI 1.280 to 5.583),p=0.0089,interactive p=0.0002).Conclusions In this large prospective multicentre registry,there was a significant difference in the characteristics and periprocedural features between patients with PCO and ***,successful recanalisation and 90-day favourable functional outcomes in PCO were equivalent to those in ACO.

关键词： occlusion acute treatment

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Immunohistochemical study in dural arteriovenous fistula and possible role of ephrin-B2 for development of dural arteriovenous fistula

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Chinese Medical Journal 2004年第12期17卷 1815-1820页

作者：王宝隆卞留贯 Helmut Bertalanffy Siegfried Bien Ulrich Sure Department of Neurosurgery Philipps University Marburg 35033 Germany Department of neuroradiology Philipps University Marburg 35033 Germany

Background Although there were several clinical and experimental studies discussing the pathogenesis of dural arteriovenous fistula (DAVF), the pathological process leading to intracranial DAVF so far remains unknown In this study, we investigated the expression of vascular growth factors in order to elucidate the possible role of these factors for the development of DAVF and to study the biological activity of this uncommon lesion Methods We examined the histological features, proliferative and angiogenic capacities of the tissue specimens obtained from 6 patients who underwent surgery at our institution Immunohistochemical staining for vascular endothelial growth factor (VEGF), its receptors Flk 1 and Flt 1, ephrin B2, MIB 1 and proliferating cell nuclear antigen (PCNA) was performed using standard immunohistochemical techniques Results A positive immunostaining was found for all antibodies studied except MIB 1, whereas nuclear endothelial expression of PCNA was observed in only 3/6 cases VEGF stained positive in all of the available specimens (6/6) Flk 1 showed a positive immunoreaction in only 2/6 cases and Flt 1 in 4/6 cases Ephrin B2 was expressed in the majority (5/6) of the cases Conclusions These results support the hypothesis that DAVFs might be acquired dynamic vascular malformations with low biological activity Vascular growth factors like VEGF and ephrin B2 might play a pivotal role in the formation of DAVF

关键词： central nervous system vascular malformations · neovascularization pathologic · ephrin B2

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Haemorrhage after thrombectomy with adjuvant thrombolysis in unknown onset stroke depends on high early lesion water uptake

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Stroke & Vascular Neurology 2024年第4期9卷 390-398页

作者： Gabriel Broocks Lukas Meyer Uta Hanning Tobias Djamsched Faizy Matthias Bechstein Helge Kniep Noel Van Horn Gerhard Schön Ewgenia Barow Götz Thomalla Jens Fiehler Andre Kemmling Department of Diagnostic and Interventional neuroradiology University Medical Center Hamburg-EppendorfHamburgGermany Department of Medical Biometry and Epidemiology University Medical Center Hamburg EppendorfHamburgGermany Department of Neurology University Medical Center Hamburg-EppendorfHamburgGermany Department of neuroradiology University MarburgMarburgGermany

Background and purpose In wake-up stroke,CT-based quantitative net water uptake(NWU)might serve as an alternative tool to MRI to guide intravenous thrombolysis with alteplase(IVT).An important complication after IVT is symptomatic intracerebral haemorrhage(sICH).As NWU directly implies ischaemic lesion progression,reflecting blood-brain barrier injury,we hypothesised that NWU predicts sICH in patients who had a ischaemic stroke undergoing thrombectomy with unknown *** Consecutive analysis of all patients who had unknown onset anterior circulation ischaemic stroke who underwent CT at baseline and endovascular treatment between December 2016 and October *** NWU was assessed on baseline *** primary endpoint was *** association of NWU and other baseline parameters to sICH was investigated using inverse-probability weighting(IPW)*** A total of 88 patients were included,of which 46 patients(52.3%)received *** median NWU was 10.7%(IQR:5.1–17.7).The proportion of patients with any haemorrhage and sICH were 35.2%and 13.6%.NWU at baseline was significantly higher in patients with sICH(19.1%vs 9.6%,p<0.0001)and the median Alberta Stroke Program Early CT Score(ASPECTS)was lower(5 vs 8,p<0.0001).Following IPW,there was no association between IVT and sICH in unadjusted ***,after adjusting for ASPECTS and NWU,there was a significant association between IVT administration and sICH(14.6%,95%CI:3.3%to 25.6%,p<0.01).Conclusion In patients with ischaemic stroke with unknown onset,the combination of high NWU with IVT is directly linked to higher rates of *** ASPECTS for evaluating the extent of the early infarct lesion,quantitative NWU could be used as an imaging biomarker to assess the degree of blood-brain barrier damage in order to predict the risk of sICH in patients with wake up stroke.

关键词： throm thrombolysis high

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Perihematomal Perfusion Typing and Spot Sign of Acute Intracerebral Hemorrhage with Multimode Computed Tomography: A Preliminary Study

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Chinese Medical Sciences Journal 2014年第3期29卷 139-143页

作者： Xin-yi Hou Pei-yi Gao Department of neuroradiology Beijing Tiantan Hospital Capital Medical University

Objective To explore the perihematomal perfusion typing and spot sign on computed tomography angiography(CTA) source images in order to assist in individualizing therapeutic decisions for patients with intracerebral hemorrhage by possibly forecasting perihematomal ischemia and hematoma enlargement. Methods We examined 58 patients with spontaneous intracerebral hemorrhage by computed tomography perfusion and CTA within 6 hours after symptom onset. Hematoma volumes were determined from non-contrast CT images and compared between first and second CT images. The perfusion of hematoma region and perihematoma region was evaluated for presence or absence of the perihematomal penumbra. Three kinds of perihematoma perfusion typing were defined according to the perfusion of hematoma region and perihematoma region. CTA source images was reviewed to make sure presence or absence of the spot sign. Results Finally, 53 patients(34 males, 19 females) were enrolled in our study according to exclusion criteria. Finally, 21 patients were classified into the normal group, 23 patients were classified into the mild group, and 9 patients were classified into the severe group. There were significant differences in hematoma size between the presence and absence of the perihematomal penumbra group(P<0.05). Thirteen(24.5%) patients presented with spot sign. Hematoma expansion occurred in 15(28.3%) patients on follow-up. In which 12 patients were with spot sign. Sensitivity, specificity, positive predictive value, and negative predictive value for expansion were 80.0%, 97.4%, 92.3%, and 92.5%, respectively. Conclusion In acute intracerebral hemorrhage patients, the perihematoma perfusion typing and CTA spot sign provide more radiological information that might assist in individualizing therapeutic decisions for patients by possibly forecasting perihematomal ischemia and hematoma enlargement.

关键词： intracerebral hemorrhage computed tomography perfusion computed tomography angiography

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Intracochlear schwannoma: Imaging diagnosis

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Journal of Otology 2023年第2期18卷 101-103页

作者： Safaa Choayb Yahya El Harras Meriem Fikri Najoua Ech-Cherif El Kettani Mohamed Jiddane Firdaous Touarsa neuroradiology Department Ibn Sina University Hospital CenterRabatMorocco

Intralabyrinthine schwannomas(ILS)are rare benign tumors,often responsible for hearing *** is important in establishing the *** present the example of a 48-year-old lady who reported a 3-years history of right-sided sensorineural *** demonstrated a loss of the normal hypersignal of the second turn of the right cochlea compatible with intracochlear schwannoma.

关键词： Intracochlear schwannoma Intralabyrinthine schwannoma Sensorineural hearing loss

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A novel arterial pouch model of saccular aneurysm by concomitant elastase and collagenase digestion

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Journal of Zhejiang university-Science B(Biomedicine & Biotechnology) 2007年第10期8卷 697-703页

作者： YANG Xin-jian, LI Li, WU Zhong-xue (Department of Interventional neuroradiology, Beijing Neurosurgical Institute, Capital Medical university, Beijing 100050, China) Department of Interventional neuroradiology Beijing Neurosurgical Institute Capital Medical University Beijing 100050 China

Background: An ideal aneurysm model of cerebral aneurysm is of great importance for studying the pathogenesis of the lesion and testing new techniques for diagnosis and treatment. Several models have been created in rabbits and are now widely used in experimental studies; however, every model has certain intrinsic limitations. Here we report the development of a novel saccular aneurysm model in rabbits using an arterial pouch that is subject to in vitro pre-digestion with combined elastase and collagenase. Methods: A segment of right common carotid artery (CCA) was dissected out and treated with elastase (60 U/ml, 20 min) followed by type I collagenase (1 mg/ml, 15 min) in vitro. The graft was anastomosed to an arterial arch built with the left CCA and the remaining right CCA, while the other end of the graft was ligated. The dimension and tissue structure of the pouch were analysed immediately, 2 or 8 weeks after operation. Findings: Ten terminal aneurysms were produced. The gross mor-phology of the aneurysm resembles the human cerebral terminal aneurysms. We have observed the following pathological changes: (1) growth of the aneurysm (mean diameter increased from (2.0±0.1) to (3.2±0.3) mm at 2 weeks, P<0.001, n=7~10); (2) thinning of the aneurysmal wall (the mean wall thickness decreased to 44% at 2 weeks), which was accompanied by significant losses of elastic fibres, collagen and the cellular component; and (3) spontaneous rupture (3 out of 9, one aneurysm ruptured 24 h after operation with the other two at 2 and 4 weeks respectively). Conclusion: This rabbit arterial pouch model mimics human cerebral aneurysms in relation to morphology and histology. In particular, this model exhibited an increased tendency of spontaneous rupture.

关键词： Animal model Collagenase Elastase Intracranial aneurysm

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A rare neurological manifestation of a malnourished alcohol-dependent acute pancreatitis patient with Marchiafava-Bignami disease

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Gastroenterology Report 2021年第2期9卷 179-181,I0003页

作者： Maciej Szmygin Joanna Bielewicz Krzysztof Pyra Anna Szczepanska-Szerej Konrad Rejdak Department of Interventional Radiology and neuroradiology Medical University of LublinLublinPoland Department of Neurology Medical University of LublinLublinPoland

Introduction Marchiafava-Bignami disease(MBD)is a rare demyelinating disorder,usually associated with heavy chronic alcohol *** may occasionally occur in patients who are not alcoholics but are chronically malnourished and patients with severe nutritional deficiencies[1].White-matter degeneration affects the corpus callosum and results in neurocognitive impairment and dysfunction of the corticobulbar and pyramidal tracts[2].

关键词： degeneration alcohol rare

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