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2. A Robust Ensemble Algorithm for Ischemic Stroke Lesion Segmentation: Generalizability and Clinical Utility Beyond the ISLES Challenge

Author

de la Rosa, Ezequiel, Reyes, Mauricio, Liew, Sook-Lei, Hutton, Alexandre, Wiest, Roland, Kaesmacher, Johannes, Hanning, Uta, Hakim, Arsany, Zubal, Richard, Valenzuela, Waldo, Robben, David, Sima, Diana M., Anania, Vincenzo, Brys, Arne, Meakin, James A., Mickan, Anne, Broocks, Gabriel, Heitkamp, Christian, Gao, Shengbo, Liang, Kongming, Zhang, Ziji, Siddiquee, Md Mahfuzur Rahman, Myronenko, Andriy, Ashtari, Pooya, Van Huffel, Sabine, Jeong, Hyun-su, Yoon, Chi-ho, Kim, Chulhong, Huo, Jiayu, Ourselin, Sebastien, Sparks, Rachel, Clèrigues, Albert, Oliver, Arnau, Lladó, Xavier, Chalcroft, Liam, Pappas, Ioannis, Bertels, Jeroen, Heylen, Ewout, Moreau, Juliette, Hatami, Nima, Frindel, Carole, Qayyum, Abdul, Mazher, Moona, Puig, Domenec, Lin, Shao-Chieh, Juan, Chun-Jung, Hu, Tianxi, Boone, Lyndon, Goubran, Maged, Liu, Yi-Jui, Wegener, Susanne, Kofler, Florian, Ezhov, Ivan, Shit, Suprosanna, Petzsche, Moritz R. Hernandez, Menze, Bjoern, Kirschke, Jan S., and Wiestler, Benedikt

Subjects
Electrical Engineering and Systems Science - Image and Video Processing, Computer Science - Computer Vision and Pattern Recognition
Abstract

Diffusion-weighted MRI (DWI) is essential for stroke diagnosis, treatment decisions, and prognosis. However, image and disease variability hinder the development of generalizable AI algorithms with clinical value. We address this gap by presenting a novel ensemble algorithm derived from the 2022 Ischemic Stroke Lesion Segmentation (ISLES) challenge. ISLES'22 provided 400 patient scans with ischemic stroke from various medical centers, facilitating the development of a wide range of cutting-edge segmentation algorithms by the research community. Through collaboration with leading teams, we combined top-performing algorithms into an ensemble model that overcomes the limitations of individual solutions. Our ensemble model achieved superior ischemic lesion detection and segmentation accuracy on our internal test set compared to individual algorithms. This accuracy generalized well across diverse image and disease variables. Furthermore, the model excelled in extracting clinical biomarkers. Notably, in a Turing-like test, neuroradiologists consistently preferred the algorithm's segmentations over manual expert efforts, highlighting increased comprehensiveness and precision. Validation using a real-world external dataset (N=1686) confirmed the model's generalizability. The algorithm's outputs also demonstrated strong correlations with clinical scores (admission NIHSS and 90-day mRS) on par with or exceeding expert-derived results, underlining its clinical relevance. This study offers two key findings. First, we present an ensemble algorithm (https://github.com/Tabrisrei/ISLES22_Ensemble) that detects and segments ischemic stroke lesions on DWI across diverse scenarios on par with expert (neuro)radiologists. Second, we show the potential for biomedical challenge outputs to extend beyond the challenge's initial objectives, demonstrating their real-world clinical applicability.

Published
2024

5. How much of the variance in functional outcome related to intracerebral hemorrhage volume is already apparent in neurological status at admission?

Author

Geest, Vincent, Oblak, Janja Pretnar, Popović, Katarina Šurlan, Nawabi, Jawed, Elsayed, Sarah, Friedrich, Constanze, Böhmer, Maik, Akkurt, Burak, Sporns, Peter, Morotti, Andrea, Schlunk, Frieder, Steffen, Paul, Broocks, Gabriel, Meyer, Lukas, Hanning, Uta, Thomalla, Götz, Gellissen, Susanne, Fiehler, Jens, Frol, Senta, and Kniep, Helge

Published
2024
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7. ISLES 2022: A multi-center magnetic resonance imaging stroke lesion segmentation dataset

Author

Petzsche, Moritz Roman Hernandez, de la Rosa, Ezequiel, Hanning, Uta, Wiest, Roland, Pinilla, Waldo Enrique Valenzuela, Reyes, Mauricio, Meyer, Maria Ines, Liew, Sook-Lei, Kofler, Florian, Ezhov, Ivan, Robben, David, Hutton, Alexander, Friedrich, Tassilo, Zarth, Teresa, Bürkle, Johannes, Baran, The Anh, Menze, Bjoern, Broocks, Gabriel, Meyer, Lukas, Zimmer, Claus, Boeckh-Behrens, Tobias, Berndt, Maria, Ikenberg, Benno, Wiestler, Benedikt, and Kirschke, Jan S.

Subjects
Computer Science - Computer Vision and Pattern Recognition
Abstract

Magnetic resonance imaging (MRI) is a central modality for stroke imaging. It is used upon patient admission to make treatment decisions such as selecting patients for intravenous thrombolysis or endovascular therapy. MRI is later used in the duration of hospital stay to predict outcome by visualizing infarct core size and location. Furthermore, it may be used to characterize stroke etiology, e.g. differentiation between (cardio)-embolic and non-embolic stroke. Computer based automated medical image processing is increasingly finding its way into clinical routine. Previous iterations of the Ischemic Stroke Lesion Segmentation (ISLES) challenge have aided in the generation of identifying benchmark methods for acute and sub-acute ischemic stroke lesion segmentation. Here we introduce an expert-annotated, multicenter MRI dataset for segmentation of acute to subacute stroke lesions. This dataset comprises 400 multi-vendor MRI cases with high variability in stroke lesion size, quantity and location. It is split into a training dataset of n=250 and a test dataset of n=150. All training data will be made publicly available. The test dataset will be used for model validation only and will not be released to the public. This dataset serves as the foundation of the ISLES 2022 challenge with the goal of finding algorithmic methods to enable the development and benchmarking of robust and accurate segmentation algorithms for ischemic stroke., Comment: 12 pages, 2 figures

Published
2022
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9. Endovascular thrombectomy for acute ischaemic stroke with established large infarct (TENSION): 12-month outcomes of a multicentre, open-label, randomised trial

Author

Aamodt, Anne Hege, Adamczewski, Olaf, Alektoror, Kirill, Alexander, März, Alexandrou, Maria, Alias, Quentin, Al-Kuzae, Fadha Elawi, Allard, Julien, Al-Schameri, Rahman, Álvarez, Alberto, Andersen, Grethe, AnkerlundBlaufeldt, Rolf, Antje, Riedel, Appelbohm, Hannes, Argren, Maria, Assmann, Anne, Augustin, Michael, Bach, Elke, Bar, Michal, Barleben, Maria, Baronnet, Flore, Barrios, Andrés, Bavúzová, Xénia, BayThomsen, Rikke, Becker, Sandra, Beer, Sylvia, Behme, Daniel, Bellut, Maximilian, Bendszus, Martin, Berkefeld, Joachim, Bester, Maximillian, Bode, Felix J., Boehme, Christian, Boese, Ramona, Bohmann, Ferdinand, Bonekamp, Susanne, Borggrefe, Jan, Boss, Erendira Gabriela, Boutchakova, Maria, Boxhammer, Elfi, Brandhofe, Annemarie, Breckwoldt, Michael, Brekenfeld, Casper, Brehm, Alex, Brem, Christian, Breuer, Stella, Breyer, Tobias, Brodová, Petra, Broocks, Gabriel, Brosinski, Christoph, Bubel, Nele, Búřil, Jiří, Čábal, Martin, Casado, Laura, de Celis, Elena, Chabert, Emmanuel, Charisse, Daniel, Cheng, Bastian, Chovanec, Vendelín, Cidlinsky, Peter, Cisár, Juraj, Clarençon, Fréderic, Crozier, Sophie, Čurdová, Nina, Damaskinos, Michele, Damgaard, Dorte, Daniš, Martin, Dazinger, Florian, Deb-Chatterji, Milani, Delalic, Asima, Delekta, Agnieszka, Delorme, Stephen, Deutschmann, Hannes, Diamandis, Elie, Diedrichsen, Tove, Doležalová, Irena, Dorn, Franziska, du Mesnil de Rochemont, Richard, DupontHougaard, Kristina, Ebrahimi, Taraneh, Eff, Florian, Eliášová, Ilona, Enriquez, Brian, Ergawy, Mostafa, Essig, Fabian, Falkesgaard, Maiken, Fandler-Höfler, Simon, Fernández, Andrés, Ferré, Jean-Christophe, Ferrier, Anna, Fiehler, Jens, Figlewski, Krystian, Fischer, Sebastian, Fischer, Urs, Flottmann, Fabian, Forbrig, Robert, Förch, Christian, Fromm, Annette, Fuentes, Blanca, Gaedke, Ines, Galczak, Romana, Galijasevic, Malik, Ganser, Bernhard, Gattringer, Thomas, Gawlitza, Matthias, Gelhard, Sarah, Gellißen, Susanne, Gerber, Johannes, Giannakakis, Michail Panagiotis, Gindlhuber, Karin, Gizewski, Elke R., Glodny, Bernhard, Godel, Tim, Goebell, Einar, Goldemund, David, Görtler, Michael, Goyal, Mayank, Grams, Astrid E., Gruber, Joachim, Gruber, Katharina, Günthner-Lengsfeld, Thomas, Haase, Kathrin, Hacker-Ivan, Floriana, Hallerstig, Erika, Hametner, Christian, Hanning, Uta, Haring, Jozef, Haršány, Michal, Haršány, Ján, Hartmann, Christian, Hassler, Eva Maria, Hauptmann, Kristina, Haeusler, Karl Georg, Hecker, Constantin, Hellstern, Victoria, Henkes, Hans, Hernández, Victoria, Herweh, Christian, Hilgenfeld, Tim, Hill, Michael D., Hjort, Niels, HjortJensen, Nina, Hoelter, Maya, Hoffmann, Karl-Titus, Holst, Brigitte, Holtmannspoetter, Markus, Hopf-Jensen, Silke, Hoppe, Julia, Horner, Susanne, HougaardSoerensen, Leif, Hua, Vi Tuan, Hubert, Alexander, Hurtíková, Eva, Jakubíček, Stanislava, Janjic, Tanja, Jaramillo, Kirsten, Jedlitschka, Angela, Jensen, Schiela, Jensen, Märit, Jesser, Jessica, Jestaedt, Leonie, Johnson, Sabine, Jonszta, Tomáš, Kalmar, Peter, Karabegovic, Sanja, Karen, Kollo, Kastrup, Andreas, Katja, Hopp, Keeba, Natalia, Keese, Petra, Kefaloykos, Christina, Keil, Fee, Kellert, Lars, Kellinghaus, Christoph, Kestner, Roxane-Isabelle, Kiechl, Stefan, Killer-Oberpfalzer, Monika, Klepanec, Andrej, Knispel, Casjupea, Knoflach, Michael, Kohler, Sabine, Kohlhase, Konstantin, Kollikowski, Alexander Marco, Kovář, Martin, Krajina, Antonín, Kral, Michael, Krastev, Georgi, Krause, Lars Udo, Kreidenhuber, Rudolf, Křivka, Tomáš, Krkoška, Adam, Kröger, Jan Robert, Kronlage, Moritz, Krukowski, Pawel, Kühn, Julia, Kurča, Egon, Kurka, Natalia, Kuschnerow, Michael, Lachmund, Rita, Lamprecht, Susanne, Lange, Rüdiger, Lauer, Monika, de Leciñana, Alonso, Leder, Sara, Leger, Anne, Lehnen, Nils, Lehrieder, Dominik, Leißner, Maximilian, Leitinger, Markus, Leitner, Ursula, Lenck, Stéphanie, Lenzenweger, Eva, Liebig, Thomas, Lowens, Stephan, Lunzer, Manuel, Maegerlein, Christian, Magyar, Marton, Marques, Leonardo, Matyáš, David, Maurer, Gabriele, Mauritz, Matthias, Maximilian, Thormann, Mayer-Süß, Lukas, Meckel, Stephan, Medek, Oldřich, Meissner, Julius N., Mencl, Pavel, Merkle, Andrea, Mesche, Birte, Michalski, Dominik, Mikulík, Robert, Modrau, Boris, Möhlenbruch, Markus A., Mohr, Alexander, Mönninghoff, Christoph, Moser, Tobias, Mücke, Ramona, Müller-Hülsbeck, Stefan, Müller-Thies-Broussalis, Erasmia, Mutzenbach, Sebastian, Navia, Pedro, Neuberger, Ulf, Neugebauer, Hermann, Neumann, Jens, Nguyên, Anh, Niederkorn, Kurt, Nosál', Vladimír, Novobilský, Richard, Ntoulias, Nikos, Nussbaum, Lukas, Oder, Joanna, Oldag, Andreas, Ondrejkovič, Marián, Otto, Ferdinand, Otto, Dagmar, Paech, Daniel, Pagano, Paolo, Pallesen, Lars-Peder, Panský, Michal, Papanagiotou, Panagiotis, Patrick, Samp, Paukisch, Harald, Pelz, Johann, Petersen, Inga, Petersen, Martina, Petzold, Gabor C., Pfaff, Johannes, Pfeilschifter, Waltraud, Pham, Mirko, Pichler, Alexander, Pierot, Laurent, Pikija, Slaven, PlougmannPovlsen, Jan, Polkowski, Christoph, Polomac, Nenad, Portugaller, Rupert Horst, Poulsen, Marika, Preiß, Michael, Premat, Kévin, Prestsæter, Sjur, Prieto-Pérez, Rocio, Psychogios, Marios, Puetz, Volker, Purrucker, Jan, Rai, Heike, Rauch, Maximilian, Raupach, Jan, Reimann, Gernot, Reimann, Georg, Reitz, Sarah, Renc, Ondřej, Retzlaff, Jasmin, Rigual, Ricardo, Ringleb, Peter Arthur, Rivera-Bengoa, Carlota, Rodríguez, Jorge, Rohde, Stefan, Rohler, Siegfried, Rosso, Charlotte, Roth, Christian, Röttcher, Thomas, Roubec, Martin, Roztočilová, Milada, Rudnicka, Svetlana, Ruiz, Gerardo, Ryan, Stephen, Ryckborst, Karla J., Sandvik, Simen, Schäfer, Jan-Hendrik, Schaller-Paule, Martin, Schell, Maximillian, Schellinger, Peter, Schlemm, Eckhard, Schmid, Florian, Schmidt, Christoph, Schmitz, Marie Louise, Schneider, Claus, Scholtz, Jan-Erik, Schönenberger, Silvia, Schröter, Andreas, Schwarz, Daniel, Schwarz, Stephan, Schwarzenhofer, Daniel, Seifert-Held, Thomas, Seiler, Alexander, Seker, Fatih, Shotar, Eimad, Simonsen, Claus Z., Simonsen, Maria Theresa, Sivák, Jozef, Skagen, Karolina, Skjelland, Mona, Šnajdrová, Alena, Solymosi, Lazlo, Sømark, Jesper, Sonnberger, Michael, Soršák, Jakub, Sourour, Nader, Søyland, Jogrim, Spitzer, Daniel, Sporns, Peter, Städt, Michael, Steidl, Eike, Størdal, Anne Margrethe Kaalaas, Stösser, Sebastian, Strickmann, Sarah, Strýček, Ondřej, Suškevič, Igor, Sýkora, Jan, Tennøe, Bjørn, Thaler, Daniela, Theisen, Sara, Thomalla, Götz, Trendafilov, Petar, Trenkler, Johannes, Trumm, Christoph, Tsogkas, Ioannis, Tunold, Jon-Anders, Tveit, Lars, Ulfert, Christian, Vališ, Kateřina, Vaníček, Jiří, Vassilev, Christine, Vítková, Eva, Voit-Höhne, Heinz-Leonhard, Vojtíšek, Bohuslav, Volderauer, Karoline, Vollherbst, Dominik, Vollmuth, Christoph, Volna, Kamila, Volný, Ondřej, VonWeitzel-Mudersbach, Poul, Vorčák, Martin, Wagner, Marlies, Wathle, Gaute Kjellevold, Weber, Werner, Weber, Anushe, Weiss, Viktor, Weller, Johannes M., Wenger-Alakmeh, Katharina, Weyland, Cyrill, Weymayr, Friedrich, Wießpeiner, Ulrike, Willeit, Johannes, Wittwer, Aymeric, Wollenweber, Frank, Wortmann, Ginette, Wunderlich, Silke, Xiong, Yanyan, You, Se-Jong, ZachoSpeiser, Lasse, Zamani, Mahtab, Zelenak, Kamil, Zeleňáková, Jana, Zubel, Seraphine, Subtil, Fabien, Gizewski, Elke R, Hill, Michael D, Krajina, Antonin, Simonsen, Claus Z, Zeleňák, Kamil, Blauenfeldt, Rolf A, Denis, Angélique, Gerber, Johannes C, Keil, Christiane Fee, Mikkelsen, Ronni, Möhlenbruch, Markus, Münnich, Nico, Petzold, Gabor C, Schell, Maximilian, Vollherbst, Dominik F, and Wick, Wolfgang

Published
2024
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14. Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomised trial

Author

Aamodt, Anne Hege, Adamczewski, Olaf, Alektoror, Kirill, Alexander, März, Alexandrou, Maria, Alias, Quentin, Al-Kuzae, Fadha Elawi, Allard, Julien, Al-Schameri, Rahman, Álvarez, Alberto, Andersen, Grethe, AnkerlundBlaufeldt, Rolf, Antje, Riedel, Appelbohm, Hannes, Argren, Maria, Assmann, Anne, Augustin, Michael, Bach, Elke, Bar, Michal, Barleben, Maria, Baronnet, Flore, Barrios, Andrés, Bavúzová, Xénia, BayThomsen, Rikke, Becker, Sandra, Beer, Sylvia, Behme, Daniel, Bellut, Maximilian, Bendszus, Martin, Berkefeld, Joachim, Bester, Maximillian, Bode, Felix J., Boehme, Christian, Boese, Ramona, Bohmann, Ferdinand, Bonekamp, Susanne, Borggrefe, Jan, Boss, Erendira Gabriela, Boutchakova, Maria, Boxhammer, Elfi, Brandhofe, Annemarie, Breckwoldt, Michael, Brekenfeld, Casper, Brehm, Alex, Brem, Christian, Breuer, Stella, Breyer, Tobias, Brodová, Petra, Broocks, Gabriel, Brosinski, Christoph, Bubel, Nele, Búřil, Jiří, Čábal, Martin, Casado, Laura, Celis, Elena de, Chabert, Emmanuel, Charisse, Daniel, Cheng, Bastian, Chovanec, Vendelín, Cidlinsky, Peter, Cisár, Juraj, Clarençon, Fréderic, Crozier, Sophie, Čurdová, Nina, Damaskinos, Michele, Damgaard, Dorte, Daniš, Martin, Dazinger, Florian, Deb-Chatterji, Milani, Delalic, Asima, Delekta, Agnieszka, Delorme, Stephen, Deutschmann, Hannes, Diamandis, Elie, Diedrichsen, Tove, Doležalová, Irena, Dorn, Franziska, du Mesnil de Rochemont, Richard, DupontHougaard, Kristina, Ebrahimi, Taraneh, Eff, Florian, Eliášová, Ilona, Enriquez, Brian, Ergawy, Mostafa, Essig, Fabian, Falkesgaard, Maiken, Fandler-Höfler, Simon, Fernández, Andrés, Ferré, Jean-Christophe, Ferrier, Anna, Fiehler, Jens, Figlewski, Krystian, Fischer, Sebastian, Fischer, Urs, Flottmann, Fabian, Forbig, Robert, Förch, Christian, Fromm, Annette, Fuentes, Blanca, Gaedke, Ines, Galczak, Romana, Galijasevic, Malik, Ganser, Bernhard, Gattringer, Thomas, Gawlitza, Matthias, Gelhard, Sarah, Gellißen, Susanne, Gerber, Johannes, Giannakakis, Michail Panagiotis, Gindlhuber, Karin, Gizewski, Elke R., Glodny, Bernhard, Godel, Tim, Goebell, Einar, Goldemund, David, Görtler, Michael, Goyal, Mayank, Grams, Astrid E., Gruber, Joachim, Gruber, Katharina, Günthner-Lengsfeld, Thomas, Haase, Kathrin, Hacker-Ivan, Floriana, Hallerstig, Erika, Hanning, Uta, Haring, Jozef, Haršány, Michal, Haršány, Ján, Hartmann, Christian, Hassler, Eva Maria, Hauptmann, Kristina, Häusler, Karl Georg, Hecker, Constantin, Hellstern, Victoria, Henkes, Hans, Hernández, Victoria, Herweh, Christian, Hilgenfeld, Tim, Hill, Michael D., Hjort, Niels, HjortJensen, Nina, Hoelter, Maya, Hoffmann, Karl-Titus, Holst, Brigitte, Holtmannspoetter, Markus, Hopf-Jensen, Silke, Hoppe, Julia, Horner, Susanne, HougaardSoerensen, Leif, Hua, Vi Tuan, Hubert, Alexander, Hurtíková, Eva, Jakubíček, Stanislava, Janjic, Tanja, Jaramillo, Kirsten, Jedlitschka, Angela, Jensen, Schiela, Jensen, Märit, Jesser, Jessica, Jestaedt, Leonie, Johnson, Sabine, Jonszta, Tomáš, Kalmar, Peter, Karabegovic, Sanja, Karen, Kollo, Kastrup, Andreas, Katja, Hopp, Keeba, Natalia, Keese, Petra, Kefalaykos, Christina, Keil, Fee, Kellert, Lars, Kellinghaus, Christoph, Kestner, Roxane-Isabelle, Kiechl, Stefan, Killer-Oberpfalzer, Monika, Klepanec, Andrej, Knispel, Casjupea, Knoflach, Michael, Kohler, Sabine, Kohlhase, Konstantin, Kollikowski, Alexander Marco, Kovář, Martin, Krajina, Antonín, Kral, Michael, Krastev, Georgi, Krause, Lars Udo, Kreidenhuber, Rudolf, Křivka, Tomáš, Krkoška, Adam, Kröger, Jan Robert, Kronlage, Moritz, Krukowski, Pawel, Kühn, Julia, Kurča, Egon, Kurka, Natalia, Kuschnerow, Michael, Lachmund, Rita, Lamprecht, Susanne, Lange, Rüdiger, Lauer, Monika, Leciñana, Alonso de, Leder, Sara, Leger, Anne, Lehnen, Nils, Lehrieder, Dominik, Leißner, Maximilian, Leitinger, Markus, Leitner, Ursula, Lenck, Stéphanie, Lenzenweger, Eva, Liebig, Thomas, Lowens, Stephan, Lunzer, Manuel, Maegerlein, Christian, Magyar, Marton, Marques, Leonardo, Matyáš, David, Maurer, Gabriele, Mauritz, Matthias, Maximilian, Thormann, Mayer-Süß, Lukas, Meckel, Stephan, Medek, Oldřich, Meissner, Julius N., Mencl, Pavel, Merkle, Andrea, Mesche, Birte, Michalski, Dominik, Mikulík, Robert, Modrau, Boris, Möhlenbruch, Markus A., Mohr, Alexander, Mönninghoff, Christoph, Moser, Tobias, Mücke, Ramona, Müller-Hülsbeck, Stefan, Müller-Thies-Broussalis, Erasmia, Mutzenbach, Sebastian, Navia, Pedro, Neuberger, Ulf, Neugebauer, Hermann, Neumann, Jens, Nguyên, Anh, Niederkorn, Kurt, Nosál', Vladimír, Novobilský, Richard, Ntoulias, Nikos, Nussbaum, Lukas, Oder, Joanna, Oldag, Andreas, Ondrejkovič, Marián, Otto, Ferdinand, Otto, Dagmar, Paech, Daniel, Pagano, Paolo, Pallesen, Lars-Peder, Panský, Michal, Papanagiotou, Panagiotis, Patrick, Samp, Paukisch, Harald, Pelz, Johann, Petersen, Inga, Petersen, Martina, Petzold, Gabor C., Pfaff, Johannes, Pfeilschifter, Waltraud, Pham, Mirko, Pichler, Alexander, Pierot, Laurent, Pikija, Slaven, PlougmannPovlsen, Jan, Polkowski, Christoph, Polomac, Nenad, Portugaller, Rupert Horst, Poulsen, Marika, Preiß, Michael, Premat, Kévin, Prestsæter, Sjur, Prieto-Pérez, Rocio, Psychogios, Marios, Puetz, Volker, Purrucker, Jan, Rai, Heike, Rauch, Maximilian, Raupach, Jan, Reimann, Gernot, Reimann, Georg, Reitz, Sarah, Renc, Ondřej, Retzlaff, Jasmin, Rigual, Ricardo, Ringleb, Peter Arthur, Rivera-Bengoa, Carlota, Rodríguez, Jorge, Rohde, Stefan, Rohler, Siegfried, Rosso, Charlotte, Roth, Christian, Röttcher, Thomas, Roubec, Martin, Roztočilová, Milada, Rudnicka, Svetlana, Ruiz, Gerardo, Ryan, Stephen, Ryckborst, Karla J., Sandvik, Simen, Schäfer, Jan-Hendrik, Schaller-Paule, Martin, Schell, Maximillian, Schellinger, Peter, Schlemm, Eckhard, Schmid, Florian, Schmidt, Christoph, Schmitz, Marie Louise, Schneider, Claus, Scholtz, Jan-Erik, Schönenberger, Silvia, Schröter, Andreas, Schwarz, Daniel, Schwarz, Stephan, Schwarzenhofer, Daniel, Seifert-Held, Thomas, Seiler, Alexander, Seker, Fatih, Shotar, Eimad, Simonsen, Claus Z., Simonsen, Maria Theresa, Sivák, Jozef, Skagen, Karolina, Skjelland, Mona, Šnajdrová, Alena, Solymosi, Lazlo, Sømark, Jesper, Sonnberger, Michael, Soršák, Jakub, Sourour, Nader, Søyland, Jogrim, Spitzer, Daniel, Sporns, Peter, Städt, Michael, Steidl, Eike, Størdal, Anne Margrethe Kaalaas, Stösser, Sebastian, Strickmann, Sarah, Strýček, Ondřej, Suškevič, Igor, Sýkora, Jan, Tennøe, Bjørn, Thaler, Daniela, Theisen, Sara, Thomalla, Götz, Trendafilov, Petar, Trenkler, Johannes, Trumm, Christoph, Tsogkas, Ioannis, Tunold, Jon-Anders, Tveit, Lars, Ulfert, Christian, Vališ, Kateřina, Vaníček, Jiří, Vassilev, Christine, Vítková, Eva, Voit-Höhne, Heinz-Leonhard, Vojtíšek, Bohuslav, Volderauer, Karoline, Vollherbst, Dominik, Vollmuth, Christoph, Volna, Kamila, Volný, Ondřej, VonWeitzel-Mudersbach, Poul, Vorčák, Martin, Wagner, Marlies, Wathle, Gaute Kjellevold, Weber, Werner, Weber, Anushe, Weiss, Viktor, Weller, Johannes M., Wenger-Alakmeh, Katharina, Weyland, Cyrill, Weymayr, Friedrich, Wießpeiner, Ulrike, Willeit, Johannes, Wittwer, Aymeric, Wollenweber, Frank, Wortmann, Ginette, Wunderlich, Silke, Xiong, Yanyan, You, Se-Jong, ZachoSpeiser, Lasse, Zelenak, Kamil, Zeleňáková, Jana, Zubel, Seraphine, Subtil, Fabien, Gizewski, Elke R, Hill, Michael D, Krajina, Antonin, Simonsen, Claus Z, Zeleňák, Kamil, Blauenfeldt, Rolf A, Denis, Angélique, Gerber, Johannes C, Keil, Christiane Fee, Mikkelsen, Ronni, Möhlenbruch, Markus, Münnich, Nico, Petzold, Gabor C, Schell, Maximilian, Vollherbst, Dominik F, and Wick, Wolfgang

Published
2023
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15. Remote Training of Neurointerventions by Audiovisual Streaming: Experiences from the European ESMINT-EYMINT E-Fellowship Program

Author

Hanning, Uta, Bechstein, Matthias, Kaesmacher, Johannes, Boulouis, Grégoire, Chapot, René, Andersson, Tommy, Boccardi, Edoardo, Psychogios, Marios, Cognard, Christophe, de Dios Lascuevas, Marta, Rodrigues, Marta, Rodriguez Caamaño, Isabel, Gargalas, Sergios, Simonato, Davide, Zupancic, Vedran, Daller, Cornelia, Meyer, Lukas, Broocks, Gabriel, Guerreiro, Helena, Fiehler, Jens, Martínez-Galdamez, Mario, and Kalousek, Vladimir

Published
2023
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17. Effect of Asymptomatic and Symptomatic COVID-19 on Acute Ischemic Stroke Revascularization Outcomes

Author

Strambo, Davide, Marto, João Pedro, Ntaios, George, Nguyen, Thanh N., Michel, Patrik, Herzig, Roman, Członkowksa, Anna, Demeestere, Jelle, Yassin Mansour, Ossama, Georgiopoulos, Georgios, Nogueira, Raul G., Salerno, Alexander, Wegener, Susanne, Baumgartner, Philipp, Cereda, Carlo W., Bianco, Giovanni, Beyeler, Morin, Arnold, Marcel, Carrera, Emmanuel, Machi, Paolo, Altersberger, Valerian, Bonati, Leo, Gensicke, Henrik, Bolognese, Manuel, Peters, Nils, Wetzel, Stephan, Magriço, Marta, Nuno Ramos, João, Sargento-Freitas, João, Machado, Rita, Maia, Carolina, Machado, Egídio, Paiva-Nunes, Ana, Ferreira, Patrícia, Pinho-e-Melo, Teresa, Carvalho-Dias, Mariana, Paula, André, Alberto Correia, Manuel, Castro, Pedro, Azevedo, Elsa, Albuquerque, Luís, Nuno-Alves, José, Ferreira-Pinto, Joana, Meira, Torcato, Pereira, Liliana, Rodrigues, Miguel, Araújo, André, Rodrigues, Marta, Rocha, Mariana, Pereira-Fonseca, Ângelo, Ribeiro, Luís, Varela, Ricardo, Cappellari, Manuel, Zivelonghi, Cecilia, Sajeva, Giulia, Zini, Andrea, Gentile, Mauro, Forlivesi, Stefano, Migliaccio, Ludovica, Sessa, Maria, Pezzini, Alessandro, Sangalli, Davide, Zedde, Marialuisa, Pascarella, Rosario, Diamanti, Susanna, Beretta, Simone, Schwarz, Ghil, Frisullo, Giovanni, Marcheselli, Simona, Seners, Pierre, Sabben, Candice, Escalard, Simon, Piotin, Michel, Maier, Benjamin, Charbonnier, Guillaume, Vuillier, Fabrice, Legris, Loic, Cuisenier, Pauline, Vodret, Francesca R., Marnat, Gaultier, Liegey, Jean-Sebastien, Sibon, Igor, Flottmann, Fabian, Broocks, Gabriel, Gloyer, Nils-Ole, Bohmann, Ferdinand O., Hendrik Schaefer, Jan, Nolte, Christian H., Audebert, Heinrich, Siebert, Eberhard, Sykora, Marek, Lang, Wilfried, Ferrari, Julia, Mayer-Suess, Lukas, Knoflach, Michael, Gizewski, Elke-Ruth, Stolp, Jeffrey, Stolze, Lotte J., Coutinho, Jonathan M., Nederkoorn, Paul J., van-den-Wijngaard, Ido, de Meris, Joke, Lemmens, Robin, De Raedt, Sylvie, Vandervorst, Fenne, Pierre Rutgers, Matthieu, Guilmot, Antoine, Dusart, Anne, Bellante, Flavio, Calleja-Castaño, Patricia, Ostos, Fernando, Gonzalez-Ortega, Guillermo, Martín-Jiménez, Paloma, García-Madrona, Sebastian, Cruz-Culebras, Antonio, Vera, Rocio, Matute, Maria-Consuelo, Fuentes, Blanca, Alonso-de-Leciñana, María, Rigual, Ricardo, Díez-Tejedor, Exuperio, Pérez-Sánchez, Soledad, Montaner, Joan, Díaz-Otero, Fernando, Perez de la Ossa, Natalia, Flores-Pina, Belén, Muñoz-Narbona, Lucia, Chamorro, Angel, Rodríguez-Vázquez, Alejandro, Renú, Arturo, Ayo-Martin, Oscar, Hernandez-Fernandez, Francisco, Segura, Tomas, Tejada-Meza, Herbert, Hlaing, Thant, See, Isaiah, Simister, Robert, Werring, David J., Saxhaug Kristoffersen, Espen, Nordanstig, Annika, Jood, Katarina, Rentzos, Alexandros, Šimůnek, Libor, Krajíčková, Dagmar, Krajina, Antonín, Mikulík, Robert, Cviková, Martina, Vinklárek, Jan, Školoudík, David, Roubec, Martin, Hurtikova, Eva, Hrubý, Rostislav, Ostry, Svatopluk, Skoda, Ondrej, Pernicka, Marek, Kočí, Lubomír, Eichlová, Zuzana, Jíra, Martin, Kovář, Martin, Panský, Michal, Mencl, Pavel, Paloušková, Hana, Tomek, Aleš, Janský, Petr, Olšerová, Anna, Šrámek, Martin, Havlíček, Roman, Malý, Petr, Trakal, Lukáš, Fiksa, Jan, Slovák, Matěj, Karliński, Michał, Nowak, Maciej, Sienkiewicz-Jarosz, Halina, Bochynska, Anna, Wrona, Pawel, Homa, Tomasz, Sawczynska, Katarzyna, Slowik, Agnieszka, Wlodarczyk, Ewa, Wiącek, Marcin, Tomaszewska-Lampart, Izabella, Sieczkowski, Bartosz, Bartosik-Psujek, Halina, Bilik, Marta, Bandzarewicz, Anna, Dorobek, Malgorzata, Zielińska-Turek, Justyna, Nowakowska-Kotas, Marta, Obara, Krystian, Urbanowski, Paweł, Budrewicz, Sławomir, Guziński, Maciej, Świtońska, Milena, Rutkowska, Iwona, Sobieszak-Skura, Paulina, Łabuz-Roszak, Beata, Dębiec, Aleksander, Staszewski, Jacek, Stępień, Adam, Zwiernik, Jacek, Wasilewski, Grzegorz, Tiu, Cristina, Terecoasă, Elena-Oana, Radu, Razvan-Alexandru, Negrila, Anca, Dorobat, Bogdan, Panea, Cristina, Tiu, Vlad, Petrescu, Simona, Özcan-Özdemir, Atilla, Mahmoud, Mostafa, El-Samahy, Hussam, Abdelkhalek, Hazem, Al-Hashel, Jasem, Ibrahim Ismail, Ismail, Salmeen, Athari, Ghoreishi, Abdoreza, Sabetay, Sergiu, Gross, Hana, Klein, Piers, Abdalkader, Mohamad, Jabbour, Pascal, El Naamani, Kareem, Tjoumakaris, Stavropoula, Abbas, Rawad, Mohamed, Ghada-A., Chebl, Alex, Min, Jiangyong, Hovingh, Majesta, Tsai, Jenny, Khan, Muhib-A., Nalleballe, Krishna, Onteddu, Sanjeeva, Masoud, Hesham E., Michael, Mina, Kaur, Navreet, Maali, Laith, Abraham, Michael, Khandelwal, Priyank, Bach, Ivo, Ong, Melody, Babici, Denis, Khawaja, Ayaz-M., Hakemi, Maryam, Rajamani, Kumar, Cano-Nigenda, Vanessa, Arauz, Antonio, Amaya, Pablo, Llanos, Natalia, Arango, Akemi, Vences, Miguel A., Barrientos, José-Domingo, Caetano, Rayllene, Targa, Rodrigo, Scollo, Sergio, Yalung, Patrick, Nagendra, Shashank, Gaikwad, Abhijit, and Seo, Kwon-Duk

Published
2024
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18. Correction to: Non-contrast computed tomography features predict intraventricular hemorrhage growth

Author

Nawabi, Jawed, Schlunk, Frieder, Dell’Orco, Andrea, Elsayed, Sarah, Mazzacane, Federico, Desser, Dmitriy, Vu, Ly, Vogt, Estelle, Cao, Haoyin, Böhmer, Maik F. H., Akkurt, Burak Han, Sporns, Peter B., Pasi, Marco, Jensen-Kondering, Ulf, Broocks, Gabriel, Penzkofer, Tobias, Fiehler, Jens, Padovani, Alessandro, Hanning, Uta, and Morotti, Andrea

Published
2023
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19. Association Between Recanalization Attempts and Functional Outcome After Thrombectomy for Large Ischemic Stroke

Author

Winkelmeier, Laurens, Faizy, Tobias D., Broocks, Gabriel, Meyer, Lukas, Heitkamp, Christian, Brekenfeld, Caspar, Thaler, Christian, Steffen, Paul, Schell, Maximilian, Deb-Chatterji, Milani, Hanning, Uta, Kniep, Helge, Maros, Máté E., Thomalla, Götz, Fiehler, Jens, Flottmann, Fabian Alexander, Alegiani, Anna, Berrouschot, Jörg, Boeckh-Behrens, Tobias, Bohner, Georg, Borggrefe, Jan, Bormann, Albrecht, Braun, Michael, Dorn, Franziska, Eckert, Bernd, Ernemann, Ulrike, Ernst, Marielle, Gerloff, Christian, Gröschel, Klaus, Hamann, Gerhard F., Hattingen, Jörg, Henn, Karl-Heinz, Keil, Fee, Kellert, Lars, Kraemer, Christoffer, Mühl-Benninghaus, Ruben, Liman, Jan, Ludolph, Alexander, Nolte, Christian, Nikoubashman, Omid, Petersen, Martina, Petzold, Gabor, Poli, Sven, Reich, Arno, Röther, Joachim, Schäfer, Jan Hendrik, Schellinger, Peter, Siebert, Eberhard, Stögbauer, Florian, Tiedt, Steffen, Trumm, Christoph, Uphaus, Timo, Wunderlich, Silke, and Zweynert, Sarah

Published
2023
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21. Thrombectomy for M2 Occlusions: Predictors of Successful and Futile Recanalization

Author

Kniep, Helge, Meyer, Lukas, Broocks, Gabriel, Bechstein, Matthias, Heitkamp, Christian, Winkelmeier, Laurens, Faizy, Tobias, Brekenfeld, Caspar, Flottmann, Fabian, Deb-Chatterji, Milani, Alegiani, Anna, Hanning, Uta, Thomalla, Götz, Fiehler, Jens, Gellißen, Susanne, Röther, Joachim, Eckert, Bernd, Braun, Michael, Hamann, Gerhard F., Siebert, Eberhard, Nolte, Christian, Zweynert, Sarah, Bohner, Georg, Berrouschot, Jörg, Bormann, Albrecht, Kraemer, Christoffer, Leischner, Hannes, Hattingen, Jörg, Petersen, Martina, Stögbauer, Florian, Boeckh-Behrens, Tobias, Wunderlich, Silke, Ludolph, Alexander, Henn, Karl-Heinz, Gerloff, Christian, Schell, Maximilian, Reich, Arno, Nikoubashman, Omid, Dorn, Franziska, Petzold, Gabor, Liman, Jan, Schäfer, Jan Hendrik, Keil, Fee, Gröschel, Klaus, Uphaus, Timo, Schellinger, Peter, Borggrefe, Jan, Tiedt, Steffen, Kellert, Lars, Trumm, Christoph, Ernemann, Ulrike, Poli, Sven, Riedel, Christian, and Ernst, Marielle Sophie

Published
2023
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28. Brain edema growth after thrombectomy is associated with comprehensive collateral blood flow.

Author

Faizy, Tobias D., Winkelmeier, Laurens, Mlynash, Michael, Broocks, Gabriel, Heitkamp, Christian, Thaler, Christian, van Horn, Noel, Seners, Pierre, Kniep, Helge, Stracke, Paul, Zelenak, Kamil, Lansberg, Maarten G., Albers, Gregory W., Wintermark, Max, Fiehler, Jens, and Heit, Jeremy J.

Subjects
RISK assessment, RESEARCH funding, BLOOD vessels, COMPUTED tomography, MULTIPLE regression analysis, RETROSPECTIVE studies, QUANTITATIVE research, MULTIVARIATE analysis, DESCRIPTIVE statistics, ODDS ratio, RESEARCH, MEDICAL records, ACQUISITION of data, THROMBECTOMY, COLLATERAL circulation, CEREBRAL circulation, STROKE patients, COMPARATIVE studies, CONFIDENCE intervals, CEREBRAL ischemia, CEREBRAL edema, PSYCHOSOCIAL factors, DISEASE risk factors
Abstract

Background We determined whether a comprehensive assessment of cerebral collateral blood flow is associated with ischemic lesion edema growth in patients successfully treated by thrombectomy. Methods This was a multicenter retrospective study of ischemic stroke patients who underwent thrombectomy treatment of large vessel occlusions. Collateral status was determined using the cerebral collateral cascade (CCC) model, which comprises three components: arterial collaterals (Tan Scale) and venous outflow profiles (Cortical Vein Opacification Score) on CT angiography, and tissue-level collaterals (hypoperfusion intensity ratio) on CT perfusion. Quantitative ischemic lesion net water uptake (NWU) was used to determine edema growth between admission and follow-up non-contrast head CT (ΔNWU). Three groups were defined: CCC+ (good pial collaterals, tissue-level collaterals, and venous outflow), CCC- (poor pial collaterals, tissue-level collaterals, and venous outflow), and CCCmixed (remainder of patients). Primary outcome was ischemic lesion edema growth (ΔNWU). Multivariable regression models were used to assess the primary and secondary outcomes. Results 538 patients were included. 157 patients had CCC+, 274 patients CCC mixed, and 107 patients CCC-profiles. Multivariable regression analysis showed that compared with patients with CCC+ profiles, CCC- (β 1.99, 95% CI 0.68 to 3.30, P=0.003) and CCC mixed (β 1.65, 95% CI 0.75 to 2.56, P<0.001) profiles were associated with greater ischemic lesion edema growth (ΔNWU) after successful thrombectomy treatment. ΔNWU (OR 0.74, 95% CI 0.68 to 0.8, P<0.001) and CCC+ (OR 13.39, 95% CI 4.88 to 36.76, P<0.001) were independently associated with functional independence. Conclusion A comprehensive assessment of cerebral collaterals using the CCC model is strongly associated with edema growth and functional independence in acute stroke patients successfully treated by endovascular thrombectomy. [ABSTRACT FROM AUTHOR]

Published
2024
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29. Predictors of futile recanalization in ischemic stroke patients with low baseline NIHSS.

Author

Heitkamp, Christian, Heitkamp, Alexander, Winkelmeier, Laurens, Thaler, Christian, Flottmann, Fabian, Schell, Maximilian, Kniep, Helge C, Broocks, Gabriel, Heit, Jeremy J, Albers, Gregory W, Thomalla, Götz, Fiehler, Jens, and Faizy, Tobias D

Subjects
STROKE patients, CEREBRAL infarction, INTRACRANIAL hemorrhage, LOGISTIC regression analysis, ISCHEMIC stroke
Abstract

Background: There is yet no randomized controlled evidence that mechanical thrombectomy (MT) is superior to best medical treatment in patients with large vessel occlusion but minor stroke symptoms (National Institutes of Health Stroke Scale (NIHSS) <6). Prior studies of patients with admission NIHSS scores ≥ 6 observed unfavorable functional outcomes despite successful recanalization, commonly termed as futile recanalization (FR), in up to 50% of cases. Aim: The aim of this study is to determine the prevalence of FR in patients with minor stroke and identify associated patient-specific risk factors. Methods: Our multicenter cohort study screened all patients prospectively enrolled in the German Stroke Registry Endovascular Treatment from 2015 to 2021 (n = 13,082). Included were patients who underwent MT for anterior circulation vessel occlusion with a baseline NIHSS score of <6 and successful recanalization (modified Thrombolysis in Cerebral Infarction (mTICI) scores of 2b–3). FR was defined by modified Rankin Scale (mRS) scores of 2–6 at 90 days. Multivariable logistic regression analysis was conducted to explore factors associated with FR. Results: A total of 674 patients met the inclusion criteria. FR occurred in 268 (40%) patients. Multivariable logistic regression analysis indicates that higher age (adjusted odds ratio (aOR) = 1.04 (95% confidence interval (CI) = 1.02–1.06)), pre-stroke mRS 1 (aOR = 2.70 (95% CI = 1.51–4.84)), transfer from admission hospital to comprehensive stroke center (aOR = 1.67 (95% CI = 1.08–2.56)), longer time from symptom onset/last seen well to admission (aOR = 1.02 (95% CI = 1.00–1.04)), MT under general anesthesia (aOR = 1.78 (95% CI = 1.13–2.82)), higher NIHSS after 24 h (aOR = 1.09 (95% CI = 1.05–1.14)), and symptomatic intracranial hemorrhage (aOR = 16.88 (95% CI = 2.03–140.14)) increased the odds of FR. There was no significant difference in primary outcome between achieving mTICI score of 2b or 3. Conclusions: Unfavorable functional outcomes despite successful vessel recanalization were frequent in acute ischemic stroke patients with low NIHSS scores on admission. We provide patient-specific risk factors that indicate an increased risk of FR and should be considered when treating patients with minor stroke. Data accessibility statement: The data that support the findings of our study are available on reasonable request after approval of the German Stroke Registry (GSR) steering committee. [ABSTRACT FROM AUTHOR]

Published
2024
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30. Comparison of Thrombolysis In Cerebral Infarction (TICI) 2b and TICI 3 reperfusion in endovascular therapy for large ischemic anterior circulation strokes.

Author

Winkelmeier, Laurens, Faizy, Tobias D., Brekenfeld, Caspar, Heitkamp, Christian, Broocks, Gabriel, Bechstein, Matthias, Steffen, Paul, Schell, Maximilian, Gellissen, Susanne, Kniep, Helge, Thomalla, Goetz, Fiehler, Jens, and Flottmann, Fabian

Subjects
INTRACRANIAL hemorrhage, THROMBOLYTIC therapy, PATIENT safety, ENDOVASCULAR surgery, TREATMENT effectiveness, RETROSPECTIVE studies, DESCRIPTIVE statistics, LONGITUDINAL method, ODDS ratio, ISCHEMIC stroke, RESEARCH, CEREBRAL infarction, REPERFUSION, CEREBRAL circulation, COMPARATIVE studies, CONFIDENCE intervals
Abstract

Background Landmark thrombectomy trials have provided evidence that selected patients with large ischemic stroke benefit from successful endovascular therapy, commonly defined as incomplete (modified Thrombolysis In Cerebral Infarction (mTICI) 2b) or complete reperfusion (mTICI 3). We aimed to investigate whether mTICI 3 improves functional outcomes compared with mTICI 2b in large ischemic strokes. Methods This retrospective multicenter cohort study was conducted to compare mTICI 2b versus mTICI 3 in large ischemic strokes in the anterior circulation. Patients enrolled in the German Stroke Registry between 2015-2021 were analyzed. Large ischemic stroke was defined as an Alberta Stroke Program Early CT Score (ASPECTS) of 3-5. Patients were matched by final mTICI grade using propensity score matching. Primary outcome was the 90-day modified Rankin Scale (mRS) score. Results After matching, 226 patients were included. Baseline and imaging characteristics were balanced between mTICI 2b and mTICI 3 patients. There was no shift on the mRS favoring mTICI 3 compared with mTICI 2b in large ischemic strokes (adjusted common odds ratio (acOR) 1.12, 95% confidence interval (95% CI) 0.64 to 1.94, P=0.70). The rate of symptomatic intracranial hemorrhage was higher in mTICI 2b than in mTICI 3 patients (12.6% vs 4.5%, P=0.03). Mortality at 90 days did not differ between mTICI 3 and mTICI 2b (33.6% vs 37.2%; adjusted OR 0.69, 95% CI 0.33 to 1.45, P=0.33). Conclusions In endovascular therapy for large ischemic strokes, mTICI 3 was not associated with better 90-day functional outcomes compared with mTICI 2b. This study suggests that mTICI 2b might be warranted as the final angiographic result, questioning the benefit/risk ratio of additional maneuvers to seek for mTICI 3 in large ischemic strokes. [ABSTRACT FROM AUTHOR]

Published
2024
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38. Thrombectomy in ischemic stroke patients with large core but minor ischemic changes on non-enhanced computed tomography.

Author

Broocks, Gabriel, Kniep, Helge, McDonough, Rosalie, Bechstein, Matthias, Heitkamp, Christian, Winkelmeier, Laurens, Klapproth, Susan, Faizy, Tobias D, Schell, Maximilian, Schön, Gerhard, Hanning, Uta, Gellißen, Susanne, Kemmling, Andre, Papanagiotou, Panagiotis, Fiehler, Jens, and Meyer, Lukas

Abstract

Purpose: The Alberta Stroke Program Early CT Score (ASPECTS) is regularly used to guide patient selection for mechanical thrombectomy (MT). Similarly, penumbral imaging based on computed tomography perfusion (CTP) may serve as neuroimaging tool to guide treatment. Yet, patients with a large ischemic core on CTP may show only minor ischemic changes resulting in a high ASPECTS. Aim: We hypothesized twofold: (1) the treatment effect of vessel recanalization in patients with core volume > 50 mL but ASPECTS ⩾ 6 is not different compared to high ASPECTS patients with core volume < 50 mL, and (2) recanalization is associated with core overestimation. Methods: We conducted an observational study analyzing ischemic stroke patients consecutively treated with MT after triage by multimodal CT. Functional endpoint was the rate of functional independence at Day 90 defined as modified Rankin Scale (mRS) 0–2. Imaging endpoint was core overestimation, which was considered when CTP-derived core was larger than the final infarct volume assessed on follow-up imaging. Recanalization was evaluated with the extended Thrombolysis in Cerebral Infarction (eTICI) scale. Multivariable logistic regression analysis and propensity score matching (PSM) were used to assess the association of recanalization (eTICI ⩾ 2b) with functional outcome and core overestimation. Results: Of 630 patients with ASPECTS ⩾ 6, 91 patients (14.4%) had a large ischemic core. Following 1:1 PSM, the treatment effect of recanalization was not different in patients with large core and ASPECTS ⩾ 6 (+ 25.8%, 95% CI: 16.3–35.4, p < 0.001) compared to patients with ASPECTS ⩾ 6 and core volume < 50 mL (+ 14.9%, 95% CI: 5.7–24.1, p = 0.002). Recanalization (aOR: 3.46, 95% CI: 1.85–6.47, p < 0.001) and higher core volume (aOR: 1.03, 95% CI: 1.02–1.04, p < 0.001) were significantly associated with core overestimation. Conclusion: In patients with ASPECTS ⩾ 6, core volumes did not significantly modify outcomes following recanalization. Reperfusion and higher core volume were significantly associated with core overestimation which may explain the treatment effect of MT for patients with a large ischemic core but minor ischemic changes on non-enhanced CT. Data access statement: The data analyzed in this study will be available and shared on reasonable request from any qualified researcher for the purpose of replicating the results after clearance by the local ethics committee. [ABSTRACT FROM AUTHOR]

Published
2024
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39. Association between occlusion location, net water uptake and ischemic lesion growth in large vessel anterior circulation strokes.

Author

Winkelmeier, Laurens, Heit, Jeremy J, Broocks, Gabriel, Prüter, Julia, Heitkamp, Christian, Schell, Maximilian, Albers, Gregory W, Lansberg, Maarten G, Wintermark, Max, Kemmling, André, Stracke, Christian Paul, Guenego, Adrien, Paech, Daniel, Fiehler, Jens, and Faizy, Tobias D

Abstract

Ischemic lesion net water uptake (NWU) represents a quantitative imaging biomarker for cerebral edema in acute ischemic stroke. Data on NWU for distinct occlusion locations remain scarce, but might help to improve the prognostic value of NWU. In this retrospective multicenter cohort study, we compared NWU between patients with proximal large vessel occlusion (pLVO; ICA or proximal M1) and distal large vessel occlusion (dLVO; distal M1 or M2). NWU was quantified by densitometric measurements of the early ischemic region. Arterial collateral status was assessed using the Maas scale. Regression analysis was used to investigate the relationship between occlusion location, NWU and ischemic lesion growth. A total of 685 patients met inclusion criteria. Early ischemic lesion NWU was higher in patients with pLVO compared with dLVO (7.7% vs 3.9%, P <.001). The relationship between occlusion location and NWU was partially mediated by arterial collateral status. NWU was associated with absolute ischemic lesion growth between admission and follow-up imaging (β estimate, 5.50, 95% CI, 3.81–7.19, P <.001). This study establishes a framework for the relationship between occlusion location, arterial collateral status, early ischemic lesion NWU and ischemic lesion growth. Future prognostic thresholds for NWU might be optimized by adjusting for the occlusion location. [ABSTRACT FROM AUTHOR]

Published
2024
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41. Prediction of tissue outcome in acute ischemic stroke based on single-phase CT angiography at admission

Author

Palsson, Frosti, primary, Forkert, Nils D., additional, Meyer, Lukas, additional, Broocks, Gabriel, additional, Flottmann, Fabian, additional, Maros, Máté E., additional, Bechstein, Matthias, additional, Winkelmeier, Laurens, additional, Schlemm, Eckhard, additional, Fiehler, Jens, additional, Gellißen, Susanne, additional, and Kniep, Helge C., additional

Published
2024
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46. Cerebrovascular Collateral Integrity in Pediatric Large Vessel Occlusion: Analysis of the Save ChildS Study

Author

Lee, Sarah, Jiang, Bin, Wintermark, Max, Mlynash, Michael, Christensen, Soren, Sträter, Ronald, Broocks, Gabriel, Grams, Astrid, Dorn, Franziska, Nikoubashman, Omid, Kaiser, Daniel, Morotti, Andrea, Jensen-Kondering, Ulf, Trenkler, Johannes, Möhlenbruch, Markus, Fiehler, Jens, Wildgruber, Moritz, Kemmling, André, Psychogios, Marios, and Sporns, Peter B.

Published
2022
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47. How much of the outcome improvement after successful recanalization is explained by follow-up infarct volume reduction?

Author

Kniep, Helge, Meyer, Lukas, Broocks, Gabriel, Bechstein, Matthias, Austein, Friederike, McDonough, Rosalie V., Brekenfeld, Caspar, Flottmann, Fabian, Deb-Chatterji, Milani, Alegiani, Anna, Hanning, Uta, Thomalla, Goetz, Fiehler, Jens, and Gellissen, Susanne

Subjects
NIH Stroke Scale, INTRACRANIAL hemorrhage, STATISTICAL models, LOGISTIC regression analysis, HYPERTENSION, TREATMENT effectiveness, DESCRIPTIVE statistics, ODDS ratio, REOPERATION, ISCHEMIC stroke, THROMBECTOMY, CEREBRAL infarction, STROKE patients, CONFIDENCE intervals, FACTOR analysis, PATIENT aftercare
Abstract

Background Follow-up infarct volume (FIV) is used as surrogate for treatment efficiency in mechanical thrombectomy (MT). However, previous works suggest that MT-related FIV reduction has only limited association with outcome comparing MT independently of recanalization success versus medical care. It remains unclear to what extent the relationship between successful recanalization versus persistent occlusion and functional outcome is explained by FIV reduction. Objective To determine whether FIV mediates the relationship between successful recanalization and functional outcome. Methods All patients from our institution enrolled in the German Stroke Registry (May 2015-December 2019) with anterior circulation stroke; availability of the relevant clinical data, and follow-up-CT were analyzed. The effect of FIV reduction on functional outcome (90-day modified Rankin Scale (mRS) score ≤2) after successful recanalization (Thrombolysis in Cerebral Infarction ≥2b) was quantified using mediation analysis. Results 429 patients were included, of whom, 309 (72 %) had successful recanalization and 127 (39%) had good functional outcome. Good outcome was associated with age (0R=0.89, P<0.001), pre-stroke mRS score (0R=0.38, P<0.001), FIV (0R=0.98, P<0.001), hypertension (0R=2.08, P<0.05), and successful recanalization (0R=3.57, P<0.01). Using linear regression in the mediator pathway, FIV was associated with Alberta Stroke program Early CT Score (coefficient (Co)=-26.13, P<0.001), admission National Institutes of Health Stroke Scale score (Co=3.69, P<0.001), age (Co=-1.18, P<0.05), and successful recanalization (Co=-85.22, P<0.001). Successful recanalization increased the probability of good outcome by 23 percentage points (pp) (95% CI 16pp to 29pp). 56% (95% CI 38% to 78%) of the improvement in good outcome was explained by FIV reduction. Conclusion 56% (95% CI 38% to 78%) of outcome improvement after successful recanalization was explained by FIV reduction. Results corroborate pathophysiological assumptions and confirm the value of FIV as an imaging endpoint in clinical trials. 44% (95% CI 22% to 62%) of the improvement in outcome was not explained by FIV reduction and reflects the remaining mismatch between radiological and clinical outcome measures. [ABSTRACT FROM AUTHOR]

Published
2024
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48. Early neurological deterioration in patients with acute ischemic stroke is linked to unfavorable cerebral venous outflow

Author

Heitkamp, Christian, primary, Winkelmeier, Laurens, additional, Heit, Jeremy J, additional, Albers, Gregory W, additional, Lansberg, Maarten G, additional, Kniep, Helge, additional, Broocks, Gabriel, additional, Stracke, Christian Paul, additional, Schell, Maximilian, additional, Guenego, Adrien, additional, Paech, Daniel, additional, Wintermark, Max, additional, Fiehler, Jens, additional, and Faizy, Tobias D, additional

Published
2023
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49. Effect of short‐ versus long‐term serum glucose levels on early ischemic water homeostasis and functional outcome in patients with large vessel occlusion stroke

Author

Klapproth, Susan, primary, Meyer, Lukas, additional, Kniep, Helge, additional, Bechstein, Matthias, additional, Kyselyova, Anna, additional, Hanning, Uta, additional, Schön, Gerhard, additional, Rimmele, Leander, additional, Fiehler, Jens, additional, and Broocks, Gabriel, additional

Published
2023
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50. Prognostic value of recanalization attempts in endovascular therapy for M2 segment middle cerebral artery occlusions

Author

Winkelmeier, Laurens, primary, Heitkamp, Christian, additional, Faizy, Tobias D, additional, Broocks, Gabriel, additional, Kniep, Helge, additional, Meyer, Lukas, additional, Bester, Maxim, additional, Brekenfeld, Caspar, additional, Schell, Maximilian, additional, Hanning, Uta, additional, Thomalla, Götz, additional, Fiehler, Jens, additional, and Flottmann, Fabian, additional

Published
2023
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