1.CT- versus MRI-Based Imaging for Thrombolysis and Mechanical Thrombectomy in Ischemic Stroke: Analysis from the Austrian Stroke Registry
Stefan KREBS ; Alexandra POSEKANY ; Alina PILZ ; Julia FERRARI ; Alexandra BERNEGGER ; Christian NEUMANN ; Siegfried THURNHER ; Dominik ROTH ; Wilfried LANG ; Marek SYKORA ;
Journal of Stroke 2022;24(3):383-389
Background:
and Purpose It is unclear whether a particular stroke imaging modality offers an advantage for the acute stroke treatment. The aim of this study was to compare procedure times, efficacy and safety of thrombolysis and/or thrombectomy based on computed tomography (CT) versus magnetic resonance imaging (MRI) acute stroke imaging.
Methods:
Data of stroke patients who received intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) were extracted from a nationwide, prospective stroke unit registry and categorized according to initial imaging modality. Study endpoints included procedure times, symptomatic intracerebral hemorrhage (sICH), early neurological improvement, 3-month functional outcome by modified Rankin Scale (mRS) and mortality.
Results:
Stroke patients (n=16,799) treated with IVT and 2,248 treated with MT were included. MRI-guided patients (n=2,599) were younger, had less comorbidities and higher rates of strokes with unknown onset as compared to CT-guided patients. In patients treated with IVT, no differences were observed regarding the rates of functional outcome by mRS 0–1 (adjusted odds ratio [OR], 0.87; 95% confidence interval [CI], 0.71 to 1.05), sICH (adjusted OR, 0.82; 95% CI, 0.61 to 1.08), and mortality (adjusted OR, 0.88; 95% CI, 0.63 to 1.22). Patients undergoing MT selected by MRI as compared to CT showed equal rates of functional outcome by mRS 0–2 (adjusted OR, 0.87; 95% CI, 0.65 to 1.16), sICH (adjusted OR, 0.9; 95% CI, 0.51 to 1.69), and mortality (adjusted OR, 0.62; 95% CI, 0.35 to 1.09). MRI-guided patients showed a significant intrahospital delay of about 20 minutes in both the IVT and the MT group.
Conclusions
This large non-randomized comparison study indicates that CT- and MRI-guided patient selection for IVT/MT may perform equally well in terms of functional outcome and safety.
2.Mechanical Thrombectomy in Acute Stroke Patients with Moderate to Severe Pre-Stroke Disability
Marek SYKORA ; Patrik MICHEL ; Davide STRAMBO ; Stefan KREBS ; Julia FERRARI ; Alexandra POSEKANY ; Dominika MIKŠOVÁ ; Konstantin HERMANN ; Thomas GATTRINGER ; Elke GIZEWSKI ; Hannes DEUTSCHMANN ; Christian NEUMANN ; Wilfried LANG
Journal of Stroke 2022;24(3):396-403
and Purpose Studies on mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients with preexisting disability are limited. We aimed to compare the outcomes of MT versus best medical treatment (BMT) in these patients. Methods In the nationwide Austrian registry and Swiss monocentric registry, we identified 462 AIS patients with pre-stroke disability (modified Rankin Scale [mRS] score ≥3) and acute large vessel occlusion. The primary outcome was returning to pre-stroke mRS or better at 3 months. Secondary outcomes were early neurological improvement (National Institutes of Health Stroke Scale score improvement ≥8 at 24 to 48 hours), 3-month mortality, and symptomatic intracerebral hemorrhage (sICH). Multivariable regression models and propensity score matching (PSM) were used for statistical analyses. Results Compared with the BMT group (n=175), the MT group (n=175) had younger age, more severe strokes, and lower pre-stroke mRS, but similar proportion of receiving intravenous thrombolysis. MT was associated with higher odds of returning to baseline mRS or better at 3 months (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI], 1.39 to 4.47), early neurological improvement (aOR, 2.62; 95% CI, 1.41 to 4.88), and lower risk of 3-month mortality (aOR, 0.29; 95% CI, 0.18 to 0.49). PSM analysis showed similar findings. MT was not associated with an increased risk of sICH (4.0% vs. 2.1% in all patients; 4.2% vs. 2.4% in the PSM cohort). Conclusions MT in patients with pre-stroke mRS ≥3 might improve the 3-month outcomes and short-term neurological impairment, suggesting that pre-stroke disability alone should not be a reason to withhold MT, but that individual case-by-case decisions may be more appropriate.
3.Effect of ultraviolet photofunctionalization of dental titanium implants on osseointegration.
Christian MEHL ; Matthias KERN ; Friederike NEUMANN ; Telse BÄHR ; Jörg WILTFANG ; Volker GASSLING
Journal of Zhejiang University. Science. B 2018;19(7):525-534
OBJECTIVE:
The aim of the current study was to evaluate the effect of ultraviolet (UV) photofunctionalization of dental titanium implants with exposure to the oral cavity on osseointegration in an animal model.
METHODS:
Forty-eight titanium implants (Camlog Conelog 4.3 mmx9.0 mm) were placed epicrestally into the edentulous jaws of three minipigs and implant stability was assessed by measuring the implant stability quotient (ISQ). Prior to implantation half of the implants were photofunctionalized with intense UV-light. After three months, the implants were exposed and ISQ was measured again. After six months of implant exposure, the minipigs were sacrificed and the harvested specimens were analyzed using histomorphometric, light, and fluorescence microscopy.
MAIN RESULTS:
Forty-two of 48 implants osseointegrated. The overall mean bone-implant contact area (BIC) was (64±22)%. No significant differences were found in BIC or ISQ value (multivariate analysis of variance (MANOVA), P>0.05) between implants with and without exposure to UV photofunctionalization.
CONCLUSIONS
No significant effects were observed on osseointegration of dental titanium implants nine months after exposure of UV photofunctionalization.
Animals
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Dental Implantation, Endosseous
;
methods
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Dental Implants
;
Equipment Failure Analysis
;
Female
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Hydrophobic and Hydrophilic Interactions
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Male
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Models, Animal
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Osseointegration
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Surface Properties
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Swine
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Swine, Miniature
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Titanium
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Ultraviolet Rays
4.Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality
Thanh N. NGUYEN ; Muhammad M. QURESHI ; Piers KLEIN ; Hiroshi YAMAGAMI ; Mohamad ABDALKADER ; Robert MIKULIK ; Anvitha SATHYA ; Ossama Yassin MANSOUR ; Anna CZLONKOWSKA ; Hannah LO ; Thalia S. FIELD ; Andreas CHARIDIMOU ; Soma BANERJEE ; Shadi YAGHI ; James E. SIEGLER ; Petra SEDOVA ; Joseph KWAN ; Diana Aguiar DE SOUSA ; Jelle DEMEESTERE ; Violiza INOA ; Setareh Salehi OMRAN ; Liqun ZHANG ; Patrik MICHEL ; Davide STRAMBO ; João Pedro MARTO ; Raul G. NOGUEIRA ; ; Espen Saxhaug KRISTOFFERSEN ; Georgios TSIVGOULIS ; Virginia Pujol LEREIS ; Alice MA ; Christian ENZINGER ; Thomas GATTRINGER ; Aminur RAHMAN ; Thomas BONNET ; Noémie LIGOT ; Sylvie DE RAEDT ; Robin LEMMENS ; Peter VANACKER ; Fenne VANDERVORST ; Adriana Bastos CONFORTO ; Raquel C.T. HIDALGO ; Daissy Liliana MORA CUERVO ; Luciana DE OLIVEIRA NEVES ; Isabelle LAMEIRINHAS DA SILVA ; Rodrigo Targa MARTÍNS ; Letícia C. REBELLO ; Igor Bessa SANTIAGO ; Teodora SADELAROVA ; Rosen KALPACHKI ; Filip ALEXIEV ; Elena Adela CORA ; Michael E. KELLY ; Lissa PEELING ; Aleksandra PIKULA ; Hui-Sheng CHEN ; Yimin CHEN ; Shuiquan YANG ; Marina ROJE BEDEKOVIC ; Martin ČABAL ; Dusan TENORA ; Petr FIBRICH ; Pavel DUŠEK ; Helena HLAVÁČOVÁ ; Emanuela HRABANOVSKA ; Lubomír JURÁK ; Jana KADLČÍKOVÁ ; Igor KARPOWICZ ; Lukáš KLEČKA ; Martin KOVÁŘ ; Jiří NEUMANN ; Hana PALOUŠKOVÁ ; Martin REISER ; Vladimir ROHAN ; Libor ŠIMŮNEK ; Ondreij SKODA ; Miroslav ŠKORŇA ; Martin ŠRÁMEK ; Nicolas DRENCK ; Khalid SOBH ; Emilie LESAINE ; Candice SABBEN ; Peggy REINER ; Francois ROUANET ; Daniel STRBIAN ; Stefan BOSKAMP ; Joshua MBROH ; Simon NAGEL ; Michael ROSENKRANZ ; Sven POLI ; Götz THOMALLA ; Theodoros KARAPANAYIOTIDES ; Ioanna KOUTROULOU ; Odysseas KARGIOTIS ; Lina PALAIODIMOU ; José Dominguo BARRIENTOS GUERRA ; Vikram HUDED ; Shashank NAGENDRA ; Chintan PRAJAPATI ; P.N. SYLAJA ; Achmad Firdaus SANI ; Abdoreza GHOREISHI ; Mehdi FARHOUDI ; Elyar SADEGHI HOKMABADI ; Mazyar HASHEMILAR ; Sergiu Ionut SABETAY ; Fadi RAHAL ; Maurizio ACAMPA ; Alessandro ADAMI ; Marco LONGONI ; Raffaele ORNELLO ; Leonardo RENIERI ; Michele ROMOLI ; Simona SACCO ; Andrea SALMAGGI ; Davide SANGALLI ; Andrea ZINI ; Kenichiro SAKAI ; Hiroki FUKUDA ; Kyohei FUJITA ; Hirotoshi IMAMURA ; Miyake KOSUKE ; Manabu SAKAGUCHI ; Kazutaka SONODA ; Yuji MATSUMARU ; Nobuyuki OHARA ; Seigo SHINDO ; Yohei TAKENOBU ; Takeshi YOSHIMOTO ; Kazunori TOYODA ; Takeshi UWATOKO ; Nobuyuki SAKAI ; Nobuaki YAMAMOTO ; Ryoo YAMAMOTO ; Yukako YAZAWA ; Yuri SUGIURA ; Jang-Hyun BAEK ; Si Baek LEE ; Kwon-Duk SEO ; Sung-Il SOHN ; Jin Soo LEE ; Anita Ante ARSOVSKA ; Chan Yong CHIEH ; Wan Asyraf WAN ZAIDI ; Wan Nur Nafisah WAN YAHYA ; Fernando GONGORA-RIVERA ; Manuel MARTINEZ-MARINO ; Adrian INFANTE-VALENZUELA ; Diederik DIPPEL ; Dianne H.K. VAN DAM-NOLEN ; Teddy Y. WU ; Martin PUNTER ; Tajudeen Temitayo ADEBAYO ; Abiodun H. BELLO ; Taofiki Ajao SUNMONU ; Kolawole Wasiu WAHAB ; Antje SUNDSETH ; Amal M. AL HASHMI ; Saima AHMAD ; Umair RASHID ; Liliana RODRIGUEZ-KADOTA ; Miguel Ángel VENCES ; Patrick Matic YALUNG ; Jon Stewart Hao DY ; Waldemar BROLA ; Aleksander DĘBIEC ; Malgorzata DOROBEK ; Michal Adam KARLINSKI ; Beata M. LABUZ-ROSZAK ; Anetta LASEK-BAL ; Halina SIENKIEWICZ-JAROSZ ; Jacek STASZEWSKI ; Piotr SOBOLEWSKI ; Marcin WIĄCEK ; Justyna ZIELINSKA-TUREK ; André Pinho ARAÚJO ; Mariana ROCHA ; Pedro CASTRO ; Patricia FERREIRA ; Ana Paiva NUNES ; Luísa FONSECA ; Teresa PINHO E MELO ; Miguel RODRIGUES ; M Luis SILVA ; Bogdan CIOPLEIAS ; Adela DIMITRIADE ; Cristian FALUP-PECURARIU ; May Adel HAMID ; Narayanaswamy VENKETASUBRAMANIAN ; Georgi KRASTEV ; Jozef HARING ; Oscar AYO-MARTIN ; Francisco HERNANDEZ-FERNANDEZ ; Jordi BLASCO ; Alejandro RODRÍGUEZ-VÁZQUEZ ; Antonio CRUZ-CULEBRAS ; Francisco MONICHE ; Joan MONTANER ; Soledad PEREZ-SANCHEZ ; María Jesús GARCÍA SÁNCHEZ ; Marta GUILLÁN RODRÍGUEZ ; Gianmarco BERNAVA ; Manuel BOLOGNESE ; Emmanuel CARRERA ; Anchalee CHUROJANA ; Ozlem AYKAC ; Atilla Özcan ÖZDEMIR ; Arsida BAJRAMI ; Songul SENADIM ; Syed I. HUSSAIN ; Seby JOHN ; Kailash KRISHNAN ; Robert LENTHALL ; Kaiz S. ASIF ; Kristine BELOW ; Jose BILLER ; Michael CHEN ; Alex CHEBL ; Marco COLASURDO ; Alexandra CZAP ; Adam H. DE HAVENON ; Sushrut DHARMADHIKARI ; Clifford J. ESKEY ; Mudassir FAROOQUI ; Steven K. FESKE ; Nitin GOYAL ; Kasey B. GRIMMETT ; Amy K. GUZIK ; Diogo C. HAUSSEN ; Majesta HOVINGH ; Dinesh JILLELA ; Peter T. KAN ; Rakesh KHATRI ; Naim N. KHOURY ; Nicole L. KILEY ; Murali K. KOLIKONDA ; Stephanie LARA ; Grace LI ; Italo LINFANTE ; Aaron I. LOOCHTAN ; Carlos D. LOPEZ ; Sarah LYCAN ; Shailesh S. MALE ; Fadi NAHAB ; Laith MAALI ; Hesham E. MASOUD ; Jiangyong MIN ; Santiago ORGETA-GUTIERREZ ; Ghada A. MOHAMED ; Mahmoud MOHAMMADEN ; Krishna NALLEBALLE ; Yazan RADAIDEH ; Pankajavalli RAMAKRISHNAN ; Bliss RAYO-TARANTO ; Diana M. ROJAS-SOTO ; Sean RULAND ; Alexis N. SIMPKINS ; Sunil A. SHETH ; Amy K. STAROSCIAK ; Nicholas E. TARLOV ; Robert A. TAYLOR ; Barbara VOETSCH ; Linda ZHANG ; Hai Quang DUONG ; Viet-Phuong DAO ; Huynh Vu LE ; Thong Nhu PHAM ; Mai Duy TON ; Anh Duc TRAN ; Osama O. ZAIDAT ; Paolo MACHI ; Elisabeth DIRREN ; Claudio RODRÍGUEZ FERNÁNDEZ ; Jorge ESCARTÍN LÓPEZ ; Jose Carlos FERNÁNDEZ FERRO ; Niloofar MOHAMMADZADEH ; Neil C. SURYADEVARA, MD ; Beatriz DE LA CRUZ FERNÁNDEZ ; Filipe BESSA ; Nina JANCAR ; Megan BRADY ; Dawn SCOZZARI
Journal of Stroke 2022;24(2):256-265
Background:
and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year.
Methods:
We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020).
Results:
There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths.
Conclusions
During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.