0000000000065352
AUTHOR
Martin Wiesmann
Necessary Catheter Diameters for Mechanical Thrombectomy with ADAPT
BACKGROUND AND PURPOSE: Large-bore catheters allow mechanical thrombectomy in ischemic stroke by engaging and retrieving clots without additional devices (direct aspiration first-pass technique [ADAPT]). The purpose of this study was to establish a model for minimal catheter diameters needed for ADAPT. MATERIALS AND METHODS: We established a theoretic model for the calculation of minimal catheter diameters needed for ADAPT. We then verified its validity in 28 ADAPT maneuvers in a porcine in vivo model. To account for different mechanical thrombectomy techniques, we factored in ADAPT with/without a hypothetic 0.021-inch microcatheter or 0.014-inch microwire inside the lumen of the aspiration…
Optimizing endovascular stroke treatment: removing the microcatheter before clot retrieval with stent-retrievers increases aspiration flow
BackgroundFlow control during endovascular stroke treatment with stent-retrievers is crucial for successful revascularization. The standard technique recommended by stent-retriever manufacturers implies obstruction of the respective access catheter by the microcatheter, through which the stent-retriever is delivered. This, in turn, results in reduced aspiration during thrombectomy. In order to maximize aspiration, we fully retract the microcatheter out of the access catheter before thrombectomy—an approach we term the ‘bare wire thrombectomy’ (BWT) technique. We verified the improved throughput with systematic in vitro studies and assessed the clinical effectiveness and safety of this metho…
Eyes open and eyes closed as rest conditions: impact on brain activation patterns
The patterns of associated brain activations during eyes-open and eyes-closed states in complete darkness considerably differ in fMRI. An "interoceptive" state with the eyes closed is characterized by visual cortex activation, while an "exteroceptive" state with the eyes open is characterized by ocular motor system activity. The impact of the chosen rest condition (eyes open or eyes closed in complete darkness) on the pattern of brain activations during visual stimulation was evaluated in 14 healthy volunteers. During fixation or dim light room illumination, the activation of the visual cortex was larger with the eyes-open rest condition than with the eyes-closed rest condition; however, ac…
Imaging the visual autokinetic illusion with fMRI
During fixation of a stationary, dim light-emitting diode (LED) in complete darkness, a subtle, apparent motion is perceived which is called autokinesis. This autokinetic illusion increases with increasing fixation time. Eleven healthy subjects were examined by fMRI while fixating an LED in darkness for 35 s. BOLD signal changes of the first and the second half of the fixation period were compared. While the stimulus was the same for both periods, perception differed in that autokinesis was more pronounced in the second half. This second half of the period was associated with bilateral activations in the motion-sensitive middle occipito-temporal area known as MT/V5. Our finding suggests tha…
Endovascular stentectomy using the snare over stent-retriever (SOS) technique: An experimental feasibility study
PLoS one 12(5), e0178197 (2017). doi:10.1371/journal.pone.0178197
Under Pressure: Comparison of Aspiration Techniques for Endovascular Mechanical Thrombectomy.
BACKGROUND AND PURPOSE: Blood flow should be interrupted during mechanical thrombectomy to prevent embolization of clot fragments. The purpose of our study was to provide a handy overview of the most common aspiration devices and to quantify their flow characteristics. MATERIALS AND METHODS: We assessed volumetric flow rates generated by a 60-mL VacLok vacuum pressure syringe, a Pump MAX aspiration pump, and a Dominant Flex suction pump connected to the following: 1) an 8F long sheath, 2) an 8F balloon-guide catheter, 3) an ACE 64 distal aspiration catheter, and 4) an AXS Catalyst 6 Distal Access Catheter. We used a water/glycerol solution, which was kept at a constant temperature of 20°C (…
Safety of endovascular treatment in acute stroke patients taking oral anticoagulants
International journal of stroke 12(4), 412-415 (2017). doi:10.1177/1747493016677986
Cervical spondylotic myelopathy: Changes of fractional anisotropy in the spinal cord and magnetic resonance spectroscopy of the primary motor cortex in relation to clinical symptoms and their duration
Abstract Objective To determine the changes in fractional anisotropy (FA) at the proximal spinal cord and in magnetic resonance spectroscopy (MRS) of the precentral gyrus in patients with cervical spondylotic myelopathy (CSM) with respect to clinical symptoms and their duration. Material and Methods 20 patients with CSM (7 female; mean age 64.6 ± 10.5 years) and 18 age/sex matched healthy controls (9 female; mean age 63.5 ± 6.6 years) were prospectively included. Clinical data (modified Japanese Orthopaedic Association Score (mJOA) and Neck Disability Index (NDI)) and 3T MR measurements including DTI at the spinal cord (level C2/3) with FA and MRS of the left and right precentral gyrus were…
Platelet function testing in pigs using the Multiplate® Analyzer.
PLOS ONE 14(8), e0222010 (2019). doi:10.1371/journal.pone.0222010
Implant-specific follow-up imaging of treated intracranial aneurysms: TOF-MRA vs. metal artifact reduced intravenous flat panel computed tomography angiography (FPCTA).
Aim To compare the diagnostic quality of time-of-flight magnetic resonance angiography (TOF-MRA) and metal-artefact-reduction (MAR) flat-panel-detector computed tomography angiography (FPCTA) and to determine the imaging technique best suited for evaluation endovascular and surgically treated aneurysms. Methods The image quality of TOF-MRA and MAR-FPCTA of 44 intracranial implants (coiling: n= 20; clipping: n= 15; coiling + stenting: n= 9) in a patient cohort of 25 was evaluated by two independent readers. Images obtained using MAR-FPCTA (20 second scan time, 496 projections, intravenous contrast medium administration; Artis Zee, Siemens Healthcare, Forchheim) were compared with TOF-MRA-ima…
Functional MRI of galvanic vestibular stimulation with alternating currents at different frequencies.
Abstract Functional MRI was performed in 28 healthy volunteers to study the effects of galvanic vestibular stimulation with alternating currents (AC-GVS) of different frequencies on brain activation patterns. The aims of this study were (1) to identify specific areas within the vestibular cortical network that are involved in the processing of frequency-specific aspects by correlation analyses, (2) to determine the optimal frequency for stimulation of the vestibular system with respect to perception, and (3) to analyze whether different frequencies of AC-GVS are mediated in different cortical areas or different sites within the vestibular cortex. AC-GVS was performed using sinusoidal stimul…
Long Term Outcome after Application of the Angio-Seal Vascular Closure Device in Minipigs
PLoS one 11(9), e0163878 (2016). doi:10.1371/journal.pone.0163878
Asymmetric modulation of human visual cortex activity during 10 degrees lateral gaze (fMRI study).
We used BOLD fMRI to study the differential effects of the direction of gaze on the visual and the ocular motor systems. Fixation of a target straight ahead was compared to fixation of a target 10 degrees to the right and 10 degrees to the left from gaze straight ahead, and to eyes open in complete darkness in thirteen healthy volunteers. While retinotopic coordinates remained the same in all fixation conditions, the fixation target shifted with respect to a head-centered frame of reference. During lateral fixation, deactivations in higher-order visual areas (one ventral cluster in the lingual and fusiform gyri and one dorsal cluster in the postero-superior cuneus) and, as a trend, activati…
Imaging of Ventriculoperitoneal Shunt Complications: Comparison of Whole Body Low-Dose Computed Tomography and Radiographic Shunt Series.
OBJECTIVE To determine diagnostic value and radiation exposure of low-dose computed tomography (LD-CT) compared to radiographic shunt series (SS) for the detection of ventriculoperitoneal (VP) shunt complications. METHODS Fourteen VP shunts were implanted in 7 swine cadavers. Mechanical complications were induced in 50% of VP shunts. Low-dose CT (80 kVp, 10 mAs, Pitch = 1.5) and SS were acquired. Dose area product (DAP) and effective doses for SS and LD-CT were collected. Scoring of diagnostic confidence and blinded readings of SS and CT data were performed. RESULTS The sensitivity of LD-CT was high (0.97; 95% confidence interval, 0.91-1.00) with excellent interobserver agreement (κ = 0.88)…
Influence of carotid tortuosity on internal carotid artery access time in the treatment of acute ischemic stroke
Purpose Carotid artery anatomy is thought to influence internal carotid artery access time (ICA-AT) in patients requiring mechanical thrombectomy for acute ischemic stroke. This study investigates the association between ICA-AT and carotid anatomy. Material and methods Computed tomography angiography (CTA) data of 76 consecutive patients presenting with acute ischemic stroke requiring mechanical thrombectomy for middle cerebral artery or carotid T occlusion were evaluated. The supraaortic extracranial vasculature was analyzed regarding take-off angles and curvature of the affected side. Digital subtraction angiography data were primarily analyzed regarding ICA-AT and secondarily regarding r…