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  • 1
    Online Resource
    Online Resource
    Contrast-Enhanced Ultrasonic Parametric Perfusion Imaging Detects Dysfunctional Tissue at Risk in Acute MCA Stroke
    SAGE Publications ; 2006
    In:  Journal of Cerebral Blood Flow & Metabolism Vol. 26, No. 4 ( 2006-04), p. 576-582
    Details
    In: Journal of Cerebral Blood Flow & Metabolism, SAGE Publications, Vol. 26, No. 4 ( 2006-04), p. 576-582
    Abstract: Ultrasonic perfusion imaging predicts size and localization of acute stroke. It is unclear whether irreversibly damaged tissue can be differentiated from tissue at risk. Thirty-four patients (ischemic stroke 〈 12 h) were included (Phase Inversion Harmonic Perfusion Imaging; bolus kinetic; fitted model function). Three patterns of perfusion were defined in 14 prespecified regions of interest (ROI): ‘normal', ‘hypoperfusion', and ‘no perfusion'. Clinical status was assessed using the National Institutes of Health Stroke Scale (NIHSS) (at baseline and at days 2 to 4). Cranial Computed Tomography (CCT) (days 2 to 4) displayed final infarction. The pattern ‘hypoperfusion’ (ROIs presumably representing tissue at risk) was tested twofold: (i) Functional impairment by correlating their number with baseline NIHSS. (ii) Viability by correlating their recruitment rate to infarction with clinical course (ΔNIHSS days 2 to 4). In addition, various predictive values were assessed. Twenty-seven patients were eligible for analysis. The sum of ROIs with ‘no perfusion’ and ‘hypoperfusion’ correlated highest with baseline NIHSS ( ρ = 0.78, P 〈 0.001). Recruitment of hypoperfused ROIs to infarction highly correlated with clinical course ( ρ = 0.79, P 〈 0.001). Clinical course dichotomized the patients into subgroups A ('stable', ΔNIHSS ≥ −3) and B ('improved', ΔNIHSS ≤ −4). In A, sensitivity and specificity for hypo- and nonperfused tissue being eventually infarcted were 96% and 88% positive predictive value, PPV 89%, negative predictive value, NPV 96%). In B, sensitivity and specificity for nonperfused tissue eventually being infarcted were 81% and 99% (PPV 99%, NPV 84%). Different perfusion patterns (hypoperfusion, no perfusion) and dysfunctional but viable tissue at risk can be reliably detected by ultrasonic perfusion imaging. This method may give Supplementary information in cases illegible for perfusion-weighted magnetic resonance imaging (PW-MRI).
    Type of Medium: Online Resource
    ISSN: 0271-678X , 1559-7016
    URL: Article
    DOI: 10.1038/sj.jcbfm.9600216
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2006
    detail.hit.zdb_id: 2039456-1
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  • 2
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    Online Resource
    Outcome After Thrombectomy and Intravenous Thrombolysis in Patients With Acute Ischemic Stroke : A Prospective Observational Study
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. 6 ( 2016-06), p. 1584-1592
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 6 ( 2016-06), p. 1584-1592
    Abstract: In patients with ischemic stroke, randomized trials showed a better functional outcome after endovascular therapy with new-generation thrombectomy devices compared with medical treatment, including intravenous thrombolysis. However, effects on mortality and the generalizability of results to routine clinical practice are uncertain. Methods— In a prospective observational register-based study patients with ischemic stroke treated either with thrombectomy, intravenous thrombolysis, or their combination were included. Primary outcome was the modified Rankin scale score (0 [no symptoms] to 6 [death] ) at 3 months. Ordinal logistic regression was used to estimate the common odds ratio as treatment effects (shift analysis). Propensity score matching was applied to compare patients treated either with intravenous thrombolysis alone or with intravenous thrombolysis plus thrombectomy. Results— Among 2650 recruited patients, 1543 received intravenous thrombolysis, 504 underwent thrombectomy, and 603 received intravenous thrombolysis in combination with thrombectomy. Later time-to-treatment was associated with worse outcomes among patients treated with thrombectomy plus thrombolysis. In 241 pairs of propensity score–matched patients with a proximal intracranial occlusion, thrombectomy plus thrombolysis was associated with improved functional outcome (common odds ratio, 1.84; 95% confidence interval, 1.32–2.57), and reduced mortality (15% versus 33%; P 〈 0.0001) compared with intravenous thrombolysis alone. Results were similar in various sensitivity analyses accounting for missing outcome data and different analytic methods. Conclusions— Results from this large prospective registry show that also in routine clinical care thrombectomy plus thrombolysis compared with thrombolysis alone improved functional outcome and reduced mortality in patients with ischemic stroke. Earlier treatment was associated with better outcomes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.116.012619
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Online Resource
    When Can an Emergency CTA Be Dispensed with for TIA Patients?
    MDPI AG ; 2022
    In:  Journal of Clinical Medicine Vol. 11, No. 19 ( 2022-09-26), p. 5686-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 11, No. 19 ( 2022-09-26), p. 5686-
    Abstract: Background: Transient ischemic attacks (TIAs) and minor strokes are often precursors of a major stroke. Therefore, diagnostic work-up of the TIA is essential to reduce the patient’s risk of further ischemic events. Purpose: With the help of this retrospective study, we aim to determine for which TIA patients a CT angiography (CTA) is not immediately necessary in order to reduce radiation exposure and nephrotoxicity. Material and Methods: Clinical and imaging data from patients who presented as an emergency case with a suspected diagnosis of TIA at a teaching hospital between January 2016 and December 2021 were evaluated. The included 1526 patients were divided into two groups—group 1, with major pathologic vascular findings in the CTA, and group 2, with minor vascular pathologies. Results: Out of 1821 patients with suspected TIA on admission, 1526 met the inclusion criteria. In total, 336 (22%) had major vascular pathologies on CTA, and 1190 (78%) were unremarkable. The majority of patients with major vascular pathologies were male and had a history of arterial hypertension, coronary heart disease, myocardial infarction, ischemic stroke, TIA, atherosclerotic peripheral vascular disease, smoking, antiplatelet medication, had a lower duration of TIA symptoms, and had lower ABCD2 scores. Conclusions: We were able to demonstrate a direct correlation between major CTA pathologies and a history of smoking, age, hyperlipidemia, history of peripheral arterial disease, and a history of stroke and TIA. We were able to prove that the ABCD2 score is even reciprocal to CTA pathology. This means that TIA patients without described risk factors do not immediately require a CTA and could be clarified in the course of treatment with ultrasound or MRI.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm11195686
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662592-1
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  • 4
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    Online Resource
    CT and DSA for evaluation of spontaneous intracerebral lobar bleedings
    Frontiers Media SA ; 2022
    In:  Frontiers in Neurology Vol. 13 ( 2022-10-3)
    Details
    In: Frontiers in Neurology, Frontiers Media SA, Vol. 13 ( 2022-10-3)
    Abstract: This study retrospectively examined the extent to which computed tomography angiography (CTA) and digital subtraction angiography (DSA) can help identify the cause of lobar intracerebral bleeding. Materials and methods In the period from 2002 to 2020, data from patients who were & gt;18 years at a university and an academic teaching hospital with lobar intracerebral bleeding were evaluated retrospectively. The CTA DSA data were reviewed separately by two neuroradiologists, and differences in opinion were resolved by consensus after discussion. A positive finding was defined as an underlying vascular etiology of lobar bleeding. Results The data of 412 patients were retrospectively investigated. DSA detected a macrovascular cause of bleeding in 125/412 patients (33%). In total, sixty patients had AVMs (15%), 30 patients with aneurysms (7%), 12 patients with vasculitis (3%), and 23 patients with dural fistulas (6%). The sensitivity, specificity, positive and negative predictive values, and accuracy of CTA compared with DSA were 93, 97, 100, and 97%. There were false-negative CTA readings for two AVMs and one dural fistula. Conclusion The DSA is still the gold standard diagnostic modality for detecting macrovascular causes of ICH; however, most patients with lobar ICH can be investigated first with CTA, and the cause of bleeding can be found. Our results showed higher sensitivity and specificity than those of other CTA studies.
    Type of Medium: Online Resource
    ISSN: 1664-2295
    URL: Article
    DOI: 10.3389/fneur.2022.956888
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
    detail.hit.zdb_id: 2564214-5
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  • 5
    Online Resource
    Online Resource
    Ultrasound Perfusion Imaging of the Brain-Routine and Novel Applications: Uncommon Cases and Review of the Literature
    Wiley ; 2011
    In:  Journal of Neuroimaging Vol. 21, No. 3 ( 2011-07), p. 255-258
    Details
    In: Journal of Neuroimaging, Wiley, Vol. 21, No. 3 ( 2011-07), p. 255-258
    Type of Medium: Online Resource
    ISSN: 1051-2284
    URL: Issue
    URL: Article
    DOI: 10.1111/jon.2011.21.issue-3
    DOI: 10.1111/j.1552-6569.2010.00485.x
    Language: English
    Publisher: Wiley
    Publication Date: 2011
    detail.hit.zdb_id: 2035400-9
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  • 6
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    Comparison Between Echo Contrast Agent-Specific Imaging Modes and Perfusion-Weighted Magnetic Resonance Imaging for the Assessment of Brain Perfusion
    Ovid Technologies (Wolters Kluwer Health) ; 2002
    In:  Stroke Vol. 33, No. 10 ( 2002-10), p. 2433-2437
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 33, No. 10 ( 2002-10), p. 2433-2437
    Abstract: Background and Purpose— Contrast burst imaging (CBI) and time variance imaging (TVI) are new ultrasonic imaging modes enabling the visualization of intravenously injected echo contrast agents in brain parenchyma. The aim of this study was to compare the quantitative ultrasonic data with corresponding perfusion-weighted MRI data (p-MRI) with respect to the assessment of brain perfusion. Methods— Twelve individuals with no vascular abnormalities were examined by CBI and TVI after an intravenous bolus injection of 4 g galactose-based microbubble suspension (Levovist) in a concentration of 400 mg/mL. Complementary, a dynamic susceptibility contrast MRI, ie, p-MRI, of each individual was obtained. In both ultrasound (US) methods and p-MRI, time-intensity curves were calculated offline, and absolute time to peak intensities (TPI), peak intensities (PI), and peak width (PW) of US investigations and TPI, relative cerebral blood flow (CBF) and relative cerebral blood volume (CBV) of p-MRI examinations were determined in the following regions of interest (ROIs): lentiform nucleus (LN), white matter (WM), posterior (PT), and anterior thalamus (AT). In addition, the M 2 segment of the middle cerebral artery (MCA) was evaluated in the US, and the precentral gyrus (PG) was examined in the p-MRI examinations. In relation to a reference parenchymal ROI (AT), relative TPIs were compared between the US and p-MRI methods and relative PI of US investigations with the ratio of CBF (rCBF) of p-MRI examinations in identical ROIs. Results— Mean TPIs varied from 18.3±5.0 (AT) to 20.1± 5.8 (WM) to 17.2±4.9 (MCA) seconds in CBI examinations and from 19.4±5.3 (AT) to 20.4±4.3 (WM) to 17.3±4.0 (MCA) seconds in TVI examinations. Mean PIs were found to vary from 581.9±342.4 (WM) to 1522.9±574.2 (LN) to 3400.9± 621.7 arbitrary units (MCA) in CBI mode and from 7.5±4.6 (WM) to 17.5±4.9 (LN) to 46.3±7.1 (MCA) arbitrary units in TVI mode. PW ranged from 7.3±4.5 (AT) to 9.1±4.0 (LN) to 24.3±12.8 (MCA) seconds in CBI examinations and from 7.1±3.9 (AT) to 8.7±3.5 (LN) to 26.7±18.2 (MCA) seconds in TVI examinations. Mean TPI was significantly shorter and mean PI and mean PW were significantly higher in the MCA compared with all other ROIs ( P 〈 0.05). Mean TPI of the p-MRI examinations ranged from 22.0±6.9 (LN) to 23.0±6.8 (WM) seconds; mean CBF ranged from 0.0093± 0.0041 (LN) to 0.0043±0.0021 (WM). There was no significant difference in rTPI in any ROI between US and p-MRI measurements ( P 〉 0.2), whereas relative PIs were significantly higher in areas with lower insonation depth such as the LN compared with rCBF. Conclusions— In contrast to PI, TPI and rTPI in US techniques are robust parameters for the evaluation of cerebral perfusion and may help to differentiate physiological and pathological perfusion in different parenchymal regions of the brain.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000032246.85531.8E
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2002
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  • 7
    Online Resource
    Online Resource
    Contrast Burst Depletion Imaging (CODIM) : A New Imaging Procedure and Analysis Method for Semiquantitative Ultrasonic Perfusion Imaging
    Ovid Technologies (Wolters Kluwer Health) ; 2003
    In:  Stroke Vol. 34, No. 1 ( 2003-01), p. 77-83
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 34, No. 1 ( 2003-01), p. 77-83
    Abstract: Background and Purpose— Established methods of ultrasonic perfusion imaging using a bolus application of echo contrast agent provide only qualitative data because of various physical phenomena. This study was intended to investigate whether a new ultrasound perfusion imaging method termed contrast burst depletion imaging (CODIM) may provide semiquantitative measures of parenchymal perfusion independent of examination depth and acoustic energy distribution. Methods— In a system with a constant concentration of contrast agent, analyzing the decrease in image intensity that occurs with microbubble-destructive imaging modes yields parameters that are considered to correlate with tissue perfusion. This method was first evaluated with a perfusion model that showed that the main resulting parameter “perfusion coefficient” (PC) is a monotonic nonlinear function of flow velocity. Seventeen human volunteers were then scanned according to this method with the use of 2 different contrast agents. Results were correlated with those from perfusion-weighted MRI examinations. Results— The PC did not show significant differences in gray matter areas (ranging from 1.466×10 −2 s −1 to 1.641×10 −2 s −1 ) of the brain despite different insonation depths (eg, ipsilateral and contralateral thalamus). In contrast, white matter exhibited significantly lower perfusion values in both imaging modes (PC: 0.604×10 −2 s −1 to 0.745×10 −2 s −1 ; P 〈 0.05). Conclusions— CODIM is a promising new tool of imaging parenchymal (brain) perfusion in healthy persons. The method provides semiquantitative and depth-independent perfusion parameters and in this way overcomes the limitations of the perfusion methods using a bolus kinetic. Further investigations must be done to evaluate the potential of the method in patients with perfusion deficits.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000046455.51363.E2
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2003
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  • 8
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    Analysis of Nationwide Stroke Patient Care in Times of COVID-19 Pandemic in Germany
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. 2 ( 2021-02), p. 716-721
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 2 ( 2021-02), p. 716-721
    Abstract: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, many countries have introduced strict hygiene measures of social distancing to prevent further spreading of the disease. This may have led to a decreased presentation to hospital of patients with acute medical conditions and time-dependent management, such as stroke. Methods: We conducted a nationwide cohort study using administrative database of all hospitalized patients with main diagnosis of acute ischemic stroke (AIS), transient ischemic attack, or intracerebral hemorrhage. Data from a total of 1463 hospitals in Germany were included. We compared case numbers and treatment characteristics of pandemic (March 16 to May 15, 2020) and prepandemic (January 16 to March 15, 2020) cases and also with corresponding time period in 2019. Results: We identified a strong decline for hospitalization of AIS (−17.4%), transient ischemic attack (−22.9%), and intracerebral hemorrhage (−15.8%) patients during the pandemic compared with prepandemic period. IVT rate in patients with AIS was comparable (prepandemic versus pandemic: 16.4% versus 16.6%, P =0.448), whereas mechanical thrombectomy rate was significantly higher during the pandemic (8.1% versus 7.7%, P =0.044). In-hospital mortality was significantly increased in patients with AIS during the pandemic period (8.1% versus 7.6%, P =0.006). Conclusions: Besides a massive decrease in absolute case numbers, our data suggest that patients with AIS who did seek acute care during the pandemic, continued to receive acute recanalization treatment in Germany.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.033160
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 9
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    Gestaltung und Organisation der akuten endovaskulären Schlaganfalltherapie – Implikationen aus dem Neurovaskulären Netz Ruhr
    Georg Thieme Verlag KG ; 2017
    In:  Aktuelle Neurologie Vol. 44, No. 07 ( 2017-09), p. 458-465
    Details
    In: Aktuelle Neurologie, Georg Thieme Verlag KG, Vol. 44, No. 07 ( 2017-09), p. 458-465
    Abstract: Hintergrund Die flächendeckende Bereitstellung evidenzgestützter Therapien zur Behandlung des akuten Schlaganfalls wird in Deutschland durch ein enges Netz von gegenwärtig mehr als 300 Stroke Units gewährleistet. Seit dem Jahr 2015 ist die Mechanische Thrombektomie (MT) als weitere Option zur Rekanalisation eines großen arteriellen Gefäßverschlusses der vorderen Zirkulation bis zu sechs Stunden nach Symptombeginn zugelassen und wird in besonderen Fällen auch darüber hinaus empfohlen. In der vorliegenden Arbeit werden die Entwicklung der regionalen Verfügbarkeit und Anwendungshäufigkeit der MT zwischen dem Jahr 2010 und 2015 dargelegt sowie Rückschlüsse für die Gestaltung der Versorgungsstruktur gezogen. Methoden Grundlage des analytischen Teils sind die regionalisierten DRG-Statistiken (www.destatis.de) u. a. aggregiert auf die Verwaltungsebene der Kreise und kreisfreien Städte für die wohnortbezogene Auswertung sowie die strukturierten Qualitätsberichte (sQB) der Krankenhäuser für die behandlungsortbezogene Auswertung im Hinblick auf die durchgeführten MT. Überdies finden die publizierten Daten zu Interventionen an den hirnversorgenden Gefäßen aus dem BQS-Register für das Modul E des DeGIR/DGNR-Modul- und Stufenkonzeptes Berücksichtigung. Ergebnisse Folgende Entwicklungen lassen sich aufzeigen: Ausgehend von einer bundesweiten MT-Rate von 0,7 % aller Schlaganfallpatienten mit Hirninfarkt in 2010 kam es in den folgenden Jahren zu einem stetigen Anstieg der Interventionszahlen mit einer zuletzt zwischen 2014 und 2015 sprunghaften Entwicklung auf 3,1 %. Die Streubreite variierte abhängig vom Wohnort zwischen 0 und 7,4 % (2014). In diesem Zeitraum verdoppelte sich die Anzahl der MT-kodierenden Klinken von 107 (2010) auf 209 (2015). Die Summe der Prozeduren stieg im selben Zeitraum um fast das Fünffache (von 1630 auf 7797), wobei eine klare Entwicklung hin zur Zentrumsbildung erkennbar ist. 2015 erfolgten bereits ca. 3/4 aller MT in Häusern mit 〉  50 Interventionen/Jahr. Bezogen auf die Wohnorte der Patienten wurde in 2014 nur noch bei Patienten aus 4 % (n = 18) der insgesamt 413 Städte/Kreise keine einzige MT durchgeführt, zeitgleich verfügte aber erst 1/4 dieser 413 Verwaltungsbezirke über Interventionsmöglichkeiten vor Ort. Die im BQS-Register für das Modul E erfassten MT-Zahlen beim akuten Schlaganfall übertreffen für viele Interventionskliniken teils in erheblichem Maße die administrativen Versorgungsdaten auf Basis der sQB-Daten. Diskussion Insgesamt erscheinen in Deutschland bereits sowohl die personellen als auch strukturellen Voraussetzungen für eine flächendeckende Implementierung der MT in die Schlaganfallakutversorgung günstig. Unter dem Aspekt der Behandlungsqualität ist die Entwicklung hin zu Interventionszentren mit ausreichend hohen Behandlungszahlen sinnvoll. Nun stellt die Etablierung individueller regionaler Zuweisungskonzepte bei gleichzeitigem Erhalt der gegenwärtig hohen Basiskompetenz bei der Schlaganfallversorgung in der Fläche durch Konsolidierung der regionalen Stroke Units eine wesentliche Aufgabe dar. Hinsichtlich einer weiteren realistischen Bedarfsplanung zur MT-Bereitstellung sind zuverlässige Leistungszahlen erforderlich, sodass die Abweichungen zwischen den BQS-Registerdaten und den offiziellen DRG-Statistiken bzgl. der dokumentierten MT zukünftig ausgeräumt werden sollten.
    Type of Medium: Online Resource
    ISSN: 0302-4350 , 1438-9428
    URL: Article
    DOI: 10.1055/s-0043-113323
    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2017
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  • 10
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    Online Resource
    Transcranial Ultrasound Brain Perfusion Assessment With a Contrast Agent-Specific Imaging Mode : Results of a Two-Center Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2005
    In:  Stroke Vol. 36, No. 10 ( 2005-10), p. 2283-2285
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. 10 ( 2005-10), p. 2283-2285
    Abstract: Background and Purpose— The purpose of this study was to assess brain perfusion with an ultrasound contrast-specific imaging mode and to prove if the results are comparable between 2 centers using a standardized study protocol. Methods— A total of 32 individuals without known cerebrovascular disease were included in the study. Perfusion studies were performed ipsilaterally in an axial diencephalic plane after intravenous administration of 0.75 mL of Optison. Offline time intensity curves (TIC) were generated in different anatomic regions. Both centers used identical study protocols, ultrasound machines, and contrast agent. Results— In both centers, the comparison of the parameter time to peak intensity (TPI) revealed significantly shorter TPIs in the main vessel structures compared with any parenchymal region of interest (ROI), whereas no significant differences were seen between the parenchymal ROIs. The parameter peak intensity (PI) varied widely interindividually in both centers, whereas the inter -ROI comparison revealed statistical significance ( P 〈 0.05) in most of the cases according to the following pattern: (1) lentiforme nucleus 〉 thalamus and white matter region, (2) thalamus 〉 white matter region, and (3) main vessel 〉 any parenchymal structure. Similar results were achieved in both centers independently. Conclusion— The study demonstrates that brain perfusion assessment with an ultrasound contrast-specific imaging mode is comparable between different centers using the same study protocol.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000179038.63109.b0
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2005
    detail.hit.zdb_id: 1467823-8
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