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Stenting in Intracranial Stenosis: Current Controversies and Future Directions

  • Cardiovascular Disease and Stroke (S Prabhakaran, Section Editor)
  • Published:
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Abstract

Angioplasty and stenting for intracranial atherosclerotic stenosis (ICAS) are a last resort for patients with high-grade intracranial stenosis with multiple ischemic events unresponsive to medical therapy. Medical management, consisting of aggressive risk factor control and dual antiplatelet therapy, is superior to angioplasty and stenting for the prevention of future stroke. Future studies of angioplasty and stenting in this population are important, as the stroke risk on medical therapy is 12 % at 1 year and post-procedure stroke rates are similar to rates with medical treatment. There are many issues that will need to be resolved for stenting to offer any benefit, however. Procedural risks of hemorrhagic and ischemic stroke are unacceptably high. High-risk subgroups, potentially based on hemodynamic factors, will need to be identified for future interventional trials. Nevertheless, it is still reasonable to consider angioplasty and stenting for selected patients with multiple recurrent events despite aggressive medical management, but benefits are unclear at this time.

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References

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  1. Sacco RL, Kargman DE, Gu Q, Zamanillo MC. Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke. 1995;26(1):14–20.

    Article  CAS  PubMed  Google Scholar 

  2. Higashida RT, Meyers PM, Connors JJ, Sacks D, Strother CM, Barr JD, et al. Intracranial angioplasty & stenting for cerebral atherosclerosis: a position statement of the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, and the American Society of Neuroradiology. J Vasc Intervent Radiol: JVIR. 2005;16(10):1281–5.

    Article  Google Scholar 

  3. Qureshi AI, Caplan LR. Intracranial atherosclerosis. Lancet. 2014;383(9921):984–98. Review article covering the epidemiology, risk factors, pathologic appearance, clinical manifestations, diagnosis and characterization, natural history, and treatment strategies for intracranial atherosclerosis.

    Article  PubMed  Google Scholar 

  4. De Silva DA, Woon FP, Lee MP, Chen CP, Chang HM, Wong MC. South Asian patients with ischemic stroke: intracranial large arteries are the predominant site of disease. Stroke. 2007;38(9):2592–4.

    Article  PubMed  Google Scholar 

  5. Yarchoan M, Xie SX, Kling MA, Toledo JB, Wolk DA, Lee EB, et al. Cerebrovascular atherosclerosis correlates with Alzheimer pathology in neurodegenerative dementias. Brain : J Neurol. 2012;135(Pt 12):3749–56.

    Article  Google Scholar 

  6. Resch JA, Loewenson RB, Baker AB. Physical factors in the pathogenesis of cerebral atherosclerosis. Stroke. 1970;1(2):77–85.

    Article  CAS  PubMed  Google Scholar 

  7. Troncoso JC, Zonderman AB, Resnick SM, Crain B, Pletnikova O, O’Brien RJ. Effect of infarcts on dementia in the Baltimore longitudinal study of aging. Ann Neurol. 2008;64(2):168–76.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR, et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med. 2005;352(13):1305–16.

    Article  CAS  PubMed  Google Scholar 

  9. Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med. 2011;365(11):993–1003.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Zaidat OO, Fitzsimmons BF, Woodward BK, Wang Z, Killer-Oberpfalzer M, Wakhloo A, et al. Effect of a balloon-expandable intracranial stent vs medical therapy on risk of stroke in patients with symptomatic intracranial stenosis: the VISSIT randomized clinical trial. JAMA. 2015;313(12):1240–8.

    Article  CAS  PubMed  Google Scholar 

  11. Chimowitz MI, Derdeyn CP. Endovascular therapy for atherosclerotic intracranial arterial stenosis: back to the drawing board. JAMA. 2015;313(12):1219–20.

    Article  CAS  PubMed  Google Scholar 

  12. Ritz K, Denswil NP, Stam OC, van Lieshout JJ, Daemen MJ. Cause and mechanisms of intracranial atherosclerosis. Circulation. 2014;130(16):1407–14. Review of epidemiology, morphology, and risk factors leading to intracranial atherosclerosis. Proposal of a mechanism specifically for intracranial atherosclerosis based on the tissue characteristics of intracranial arterial vasculature.

    Article  PubMed  Google Scholar 

  13. Turan TN, Makki AA, Tsappidi S, Cotsonis G, Lynn MJ, Cloft HJ, et al. Risk factors associated with severity and location of intracranial arterial stenosis. Stroke. 2010;41(8):1636–40.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Kasner SE, Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, et al. Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation. 2006;113(4):555–63.

    Article  PubMed  Google Scholar 

  15. Williams JE, Chimowitz MI, Cotsonis GA, Lynn MJ, Waddy SP, Investigators W. Gender differences in outcomes among patients with symptomatic intracranial arterial stenosis. Stroke. 2007;38(7):2055–62.

    Article  PubMed  Google Scholar 

  16. Derdeyn CP. Mechanisms of ischemic stroke secondary to large artery atherosclerotic disease. Neuroimaging Clin N Am. 2007;17(3):303–11. vii-viii.

    Article  PubMed  Google Scholar 

  17. Derdeyn CP, Powers WJ, Grubb Jr RL. Hemodynamic effects of middle cerebral artery stenosis and occlusion. AJNR Am J Neuroradiol. 1998;19(8):1463–9.

    CAS  PubMed  Google Scholar 

  18. Feldmann E, Wilterdink JL, Kosinski A, Lynn M, Chimowitz MI, Sarafin J, et al. The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial. Neurology. 2007;68(24):2099–106.

    Article  CAS  PubMed  Google Scholar 

  19. Aoki S, Shirouzu I, Sasaki Y, Okubo T, Hayashi N, Machida T, et al. Enhancement of the intracranial arterial wall at MR imaging: relationship to cerebral atherosclerosis. Radiology. 1995;194(2):477–81.

    Article  CAS  PubMed  Google Scholar 

  20. Zacharatos H, Hassan AE, Qureshi AI. Intravascular ultrasound: principles and cerebrovascular applications. AJNR Am J Neuroradiol. 2010;31(4):586–97.

    Article  CAS  PubMed  Google Scholar 

  21. Derdeyn CP, Grubb Jr RL, Powers WJ. Cerebral hemodynamic impairment: methods of measurement and association with stroke risk. Neurology. 1999;53(2):251–9.

    Article  CAS  PubMed  Google Scholar 

  22. An H, Lin W. Cerebral oxygen extraction fraction and cerebral venous blood volume measurements using MRI: effects of magnetic field variation. Magn Reson Med : Off J Soc Magn Reson Med / Soc Magn Reson Med. 2002;47(5):958–66.

    Article  Google Scholar 

  23. Chimowitz MI, Lynn MJ, Turan TN, Fiorella D, Lane BF, Janis S, et al. Design of the stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis trial. J Stroke Cerebrovasc Dis. 2011;20(4):357–68.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Derdeyn CP, Chimowitz MI, Lynn MJ, Fiorella D, Turan TN, Janis LS, et al. Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. Lancet. 2014;383(9914):333–41. Largest prospective randomized trial showing both 30-day and long term benefit of aggressive medical management over stenting with the Wingspan stent for high-risk patients with ICAS.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Hankey GJ. Warfarin-Aspirin Recurrent Stroke Study (WARSS) trial: is warfarin really a reasonable therapeutic alternative to aspirin for preventing recurrent noncardioembolic ischemic stroke? Stroke. 2002;33(6):1723–6.

    Article  PubMed  Google Scholar 

  26. Wang X, Lin WH, Zhao YD, Chen XY, Leung TW, Chen C, et al. The effectiveness of dual antiplatelet treatment in acute ischemic stroke patients with intracranial arterial stenosis: a subgroup analysis of CLAIR study. Int J Stroke. 2013;8(8):663–8.

    Article  PubMed  Google Scholar 

  27. Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013;369(1):11–9.

    Article  CAS  PubMed  Google Scholar 

  28. Lutsep HL, Barnwell SL, Larsen DT, Lynn MJ, Hong M, Turan TN, et al. Outcome in Patients Previously on Antithrombotic Therapy in the SAMMPRIS Trial: Subgroup Analysis. Stroke. 2015. Subgroup analysis of SAMMPRIS showing no benefit for PTAS over AMM in patients who were either on or off antithrombotic therapy at the time of their qualifying event. This also showed that antithrombotic failure at the time of the qualifying event was not associated with a higher risk for a primary endpoint consisting of stroke or death within 30 days or ipsilateral stroke beyond 30 days.

  29. Tanweer O, Wilson TA, El Helou A, Becske T, Riina HA. National trends in utilization and outcomes of angioplasty and stenting for revascularization in intracranial stenosis. Clin Neurol Neurosurg. 2014;116:54–60.

    Article  PubMed  Google Scholar 

  30. Wojak JC, Dunlap DC, Hargrave KR, DeAlvare LA, Culbertson HS, Connors 3rd JJ. Intracranial angioplasty and stenting: long-term results from a single center. AJNR Am J Neuroradiol. 2006;27(9):1882–92.

    CAS  PubMed  Google Scholar 

  31. Siddiq F, Vazquez G, Memon MZ, Suri MF, Taylor RA, Wojak JC, et al. Comparison of primary angioplasty with stent placement for treating symptomatic intracranial atherosclerotic diseases: a multicenter study. Stroke. 2008;39(9):2505–10.

    Article  PubMed  Google Scholar 

  32. Nguyen TN, Zaidat OO, Gupta R, Nogueira RG, Tariq N, Kalia JS, et al. Balloon angioplasty for intracranial atherosclerotic disease: periprocedural risks and short-term outcomes in a multicenter study. Stroke. 2011;42(1):107–11.

    Article  PubMed  Google Scholar 

  33. Connors 3rd JJ, Wojak JC, Hoppe BH. The technique of endovascular intracranial revascularization. Front Neurol. 2014;5:246. Detailed description of ICAS angioplasty procedural techniques used to mitigate complication risks with a description of changes implemented since the SAMMPRIS trial.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Fiorella D, Chow MM, Anderson M, Woo H, Rasmussen PA, Masaryk TJ. A 7-year experience with balloon-mounted coronary stents for the treatment of symptomatic vertebrobasilar intracranial atheromatous disease. Neurosurgery. 2007;61(2):236–42. discussion 42–3.

    Article  PubMed  Google Scholar 

  35. Al-Ali F, Cree T, Hall S, Louis S, Major K, Smoker S, et al. Predictors of unfavorable outcome in intracranial angioplasty and stenting in a single-center comparison: results from the Borgess Medical Center-Intracranial Revascularization Registry. AJNR Am J Neuroradiol. 2011;32(7):1221–6.

    Article  CAS  PubMed  Google Scholar 

  36. Marks MP, Wojak JC, Al-Ali F, Jayaraman M, Marcellus ML, Connors JJ, et al. Angioplasty for symptomatic intracranial stenosis: clinical outcome. Stroke. 2006;37(4):1016–20.

    Article  PubMed  Google Scholar 

  37. Nguyen TN, Lazzaro MA, Qureshi AI. New standards for intracranial atherosclerotic disease treatment. Front Neurol. 2011;2:77.

    PubMed Central  PubMed  Google Scholar 

  38. Shin YS, Kim BM, Suh SH, Jeon P, Kim DJ, Kim DI, et al. Wingspan stenting for intracranial atherosclerotic stenosis: clinical outcomes and risk factors for in-stent restenosis. Neurosurgery. 2013;72(4):596–604. discussion.

    Article  PubMed  Google Scholar 

  39. Blasel S, Yukzek Z, Kurre W, Berkefeld J, Neumann-Haefelin T, Hattingen E, et al. Recanalization results after intracranial stenting of atherosclerotic stenoses. Cardiovasc Intervent Radiol. 2010;33(5):914–20.

    Article  PubMed  Google Scholar 

  40. Durst CR, Geraghty SR, Southerland AM, Starke RM, Rembold K, Malik S, et al. Stenting of symptomatic intracranial stenosis using balloon mounted coronary stents: a single center experience. J Neurointerv Surg. 2014.

  41. Investigators SS. Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries (SSYLVIA): study results. Stroke. 2004;35(6):1388–92.

    Article  Google Scholar 

  42. Jiang WJ, Xu XT, Du B, Dong KH, Jin M, Wang QH, et al. Comparison of elective stenting of severe vs moderate intracranial atherosclerotic stenosis. Neurology. 2007;68(6):420–6.

    Article  CAS  PubMed  Google Scholar 

  43. Kurre W, Brassel F, Bruning R, Buhk J, Eckert B, Horner S, et al. Complication rates using balloon-expandable and self-expanding stents for the treatment of intracranial atherosclerotic stenoses : analysis of the INTRASTENT multicentric registry. Neuroradiology. 2012;54(1):43–50.

    Article  PubMed  Google Scholar 

  44. von Schoenfeldt P, Krutzelmann A, Bussmeyer M, Mpotsaris A, Rosenkranz M, Fiehler J, et al. Elective treatment of intracranial stenosis with the balloon-expandable Pharos Vitesse stent: 30-day stroke rate and complications. J Neurointerv Surg. 2015;7(3):188–93. A more recent retrospective study of 92 patients with high-grade ICAS and recurrent ischemic events despite AMM (including Apirin and clopidogrel for 90 days following stenting) treated with the balloon-expandable Pharos Vitesse stent demonstrated an overall 30-day complication rate of 7.6%.

    Article  Google Scholar 

  45. Natarajan SK, Ogilvy CS, Hopkins LN, Siddiqui AH, Levy EI. Initial experience with an everolimus-eluting, second-generation drug-eluting stent for treatment of intracranial atherosclerosis. J Neurointerv Surg. 2010;2(2):104–9.

    Article  PubMed  Google Scholar 

  46. Gupta R, Al-Ali F, Thomas AJ, Horowitz MB, Barrow T, Vora NA, et al. Safety, feasibility, and short-term follow-up of drug-eluting stent placement in the intracranial and extracranial circulation. Stroke. 2006;37(10):2562–6.

    Article  CAS  PubMed  Google Scholar 

  47. Vajda Z, Guthe T, Perez MA, Kurre W, Schmid E, Bazner H, et al. Prevention of intracranial in-stent restenoses: predilatation with a drug eluting balloon, followed by the deployment of a self-expanding stent. Cardiovasc Intervent Radiol. 2013;36(2):346–52.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Marks MP. Is there a future for endovascular treatment of intracranial atherosclerotic disease after Stenting and Aggressive Medical Management for Preventing Recurrent Stroke and Intracranial Stenosis (SAMMPRIS)? Stroke. 2012;43(2):580–4.

    Article  PubMed  Google Scholar 

  49. Derdeyn CP, Fiorella D, Lynn MJ, Rumboldt Z, Cloft HJ, Gibson D, et al. Mechanisms of stroke after intracranial angioplasty and stenting in the SAMMPRIS trial. Neurosurgery. 2013;72(5):777–95; discussion 95. A review of the SAMMPRIS trial data to investigate the types and mechanism of periprocedural stroke following PTAS for ICAD. This data is critical for developing an understanding of the periprocedural events in the trial. This also provides insight to guide patient selection criteria and device development for future investigations of symptomatic ICAD.

  50. Bose A, Hartmann M, Henkes H, Liu HM, Teng MM, Szikora I, et al. A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study. Stroke. 2007;38(5):1531–7.

    Article  CAS  PubMed  Google Scholar 

  51. Fiorella D, Levy EI, Turk AS, Albuquerque FC, Niemann DB, Aagaard-Kienitz B, et al. US multicenter experience with the wingspan stent system for the treatment of intracranial atheromatous disease: periprocedural results. Stroke. 2007;38(3):881–7.

    Article  PubMed  Google Scholar 

  52. Fiorella DJ, Turk AS, Levy EI, Pride Jr GL, Woo HH, Albuquerque FC, et al. U.S. Wingspan Registry: 12-month follow-up results. Stroke. 2011;42(7):1976–81.

    Article  PubMed  Google Scholar 

  53. Zaidat OO, Klucznik R, Alexander MJ, Chaloupka J, Lutsep H, Barnwell S, et al. The NIH registry on use of the Wingspan stent for symptomatic 70-99% intracranial arterial stenosis. Neurology. 2008;70(17):1518–24.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  54. Albuquerque FC, Levy EI, Turk AS, Niemann DB, Aagaard-Kienitz B, Pride Jr GL, et al. Angiographic patterns of Wingspan in-stent restenosis. Neurosurgery. 2008;63(1):23–7. discussion 7–8.

  55. Yu SC, Leung TW, Lee KT, Hui JW, Wong LK. Angioplasty and stenting of atherosclerotic middle cerebral arteries with Wingspan: evaluation of clinical outcome, restenosis, and procedure outcome. AJNR Am J Neuroradiol. 2011;32(4):753–8.

    Article  CAS  PubMed  Google Scholar 

  56. Ma MM, Yin Q, Xu GL, Zhang RL, Zhu SG, Fan XY, et al. Predictors of Wingspan in-stent restenosis for the treatment of symptomatic intracranial arterial stenosis. Zhonghua Yi Xue Za Zhi. 2011;91(19):1303–7.

    PubMed  Google Scholar 

  57. Turk AS, Levy EI, Albuquerque FC, Pride Jr GL, Woo H, Welch BG, et al. Influence of patient age and stenosis location on wingspan in-stent restenosis. AJNR Am J Neuroradiol. 2008;29(1):23–7.

    Article  CAS  PubMed  Google Scholar 

  58. Levy EI, Turk AS, Albuquerque FC, Niemann DB, Aagaard-Kienitz B, Pride L, et al. Wingspan in-stent restenosis and thrombosis: incidence, clinical presentation, and management. Neurosurgery. 2007;61(3):644–50. discussion 50–1.

    Article  PubMed  Google Scholar 

  59. Nahab F, Lynn MJ, Kasner SE, Alexander MJ, Klucznik R, Zaidat OO, et al. Risk factors associated with major cerebrovascular complications after intracranial stenting. Neurology. 2009;72(23):2014–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  60. McTaggart RA, Marks MP. The case for angioplasty in patients with symptomatic intracranial atherosclerosis. Front Neurol. 2014;5:36.

    Article  PubMed Central  PubMed  Google Scholar 

  61. Mori T, Fukuoka M, Kazita K, Mori K. Follow-up study after intracranial percutaneous transluminal cerebral balloon angioplasty. AJNR Am J Neuroradiol. 1998;19(8):1525–33.

    CAS  PubMed  Google Scholar 

  62. Zhu SG, Zhang RL, Liu WH, Yin Q, Zhou ZM, Zhu WS, et al. Predictive factors for in-stent restenosis after balloon-mounted stent placement for symptomatic intracranial atherosclerosis. Eur J Vasc Endovasc Surg. 2010;40(4):499–506.

    Article  CAS  PubMed  Google Scholar 

  63. Kurre W, Berkefeld J, Brassel F, Bruning R, Eckert B, Kamek S, et al. In-hospital complication rates after stent treatment of 388 symptomatic intracranial stenoses: results from the INTRASTENT multicentric registry. Stroke. 2010;41(3):494–8.

    Article  PubMed  Google Scholar 

  64. Miao ZR, Feng L, Li S, Zhu F, Ji X, Jiao L, et al. Treatment of symptomatic middle cerebral artery stenosis with balloon-mounted stents: long-term follow-up at a single center. Neurosurgery. 2009;64(1):79–84. discussion −5.

    Article  PubMed  Google Scholar 

  65. Miao Z. Intracranial Angioplasty and Stenting before and after SAMMPRIS: “From Simple to Complex Strategy - The Chinese Experience”. Front Neurol. 2014;5:129.

    Article  PubMed Central  PubMed  Google Scholar 

  66. Miao Z, Song L, Liebeskind DS, Liu L, Ma N, Wang Y, et al. Outcomes of tailored angioplasty and/or stenting for symptomatic intracranial atherosclerosis: a prospective cohort study after SAMMPRIS. J Neurointerv Surg. 2014. Single center prospective study with 158 patients presenting with symptomatic high-grade ICAS, hypoperfusion symptoms, and poor collaterals divided into endovascular treatment with balloon-mounted stent deployment, PTAS, and angioplasty alone based on technical access considerations and lesion morphology. 30 day stroke, myocardial infarction, or death rate was 4.4%.

  67. Alexander MD, Meyers PM, English JD, Stradford TR, Sung S, Smith WS, et al. Symptom differences and pretreatment asymptomatic interval affect outcomes of stenting for intracranial atherosclerotic disease. AJNR Am J Neuroradiol. 2014;35(6):1157–62.

    Article  CAS  PubMed  Google Scholar 

  68. Rothwell PM, Gutnikov SA, Warlow CP. Reanalysis of the final results of the European Carotid Surgery Trial. Stroke. 2003;34(2):514–23.

    Article  CAS  PubMed  Google Scholar 

  69. Edwards DF, Hollingsworth H, Zazulia AR, Diringer MN. Artificial neural networks improve the prediction of mortality in intracerebral hemorrhage. Neurology. 1999;53(2):351–7.

    Article  CAS  PubMed  Google Scholar 

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Conflict of Interest

AR Chatterjee declares no conflicts of interest. CP Derdeyn has received consultant fees from Microvention, Penumbra, and Silk Road.

Human and Animal Rights and Informed Consent

All studies by the authors involving animal and/or human subjects were performed after approval by the appropriate institutional review boards. When required, written informed consent was obtained from all participants.

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Authors and Affiliations

  1. Department of Radiology, Medical University of South Carolina, Suite 210, 96 Jonathan Lucas St., Charleston, SC, 29425, USA

    Arindam R. Chatterjee

  2. Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Blvd., Campus Box 8131, Saint Louis, MO, 63110, USA

    Colin P. Derdeyn

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  1. Arindam R. Chatterjee
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Correspondence to Arindam R. Chatterjee.

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Chatterjee, A.R., Derdeyn, C.P. Stenting in Intracranial Stenosis: Current Controversies and Future Directions. Curr Atheroscler Rep 17, 48 (2015). https://doi.org/10.1007/s11883-015-0527-4

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