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01.10.2012 | Leitlinien

S3-Leitlinie Extracranielle Carotisstenose

Kapitel 8.2: Wann und zu welchem Zeitpunkt besteht die Indikation zur Operation oder zur Intervention einer asymptomatischen/symptomatischen Stenose (einschließlich Notfallindikation), inkl. Subgruppen, die eher von einer operativen, endovaskulären oder konservativen Therapie profitieren?

verfasst von: P. Ringleb, J. Berkefeld, Prof. Dr. H.-H. Eckstein

Erschienen in: Gefässchirurgie | Ausgabe 6/2012

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Joachim Berkefeld: Deutsche Gesellschaft für Neuroloradiologie (DGNR) …

Marquardt L, Geraghty OC, Mehta Z, Rothwell PM (2010) Low risk of ipsilateral stroke in patients with asymptomatic carotid stenosis on best medical treatment: a prospective, population-based study. Stroke 41:e11–e17PubMedCrossRef

Abbott AL (2009) Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis: results of a systematic review and analysis. Stroke 40:e573–e83PubMedCrossRef

Sillesen H, Amarenco P, Hennerici MG et al (2008) Atorvastatin reduces the risk of cardiovascular events in patients with carotid atherosclerosis: a secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Stroke 39:3297–3302PubMedCrossRef

Spence JD, Coates V, Li H et al (2010) Effects of intensive medical therapy on microemboli and cardiovascular risk in asymptomatic carotid stenosis. ArchNeurol 67:180–186

Reiff T, Stingele R, Eckstein HH et al (2009) Stent-protected angioplasty in asymptomatic carotid artery stenosis vs. endarterectomy: SPACE2: a three-arm randomised-controlled clinical trial. Int J Stroke 4:294–299PubMedCrossRef

Goldstein LB, Bushnell CD, Adams RJ et al (2011) Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42:517–584PubMedCrossRef

Liapis CD, Bell PR, Mikhailidis D et al (2009) ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg 37:1–19PubMedCrossRef

(o A) (2008) Management of atherosclerotic carotid artery disease: clinical practice guidelines of the Society for Vascular Surgery. 480–486

Goldstein LB, Adams R, Alberts MJ et al (2006) Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 113:e873–e923PubMedCrossRef

10.

European Stroke Organisation (ESO) Executive Committee and ESO Writing Committee (2008) Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 25:457–507CrossRef

11.

Sobel M, Verhaeghe R (2008) Antithrombotic therapy for peripheral artery occlusive disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133:815S–843SPubMedCrossRef

12.

Brott TG, Halperin JL, Abbara S et al (2011) ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery Developed in Collaboration With the American Academy of Neurology and Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 57:1002-1044PubMedCrossRef

13.

Deutsche Gesellschaft für Neurologie (2008) Primär- und Sekundärprävention der zerebralen Ischämie. Gemeinsame Leitlinie der DGN und der Deutschen Schlaganfallgesellschaft. http://www.dgn.org/images/stories/dgn/leitlinien/LL2008/ll08kap_024.pdf

14.

Tendera M, Aboyans V, Bartelink ML et al (2011) ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries * The Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 32:2851–2906PubMedCrossRef

15.

Ricotta JJ, AbuRahma A, Ascher E et al (2011) Updated society for vascular surgery guidelines for management of extracranial carotid disease. J Vasc Surg 54:e1–31PubMedCrossRef

16.

Grundy SM, Cleeman JI, Merz CN et al (2004) Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. J AmCollCardiol 44:720–732CrossRef

17.

Engelter S, Lyrer P (2003) Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy. Cochrane Database Syst Rev:CD001458

18.

Taylor DW, Barnett HJ, Haynes RB et al (1999) Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: a randomised controlled trial. ASA and Carotid Endarterectomy (ACE) Trial Collaborators. Lancet 353:2179–2184PubMedCrossRef

19.

McGirt MJ, Perler BA, Brooke BS et al (2005) 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors reduce the risk of perioperative stroke and mortality after carotid endarterectomy. J Vasc Surg 42:829–836PubMedCrossRef

20.

Kennedy J, Quan H, Buchan AM et al (2005) Statins are associated with better outcomes after carotid endarterectomy in symptomatic patients. Stroke36:2072–2076

21.

Payne DA, Jones CI, Hayes PD et al (2004) Beneficial effects of clopidogrel combined with aspirin in reducing cerebral emboli in patients undergoing carotid endarterectomy. Circulation 109:1476–1481PubMedCrossRef

22.

Sharpe RY, Dennis MJ, Nasim A et al (2010) Dual antiplatelet therapy prior to carotid endarterectomy reduces post-operative embolisation and thromboembolic events: post-operative transcranial Doppler monitoring is now unnecessary. EurJ Vasc Endovasc Surg 40:162–167CrossRef

23.

National Stroke Foundation Melbourne Australia (2010) Clinical guidelines for stroke management. Melbourne Australia. http://www.strokefoundation.com.au

24.

Scottish Intercollegiate Guidelines Network (2008) Management of patients with stroke or TIA: assessment, investigation, immediate management and secondary prevention. http://www.sign.ac.uk/pdf/sign108.pdf

25.

National Stroke Foundation Melbourne Australia (2007) Clinical Guidelines for Acute Stroke Management. http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp109.pdf

26.

Lindsay P, Bayley M, Hellings C et al (2008) Canadian best practice recommendations for stroke care (updated 2008). CMAJ 179:S1–S25CrossRef

27.

Stroke Foundation of New Zealand and New Zealand Guidelines Group (2006) New Zealand guideline for management of stroke. Stroke Foundation of New Zealand, Wellington

28.

Toole JF, Baker WH, Castaldo JE et al (1995) Endarterectomy for asymptomatic carotid artery stenosis. J Am Med Assoc 273:1421–1428CrossRef

29.

Halliday A, Mansfield A, Marro J et al (2004) Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 363:1491–1502PubMedCrossRef

30.

Chambers BR, Donnan GA (2005) Carotid endarterectomy for asymptomatic carotid stenosis. Cochrane Database Syst Rev:CD001923

31.

Halliday A, Harrison M, Hayter E et al (2010) 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet 376:1074–1084PubMedCrossRef

32.

Chalela JA (2009) Evaluating the carotid plaque: going beyond stenosis. Cerebrovasc Dis 27(Suppl 1):19–24PubMedCrossRef

33.

Hermus L, Lefrandt JD, Tio RA et al (2010) Carotid plaque formation and serum biomarkers. Atherosclerosis 213:21–29PubMedCrossRef

34.

Hermus L, Dam GM van, Zeebregts CJ (2010) Advanced carotid plaque imaging. Eur J Vasc Endovasc Surg 39:125–133PubMedCrossRef

35.

Wasserman BA (2010) Advanced contrast-enhanced MRI for looking beyond the lumen to predict stroke: building a risk profile for carotid plaque. Stroke 41:S12–S16PubMedCrossRef

36.

Watanabe Y, Nagayama M (2010) MR plaque imaging of the carotid artery. Neuroradiology 52:253–274PubMedCrossRef

37.

Yazdani SK, Vorpahl M, Ladich E, Virmani R (2010) Pathology and vulnerability of atherosclerotic plaque: identification, treatment options, and individual patient differences for prevention of stroke. Curr Treat Options Cardiovasc Med 12:297–314PubMedCrossRef

38.

Alsheikh-Ali AA, Kitsios GD, Balk EM et al (2010) The vulnerable atherosclerotic plaque: scope of the literature. Ann Intern Med 153:387–395PubMed

39.

Brooks WH, McClure RR, Jones MR et al (2004) Carotid angioplasty and stenting versus carotid endarterectomy for treatment of asymptomatic carotid stenosis: a randomized trial in a community hospital. Neurosurgery 54:318–324PubMedCrossRef

40.

Gurm HS, Yadav JS, Fayad P et al (2008) Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med 358:1572–1579PubMedCrossRef

41.

Yadav JS, Wholey MH, Kuntz RE et al (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351:1493–1501PubMedCrossRef

42.

Brott TG, Hobson RW, Howard G et al (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363:11–23PubMedCrossRef

43.

Furie KL, Kasner SE, Adams RJ et al (2011) Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42:227–276PubMedCrossRef

44.

Royal College of Physicians Intercollegiate Stroke Working Party (2008) National clinical guidelines for stroke, 3rd edition. Royal College of Physicians, London. http://bookshop.rcplondon.ac.uk/details.aspx?e=250

45.

Johnston Sc N-HMNSMEFKWCEJSA. National Stroke Association Guidelines for the Management of Transient Ischemic Attacks:301–313

46.

Rothwell PM, Eliasziw M, Gutnikov SA et al (2004) Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 363:915–924PubMedCrossRef

47.

Rothwell PM, Eliasziw M, Gutnikov SA et al (2003) Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 361:107–116PubMedCrossRef

48.

Naylor AR, Rothwell PM, Bell PR (2003) Overview of the principal results and secondary analyses from the European and North American randomised trials of endarterectomy for symptomatic carotid stenosis. Eur J Vasc Endovasc Surg 26:115–129PubMedCrossRef

49.

Paddock-Eliasziw LM, Eliasziw M, Barr HW, Barnett HJ (1996) Long-term prognosis and the effect of carotid endarterectomy in patients with recurrent ipsilateral ischemic events. North American Symptomatic Carotid Endarterectomy Trial Group. Neurology 47:1158–1162PubMedCrossRef

50.

Henderson RD, Eliasziw M, Fox AJ et al (2000) Angiographically defined collateral circulation and risk of stroke in patients with severe carotid artery stenosis. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Stroke31:128–132

51.

Kappelle LJ, Eliasziw M, Fox AJ et al (1999) Importance of intracranial atherosclerotic disease in patients with symptomatic stenosis of the internal carotid artery. The North American Symptomatic Carotid Endarterectomy Trail. Stroke30:282–286

52.

Inzitari D, Eliasziw M, Sharpe BL et al (2000) Risk factors and outcome of patients with carotid artery stenosis presenting with lacunar stroke. North American Symptomatic Carotid Endarterectomy Trial Group. Neurology 54:660–666PubMedCrossRef

53.

Barnett HJ, Meldrum HE, Eliasziw M (2002) The appropriate use of carotid endarterectomy. CMAJ 166:1169–1179PubMed

54.

Kappelle LJ, Eliasziw M, Fox AJ, Barnett HJ (2000) Small, unruptured intracranial aneurysms and management of symptomatic carotid artery stenosis. North American Symptomatic Carotid Endarterectomy Trial Group. Neurology 55:307–309PubMedCrossRef

55.

Streifler JY, Eliasziw M, Benavente OR et al (1995) Lack of relationship between leukoaraiosis and carotid artery disease. The North American Symptomatic Carotid Endarterectomy Trial. Arch Neurol 52:21–24PubMedCrossRef

56.

Gasecki AP, Ferguson GG, Eliasziw M et al (1994) Early endarterectomy for severe carotid artery stenosis after a nondisabling stroke: results from the North American Symptomatic Carotid Endarterectomy Trial. J Vasc Surg 20:288–295PubMedCrossRef

57.

Brinjikji W, Rabinstein AA, Meyer FB et al (2010) Risk of early carotid endarterectomy for symptomatic carotid stenosis. Stroke 41:2186–2190PubMedCrossRef

58.

Naylor AR (2008) Delay may reduce procedural risk, but at what price to the patient? Eur J Vasc Endovasc Surg 35:383–391PubMedCrossRef

59.

Rantner B, Eckstein HH, Ringleb P et al (2006) American society of anesthesiology and rankin as predictive parameters for the outcome of carotid endarterectomy within 28 days after an Ischemic Stroke. J Stroke Cerebrovasc Dis 15:114–120PubMedCrossRef

60.

Eckstein HH, Ringleb P, Dorfler A et al (2002) The Carotid Surgery for Ischemic Stroke trial: a prospective observational study on carotid endarterectomy in the early period after ischemic stroke. J Vasc Surg 36:997–1004PubMedCrossRef

61.

Rerkasem K, Rothwell PM (2009) Systematic review of the operative risks of carotid endarterectomy for recently symptomatic stenosis in relation to the timing of surgery. Stroke 40:e564–e572PubMedCrossRef

62.

Greenhalgh RM, Cuming R, Perkin GD, McCollum CN (1993) Urgent carotid surgery for high risk patients. Eur J Vasc Surg 7(Suppl A):25–32PubMedCrossRef

63.

Karkos CD, Hernandez-Lahoz I, Naylor AR (2009) Urgent carotid surgery in patients with crescendo transient ischaemic attacks and stroke-in-evolution: a systematic review. Eur J Vasc Endovasc Surg 37:279–288PubMedCrossRef

64.

Weis-Muller BT, Huber R, Spivak-Dats A et al (1993) Symptomatic acute occlusion of the internal carotid artery: reappraisal of urgent vascular reconstruction based on current stroke imaging. J Vasc Surg 47:752–759CrossRef

65.

Wilson SE, Mayberg MR, Yatsu F, Weiss DG (1993) Crescendo transient ischemic attacks: a surgical imperative. Veterans Affairs trialists. J Vasc Surg 17:249–255PubMedCrossRef

66.

Gertler JP, Blankensteijn JD, Brewster DC et al (1994) Carotid endarterectomy for unstable and compelling neurologic conditions: do results justify an aggressive approach? J Vasc Surg 19:32–40 (discussion 40–42)PubMedCrossRef

67.

Eckstein HH, Schumacher H, Klemm K et al (1999) Emergency carotid endarterectomy. Cerebrovasc Dis 9:270–281PubMedCrossRef

68.

Meyer FB, Sundt TM Jr, Piepgras DG et al (1986) Emergency carotid endarterectomy for patients with acute carotid occlusion and profound neurological deficits. Ann Surg 203:82–89PubMedCrossRef

69.

Eckstein HH, Hupp T, Allenberg JR et al (1995) Carotid endarterectomy and local intraarterial thrombolysis: simultaneous procedure in acute occlusion of the internal carotid artery and middle cerebral artery embolism. J Vasc Surg22:196–198CrossRef

70.

Bakoyiannis C, Economopoulos KP, Georgopoulos S et al (2010) Carotid endarterectomy versus carotid angioplasty with or without stenting for treatment of carotid artery stenosis: an updated meta-analysis of randomized controlled trials. Int Angiol 29:205–215PubMed

71.

Bangalore S, Kumar S, Wetterslev J et al (2011) Carotid artery stenting vs carotid endarterectomy: meta-analysis and diversity-adjusted trial sequential analysis of randomized trials. ArchNeurol 68:172–184

72.

Coward LJ, Featherstone RL, Brown MM (2004) Percutaneous transluminal angioplasty and stenting for carotid artery stenosis. Cochrane Database Syst Rev (electronic resource):CD000515

73.

Ederle J, Featherstone RL, Brown MM (2009) Randomized controlled trials comparing endarterectomy and endovascular treatment for carotid artery stenosis: a Cochrane systematic review. Stroke 40:1373–1380PubMedCrossRef

74.

Kastrup A, Schnaudigel S, Wasser K, Groschel K (2008) Carotid artery disease: stenting versus endarterectomy. Curr Atheroscler Rep 10:391–397PubMedCrossRef

75.

Luebke T, Aleksic M, Brunkwall J (2007) Meta-analysis of randomized trials comparing carotid endarterectomy and endovascular treatment. EurJ Vasc Endovasc Surg 34:470–479CrossRef

76.

Meier P, Knapp G, Tamhane U et al (2010) Short term and intermediate term comparison of endarterectomy versus stenting for carotid artery stenosis: systematic review and meta-analysis of randomised controlled clinical trials. BMJ 340:c467PubMedCrossRef

77.

Ringleb PA, Chatellier G, Hacke W et al (2008) Safety of endovascular treatment of carotid artery stenosis compared with surgical treatment: a meta-analysis. J Vasc Surg 47:350–355PubMedCrossRef

78.

Roffi M, Mukherjee D, Clair DG (2009) Carotid artery stenting vs. endarterectomy. Eur Heart J 30:2693–2704PubMedCrossRef

79.

Mas JL, Chatellier G, Beyssen B et al (2006) Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med 355:1660–1671PubMedCrossRef

80.

Mas JL, Trinquart L, Leys D et al (2008) Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol 7:885–892PubMedCrossRef

81.

Ringleb PA, Allenberg J, Bruckmann H et al (2006) 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet 368:1239–1247PubMedCrossRef

82.

Ederle J, Dobson J, Featherstone RL et al (2010) Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 375:985–997PubMedCrossRef

83.

Eckstein HH, Ringleb P, Allenberg JR et al (2008) Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol 7:893–902PubMedCrossRef

84.

Bonati LH, Dobson J, Algra A et al (2010) Short-term outcome after stenting versus endarterectomy for symptomatic carotid stenosis: a preplanned meta-analysis of individual patient data. Lancet 376:1062–1073PubMedCrossRef

85.

Silver FL, Mackey A, Clark WM et al (2011) Safety of stenting and endarterectomy by symptomatic status in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST). Stroke 42:675–680PubMedCrossRef

86.

Nothacker M (2010) Therapie der Karotisstenose mittels Endarterektomie oder Angioplastie mit Stenting – Analyse der vorliegenden Evidenz. Ärztliches Zentrum für Qualität in der Medizin (ÄZQ) Berlin

87.

Alberts M (2001) Results of a multicenter prospective randomized trial of carotid artery stenting vs carotid endarterectomy. Stroke 32: 325-dCrossRef

88.

Cavatas I (2001) Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet (North American Edition) 357:1729–1737

89.

Brooks WH, McClure RR, Jones MR et al (2001) Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital. J Am Coll Cardiol 38:1589–1595PubMedCrossRef

90.

Naylor AR, Bolia A, Abbott RJ et al (1998) Randomized study of carotid angioplasty and stenting versus carotid endarterectomy: a stopped trial. J Vasc Surg 28:326–334PubMedCrossRef

91.

Steinbauer MG, Pfister K, Greindl M et al (2008) Alert for increased long-term follow-up after carotid artery stenting: results of a prospective, randomized, single-center trial of carotid artery stenting vs carotid endarterectomy. J Vasc Surg 48:93–98PubMedCrossRef

92.

Hoffmann A, Engelter S, Taschner C et al (2008) Carotid artery stenting versus carotidendarterectomy-a prospective randomised controlled single-centre trial with long-term follow-up (BACASS):84–89

93.

Bonati LH, Jongen LM, Haller S et al (2010) New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol 9:353–362PubMedCrossRef

94.

Schnaudigel S, Groschel K, Pilgram SM, Kastrup A (2008) New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke 39:1911–1919PubMedCrossRef

95.

Bendszus M, Stoll G (2006) Silent cerebral ischaemia: hidden fingerprints of invasive medical procedures. Lancet Neurol 5:364–372PubMedCrossRef

96.

Wasser K, Pilgram-Pastor SM, Schnaudigel S et al (2011) New brain lesions after carotid revascularization are not associated with cognitive performance. J Vasc Surg 53:61–70PubMedCrossRef

97.

Ederle J, Bonati LH, Dobson J et al (2009) Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial. Lancet Neurol 8:898–907PubMedCrossRef

Titel: S3-Leitlinie Extracranielle Carotisstenose
Kapitel 8.2: Wann und zu welchem Zeitpunkt besteht die Indikation zur Operation oder zur Intervention einer asymptomatischen/symptomatischen Stenose (einschließlich Notfallindikation), inkl. Subgruppen, die eher von einer operativen, endovaskulären oder konservativen Therapie profitieren?
verfasst von: P. Ringleb
J. Berkefeld
Prof. Dr. H.-H. Eckstein
Publikationsdatum: 01.10.2012
Verlag: Springer-Verlag
Erschienen in: Gefässchirurgie / Ausgabe 6/2012
Print ISSN: 0948-7034
Elektronische ISSN: 1434-3932
DOI: https://doi.org/10.1007/s00772-012-1054-z

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