Publications by authors named "Matthias Bechstein"
Background: Embolization of the middle meningeal artery (EMMA) is a promising novel technique for the treatment of patients with chronic subdural hematomas (cSDH).
Methods: After a nationwide query in Germany, patients with cSDH, treated with EMMA were retrospectively analyzed. Patient and cSDH characteristics, procedural parameters, complications, and rates of treatment failure (TF; residual cSDH > 10 mm, cSDH progression or requirement of rescue surgery) were investigated.
Background And Objectives: Intravenous thrombolysis (IVT) followed by endovascular thrombectomy (EVT) improves functional outcomes in patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). There are limited data on the effect of thrombolysis-to-puncture time (TTP) on outcomes in patients with AIS undergoing IVT plus EVT.
Methods: We selected 1,104 patients receiving IVT + EVT for anterior circulation LVO stroke from 2 prospective nationwide registries (259 cases from ANGEL-ACT in China: November 2017 to March 2019, 845 cases from German Stroke Registry-Endovascular Treatment in Germany: June 2015 to December 2019).
Background And Purpose: First pass (FP) recanalization, defined as achieving mTICI 2b or higher in a single thrombectomy attempt, has been linked to better functional recovery in acute ischemic stroke patients. This study aimed to investigate whether the benefits of FP are primarily driven by higher rates of complete reperfusion (mTICI 3) or by faster procedure times.
Methods: Data from 3707 patients with middle cerebral artery occlusion and successful recanalization (mTICI 2b or higher) were extracted from the prospectively designed German Stroke Registry (2015-2021).
Background And Aims: In ischemic stroke, there is limited data regarding the impact of baseline hyperglycemia on the treatment effect of recanalization on neurological recovery. This study aimed to directly compare-how short- and long-term serum glucose levels modify the effect of recanalization on functional outcome in patients with ischemic stroke and specifically analyze the occurrence of delayed neurological recovery ("stunned brain phenomenon").
Methods: Observational retrospective analysis including patients with anterior circulation ischemic stroke and large vessel occlusion undergoing mechanical thrombectomy following multimodal-CT upon admission.
Background: Recent randomized trials demonstrated the beneficial effect of endovascular therapy in patients with low Alberta Stroke Program Early CT Score. Despite large follow-up infarct volumes, a significantly increased rate of good functional outcomes was observed, challenging the role of infarct volume as a predictive imaging marker. This analysis evaluates the extent to which the effects of endovascular thrombectomy on functional outcomes are explained by (1) follow-up infarct volume and (2) early neurological status in patients with stroke with low Alberta Stroke Program Early CT Score.
View Article and Find Full Text PDFBackground: The optimal anesthetic approach for patients with acute ischemic stroke with large vessel occlusion but low National Institutes of Health Stroke Scale receiving mechanical thrombectomy remains unclear. We aimed to evaluate the association of anesthetic strategies with procedural and clinical outcomes, hypothesizing that conscious sedation/local anesthesia (CS/LA) may offer a more favorable risk-benefit ratio than general anesthesia (GA).
Methods: Multicenter cohort study screening all thrombectomy patients prospectively enrolled in GSR-ET (German Stroke Registry-Endovascular Treatment) across 25 centers between 2015 and 2021.
Background And Purpose: Cerebral vasospasm remains a strong predictor of poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Endovascular treatment of vasospasm can be considered when conservative treatment options are exhausted, but its superiority over standard treatment remains a subject of critical debate. This study focuses on patients with clinically relevant vasospasm after aSAH who underwent endovascular vasospasm treatment and aims to analyze patients' individual risk factors, intensity, and extent of cerebral vasospasm associated with poor functional outcomes after aSAH.
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- The study investigates the potential benefits of mechanical thrombectomy for ischemic stroke patients with distal medium vessel occlusions, focusing on the role of computed tomography perfusion imaging.
- The research analyzed data from 140 patients treated at a high-volume stroke center from 2015 to 2023, assessing the relationship between recanalization and functional outcomes using logistic regression analysis.
- Findings suggest that while recanalization did not universally improve outcomes, significant treatment effects were observed in patients with larger hypoperfusion and penumbral volumes, indicating that penumbral imaging could help guide treatment decisions.
Article Synopsis
- The study investigates factors leading to early stopping during mechanical thrombectomy (MT) in acute ischemic stroke patients, focusing on those that do not achieve a successful recanalization score (mTICI ≥2b).
- An analysis of 2,977 patients revealed that factors such as higher age, worse pre-stroke conditions, and certain complications during the procedure were linked to early stopping without successful recanalization.
- The findings suggest that decisions to stop the procedure often correspond to the patient's overall prognosis, indicating that both favorable and unfavorable conditions can influence the likelihood of early intervention cessation.
Article Synopsis
- The Alberta Stroke Program Early CT Score (ASPECTS) and penumbral imaging through computed tomography perfusion (CTP) are used to help determine who is eligible for mechanical thrombectomy (MT) in stroke patients.
- The study hypothesized that the effectiveness of recanalization in patients with large ischemic cores (volume > 50 mL) but high ASPECTS scores (≥6) would be comparable to those with smaller core volumes, and that there could be a tendency to overestimate the core size.
- Results showed that recanalization did not significantly differ between the two patient groups, and both recanalization and larger core volumes were associated with the overestimation of the ischemic core
Article Synopsis
- The study investigates the impact of mechanical thrombectomy (MT) on patients with ischemic stroke who do not have salvageable brain tissue identified by computed tomography perfusion (CTP) imaging.
- Out of 724 patients analyzed, 110 had no CTP mismatch, with successful recanalization in 66% of these cases, which was linked to improved functional independence after 90 days.
- Results show that MT is particularly effective for patients under 70 years old and those with moderate brain injury (measured by the Alberta Stroke Program Early Computed Tomography Score).
Introduction: In acute ischemic stroke, prediction of the tissue outcome after reperfusion can be used to identify patients that might benefit from mechanical thrombectomy (MT). The aim of this work was to develop a deep learning model that can predict the follow-up infarct location and extent exclusively based on acute single-phase computed tomography angiography (CTA) datasets. In comparison to CT perfusion (CTP), CTA imaging is more widely available, less prone to artifacts, and the established standard of care in acute stroke imaging protocols.
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- The study focused on comparing the effects of short-term blood glucose levels (BGL) and long-term levels (measured by HbA1c) in patients with ischemic stroke on early brain swelling (edema) and overall recovery outcomes.
- Analyzed data from 345 patients showed that those who were functionally independent at Day 90 had lower early edema and serum BGL, but HbA1c levels did not differ significantly between groups.
- The findings suggest that high short-term BGL correlates with increased early edema and poorer recovery, indicating that managing short-term BGL could be a potential treatment strategy for stroke patients.
Article Synopsis
- Mechanical thrombectomy (MT) for acute ischemic stroke with medium vessel occlusions (like M2-occlusions) is debated, with a recent analysis from the German Stroke Registry Endovascular Treatment exploring factors affecting patient outcomes.
- 1348 patients were studied, revealing that successful recanalization, higher Alberta stroke scores, and intravenous thrombolysis positively influenced the likelihood of good outcomes, while older age, high pre-stroke mRS scores, and diabetes had a negative impact.
- The study concluded that, similar to large-vessel occlusions, factors like younger age and low pre-stroke disability are linked to better outcomes after MT, while treatment-related complications also play a role.
Comparison of Thrombolysis In Cerebral Infarction (TICI) 2b and TICI 3 reperfusion in endovascular therapy for large ischemic anterior circulation strokes.
J Neurointerv Surg
October 2024
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.
Background And Purpose: In wake-up stroke, CT-based quantitative net water uptake (NWU) might serve as an alternative tool to MRI to guide intravenous thrombolysis with alteplase (IVT). An important complication after IVT is symptomatic intracerebral haemorrhage (sICH). As NWU directly implies ischaemic lesion progression, reflecting blood-brain barrier injury, we hypothesised that NWU predicts sICH in patients who had a ischaemic stroke undergoing thrombectomy with unknown onset.
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- - The study explores how imaging techniques, specifically "tissue clock" indicators like CT perfusion and net water uptake, can better predict early neurologic improvement in stroke patients receiving intravenous thrombolysis (IVT) than traditional time-based criteria.
- - Four hundred nine patients with strokes caused by proximal vessel occlusion were analyzed, revealing that IVT significantly improved early neurologic outcomes in those with low NWU or CTP mismatch, independent of the time since symptom onset.
- - The findings suggest that using CT-based "tissue clock" measures could more accurately identify patients who would benefit from IVT, potentially changing treatment approaches for stroke patients within extended time frames.
Article Synopsis
- - The study aimed to identify patient-specific predictors of successful recanalization during mechanical thrombectomy for M2 occlusions in acute ischemic stroke, as previous research had primarily focused on larger vessel occlusions.
- - Using data from the German Stroke Registry, 1,294 patients with isolated M2 occlusions were analyzed, finding that general anesthesia was positively associated with successful recanalization, while factors like older age, higher pre-stroke disability, and diabetes increased the likelihood of futile recanalization.
- - Key findings indicated that success rates varied, with 49.7% achieving complete recanalization, and it was noted that certain procedural and patient demographics could significantly influence outcomes, particularly in terms of functional recovery measured by the modified
Article Synopsis
- Discordance between receptor expressions in metastatic brain lesions and primary tumors in breast cancer patients shows the need for personalized therapy through constant monitoring of these expressions.
- This study investigates using machine learning on MR imaging features to predict receptor status in brain metastases, analyzing 412 samples from 106 patients over a 14-year period.
- Results reveal that MR image features can accurately predict the receptor status (ER+, PR+, HER2+) with high discriminatory accuracy, suggesting a valuable tool for individualized treatment planning.
Article Synopsis
- - The study investigates how follow-up infarct volume (FIV) affects the link between successful medical recanalization after stroke and patient functional outcomes, aiming to clarify their relationship.
- - An analysis of 429 patients revealed that good functional outcomes were notably linked to successful recanalization, age, and pre-stroke conditions, with FIV playing a mediating role in this association.
- - Results indicated that successful recanalization increased the chances of good outcomes by 23%, and remarkably, 56% of the improvement in patient outcomes was attributed to reductions in FIV.
Background: Emerging data suggest that mechanical thrombectomy (MT) might also be safe and efficient for medium and distal occlusions. This study aims to compare average treatment effects on functional outcome of different degrees of recanalization after MT in patients with M2 occlusion and M1 occlusion.
Methods: All patients enrolled in the German Stroke Registry (GSR) between June 2015 and December 2021 were analyzed.
Penumbra salvage in extensive stroke: exploring limits for reperfusion therapy.
J Neurointerv Surg
December 2023
Background: The effect of thrombectomy in patients presenting with extensive ischemic stroke at baseline is currently being investigated; it remains uncertain to what extent brain tissue may be saved by reperfusion in such patients. Penumbra salvage volume (PSV) has been described as a tool to measure the volume of rescued penumbra.
Objective: To assess whether the effect of recanalization on PSV is dependent on the extent of early ischemic changes.
Article Synopsis
- Computed-tomography perfusion (CTP) is commonly used to evaluate acute ischemic stroke (AIS) patients for endovascular treatment (EVT), but it often overestimates the ischemic "core," which can lead to some patients being unfairly excluded from treatment.
- The study reviewed data from 284 AIS patients treated between June 2015 and July 2020, examining the relationship between the baseline core volume (pCore) from CTP and net water uptake (NWU) in assessing the extent of tissue infarction.
- Findings reveal that NWU serves as a valuable complementary tool to CTP as it correlates with lesion growth and helps achieve a more accurate assessment of ischemia, especially for
Background: Parenchymal hematoma (PH) is a major complication after endovascular treatment (EVT) for ischemic stroke. The hypoperfusion intensity ratio (HIR) represents a perfusion parameter reflecting arterial collateralization and cerebral microperfusion in ischemic brain tissue. We hypothesized that HIR correlates with the risk of PH after EVT.
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