Rhön-Klinikum

Stent-assisted coiling is widely used for the treatment of wide-necked intracranial aneurysms. The pEGASUS-HPC stent features a hydrophilic polymer coating designed to reduce thrombogenicity, potentially improving safety, particularly in ruptured aneurysms and complex configurations. To evaluate the safety, efficacy, and technical feasibility of stent-assisted coiling using the pEGASUS-HPC stent in the treatment of wide-necked intracranial aneurysms. We retrospectively analyzed 223 patients with 251 wide-necked aneurysms treated at six centers between July 2021 and March 2025. Primary endpoints included angiographic occlusion (modified Raymond-Roy classification, MRRC), periprocedural complications, and clinical outcome (modified Rankin Scale, mRS) at discharge and follow-up. Subgroup analysis was performed for ruptured aneurysms and bifurcation cases requiring Y-stenting. Stent deployment and coiling were technically successful in all cases. Immediate complete occlusion (MRRC I) was achieved in 92.4% of aneurysms, increasing to 96.8% at follow-up. The overall retreatment rate was 2.2%. Periprocedural complications occurred in 1.6% of cases, consisting of two minor perforations in unruptured aneurysms, both managed without clinical consequences. In ruptured cases a favorable outcome (mRS ≤2) was observed in 71.1%, with mortality confined to Hunt and Hess grade V or basilar artery aneurysms. Y-stenting was performed in 15.9% of cases without technical failure. No perforations occurred in ruptured cases. Stent-assisted coiling with the pEGASUS-HPC stent appears technically feasible and effective for wide-necked aneurysms, including acute ruptured cases and those requiring Y-stenting, with high occlusion rates and low complication rates.

Atrial tachycardias (AT) represent an increasingly common cause of morbidity and mortality. Driven by substantial advances in mapping and ablation technologies, the mechanistic understanding and therapeutic strategies for AT management have evolved rapidly in recent years, and catheter ablation is now regarded as the most effective strategy for maintaining sinus rhythm. Against this background, the recently published international clinical consensus statement on the management of patients with AT introduces, for the first time, astructured 10-point plan for "SMART-AT care" as aframework for the diagnosis and treatment of regular AT. This review highlights key developments and clinical implications, taking into account recent changes within the healthcare system.

We present a novel technique for tricuspidation of the very asymmetrical bicuspid aortic valve (AV) with commissural orientation of about 120-140, via replacement of the fused AV cusp with 2 neo-cusps. The neo-cusps are fashioned from bovine pericardium and sutured to the annulus. Successful repair using the described technique requires good quality and adequate commissure height of the non-fused cusp. Since 2020, this technique has been applied to 15 patients. To date, all patients are alive with well-functioning AVs, presenting no or trivial insufficiency, large orifice areas, and nearly physiological transvalvular gradients.

Counselling regarding a planned provision of medical aids is currently neither reimbursed nor regulated in Germany. It is offered by a range of providers with employees with varying levels of qualification and may be provided in a personal conversation, by phone, or remotely. In many cases, counselling is omitted entirely between the prescription and trial use or delivery of the product. The quality of medical aids counselling, which plays a key role in temporary, supportive or palliative care for urinary incontinence, is therefore considered problematic.In 2019, the working group "Geriatric Urology" of the German Society for Urology published the first guideline on the counselling process related to the provision of medical aids. An updated version is currently available and has been listed by the Association of the Scientific Medical Societies. The underlying idea was to define quality standard in Germany for the individual components of the counselling process - from identifying the type of incontinence and its severity to product trial use, the counselling setting, the counselling itself, the qualification of the counselling personnel, and the communication between prescribing physicians, service providers, and patients.This article presents the published guideline sections regarding the content of the medical aids prescription, the characteristics of the counselling setting, and the quality of counselling and product trial use.As medical aids counselling is expected to be financed from the low reimbursement rates provided by statutory health insurers for what is defined as an "appropriate and sufficient" supply - typically amounting to less than EUR 15 a month - more and more providers are withdrawing entirely from the sector of medical aids provision. Others continue to supply medical aids but offer no counselling at all or only to a very limited extent. The guideline "Medical Aids Counselling for Urinary Incontinence" developed by the working group "Geriatric Urology" of the German Society for Urology is meant to define quality standards, also with a view to a political discussion on reimbursement rates.

Dual rehabilitation (dR) of patients with physical and mental illnesses comprises equal care and cooperation between two specialist departments. As part of the multi-method project that aimed to evaluate dR in different indications (DUAL), we explored the acceptance from the rehabilitants' perspective.We conducted 36 semi-structured interviews with rehabilitants of different indications (psycho-gastroenterology, -dermatology, -orthopedics, -diabetology, -cardiology, -pneumology). Interviews were analyzed using qualitative content analysis. Knowledge and access, expectations, experiences, and subjective benefits were explored as indicators for acceptance.Rehabilitants reported appropriate expectations such as improvement of mental and physical complaints or open expectations. Cross-departmental aspects such as admission and ward rounds were experienced as beneficial if there was sufficient exchange and cooperation between specialist departments. In individual psychotherapeutic consultations and groups, an improved understanding of both disorders and contact with fellow patients were important which also had a positive effect outside therapies. The multimodality of the dR was perceived to be beneficial just as the therapists' behavior and offers for counseling on both diseases. Hindering experiences included a lack of interdisciplinarity/coordination between the specialist areas, a lack of individualization in therapy planning and structural aspects in almost all areas. Subjective benefits were improved self-management and symptoms of both illnesses, as well as occupational performance.Appropriate expectations, beneficial experiences with the multimodal therapy components, therapists, and fellow patients as well as perceived positive effects support rehabilitants' satisfaction and indicate a high level of acceptance. Hindering experiences and modification requests suggest ways for overcoming obstacles, for example, by increasing interdisciplinarity and cooperation between the specialist departments. Providing sufficient information and knowledge about dR available to practitioners and patients can further support acceptance and patient participation.

The ablation index (AI) standardizes lesions in radiofreqency ablation (RF) of atrial fibrillation (AF). High-power, short-duration ablation (HPSD) shortens procedures, but AI is histologically unvalidated in HPSD. We evaluated esophageal safety with voltage-adapted AF ablation using an optimized, AI-guided HPSD (AI-HPSD) protocol. Consecutive AF patients undergoing AI-HPSD at 50 W (AI = 400-450 for posterior left atrium (LA); AI ≥ 500 anteriorly) were compared with a recent AF cohort treated by AI-guided low-power, long-duration ablation (AI-LPLD). Esophageal endoscopy was performed 1-3 days postablation. Posterior wall lesion characteristics and endoscopically-detected esophageal lesions (EDEL) were compared. AI-LPLD (n = 100) and AI-HPSD (n = 100) groups had similar baselines, except AI-LPLD had slightly larger LA-area. VISITAG numbers were comparable, but total posterior wall RF time was shorter with AI-HPSD versus AI-LPLD [4.1 (2.1-12.7) vs. 10.9 (5.1-26.6), p < 0.001]. Mean AI and mean impedance drop were higher in AI-HPSD [449 (394-487) vs. 399 (329-485), p < 0.001 and 8.7 (3.9-15.7) vs. 7.4 (3.6-18.2), p = 0.004]. AI standard deviation was lower with AI-HPSD [25 (9-79) vs. 48 (19-100), p < 0.001]. Although Max AI values were higher in AI-HPSD [514 (435-662) vs. 492 (404-644), p = 0.003), maximum impedance drop did not differ significantly. EDEL rate was comparably low at 2% (AI-HPSD) and 4% (AI-LPLD), but AI > 520 occurred more with AI-HPSD (3.5 ± 5.5% vs. 2.5 ± 5.2%; p = 0.048). Optimized AI-HPSD at 50 W with posterior LA target AI = 400-450 was not associated with more EDEL. However, a signal for more unacceptable Max AI values existed. We recommend limiting AI to 400 and developing an automatic, AI-guided ablation stop.

This study documented changes in cartilage lesions in the arthritic medial knee compartment after medial opening wedge high tibial osteotomy (MOWHTO), their impact on clinical outcomes and possible factors influencing this improvement. Forty-nine patients indicated for MOWHTO (per ISAKOS criteria) underwent arthroscopy at osteotomy and implant removal (mean interval: 22.2 months). Cartilage lesions (medial femoral condyle [MFC], medial tibial plateau [MTP]) and clinical scores (Lysholm score and KOOS) were documented. No cartilage restoration procedures were performed. The mean age was 47.5 years and most were females (n = 32). Arthroscopically, cartilage improvement occurred in 32 (65.3%) MFC and 25 (51%) MTP lesions. MOWHTO significantly improved the mechanical tibiofemoral angle (TFA) (7.88 ± 3.66 vs. - 2.71 ± 1.98 (°); P < 0.001). Lysholm knee score (77 ± 16.2 vs. 48.4 ± 16.3, p < 0.001) and KOOS (64.1 ± 13.6 vs. 43.8 ± 12.5, p < 0.001) significantly improved after osteotomy. On the femoral side, cartilage repair was documented in patients who achieved relatively more valgus correction, with a mean final TFA of 3.32 ± 1.7, compared with 1.57 ± 2 in the no improvement group (P = 0.001). For the MTP, no factor of statistical significance could be detected. MOWHTO can improve articular cartilage lesions as a standalone procedure. A greater incidence of cartilage repair is expected with more valgus correction of the mechanical axis of the limb. This cartilage infill is associated with slightly better clinical outcomes. ClinicalTrials.gov (ID NCT04541342) registered on 9.9.2020, https://clinicaltrials.gov/study/NCT04541342 .

BackgroundFunctional dizziness is one of the most common causes of chronic dizziness. Associated psychiatric diseases such as depression and anxiety lead to significant impairment, possibly due to autonomic nervous system imbalance. We investigated whether heart rate variability (HRV) biofeedback can modulate autonomic function in patients with functional dizziness.MethodsWe performed a randomized controlled study in 24 patients diagnosed functional dizziness for the first time. Patients received six 20 min sessions of HRV biofeedback or no intervention. We assessed HRV (time and frequency domains), sympathetic vasomotor function, sympathetic skin response and psychometric assessments at baseline, immediately post-intervention (or control period) and another 3 and 6 weeks later.ResultsPatients in the HRV biofeedback group showed improved cardiac autonomic function with elevated HRV time-dependent parameters immediately post-intervention [Root Mean Square of Successive Differences (RMSSD): 71.2 ms ± 38 ms vs. 38.2 ms ± 18.5 ms, p = 0.014; Standard Deviation of all NN Intervals (SDNN): 78.3 ms ± 35.9 ms vs. 48.1 ms ± 20.5 ms, p = 0.001], increased HRV frequency-dependent parameter [Low Frequency (LF): p = 0.001], as well as reduced depressiveness (BDI-II: p = 0.0236). None of these parameters were changed in control patients (p = ns). Dizziness-associated symptoms and sympathetic function of vasculature and sweat glands were unaltered in both study arms.ConclusionIn a randomized controlled pilot study, HRV biofeedback led to improved autonomic cardiac function and alleviated symptoms of depression in patients with functional dizziness, most likely mediated by a predominantly parasympathetic effect.