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A neurointerventional training model called HANNES (Hamburg ANatomical NEurointerventional Simulator) has been developed to replace animal models in catheter-based aneurysm treatment training. A methodical approach to design for mass adaptation is applied so that patient-specific aneurysm models can be designed recurrently based on real patient data to be integrated into the training system.
HANNES’ modular product structure designed for mass adaptation consists of predefined and individualized modules that can be combined for various training scenarios. Additively manufactured, individualized aneurysm models enable high reproducibility of real patient anatomies. Due to the implementation of a standardized individualization process, order-related adaptation can be realized for each new patient anatomy with modest effort. The paper proves how the application of design for mass adaptation leads to a well-designed modular product structure of the neurointerventional training model HANNES, which supports quality treatment and provides an animal-free and patient-specific training environment.
After five positive randomized controlled trials showed benefit of mechanical thrombectomy in the management of acute ischemic stroke with emergent large-vessel occlusion, a multi-society meeting was organized during the 17th Congress of the World Federation of Interventional and Therapeutic Neuroradiology in October 2017 in Budapest, Hungary. This multi-society meeting was dedicated to establish standards of practice in acute ischemic stroke intervention aiming for a consensus on the minimum requirements for centers providing such treatment. In an ideal situation, all patients would be treated at a center offering a full spectrum of neuroendovascular care (a level 1 center). However, for geographical reasons, some patients are unable to reach such a center in a reasonable period of time. With this in mind, the group paid special attention to define recommendations on the prerequisites of organizing stroke centers providing medical thrombectomy for acute ischemic stroke, but not for other neurovascular diseases (level 2 centers). Finally, some centers will have a stroke unit and offer intravenous thrombolysis, but not any endovascular stroke therapy (level 3 centers). Together, these level 1, 2, and 3 centers form a complete stroke system of care. The multi-society group provides recommendations and a framework for the development of medical thrombectomy services worldwide.
NCCT can be performed in less than a minute with a helical CT scanner, and is considered sufficient to select patients for intravenous thrombolysis with iv-RTP within 4.5 hours, or endovascular treatment within 6 hours. It is a highly accurate method for identifying acute intracerebral hemorrhage and subarachnoid hemorrhage, but quite insensitive for detecting acute ischemia. The approximate sensitivity of CT and perfusion CT (PCT) in different ischemic stroke subtypes is depicted inFigure 3.1. Focal hypoattenuation (hypodensity) is very specific and predictive for irreversible ischemia, whereas early edema without hypoattenuation indicates low perfusion pressure with increased MCV and therefore represents potentially salvageable tissue . The “fogging effect” relates to the potential disappearance of hypoattenuation from approximately day 7 for up to 2 months after the acute stroke. It may result in false-negative NCCT in the subacute stage of ischemic stroke.
Prognosis in thrombolysed and non-thrombolysed patients is worse if there are clear early ischemic signs on NCCT [2, 3]. However, patients benefit from early intravenous and intra-arterial thrombolysis despite early ischemic signs [3, 4].
Non-contrast CT (NCCT) is highly accurate for identifying acute intracerebral hemorrhage and subarachnoid hemorrhage, but quite insensitive for detecting acute ischemia.
Perfusion CT (PCT)
PCT with iodinated contrast may be used in two ways:
as a slow-infusion/whole-brain technique
as dynamic perfusion CT with first-pass bolus-tracking methodology.
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