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Ziel Anhand von Fallbeispielen sollen die Anwendungsmöglichkeiten, Technik und initialen Ergebnisse der transarteriellen periartikulären Embolisation (TAPE) dargestellt werden. Material und Methoden Die TAPE wurde bei 3 Patienten mit chronischen Schmerzen an unterschiedlichen Gelenken angewendet. Im ersten Fall lag eine aktivierte Arthrose des Schultergelenks, im zweiten Fall eine Epicondylitis humeri ulnaris („Golfer-Ellenbogen“) und im dritten Fall ein Patellaspitzensyndrom („Jumpers Knee“) vor. Ergebnisse Bei allen 3 Patienten konnte die TAPE technisch erfolgreich durchgeführt werden. Dabei wurden entweder durch einen transradialen oder transfemoralen Zugang die Endäste der entsprechenden Gelenkarterien superselektiv mittels Mikrokatheter sondiert und mit in Kontrastmittel aufgelöstem Imipenem/Cilastatin embolisiert. Postinterventionell kam es bei der Behandlung des Kniegelenks zu einer Hautrötung, die sich innerhalb einer Woche wieder zurückbildete. Weitere Komplikationen traten nicht auf. Bei allen Patienten zeigte sich bereits am ersten postoperativen Tag eine Linderung der Beschwerden, die anhand von klinischen Tests und der subjektiven Einschätzung der Schmerzen auf einer visuellen Analogskala dokumentiert werden konnte. Schlussfolgerung Die initialen Erfahrungen, die in unserer Klinik mit der TAPE gemacht werden konnten, sind ermutigend und zeigen, dass das Verfahren das Potenzial zur Erweiterung der gering invasiven Therapieoptionen bei Patienten mit therapierefraktären chronischen Gelenkschmerzen und Enthesiopathien hat. Kernaussagen

Purpose Outcome prediction of large vessel occlusion of the anterior circulation in patients with wake-up stroke is important to identify patients that will benefit from thrombectomy. Currently, mismatch concepts that require MRI or CT-Perfusion (CTP) are recommended to identify these patients. We evaluated machine learning algorithms in their ability to discriminate between patients with favorable (defined as a modified Rankin Scale (mRS) score of 0–2) and unfavorable (mRS 3–6) outcome and between patients with poor (mRS5–6) and non-poor (mRS 0–4) outcome. Methods Data of 8395 patients that were treated between 2018 and 2020 from the nationwide registry of the German Society for Neuroradiology was retrospectively analyzed. Five models were trained with clinical variables and Alberta Stroke Program Early CT Score (ASPECTS). The model with the highest accuracy was validated with a test dataset with known stroke onset and with a test dataset that consisted only of wake-up strokes. Results 2419 patients showed poor and 3310 patients showed favorable outcome. The best performing Random Forest model achieved a sensitivity of 0.65, a specificity of 0.81 and an AUC of 0.79 on the test dataset of patients with wake-up stroke in the classification analysis between favorable and unfavorable outcome and a sensitivity of 0.42, a specificity of 0.83 and an AUC of 0.72 in the classification analysis between poor and non-poor outcome. Conclusion Machine learning algorithms have the potential to aid in the decision making for thrombectomy in patients with wake-up stroke especially in hospitals, where emergency CTP or MRI imaging is not available.

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.

Background: Intravenous immunoglobulin (IVIg) is efficient and one of very few treatment options for patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). However, finding the optimal dose of IVIg for individual CIDP patients remains challenging. The dose of IVIg needs to be adjusted individually. Considering the high healthcare costs of IVIg therapy, the overtreatment of some patients seen in placebo studies and the shortage of IVIg we recently experienced, as well as identifying factors associated with the required dose of IVIg in maintenance treatment, is extremely important. Thus, in this retrospective study, we analyze characteristics of patients with stable CIDP, which are associated with the required drug dose. Methods: 32 patients with stable CIDP treated with IVIg between July 2021 and July 2022 were identified from our database and included in this retrospective study. Patients’ characteristics were registered, and parameters were identified that were associated with the IVIg dose. Results: Age, cerebrospinal fluid protein elevation, disease duration, delay between symptom onset/diagnosis, Inflammatory Neuropathy Cause and Treatment (INCAT) score, and Medical Research Council Sum Score (MRC SS) were significantly associated with the required drug dose. In addition, an association of age, sex, elevated CSF protein, time interval between symptom onset and diagnosis, and the MRC SS with the required IVIg dose could be demonstrated in the multivariable regression analysis. Conclusions: Our model, which is based on routine parameters that are simple to address in the clinical practice, can be useful in adjusting the IVIg dose in patients with stable CIDP.

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Background: Wearable cardioverter-defibrillators (WCDs) are a well-established tool to bridge the recovery time of left ventricular ejection fraction (LVEF) until the implantation of an implantable cardioverter defibrillator (ICD), as recommended by the current guidelines. Besides their function to detect and treat malignant arrhythmias, WCDs may be used as a telemonitoring system. In this study, we sought to illustrate and discuss the telemonitoring potential of WCDs and to analyze physical activity in specific patient cohorts. Methods and Results: We retrospectively included 140 patients with reduced LVEF who were prescribed WCDs in our clinic. We analyzed the patients’ physical activity (n = 105 with a WCD compliance above 21 h/day), body position and resting position. We found a reduced physical activity in women and in patients over the age of 65 compared to younger patients. Furthermore, the patients who were overweight or obese showed significantly reduced physical activity compared to the patients with a normal weight (6365 ± 3572 vs. 4972 ± 2476 vs. 7045 ± 3521, p = 0.02). Conclusion: WCDs may be used as a telemonitoring and intervention tool in patients with reduced LVEF. Specific patient groups may benefit from guidance from their treating physician regarding physical activity.