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  • Springer Science and Business Media LLC  (32)
  • 1
    Online Resource
    Online Resource
    Elevated plasma concentrations of lipoprotein(a) in medicated epileptic patients
    Springer Science and Business Media LLC ; 2000
    In:  Journal of Neurology Vol. 247, No. 9 ( 2000-10-2), p. 687-690
    Details
    In: Journal of Neurology, Springer Science and Business Media LLC, Vol. 247, No. 9 ( 2000-10-2), p. 687-690
    Type of Medium: Online Resource
    ISSN: 0340-5354 , 1432-1459
    URL: Article
    DOI: 10.1007/s004150070111
    RVK:
    XA 10000
    Language: Unknown
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2000
    detail.hit.zdb_id: 1421299-7
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  • 2
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    SOP: thrombolysis in ischemic stroke under oral anticoagulation therapy
    Springer Science and Business Media LLC ; 2022
    In:  Neurological Research and Practice Vol. 4, No. 1 ( 2022-12)
    Details
    In: Neurological Research and Practice, Springer Science and Business Media LLC, Vol. 4, No. 1 ( 2022-12)
    Abstract: Based on demographical trends and the expected worldwide increase in the number of individuals with atrial fibrillation, the rate of patients who are on oral anticoagulation therapy for secondary prevention of stroke rises continuously. Despite correct drug intake and good adherence to the respective medication, recurrent ischemic stroke still occurs in ~ 3% of patients. The question how to deal with such patients with regard to intravenous thrombolysis with rt-PA within the 4.5 h time window is of great relevance for daily clinical routine. However, international guidelines can be considered heterogenous or do even lack recommendations on this topic especially in light of available reversal agents. Therefore, we provide this SOP. Comments Beyond the identification of acute stroke patients on oral anticoagulation therapy, the type of medication, time since last intake, renal function and laboratory exams as well as the availability of reversal agents have to be considered before rt-PA application and potential endovascular therapy. Treatment on a Stroke Unit or Neuro-ICU is certainly recommended in any of those patients. Conclusions This standardized operating procedure was designed to guide stroke physicians through questions on eligibility for rt-PA treatment in patients with acute ischemic stroke who are on approved oral anticoagulation therapy thereby increasing the number of patients benefitting from thrombolysis and minimizing door-to-needle times.
    Type of Medium: Online Resource
    ISSN: 2524-3489
    URL: Article
    DOI: 10.1186/s42466-022-00174-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2947493-0
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  • 3
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    Combined Perfusion and Permeability Imaging Reveals Different Pathophysiologic Tissue Responses After Successful Thrombectomy
    Springer Science and Business Media LLC ; 2021
    In:  Translational Stroke Research Vol. 12, No. 5 ( 2021-10), p. 799-807
    Details
    In: Translational Stroke Research, Springer Science and Business Media LLC, Vol. 12, No. 5 ( 2021-10), p. 799-807
    Abstract: Despite successful recanalization of large-vessel occlusions in acute ischemic stroke, individual patients profit to a varying degree. Dynamic susceptibility-weighted perfusion and dynamic T1-weighted contrast-enhanced blood-brain barrier permeability imaging may help to determine secondary stroke injury and predict clinical outcome. We prospectively performed perfusion and permeability imaging in 38 patients within 24 h after successful mechanical thrombectomy of an occlusion of the middle cerebral artery M1 segment. Perfusion alterations were evaluated on cerebral blood flow maps, blood-brain barrier disruption (BBBD) visually and quantitatively on k trans maps and hemorrhagic transformation on susceptibility-weighted images. Visual BBBD within the DWI lesion corresponded to a median k trans elevation (IQR) of 0.77 (0.41–1.4) min −1 and was found in all 7 cases of hypoperfusion (100%), in 10 of 16 cases of hyperperfusion (63%), and in only three of 13 cases with unaffected perfusion (23%). BBBD was significantly associated with hemorrhagic transformation ( p 〈  0.001). While BBBD alone was not a predictor of clinical outcome at 3 months (positive predictive value (PPV) = 0.8 [0.56–0.94]), hypoperfusion occurred more often in patients with unfavorable clinical outcome (PPV = 0.43 [0.10–0.82] ) compared to hyperperfusion (PPV = 0.93 [0.68–1.0]) or unaffected perfusion (PPV = 1.0 [0.75–1.0] ). We show that combined perfusion and permeability imaging reveals distinct infarct signatures after recanalization, indicating the severity of prior ischemic damage. It assists in predicting clinical outcome and may identify patients at risk of stroke progression.
    Type of Medium: Online Resource
    ISSN: 1868-4483 , 1868-601X
    URL: Article
    DOI: 10.1007/s12975-020-00885-y
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2541897-X
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  • 4
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    Radiation exposure per thrombectomy attempt in modern endovascular stroke treatment in the anterior circulation
    Springer Science and Business Media LLC ; 2020
    In:  European Radiology Vol. 30, No. 9 ( 2020-09), p. 5039-5047
    Details
    In: European Radiology, Springer Science and Business Media LLC, Vol. 30, No. 9 ( 2020-09), p. 5039-5047
    Abstract: To quantify radiation exposure (RE) of endovascular stroke treatment (EST) in the anterior circulation per thrombectomy attempt and determine causes for interventions associated with high RE. Methods A retrospective single-center study of an institutional review board−approved stroke database of patients receiving EST for large vessel occlusions in the anterior circulation between January 2013 and April 2018 to evaluate reference levels (RL) per thrombectomy attempt. ESTs with RE above the RL were analyzed to determine causes for high RE. Results Overall, n  = 544 patients (occlusion location, M1 and M2 segments of the middle cerebral artery 53.5% and 27.2%, carotid artery 17.6%; successful recanalization rate 85.7%) were analyzed. In the overall population, DAP (in Gy cm 2 , median (IQR)) was 113.7 (68.9–181.7) with a median fluoroscopy time of 31 min (IQR, 17–53) and a median of 2 (IQR, 1–4) thrombectomy attempts. RE increased significantly with every thrombectomy attempt (DAP 1 , 68.7 (51.2–106.8); DAP 2 , 106.4 (84.8–115.6); p value 1vs2 , 〈  0.001; DAP 3 , 130.2 (89.1–183.6); p value 2vs3 , 0.044; DAP 4 , 169.9 (128.4–224.1); p value 3vs4 , 0.001; and DAP 5 , 227.6 (146.3–294.6); p value 4vs5 , 0.019). Procedures exceeding the 90th percentile of the attempt-dependent radiation exposure level were associated with procedural complications ( n  = 17/52, 29.8%) or a difficult vascular access ( n  = 8/52, 14%). Conclusions Radiation exposure in endovascular stroke treatment is depending on the number of thrombectomy attempts. Radiation exposure doubles when three attempts and triples when five attempts are necessary compared with single-maneuver interventions. Procedural complications and difficult vascular access were associated with a high radiation exposure in this collective. Key Points • Radiation exposure of endovascular stroke treatment (EST) is dependent on the number of thrombectomy attempts. • Reference levels as means for quality control in hospitals performing endovascular stroke treatment should be defined by the number of thrombectomy attempts—we suggest 107 Gy cm 2 , 156 Gy cm 2 , 184 Gy cm 2 , 244 Gy cm 2 , and 295 Gy cm 2 for 1 to 5 maneuvers, respectively, for EST of the anterior circulation • Cases with high rates of radiation exposure are associated with periprocedural complications and difficult anatomical access as a probable cause for a high radiation exposure.
    Type of Medium: Online Resource
    ISSN: 0938-7994 , 1432-1084
    URL: Article
    DOI: 10.1007/s00330-020-06837-2
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 1472718-3
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  • 5
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    Exact Basilar Artery Occlusion Location Indicates Stroke Etiology and Recanalization Success in Patients Eligible for Endovascular Stroke Treatment
    Springer Science and Business Media LLC ; 2023
    In:  Clinical Neuroradiology Vol. 33, No. 2 ( 2023-06), p. 483-490
    Details
    In: Clinical Neuroradiology, Springer Science and Business Media LLC, Vol. 33, No. 2 ( 2023-06), p. 483-490
    Abstract: Endovascular stroke treatment (EST) is commonly performed for acute basilar artery occlusion (BAO). We aimed to identify the role of the exact location of BAO in patients receiving EST regarding the stroke etiology, recanalization success and prediction of favorable clinical outcome. Methods Retrospective analysis of 191 consecutive patients treated for BAO with EST from 01/2013 until 06/2021 in a tertiary stroke center. Groups were defined according to exact location of BAO in I: proximal third, II: middle third, III: distal third and IV: tip of the basilar artery. Univariate and multivariate analyses were performed for BAO location comparing stroke etiology, recanalization result and favorable clinical outcome according to mRS 0–3 90 days after stroke onset. Results Occlusion sides types I–IV were evenly distributed (37, 36, 60 and 58 patients). Types I and II were more often associated with large artery atherosclerosis (50 vs. 10 patients, p   〈  0.001). Distal/tip occlusion (types III/IV) occurred mostly in cardiac embolism or embolic stroke of unknown source (89 vs. 12 in types I/II, p   〈  0.001). Occlusion site correlated with the underlying stroke etiology (AUC [Area under the curve] 0.89, p   〈  0.0001, OR [odds ratio] for embolism in type IV: 245). Recanalization rates were higher in patients with distal occlusions (type III/IV OR 3.76, CI [95% confidence interval] 1.51–9.53, p  = 0.0076). The BAO site is not predicting favorable clinical outcome. Conclusion The exact basilar artery occlusion site in patients eligible for endovascular stroke treatment reflects the stroke etiology and is associated with differing recanalization success but does not predict favorable clinical outcome.
    Type of Medium: Online Resource
    ISSN: 1869-1439 , 1869-1447
    URL: Article
    DOI: 10.1007/s00062-022-01236-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2232347-8
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  • 6
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    Full Reperfusion Without Functional Independence After Mechanical Thrombectomy in the Anterior Circulation : Performance of Prediction Models Before Versus After Treatment Initiation
    Springer Science and Business Media LLC ; 2022
    In:  Clinical Neuroradiology Vol. 32, No. 4 ( 2022-12), p. 987-995
    Details
    In: Clinical Neuroradiology, Springer Science and Business Media LLC, Vol. 32, No. 4 ( 2022-12), p. 987-995
    Abstract: Prediction of futile recanalization (FR), i.e. failure of long-term functional independence despite full reperfusion in mechanical thrombectomy (MT), is instrumental in patients undergoing endovascular therapy. Methods Retrospective single-center analysis of patients treated for anterior circulation LVO ensuing successful MT (mTICI 2c–3) between January 2014 and April 2019. FR was defined as modified Rankin Scale (mRS) 90 days after stroke onset 〉  2 or mRS  〉  pre-stroke mRS. Multivariable analysis was performed with variables available before treatment initiation regarding their association with FR. Performance of the regression model was then compared with a model including parameters available after MT. Results Successful MT was experienced by 549/1146 patients in total. FR occurred in 262/549 (47.7%) patients. Independent predictors of FR were male sex, odds ratio (OR) with 95% confidence interval (CI) 1.98 (1.31–3.05, p  0.001), age (OR 1.05, CI 1.03–1.07, p   〈  0.001), NIHSS on admission (OR 1.10, CI 1.06–1.13, p   〈  0.001), pre-stroke mRS (OR 1.22, CI 1.03–1.46, p  0.025), neutrophile-lymphocyte ratio (OR 1.03, CI 1.00–1.06, p  0.022), baseline ASPECTS (OR 0.77, CI 0.68–0.88, p   〈  0.001), and absence of bridging i.v. lysis (OR 1.62, 1.09–2.42, p  0.016). The prediction model’s Area Under the Curve was 0.78 (CI 0.74–0.82) and increased with parameters available after MT to 0.86 (CI 0.83–0.89) with failure of early neurological improvement being the most important predictor of FR (OR 15.0, CI 7.2–33.8). Conclusion A variety of preinterventional factors may predict FR with substantial certainty, but the prediction model can still be improved by considering parameters only available after MT, in particular early neurological improvement.
    Type of Medium: Online Resource
    ISSN: 1869-1439 , 1869-1447
    URL: Article
    DOI: 10.1007/s00062-022-01166-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 7
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    Delivery Assist Catheters : A new Device Class and Initial Experience in Mechanical Thrombectomy in Acute Ischemic Stroke Patients
    Springer Science and Business Media LLC ; 2019
    In:  Clinical Neuroradiology Vol. 29, No. 4 ( 2019-12), p. 661-667
    Details
    In: Clinical Neuroradiology, Springer Science and Business Media LLC, Vol. 29, No. 4 ( 2019-12), p. 661-667
    Type of Medium: Online Resource
    ISSN: 1869-1439 , 1869-1447
    URL: Article
    DOI: 10.1007/s00062-018-0725-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
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  • 8
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    Radiation exposure in endovascular stroke treatment of acute basilar artery occlusions—a matched-pair analysis
    Springer Science and Business Media LLC ; 2020
    In:  Neuroradiology Vol. 62, No. 12 ( 2020-12), p. 1701-1707
    Details
    In: Neuroradiology, Springer Science and Business Media LLC, Vol. 62, No. 12 ( 2020-12), p. 1701-1707
    Abstract: To determine the radiation exposure in endovascular stroke treatment (EST) of acute basilar artery occlusions (BAO) and compare it with radiation exposure of EST for embolic middle cerebral artery occlusions (MCAO). Methods In this retrospective analysis of an institutional review board−approved prospective stroke database of a comprehensive stroke center, we focused on radiation exposure (as per dose area product in Gy × cm 2 , median (IQR)), procedure time, and fluoroscopy time (in minutes, median [IQR]) in patients receiving EST for BAO. Patients who received EST for BAO were matched case by case with patients who received EST for MCAO according to number of thrombectomy attempts, target vessel reperfusion result, and thrombectomy technique. Results Overall 180 patients ( n  = 90 in each group) were included in this analysis. General anesthesia was conducted more often during EST of BAO (BAO: 75 (83.3%); MCAO: 18 (31.1%), p   〈  0.001). Procedure time (BAO: 31 (20–43); MCAO: 27 (18–38); p value 0.226) and fluoroscopy time (BAO: 29 (20–59); MCAO: 29 (17–49), p value 0.317) were comparable. Radiation exposure was significantly higher in patients receiving EST for BAO (BAO: 123.4 (78.7–204.2); MCAO: 94.3 (65.5–163.7), p value 0.046), which represents an increase by 23.7%. Conclusion Endovascular stroke treatment of basilar artery occlusions is associated with a higher radiation exposure compared with treatment of middle cerebral artery occlusions.
    Type of Medium: Online Resource
    ISSN: 0028-3940 , 1432-1920
    URL: Article
    DOI: 10.1007/s00234-020-02490-0
    RVK:
    XA 10000
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 1462953-7
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  • 9
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    Access to and application of recanalizing therapies for severe acute ischemic stroke caused by large vessel occlusion
    Springer Science and Business Media LLC ; 2023
    In:  Neurological Research and Practice Vol. 5, No. 1 ( 2023-05-18)
    Details
    In: Neurological Research and Practice, Springer Science and Business Media LLC, Vol. 5, No. 1 ( 2023-05-18)
    Abstract: Groundbreaking study results since 2014 have dramatically changed the therapeutic options in acute therapy for severe ischemic stroke caused by large vessel occlusion (LVO). The scientifically proven advances in stroke imaging and thrombectomy techniques have allowed to offer the optimal version or combination of best medical and interventional therapy to the selected patient, yielding favorable or even excellent clinical outcomes within time windows unheard of before. The provision of the best possible individual therapy has become a guideline-based gold standard, but remains a great challenge. With geographic, regional, cultural, economic and resource differences worldwide, optimal local solutions have to be strived for. Aim This standard operation procedure (SOP) is aimed to give a suggestion of how to give patients access to and apply modern recanalizing therapy for acute ischemic stroke caused by LVO. Method The SOP was developed based on current guidelines, the evidence from the most recent trials and the experience of authors who have been involved in the above-named development at different levels. Results This SOP is meant to be a comprehensive, yet not too detailed template to allow for freedom in local adaption. It comprises all relevant stages in providing care to the patient with severe ischemic stroke such as suspicion and alarm, prehospital acute measures, recognition and grading, transport, emergency room workup, selective cerebral imaging, differential treatment by recanalizing therapies (intravenous thrombolysis, endovascular stroke treatmet, or combined), complications, stroke unit and neurocritical care. Conclusions The challenge of giving patients access to and applying recanalizing therapies in severe ischemic stroke may be facilitated by a systematic, SOP-based approach adapted to local settings.
    Type of Medium: Online Resource
    ISSN: 2524-3489
    URL: Article
    DOI: 10.1186/s42466-023-00245-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2947493-0
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  • 10
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    Location-specific ASPECTS does not improve Outcome Prediction in Large Vessel Occlusion compared to Cumulative ASPECTS
    Springer Science and Business Media LLC ; 2023
    In:  Clinical Neuroradiology Vol. 33, No. 3 ( 2023-09), p. 661-668
    Details
    In: Clinical Neuroradiology, Springer Science and Business Media LLC, Vol. 33, No. 3 ( 2023-09), p. 661-668
    Abstract: Individual regions of the Alberta Stroke Programme Early CT Score (ASPECTS) may contribute differently to the clinical symptoms in large vessel occlusion (LVO). Here, we investigated whether the predictive performance on clinical outcome can be increased by considering specific ASPECTS subregions. Methods A consecutive series of patients with LVO affecting the middle cerebral artery territory and subsequent endovascular treatment (EVT) between January 2015 and July 2020 was analyzed, including affected ASPECTS regions. A multivariate logistic regression was performed to assess the individual impact of ASPECTS regions on good clinical outcome (defined as modified Rankin scale after 90 days of 0–2). Machine-learning-driven logistic regression models were trained (training = 70%, testing = 30%) to predict good clinical outcome using i) cumulative ASPECTS and ii) location-specific ASPECTS, and their performance compared using deLong’s test. Furthermore, additional analyses using binarized as well as linear clinical outcomes using regression and machine-learning techniques were applied to thoroughly assess the potential predictive properties of individual ASPECTS regions and their combinations. Results Of 1109 patients (77.3 years ± 11.6, 43.8% male), 419 achieved a good clinical outcome and a median NIHSS after 24 h of 12 (interquartile range, IQR 4–21). Individual ASPECTS regions showed different impact on good clinical outcome in the multivariate logistic regression, with strongest effects for insula (odds ratio, OR 0.56, 95% confidence interval, CI 0.42–0.75) and M5 (OR 0.53, 95% CI 0.29–0.97) regions. Accuracy (ACC) in predicting good clinical outcome of the test set did not differ between when considering i) cumulative ASPECTS and ii) location-specific ASPECTS (ACC = 0.619, 95% CI 0.58–0.64 vs. ACC = 0.629, 95% CI 0.60–0.65; p  = 0.933). Conclusion Cumulative ASPECTS assessment in LVO remains a stable and reliable predictor for clinical outcome and is not inferior to a weighted (location-specific) ASPECTS assessment.
    Type of Medium: Online Resource
    ISSN: 1869-1439 , 1869-1447
    URL: Article
    DOI: 10.1007/s00062-022-01258-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
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