Endovascular stroke therapy in Austria: a nationwide 1-year experience.

BACKGROUND AND PURPOSE: Based on a tight network of stroke units (SUs) and interventional centres, endovascular treatment of acute major intracranial vessel occlusion has been widely implemented in Austria. Documentation of all patients in the nationwide SU registry has thereby become mandatory. METHODS: Demographic, clinical and interventional characteristics of patients who underwent endovascular treatment for acute ischaemic stroke in 11 Austrian interventional centres between 1 October 2013 and 30 September 2014 were analysed. RESULTS: In total, 301 patients (50.5% women; median age 70.5 years; median National Institutes of Health Stroke Scale score 17) were identified.193 patients (64.1%) additionally received intravenous thrombolysis. The most frequent vessel occlusion sites were the M1 segment of the middle cerebral artery (n = 161, 53.5%), the intracranial internal carotid artery (n = 60, 19.9%) and the basilar artery (n = 40, 13.3%). Stent retrievers were used in 235 patients (78.1%) and adequate reperfusion (modified Thrombolysis in Cerebral Infarction scores 2b and 3, median onset to reperfusion time 254 min) was achieved in 242 patients (81.4%). Symptomatic intracranial haemorrhage occurred in 7%. 43.8% of patients (n = 132) had good functional outcome (modified Rankin Scale score 0-2) and the mortality rate was 20.9% (n = 63) after 3 months. Compared to the anterior circulation, vertebrobasilar stroke patients had higher mortality. Patients with secondary hospital transportation had better outcomes after 3 months than in-house treated patients. CONCLUSION: Our results document nationwide favourable outcome and safety rates of endovascular stroke treatment comparable to recent randomized trials. The ability to provide such data and the need to further optimize such an approach also underscore the contribution of respective registries.

[Technical feasibility of the implantation of a monorail stent system into the renal arteries without pre-dilatation]. / Technische Machbarkeit der Implantation eines Monorail-Stent-Systems in die Nierenarterien ohne vorherige Dilatation.

PURPOSE: To evaluate the technical feasibility of the implantation of the monorail RX Herculink system into the renal arteries without pre-dilatation. MATERIALS AND METHODS: Forty-two patients (mean age 71 years) from four centers with a total of 44 renal artery stenoses underwent implantation of the RX Herculink stent. The mean grade of the stenosis was 83.8 %, the mean length 7.5 mm. The stenoses were ostial in 38 cases and in immediate proximity to the ostium in 6 cases. The mean follow-up-period was 57 weeks (24 - 176 weeks). RESULTS: In 42 cases, the implantation was successful without pre-dilatation. In 2 cases, pre-dilatation was carried out. In none of the cases, detachment of the stent from the balloon was observed. In one stenosis with a length of 17 mm, implantation of two stents was performed. In 9 cases, post-dilatation with a larger balloon or higher balloon pressure was necessary. Residual stenoses exceeding 30 % were not observed. Two patients developed local bleeding at the puncture site. During the follow-up, restenoses were observed in 5 stents after 26 to 126 weeks, which necessitated a second intervention in 3 cases (PTA in 2 cases, re-stenting in 1 case). The primary patency rate after 6 and 12 months was 0.92 +/- 0.056 according to Kaplan-Meier, the secondary patency rate after 6 and 12 months was 1.0 +/- 0.0. CONCLUSION: Implantation of the RX Herculink stent system into the renal arteries without pre-dilatation is technically feasible and safe. Even without pre-dilatation, the stent-system can be advanced through the stenosis without detachment. The complication rate is low. Our clinical results are comparable to previous studies.

[Radiologic recanalization of veins, vascular prostheses and arteries in cases of insufficient dialysis fistulas]. / Radiologische Rekanalisation von Venen, Gefässprothesen und Arterien bei insuffizienten Dialysefisteln.

Two hundred and sixty-five radiological recanalisations have been carried out in 196 patients with stenoses or occlusions of haemodialysis shunts (167 Cimino shunts, 29 prosthetic shunts). Balloon dilatation was successful in 93% (144 out of 155) stenoses of the shunt vein; redilatation was occasionally necessary, but at six, 12 and 24 months, the patency rate was 75% (56/75), 62% (40/64) and 34% (19/55). Eighty occlusions of shunt veins or prosthetic shunts in 71 patients were treated by a combination of a local fibrinolysis and balloon dilatation or by balloon dilatation alone. Primary recanalisation rate was 56% (14/25) and 65% (36/55), respectively; the six, 12 and 24 months patency rates were 73% (22/30), 54% (7/13) and 14% (1/7). All six recanalisations of the shunt artery--five stenoses and one occlusion--proved successful. In 19 patients with oedema of the arm, 30 dilatations of central veins were performed (18 stenoses, one occlusion). The recanalisation rate was 97% (29/30), the six months patency rate was 57% (8/14). The long-term results of radiological recanalisation are comparable with surgical revision by patch plasty or thrombectomy, but the radiological techniques are simpler, can be carried out on out patients and can be repeated if necessary.

[The percutaneous aspiration and drainage of infected fluid retention after organ transplantation]. / Perkutane Aspiration und Drainage infizierter Flüssigkeitsretentionen nach Organtransplantation.

Local postoperative infections in immunosuppressed patients carry a high mortality rate. In this group of patients interventional radiological procedures are particularly valuable in diagnosis and treatment. We report on the results of radiologically controlled aspirations (11 cases) and drainage (37 cases) of infected fluid collections in 47 patients following transplantation of various organs. By percutaneous aspiration or drainage, 91.7% of infected fluid collections were successfully treated or the clinical condition of the patient improved so that surgical intervention could be avoided. The causative organism was identified and antibiotic treatment carried out in 72.9% (35 cases). Surgical intervention was necessary in only 4.3% (2/48). Needle aspiration or drainage of percutaneously accessible fluid collections thought to be infected appears to be particularly useful for transplant patients at increased risk and is a good alternative to surgical treatment.

[The value of intravenous digital subtraction angiography in Leriche's syndrome]. / Wert der intravenösen digitalen Subtraktions-angiographie beim Leriche-Syndrom.

The value of intravenous digital subtraction angiography was examined in 20 patients with Leriche's syndrome. The method is highly accurate for localising the level of the aortic occlusion (100%), the demonstration of distal patency (95%) and the collateral circulation (90%). An important advantage of this method compared with transaxillary, transbrachial or translumbar aortography is its low invasiveness.

[Percutaneous CT-guided catheter drainage of intrathoracic fluid accumulations]. / Perkutane CT-geführte Katheterdrainage intrathorakaler Flüssigkeitsansammlungen.

To verify the value of percutaneous CT-guided drainage of thoracic fluid collections we studied the outcome in 39 patients retrospectively. 24 (61.5%) of the fluid collections were located in the pleural space, 10 (25.6%) in the lungs and 5 (12.8%) in the mediastinum. 11 CT-guided drainages after a previous attempt were necessary in 9 patients, because of recurrent (n = 6) or residual (n = 5) fluid collections. 70% of the drainage procedures were done using Seldinger's, 30% using trocar technique, mainly with 8.3-12 F catheters. The mean duration of drainage was 10.7 days. In 28 patients (71.8%) the percutaneous CT-guided drainage was curative. In 9 cases (23.1%) the patient's course was stabilised and surgery could be applied electively. 2 patients (5.1%) died because of their underlying end-stage malignancy. None of the drainage procedures changed the patient's course to the worse. There was only 1 pneumothorax with no need of any treatment; no other complication occurred. Our results suggest that percutaneous CT-guided drainage of thoracic fluid collections is a safe and straightforward alternative to surgical treatment.

[Radiologic-endoscopic correlation in ulcerative colitis]. / Radiologisch-endoskopische Korrelation bei Colitis ulcerosa.

Double-contrast irrigoscopies (DCI) performed in 32 patients with confirmed ulcerative colitis are reviewed and correlated with colonoscopy. Whereas endoscopy proved more efficient in assessing superficial changes of the mucosa, DCI was found to be superior in the detection of deeper mucosal lesions and changes in the anatomic aspect of the colon wall. Moreover, DCI showed advantages in the evaluation of the entire colon including the coecum; examination of the coecum by endoscopy was achieved in 31% only of the scrutinised cases.

[Value and importance of genital urography in the diagnosis of intersexuality and other malformations of the urogenital tract]. / Aussagekraft und Bedeutung der Genitourographie in der Diagnostik der Intersexualität und anderer Malformationen des Urogenitaltraktes.

The accuracy of genital urography in the diagnosis of intersex and for the demonstration of the internal genitalia has been studied in 16 patients. It was found that the radiological appearances agreed in all cases with the surgical findings. Individual malformations of the genitals have been considered with reference to the classification of Shopfner and Prader and the advantages and disadvantages of various examination techniques are discussed.

[Sonography in salivary calculi--indications and status]. / Sonographie bei Speichelsteinen--Indikation und Stellenwert.

In 23 patients with sialolithiasis the value of real time sonography was investigated. The calculi were correctly diagnosed in 91% of the patients. 3 of 4 calculi could be localized in the main duct of the salivary gland. Because of the high accuracy and the possibility to detect non opaque stones, sonography should be performed, if on plain film the localisation of the calculi is questionable, before sialography is done. In sonolithotrypsy, sonography can be used to document the extraglandular localisation of intraductal calculi.

[Real-time sonography in extranodal lymphoma]. / Real-time-Sonographie bei extranodalem Lymphombefall.

Sonography is the primary imaging method for staging malignant lymphomas. The accuracy of sonography in diagnosing hepatic and splenic involvement was examined in 132 histologically proven cases. Focal involvement was differentiated from diffuse lymphoma. The value of sonography is discussed with reference to cases showing involvement of the gastro-intestinal tract, kidneys, suprarenals, pancreas, testes, breast, thyroid, parotid and muscle.

[Sonographic anatomy of the neck and its importance in lymph node staging of head and neck cancer]. / Sonographische Halsanatomie und ihre Bedeutung beim Lymphknotenstaging von Kopf-Hals-Malignomen.

Our experience with sonography of the neck (about 1,500 examinations) indicates that most of the structures that are of therapeutic importance can be demonstrated by ultrasound. The cervical nerves, however, cannot be differentiated sonographically from perivascular fat because there is insufficient impedance difference presented by the myelin sheaths. The typical sonographic anatomy of the anterior and lateral cervical muscles, of the major vessels, the thyroid and parathyroid and salivary glands has been analysed. The structures that can be shown by sonography have been related to dissections of the neck.

[Value and indications for high-resolution real-time sonography in nontumor salivary gland diseases]. / Stellenwert und Indikation der hochauflösenden Real-time-Sonographie bei nichttumorösen Speicheldrüsenerkrankungen.

308 patients with salivary gland diseases were investigated using real-time sonography. In 142 patients we suspected neoplasms of the salivary glands on the sonograms. In the remaining 166 patients we investigated the following entities: sialolithiasis (74 patients), acute sialadenitis (54 patients), abscess formation (16 patients), chronic sialadenitis or autoimmune disease (53 patients) and cysts of salivary gland (5 patients). The changes in the sonographic morphology of the different diseases will be described. The role of ultrasound in the diagnosis of the different diseases will be discussed and the indications for sonographic investigations are summarised.

[Differential diagnostic problems of subtotal hepatic steatosis in the sonogram]. / Differentialdiagnostische Probleme der subtotalen Steatotis hepatis im Sonogramm.

The authors describe the appearance of focal sparing in otherwise diffuse fatty infiltration of the liver found in 35 patients. These are pseudotumours which are less echogenic than the surrounding abnormal parenchyma. They are sharply marginated, of triangular shape and show no mass effect--neither by displacement of vessels nor by deformity of the contour of the liver. These characteristic morphologic features allowed a differentiation from neoplasms or abscesses in 80% of our cases. Hence, biopsies are rarely indicated in these patients.

[CT before and after liver transplantation]. / CT vor und nach Lebertransplantation.

In our retrospective study, we evaluated the role of CT in cases of liver transplantation. 118 examinations (37 pre- and 81 post-operative) were carried out in 46 transplant recipients. Pre-operatively CT was used to exclude retroperitoneal secondary lesions, although ultrasound was superior in the region of the porta hepatis. Patency of the portal vein can be established by means of duplex sonography and CT. Portography is indicated only in exceptional circumstances. Post-operative complications (abscesses, hematomas, infarcts) can be demonstrated by CT. CT-guided fine needle biopsies and percutaneous drainage can be carried out post-operatively, even under difficult conditions. Liver cell necrosis, if extensive, represents a serious risk to transplant survival. CT may clarify this, while other problems and differential diagnosis may be solved by angiography.

[Color-coded Doppler sonography of the carotid arteries]. / Farbkodierte Doppler-Sonographie der Karotiden.

Doppler colour flow imaging provides colour-coded visualisation of blood flow additional to the B-mode image. In this study, the carotid arteries of 92 patients were examined comparing duplex sonography with Doppler colour flow imaging. Efficiency of these methods was evaluated by angiography in 16 patients. Examination time was shorter by using Doppler colour flow imaging; evaluation of haemodynamics and anatomical changes was simplified.

[The screening of renal artery stenoses. The initial results with the value of color Doppler sonography]. / Screening von Nierenarterienstenosen. Erste Ergebnisse zur Aussagekraft der Farbdopplersonographie.

The value of colour Doppler sonography in the diagnosis of renal artery stenosis has been studied retrospectively. 17 patients were examined (34 main renal arteries and 7 accessory renal arteries; ages 37 to 84 years; 7 males and 10 females). We studied 1) ability to study the main renal arteries, 2) visibility of accessory renal arteries and 3) the sensitivity and specificity of colour Doppler sonography for the diagnosis of renal artery stenosis. The results were compared with intraarterial angiography. Demonstration of the main renal arteries with colour Doppler sonography was possible in 23 of the 34 vessels. Not a single of the 7 accessory renal arteries was demonstrated by colour Doppler sonography. Of 8 angiographically demonstrated stenoses (more than 50% narrowing) 2 were missed by colour Doppler sonography. One stenosis was correctly diagnosed and 5 were incorrectly evaluated by sonography. 16 out of 18 angiographically normal main renal arteries were correctly evaluated by colour Doppler sonography but 2 showed a false positive finding. This results in a sensitivity of 17% and a specificity of 89% per kidney. Colour Doppler sonography cannot be recommended as a screening method for renal artery stenosis in view of its limited accuracy.

[Radiologic therapy of symptomatic lymphoceles following kidney transplantation]. / Radiologische Therapie von symptomatischen Lymphozelen nach Nierentransplantation.

During a four and a half year period ending in November 1988, we performed 13 percutaneous needle aspirations and 35 percutaneous drainages on 32 patients suffering from symptomatic lymphoceles (LC) following renal transplantation. Of 13 needle aspirations, 4 were therapeutic (31%); in 9 cases recurrent lymphoceles were observed within 3 days. 35 percutaneous catheter drainages were carried out on 29 patients. 16 of these (55%) did not require any additional therapy. In 8 cases recurrent lymphoceles were treated surgically by marsupialization, another 5 underwent repeated percutaneous drainage. One patient needed 3 percutaneous interventions until his symptoms ceased. In 8 patients 5 ml. of fibrinous glue was administered before the catheter was removed; nevertheless, 3 of them developed recurrent LC. In the group of patients without any symptoms after percutaneous drainage, 5 LC were infected, in the group of repeatedly drained LC, 2 had superinfection which was treated with antibiotics. All of the infected LC could be managed successfully by percutaneous drainage. The overall rate of success was 72%.

[Duplex sonography after femoro-distal vascular reconstruction using umbilical veins]. / Duplexsonographie nach femoro-distalen Gefässrekonstruktionen mit Nabelschnurvenen.

In 34 patients femoro-distal reconstructions with umbilical vein grafts were assessed by means of pulsed Duplex sonography. Dilatations of the grafts and aneurysms were diagnosed easily by means of DS, likewise thrombotic plaques and perivascular pathologies. Haemodynamically significant stenoses can be quantified due to the increased velocity measured by pulsed Doppler. It can be concluded that DS is the method of choice for the postoperative follow-up of umbilical vein grafts of the femoro-distal vascular system.

[Balloon dilatation of benign esophageal stenoses]. / Ballondilatation von benignen Osophagusstenosen.

Benign stenoses of the oesophagus have been conventionally treated by endoscopic bougienage and were operated on in case of failure. Now that balloon catheters with large balloon diameters are available, interventional radiological dilatation of enteric strictures can be easily performed. In case of eccentric high-grade stenosis with or without blind loop, stenosis is often easier to manage and associated with less risk with an angiographic guide wire and catheter than by endoscopy. 53.3% of the patients were referred to balloon dilatation after failed endoscopic bougienage. The indications for balloon dilatation were anastomotic stenosis (66.2%), peptic stenosis (16.9%), achalasia (7%), pylorospasm (5.6%) and stenosis due to pemphigus vulgaris, acid ingestion and (in one case) a Schatzki ring. The complication rate was low at 1%. The experience collected with 297 dilatations in 71 patients with benign oesophageal stenosis, is reported.

[The patency of the external and internal carotid arteries in patients with occlusion of the common carotid: detection using color-coded Doppler sonography]. / Durchgängigkeit der Carotis externa und interna bei Patienten mit Carotis-communis-Okklusion: Nachweis in der farbkodierten Doppler-Sonographie.

Common carotid artery occlusion is not necessarily associated with thrombosis of the ipsilateral internal carotid artery. Noninvasive imaging of the carotid bifurcation with colour-coded Doppler sonography demonstrated patency of the external and internal carotid arteries distal to a common carotid occlusion in 4 patients which could be proven surgically. Identification of internal carotid artery patency could be demonstrated by angiography in two of the patients while in the other two cases angiography was inconclusive. Thus, CCDS provided a correct diagnosis of the internal carotid patency in these patients with common carotid occlusion.