TY  - JOUR
A1  - Fabritius, Matthias Philipp
A1  - Wölfer, Teresa A.
A1  - Herzberg, Moriz
A1  - Tiedt, Steffen
A1  - Puhr-Westerheide, Daniel
A1  - Grosu, Sergio
A1  - Maurus, Stefan
A1  - Geyer, Thomas
A1  - Curta, Adrian
A1  - Kellert, Lars
A1  - Küpper, Clemens
A1  - Liebig, Thomas
A1  - Ricke, Jens
A1  - Dimitriadis, Konstantinos
A1  - Kunz, Wolfgang G.
A1  - Zimmermann, Hanna
A1  - Reidler, Paul
T1  - Course of early neurologic symptom severity after endovascular treatment of anterior circulation large vessel occlusion stroke: association with baseline multiparametric CT imaging and clinical parameters
JF  - Diagnostics
N2  - Background: Neurologic symptom severity and deterioration at 24 hours (h) predict long-term outcomes in patients with acute large vessel occlusion (LVO) stroke of the anterior circulation. We aimed to examine the association of baseline multiparametric CT imaging and clinical factors with the course of neurologic symptom severity in the first 24 h after endovascular treatment (EVT). Methods: Patients with LVO stroke of the anterior circulation were selected from a prospectively acquired consecutive cohort of patients who underwent multiparametric CT, including non-contrast CT, CT angiography and CT perfusion before EVT. The symptom severity was assessed on admission and after 24 h using the 42-point National Institutes of Health Stroke Scale (NIHSS). Clinical and imaging data were compared between patients with and without early neurological deterioration (END). END was defined as an increase in ≥4 points, and a significant clinical improvement as a decrease in ≥4 points, compared to NIHSS on admission. Multivariate regression analyses were used to determine independent associations of imaging and clinical parameters with NIHSS score increase or decrease in the first 24 h. Results: A total of 211 patients were included, of whom 38 (18.0%) had an END. END was significantly associated with occlusion of the internal carotid artery (odds ratio (OR), 4.25; 95% CI, 1.90–9.47) and the carotid T (OR, 6.34; 95% CI, 2.56–15.71), clot burden score (OR, 0.79; 95% CI, 0.68–0.92) and total ischemic volume (OR, 1.01; 95% CI, 1.00–1.01). In a comprehensive multivariate analysis model including periprocedural parameters and complications after EVT, carotid T occlusion remained independently associated with END, next to reperfusion status and intracranial hemorrhage. Favorable reperfusion status and small ischemic core volume were associated with clinical improvement after 24 h. Conclusions: The use of imaging parameters as a surrogate for early NIHSS progression in an acute LVO stroke after EVT reached limited performance with only carotid T occlusion as an independent predictor of END. Reperfusion status and early complications in terms of intracranial hemorrhage are critical factors that influence patient outcome in the acute stroke phase after EVT.
KW  - stroke
KW  - large vessel occlusion
KW  - multiparametric CT
KW  - CT perfusion
KW  - CT angiography
KW  - NIHSS
KW  - EVT
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-242681
SN  - 2075-4418
VL  - 11
IS  - 7
ER  - 
TY  - JOUR
A1  - Schmidbauer, Moritz L.
A1  - Ferse, Caroline
A1  - Salih, Farid
A1  - Klingner, Carsten
A1  - Musleh, Rita
A1  - Kunst, Stefan
A1  - Wittstock, Matthias
A1  - Neumann, Bernhard
A1  - Schebesch, Karl-Michael
A1  - Bösel, Julian
A1  - Godau, Jana
A1  - Lochner, Piergiorgio
A1  - Adam, Elisabeth H.
A1  - Jahnke, Kolja
A1  - Knier, Benjamin
A1  - Schirotzek, Ingo
A1  - Müllges, Wolfgang
A1  - Notz, Quirin
A1  - Dengl, Markus
A1  - Güldner, Andreas
A1  - Onur, Oezguer A.
A1  - Garcia Borrega, Jorge
A1  - Dimitriadis, Konstantinos
A1  - Günther, Albrecht
T1  - COVID-19 and intracranial hemorrhage: a multicenter case series, systematic review and pooled analysis
JF  - Journal of Clinical Medicine
N2  - Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) profoundly impacts hemostasis and microvasculature. In the light of the dilemma between thromboembolic and hemorrhagic complications, in the present paper, we systematically investigate the prevalence, mortality, radiological subtypes, and clinical characteristics of intracranial hemorrhage (ICH) in coronavirus disease (COVID-19) patients. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review of the literature by screening the PubMed database and included patients diagnosed with COVID-19 and concomitant ICH. We performed a pooled analysis, including a prospectively collected cohort of critically ill COVID-19 patients with ICH, as part of the PANDEMIC registry (Pooled Analysis of Neurologic Disorders Manifesting in Intensive Care of COVID-19). Results: Our literature review revealed a total of 217 citations. After the selection process, 79 studies and a total of 477 patients were included. The median age was 58.8 years. A total of 23.3% of patients experienced the critical stage of COVID-19, 62.7% of patients were on anticoagulation and 27.5% of the patients received ECMO. The prevalence of ICH was at 0.85% and the mortality at 52.18%, respectively. Conclusion: ICH in COVID-19 patients is rare, but it has a very poor prognosis. Different subtypes of ICH seen in COVID-19, support the assumption of heterogeneous and multifaceted pathomechanisms contributing to ICH in COVID-19. Further clinical and pathophysiological investigations are warranted to resolve the conflict between thromboembolic and hemorrhagic complications in the future.
KW  - COVID-19
KW  - intracranial hemorrhage
KW  - prognosis
KW  - anticoagulation
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-255236
SN  - 2077-0383
VL  - 11
IS  - 3
ER  -