Liman, Jan

[["dc.bibliographiccitation.journal","Frontiers in Neurology"],["dc.bibliographiccitation.volume","12"],["dc.contributor.author","Maier, Ilko L."],["dc.contributor.author","Leha, Andreas"],["dc.contributor.author","Badr, Mostafa"],["dc.contributor.author","Allam, Ibrahim"],["dc.contributor.author","Bähr, Mathias"],["dc.contributor.author","Jamous, Ala"],["dc.contributor.author","Hesse, Amelie"],["dc.contributor.author","Psychogios, Marios-Nikos"],["dc.contributor.author","Behme, Daniel"],["dc.contributor.author","Liman, Jan"],["dc.date.accessioned","2021-08-12T07:45:45Z"],["dc.date.available","2021-08-12T07:45:45Z"],["dc.date.issued","2021"],["dc.description.abstract","Background: Endovascular treatment (EVT) for large vessel occlusion stroke (LVOS) is highly effective. To date, it remains controversial if intravenous thrombolysis (IVT) prior to EVT is superior compared with EVT alone. The aim of our study was to specifically address the question, whether bridging IVT directly prior to EVT has additional positive effects on reperfusion times, successful reperfusion, and functional outcomes compared with EVT alone. Methods: Patients with LVOS in the anterior circulation eligible for EVT with and without prior IVT and direct admission to endovascular centers (mothership) were included in this multicentric, retrospective study. Patient data was derived from the German Stroke Registry (an open, multicenter, and prospective observational study). Outcome parameters included groin-to-reperfusion time, successful reperfusion [defined as a Thrombolysis in Cerebral Infarction (TICI) scale 2b-3], change in National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and mortality at 90 days. Results: Of the 881 included mothership patients with anterior circulation LVOS, 486 (55.2%) received bridging therapy with i.v.-rtPA prior to EVT, and 395 (44.8%) received EVT alone. Adjusted, multivariate linear mixed effect models revealed no difference in groin-to-reperfusion time between the groups (48 ± 36 vs. 49 ± 34 min; p = 0.299). Rates of successful reperfusion (TICI ≥ 2b) were higher in patients with bridging IVT (fixed effects estimate 0.410, 95% CI, 0.070; 0.750, p = 0.018). There was a trend toward a higher improvement in the NIHSS during hospitalization [ΔNIHSS: bridging-IVT group 8 (IQR, 9.8) vs. 4 (IQR 11) points in the EVT alone group; fixed effects estimate 1.370, 95% CI, −0.490; 3.240, p = 0.149]. mRS at 90 days follow-up was lower in the bridging IVT group [3 (IQR, 4) vs. 4 (IQR, 4); fixed effects estimate −0.350, 95% CI, −0.680; −0.010, p = 0.041]. There was a non-significantly lower 90 day mortality in the bridging IVT group compared with the EVT alone group (22.4% vs. 33.6%; fixed effects estimate 0.980, 95% CI −0.610; 2.580, p = 0.351). Rates of any intracerebral hemorrhage did not differ between both groups (4.1% vs. 3.8%, p = 0.864). Conclusions: This study provides evidence that bridging IVT might improve rates of successful reperfusion and long-term functional outcome in mothership patients with anterior circulation LVOS eligible for EVT."],["dc.description.abstract","Background: Endovascular treatment (EVT) for large vessel occlusion stroke (LVOS) is highly effective. To date, it remains controversial if intravenous thrombolysis (IVT) prior to EVT is superior compared with EVT alone. The aim of our study was to specifically address the question, whether bridging IVT directly prior to EVT has additional positive effects on reperfusion times, successful reperfusion, and functional outcomes compared with EVT alone. Methods: Patients with LVOS in the anterior circulation eligible for EVT with and without prior IVT and direct admission to endovascular centers (mothership) were included in this multicentric, retrospective study. Patient data was derived from the German Stroke Registry (an open, multicenter, and prospective observational study). Outcome parameters included groin-to-reperfusion time, successful reperfusion [defined as a Thrombolysis in Cerebral Infarction (TICI) scale 2b-3], change in National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and mortality at 90 days. Results: Of the 881 included mothership patients with anterior circulation LVOS, 486 (55.2%) received bridging therapy with i.v.-rtPA prior to EVT, and 395 (44.8%) received EVT alone. Adjusted, multivariate linear mixed effect models revealed no difference in groin-to-reperfusion time between the groups (48 ± 36 vs. 49 ± 34 min; p = 0.299). Rates of successful reperfusion (TICI ≥ 2b) were higher in patients with bridging IVT (fixed effects estimate 0.410, 95% CI, 0.070; 0.750, p = 0.018). There was a trend toward a higher improvement in the NIHSS during hospitalization [ΔNIHSS: bridging-IVT group 8 (IQR, 9.8) vs. 4 (IQR 11) points in the EVT alone group; fixed effects estimate 1.370, 95% CI, −0.490; 3.240, p = 0.149]. mRS at 90 days follow-up was lower in the bridging IVT group [3 (IQR, 4) vs. 4 (IQR, 4); fixed effects estimate −0.350, 95% CI, −0.680; −0.010, p = 0.041]. There was a non-significantly lower 90 day mortality in the bridging IVT group compared with the EVT alone group (22.4% vs. 33.6%; fixed effects estimate 0.980, 95% CI −0.610; 2.580, p = 0.351). Rates of any intracerebral hemorrhage did not differ between both groups (4.1% vs. 3.8%, p = 0.864). Conclusions: This study provides evidence that bridging IVT might improve rates of successful reperfusion and long-term functional outcome in mothership patients with anterior circulation LVOS eligible for EVT."],["dc.identifier.doi","10.3389/fneur.2021.649108"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/88544"],["dc.language.iso","en"],["dc.notes.intern","DOI Import GROB-448"],["dc.publisher","Frontiers Media S.A."],["dc.relation.eissn","1664-2295"],["dc.rights","http://creativecommons.org/licenses/by/4.0/"],["dc.title","Inhouse Bridging Thrombolysis Is Associated With Improved Functional Outcome in Patients With Large Vessel Occlusion Stroke: Findings From the German Stroke Registry"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.artnumber","118"],["dc.bibliographiccitation.issue","1"],["dc.bibliographiccitation.journal","BMC Neurology"],["dc.bibliographiccitation.volume","21"],["dc.contributor.author","Schnieder, Marlena"],["dc.contributor.author","Chebbok, Mohammed"],["dc.contributor.author","Didié, Michael"],["dc.contributor.author","Wolf, Frieder"],["dc.contributor.author","Badr, Mostafa"],["dc.contributor.author","Allam, Ibrahim"],["dc.contributor.author","Bähr, Mathias"],["dc.contributor.author","Hasenfuß, Gerd"],["dc.contributor.author","Liman, Jan"],["dc.contributor.author","Schroeter, Marco R."],["dc.date.accessioned","2021-04-14T08:28:09Z"],["dc.date.accessioned","2022-08-18T12:34:55Z"],["dc.date.available","2021-04-14T08:28:09Z"],["dc.date.available","2022-08-18T12:34:55Z"],["dc.date.issued","2021-03-17"],["dc.date.updated","2022-07-29T12:07:15Z"],["dc.description.abstract","Abstract\r\n \r\n Background\r\n Echocardiography is one of the main diagnostic tools for the diagnostic workup of stroke and is already well integrated into the clinical workup. However, the value of transthoracic vs. transesophageal echocardiography (TTE/TEE) in stroke patients is still a matter of debate. Aim of this study was to characterize relevant findings of TTE and TEE in the management of stroke patients and to correlate them with subsequent clinical decisions and therapies.\r\n \r\n \r\n Methods\r\n We evaluated n = 107 patients admitted with an ischemic stroke or transient ischemic attack to our stroke unit of our university medical center. They underwent TTE and TEE examination by different blinded investigators.\r\n \r\n \r\n Results\r\n Major cardiac risk factors were found in 8 of 98 (8.2%) patients and minor cardiac risk factors for stroke were found in 108 cases. We found a change in therapeutic regime after TTE or TEE in 22 (22.5%) cases, in 5 (5%) cases TEE leads to the change of therapeutic regime, in 4 (4%) TTE and in 13 cases (13.3%) TTE and TEE lead to the same change in therapeutic regime. The major therapy change was the indication to close a patent foramen ovale (PFO) in 9 (9.2%) patients with TTE and in 10 (10.2%) patients with TEE (p = 1.000).\r\n \r\n \r\n Conclusion\r\n Major finding with clinical impact on therapy change is the detection of PFO. But for the detection of PFO, TTE is non inferior to TEE, implicating that TTE serves as a good screening tool for detection of PFO, especially in young age patients.\r\n \r\n \r\n Trial registration\r\n The trial was registered and approved prior to inclusion by our local ethics committee (1/3/17)."],["dc.description.sponsorship","Open-Access-Publikationsfonds 2021"],["dc.identifier.citation","BMC Neurology. 2021 Mar 17;21(1):118"],["dc.identifier.doi","10.1186/s12883-021-02136-5"],["dc.identifier.purl","https://resolver.sub.uni-goettingen.de/purl?gs-1/17746"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/82515"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/112935"],["dc.language.iso","en"],["dc.notes.intern","DOI Import GROB-399"],["dc.notes.intern","Merged from goescholar"],["dc.publisher","BioMed Central"],["dc.relation.eissn","1471-2377"],["dc.rights","CC BY 4.0"],["dc.rights.holder","The Author(s)"],["dc.rights.uri","https://creativecommons.org/licenses/by/4.0"],["dc.subject","Stroke"],["dc.subject","Echocardiography"],["dc.subject","Patent foramen ovale"],["dc.subject","Cardio-embolic stroke"],["dc.title","Comparing the diagnostic value of Echocardiography In Stroke (CEIS) – results of a prospective observatory cohort study"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.version","published_version"],["dspace.entity.type","Publication"]]