Publications by authors named "Marios Nikos Psychogios"

Background: Data about the safety and the efficacy of flow diversion for distal anterior cerebral artery (DACA) aneurysms are limited. We present the largest multicenter analysis evaluating the outcomes of flow diversion in unruptured DACA aneurysm treatment.

Methods: Databases from 39 centers were retrospectively reviewed for unruptured DACA aneurysms treated with flow-diverting stents.

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Introduction: The impact of streamlining algorithms for stroke patients on process times in pre-hospital emergency medicine (PHEM) is not well investigated. We analyzed the changes in pre- and in-hospital process times after implementation of a streamlining algorithm in a physician staffed PHEM system.

Patients: We conducted a prospective observational study and analyzed process times of adult stroke patients attended by emergency physicians (EP) of the city of Göttingen PHEM service after implementation of a streamlining algorithm including stroke triage using the FAST-ED score.

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Background: Underlying intracranial stenosis is the most common cause of failed mechanical thrombectomy in acute ischemic stroke patients with large vessel occlusion. Adjunct emergent stenting is sometimes performed to improve or maintain reperfusion, despite limited data regarding its safety or efficacy.

Methods: We conducted a prospective multicenter observational international cohort study.

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Article Synopsis
  • Assessment of MS lesions via MRI is usually time-consuming, and the study explores how AI can make this process more efficient for radiologists.* -
  • The study involved evaluating MRIs of 35 MS patients, revealing that AI assistance reduced the reading time significantly during follow-ups, while baseline readings showed minimal improvement.* -
  • Overall, results indicate that AI can considerably shorten the time needed to assess MRIs for MS, suggesting a more efficient approach for radiologists.*
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Article Synopsis
  • Researchers aimed to create and validate a prediction score for futile recanalization (FR) in patients with low Alberta Stroke Program Early Computed Tomography Scores (ASPECTS) who underwent endovascular thrombectomy (EVT) for large vessel occlusions (LVO).
  • The study analyzed data from 219 patients with anterior circulation LVO and identified key predictors of FR, resulting in the development of the SNAP score, which considers factors like the site of occlusion and patient age.
  • The SNAP score successfully predicted FR with an area under the curve of 0.79 in both training and validation cohorts, indicating its potential usefulness for guiding expectations in patients undergoing EVT for severe strokes.
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Background/objectives: Detailed morphometric analysis of an aneurysm and the related vascular bifurcation are critical factors when determining rupture risk and planning treatment for unruptured intracranial aneurysms (UIAs). The standard visualization of digital subtraction angiography (DSA) and its 3D reconstruction on a 2D monitor provide precise measurements but are subject to variability based on the rater. Visualization using virtual (VR) and augmented reality platforms can overcome those limitations.

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Background: Emerging evidence suggests that endovascular thrombectomy is beneficial for treatment of childhood stroke, but the safety and effectiveness of endovascular thrombectomy has not been compared with best medical treatment. We aimed to prospectively analyse functional outcomes of endovascular thrombectomy versus best medical treatment in children with intracranial arterial occlusion stroke.

Methods: In this prospective registry study, 45 centres in 12 countries across Asia and Australia, Europe, North America, and South America reported functional outcomes for children aged between 28 days and 18 years presenting with arterial ischaemic stroke caused by a large-vessel or medium-vessel occlusion who received either endovascular thrombectomy plus best medical practice or best medical treatment alone.

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Background: A higher number of recanalization attempts reduces the efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke secondary to large vessel occlusion (LVO). We assessed the impact of switching EVT techniques after a failed first pass on procedural and clinical outcomes.

Methods: This multicenter international study, conducted between January 2013 and December 2022, included patients undergoing EVT for anterior circulation LVO (internal carotid artery or M1 segments) with failed first pass recanalization.

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Background And Objectives: This study aimed to compare outcomes of low Alberta Stroke Program Early Computed Tomography Score (ASPECTS) patients with stroke who underwent mechanical thrombectomy (MT) within 6 hours or 6 to 24 hours after stroke onset.

Methods: A retrospective cohort study was conducted using data from a large multicenter international registry from 2013 to 2023. Patients with low ASPECTS (2-5) who underwent MT for anterior circulation intracranial large vessel occlusion were included.

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Background: The benefit of intravenous thrombolysis (IVT) is well established. We aim to study the benefits of IVT in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) who underwent unsuccessful mechanical thrombectomy (MT).

Methods: We included AIS patients who underwent MT for anterior circulation LVO with failed recanalization (modified treatment in cerebral ischemia [mTICI] score ≤ 2A).

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Background: The effect of endovascular therapy (EVT) on the outcome of stroke patients with a medium distal vessel occlusion (MDVO) is unclear. We report the results of MDVO patients treated with the 3 mm Trevo stent retriever (SR) and/or the AXS Catalyst 5 distal access catheter.

Methods: Data was derived from a prospective, multicenter global registry (ASSIST registry) which enrolled patients treated with operator preferred EVT technique at 71 sites from January 2019 to January 2022.

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Background: A combination of intravenous (IVT) or intra-arterial (IAT) thrombolysis with mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion (AIS-LVO) has been investigated. However, there is limited data on patients who receive both IVT and IAT compared with IVT alone before MT.

Methods: STAR data from 2013 to 2023 was utilized.

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Article Synopsis
  • * Data from 459 patients with vessel perforation showed a 90-day mortality rate of 51.9%, with only 16.3% achieving a favorable recovery (mRS 0-2).
  • * The findings indicate that large vessel perforation leads to worse outcomes, while thrombolysis doesn’t worsen prognoses; quick management of bleeding is crucial for survival.
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Background: Whereas mechanical thrombectomy (MT) has become standard-of-care treatment for patients with salvageable brain tissue after acute stroke caused by large-vessel occlusions, the results of MT in patients with medium-vessel occlusions (MEVOs), particularly in the posterior cerebral artery (PCA), are not well known.

Methods: Using data from the international Stroke Thrombectomy and Aneurysm Registry (STAR), we assessed presenting characteristics and clinical outcomes for patients who underwent MT for primary occlusions in the P2 PCA segment. As a subanalysis, we compared the PCA MeVO outcomes with STAR's anterior circulation MeVO outcomes, namely middle cerebral artery (MCA) M2 and M3 segments.

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Background: The definitive impact of onset to arterial puncture time (OPT) on 90-day mortality after endovascular thrombectomy (EVT) in patients with acute ischemic stroke (AIS) caused by anterior circulation large vessel occlusion (LVO) remains unknown. The present study aimed to evaluate the influence of OPT on 90-day mortality in anterior circulation AIS-LVO patients who underwent EVT.

Methods: Data from 33 international centers were retrospectively analyzed.

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Background And Aims: Postinterventional hypothermia is a frequent complication in patients with large-vessel occlusion strokes (LVOS) after mechanical thrombectomy (MT). This inadvertent hypothermia might potentially have neuroprotective but also adverse effects on patients' outcomes. The aim of the study was to determine the rate of hypothermia in patients with LVOS receiving MT and its influence on functional outcome.

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Background: The outcomes of endovascular thrombectomy (EVT) for medium vessel occlusions (MeVOs) of specific vascular territories remain unknown. We aimed to investigate EVT outcomes by MeVO locations using the data from an ongoing international multicenter registry.

Methods: Patients with isolated MeVO who underwent EVT between January 2013 and December 2022 were retrospectively analyzed.

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Article Synopsis
  • The study investigates the effectiveness of two anesthesia methods—general anesthesia (GA) and conscious sedation (non-GA)—for patients undergoing endovascular treatment for isolated posterior cerebral artery (PCA) occlusion stroke.
  • Researchers analyzed data from the PLATO study focusing on patient outcomes such as the modified Rankin Scale scores after 90 days, as well as successful reperfusion rates and safety measures like intracranial hemorrhage.
  • Results show that while both anesthesia methods had similar functional outcomes and safety profiles, GA was associated with significantly higher rates of successful reperfusion during treatment.
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Background: Multiple studies and meta-analyses have described the technical and clinical outcomes in large cohorts of aneurysm patients treated with flow diverters (FDs). Variations in evaluation methodology complicate making comparisons among studies, hinder understanding of the device behavior, and pose an obstacle in the assessment of further advances in FD therapy.

Methods: A multidisciplinary panel of neurointerventionalists, imaging experts, and neuroradiologists convened with the goal of establishing consensus recommendations for the standardization of image analyses in FD studies.

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Rationale: Whether endovascular therapy (EVT) in addition to best medical treatment (BMT) in people with acute ischemic stroke (AIS) due to a medium distal vessel occlusion (MDVO) is beneficial remains unclear.

Aim: To determine if people experiencing an AIS due to an isolated MDVO (defined as the co- or non-dominant M2 segment, the M3 or M4 segment of the middle cerebral artery, the A1, A2, or A3 segment of the anterior cerebral artery or the P1, P2 or P3 segment of the posterior cerebral artery) will have superior outcome if treated with EVT in addition to BMT compared to BMT alone.

Sample Size: To randomize 526 participants 1:1 to EVT plus BMT or BMT alone.

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Background: The literature on endovascular treatment (EVT) for large-vessel occlusion (LVO) acute ischaemic stroke (AIS) has been rapidly increasing after the publication of positive randomized-controlled clinical trials (RCTs) and a plethora of systematic reviews (SRs) showing benefit compared to best medical therapy (BMT) for LVO.

Objectives: An overview of SRs (umbrella review) and meta-analysis of primary RCTs were performed to summarize the literature and present efficacy and safety of EVT.

Design And Methods: MEDLINE Pubmed, Embase and Epistemonikos databases were searched from January 2015 until 15 October 2023.

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Article Synopsis
  • - The study compared flat-panel detector computed tomography perfusion (FDCTP) with conventional multidetector computed tomography perfusion (MDCTP) in analyzing patients with acute ischemic stroke, specifically those who underwent mechanical thrombectomy.
  • - Results indicated strong correlations between FDCTP and MDCTP for manually segmented hypoperfused tissue volumes, yet showed lower correlations for direct quantitative comparisons, implying FDCTP may underestimate some values compared to MDCTP.
  • - Overall, while FDCTP and MDCTP offered comparable qualitative results in measuring perfusion maps, the direct quantitative assessment had limitations, suggesting the need for improved normalization techniques for accurate evaluations.
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Background And Objectives: First pass effect (FPE) is a metric increasingly used to determine the success of mechanical thrombectomy (MT) procedures. However, few studies have investigated whether the duration of the procedure can modify the clinical benefit of FPE. We sought to determine whether FPE after MT for anterior circulation large vessel occlusion acute ischemic stroke is modified by procedural time (PT).

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Background: The role for the transradial approach for mechanical thrombectomy is controversial. We sought to compare transradial and transfemoral mechanical thrombectomy in a large multicenter database of acute ischemic stroke.

Methods: The prospectively maintained Stroke Thrombectomy and Aneurysm Registry (STAR) was reviewed for patients who underwent mechanical thrombectomy for an internal carotid artery (ICA) or middle cerebral artery M1 occlusion.

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