Clinical Neuroradiology最新文献

{"title":"Outcomes with General Anesthesia Compared to Conscious Sedation for Endovascular Treatment of Medium Vessel Occlusions: Results of an International Multicentric Study","authors":"Răzvan Alexandru Radu, Vincent Costalat, Michele Romoli, Basel Musmar, James E. Siegler, Sherief Ghozy, Jane Khalife, Hamza Salim, Hamza Shaikh, Nimer Adeeb, Hugo H. Cuellar-Saenz, Ajith J. Thomas, Ramanathan Kadirvel, Mohamad Abdalkader, Piers Klein, Thanh N. Nguyen, Jeremy J. Heit, Robert W. Regenhardt, Joshua D. Bernstock, Aman B. Patel, James D. Rabinov, Christopher J. Stapleton, Nicole M. Cancelliere, Thomas R. Marotta, Vitor Mendes Pereira, Kareem El Naamani, Abdelaziz Amllay, Stavropoula I. Tjoumakaris, Pascal Jabbour, Lukas Meyer, Jens Fiehler, Tobias D. Faizy, Helena Guerreiro, Anne Dusart, Flavio Bellante, Géraud Forestier, Aymeric Rouchaud, Charbel Mounayer, Anna Luisa Kühn, Ajit S. Puri, Christian Dyzmann, Peter T. Kan, Marco Colasurdo, Gaultier Marnat, Jérôme Berge, Xavier Barreau, Igor Sibon, Simona Nedelcu, Nils Henninger, Takahiro Ota, Shogo Dofuku, Leonard L. L. Yeo, Benjamin YQ Tan, Anil Gopinathan, Juan Carlos Martinez-Gutierrez, Sergio Salazar-Marioni, Sun..","doi":"10.1007/s00062-024-01415-1","DOIUrl":"https://doi.org/10.1007/s00062-024-01415-1","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Optimal anesthetic strategy for the endovascular treatment of stroke is still under debate. Despite scarce data concerning anesthetic management for medium and distal vessel occlusions (MeVOs) some centers empirically support a general anesthesia (GA) strategy in these patients.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We conducted an international retrospective study of MeVO cases. A propensity score matching algorithm was used to mitigate potential differences across patients undergoing GA and conscious sedation (CS). Comparisons in clinical and safety outcomes were performed between the two study groups GA and CS. The favourable outcome was defined as a modified Rankin Scale (mRS) 0–2 at 90 days. Safety outcomes were 90-days mortality and symptomatic intracranial hemorrhage (sICH). Predictors of a favourable outcome and sICH were evaluated with backward logistic regression.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>After propensity score matching 668 patients were included in the CS and 264 patients in the GA group. In the matched cohort, either strategy CS or GA resulted in similar rates of good functional outcomes (50.1% vs. 48.4%), and successful recanalization (89.4% vs. 90.2%). The GA group had higher rates of 90-day mortality (22.6% vs. 16.5%, <i>p</i> &lt; 0.041) and sICH (4.2% vs. 0.9%, <i>p</i> = 0.001) compared to the CS group. Backward logistic regression did not identify GA vs CS as a predictor of good functional outcome (OR for GA vs CS = 0.95 (0.67–1.35)), but GA remained a significant predictor of sICH (OR = 5.32, 95% CI 1.92–14.72).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Anaesthetic strategy in MeVOs does not influence favorable outcomes or final successful recanalization rates, however, GA may be associated with an increased risk of sICH and mortality.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"89 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140840072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Thrombectomy for Large Ischemic Strokes with ASPECTS 0–2: a Meta-analysis of Randomized Controlled Trials","authors":"Laurens Winkelmeier, Máté Maros, Fabian Flottmann, Christian Heitkamp, Gerhard Schön, Götz Thomalla, Jens Fiehler, Uta Hanning","doi":"10.1007/s00062-024-01414-2","DOIUrl":"https://doi.org/10.1007/s00062-024-01414-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Randomized controlled trials (RCTs) demonstrated a treatment effect of endovascular thrombectomy in acute ischemic stroke with large infarct, commonly defined as an Alberta Stroke Program Early CT Score (ASPECTS) of 3–5. However, data on endovascular thrombectomy in patients with very low ASPECTS of 0–2 remain scarce.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We conducted a systematic review and meta-analysis of RCTs comparing endovascular thrombectomy versus medical treatment alone in acute ischemic anterior circulation stroke with very large infarct, defined as ASPECTS of 0–2. The primary outcome was the shift toward better functional outcomes on the 90-day modified Rankin Scale (mRS). Random effects meta-analysis was performed using the generic inverse variance method.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Literature research identified four RCTs which evaluated the treatment effect of endovascular thrombectomy for large infarcts and provided a subgroup analysis of the mRS shift in patients with ASPECTS of 0–2. The pooled analysis showed a significant shift toward better 90-day mRS scores in favor of endovascular thrombectomy (pooled odds ratio, 1.62, 95% confidence interval, 1.29–2.04, <i>P</i> &lt; 0.001).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>This meta-analysis suggests a treatment effect of endovascular thrombectomy in specific patients with very low ASPECTS of 0–2, challenging the use of ASPECTS for treatment selection in acute ischemic stroke due to large vessel occlusion. An individual patient meta-analysis of RCTs would strengthen evidence in the treatment of patients with ASPECTS of 0–2.</p><h3 data-test=\"abstract-sub-heading\">Graphic abstract</h3>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"6 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140840254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced diffusion MRI provides evidence for altered axonal microstructure and gradual peritumoral infiltration in GBM in comparison to brain metastases","authors":"U. Würtemberger, A. Rau, M. Diebold, L. Becker, M. Hohenhaus, J. Beck, P. C. Reinacher, D. Erny, M. Reisert, H. Urbach, T. Demerath","doi":"10.1007/s00062-024-01416-0","DOIUrl":"https://doi.org/10.1007/s00062-024-01416-0","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>In contrast to peritumoral edema in metastases, GBM is histopathologically characterized by infiltrating tumor cells within the T2 signal alterations. We hypothesized that depending on the distance from the outline of the contrast-enhancing tumor we might reveal imaging evidence of gradual peritumoral infiltration in GBM and predominantly vasogenic edema around metastases. We thus investigated the gradual change of advanced diffusion metrics with the peritumoral zone in metastases and GBM.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>In 30 patients with GBM and 28 with brain metastases, peritumoral T2 hyperintensity was segmented in 33% partitions based on the total volume beginning at the enhancing tumor margin and divided into inner, middle and outer zones. Diffusion Tensor Imaging (DTI)-derived fractional anisotropy and mean diffusivity as well as Diffusion Microstructure Imaging (DMI)-based parameters Dax-intra, Dax-extra, V‑CSF and V-intra were employed to assess group-wise differences between inner and outer zones as well as within-group gradients between the inner and outer zones.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>In metastases, fractional anisotropy and Dax-extra were significantly reduced in the inner zone compared to the outer zone (FA <i>p</i> = 0.01; Dax-extra <i>p</i> = 0.03). In GBM, we noted a reduced Dax-extra and significantly lower intraaxonal volume fraction (Dax-extra <i>p</i> = 0.008, V‑intra <i>p</i> = 0.006) accompanied by elevated axial intraaxonal diffusivity in the inner zone (<i>p</i> = 0.035). Between-group comparison of the outer to the inner zones revealed significantly higher gradients in metastases over GBM for FA (<i>p</i> = 0.04) as well as the axial diffusivity in the intra- (<i>p</i> = 0.02) and extraaxonal compartment (<i>p</i> &lt; 0.001).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Our findings provide evidence of gradual alterations within the peritumoral zone of brain tumors. These are compatible with predominant (vasogenic) edema formation in metastases, whereas our findings in GBM are in line with an axonal destructive component in the immediate peritumoral area and evidence of tumor cell infiltration with accentuation in the tumor’s vicinity.</p>","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"15 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140809973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Imaging-based Predictors with Outcome in Different Treatment Options for Intracerebral Hemorrhage.","authors":"R. Krzyżewski, B. Kwinta, Krzysztof Stachura, Tadeusz J Popiela, R. Pułyk, Agnieszka Słowik, Jerzy Gąsowski, K. Kliś","doi":"10.1007/s00062-024-01406-2","DOIUrl":"https://doi.org/10.1007/s00062-024-01406-2","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"13 4","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140652260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thalamo-mesencephalic Branches of the Posterior Cerebral Artery: a 3D Rotational Angiography Study.","authors":"Maximilian Rauch, Joachim Berkefeld, Madleen Klonowski, E. Hattingen, S. Weidauer","doi":"10.1007/s00062-024-01418-y","DOIUrl":"https://doi.org/10.1007/s00062-024-01418-y","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"5 12","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140652983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Answer to: Complications During Ozone Therapy as a Result of Malpractice and Lack of Guidelines.","authors":"Daniel S. Marín-Medina, Adriana P Ortega-Quintero","doi":"10.1007/s00062-024-01411-5","DOIUrl":"https://doi.org/10.1007/s00062-024-01411-5","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"57 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140671003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Flow Reduction Efficacy of Nominal and Oversized Flow Diverters Using a Novel Measurement-assisted in Silico Method.","authors":"B. Csippa, Levente Sándor, Gábor Závodszky, I. Szikora, György Paál","doi":"10.1007/s00062-024-01404-4","DOIUrl":"https://doi.org/10.1007/s00062-024-01404-4","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"51 17","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140667179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications During Ozone Therapy as a Result of Malpractice and Lack of Guidelines.","authors":"S. Chirumbolo, S. Pandolfi, L. Valdenassi, Marianna Chierchia, M. Franzini","doi":"10.1007/s00062-024-01412-4","DOIUrl":"https://doi.org/10.1007/s00062-024-01412-4","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"23 12","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140667531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Societies' Communications.","authors":"","doi":"10.1007/s00062-024-01413-3","DOIUrl":"https://doi.org/10.1007/s00062-024-01413-3","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"85 18","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140675405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Thrombectomy for Extensive Infarction (ASPECTS 0-2) in Acute Ischemic Stroke.","authors":"P. Dhillon, Vinicius Carraro do Nascimento, L. de Villiers, Hal Rice","doi":"10.1007/s00062-024-01408-0","DOIUrl":"https://doi.org/10.1007/s00062-024-01408-0","url":null,"abstract":"","PeriodicalId":10391,"journal":{"name":"Clinical Neuroradiology","volume":"22 25","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}