Daniel Behme

University Hospital Magdeburg · Department of Neuroradiology

Objective: The role of endovascular mechanical thrombectomy (MT) in patients presenting with "minor" stroke is uncertain. We aimed to compare outcomes after MT for ischemic stroke patients presenting with National Institutes of Health Stroke Scale (NIHSS) 5 and - within the low NIHSS cohort - identify predictors of a favorable outcome, mortality,...

Purpose Intracranial aneurysms are vascular deformations in the brain which are complicated to treat. In clinical routines, the risk assessment of intracranial aneurysm rupture is simplified and might be unreliable, especially for patients with multiple aneurysms. Clinical research proposed more advanced analysis of intracranial aneurysm, but requi...

Background Recent clinical trials have shown that mechanical thrombectomy is superior to medical management for large vessel occlusion for up to 24 hours from onset. Our objective is to examine the safety and efficacy of thrombectomy beyond the standard of care window. Methods A retrospective review was undertaken of the multicenter Stroke Thrombe...

Background Flow diverters are an increasingly used treatment option for intracranial aneurysms. A recent addition to the European market is the DERIVO®2 Embolization Device (DED2), promising improved radiopacity. We aimed to assess the safety and efficacy of the DED2 regarding angiographic and clinical outcomes in ruptured and unruptured cerebral a...

Background and purpose Flow diverters coated with antithrombogenic substances were recently introduced and showed encouraging results in the preclinical setting. Our aim was to analyze their clinical application in patients with ruptured intracranial aneurysms using single-antiplatelet therapy (SAPT). Data sources We performed a PRISMA–compliant s...

Background Mechanical thrombectomy has become the first‐line treatment strategy for patients with large‐vessel occlusion strokes. Often >1 thrombectomy maneuver is necessary to achieve reperfusion. A first‐pass (FP) effect with improved functional outcomes after mechanical thrombectomy has been described. Aim of the present study is to investigate...

Background and Purpose The ThrombX Retriever is a novel mechanical thrombectomy device that adjusts the distance between two mesh segments to axially hold thrombus. A post-market study assessed safety and performance in acute ischemic stroke patients with large artery occlusion. Methods A single-arm prospective multi-center study enrolled patients...

Clinical history/pre-treatment-imaging We report a successful implantation of a peripheral stent in a dural arteriovenous fistula (dAVF) over a j-shaped 0.035” steel-wire (Rosen). The patient was a 61-year old male presenting with a known dAVF Cognard 2b in the right sigmoid sinus. The jugular vein was thrombosed intracranially. Treatment options/...

Introduction Data on the safety and efficacy of flow diverters (FD) for the treatment of unruptured internal carotid artery (ICA) aneurysms with compressive neuro-ophthalmological symptoms are scarce. Aim of the Study To provide evidence compiling the largest dataset published to date. Methods Data from nine neurointerventional departments, encom...

Introduction Flow diverters have emerged as an effective and widely utilized therapy option for intracranial aneurysms. The DERIVO 2 Embolization Device (DED2) is a new addition to the market and promises better radiopacity.¹ Aim of study The purpose of this study was to evaluate the safety and efficacy of the DED2. Methods We conducted a retrosp...

Background Whether thrombectomy alone is equally as effective as intravenous alteplase plus thrombectomy remains controversial. We aimed to determine whether thrombectomy alone would be non-inferior to intravenous alteplase plus thrombectomy in patients presenting with acute ischaemic stroke. Methods In this multicentre, randomised, open-label, bl...

Background and Purpose The ThrombX Retriever is a novel mechanical thrombectomy device that adjusts the distance between two mesh segments to axially hold thrombus. A post-market study assessed safety and performance in acute ischemic stroke patients with large artery occlusion. Methods A single-arm prospective multi-center study enrolled patients...

Background The role of endovascular mechanical thrombectomy (MT) in patients presenting with ‘minor’ stroke is uncertain. There are also variable definitions reported for ‘minor’ stroke based on the National Institutes of Health Stroke Scale (NIHSS) Objective To compare various cohorts of ‘low’ and ‘high’ NIHSS using cutoff threshold values for NI...

Background Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke secondary to large vessel occlusion (LVO). MT success (MTS) is associated with a five times greater chance of achieving a favorable clinical outcome. Despite major advances in catheter and stent retriever (SR) technology, MT failure (MTF) still occurs in appro...

Background The utility of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) remains a matter of debate. The data regarding the safety and efficacy of IVT prior to MT in patients with large core infarct is scarce. Objective To compare the functional and safety outcomes between patients with large core infarct due to LVO treated wit...

Background The safety and efficacy of mechanical thrombectomy (MT) for the M2 segment of the middle cerebral artery (MCA) has been shown to be effective and safe in recent post-hoc or observational studies. There is, however, no known benefit to MT for the M2 segment in the delayed time window (>6 hours). Here, we perform a propensity score analysi...

7T TOF MRI scans provide high resolution images of intracranial vasculature. When segmented, the Circle of Willis is detailed and thus opens up new possibilities, in research but also in education. We propose a segmentation pipeline for the Circle ofWillis, and introduce a prototype that enables exploration of not just the entire Circle of Willis,...

For hemodynamic simulations of intracranial aneurysms boundary conditions (BC) are required. In most cases, these are not patient-specific and thus do not reflect the real flow conditions in the patient. This study investigates the influence of patient-specific inflow BC on intra-aneurysmal hemodynamics. The focus lies on gender and age variations...

In contrast to unstructured meshes, structured meshes yield faster simulation results for bio-medical simulations, but are very time-consuming to create. A preprocessing step in the generation of structured meshes is the manual construction of a blockstructure approximating the vessel. Here, we present an automatic centerline calculation and blocks...

Background and purpose: Flow diversion is an effective treatment for aneurysms of the ICA with compression-related neuro-ophthalmologic symptoms, especially when treatment is initiated early after symptom onset and aneurysm occlusion is complete. However, non-negligible complication rates have been reported. Our aim was to identify risk factors fo...

Objective Cerebral vasospasm (CVS) represents one of the multiple contributors to delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH). Especially the management of CVS, refractory to medical treatment, is a challenging task during the acute phase after aSAH. Endovascular rescue therapies (ERT), such as medical...

Background: The optimal endovascular strategy for reperfusing distal medium-vessel occlusions (DMVO) remains unknown. This study evaluates angiographic and clinical outcomes of thrombectomy strategies in DMVO stroke of the posterior circulation. Methods: TOPMOST (Treatment for Primary Medium Vessel Occlusion Stroke) is an international, retrospe...

Background Data on the frequency and outcome of mechanical thrombectomy (MT) for large vessel occlusion (LVO) in patients with COVID-19 is limited. Addressing this subject, we report our multicenter experience. Methods A retrospective cohort study was performed of consecutive acute stroke patients with COVID-19 infection treated with MT at 26 tert...

The Subdural Hematoma in the Elderly (SHE) score was developed as a model to predict 30-day mortality from acute, chronic, and mixed subdural hematoma in the elderly population after minor or no trauma. Emerging evidence suggests frailty to be predictive of mortality and morbidity in the elderly. In this study, we aim to externally validate the SHE...

Numerous studies assess intracranial aneurysm rupture risk based on morphological and hemodynamic parameter analysis in addition to clinical information such as aneurysm localization, age, and sex. However, intracranial aneurysms mostly occur with a saccular shape located either lateral to the parent artery or at a bifurcation. In contrast, fusifor...

Background In acute ischemic stroke due to anterior large vessel occlusion (AIS-LVO), accessing the target occluded vessel for mechanical thrombectomy (MT) is sometimes impossible through the femoral approach. We aimed to evaluate the safety and efficacy of direct carotid artery puncture (DCP) for MT in patients with failed alternative vascular acc...

Background: Patients with large vessel occlusion stroke (LVOS) eligible for mechanical thrombectomy (MT) are at risk for stroke- and non-stroke-related complications resulting in the need for tracheostomy (TS). Risk factors for TS have not yet been systematically investigated in this subgroup of stroke patients. Methods: Prospectively derived data...

Purpose The treatment of intracranial arteriovenous malformations (AVM) is challenging due to their complex anatomy. For this vessel pathology, arteries are directly linked to veins without a capillary bed in between. For endovascular treatment, embolization is carried out, where the arteries that supply the AVM are consecutively blocked. A virtual...

Background Scientific data on the safety and efficacy of flow diverter stents (FDS) for the treatment of unruptured internal carotid artery (ICA) aneurysms with compressive neuro-ophthalmological symptoms are scarce. We studied this subject in a retrospective international multicenter series, pooling data of 9 tertiary care neurointerventional depa...

Introduction : The grade of reperfusion after endovascular treatment of ischemic stroke e.g. mechanical thrombectomy is determined based on the mTICI score. The mTICI score shows significant interrater variability; it is usually biased towards better reperfusion results if selfassessed by the operator. We therefore developed a semiautomated image p...

Intracranial aneurysms at the anterior communicating artery (AcomA) are associated with a higher rupture risk and a more challenging therapy since they are supplied with blood from both sides of the anterior vasculature. Since the standard imaging modality, i.e. digital subtraction angiography, involves the contrast agent injection into a single ce...

Background For wide-necked intracranial aneurysms, endo-saccular flow disruption can be a viable alternative to coiling or flow diverters. The Contour Neurovascular System is an intrasaccular flow diverter device targeting the neck of the aneurysm. Until now, the system had to be delivered through a 0.027″ microcatheter. We report the first implant...

Background and Purpose We aimed to compare outcome of endovascular thrombectomy in acute ischemic stroke in patients with and without cerebral amyloid angiopathy (CAA). Methods We included patients with and without possible or probable CAA based on the modified Boston criteria from an observational multicenter cohort of patients with acute ischemi...

Background and Purpose Endovascular therapy for tandem occlusion strokes of the anterior circulation is an effective and safe treatment. The best treatment approach for the cervical internal carotid artery (ICA) lesion is still unknown. In this study, we aimed to compare the functional and safety outcomes between different treatment approaches for...

Background Endovascular therapy (EVT) has become the first line treatment strategy for patients with large vessel occlusion strokes (LVOS). However, often more than one thrombectomy maneuver - either using stent-retrievers, thrombus aspiration or combined approaches - is necessary to achieve reperfusion. A true first pass effect with improved funct...

Introduction/Purpose The discrimination between hemodynamically stable and unstable intracranial aneurysms remains challenging. Recent studies reveal the potential existence of intra-aneurysmal velocity fluctuations, which appear at high frequency. Since these flow disturbances might promote the vessel wall remodeling process, indications regarding...

Introduction/Purpose Interventional treatment of arteriovenous malformations (AVMs) using liquid embolics is challenging especially in larger AVMs with multiple feeding arteries. Premature occlusion of the draining vein(s) may lead to fatal AVM rupture and sequential occlusion of different feeding arteries is associated with the risks of incomplete...

Introduction/Purpose Counseling of patients harboring unruptured intracranial aneurysms (UIAs) has remained challenging despite the availability of several risk scores assessing the aneurysm rupture risk for individual patients. However, besides aneurysm size and simple morphological features no advanced hemodynamic or geometric factors have been u...

Introduction/Purpose Blebs of intracranial aneurysms are clear bulges or outpouchings of the aneurysms wall. Since irregularly shaped aneurysms, i.e. aneurysms with lobulated shapes including one or multiple blebs are associated with a higher rupture risk, bleb occurrence is important for aneurysm treatment planning. Hence, an automatic computer-ba...

Background The mTICI score used to assess the degree of reperfusion after mechanical thrombectomy is an independent predictor of patient outcome after acute ischemic stroke. Its inter-rater reliability, however, is low and interventionalists often overrate their own performance.¹ Objectives We devised an image-processing based semi-automated gradi...

Interdisciplinary exchange of medical datasets between clinicians and engineers is essential for clinical research. Due to the Data Protection Act, which preserves the rights of patients, full anonymization is necessary before any exchange can take place. Due to the continuous improvement of image quality of tomographic datasets, anonymization of p...

Background Whether to approach distal occlusions endovascularly or not in medium-sized vessels secondary to proximal large vessel occlusion stroke remains unanswered. Objective To investigates the technical feasibility and safety of thrombectomy for secondary posterior circulation distal, medium vessel occlusions (DMVO). Methods TOPMOST (Treatmen...

Background Complete reperfusion (mTICI 3) in anterior circulation ischemic stroke patients after a single mechanical thrombectomy (MT) pass has been identified as a predictor of favorable outcome (modified Rankin Score 0–2) and defined as true first-pass effect recently. This effect has not yet been demonstrated in posterior circulation ischemic st...

Objective To identify factors associated with early angiographic reperfusion improvement (EARI) following intra-arterial fibrinolytics (IAF) after failed or incomplete mechanical thrombectomy (MT). Methods A subset of patients treated with MT and IAF rescue after incomplete reperfusion included in the INFINITY (INtra-arterial FIbriNolytics In Thro...

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...

Stroke remains one of the leading causes of death and disability in Europe. The European Stroke Action Plan (ESAP) defines four main targets for the years 2018 to 2030. The COVID-19 pandemic forced the use of innovative technologies and created pressure to improve internet networks. Moreover, 5G internet network will be helpful for the transfer and...

Frailty is associated with an increased risk of adverse health-care outcomes in elderly patients. The Hospital Frailty Risk Score (HFRS) has been developed and proven to be capable of identifying patients which are at high risk of adverse outcomes. We aimed to investigate whether frail patients also face adverse outcomes after experiencing an endov...

Background Endovascular thrombectomy (EVT) is standard of care for anterior circulation acute ischemic stroke (AIS) with large vessel occlusion (LVO). Young patients with AIS‐LVO have distinctly different underlying stroke mechanisms and etiologies. Much is unknown about the safety and efficacy of EVT in this population of young AIS‐LVO patients....

Object Cerebral venous sinus thrombosis (CVST) is a rare but potentially morbid disease in the pediatric population, and the optimal treatment is not fully understood. Endovascular intervention for this condition has been rarely reported. Methods The Stroke Thrombectomy and Aneurysm Registry (STAR) was queried for patient </= 18 years of age under...

Introduction: Endovascular thrombectomy(EVT) is considered standard of care for anterior circulation acute ischemic stroke(AIS) with large vessel occlusion(LVO). Young AIS-LVO patients have distinctly different underlying stroke mechanisms and etiologies. Methods: In this multicenter cohort study conducted from August 2014 to January 2020, we inves...

Importance Clinical evidence of the potential treatment benefit of mechanical thrombectomy for posterior circulation distal, medium vessel occlusion (DMVO) is sparse. Objective To investigate the frequency as well as the clinical and safety outcomes of mechanical thrombectomy for isolated posterior circulation DMVO stroke and to compare them with...

Background and purpose: Data on safety and efficacy of intra-arterial (IA) fibrinolytics as adjunct to mechanical thrombectomy (MT) are sparse. Methods: INtra-arterial FIbriNolytics In ThrombectomY (INFINITY) is a retrospective multi-center observational registry of consecutive patients with anterior circulation large-vessel occlusion ischemic s...

Background and purpose: In certain clinical circumstances, dual-antiplatelet therapy can be problematic in patients with acute SAH. In some aneurysms, however, flow-diverting stents are the ideal therapeutic option. We report our experience with ruptured intracranial aneurysms treated with flow diverters with hydrophilic coating (p48 MW HPC and p6...

OBJECTIVE Several studies have proven the benefits of a wide extent of resection (EOR) of contrast-enhancing tumor in terms of progression-free survival (PFS) and overall survival (OS) in patients with glioblastoma (GBM). Thus, gross-total resection (GTR) is the main surgical goal in noneloquently located GBMs. Complete tumor removal can be almost...

Background: The targeted use of endovascular therapy (EVT), with or without intravenous thrombolysis (IVT) in acute large cerebral vessel occlusion stroke (LVOS) has been proven to be superior compared to IVT alone. Despite favorable functional outcome, many patients complain about cognitive decline after EVT. If IVT in addition to EVT has positiv...

Background and Purpose The efficacy of endovascular therapy in patients with acute ischemic stroke due to tandem occlusion is comparable to that for isolated intracranial occlusion in the anterior circulation. However, the optimal management of acute cervical internal carotid artery lesions is unknown, especially in the setting of carotid dissectio...

Background Cervical spondylotic myelopathy (CSM) is a degenerative process of the cervical spine requiring surgical decompression to prevent neurological deterioration. While both anterior and posterior approaches yield satisfactory results, posterior decompression is preferred in cases of the multilevel disease. In 2015, we described a muscle-spar...

Mannose phosphate isomerase deficiency‐congenital disorder of glycosylation (MPI‐CDG; formerly named CDG type 1b) is characterized by the clinical triad of hepatopathy, protein‐losing enteropathy, and hyperinsulinemic hypoglycemia in combination with coagulation disorder (thrombophilia, depletion of antithrombin, proteins C and S, factor XI). In th...

Background: Delayed cerebral ischemia is one of the leading causes of death and disability in patients with subarachnoid hemorrhage (SAH). Transluminal balloon angioplasty (TBA) is a therapeutic option for vasospasms affecting proximal intracranial arteries. Methods: Aim of this study was to report our experience using the Scepter C balloon cath...

Purpose Extended thrombolysis in cerebral infarction (eTICI) score results of 2b or higher are known to be predictors for favorable outcome after acute stroke. Additionally, time is a major factor influencing outcome after ischemic stroke. Until today only little is known about the impact of time on angiographic results regarding the outcome after...

An amendment to this paper has been published and can be accessed via the original article.

Background Data on the frequency and outcome of repeated mechanical thrombectomy (MT) in patients with short-term re-occlusion of intracranial vessels is limited. Addressing this subject, we report our multicenter experience with a systematic review of the literature. Methods A retrospective analysis was conducted of consecutive acute stroke patie...

Background Mechanical thrombectomy has become the standard care for acute ischemic stroke caused by large vessel occlusion. However, complete reperfusion cannot be achieved in all cases, and several factors influencing the results of mechanical thrombectomy have been investigated. Among others, a tortuous anatomy is associated with lower rates of c...

Early prediction of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) is essential to prevent infarction. CT perfusion (CTP) is used to identify perfusion deficits and to guide treatment decisions. In this study, we aimed to evaluate CTP parameters and to establish cutoff values for DCI prediction in the early phase af...

Background and Purpose— Antiplatelet agents could be used in the setting of endovascular therapy for tandem occlusions to reduce the risk of de novo intracranial embolic migration, reocclusion of the extracranial internal carotid artery lesion, or in-stent thrombosis in case of carotid stent placement but have to be balanced with the intracerebral...

Background Complete reperfusion (mTICI 3) in anterior circulation ischemic stroke patients after a single mechanical thrombectomy (MT) pass has been identified as a predictor of favorable outcome (modified Rankin Score 0-2) and defined as true first-pass effect recently. This effect has not yet been demonstrated in posterior circulation ischemic st...

Introdruction: Rapid thrombectomy for acute ischemic stroke caused by large vessel occlusion leads to improved outcome. Optimizing intrahospital management might diminish treatment delays. To examine if one-stop management reduces intrahospital treatment delays and improves functional outcome of acute stroke patients with large vessel occlusion. Me...

Background: Due to uniform stiffness of standard platinum coils, dense packing of intracranial aneurysms can be difficult to achieve, since stiffer coils can cause microcatheter prolapse or coil migration. SMART coils have a varying softness along the length of the coils to improve deliverability. We report our initial 2 year experience with the S...

Background The targeted use of endovascular therapy (EVT), with or without intravenous thrombolysis (IVT) in acute large cerebral vessel occlusion stroke (LVOS) has been proven to be superior compared to IVT alone. Despite favorable functional outcome, many patients complain about cognitive decline after EVT. If IVT in addition to EVT has positive...