Thrombectomy in ischemic stroke patients with alberta stroke program early computed tomography score 4-5 and 0-3: Factors associated with favorable outcome.

OBJECTIVES: Recently published results of the ANGEL-ASPECT and SELECT2 trials suggest that stroke patients presenting with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) benefit from mechanical thrombectomy. Purpose of this retrospective study was to identify factors that are associated with a favorable outcome in patients with low ASPECTS of 4-5 and 0-3 undergoing mechanical thrombectomy. MATERIAL AND METHODS: All patients reported in the quality registry of the German Society for Neuroradiology that were treated between 2018 and 2020 were analyzed. Favorable outcome was defined as a National Institute of Health Stroke Scale (NIHSS) score of less than 9 at dismissal. Successful recanalization was defined as Thrombolysis in Cerebral Infarction (mTICI) ≥ 2b. Multivariable logistic regression analyses were performed to assess the association of baseline and treatment variables with favorable outcome. RESULTS: 621 patients were included in the analysis, thereof 495 with ASPECTS 4-5 and 126 with ASPECTS 0-3. In patients with ASPECTS 4-5patients with favorable outcome had less severe neurological symptoms at admission with median NIHSS of 15 vs. 18 (p<0.001), had less often wake-up strokes (44% vs. 81%, p<0.001), received more often iv-lysis (37% vs. 30%, p<0.001), had more often conscious sedation (29% vs. 16%, p<0.001), had a higher rate of successful recanalization (94% vs. 66% and lower times from groin puncture to recanalization. In multivariate regression analysis lower NIHSS at admission (aOR 0.87, CI 0.89-0.91) and successful recanalization (aOR 3.96, CI 2-8.56) were associated with favorable outcome. For ASPECTS 0-3, patients with favorable outcome had lower median NIHSS at admission (16 vs. 18 (p<0.001), lower number of passes (1 vs. 3, p=0.003) and a higher rate of successful recanalization (94% vs. 66%, p<0.001) and lower times from groin puncture to recanalization. In multivariate regression analysis lower NIHSS at admission (aOR 0.87, CI 0.81-0.94) and successful recanalization, (aOR 11.19, CI 3.19-55.53), were associated with favorable outcome. CONCLUSION: Full recanalization with low groin punction to recanalization times and low number of passes were associated with favorable outcome in patients with low ASPECTS.

[Back pain: a phenomenon of age? : Degenerative alterations of the spine are normal with increasing age. But how is this "normal" in old age defined, does it compulsorily lead to more complaints and a relevant impairment of the quality of life?] / Rückenschmerz: ein Phänomen des Alters? : Degenerative Veränderungen an der Wirbelsäule gelten mit zunehmendem Alter als normal. Aber wie ist dieses "Normal" im Alter definiert, führt es zwangsweise zu mehr Beschwerden und einer relevanten Einschränkung der Lebensqualität?

BACKGROUND: Under the assumption that a certain degree of degeneration is normal in old age, the changes that significantly lead to discomfort should be identified. Care should be taken to ensure that the geriatric patient receives adequate treatment and can quickly return to a normal pain-free life. MATERIAL AND METHODS: A prospective study was performed on symptomatic outpatients who came for a magnetic resonance (MR) examination of the spine. The presence of spinal stenosis, osteochondrotic and spondylarthrotic changes and nerve root affections were assessed. A brief interview was conducted to assess impairment of daily life, duration of symptoms until contact with the physician, and resulting impairment. The results were correlated with age, the groups of patients under and over 65 years of age, and the pain score. RESULTS: Age is significantly positively correlated with facet joint arthrosis, spinal stenosis, osteochondrotic changes and intraforaminal nerve root affection. There is no significant correlation between the pain score and age. The pain score shows significant correlation to nerve root affection, facet joint osteoarthritis and spinal constriction. The duration of pain until a visit to the treating physician is significantly shorter in older patients, while the impairments in everyday life are significantly more pronounced under the existing back pain. CONCLUSION: Age itself is not correlated with pain perception. Isolated features such as nerve root affection and facet joint arthrosis show a positive correlation with the pain. The older patient goes to the doctor more quickly because the back pain is perceived as a restriction of daily life.

The physician as a success determining factor in CT-guided pain therapy.

BACKGROUND: Back pain is a common problem and a burden for the patient. MR-morphologically proven pain-causing changes of the spine is often successfully treated utilizing CT-guided pain therapy. The CT-guided execution enables a controlled and reproducible therapy. Nevertheless, treatment results can differ even with the same patient; the physician is a possible influencing factor of the outcome. Accordingly, the present study analyzes the different behaviors and forms of communication of the treating physicians during the course of the intervention as factors influencing the outcome of treatment. METHODS: 67 patients suffering from specific back pain were included in this study. 5 treating physicians (2 female, 3 male) of different age (29-63 years), and experience and a total of 244 CT-guided treatments were included in this study. In every case a psychologist observed the treatment based on a standardized observation protocol. Observed were both the verbal and non-verbal interactions as well as the reaction of patient and physician. The success of the therapy was measured in the course of the treatment using the visual analogue pain scale. The technical comparability of the performed CT-guided periradicular therapy was ensured by the distribution of the drug mixture. RESULTS: The outcome is significantly better if the patient considers the treating physician to be competent (correlation coefficient: 0.24, p < 0.006) and feels understood (correlation coefficient: 0.29, p < 0.001). In addition, the outcome is better when the physician believes that the treatment brings a positive reduction of pain, underlining his belief with positive statements of affirmation before the intervention thus creating a positive atmosphere [correlation coefficient: 0.24 (p < 0.009)]. In contrast, the outcome is worse if the patient complains about pain during the intervention [average pain reduction M = 0.9 (pain group) vs. M = 2.0 (no-pain group)]. CONCLUSION: Our study shows that with comparable implementation of CT-guided periradicular therapy, the outcome of the patient with specific back pain can be significantly improved by certain behavioral patterns of the performing physician and this without side effects and without significant additional time expenditure. Our findings indicate that there is a non-negligible psychological factor linking confidence in therapy to actual therapy success. TRIAL REGISTRATION: The study was designed as an observational study, therefore a trial registration was not necessary.

[CT-guided pain management of specific low back pain : Disc impairment vs. osseous degeneration]. / CT-gesteuerte Schmerztherapie des spezifischen Rückenschmerzes : Bandscheibenschädigung vs. ossäre Degeneration.

BACKGROUND: Back pain is common and leads the patient to the radiologist both for diagnosis and in specific cases for therapy. OBJECTIVES: The current study compares the pain-reducing effect of microinvasive computed tomography (CT)-guided pain therapy for specific back pain caused by herniated discs or spondylarthrosis. MATERIALS AND METHODS: Over a period of 3.3 years, a total of 239 patients were included, in whom 686 CT-guided periradicular therapies (PRT) and 264 CT-guided facet joint therapies (FAC) were performed. In all patients, the pain score was determined using a visual analog pain scale (VAS) before the intervention, during the course of treatment and at the end of treatment. Finally, treatment success was correlated to the type of treatment performed and to the morphological changes present. RESULTS: Both groups showed good improvement of pain under treatment (74% of the PRT patients and 60% of the FAC patients). Patients who underwent PRT showed an average improvement in pain score of 3.1, while those who underwent FAC showed an average improvement of 2.1. The efficacy of FAC was dependent on the degree of degenerative changes present. The more extensive the proven degeneration was in the treated segment, the more interventions were necessary for a good treatment response. CONCLUSION: CT-guided PRT and CT-guided FAC both lead to a good reduction of pain symptoms. In comparison, PRT achieves significantly higher pain reduction than FAC.

[Patient satisfaction with radiologists in private practice]. / Patientenzufriedenheit beim niedergelassenen Radiologen.

BACKGROUND: Radiology is an interface discipline. The radiologist must provide answers for various diagnostic questions in a short time by means of various examinations. The patient as well as the referring physician must be adequately and appropriately considered within a reasonable period, at the same time ensuring a high quality of examination with the lowest possible radiation exposure. MATERIALS AND METHODS: Over a 4-month period, a total of 102 patient interviews and 259 physician-patient interviews on patient satisfaction were randomly analyzed, specifically patient-physician communication and patient expectations and physician satisfaction and patient expectations. A psychologist carried out the questioning of the patients. Four radiologists evaluated their patient interaction using a standardized questionnaire, which was anonymized with regard to the patient data, based on a visual analogue scale. RESULTS: The patients displayed a high level of satisfaction with the discussion of radiologic findings. There was a positive correlation between the satisfaction with the discussion of findings and the clarity about the further steps necessary. Looking at the radiologists, there was also a positive correlation between the satisfaction with the patient interview and the fulfillment of the expectations; overall, physician's satisfaction with the interview was less positive than patient satisfaction. CONCLUSION: The radiologic patient is generally satisfied with the visit to the radiologist if a brief, understandable explanation of the disease is given, complemented by instructive next necessary steps.

Temporarily increased stroke rate after Takotsubo syndrome: need for an anticoagulation?

BACKGROUND: Previous studies have reported slightly higher stroke rates in Takotsubo Syndrome compared to acute myocardial infarction. Our goal was to evaluate the temporal course of stroke rates and left ventricular recovery in patients with Takotsubo Syndrome. METHODS: We retrospectively examined the clinical and imaging data of 72 patients with Takotsubo Syndrome. The data collected came from January 2005 to March 2017. Left ventricular performance was evaluated by cardiovascular magnetic resonance imaging (MRI) in all patients during the acute phase of Takotsubo Syndrome and in a follow-up scan 2 months later. Acute stroke and major adverse clinical events, such as myocardial infarction or recurrence of Takotsubo Syndrome and death, were also determined for each patient at 30 days and 12 months after initial presentation. RESULTS: The MRI scans performed during the acute phase of Takotsubo Syndrome demonstrated apical ballooning with anterior wall motion dysfunction in 65 (90%) patients. Imaging performed 2 months later demonstrated resolution of this in 97% of those patients. Median left ventricular ejection fraction also significantly increased between both scans (49.5% vs. 64.0%, P < 0.001). We observed 9 (12%) events in the study population within 12 months of the initial diagnosis of Takotsubo Syndrome. Stroke had an event rate of 2.8% after 30 days and 4.2% after 12 months. CONCLUSIONS: Apical ballooning was found in the majority of our Takotsubo Syndrome patients on the MRI scans performed at presentation. This finding was subsequently associated with higher than expected stroke rates within 30 days of diagnosis and with rapid recovery of left ventricular function within 2 months of diagnosis. This suggests that rapid improvement in left ventricular morphology and function may facilitate the formation of cardiac emboli and consequently increase stroke rates in Takotsubo Syndrome. Although no guidelines currently exist for the treatment of Takotsubo Syndrome, these results may point to a potential role for temporary oral anticoagulation in high-risk patients. Future studies should examine if stroke rates after Takotsubo Syndrome have been underestimated.

Ruptured Mycotic Aortic Aneurysm after Bacille Calmette-Guerin Therapy.

To report a case of a ruptured mycotic abdominal aortic aneurysm (MAA) after intravesical Bacille Calmette-Guerin (BCG) therapy because of bladder carcinoma. A 57-year-old male patient was admitted to our hospital for follow-up computed tomography 14 months after transurethral resection of a papillary carcinoma of the bladder and intravesical BCG therapy. The CT scan revealed a ruptured MAA aneurysm and the patient underwent an endovascular repair with an aorto-bi-iliac stent graft. A ruptured MAA is a rare but lethal complication after BCG instillation therapy. The standard therapy is the open reconstruction but according to the literature an endovascular therapy in combination with long-term antibiotics should be considered as a bridging or a definite solution.

Tamoxifen monotherapy in the treatment of retroperitoneal fibrosis.

OBJECTIVE: To evaluate the therapeutic effect of tamoxifen monotherapy in patients with retroperitoneal fibrosis (RPF). PATIENTS AND METHODS: From 2007 on, 31 patients with idiopathic RPF were treated with tamoxifen monotherapy. Follow-up investigations included magnetic resonance imaging, laboratory measurements, registration of side effects and changes or removal of ureteral stents. Data were stored in the Else Kröner-Fresenius Registry of Retroperitoneal Fibrosis. RESULTS: 25 men and 6 women with a mean age of 56.6 years were treated with tamoxifen monotherapy. Mean duration of treatment was 13.3 months, mean follow-up 26.8 months. A total of 44 renal units were affected by hydronephrosis and covered by DJ stents. Radiological regression of fibrosis was detected in 22 cases (71.0%); removal of ureteral stents was possible in 27/44 renal units (61.4%) and 17/29 patients (58.6%), respectively. Most patients showed only mild or no side effects of therapy. In 7 cases (22.3%) tamoxifen therapy had to be abandoned because of severe side effects, progression of fibrosis or persistent intolerance. CONCLUSIONS: Tamoxifen is an alternative in the medical treatment of RPF, especially if patients want to avoid glucocorticoids. The potential of regression of fibrosis seems to be slightly inferior and the relapse rate is higher compared to steroids, but the rate of successful DJ removals is comparable.

The radiologist as a physician - artificial intelligence as a way to overcome tension between the patient, technology, and referring physicians - a narrative review. / Der Arzt im Radiologen ­ künstliche Intelligenz als Möglichkeit, das Spannungsfeld zwischen Patient, Technik und Zuweisern zu lösen ­ ein narratives Review.

BACKGROUND: Large volumes of data increasing over time lead to a shortage of radiologists' time. The use of systems based on artificial intelligence (AI) offers opportunities to relieve the burden on radiologists. The AI systems are usually optimized for a radiological area. Radiologists must understand the basic features of its technical function in order to be able to assess the weaknesses and possible errors of the system and use the strengths of the system. This "explainability" creates trust in an AI system and shows its limits. METHOD: Based on an expanded Medline search for the key words "radiology, artificial intelligence, referring physician interaction, patient interaction, job satisfaction, communication of findings, expectations", subjective additional relevant articles were considered for this narrative review. RESULTS: The use of AI is well advanced, especially in radiology. The programmer should provide the radiologist with clear explanations as to how the system works. All systems on the market have strengths and weaknesses. Some of the optimizations are unintentionally specific, as they are often adapted too precisely to a certain environment that often does not exist in practice - this is known as "overfitting". It should also be noted that there are specific weak points in the systems, so-called "adversarial examples", which lead to fatal misdiagnoses by the AI even though these cannot be visually distinguished from an unremarkable finding by the radiologist. The user must know which diseases the system is trained for, which organ systems are recognized and taken into account by the AI, and, accordingly, which are not properly assessed. This means that the user can and must critically review the results and adjust the findings if necessary. Correctly applied AI can result in a time savings for the radiologist. If he knows how the system works, he only has to spend a short amount of time checking the results. The time saved can be used for communication with patients and referring physicians and thus contribute to higher job satisfaction. CONCLUSION: Radiology is a constantly evolving specialty with enormous responsibility, as radiologists often make the diagnosis to be treated. AI-supported systems should be used consistently to provide relief and support. Radiologists need to know the strengths, weaknesses, and areas of application of these AI systems in order to save time. The time gained can be used for communication with patients and referring physicians. KEY POINTS: · Explainable AI systems help to improve workflow and to save time.. · The physician must critically review AI results, under consideration of the limitations of the AI.. · The AI system will only provide useful results if it has been adapted to the data type and data origin.. · The communicating radiologist interested in the patient is important for the visibility of the discipline.. CITATION FORMAT: · Stueckle CA, Haage P. The radiologist as a physician - artificial intelligence as a way to overcome tension between the patient, technology, and referring physicians - a narrative review. Fortschr Röntgenstr 2024; DOI: 10.1055/a-2271-0799.

Specific back pain - effective diagnosis and treatment from the radiologist's point of view. / Spezifischer Rückenschmerz ­ sinnvolle Diagnostik und Therapie aus Sicht der Radiologie.

The diagnosis and treatment of specific back pain is important in radiology. Due to the high number of patients suffering from back pain, it is important to provide excellent diagnostic and therapeutic support.Based on a recent literature search and considering the relevant guidelines as well as expert opinions, the aspects of specific back pain important for radiologists in terms of pathogenesis, diagnosis, and treatment are presented.Clinical examination in combination with the medical history provides a valid suspected diagnosis. This should subsequently be verified radiologically. MRI is the most effective cross-sectional diagnostic method for investigating specific back pain. A conventional X-ray on two planes in a standing position can be a useful addition if postural causes are suspected. If the clinical symptoms match the morphological findings, radiological treatment can be carried out for nerve root involvement as well as for inflammatory changes of the facet joints. The improvement in symptoms after radiological therapy is considered good overall; at least a short-term improvement in symptoms can generally be achieved, but no reliable data is available regarding the long-term outcome. Using preparations containing triamcinolone, low dosages should be selected in accordance with the guidelines. Embedding in a multimodal pain therapy treatment concept should be considered.Radiology provides essential diagnostic findings regarding specific back pain. Interventional pain therapy is an effective and safe method of treating proven specific back pain. · First examine clinically, then confirm the suspected diagnosis radiologically.. · MRI is usually the method of choice.. · Interventional pain therapy should show success after a maximum of 2 interventions.. · The anti-inflammatory drug dose should be kept as low as possible.. · The individual course determines the number of interventions.. · Stueckle CA, Haage P. Specific back pain - effective diagnosis and treatment from the radiologist's point of view. Fortschr Röntgenstr 2024; DOI 10.1055/a-2371-1752.

Endovascular treatment of renal artery stenosis in Germany: a retrospective analysis of the DEGIR registry 2018-2021.

PURPOSE: To provide an overview of endovascular treatment of renal artery stenosis (RAS) using the data of the Deutsche Gesellschaft für interventionelle Radiologie (DeGIR) quality management system. MATERIALS AND METHODS: A retrospective analysis was performed. Pre-, peri- and postprocedural data, technical success rates, complication rates, and clinical success rates at dismissal were examined. RESULTS: Between 2018 and 2021, 2134 angiography examinations of the renal arteries were performed: diagnostic angiography in 70 patients (3 %), balloon angioplasty in 795 (37 %), stent implantation in 1166 (55 %) and miscellaneous procedures in 103 (5 %). The lesion length was less than or equal to 5 mm in 1837 patients (87 %), between 5 and 10 mm in 197 (9 %), and between 10 and 20 mm in 62 (3 %). The degree of stenosis was less than 50 % in 156 patients (7 %), greater than 50 % in 239 (11 %), and greater than 70 % in 1472 (70 %). Occlusion was treated in 235 patients (11 %). Symptoms at discharge resolved in 600 patients (29 %), improved in 1012 (49 %), were unchanged in 77 (4 %), and worsened in 5 (0.2 %). Complications were reported in 51 patients (2.5 %) and the mortality rate was 0.15 %. CONCLUSION: A substantial number of patients with RAS and occlusions were treated by radiologists in Germany, with high technical success rates and low complication rates. The indication should be determined carefully as the current European guidelines for the treatment of RAS suggest that only carefully selected groups of patients will benefit from recanalizing treatment. KEY POINTS: · Carefully selected patient groups may benefit from endovascular treatment of renal artery stenosis.. · Analysis of the DEGIR quality management database shows that treatment of renal artery stenosis was performed by radiologists in Germany with high technical success rates and low complication rates.. · Recanalization even led to symptom improvement in a large proportion of patients with occlusions..

[Infrarenal aortic ectasia in retroperitoneal fibrosis (RPF)]. / Aufweitungen der infrarenalen Aorta bei retroperitonealer Fibrose (RPF).

We analysed the infrarenal aortic morphology by abdominal MR-examinations of 47 RPF patients compared to a control group. A significant larger aortic calibre and higher rates of infrarenal dilatation in male RPF patients were observed. The larger aortic diameter in male RPF patients may be due to periaortic inflammation with resulting aortic ectasia and supports the classification of RPF into the spectrum of chronic periaortitis.

[Correlation between comorbidities and thoracic CT manifestations of COVID-19 pneumonia]. / Korrelation zwischen Komorbiditäten und Veränderungen des Lungenparenchyms im CT des Thorax bei Patienten mit COVID-19-Pneumonie.

BACKGROUND AND OBJECTIVES: Pulmonary manifestation of coronavirus disease 2019 (COVID-19) is described using standardized computed tomography (CT) morphologic criteria. In this study, we investigated possible associations between thoracic CT manifestations in COVID-19 pneumonia and typical comorbidities, as well as clinical course. METHODS: We analyzed clinical data and pulmonary imaging of 61 patients with positive PCR test. Pulmonary changes were categorized and reviewed for associations with pre-existing comorbidities and clinical course. RESULTS: Compared to patients with atypical infiltrate patterns (2/19, 10.5%), 25 patients with typical infiltrate patterns (25/42, 59.5%) were significantly more likely to receive intensive care (p<0.001). In addition, patients with typical infiltrate patterns were more likely to receive non-invasive ventilation (12/42, 28.6%, p=0.040) and high-flow therapy (8/42, 19%, p=0.041) compared to patients with atypical infiltrate patterns. Mortality was also higher in patients with typical infiltrate patterns, with 15 patients (15/42, 35.7%) dying during follow-up compared to only 1 patient with atypical infiltrate pattern (1/19, 10.5%, p=0.012). No significant association between specific comorbidities and the resulting infiltrate pattern could be demonstrated. CONCLUSIONS: Patients with a typical COVID-19 infiltrate pattern are more likely to receive intensive care and show higher mortality rates. Further analysis with larger patient collectives is needed to identify specific risk factors for typical COVID-19 pneumonia.

Value of CT in COVID-19-pandemia: A systematic analysis of CT-findings and outcomes in patients with COVID-19 pneumonia.

Chest-computer tomography (CT) is a crucial factor in the clinical course and evaluation of patients with COVID-pneumonia. In the initial phase of the COVID-19 pandemic little information was known on the prognostic value of the initially taken thoracic CTs. The purpose of this study was to determine predictive values for clinical outcome based on CT classification of the pulmonary pathologies in patients with COVID-pneumonia. This single center study included 51 non-immunized patients during the first COVID-19 outbreak in Germany. The patients underwent a clinically indicated chest-CT. Using the radiological society of North America (RSNA)-report template, chest-CTs were classified into 4 categories (typical, atypical, indeterminate, and no changes). We analyzed the outcomes based on these imaging classifications and relevant comorbidities. Among the 51 patients of our study population 14 (27.5%) patients had a lethal outcome. Typical radiological COVID-19 pattern was found in 92.9% of the deceased patients and in 59.5% of the surviving patients (P = .022). The lethal group showed a significant higher proportion of diabetes mellitus (50% vs 10.8%; P = .003) and arterial hypertension (aHTN) (85.7% vs 54.1%; P = .037). Male sex, higher age and coronary heart disease (CHD) were also seen more often in the lethal group. In patients with clinically proven COVID-19 pneumonia, typical chest CT findings show a negative outcome. A classification system used in this study is helpful for classifying imaging features and is recommended as a standardized CT reporting tool. It could also help in triaging of the therapy of patients with COVID-19 pneumonia. Especially the comorbidities, diabetes and arterial hypertonia triggered a negative outcome in our study population.

Machine learning based prediction of length of stay in acute ischaemic stroke of the anterior circulation in patients treated with thrombectomy.

BACKGROUND: Length of stay is an important factor for managing the limited resources of a hospital. The early, accurate prediction of hospital length of stay leads to the optimized disposition of resources particularly in complex stroke treatment. OBJECTIVE: In the present study we evaluated different machine learning techniques in their ability to predict the length of stay of patients with stroke of the anterior circulation who were treated with thrombectomy. MATERIAL AND METHODS: This retrospective study evaluated four algorithms (support vector machine, generalized linear model, K-nearest neighbour and Random Forest) to predict the length of hospitalization of 113 patients with acute stroke who were treated with thrombectomy. Input variables encompassed baseline data at admission, as well as periprocedural and imaging data. Ten-fold cross-validation was used to estimate accuracy. The accuracy of the algorithms was checked with a test dataset. In addition to regression analysis, we performed a binary classification analysis to identify patients that stayed longer than the mean length of stay. RESULTS: Mean length of stay was 10.7 days (median 10, interquartile range 6-15). The sensitivity of the best-performing Random Forest model was 0.8, the specificity was 0.68 and the area under the curve was 0.73 in the classification analysis. The mean absolute error of the best-performing Random Forest Model was 4.6 days in the test dataset in the regression analysis. CONCLUSION: Machine learning has potential use to estimate the length of stay of patients with acute ischaemic stroke that were treated with thrombectomy.

Feasibility of Network-Based, Online Endovascular Simulator Training in Real Time: Results from a Pilot Study.

PURPOSE: To test the feasibility of an online, simulator-based comprehensive interventional radiology (IR) training curriculum in times of COVID-19-induced travel restrictions. MATERIALS AND METHODS: A network of six VIST simulators (Mentice, Gothenburg, Sweden) was installed in six geographically different radiology departments. Two courses with six sessions each took place. 43 participants were recruited on a voluntary basis among local residents. The training sessions were conducted in real time with interconnected simulation devices and were led by experts in the field of IR on a rotational basis. The participants attitude toward various topics was quantified before and after training on a seven-point Likert scale (1 = "not at all", 7 = "to the highest degree"). In addition, post-course surveys were conducted. RESULTS: The courses led to an improvement for all items compared with baseline: interest in IR (pre: 5.5, post: 6.1), knowledge of endovascular procedures (pre: 4.1, post: 4.6), likelihood of choosing IR as a subspecialty (pre: 5.7, post: 5.9). Experience with endovascular procedures (pre: 3.7, post: 4.6) improved significantly (p = 0.016). In the post-course surveys high satisfaction rates with the pedagogical approach (mean 6), the teaching content (mean 6.4), and the duration and frequency of the course (mean 6.1) were observed. CONCLUSION: The implementation of a simultaneous endovascular online training curriculum in different geographic locations is feasible. The curriculum has the potential to meet the demand for training in IR in times of COVID-19-associated travel restrictions and can complement future training in the context of radiologic congresses. KEY POINTS: · The implementation of a simultaneous endovascular online training curriculum in different geographic locations is feasible. For interested residents, the presented online curriculum can offer a low-threshold and comprehensive entry into the world of interventional radiology at the site of their training..

Outcome prediction prior to thrombectomy of the posterior circulation with machine learning.

PURPOSE: Various studies have identified prognostic factors for a favorable outcome of endovascular treatment in posterior circulation. We evaluated various machine learning algorithms in their ability to classify between patients with favorable (defined as 0-2 points on the modified Rankin scale [mRS]), unfavorable (mRS 3-6), poor (mRS 5-6), and nonpoor (mRS 0-4) outcomes at dismissal. METHODS: We retrospectively analyzed data from 415 patients that were treated between 2018 and 2021 from the multicentric DGNR registry. Five models (random forest, support vector machine, k-nearest neighbor, neural network [NN], and generalized linear model [GLM]) were trained with clinical input variables and evaluated with a test dataset of 82 patients. The model with the highest accuracy on the training dataset was defined as the best model. RESULTS: A total of 132 patients showed poor and 162 patients showed favorable outcome. All baseline variables except sex were highly significantly different between patients with favorable and unfavorable outcomes. The variables NIHSS, the presence of wake-up stroke, the administration of IV-thrombolysis and mRS pretreatment were significantly different between patients with poor and nonpoor outcomes. The best-performing NN achieved a sensitivity of 0.56, a specificity of 0.86 and an area under the curve (AUC) of 0.77 on the test dataset in the classification analysis between favorable and unfavorable outcomes. The best-performing GLM achieved a sensitivity of 0.65, a specificity of 0.91 and an AUC of 0.81 in the classification analysis between poor and nonpoor outcomes. CONCLUSION: Short-term favorable and poor outcomes in patients with acute ischemic stroke of the posterior circulation can be predicted prior to thrombectomy with moderate sensitivity and high specificity with machine learning models.

The Current Use of Drug-Eluting Balloons and Stents in Peripheral Arterial Disease: An Online Survey by the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).

PURPOSE: To assess the current use of drug-eluting devices for peripheral arterial disease (PAD) among interventional radiologists following the controversy caused by the 2018 meta-analysis suggesting an increased mortality risk for paclitaxel-eluting devices. METHODS: An anonymous survey was sent to 7035 CIRSE members via email; only complete responses were included and statistically analysed. RESULTS: Three hundred and seven members (4.4%) completed the survey. Among these, 95.8% indicated that they personally perform peripheral vascular procedures. Thirty-eight percentage of respondents did not see any change of practice since 2018, while 47% reported that the use of drug-eluting devices decreased; for 13%, the use stopped altogether, while it increased in 3% of responses. 45.6% of respondents also felt the impact of the controversy in terms of pricing, availability or directives from hospital administration. A large majority of respondents (83.7%) who perform peripheral vascular procedures consider the use of these devices as safe, 12.9% were undecided and 3.4% did not consider them as safe. Among the respondents who do not perform endovascular procedures, 77% considered these devices as safe and 23% were undecided. CONCLUSION: Although the 2018 meta-analysis had a disruptive impact on the use of drug-eluting devices in PAD, with the increasing body of evidence available, a majority of respondents continue to believe in the safety of these devices for use in femoropopliteal disease.

Thrombectomy of Mild Stroke : An Analysis of the Nationwide Registry of the German Society for Neuroradiology.

PURPOSE: Whether patients presenting with mild stroke (NIHSS at admission < 6) should be treated with mechanical thrombectomy (MT) is the subject of an ongoing debate. This retrospective study based on large-scale clinical data aims to identify factors associated with favorable outcome (FO) in patients with mild stroke. METHODS: A total of 761 patients with mild stroke enrolled between 1 January 2020 and 31 December 2020 in the Quality Registry of the German Society for Neuroradiology were analyzed. The FO was defined as stable or improved NIHSS at discharge vs. admission. Descriptive statistics and multivariable logistic regression analyses were performed to identify factors associated with FO. Furthermore, a subgroup analysis of mild stroke based on distal vessel occlusion was conducted. RESULTS: In this study 610 patients had FO with a median NIHSS at discharge of 1 (interquartile range, IQR, 0-2) and 151 had an unfavorable outcome (UO) with median NIHSS at discharge of 10 (IQR 13). Patients with FO had a slightly higher NIHSS at admission (4 vs. 3, p < 0.001), lower mTICI 0 (2.7% vs. 14.2%, p < 0.001), higher mTICI 3 (61.3% vs. 34.5%, p < 0.001) and a lower number of passes (1 vs. 2, p < 0.001). No statistically significant difference was observed for MT-related adverse events. Multivariable logistic regression suggested that NIHSS at admission (adjusted odds ratio (aOR) = 1.28, 95% confidence interval (CI) = 1.10-1.48), mTICI 2b (aOR = 5.44, CI = 2.06-15.03), mTICI 2c (aOR = 10.81, CI = 3.65-34.07) and mTICI 3 (aOR = 11.56, CI = 4.49-31.10) as well as number of passes (aOR 0.76, CI = 0.66-0.88) were significantly associated with FO. No MT-related adverse events were observed for distal vessel occlusions. CONCLUSION: The FO in patients with mild stroke undergoing MT was associated with successful recanalization. No significant differences between patients with FO and UO were found for MT-related adverse events, suggesting that MT complications have no significant effects on the outcome of these patients. MT might improve the prognosis also in patients with mild stroke based on distal vessel occlusions without significantly increasing the risk of adverse events.