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1. Pre-stroke socioeconomic status predicts upper limb motor recovery after inpatient neurorehabilitation

Author

S. Wolf, S. E. Holm, T. Ingwersen, C. Bartling, G. Bender, G. Birke, A. Meyer, A. Nolte, K. Ottes, O. Pade, M. Peller, J. Steinmetz, C. Gerloff, and G. Thomalla

Subjects
Stroke, socioeconomic status, neurological rehabilitation, recovery of function, upper extremity, patient reported outcome measures, Medicine
Abstract

Background Lower socioeconomic status (SES) is associated with higher mortality rates and the likelihood of receiving less evidence-based treatment after stroke. In contrast, little is known about the impact of SES on recovery after discharge from inpatient rehabilitation. The aim of this study was to investigate the influence of SES on long-term recovery after stroke.Patients and methods In a prospective, observational, multicentre study, inpatients were recruited towards the end of rehabilitation. The 12-month follow-up focussed on upper limb motor recovery, measured by the Fugl-Meyer score. A clinically relevant improvement of ≥5.25 points was considered recovery. Patient-centric measures such as the Patient-reported Outcomes Measurement Information System-Physical Health (PROMIS-10 PH) provided secondary outcomes. Information on schooling, vocational training, income and occupational status pre-stroke entered a multidimensional SES index. Multivariate logistic regression models calculating odds ratios (ORs) and corresponding confidence intervals (CIs) were applied. SES was added to an initial model including age, sex and baseline neurological deficit. Additional exploratory analyses examined the association between SES and outpatient treatment.Results One hundred and seventy-six patients were enrolled of whom 98 had SES and long-term recovery data. Model comparisons showed the SES-model superior to the initial model (Akaike information criterion (AIC): 123 vs. 120, Pseudo R2: 0.09 vs. 0.13). The likelihood of motor recovery (OR = 17.12, 95%CI = 1.31; 224.18) and PROMIS-10 PH improvement (OR = 20.76, 95%CI = 1.28; 337.11) were significantly increased with higher SES, along with more frequent use of outpatient therapy (p = .02).Conclusions Higher pre-stroke SES is associated with better long-term recovery after discharge from rehabilitation. Understanding these factors can improve outpatient long-term stroke care and lead to better recovery.KEY MESSAGEHigher pre-stroke socioeconomic status (SES) is associated with better long-term recovery after discharge from rehabilitation both in terms of motor function and self-reported health status.Higher SES is associated with significantly higher utilization of outpatient therapies.Discharge management of rehabilitation clinics should identify and address socioeconomic factors in order to detect individual needs and to improve outpatient recovery. Article registration: clinicaltrials.gov NCT04119479.

Published
2022
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2. The Bigger the Better? Center Volume Dependent Effects on Procedural and Functional Outcome in Established Endovascular Stroke Centers

Author

Marianne Hahn, Sonja Gröschel, Yasemin Tanyildizi, Marc A. Brockmann, Klaus Gröschel, Timo Uphaus, German Stroke Registry-Endovascular Treatment (GSR-ET) Investigators, A Reich, O Nikoubashman, J Röther, B Eckert, M Braun, G F Hamann, E Siebert, C H Nolte, G Bohner, R M Eckert, J Borggrefe, P Schellinger, J Berrouschot, A Bormann, C Kraemer, H Leischner, M Petersen, F Stögbauer, T Boeck-Behrens, S Wunderlich, A Ludolph, K H Henn, C Gerloff, J Fiehler, G Thomalla, A Alegiani, J H Schäfer, F Keil, S Tiedt, L Kellert, C Trumm, U Ernemannn, S Poli, J Liman, M Ernst, K Gröschel, and T Uphaus

Subjects
stroke, mechanical thrombectomy, GSR-ET, endovascular stroke therapy, procedural volume, center volume, Neurology. Diseases of the nervous system, RC346-429
Abstract

BackgroundMechanical thrombectomy (MT) rates for the treatment of acute ischaemic stroke due to large vessel occlusion are steadily increasing, but are delivered in heterogenic settings. We aim to investigate effects of procedural load in centers with established MT-structures by comparing high- vs. low-volume centers with regard to procedural characteristics and functional outcomes.MethodsData from 5,379 patients enrolled in the German Stroke Registry Endovascular Treatment (GSR-ET) between June 2015 and December 2019 were compared between three groups: high volume: ≥180 MTs/year, 2,342 patients; medium volume: 135–179 MTs/year, 2,202 patients; low volume:

Published
2022
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3. Parietofrontal network upregulation after motor stroke

Author

M. Bönstrup, R. Schulz, G. Schön, B. Cheng, J. Feldheim, G. Thomalla, and C. Gerloff

Subjects
Computer applications to medicine. Medical informatics, R858-859.7, Neurology. Diseases of the nervous system, RC346-429
Abstract

Objective: Motor recovery after stroke shows a high inter-subject variability. The brain's potential to form new connections determines individual levels of recovery of motor function. Most of our daily activities require visuomotor integration, which engages parietal areas. Compared to the frontal motor system, less is known about the parietal motor system's reconfiguration related to stroke recovery. Here, we tested if functional connectivity among parietal and frontal motor areas undergoes plastic changes after stroke and assessed the behavioral relevance for motor function after stroke. Methods: We investigated stroke lesion-induced changes in functional connectivity by measuring high-density electroencephalography (EEG) and assessing task-related changes in coherence during a visually guided grip task with the paretic hand in 30 chronic stroke patients with variable motor deficits and 19 healthy control subjects. Quantitative changes in task-related coherence in sensorimotor rhythms were compared to the residual motor deficit. Results: Parietofrontal coupling was significantly stronger in patients compared to controls. Whereas motor network coupling generally increased during the task in both groups, the task-related coherence between the parietal and primary motor cortex in the stroke lesioned hemisphere showed increased connectivity across a broad range of sensorimotor rhythms. Particularly the parietofrontal task-induced coupling pattern was significantly and positively related to residual impairment in the Nine-Hole Peg Test performance and grip force. Interpretation: These results demonstrate that parietofrontal motor system integration during visually guided movements is stronger in the stroke-lesioned brain. The correlation with the residual motor deficit could either indicate an unspecific marker of motor network damage or it might indicate that upregulated parietofrontal connectivity has some impact on post-stroke motor function. Keywords: EEG, Coherence, Motor recovery, Stroke, Parietal lobe

Published
2018
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4. Endovascular thrombectomy in young patients with stroke

Author

Johannes M Weller, Franziska Dorn, Julius N Meissner, Sebastian Stösser, Niklas M Beckonert, Julia Nordsiek, Christine Kindler, Milani Deb-Chatterji, Gabor C Petzold, Felix J Bode, A. Reich, O. Nikoubashman, J. Röther, B. Eckert, M. Braun, G.F. Hamann, E. Siebert, C.H. Nolte, G. Bohner, R.M. Eckert, J. Borggrefe, P. Schellinger, J. Berrouschot, A. Bormann, C. Kraemer, H. Leischner, M. Petersen, F. Stögbauer, T. Boeck-Behrens, S. Wunderlich, A. Ludolph, K.H. Henn, C. Gerloff, J. Fiehler, G. Thomalla, A. Alegiani, J.H. Schäfer, F. Keil, S. Tiedt, L. Kellert, C. Trumm, U. Ernemann, S. Poli, J. Liman, M. Ernst, K. Gröschel, and T. Uphaus

Subjects
Neurology
Abstract

Background: Endovascular treatment (ET) is standard of care in patients with acute ischemic stroke due to large vessel occlusion, but data on ET in young patients remain limited. Aim: We aim to compare outcomes for young stroke patients undergoing ET in a matched cohort. Methods: We analyzed patients from an observational multicenter cohort with acute ischemic stroke and ET, the German Stroke Registry—Endovascular Treatment trial. Baseline characteristics, procedural parameters, and functional outcome at 90 days were compared between young (Results: Out of 6628 acute ischemic stroke patients treated with ET, 363 (5.5%) were young. Young patients differed with regard to prognostic outcome characteristics. Specifically, National Institutes of Health Stroke Scale (NIHSS) at admission was lower (median 13, interquartile range (IQR) 8–17 vs. 15, IQR 9–19, p Conclusion: Young stroke patients undergoing ET have better outcomes compared to older patients, even when matched for prestroke condition, comorbidities, and stroke severity. Hence, more liberal guidelines to perform ET for younger patients may have to be established by future studies.

Published
2022
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5. Final Study Report of Andexanet Alfa for Major Bleeding with Factor Xa Inhibitors

Author

Truman J. Milling, Saskia Middeldorp, Lizhen Xu, Bruce Koch, Andrew Demchuk, John W. Eikelboom, Peter Verhamme, Alexander T. Cohen, Jan Beyer-Westendorf, C. Michael Gibson, Jose Lopez-Sendon, Mark Crowther, Ashkan Shoamanesh, Michiel Coppens, Jeannot Schmidt, Pierre Albaladejo, Stuart J. Connolly, R. Anand, A. Bastani, C. Clark, M. Concha, J. Cornell, K. Dombrowski, G. Fermann, J. Fulmer, J. Goldstein, D. Kereiakes, T. Milling, D. Pallin, N. Patel, M. Refaai, M. Rehman, A. Schmaier, E. Schwarz, W. Shillinglaw, M. Spohn, T. Takata, A. Venkat, J. Welker, I. Welsby, J. Wilson, L. Van Keer, F. Verschuren, M. Blostein, J. Eikelboom, K. Althaus, J. Berrouschot, G. Braun, T. Doeppner, R. Dziewas, S. Genth-Zotz, P. Greinacher, F. Hamann, F. Hanses, W. Heide, B. Kallmuenzer, P. Kermer, S. Poli, G. Royl, S. Schellong, S. Schnupp, J. Schwarze, C. Spies, G. Thomalla, M. von Mering, K. Weissenborn, F. Wollenweber, C. Gumbinger, U. Jaschinski, M. Maschke, H-C. Mochmann, W. Pfeilschifter, C. Pohlmann, R. Zahn, P. Bouzat, J. Schmidt, C. Vallejo, B. Floccard, M. Coppens, S. van Wissen, E. Arellano-Rodrigo, E. Valles, R. Alikhan, K. Breen, R. Hall, M. Crowther, P. Albaladejo, A. Cohen, A.M. Demchuk, D.G. Wyse, D.A. Garcia, M. Prins, J. Nakamya, H.R. Büller, K. W. Mahaffey, J. H. Alexander, J.A. Cairns, R.G. Hart, C.D. Joyner, G.E. Raskob, S. Schulman, R. Veltkamp, B. Meeks, E. Zotova, S. Ahmad, T. Pinto, K. Baker, A. Dykstra, I. Holadyk-Gris, A. Malvaso, Vascular Medicine, ACS - Pulmonary hypertension & thrombosis, ARD - Amsterdam Reproduction and Development, ACS - Amsterdam Cardiovascular Sciences, Infectious diseases, AII - Infectious diseases, AII - Inflammatory diseases, and APH - Global Health

Subjects
clinical trials, All institutes and research themes of the Radboud University Medical Center, cohort studies, Physiology (medical), Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], factor Xa inhibitors, ddc:610, Cardiology and Cardiovascular Medicine, gastrointestinal hemorrhage, intracranial hemorrhage
Abstract

Background: Andexanet alfa is a modified recombinant inactive factor Xa (FXa) designed to reverse FXa inhibitors. ANNEXA-4 (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of Factor Xa Inhibitors) was a multicenter, prospective, phase-3b/4, single-group cohort study that evaluated andexanet alfa in patients with acute major bleeding. The results of the final analyses are presented. Methods: Patients with acute major bleeding within 18 hours of FXa inhibitor administration were enrolled. Co-primary end points were anti-FXa activity change from baseline during andexanet alfa treatment and excellent or good hemostatic efficacy, defined by a scale used in previous reversal studies, at 12 hours. The efficacy population included patients with baseline anti-FXa activity levels above predefined thresholds (≥75 ng/mL for apixaban and rivaroxaban, ≥40 ng/mL for edoxaban, and ≥0.25 IU/mL for enoxaparin; reported in the same units used for calibrators) who were adjudicated as meeting major bleeding criteria (modified International Society on Thrombosis and Haemostasis definition). The safety population included all patients. Major bleeding criteria, hemostatic efficacy, thrombotic events (stratified by occurring before or after restart of either prophylactic [ie, a lower dose, for prevention rather than treatment] or full-dose oral anticoagulation), and deaths were assessed by an independent adjudication committee. Median endogenous thrombin potential at baseline and across the follow-up period was a secondary outcome. Results: There were 479 patients enrolled (mean age, 78 years; 54% male; 86% White); 81% were anticoagulated for atrial fibrillation, and the median time was 11.4 hours since last dose, with 245 (51%) on apixaban, 176 (37%) on rivaroxaban, 36 (8%) on edoxaban, and 22 (5%) on enoxaparin. Bleeding was predominantly intracranial (n=331 [69%]) or gastrointestinal (n=109 [23%]). In evaluable apixaban patients (n=172), median anti-FXa activity decreased from 146.9 ng/mL to 10.0 ng/mL (reduction, 93% [95% CI, 94–93]); in rivaroxaban patients (n=132), it decreased from 214.6 ng/mL to 10.8 ng/mL (94% [95% CI, 95–93]); in edoxaban patients (n=28), it decreased from 121.1 ng/mL to 24.4 ng/mL (71% [95% CI, 82–65); and in enoxaparin patients (n=17), it decreased from 0.48 IU/mL to 0.11 IU/mL (75% [95% CI, 79–67]). Excellent or good hemostasis occurred in 274 of 342 evaluable patients (80% [95% CI, 75–84]). In the safety population, thrombotic events occurred in 50 (10%) patients; in 16 patients, these occurred during treatment with prophylactic anticoagulation that began after the bleeding event. No thrombotic episodes occurred after oral anticoagulation restart. Specific to certain populations, reduction of anti-FXa activity from baseline to nadir significantly predicted hemostatic efficacy in patients with intracranial hemorrhage (area under the receiver operating characteristic curve, 0.62 [95% CI, 0.54–0.70]) and correlated with lower mortality in patients P =0.022; unadjusted P =0.003). Median endogenous thrombin potential was within the normal range by the end of andexanet alfa bolus through 24 hours for all FXa inhibitors. Conclusions: In patients with major bleeding associated with the use of FXa inhibitors, treatment with andexanet alfa reduced anti-FXa activity and was associated with good or excellent hemostatic efficacy in 80% of patients. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02329327.

Published
2023

6. Signals for reduced cognitive function are associated with subtle signs of atrial cardiomyopathy and left ventricular diastolic dysfunction – insights from a large population based study

Author

S Camen, L Nagel, R Bei Der Kellen, E Barow, J N Schneider, S Blankenberg, P Kirchhof, J P Wenzel, G Thomalla, and R B Schnabel

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background/Introduction In recent years, it has been proposed that a thrombogenic atrial substrate due to various alterations in (left) atrial morphology and function could contribute to atrial thromboembolism even in the absence of (clinically overt) atrial fibrillation. This so-called atrial cardiomyopathy may pose a risk of stroke and cognitive decline beyond the presence of atrial fibrillation. Purpose To define the association of echocardiographic parameters of left atrial cardiomyopathy and left ventricular diastolic dysfunction with cognitive function in individuals free of clinically overt atrial fibrillation or stroke. Methods Data from the first 10,000 participants of a large German population-based cohort study were analysed. Of these, 8264 individuals underwent standardized transthoracic echocardiography and cognitive function testing at baseline. Parameters of left ventricular systolic and diastolic function as well as left atrial function were systematically assessed, including left atrial global peak strain. Cognitive function was quantified using the Animal Naming Test and the Trail Making Test A and B. We performed linear regression analyses with incremental adjustment to examine the association of echocardiographic parameters with the performance on the neuropsychological tests. Results After exclusion of 463 individuals with known AF and 309 individuals with prior/known stroke or severe depression, 7492 individuals were analysed (mean age 61.9±8.4 years, 52.3% women, median left ventricular ejection fraction 59% [25th/75th percentile 56/62%], median left atrial volume index 25.0 ml/m2 [25th/75th percentile 20/30 ml/m2]). In multivariable-adjusted analyses, E/e'-ratio was significantly associated with a worse performance on the Animal Naming Test (−0.24 per one standard deviation [SD] increase, 95% confidence interval [CI] −0.42 to −0.06), the Trail Making Test A (0.76 per one SD increase, 95% CI 0.35–1.17) and B (1.1 per one SD increase, 95% CI 0.09–2.11). Left atrial strain was associated with worse performance on Trail Making Test B (−1.39 per one SD increase, 95% CI −2.46 to −0.32). Increased left atrial volume index was associated with worse performance on the ANT (0.2, 95% CI 0.03–0.37). Conclusions Subtle echocardiographic signs of atrial cardiomyopathy and left ventricular diastolic dysfunction are associated with worse performance on cognitive function tests in a German middle-aged population. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): The Hamburg City Health Study (HCHS) is supported by the University Medical Center Hamburg-Eppendorf and by various grants from different institutions/organizations.

Published
2022
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7. Associations of SCORE2, circulating cardiovascular biomarkers and carotid intima-media-thickness in a population-based cohort

Author

B Toprak, J Lehmacher, Y Hu, C Waldeyer, G Thomalla, D L Rimmele, A Ziegler, T Zeller, S Blankenberg, J T Neumann, and R Twerenbold

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background The updated SCORE2 model to estimate the 10-year risk of fatal and non-fatal cardiovascular disease (CVD) was recently introduced, which is based solely on traditional cardiovascular risk factors. Purpose We aimed to investigate the associations of SCORE2-predicted risk with four circulating cardiovascular biomarkers (high-sensitivity troponin I [hs-cTnI], N-terminal pro B-type natriuretic peptide [NT-proBNP], cystatin C-derived estimated glomerular filtration rate [eGFR] and high-sensitivity C-reactive protein [hs-CRP]) as well as mean carotid intima-media-thickness (cIMT) in a prospective, population-based German cohort. Methods In the first set of 10,000 participants, who were aged 45–74 years and recruited between 2016 and 2019, the SCORE2 model was applied in a cross-sectional manner. Individuals with prevalent CVD were excluded for this purpose. Eligible individuals were then categorized into five risk groups (1mm were calculated for this extended model in comparison to SCORE2 alone as the reference. Results In 8,518 individuals free of CVD, median estimated 10-year risk of CVD based on SCORE2 was 6.1 (interquartile range [IQR] 3.2, 9.9) %. All four investigated biomarkers (hs-cTnI, R=0.41; NT-proBNP, R=0.21; hs-CRP, R=0.22; eGFR, R=−0.44; all P1mm, the joint addition of all four stepwise-selected investigated biomarkers led to a small but significant improvement of discrimination (C-index 0.770, 95% CI 0.749–0.791, P Conclusions All four investigated circulating biomarkers depicting different pathophysiological pathways and mean cIMT correlate strongly with the cardiovascular risk estimated by SCORE2. Circulating biomarkers may further improve CVD-risk prediction when added to the traditional cardiovascular risk factors currently considered by SCORE2. Funding Acknowledgement Type of funding sources: None.

Published
2022
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15. Stroke Etiology Modifies the Effect of Endovascular Treatment in Acute Stroke

Author

Steffen Tiedt, Moriz Herzberg, Clemens Küpper, Katharina Feil, Lars Kellert, Franziska Dorn, Thomas Liebig, Anna Alegiani, Martin Dichgans, Frank A. Wollenweber, B. Alber, C. Bangard, J. Berrouschot, F.J. Bode, T. Boeckh-Behrens, G. Bohner, A. Bormann, M. Braun, B. Eckert, J. Fiehler, F. Flottmann, C. Gerloff, G.F. Hamann, K.H. Henn, A. Kastrup, C. Kraemer, L. Krause, M. Lehm, J. Liman, S. Lowens, A. Mpotsaris, C.H. Nolte, P. Papanagiotou, M. Petersen, G.C. Petzold, W. Pfeilschifter, M.N. Psychogios, A. Reich, R. von Rennenberg, J. Röther, J.H. Schäfer, E. Siebert, A. Siedow, L. Solymosi, G. Thomalla, S. Thonke, M. Wagner, S. Wunderlich, and S. Zweynert

Subjects
Advanced and Specialized Nursing, medicine.medical_specialty, Stroke etiology, business.industry, Confounding, Odds ratio, Logistic regression, medicine.disease, Internal medicine, Cardiology, medicine, Etiology, Neurology (clinical), Endovascular treatment, Thrombus, Cardiology and Cardiovascular Medicine, business, Stroke
Abstract

Background and Purpose— Stroke etiology drives thrombus composition. We thus hypothesized that endovascular treatment shows different efficacy in cardioembolic versus noncardioembolic large-vessel occlusions (LVOs). Methods— Procedural characteristics, grade of reperfusion, and functional outcome at discharge and 90 days were compared between patients with cardioembolic versus noncardioembolic LVO from the GSR-ET (German Stroke Registry–Endovascular Treatment; n=2589). To determine associations with functional outcome, adjusted odds ratios and 95% CIs were calculated using ordinal multivariable logistic regression models adjusting for potential baseline confounder variables. Results— Endovascular treatment of cardioembolic LVO had a higher rate of successful reperfusion (85.6% versus 81.0%; P =0.002) and a higher rate of complete reperfusion after a single thrombectomy pass (45.7% versus 38.1%; P Conclusions— These results provide evidence for higher efficacy of endovascular treatment in cardioembolic LVO compared with noncardioembolic LVO.

Published
2020
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16. P.068 Discrepancy between post-treatment infarct volume and 90-day outcome in ischemic stroke: A validation study in the ESCAPE-NA1 randomized controlled trial

Author

A Ganesh, JM Ospel, BK Menon, AM Demchuk, RG Nogueira, RA McTaggart, AY Poppe, MA Almekhlafi, RA Hanel, G Thomalla, S Holmin, V Puetz, BA van Adel, JW Tarpley, M Tymianski, MD Hill, and M Goyal

Subjects
Neurology, Neurology (clinical), General Medicine
Abstract

Background: Some patients do poorly despite small infarcts after endovascular therapy(EVT) whilst others with large infarcts do well. We validated exploratory findings from the ESCAPE trial regarding factors associated with such discrepancies, in the ESCAPE-NA1 trial(NCT02930018). Methods: We identified “discrepant cases” with modified Rankin Scale(mRS)≥3 despite small follow-up infarct volume(FIV≤25th-percentile) on 24-hour CT/MRI or mRS≤2 despite large FIV(volume≥75th-percentile). We compared area-under-the-curve(AUC) of pre-specified logistic models containing (a)pre-treatment factors(age/cancer/vascular risk-factors) and (b)treatment-related/post-treatment factors(serious adverse events/SAEs) in identifying small-FIV/mRS≥3 and large-FIV/mRS≤2, with stepwise regression-derived models. Results: Among 1,091 patients, 42/287(14.6%) with FIV≤7mL(25th-percentile) had mRS≥3; 65/275(23.6%) with FIV≥92mL(75th-percentile) had mRS≤2. Pre-specified pre-treatment factors(age/cancer/vascular risk-factors) were associated with FIV≤7mL/mRS≥3; stepwise models selected similar variables(similar AUCs:0.92-0.93,p=0.42). SAEs(infarct-in-new-territory/recurrent stroke/pneumonia/heart failure) were strongly associated with FIV≤7mL/mRS≥3; stepwise models also identified onset-to-needle time and hemoglobin(24-hours) as treatment-related/post-treatment factors(similar AUCs:0.92-0.94,p=0.14). Younger age was associated with FIV≥92mL/mRS≤2; stepwise models also selected diabetes absence and baseline hemoglobin(similar AUCs:0.76-0.77,p=0.82). Absence of SAEs(stroke progression/pneumonia/intracerebral hemorrhage) was strongly associated with FIV≥92mL/mRS≤2; stepwise models also identified 24-hour hemoglobin, glucose, and BP(similar AUCs:0.79-0.80,p=0.030). Conclusions: FIV-mRS discrepancies are associated with pre-treatment factors like age/comorbidities; and post-treatment complications related to stroke evolution, secondary prevention, and post-acute care quality. Optimizing thrombolysis speed, BP, glucose, and hemoglobin are modifiable factors meriting further study.

Published
2021
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18. Contralateral Stenosis and Echolucent Plaque Morphology are Associated with Elevated Stroke Risk in Patients Treated with Asymptomatic Carotid Artery Stenosis within a Controlled Clinical Trial (SPACE-2)

Author

Tilman Reiff, Hans-Henning Eckstein, Ulrich Mansmann, Olav Jansen, Gustav Fraedrich, Harald Mudra, Dittmar Böckler, Michael Böhm, Hartmut Brückmann, E. Sebastian Debus, Jens Fiehler, Klaus Mathias, E. Bernd Ringelstein, Jürg Schmidli, Robert Stingele, Ralf Zahn, Thomas Zeller, Wolf-Dirk Niesen, Kristian Barlinn, Andreas Binder, Jörg Glahn, Peter Arthur Ringleb, F Beyersdorf, M Grügerny, R-R Macharzina, G Lechner, C Menz, S Schonhardt, M Weinbeck, O Greb, D Otto, T Winker, H Berger, H Poppert, V Pütz, K Haase, U Bodechtel, N Weiss, H Bergert, J Meyne, J Groß, A Botsch, M Kruse, B Gerdes, WD Reinbold, H Wuttig, A Maier-Hasselmann, M Segerer, H-H Fuchs, S Gass, H Schultz, C Groden, M Niedergethman, M Griebe, M Rosenkranz, C Beck, G Thomalla, H Zeumer, M Jauß, W Kneist, M Kneist, T Staudacher, A Bernhard, D Jost, N Prey, J Knippschild, O Kastrup, M Köhrmann, B Frank, V Bongers, J Hoffmann, H-W Kniemeyer, M Knauth, K Wasser, T Stojanovic, H Emmert, J Tacke, B Schwalbe, E-M Nam, U van Lengerich, S Lowens, K Gröschel, T Uphaus, S Gröschel, S Boor, B Dorweiler, E Schmid, H Henkes, T Hupp, O Singer, G Hamann, M Wagner-Heck, S Kerth-Krick, M Kilic, P Huppert, K Niederkorn, J Fruhwirth, G Klein, U Pulkowski, K Jöster, J-H Wacks, E Kloppmann, B Vatankhah, S Hopf-Jensen, H Stolze, S Müller-Hülsbeck, KP Walluscheck, H-M Schmitt, A Grüger, J Seemann, B Tilahun, M Dichgans, F Wollenweber, A Dörr, A Zollver, G Gäbel, G Hedtmann, R Kollmar, D Claus, C Petermann, S Kirsch, B Bosnjak, J Heiß, H Mühling, S Wunderlich, PN Sabisch, G Gahn, M Storck, S Arnold, U Fischer, J Gralla, M von Mering, R Dißmann, D Kirsch, C Schmidauer, P Waldenberger, M Furtner, H Kazarians, P Breuer, C Arning, J Rieper, G Schmidt, M Arnold, G Schroth, J Weise, J Zanow, T Mayer, R Töpper, W Gross-Fengels, H Daum, R Dittrich, M Ritter, B Kasprzak, G Torsello, C Pohlmann, R Brüning, H Amiri, I Ludwig, E Blessing, M Möhlenbruch, A Crispin, M Hofman, and T Müller

Subjects
Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Carotid endarterectomy, Carotid Intima-Media Thickness, Risk Assessment, Predictive Value of Tests, Risk Factors, Internal medicine, Occlusion, medicine, Humans, Carotid Stenosis, Plaque morphology, In patient, Prospective Studies, cardiovascular diseases, Asymptomatic carotid artery stenosis, Stroke, Aged, Endarterectomy, Carotid, business.industry, Endovascular Procedures, Rehabilitation, Middle Aged, medicine.disease, Plaque, Atherosclerotic, Europe, Clinical trial, Stenosis, Treatment Outcome, Asymptomatic Diseases, Cardiology, Female, Stents, Surgery, Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Abstract

Background Asymptomatic carotid artery stenosis (ACS) has a low risk of stroke. To achieve an advantage over noninterventional best medical treatment (BMT), carotid endarterectomy (CEA) or carotid artery stenting (CAS) must be performed with the lowest possible risk of stroke. Therefore, an analysis of risk-elevating factors is essential. Grade of ipsilateral and contralateral stenosis as well as plaque morphology are known risk factors in ACS. Methods The randomized, controlled, multicenter SPACE-2 trial had to be stopped prematurely after recruiting 513 patients. 203 patients were randomized to CEA, 197 to CAS, and 113 to BMT. Within one year, risk factors such as grade of stenosis and plaque morphology were analyzed. Results Grade of contralateral stenosis (GCS) was higher in patients with any stroke (50%ECST vs. 20%ECST; p=0.012). Echolucent plaque morphology was associated with any stroke on the day of intervention (OR 5.23; p=0.041). In the periprocedural period, any stroke was correlated with GCS in the CEA group (70%ECST vs. 20%ECST; p=0.026) and with echolucent plaque morphology in the CAS group (6% vs. 1%; p=0.048). In multivariate analysis, occlusion of the contralateral carotid artery (CCO) was associated with risk of any stroke (OR 7.00; p=0.006), without heterogeneity between CEA and CAS. Conclusion In patients with asymptomatic carotid artery stenosis, GCS, CCO, as well as echolucent plaque morphology were associated with a higher risk of cerebrovascular events. The risk of stroke in the periprocedural period was increased by GCS in CEA and by echolucent plaque in CAS. Due to small sample size, results must be interpreted carefully.

Published
2021
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19. Fortschritte in der Akuttherapie und Prophylaxe des Schlaganfalls

Author

Martin Köhrmann, Christian Gerloff, Hans-Christoph Diener, and G. Thomalla

Subjects
Gynecology, medicine.medical_specialty, business.industry, medicine, business
Abstract

Der dritte europaische Schlaganfallkongress (ESOC) fand vom 16. bis 18. Mai 2017 in Prag statt. Im Gegensatz zum Kongress der amerikanischen Herzgesellschaft (AHA) und der amerikanischen Schlaganfallgesellschaft (ASA) im Februar 2017 in Houston gab es diesmal einige positive Studien mit wichtigen Konsequenzen fur den klinischen Alltag.

Published
2017
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20. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data

Author

Bruce C V Campbell, Charles B L M Majoie, Gregory W Albers, Bijoy K Menon, Nawaf Yassi, Gagan Sharma, Wim H van Zwam, Robert J van Oostenbrugge, Andrew M Demchuk, Francis Guillemin, Philip White, Antoni Dávalos, Aad van der Lugt, Kenneth S Butcher, Aboubaker Cherifi, Henk A Marquering, Geoffrey Cloud, Juan M Macho Fernández, Jeremy Madigan, Catherine Oppenheim, Geoffrey A Donnan, Yvo B W E M Roos, Jai Shankar, Hester Lingsma, Alain Bonafé, Hélène Raoult, María Hernández-Pérez, Aditya Bharatha, Reza Jahan, Olav Jansen, Sébastien Richard, Elad I Levy, Olvert A Berkhemer, Marc Soudant, Lucia Aja, Stephen M Davis, Timo Krings, Marie Tisserand, Luis San Román, Alejandro Tomasello, Debbie Beumer, Scott Brown, David S Liebeskind, Serge Bracard, Keith W Muir, Diederik W J Dippel, Mayank Goyal, Jeffrey L Saver, Tudor G Jovin, Michael D Hill, Peter J Mitchell, Puck SS Fransen, Lucie A van den Berg, Hester F Lingsma, Albert J Yoo, Wouter J Schonewille, Jan Albert Vos, Paul J Nederkoorn, Marieke JH Wermer, Marianne AA van Walderveen, Julie Staals, Jeannette Hofmeijer, Jacques A. van Oostayen, Geert J. Lycklama à Nijeholt, Jelis Boiten, Patrick A. Brouwer, Bart J. Emmer, Sebastiaan F. de Bruijn, Lukas C. van Dijk, Jaap Kappelle, Rob H Lo, Ewoud J. van Dijk, Joost de Vries, Paul L.M. de Kort, Willem Jan J. van Rooij, Jan S.P. van den Berg, Boudewijn A.A.M. van Hasselt, Leo A.M. Aerden, René J. Dallinga, Marieke C. Visser, Joseph C.J. Bot, Patrick C. Vroomen, Omid Eshghi, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Alexander V. Tielbeek, Heleen M. den Hertog, Dick G. Gerrits, Renske M. van den Berg-Vos, Giorgos B. Karas, Ewout W. Steyerberg, Zwenneke Flach, Henk A. Marquering, Marieke E.S. Sprengers, Sjoerd F.M. Jenniskens, Ludo F.M. Beenen, René van den Berg, Peter J. Koudstaal, Wim H. van Zwam, Yvo B.W.E.M. Roos, Robert J. van Oostenbrugge, Charles B.L.M. Majoie, Diederik W.J. Dippel, Martin M. Brown, Thomas Liebig, Theo Stijnen, Tommy Andersson, Heinrich Mattle, Nils Wahlgren, Esther van der Heijden, Naziha Ghannouti, Nadine Fleitour, Imke Hooijenga, Corina Puppels, Wilma Pellikaan, Annet Geerling, Annemieke Lindl-Velema, Gina van Vemde, Ans de Ridder, Paut Greebe, José de Bont-Stikkelbroeck, Joke de Meris, Kirsten Janssen, Willy Struijk, Silvan Licher, Nikki Boodt, Adriaan Ros, Esmee Venema, Ilse Slokkers, Raymie-Jayce Ganpat, Maxim Mulder, Nawid Saiedie, Alis Heshmatollah, Stefanie Schipperen, Stefan Vinken, Tiemen van Boxtel, Jeroen Koets, Merel Boers, Emilie Santos, Jordi Borst, Ivo Jansen, Manon Kappelhof, Marit Lucas, Ralph Geuskens, Renan Sales Barros, Roeland Dobbe, Marloes Csizmadia, MD Hill, M Goyal, AM Demchuk, BK Menon, M Eesa, KJ Ryckborst, MR Wright, NR Kamal, L Andersen, PA Randhawa, T Stewart, S Patil, P Minhas, M Almekhlafi, S Mishra, F Clement, T Sajobi, A Shuaib, WJ Montanera, D Roy, FL Silver, TG Jovin, DF Frei, B Sapkota, JL Rempel, J Thornton, D Williams, D Tampieri, AY Poppe, D Dowlatshahi, JH Wong, AP Mitha, S Subramaniam, G Hull, MW Lowerison, M Salluzzi, M Maxwell, S Lacusta, E Drupals, K Armitage, PA Barber, EE Smith, WF Morrish, SB Coutts, C Derdeyn, B Demaerschalk, D Yavagal, R Martin, R Brant, Y Yu, RA Willinsky, A Weill, C Kenney, H Aram, PK Stys, TW Watson, G Klein, D Pearson, P Couillard, A Trivedi, D Singh, E Klourfeld, O Imoukhuede, D Nikneshan, S Blayney, R Reddy, P Choi, M Horton, T Musuka, V Dubuc, TS Field, J Desai, S Adatia, A Alseraya, V Nambiar, R van Dijk, NJ Newcommon, B Schwindt, KS Butcher, T Jeerakathil, B Buck, K Khan, SS Naik, DJ Emery, RJ Owen, TB Kotylak, RA Ashforth, TA Yeo, D McNally, M Siddiqui, M Saqqur, D Hussain, H Kalashyan, A Manosalva, M Kate, L Gioia, S Hasan, A Mohammad, M Muratoglu, A Cullen, P Brennan, A O'Hare, S Looby, D Hyland, S Duff, M McCusker, B Hallinan, S Lee, J McCormack, A Moore, M O'Connor, C Donegan, L Brewer, A Martin, S Murphy, K O'Rourke, S Smyth, P Kelly, T Lynch, T Daly, P O'Brien, A O'Driscoll, M Martin, R Collins, T Coughlan, D McCabe, D O'Neill, M Mulroy, O Lynch, T Walsh, M O'Donnell, T Galvin, J Harbison, P McElwaine, K Mulpeter, C McLoughlin, M Reardon, E Harkin, E Dolan, M Watts, N Cunningham, C Fallon, S Gallagher, P Cotter, M Crowe, R Doyle, I Noone, M Lapierre, VA Coté, S Lanthier, C Odier, A Durocher, J Raymond, N Daneault, Y Deschaintre, B Jankowitz, L Baxendell, L Massaro, C Jackson-Graves, S Decesare, P Porter, K Armbruster, A Adams, J Billigan, J Oakley, A Ducruet, A Jadhav, D-V Giurgiutiu, A Aghaebrahim, V Reddy, M Hammer, M Starr, V Totoraitis, L Wechsler, S Streib, S Rangaraju, D Campbell, M Rocha, D Gulati, T Krings, L Kalman, A Cayley, J Williams, R Wiegner, LK Casaubon, C Jaigobin, JM del Campo, E Elamin, JD Schaafsma, R Agid, R Farb, K ter Brugge, BL Sapkoda, BW Baxter, K Barton, A Knox, A Porter, A Sirelkhatim, T Devlin, C Dellinger, N Pitiyanuvath, J Patterson, J Nichols, S Quarfordt, J Calvert, H Hawk, C Fanale, A Bitner, A Novak, D Huddle, R Bellon, D Loy, J Wagner, I Chang, E Lampe, B Spencer, R Pratt, R Bartt, S Shine, G Dooley, T Nguyen, M Whaley, K McCarthy, J Teitelbaum, W Poon, N Campbell, M Cortes, C Lum, R Shamloul, S Robert, G Stotts, M Shamy, N Steffenhagen, D Blacquiere, M Hogan, M AlHazzaa, G Basir, H Lesiuk, D Iancu, M Santos, H Choe, DC Weisman, K Jonczak, A Blue-Schaller, Q Shah, L MacKenzie, B Klein, K Kulandaivel, O Kozak, DJ Gzesh, LJ Harris, JS Khoury, J Mandzia, D Pelz, S Crann, L Fleming, K Hesser, B Beauchamp, B Amato-Marzialli, M Boulton, P Lopez- Ojeda, M Sharma, S Lownie, R Chan, R Swartz, P Howard, D Golob, D Gladstone, K Boyle, M Boulos, J Hopyan, V Yang, L Da Costa, CA Holmstedt, AS Turk, R Navarro, E Jauch, S Ozark, R Turner, S Phillips, J Shankar, J Jarrett, G Gubitz, W Maloney, R Vandorpe, M Schmidt, J Heidenreich, G Hunter, M Kelly, R Whelan, L Peeling, PA Burns, A Hunter, I Wiggam, E Kerr, M Watt, A Fulton, P Gordon, I Rennie, P Flynn, G Smyth, S O'Leary, N Gentile, G Linares, P McNelis, K Erkmen, P Katz, A Azizi, M Weaver, C Jungreis, S Faro, P Shah, H Reimer, V Kalugdan, G Saposnik, A Bharatha, Y Li, P Kostyrko, T Marotta, W Montanera, D Sarma, D Selchen, J Spears, JH Heo, K Jeong, DJ Kim, BM Kim, YD Kim, D Song, K-J Lee, J Yoo, OY Bang, S Rho, J Lee, P Jeon, KH Kim, J Cha, SJ Kim, S Ryoo, MJ Lee, S-I Sohn, C-H Kim, H-G Ryu, J-H Hong, H-W Chang, C-Y Lee, J Rha, Bruce CV Campbell, Leonid Churilov, Bernard Yan, Richard Dowling, Thomas J Oxley, Teddy Y Wu, Gabriel Silver, Amy McDonald, Rachael McCoy, Timothy J Kleinig, Rebecca Scroop, Helen M Dewey, Marion Simpson, Mark Brooks, Bronwyn Coulton, Martin Krause, Timothy J Harrington, Brendan Steinfort, Kenneth Faulder, Miriam Priglinger, Susan Day, Thanh Phan, Winston Chong, Michael Holt, Ronil V Chandra, Henry Ma, Dennis Young, Kitty Wong, Tissa Wijeratne, Hans Tu, Elizabeth Mackay, Sherisse Celestino, Christopher F Bladin, Poh Sien Loh, Amanda Gilligan, Zofia Ross, Skye Coote, Tanya Frost, Mark W Parsons, Ferdinand Miteff, Christopher R Levi, Timothy Ang, Neil Spratt, Lara Kaauwai, Monica Badve, Henry Rice, Laetitia de Villiers, P. Alan Barber, Ben McGuinness, Ayton Hope, Maurice Moriarty, Patricia Bennett, Andrew Wong, Alan Coulthard, Andrew Lee, Jim Jannes, Deborah Field, Simon Salinas, Elise Cowley, Barry Snow, John Kolbe, Richard Stark, John King, Richard Macdonnell, John Attia, Cate D'Este, Hans-Christoph Diener, Elad I. Levy, Vitor Mendes Pereira, Gregory W. Albers, Christophe Cognard, David J. Cohen, Werner Hacke, Tudor G. Jovin, Heinrich P. Mattle, Raul G. Nogueira, Adnan H. Siddiqui, Dileep R. Yavagal, Rüdiger von Kummer, Wade Smith, Francis Turjman, Scott Hamilton, Richard Chiacchierini, Arun Amar, Nerses Sanossian, Yince Loh, B Baxter, VK Reddy, A Horev, M Star, A Siddiqui, LN Hopkins, K Snyder, R Sawyer, S Hall, V Costalat, C Riquelme, P Machi, E Omer, C Arquizan, I Mourand, M Charif, X Ayrignac, N Menjot de Champfleur, N Leboucq, G Gascou, M Moynier, R du Mesnil de Rochemont, O Singer, J Berkefeld, C Foerch, M Lorenz, W Pfeilschifer, E Hattingen, M Wagner, SJ You, S Lescher, H Braun, S Dehkharghani, SR Belagaje, A Anderson, A Lima, M Obideen, D Haussen, R Dharia, M Frankel, V Patel, K Owada, A Saad, L Amerson, C Horn, S Doppelheuer, K Schindler, DK Lopes, M Chen, R Moftakhar, C Anton, M Smreczak, JS Carpenter, S Boo, A Rai, T Roberts, A Tarabishy, L Gutmann, C Brooks, J Brick, J Domico, G Reimann, K Hinrichs, M Becker, E Heiss, C Selle, A Witteler, S Al-Boutros, M-J Danch, A Ranft, S Rohde, K Burg, C Weimar, V Zegarac, C Hartmann, M Schlamann, S Göricke, A Ringlestein, I Wanke, C Mönninghoff, M Dietzold, R Budzik, T Davis, G Eubank, WJ Hicks, P Pema, N Vora, J Mejilla, M Taylor, W Clark, A Rontal, J Fields, B Peterson, G Nesbit, H Lutsep, H Bozorgchami, R Priest, O Ologuntoye, S Barnwell, A Dogan, K Herrick, C Takahasi, N Beadell, B Brown, S Jamieson, MS Hussain, A Russman, F Hui, D Wisco, K Uchino, Z Khawaja, I Katzan, G Toth, E Cheng-Ching, M Bain, S Man, A Farrag, P George, S John, L Shankar, A Drofa, R Dahlgren, A Bauer, A Itreat, A Taqui, R Cerejo, A Richmond, P Ringleb, M Bendszus, M Möhlenbruch, T Reiff, H Amiri, J Purrucker, C Herweh, M Pham, O Menn, I Ludwig, I Acosta, C Villar, W Morgan, C Sombutmai, F Hellinger, E Allen, M Bellew, R Gandhi, E Bonwit, J Aly, RD Ecker, D Seder, J Morris, M Skaletsky, J Belden, C Baker, LS Connolly, P Papanagiotou, C Roth, A Kastrup, M Politi, F Brunner, M Alexandrou, H Merdivan, C Ramsey, C Given II, S Renfrow, V Deshmukh, K Sasadeusz, F Vincent, JT Thiesing, J Putnam, A Bhatt, A Kansara, D Caceves, T Lowenkopf, L Yanase, J Zurasky, S Dancer, B Freeman, T Scheibe-Mirek, J Robison, J Roll, D Clark, M Rodriguez, B-FM Fitzsimmons, O Zaidat, JR Lynch, M Lazzaro, T Larson, L Padmore, E Das, A Farrow-Schmidt, A Hassan, W Tekle, C Cate, O Jansen, C Cnyrim, F Wodarg, C Wiese, A Binder, C Riedel, A Rohr, N Lang, H Laufs, S Krieter, L Remonda, M Diepers, J Añon, K Nedeltchev, T Kahles, S Biethahn, M Lindner, V Chang, C Gächter, C Esperon, M Guglielmetti, JF Arenillas Lara, M Martínez Galdámez, AI Calleja Sanz, E Cortijo Garcia, P Garcia Bermejo, S Perez, P Mulero Carrillo, E Crespo Vallejo, M Ruiz Piñero, L Lopez Mesonero, FJ Reyes Muñoz, C Brekenfeld, J-H Buhk, A Krützelmann, G Thomalla, B Cheng, C Beck, J Hoppe, E Goebell, B Holst, U Grzyska, G Wortmann, S Starkman, G Duckwiler, R Jahan, N Rao, S Sheth, K Ng, A Noorian, V Szeder, M Nour, M McManus, J Huang, J Tarpley, S Tateshima, N Gonzalez, L Ali, D Liebeskind, J Hinman, M Calderon-Arnulphi, C Liang, J Guzy, S Koch, K DeSousa, G Gordon-Perue, M Elhammady, E Peterson, V Pandey, S Dharmadhikari, P Khandelwal, A Malik, R Pafford, P Gonzalez, K Ramdas, G Andersen, D Damgaard, P Von Weitzel-Mudersbach, C Simonsen, N Ruiz de Morales Ayudarte, M Poulsen, L Sørensen, S Karabegovich, M Hjørringgaard, N Hjort, T Harbo, K Sørensen, E Deshaies, D Padalino, A Swarnkar, JG Latorre, E Elnour, Z El-Zammar, M Villwock, H Farid, A Balgude, L Cross, K Hansen, M Holtmannspötter, D Kondziella, J Hoejgaard, S Taudorf, H Soendergaard, A Wagner, M Cronquist, T Stavngaard, M Cortsen, LH Krarup, T Hyldal, H-P Haring, S Guggenberger, M Hamberger, J Trenkler, M Sonnberger, K Nussbaumer, C Dominger, E Bach, BD Jagadeesan, R Taylor, J Kim, K Shea, R Tummala, H Zacharatos, D Sandhu, M Ezzeddine, A Grande, D Hildebrandt, K Miller, J Scherber, A Hendrickson, M Jumaa, S Zaidi, T Hendrickson, V Snyder, M Killer-Oberpfalzer, J Mutzenbach, F Weymayr, E Broussalis, K Stadler, A Jedlitschka, A Malek, N Mueller-Kronast, P Beck, C Martin, D Summers, J Day, I Bettinger, W Holloway, K Olds, S Arkin, N Akhtar, C Boutwell, S Crandall, M Schwartzman, C Weinstein, B Brion, S Prothmann, J Kleine, K Kreiser, T Boeckh-Behrens, H Poppert, S Wunderlich, ML Koch, V Biberacher, A Huberle, G Gora-Stahlberg, B Knier, T Meindl, D Utpadel-Fischler, M Zech, M Kowarik, C Seifert, B Schwaiger, A Puri, S Hou, A Wakhloo, M Moonis, N Henninger, R Goddeau, F Massari, A Minaeian, JD Lozano, M Ramzan, C Stout, A Patel, A Tunguturi, S Onteddu, R Carandang, M Howk, M Ribó, E Sanjuan, M Rubiera, J Pagola, A Flores, M Muchada, P Meler, E Huerga, S Gelabert, P Coscojuela, A Tomasello, D Rodriguez, E Santamarina, O Maisterra, S Boned, L Seró, A Rovira, CA Molina, M Millán, L Muñoz, N Pérez de la Ossa, M Gomis, L Dorado, E López-Cancio, E Palomeras, J Munuera, P García Bermejo, S Remollo, C Castaño, R García-Sort, P Cuadras, P Puyalto, M Hernández-Pérez, M Jiménez, A Martínez-Piñeiro, G Lucente, A Dávalos, A Chamorro, X Urra, V Obach, A Cervera, S Amaro, L Llull, J Codas, M Balasa, J Navarro, H Ariño, A Aceituno, S Rudilosso, A Renu, JM Macho, L San Roman, J Blasco, A López, N Macías, P Cardona, H Quesada, F Rubio, L Cano, B Lara, MA de Miquel, L Aja, J Serena, E Cobo, Kennedy R Lees, J Arenillas, R Roberts, F Al-Ajlan, L Zimmel, S Patel, J Martí-Fàbregas, M Salvat-Plana, S Bracard, Xavier Ducrocq, René Anxionnat, Pierre-Alexandre Baillot, Charlotte Barbier, Anne-Laure Derelle, Jean-Christophe Lacour, Yves Samson, Nader Sourour, Flore Baronnet-Chauvet, Frédéric Clarencon, Sophie Crozier, Sandrine Deltour, Federico Di Maria, Raphael Le Bouc, Anne Leger, Gurkan Mutlu, Charlotte Rosso, Zoltan Szatmary, Marion Yger, Chiara Zavanone, Serge Bakchine, Laurent Pierot, Nathalie Caucheteux, Laurent Estrade, Krzysztof Kadziolka, Alexandre Leautaud, Céline Renkes, Isabelle Serre, Hubert Desal, Benoît Guillon, Claire Boutoleau-Bretonniere, Benjamin Daumas-Duport, Solène De Gaalon, Pascal Derkinderen, Sarah Evain, Fanny Herisson, David-Axel Laplaud, Thibaud Lebouvier, Alina Lintia-Gaultier, Hélène Pouclet-Courtemanche, Tiphaine Rouaud, Violaine Rouaud Jaffrenou, Aurélia Schunck, Mathieu Sevin-Allouet, Frederique Toulgoat, Sandrine Wiertlewski, Jean-Yves Gauvrit, Thomas Ronziere, Vincent Cahagne, Jean-Christophe Ferre, Jean-François Pinel, Jean-Louis Mas, Jean-François Meder, Amen-Adam Al Najjar-Carpentier, Julia Birchenall, Eric Bodiguel, David Calvet, Valérie Domigo, Sylvie Godon-Hardy, Vincent Guiraud, Catherine Lamy, Loubna Majhadi, Ludovic Morin, Olivier Naggara, Denis Trystram, Guillaume Turc, Jérôme Berge, Igor Sibon, Patrice Menegon, Xavier Barreau, François Rouanet, Sabrina Debruxelles, Annabelle Kazadi, Pauline Renou, Olivier Fleury, Anne Pasco-Papon, Frédéric Dubas, Jildaz Caroff, Sophie Godard Ducceschi, Marie-Aurélie Hamon, Alderic Lecluse, Guillaume Marc, Maurice Giroud, Frédéric Ricolfi, Yannick Bejot, Adrien Chavent, Arnaud Gentil, Apolline Kazemi, Guy-Victor Osseby, Charlotte Voguet, Marie-Hélène Mahagne, Jacques Sedat, Yves Chau, Laurent Suissa, Sylvain Lachaud, Emmanuel Houdart, Christian Stapf, Frédérique Buffon Porcher, Hugues Chabriat, Pierre Guedin, Dominique Herve, Eric Jouvent, Jérôme Mawet, Jean-Pierre Saint-Maurice, Hans-Martin Schneble, Norbert Nighoghossian, Nadia-Nawel Berhoune, Françoise Bouhour, Tae-Hee Cho, Laurent Derex, Sandra Felix, Hélène Gervais-Bernard, Benjamin Gory, Luis Manera, Laura Mechtouff, Thomas Ritzenthaler, Roberto Riva, Fabrizio Salaris Silvio, Caroline Tilikete, Raphael Blanc, Michaël Obadia, Mario Bruno Bartolini, Antoine Gueguen, Michel Piotin, Silvia Pistocchi, Hocine Redjem, Jacques Drouineau, Jean-Philippe Neau, Gaelle Godeneche, Matthias Lamy, Emilia Marsac, Stephane Velasco, Pierre Clavelou, Emmanuel Chabert, Nathalie Bourgois, Catherine Cornut-Chauvinc, Anna Ferrier, Jean Gabrillargues, Betty Jean, Anna-Raquel Marques, Nicolas Vitello, Olivier Detante, Marianne Barbieux, Kamel Boubagra, Isabelle Favre Wiki, Katia Garambois, Florence Tahon, Vasdev Ashok, Oguzhan Coskun, Georges Rodesch, Bertrand Lapergue, Frédéric Bourdain, Serge Evrard, Philippe Graveleau, Jean Pierre Decroix, Adrien Wang, François Sellal, Guido Ahle, Gabriela Carelli, Marie-Hélène Dugay, Claude Gaultier, Ariel Pablo Lebedinsky, Lavinia Lita, Raul Mariano Musacchio, Catherine Renglewicz-Destuynder, Alain Tournade, Françis Vuillemet, Francisco Macian Montoro, Charbel Mounayer, Frederic Faugeras, Laetitia Gimenez, Catherine Labach, Géraldine Lautrette, Christian Denier, Guillaume Saliou, Olivier Chassin, Claire Dussaule, Elsa Melki, Augustin Ozanne, Francesco Puccinelli, Marina Sachet, Mariana Sarov, Jean-François Bonneville, Thierry Moulin, Alessandra Biondi, Elisabeth De Bustos Medeiros, Fabrice Vuillier, Patrick Courtheoux, Fausto Viader, Marion Apoil-Brissard, Mathieu Bataille, Anne-Laure Bonnet, Julien Cogez, Emmanuel Touze, Xavier Leclerc, Didier Leys, Mohamed Aggour, Pierre Aguettaz, Marie Bodenant, Charlotte Cordonnier, Dominique Deplanque, Marie Girot, Hilde Henon, Erwah Kalsoum, Christian Lucas, Jean-Pierre Pruvo, Paolo Zuniga, Caroline Arquizan, Vincent Costalat, Paolo Machi, Isabelle Mourand, Carlos Riquelme, Pierre Bounolleau, Charles Arteaga, Anthony Faivre, Marc Bintner, Patrice Tournebize, Cyril Charlin, Françoise Darcel, Pascale Gauthier-Lasalarie, Marcia Jeremenko, Servane Mouton, Jean-Baptiste Zerlauth, Chantal Lamy, Deramond Hervé, Hosseini Hassan, André Gaston, Francis-Guy Barral, Pierre Garnier, Rémy Beaujeux, Valérie Wolff, Denis Herbreteau, Séverine Debiais, Alicia Murray, Gary Ford, Andy Clifton, Janet Freeman, Ian Ford, Hugh Markus, Joanna Wardlaw, Andy Molyneux, Thompson Robinson, Steff Lewis, John Norrie, Fergus Robertson, Richard Perry, Anand Dixit, Andrew Clifton, Christine Roffe, Sanjeev Nayak, Kyriakos Lobotesis, Craig Smith, Amit Herwadkar, Naga Kandasamy, Tony Goddard, John Bamford, Ganesh Subramanian, Rob Lenthall, Edward Littleton, Sal Lamin, Kelley Storey, Rita Ghatala, Azra Banaras, John Aeron-Thomas, Bath Hazel, Holly Maguire, Emelda Veraque, Louise Harrison, Rekha Keshvara, James Cunningham, Clinical Neurophysiology, Weimar, Christian (Beitragende*r), Radiology and nuclear medicine, Rheumatology, ACS - Atherosclerosis & ischemic syndromes, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, MUMC+: MA AIOS Neurologie (9), The Royal Melbourne Hospital, Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA), Stanford University, University of Calgary, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University [Maastricht], Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute of Neuroscience [Newcastle] (ION), Newcastle University [Newcastle], Universitat Autònoma de Barcelona (UAB), Erasmus University Medical Center [Rotterdam] (Erasmus MC), University of Alberta, Centre d'Investigation Clinique - Innovation Technologique [Nancy] (CIC-IT), Monash University [Melbourne], St George’s University Hospitals, Institut de psychiatrie et neurosciences (U894 / UMS 1266), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Dalhousie University [Halifax], Neuroradiologie [Hôpital Gui de Chauliac], Hôpital Gui de Chauliac [Montpellier], Service de Neuroradiologie [Rennes], CHU Pontchaillou [Rennes], St. Michael's Hospital, University of California [Los Angeles] (UCLA), University of California, University Medical Center of Schleswig–Holstein = Universitätsklinikum Schleswig-Holstein (UKSH), Kiel University, Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de neurologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), University at Buffalo [SUNY] (SUNY Buffalo), State University of New York (SUNY), Toronto Western Hospital, Hôpital Foch [Suresnes], Vall d'Hebron University Hospital [Barcelona], Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), University of Glasgow, Queen Elizabeth University Hospital (Glasgow), David Geffen School of Medicine [Los Angeles], University of California-University of California, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Radiology & Nuclear Medicine, Public Health, Neurology, Radiology and Nuclear Medicine, ACS - Microcirculation, ANS - Neurovascular Disorders, ACS - Amsterdam Cardiovascular Sciences, Graduate School, ACS - Pulmonary hypertension & thrombosis, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, ARD - Amsterdam Reproduction and Development, Biomedical Engineering and Physics, APH - Personalized Medicine, APH - Quality of Care, and AMS - Restoration & Development

Subjects
SELECTION, COMPUTED TOMOGRAPHIC PERFUSION, Medizin, Perfusion scanning, 030204 cardiovascular system & hematology, Brain Ischemia, 0302 clinical medicine, Modified Rankin Scale, REPERFUSION, Stroke, ComputingMilieux_MISCELLANEOUS, Thrombectomy, Aged, 80 and over, medicine.diagnostic_test, Penumbra, Endovascular Procedures, Brain, Middle Aged, Magnetic Resonance Imaging, 3. Good health, Treatment Outcome, Cerebral blood flow, Tissue Plasminogen Activator, INFARCT, Cardiology, Female, TRIAL, CT, medicine.medical_specialty, Perfusion Imaging, Neuroimaging, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 03 medical and health sciences, Fibrinolytic Agents, ALTEPLASE, Internal medicine, medicine, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, Aged, business.industry, MECHANICAL THROMBECTOMY, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Magnetic resonance imaging, Odds ratio, medicine.disease, Neurology (clinical), business, Tomography, X-Ray Computed, 030217 neurology & neurosurgery, Fibrinolytic agent, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Background CT perfusion (CTP) and diffusion or perfusion MRI might assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of irreversibly injured ischaemic core and potentially salvageable penumbra volumes were associated with functional outcome and whether they interacted with the treatment effect of endovascular thrombectomy on functional outcome.Methods In this systematic review and meta-analysis, the HERMES collaboration pooled patient-level data from all randomised controlled trials that compared endovascular thrombectomy (predominantly using stent retrievers) with standard medical therapy in patients with anterior circulation ischaemic stroke, published in PubMed from Jan 1,2010, to May 31, 2017. The primary endpoint was functional outcome, assessed by the modified Rankin Scale (mRS) at 90 days after stroke. Ischaemic core was estimated, before treatment with either endovascular thrombectomy or standard medical therapy, by CTP as relative cerebral blood flow less than 30% of normal brain blood flow or by MRI as an apparent diffusion coefficient less than 620 mu m(2)/s. Critically hypoperfused tissue was estimated as the volume of tissue with a CTP time to maximum longer than 6 s. Mismatch volume (ie, the estimated penumbral volume) was calculated as critically hypoperfused tissue volume minus ischaemic core volume. The association of ischaemic core and penumbral volumes with 90-day mRS score was analysed with multivariable logistic regression (functional independence, defined as mRS score 0-2) and ordinal logistic regression (functional improvement by at least one mRS category) in all patients and in a subset of those with more than 50% endovascular reperfusion, adjusted for baseline prognostic variables. The meta-analysis was prospectively designed by the HERMES executive committee, but not registered.Findings We identified seven studies with 1764 patients, all of which were included in the meta-analysis. CTP was available and assessable for 591 (34%) patients and diffusion MRI for 309 (18%) patients. Functional independence was worse in patients who had CTP versus those who had diffusion MRI, after adjustment for ischaemic core volume (odds ratio [OR] 0.47 [95% CI 0.30-0.72], p=0.0007), so the imaging modalities were not pooled. Increasing ischaemic core volume was associated with reduced likelihood of functional independence (CTP OR 0.77 [0.69-0.86] per 10 mL, p(interaction)=0.29; diffusion MRI OR 0.87 [0.81-0.94] per 10 mL, p(interaction)=0.94). Mismatch volume, examined only in the CTP group because of the small numbers of patients who had perfusion MRI, was not associated with either functional independence or functional improvement. In patients with CTP with more than 50% endovascular reperfusion (n=186), age, ischaemic core volume, and imaging-to-reperfusion time were independently associated with functional improvement. Risk of bias between studies was generally low.Interpretation Estimated ischaemic core volume was independently associated with functional independence and functional improvement but did not modify the treatment benefit of endovascular thrombectomy over standard medical therapy for improved functional outcome. Combining ischaemic core volume with age and expected imagingto-reperfusion time will improve assessment of prognosis and might inform endovascular thrombectomy treatment decisions. Copyright (C) 2018 Elsevier Ltd. All rights reserved.

Published
2019
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21. Supplemental material for Clinical relevance of asymptomatic intracerebral hemorrhage post thrombectomy depends on angiographic collateral score

Author

Nawabi, Jawed, Kniep, Helge, Broocks, Gabriel, Faizy, Tobias D, Schön, Gerhard, G Thomalla, Fiehler, Jens, and Hanning, Uta

Subjects
110320 Radiology and Organ Imaging, FOS: Clinical medicine, FOS: Biological sciences, Medicine, Cell Biology, 110305 Emergency Medicine, 110306 Endocrinology, Biochemistry, 69999 Biological Sciences not elsewhere classified, 110904 Neurology and Neuromuscular Diseases, Neuroscience
Abstract

Supplemental Material for Clinical relevance of asymptomatic intracerebral hemorrhage post thrombectomy depends on angiographic collateral score by Jawed Nawabi, Helge Kniep, Gabriel Broocks, Tobias D Faizy, Gerhard Schön, G Thomalla, Jens Fiehler and Uta Hanning in Journal of Cerebral Blood Flow & Metabolism

Published
2019
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22. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

Author

Bruce C V Campbell, Wim H van Zwam, Mayank Goyal, Bijoy K Menon, Diederik W J Dippel, Andrew M Demchuk, Serge Bracard, Philip White, Antoni Dávalos, Charles B L M Majoie, Aad van der Lugt, Gary A Ford, Natalia Pérez de la Ossa, Michael Kelly, Romain Bourcier, Geoffrey A Donnan, Yvo B W E M Roos, Oh Young Bang, Raul G Nogueira, Thomas G Devlin, Lucie A van den Berg, Frédéric Clarençon, Paul Burns, Jeffrey Carpenter, Olvert A Berkhemer, Dileep R Yavagal, Vitor Mendes Pereira, Xavier Ducrocq, Anand Dixit, Helena Quesada, Jonathan Epstein, Stephen M Davis, Olav Jansen, Marta Rubiera, Xabier Urra, Emilien Micard, Hester F Lingsma, Olivier Naggara, Scott Brown, Francis Guillemin, Keith W Muir, Robert J van Oostenbrugge, Jeffrey L Saver, Tudor G Jovin, Michael D Hill, Peter J Mitchell, Puck SS Fransen, Debbie Beumer, Albert J Yoo, Wouter J Schonewille, Jan Albert Vos, Paul J Nederkoorn, Marieke JH Wermer, Marianne AA van Walderveen, Julie Staals, Jeannette Hofmeijer, Jacques A. van Oostayen, Geert J. Lycklama à Nijeholt, Jelis Boiten, Patrick A. Brouwer, Bart J. Emmer, Sebastiaan F. de Bruijn, Lukas C. van Dijk, Jaap Kappelle, Rob H Lo, Ewoud J. van Dijk, Joost de Vries, Paul L.M. de Kort, Willem Jan J. van Rooij, Jan S.P. van den Berg, Boudewijn A.A.M. van Hasselt, Leo A.M. Aerden, René J. Dallinga, Marieke C. Visser, Joseph C.J. Bot, Patrick C. Vroomen, Omid Eshghi, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Alexander V. Tielbeek, Heleen M. den Hertog, Dick G. Gerrits, Renske M. van den Berg-Vos, Giorgos B. Karas, Ewout W. Steyerberg, Zwenneke Flach, Henk A. Marquering, Marieke E.S. Sprengers, Sjoerd F.M. Jenniskens, Ludo F.M. Beenen, René van den Berg, Peter J. Koudstaal, Wim H. van Zwam, Yvo B.W.E.M. Roos, Robert J. van Oostenbrugge, Charles B.L.M. Majoie, Diederik W.J. Dippel, Martin M. 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Tahon, Vasdev Ashok, Oguzhan Coskun, Georges Rodesch, Bertrand Lapergue, Frédéric Bourdain, Serge Evrard, Philippe Graveleau, Jean Pierre Decroix, Adrien Wang, François Sellal, Guido Ahle, Gabriela Carelli, Marie-Hélène Dugay, Claude Gaultier, Ariel Pablo Lebedinsky, Lavinia Lita, Raul Mariano Musacchio, Catherine Renglewicz-Destuynder, Alain Tournade, Françis Vuillemet, Francisco Macian Montoro, Charbel Mounayer, Frederic Faugeras, Laetitia Gimenez, Catherine Labach, Géraldine Lautrette, Christian Denier, Guillaume Saliou, Olivier Chassin, Claire Dussaule, Elsa Melki, Augustin Ozanne, Francesco Puccinelli, Marina Sachet, Mariana Sarov, Jean-François Bonneville, Thierry Moulin, Alessandra Biondi, Elisabeth De Bustos Medeiros, Fabrice Vuillier, Patrick Courtheoux, Fausto Viader, Marion Apoil-Brissard, Mathieu Bataille, Anne-Laure Bonnet, Julien Cogez, Emmanuel Touze, Xavier Leclerc, Didier Leys, Mohamed Aggour, Pierre Aguettaz, Marie Bodenant, Charlotte Cordonnier, Dominique Deplanque, Marie Girot, Hilde Henon, Erwah Kalsoum, Christian Lucas, Jean-Pierre Pruvo, Paolo Zuniga, Caroline Arquizan, Vincent Costalat, Paolo Machi, Isabelle Mourand, Carlos Riquelme, Pierre Bounolleau, Charles Arteaga, Anthony Faivre, Marc Bintner, Patrice Tournebize, Cyril Charlin, Françoise Darcel, Pascale Gauthier-Lasalarie, Marcia Jeremenko, Servane Mouton, Jean-Baptiste Zerlauth, Chantal Lamy, Deramond Hervé, Hosseini Hassan, André Gaston, Francis-Guy Barral, Pierre Garnier, Rémy Beaujeux, Valérie Wolff, Denis Herbreteau, Séverine Debiais, Alicia Murray, Gary Ford, Martin M Brown, Andy Clifton, Janet Freeman, Ian Ford, Hugh Markus, Joanna Wardlaw, Andy Molyneux, Thompson Robinson, Steff Lewis, John Norrie, Fergus Robertson, Richard Perry, Geoffrey Cloud, Andrew Clifton, Jeremy Madigan, Christine Roffe, Sanjeev Nayak, Kyriakos Lobotesis, Craig Smith, Amit Herwadkar, Naga Kandasamy, Tony Goddard, John Bamford, Ganesh Subramanian, Rob Lenthall, Edward Littleton, Sal Lamin, Kelley Storey, Rita Ghatala, Azra Banaras, John Aeron-Thomas, Bath Hazel, Holly Maguire, Emelda Veraque, Louise Harrison, Rekha Keshvara, James Cunningham, University of Melbourne, University of Calgary, Erasmus University Medical Center [Rotterdam] (Erasmus MC), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), University of Amsterdam [Amsterdam] (UvA), Universitat Autònoma de Barcelona (UAB), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, ACS - Amsterdam Cardiovascular Sciences, Neurology, Graduate School, Other Research, APH - Personalized Medicine, APH - Quality of Care, Biomedical Engineering and Physics, ARD - Amsterdam Reproduction and Development, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ACS - Microcirculation, ACS - Atherosclerosis & ischemic syndromes, ACS - Pulmonary hypertension & thrombosis, Radiology & Nuclear Medicine, Public Health, Weimar, Christian (Beitragende*r), Molecular cell biology and Immunology, Pathology, Radiology and nuclear medicine, Amsterdam Neuroscience - Neurovascular Disorders, Rheumatology, Beeldvorming, RS: CARIM - R3.03 - Cerebral small vessel disease, RS: CARIM - R3.11 - Imaging, MUMC+: DA BV Medisch Specialisten Radiologie (9), Klinische Neurowetenschappen, and MUMC+: MA Neurologie (3)

Subjects
Male, medicine.medical_specialty, Sedation, Medizin, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, 030204 cardiovascular system & hematology, Anesthesia, General, CONTROLLED-TRIAL, THERAPY, law.invention, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, All institutes and research themes of the Radboud University Medical Center, Randomized controlled trial, law, Modified Rankin Scale, Journal Article, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Medicine, Humans, General anaesthesia, Stroke, Aged, Randomized Controlled Trials as Topic, Thrombectomy, Aged, 80 and over, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Odds ratio, MR, Middle Aged, Outcome and Process Assessment (Health Care), medicine.disease, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], 3. Good health, Surgery, Outcome and Process Assessment, Health Care, Meta-analysis, Observational study, Female, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Meta-Analysis
Abstract

BACKGROUND: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care.METHODS: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered.FINDINGS: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09-2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75-3·10, pINTERPRETATION: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons.FUNDING: Medtronic.

Published
2018
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23. Endovaskuläre Schlaganfallbehandlung vor dem Hintergrund der aktuellen positiven klinischen Studien

Author

G Thomalla and J Fiehler

Subjects
medicine.medical_specialty, Neurology, business.industry, medicine.medical_treatment, Standard treatment, General Medicine, Odds ratio, Thrombolysis, medicine.disease, Surgery, Clinical trial, 03 medical and health sciences, Psychiatry and Mental health, 0302 clinical medicine, Occlusion, Medicine, cardiovascular diseases, 030212 general & internal medicine, Neurology (clinical), Neurosurgery, business, Stroke, 030217 neurology & neurosurgery
Abstract

Recently, five independent randomized controlled clinical trials demonstrated the efficacy and safety of endovascular stroke treatment in stroke patients with occlusion of proximal intracranial arteries. The five trials MR CLEAN, ESCAPE, EXTEND-IA, SWIFT-PRIME and REVASCAT randomized a total of 1287 stroke patients to either standard treatment, which in the majority of patients consisted of intravenous thrombolysis within 4.5 h of symptom onset or additional endovascular stroke treatment. In all the studies endovascular treatment resulted in a better clinical outcome with an odds ratio for a better clinical outcome 90 days after stroke ranging between 1.7 and 3.1 and an absolute increase in the proportion of patients with functionally independent outcome between 14% and 31%. The overwhelming benefit of endovascular treatment mainly results from mechanical thrombectomy using stent retriever devices and starting endovascular treatment within 6 h of symptom onset in stroke patients.

Published
2015
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24. Bildgebungsbasierte Indikationsstellung für die interventionelle Schlaganfallbehandlung

Author

J. Fiehler and G. Thomalla

Subjects
medicine.medical_specialty, Neurology, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Magnetic resonance imaging, General Medicine, Thrombolysis, medicine.disease, Psychiatry and Mental health, Mechanical Thrombolysis, Internal medicine, Edema, Cardiology, medicine, Neurology (clinical), Neurosurgery, medicine.symptom, business, Stroke, Cerebral angiography
Abstract

The indications for mechanical thrombectomy are based on a proximal vessel occlusion in the absence of extensive ischemic damage in the corresponding dependent vascular territory. The maximum extent of early ischemic edema for which endovascular treatment is still useful is not clear from the studies. A benefit of mechanical thrombectomy can be safely assumed with an ASPECT score of 6-10, possibly also with lower scores. A more complex imaging with assessment of the status of collateral vessels or perfusion abnormality is scientifically interesting but usually not necessary for clinical decision-making for endovascular stroke treatment within the first 6 h after symptom onset.

Published
2015
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25. Schlaganfall bei jungen Menschen

Author

G. Thomalla and Christian Gerloff

Subjects
Gynecology, medicine.medical_specialty, business.industry, medicine, business
Abstract

Ischamische Schlaganfalle treten auch bei jungen Menschen auf. Sie haben oft andere Ursachen als Schlaganfalle bei alteren Patienten und erfordern in der diagnostischen Abklarung haufiger einen groseren Aufwand mit erweiterten Untersuchungen. Das akute Management von Schlaganfallen bei jungen Menschen unterscheidet sich nicht von dem bei alteren Patienten, die Sekundarprophylaxe richtet sich nach der Ursache.

Published
2015
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26. Untersuchung des Einflusses von motorischer Anstrengung auf das neuronale Aktivierungsmuster während der Schlaganfallrehabilitation mit FMRT und EEG

Author

G. Thomalla, Friedhelm C. Hummel, Robert Schulz, J. Feldheim, Marlene Bönstrup, B. Cheng, Maximo Zimerman, and C. Gerloff

Subjects
medicine.medical_specialty, Physical medicine and rehabilitation, medicine.diagnostic_test, business.industry, Physiology (medical), medicine, Neurology (clinical), Electroencephalography, medicine.disease, business, Stroke
Published
2016
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27. Choices of stent and cerebral protection in the ongoing ACST-2 trial: a descriptive study

Author

D.D. de Waard, A. Halliday, G.J. de Borst, R. Bulbulia, A. Huibers, R. Casana, L.H. Bonati, V. Tolva, G. Fraedrich, B. Rantner, E. Gizewski, I. Gruber, J. Hendriks, P. Cras, P. Lauwers, P. van Scheil, F. Vermassen, I. Van Herzeele, M. Geenens, D. Hemelsoet, P. Lerut, B. Lambrecht, G. Saad, A. Peeters, M. Bosiers, E. da Silva, N. de Luccia, J.C. Sitrangulo, A.E.V. Estenssoro, C. Presti, I. Casella, J.A.T. Monteiro, W. Campos, P. Puech-Leao, V. Petrov, C. Bachvarov, M. Hill, A. Mitha, J. Wong, C.-W. Liu, L. Bao, C. Yu, I. Cvjetko, V. Vidjak, J. Fiedler, S. Ostry, L. Sterba, P. Kostal, R. Staffa, R. Vlachovsky, M. Privara, Z. Kriz, B. Vojtisek, P. Krupa, M. Reif, V. Benes, P. Buchvald, L. Endrych, V. Prochazka, M. Kuliha, D. Otahal, T. Hrbac, D. Netuka, M. Mohapl, F. Kramier, M. Eldessoki, H. Heshmat, F. Abd-Allah, V. Palmiste, S. Margus, T. Toomsoo, J.-P. Becquemin, P. Bergeron, T. Abdulamit, J.-M. Cardon, S. Debus, G. Thomalla, J. Fiehler, C. Gerloss, U. Grzyska, M. Storck, E. LaMacchia, H.H. Eckstein, H. Söllner, H. Berger, M. Kallmayer, H. Popert, A. Zimmermann, A. Guenther, C. Klingner, T. Mayer, J. Schubert, J. Zanow, D. Scheinert, U. Banning-Eichenseer, Y. Bausback, D. Branzan, S. Braünilch, J. Lenzer, A. Schidt, H. Staab, M. Ulirch, J. Barlinn, K. Haase, A. Abramyuk, U. Bodechtel, J. Gerber, C. Reeps, T. Pfeiffer, G. Torello, A. Cöster, A. Giannoukas, K. Spanos, M. Matsagkas, S. Koutias, S. Vasdekis, J. Kakisis, K. Moulakakis, A. Lazaris, C. Liapas, E. Brountzos, M. Lazarides, N. Ioannou, A. Polydorou, B. Fulop, E. Fako, E. Voros, M. Bodosi, T. Nemeth, P. Barzo, S. Pazdernyik, L. Entz, Z. Szeberin, E. Dosa, B. Nemes, Z. Jaranyi, S. Pazdernyia, P. Madhaban, A. Hoffman, E. Nikolsky, R. Beyar, R. Silingardi, A. Lauricella, G. Coppi, E. Nicoloci, N. Tusini, F. Strozzi, E. Vecchiati, M. Ferri, E. Ferrero, D. Psacharopulo, A. Gaggiano, A. Viazzo, L. Farchioni, G. Parlani, V. Caso, P. De Rangoy, F. Verzini, P. Castelli, M.L. DeLodovici, G. Carrafiello, A.M. Ierardi, G. Piffaretti, G. Nano, M.T. Occhiuto, G. Malacrida, D. Tealdi, S. Steghter, A. Stella, R. Pini, G. Faggioli, S. Sacca, M.D. Negri, M. Palombo, M.C. Perfumo, G.F. Fadda, H. Kasemi, C. Cernetti, D. Tonello, A. Visonà, N. Mangialardi, S. Ronchey, M.C. Altavista, S. Michelagnoli, E. Chisci, F. Speziale, L. Capoccia, P. Veroux, A. Giaquinta, F. Patti, R. Pulli, P. Boggia, D. Angiletta, G. Amatucci, F. Spinetti, F. Mascoli, E. Tsolaki, E. Civilini, B. Reimers, C. Setacci, G. Pogany, A. Odero, F. Accrocca, G. Bajardi, I. Takashi, E. Masayuki, E. Hidenori, B. Aidashova, N. Kospanov, S. Bakke, M. Skjelland, A. Czlonkowska, A. Kobayashi, R. Proczka, A. Dowzenko, W. Czepel, J. Polanski, P. Bialek, G. Ozkinis, M. Snoch-Ziólkiewicz, M. Gabriel, M. Stanisic, W. Iwanowski, P. Andziak, F.B. Gonçalves, V. Starodubtsev, P. Ignatenko, A. Karpenko, D. Radak, N. Aleksic, D. Sagic, L. Davidovic, I. Koncar, I. Tomic, M. Colic, D. Bartkoy, F. Rusnak, M. Gaspirini, P. Praczek, Z. Milosevic, V. Flis, A. Bergauer, N. Kobilica, K. Miksic, J. Matela, E. Blanco, M. Guerra, V. Riambau, P. Gillgren, C. Skioldebrand, N. Nymen, B. Berg, M. Delle, J. Formgren, T.B. Kally, P. Qvarfordt, G. Plate, H. Pärson, H. Lindgren, K. Bjorses, A. Gottsäter, M. Warvsten, T. Kristmundsson, C. Forssell, M. Malina, J. Holst, T. Kuhme, B. Sonesson, B. Lindblad, T. Kolbel, S. Acosta, L. Bonati, C. Traenka, M. Mueller, T. Lattman, M. Wasner, E. Mujagic, A. Von Hessling, A. Isaak, P. Stierli, T. Eugster, L. Mariani, C. Stippich, T. Wolff, T. Kahles, R. Toorop, F. Moll, R. Lo, A. Meershoek, A.K. Jahrome, A.W.F. Vos, W. Schuiling, R. Keunen, M. Reijnen, S. Macsweeney, N. McConachie, A. Southam, G. Stansby, T. Lees, D. Lambert, M. Clarke, M. Wyatt, S. Kappadath, L. Wales, R. Jackson, A. Raudonaitis, S. MacDonald, P. Dunlop, A. Brown, S. Vetrivel, M. Bajoriene, R. Gopi, C. McCollum, L. Wolowczyk, J. Ghosh, D. Seriki, R. Ashleigh, J. Butterfield, M. Welch, J.V. Smyth, D. Briley, U. Schulz, J. Perkins, L. Hands, W. Kuker, C. Darby, A. Handa, L. Sekaran, K. Poskitt, J. Morrison, P. Guyler, I. Grunwald, J. Brown, M. Jakeways, S. Tysoe, D. Hargroves, G. Gunathilagan, R. Insall, J. Senaratne, J. Beard, T. Cleveland, S. Nawaz, R. Lonsdale, D. Turner, P. Gaines, R. Nair, I. Chetter, G. Robinson, B. Akomolafe, J. Hatfield, K. Saastamoinen, J. Crinnion, A.A. Egun, J. Thomas, S. Drinkwater, S. D'Souza, G. Thomson, B. Gregory, S. Babu, S. Ashley, T. Joseph, R. Gibbs, G. Tebit, A. Mehrzad, P. Enevoldson, D. Mendalow, A. Parry, G. Tervitt, A. Clifton, M. Nazzel, R. Peto, H. Pan, J. Potter, R. Bullbulia, B. Mihaylova, M. Flather, A. Mansfield, D. Simpson, D. Thomas, W. Gray, B. Farrell, C. Davies, K. Rahimi, M. Gough, P. Cao, P. Rothwell, A. Belli, M. Mafham, W. Herrington, P. Sandercock, R. Gray, C. Shearman, A. Molyneux, A. Gray, A. Clarke, M. Sneade, L. Tully, W. Brudlo, M. Lay, A. Munday, C. Berry, S. Tochlin, J. Cox, R. Kurien, and J. Chester

Subjects
Plaque echolucency, Time Factors, medicine.medical_treatment, Practice Patterns, 030204 cardiovascular system & hematology, Severity of Illness Index, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Risk Factors, Occlusion, Carotid artery stenosis, Carotid Stenosis, Practice Patterns, Physicians', Stroke, Endarterectomy, Plaque, Atherosclerotic, Endarterectomy, Carotid, Endovascular Procedures, Plaque, Atherosclerotic, Treatment Outcome, Cerebrovascular Circulation, Stents, Radiology, medicine.symptom, Cardiology and Cardiovascular Medicine, Carotid artery stenting, medicine.medical_specialty, Clinical Decision-Making, education, Cerebral protection devices, Stent design, Surgery, Prosthesis Design, Asymptomatic, Embolic Protection Devices, 03 medical and health sciences, Severity of illness, medicine, Humans, Carotid, Chi-Square Distribution, Physicians', business.industry, Patient Selection, Stent, METANÁLISE, medicine.disease, Asymptomatic Diseases, Cerebrovascular Disorders, Stenosis, business, 030217 neurology & neurosurgery
Abstract

Objectives Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics. Materials and methods Trial patients who underwent CAS between 2008 and 2015 were included in this study. Chi-square statistics were used to study the effects of plaque echolucency, ipsilateral preocclusive disease (90–99%), and contralateral high-grade stenosis (>50%) or occlusion of the carotid artery on interventionalists' choice for stent and CPD. Differences in treatment preference between specialties were also analysed. Results In this study, 831 patients from 88 ACST-2 centres were included. Almost all procedures were performed by either interventional radiologists (50%) or vascular surgeons (45%). Plaque echolucency, ipsilateral preocclusive disease (90–99%), and significant contralateral stenosis (>50%) or occlusion did not affect the choice of stent or either the use of cerebral protection and type of CPD employed (i.e., filter/flow reversal). Vascular surgeons used a CPD significantly more often than interventional radiologists (98.6% vs. 76.3%; p < .001), but this choice did not appear to be dependent on patient characteristics. Conclusions In ACST-2, plaque characteristics and severity of stenosis did not primarily determine interventionalists' choice of stent or use or type of CPD, suggesting that other factors, such as vascular anatomy or personal and centre preference, may be more important. Stent and CPD use was highly heterogeneous among participating European centres.

Published
2017

28. Coagulation testing in acute ischemic stroke patients taking non-Vitamin K antagonist oral anticoagulants

Author

Jan C. Purrucker, Kirsten Haas, Timolaos Rizos, Shujah Khan, Sven Poli, Peter Kraft, Christoph Kleinschnitz, Rainer Dziewas, Andreas Binder, Frederick Palm, Sebastian Jander, Hassan Soda, Peter U. Heuschmann, Roland Veltkamp, M. Dichgans, K. Gröschel, M. Eicke, M. Ertl, M. G. Hennerici, C. Hobohm, T. Höhle, E. Jüttler, A. Khaw, A. Kraft, M. Köhrmann, F. Meisel, T. Neumann-Haefelin, C. Opherk, J. Röther, E. Schmid, G. Seidel, C. Tanislav, G. Thomalla, K. Wartenberg, C. Weimar, and St Marys Development Trust

Subjects
Male, Vitamin K, IMPACT, medicine.medical_treatment, Medizin, Administration, Oral, 030204 cardiovascular system & hematology, Brain Ischemia, 0302 clinical medicine, Germany, Coagulation testing, Prospective Studies, Registries, Acute ischemic stroke, Stroke, Aged, 80 and over, COMPLICATIONS, ASSOCIATION, Thrombolysis, Vitamin K antagonist, stroke, Anesthesia, Female, Cardiology and Cardiovascular Medicine, Life Sciences & Biomedicine, EMERGENCY MANAGEMENT, anticoagulants, thrombolysis, medicine.medical_specialty, medicine.drug_class, Clinical Neurology, coagulation testing, 1102 Cardiovascular Medicine And Haematology, 03 medical and health sciences, medicine, Humans, Blood Coagulation, Aged, HEALTH-CARE PROFESSIONALS, Advanced and Specialized Nursing, Science & Technology, Neurology & Neurosurgery, business.industry, Antagonist, 1103 Clinical Sciences, medicine.disease, Surgery, RASUNOA Investigators (Registry of Acute Stroke Under New Oral Anticoagulants), Peripheral Vascular Disease, ATRIAL-FIBRILLATION, Cardiovascular System & Cardiology, Neurosciences & Neurology, Neurology (clinical), 1109 Neurosciences, business, 030217 neurology & neurosurgery
Abstract

Background and Purpose— In patients who present with acute ischemic stroke while on treatment with non–vitamin K antagonist oral anticoagulants (NOACs), coagulation testing is necessary to confirm the eligibility for thrombolytic therapy. We evaluated the current use of coagulation testing in routine clinical practice in patients who were on NOAC treatment at the time of acute ischemic stroke. Methods— Prospective multicenter observational RASUNOA registry (Registry of Acute Stroke Under New Oral Anticoagulants; February 2012–2015). Results of locally performed nonspecific (international normalized ratio, activated partial thromboplastin time, and thrombin time) and specific (antifactor Xa tests, hemoclot assay) coagulation tests were documented. The implications of test results for thrombolysis decision-making were explored. Results— In the 290 patients enrolled, nonspecific coagulation tests were performed in ≥95% and specific coagulation tests in 26.9% of patients. Normal values of activated partial thromboplastin time and international normalized ratio did not reliably rule out peak drug levels at the time of the diagnostic tests (false-negative rates 11%–44% [95% confidence interval 1%–69%]). Twelve percent of patients apparently failed to take the prescribed NOAC prior to the acute event. Only 5.7% (9/159) of patients in the 4.5-hour time window received thrombolysis, and NOAC treatment was documented as main reason for not administering thrombolysis in 52.7% (79/150) of patients. Conclusions— NOAC treatment currently poses a significant barrier to thrombolysis in ischemic stroke. Because nonspecific coagulation test results within normal range have a high false-negative rate for detection of relevant drug concentrations, rapid drug-specific tests for thrombolysis decision-making should be established. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01850797.

Published
2017

30. Acute Cerebrovascular Disease in the Young

Author

Arndt Rolfs, Franz Fazekas, Ulrike Grittner, Martin Dichgans, Peter Martus, Martin Holzhausen, Tobias Böttcher, Peter U. Heuschmann, Turgut Tatlisumak, Christian Tanislav, Gerhard J. Jungehulsing, Anne-Katrin Giese, Jukaa Putaala, Roman Huber, Ulf Bodechtel, Christoph Lichy, Christian Enzinger, Reinhold Schmidt, Michael G. Hennerici, Manfred Kaps, Christof Kessler, Karl Lackner, Eduard Paschke, Wolfgang Meyer, Hermann Mascher, Olaf Riess, Edwin Kolodny, Bo Norrving, A Rolfs, M Ginsberg, MG Hennerici, C Kessler, E Kolodny, P Martus, B Norrving, EB Ringelstein, PM Rothwell, G Venables, N Bornstein, P deDeyn, M Dichgans, F Fazekas, H Markus, O Rieß, C Biedermann, T Böttcher, K Brüderlein, J Burmeister, I Federow, F König, G Makowei, D Niemann, S Rösner, S Zielke, U Grittner, M Holzhausen, C Enzinger, R Schmidt, S Ropele, M Windisch, E Sterner, O Bodamer, A Fellgiebel, U Hillen, L Jonas, C Kampmann, P Kropp, K Lackner, M Laue, H Mascher, W Meyer, E Paschke, F Weidemann, J Berrouschot, A Stoll, A Rokicha, C Sternitzky, M Thomä, PP DeDeyn, R Sheorajpanday, I De Brabander, L Yperzeele, R Brouns, P Oschmann, M Pott, K Schultes, C Schultze, J Hirsekorn, GJ Jungehulsing, A Villringer, W Schmidt, T Liman, T Nowe, M Ebinger, A Wille, H Loui, A Objartel, A übelacker, R Mette, K Jegzentis, DG Nabavi, O Crome, D Bahr, M Ebke, B Platte, C Kleinen, K Mermolja Gunther, W Heide, O Pape, JR Hanssen, D Stangenberg, J Klingelhofer, B Schmidt, S Schwarz, J Schwarze, L Frandlih, J Iwanow, I Steinbach, D Krieger, G Boysen, L Leth Jeppesen, A Petersen, H Reichmann, U Becker, I Dzialkowski, H Hentschel, C Lautenschlager, H Hanso, G Gahn, T Ziemssen, K Fleischer, B Sehr, DJH McCabe, O Tobin, J Kinsella, RP Murphy, S Jander, HP Hartung, M Siebler, C Bottcher, A Kohne, J Platzen, TC Brosig, V Rothhammer, C Henseler, T Neumann-Haefelin, OC Singer, U Ermis, IMRM dos Santos, C Schuhmann, S van de Loo, M Kaps, J Allendorfer, C Tanislav, M Brandtner, K Muir, K Dani, N MacDougall, W Smith, A Rowe, A Welch, G Schrotter, U Krenn, S Horner, B Pendl, A Pluta-Fuerst, U Trummer, M Chatzopoulos, Bettina v Sarnowski, Ulf Schminke, T Link, A Khaw, E Nieber, S Zierz, T Muller, N Wegener, K Wartenberg, C Gaul, D Richter, M Rosenkranz, AC Krützelmann, J Hoppe, CU Choe, S Narr, TU Magnus, G Thomalla, F Leypoldt, D Otto, C Lichy, W Hacke, RJ Barrows, T Tatlisumak, J Putaala, S Curtze, M Metso, J Willeit, M Furtner, M Spiegel, MH Knoflach, B Prantl, OW Witte, D Brämer, A Günther, T Prell, C Herzau, K Aurich, G Deuschl, F Wodarg, P Zimmermann, CC Eschenfelder, M Levsen, JR Weber, SM Marecek, D Schneider, D Michalski, W Kloppig, L Küppers-Tiedt, M Schneider, A Schulz, P Matzen, C Weise, C Hobohm, H Meier, R Langos, D Urban, I Gerhardt, V Thijs, R Lemmens, E Marcelis, C Hulsbosch, F Aichner, HP Haring, E Bach, J Machado Candido, AA e Silva, M Lourenco, AIM de Sousa, L Derex, TH Cho, E Díez-Tejedor, B Fuentes, P Martínez-Sanchez, MI Pérez-Guevara, H Hamer, A Metz, K Hallenberger, P Müller, P Baron, A Bersano, M Gattinoni, N Vella, M Mallia, M Jauss, L Adam, F Heidler, C Gube, M Kiszka, A Karpinska, Y Mewald, V Straub, A Dörr, A Zollver, M Schilling, A Borchert, N Preuth, T Duning, G Kuhlenbäumer, D Schulte, L Marquardt, F Schlachetzki, S Boy, J Mädl, GM Ertl, NPR Fehm, C Stadler, R Benecke, A Dudesek, S Kolbaske, G Lardurner, C Sulzer, A Zerbs, S Lilek, AM Walleczek, D Sinadinowska, M Janelidze, M Beridze, N Lobjanidze, A Dzagnidze, A Melms, K Horber, I Fink, B Liske, AC Ludolph, R Huber, K Knauer, C Hendrich, S Raubold, A Czlonkowska, A Baranowska, B Blazejewska-Hyzorek, W Lang, W Kristoferitsch, J Ferrari, E Ulrich, A Flamm-Horak, A Lischka-Lindner, W Schreiber, V Demarin, Z Tranjec, M Bosner-Puretic, MJ Jurašić, V Basic Kes, M Budisic, and L Kopacevic

Subjects
Adult, Male, medicine.medical_specialty, Pediatrics, Adolescent, ischemic, cause, Cohort Studies, Young Adult, Risk Factors, medicine, Humans, risk factors, Prospective Studies, cardiovascular diseases, Young adult, Prospective cohort study, Stroke, Advanced and Specialized Nursing, Intracerebral hemorrhage, Fabry disease, Cerebral infarction, business.industry, Age Factors, imaging, young stroke, Middle Aged, medicine.disease, intracerebral hemorrhage, stroke, Europe, Cerebrovascular Disorders, Neurology, transient ischemic attack, Acute Disease, Cohort, Physical therapy, Fabry Disease, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Cohort study
Abstract

Background and Purpose— Strokes have especially devastating implications if they occur early in life; however, only limited information exists on the characteristics of acute cerebrovascular disease in young adults. Although risk factors and manifestation of atherosclerosis are commonly associated with stroke in the elderly, recent data suggests different causes for stroke in the young. We initiated the prospective, multinational European study Stroke in Young Fabry Patients (sifap) to characterize a cohort of young stroke patients. Methods— Overall, 5023 patients aged 18 to 55 years with the diagnosis of ischemic stroke (3396), hemorrhagic stroke (271), transient ischemic attack (1071) were enrolled in 15 European countries and 47 centers between April 2007 and January 2010 undergoing a detailed, standardized, clinical, laboratory, and radiological protocol. Results— Median age in the overall cohort was 46 years. Definite Fabry disease was diagnosed in 0.5% (95% confidence interval, 0.4%–0.8%; n=27) of all patients; and probable Fabry disease in additional 18 patients. Males dominated the study population (2962/59%) whereas females outnumbered men (65.3%) among the youngest patients (18–24 years). About 80.5% of the patients had a first stroke. Silent infarcts on magnetic resonance imaging were seen in 20% of patients with a first-ever stroke, and in 11.4% of patients with transient ischemic attack and no history of a previous cerebrovascular event. The most common causes of ischemic stroke were large artery atherosclerosis (18.6%) and dissection (9.9%). Conclusions— Definite Fabry disease occurs in 0.5% and probable Fabry disease in further 0.4% of young stroke patients. Silent infarcts, white matter intensities, and classical risk factors were highly prevalent, emphasizing the need for new early preventive strategies. Clinical Trial Registration Information— URL: http://www.clinicaltrials.gov .Unique identifier: NCT00414583

Published
2013
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31. Aktuelle Studien zur Akuttherapie des Schlaganfalls

Author

Hagen B. Huttner, G. Thomalla, and Martin Köhrmann

Subjects
Gynecology, Mechanical thrombectomy, medicine.medical_specialty, business.industry, medicine, Neurology (clinical), business, Acute stroke
Abstract

Intravenose Thrombolyse ist die einzige zugelassene spezifische Therapie zur Behandlung des akuten Schlaganfalls. Im vergangenen Jahr sind jedoch die Ergebnisse einiger interessanter klinischer Studien zur akuten Schlaganfalltherapie mit anderen Behandlungsansatzen publiziert worden. Daruber hinaus laufen aktuell vielversprechende klinische Schlaganfallstudien. Auf der Basis eines selektiven Reviews publizierter Daten und Studienprotokolle wird eine Ubersicht uber aktuelle Studien zur Akuttherapie des Schlaganfalls gegeben. Zur intravenosen Thrombolyse mit Alteplase bei Patienten auserhalb der Zulassungskriterien hat die IST-3 Studie neue Erkenntnisse gebracht. Tenecteplase hat in einer Phase 2-Studie vielversprechende Ergebnisse gezeigt. Weitere Studien laufen, welche die intravenose Thrombolyse im erweiterten Zeitfenster ober bei Patienten mit unbekanntem Zeitfenster auf der Basis einer Patientenauswahl mittels erweiterter Bildgebungskriterien untersuchen. Eine Dynamik zeigt Studien zur endovaskularen Behandlung, getrieben durch aktuelle Studien zur mechanischen Thrombektomie mit Stent-Retriever-Systemen. Hier konnten 2 Phase 2-Studien die Uberlegenheit der Stent-Retriever gegenuber dem MERCI-Device zeigen (SWIFT, TREVO-2), Phase 3-Studien mit klinischen Endpunkten sind in Vorbereitung. Auch zur Neuroprotektion beim akuten. Schlaganfall gibt es aktuelle Studien (ICTUS, AXIS-2), welche im Hinblick auf die primaren Endpunkte negativ waren. Ein weiterer untersuchter Behandlungsansatz ist die hamodynamische Augmentation. Zusammenfassend sind zahlreiche Aktivitaten auf dem Feld der klinischen Studien zur akuten Schlaganfallbehandlung sind zu verzeichnen, wobei der Schwerpunkt im Bereich der auf Rekanalisation zielenden Behandlungsansatze liegt. Der Nachweis der Wirksamkeit der Behandlungsansatze steht aus. Es ist zu erwarten, dass die Ergebnisse derzeit laufender oder geplanter Studien die akute Schlaganfallbehandlung beeinflussen werden. Industrieunabhangige Investigator-initiierte klinische Studien erlangen eine grosere Bedeutung.

Published
2013
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32. Real-world experience of treatment decision-making in carotid stenosis in a neurovascular board

Author

G. Thomalla, Friedhelm C. Hummel, David Leander Rimmele, Tim Magnus, Michael Rosenkranz, Axel Larena-Avellaneda, Nils Ole Schmidt, Eike Sebastian Debus, C. Gerloff, Anna C. Alegiani, Jan Regelsberger, and Jens Fiehler

Subjects
Male, medicine.medical_specialty, Consensus, medicine.medical_treatment, Clinical Decision-Making, Context (language use), Cerebral Revascularization, 030204 cardiovascular system & hematology, Revascularization, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, medicine, Humans, Carotid Stenosis, Precision Medicine, Aged, Patient Care Team, business.industry, Age Factors, Guideline, medicine.disease, Neurovascular bundle, Surgery, Clinical trial, Stenosis, Practice Guidelines as Topic, cardiovascular system, Female, Stents, Neurology (clinical), Guideline Adherence, Internal carotid artery, business, 030217 neurology & neurosurgery, Carotid Artery, Internal
Abstract

Objective:To describe our experience with consensus-based decision-making for treatment of internal carotid artery (ICA) stenosis by neurologists, interventional neuroradiologists, vascular surgeons, and neurosurgeons in a multidisciplinary neurovascular board and to study adherence to treatment recommendations in the context of uncertainty with respect to the best treatment option.Methods:We established a multidisciplinary neurovascular board meeting twice a week with structured documentation of consensus decisions. Over a time period of 53 months, 614 cases with ICA stenosis were discussed, with 285 (46%) symptomatic and 279 (45%) asymptomatic cases.Results:Recommendation for symptomatic ICA stenosis was revascularization in 76%, medical management alone in 8%, and further diagnostics in 16%. For asymptomatic ICA stenosis, recommendation was randomization in a clinical trial in 29%, revascularization in 27%, medical management alone in 23%, and further diagnostics in 22%. Treatment recommendations were followed in 94% of symptomatic ICA stenosis and 69% of asymptomatic ICA stenosis. Patients in whom carotid artery stenting was recommended for revascularization were younger and showed a higher rate of severe (≥70%) ICA stenosis.Conclusions:Interdisciplinary board decisions are a helpful and transparent tool to assure adherence to guideline recommendations, and to provide consensus-based individualized treatment strategies in clinical practice in the absence of unequivocal evidence.

Published
2016

33. Deficient intracortical inhibition (SICI) during movement preparation after chronic stroke

Author

G. Thomalla, Julia Hoppe, Leonardo G. Cohen, Friedhelm C. Hummel, Kirstin Heise, C. Gerloff, and Birte Steven

Subjects
medicine.medical_specialty, Movement, Electromyography, Central nervous system disease, Physical medicine and rehabilitation, Reaction Time, medicine, Humans, Stroke, gamma-Aminobutyric Acid, Aged, medicine.diagnostic_test, Motor Cortex, Motor control, Neural Inhibition, Articles, Middle Aged, Hand, medicine.disease, medicine.anatomical_structure, Disinhibition, Female, Neurology (clinical), Abnormality, medicine.symptom, Primary motor cortex, Psychology, Neuroscience, Psychomotor Performance, Motor cortex
Abstract

Background: In healthy subjects, preparation to move is accompanied by motor cortical disinhibition. Poor control of intracortical inhibitory function in the primary motor cortex (M1) might contribute to persistent abnormal motor behavior in the paretic hand after chronic stroke. Methods: Here, we studied GABAergic short intracortical inhibition (SICI) in the ipsilesional M1 in well-recovered chronic stroke patients (n = 14; 63.8 ± 3.0 years) engaged in preparation to move the impaired hand in a reaction time paradigm. Results: The main finding was an abnormal persistence of SICI in the ipsilesional M1 during movement preparation that was absent in age-matched controls (n = 14). Additionally, resting SICI was reduced in the patient group relative to controls. Conclusions: Our findings document a deficit of dynamic premovement modulation of intracortical inhibition in the ipsilesional primary motor cortex of patients with chronic stroke. This abnormality might contribute to deficits in motor control of the paretic hand, presenting a possible target for correction in the framework of developing novel therapeutic interventions after chronic stroke.

Published
2009
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34. Vertebrobasiläre Gefäßverschlüsse

Author

G. Thomalla and J. Fiehler

Subjects
medicine.medical_specialty, Vascular disease, business.industry, medicine.medical_treatment, Stent, Thrombolysis, medicine.disease, Central nervous system disease, Stenosis, Fibrinolysis, Occlusion, medicine, Radiology, Nuclear Medicine and imaging, Radiology, business, Stroke
Abstract

Acute vertebrobasilar occlusions (VBO) are dramatic clinical events with a mortality of up to 90% under standard medical treatment. If VBO is suspected a diagnosis of the vessel status has to be achieved immediately. For this purpose CT/CTA and MRI/MRA are equivalent diagnostic tools in the emergency setting. In contrast to the anterior circulation, local endovascular treatment is the established therapy for the posterior circulation as an underlying arteriosclerotic stenosis remains in 50% of the cases after intravenous fibrinolysis. Nevertheless, systemic fibrinolysis is considered the preferred option in cases where a neurointerventional center cannot be reached within a reasonable time frame and the patient can subsequently be transported for local therapy of a residual stenosis in order to prevent reocclusion ("drip and ship"). Profound clinical and pathophysiological knowledge is the absolute prerequisite for the correct application of state-of-the-art neurointerventional therapy. This review paper focuses on the clinical and pathophysiological details that are crucial for decision-making.

Published
2009
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35. [Endovascular stroke treatment following recent positive clinical trials]

Author

G, Thomalla and J, Fiehler

Subjects
Stroke, Evidence-Based Medicine, Treatment Outcome, Mechanical Thrombolysis, Endovascular Procedures, Humans, Stents, Randomized Controlled Trials as Topic
Abstract

Recently, five independent randomized controlled clinical trials demonstrated the efficacy and safety of endovascular stroke treatment in stroke patients with occlusion of proximal intracranial arteries. The five trials MR CLEAN, ESCAPE, EXTEND-IA, SWIFT-PRIME and REVASCAT randomized a total of 1287 stroke patients to either standard treatment, which in the majority of patients consisted of intravenous thrombolysis within 4.5 h of symptom onset or additional endovascular stroke treatment. In all the studies endovascular treatment resulted in a better clinical outcome with an odds ratio for a better clinical outcome 90 days after stroke ranging between 1.7 and 3.1 and an absolute increase in the proportion of patients with functionally independent outcome between 14% and 31%. The overwhelming benefit of endovascular treatment mainly results from mechanical thrombectomy using stent retriever devices and starting endovascular treatment within 6 h of symptom onset in stroke patients.

Published
2015

36. Estimated GFR and the Effect of Intensive Blood Pressure Lowering After Acute Intracerebral Hemorrhage

Author

Danni Zheng, Shoichiro Sato, Hisatomi Arima, Emma Heeley, Candice Delcourt, Yongjun Cao, John Chalmers, Craig S. Anderson, C.S. Anderson, J. Chalmers, H. Arima, S. Davis, E. Heeley, Y. Huang, P. Lavados, B. Neal, M.W. Parsons, R. Lindley, L. Morgenstern, T. Robinson, C. Stapf, C. Tzourio, J.G. Wang, S. Chen, X.Y. Chen, L. Cui, Z. Liu, C. Lu, J. Wang, S. Wu, E. Xu, Q. Yang, C. Zhang, J. Zhang, R. Beer, E. Schmutzhard, P. Redondo, M. Kaste, L. Soinne, T. Tatlisumak, K. Wartenberg, S. Ricci, K. Klijn, E. Azevedo, A. Chamorro, M. Arnold, U. Fischer, S. Kaul, J. Pandian, H. Boyini, S. Singh, A.A. Rabinstein, C. Estol, G. Silva, V.V. Olavarria, T.G. Robinson, R.J. Simes, M.-G. Bousser, G. Hankey, K. Jamrozik, S.C. Johnston, S. Li, K. Bailey, T. Cheung, C. Delcourt, S. Chintapatla, E. Ducasse, T. Erho, J. Hata, B. Holder, E. Knight, M. Leroux, T. Sassé, E. Odgers, R. Walsh, Z. Wolfowicz, G. Chen, S. Fuentes, B. Peng, H.-M. Schneble, M.-X. Wang, L. Billot, S. Heritier, Q. Li, M. Woodward, S. Abimbola, S. Anderson, E. Chan, G. Cheng, P. Chmielnik, S. Leighton, J.-Y. Liu, B. Rasmussen, A. Saxena, S. Tripathy, M. Armenis, M.A. Baig, B. Naidu, G. Starzec, S. Steley, A. Moles, A. Ruiz, M. Zimmermann, J. Marinho, S. Alves, R. Angelim, J. Araujo, L. Kawakami, C. Bustos, F. Gonzalez, P. Munoz Venturelli, X. Chen, R. Jia, N. Li, S. Qu, Y. Shu, A. Song, J. Sun, J. Xiao, Y. Zhao, Q. Huang, E. Vicaut, A. Chamam, M.-C. Viaud, C. Dert, U. Fiedler, V. Jovis, S. Kabla, S. Marchand, A. Pena, V. Rochaud, K. Mallikarjuna, N. Hasan, E. Berge, E.C. Sandset, A.S. Forårsveen, D. Richardson, T. Kumar, S. Lewin, N. Poulter, J. Field, A. Anjum, A. Wilson, H. Perelmuter, A.M. Agarie, A.G. Barboza, L.A. Recchia, I.F. Miranda, S.G. Rauek, R.J. Duplessis, H. Dewey, L. Walker, S. Petrolo, C. Bladin, J. Sturm, D. Crimmins, D. Griffiths, A. Schutz, V. Zenteno, F. Miteff, N. Spratt, E. Kerr, C.R. Levi, T.G. Phan, H. Ma, L. Sanders, C. Moran, K. Wong, S. Read, R. Henderson, A. Wong, R. Hull, G. Skinner, P. Hand, B. Yan, H. Tu, B. Campbell, D.J. Blacker, T. Wijeratne, M. Pathirage, M. Jasinararchchi, Z. Matkovic, S. Celestino, F. Gruber, M.R. Vosko, E. Diabl, S. Rathmaier, B. Pfausler, R. Helbok, F. Fazekas, R. Fischer, B. Poltrum, B. Zechner, U. Trummer, M.P. Rutgers, A. Peeters, A. Dusart, M.-C. Duray, C. Parmentier, S. Ferrao-Santos, R. Brouns, S. De Raedt, A. De Smedt, R.-J. VanHooff, J. De Keyser, S.C.O. Martins, A.G. de Almeida, R. Broudani, N.F. Titton, G.R. de Freitas, F.M. Cardoso, L.M. Giesel, N.A. Lima, A.C. Ferraz de Almeida, R.B. Gomes, T.S. Borges dos Santos, E.M. Veloso Soares, O.L.A. Neto, G.S. Silva, D.L. Gomes, F.A. de Carvalho, M. Miranda, A. Marques, V.F. Zétola, G. de Matia, M.C. Lange, J. Montes, A. Reccius, A. Soto, R. Rivas, C. Klapp, S. Illanes, C. Aguilera, A. Castro, C. Figueroa, J. Benavides, P. Salamanca, M.C. Concha, J. Pajarito, P. Araya, F. Guerra, Y. Li, G. Liu, B. Wang, Y. Chong, M. He, L. Wang, J. Liu, X. Zhang, C. Lai, H. Jiang, S. Cui, Q. Tao, Y. Zhang, S. Yao, M. Xu, H. Xiao, J. Hu, J. Tang, H. Ji, M. Jiang, F. Yu, X. Yang, X. Guo, Y. Wang, L. Wu, Y. Gao, D. Sun, X. Huang, L. Liu, P. Li, Y. Jiang, H. Li, H. Lu, J. Zhou, C. Yuan, X. Qi, F. Qiu, H. Qian, W. Wang, W. Sun, F. Li, R. Liu, Q. Peng, Z. Ren, C. Fan, H. Wang, T. Wang, F. Shi, C. Duan, Z. Chen, X. Tan, Z. Zhao, J. Chen, T. Han, L. Zhang, Q. Hu, Q. Hou, X. Zhao, G. Zeng, L. Ma, F. Wang, L. Zeng, Z. Guo, Y. Fu, Y. Song, L. Tai, X. Liu, X. Su, Y. Yang, R. Dong, Y. Xu, S. Tian, S. Cheng, L. Su, X. Xie, T. Xu, D. Geng, X. Yan, H. Fan, N. Zhao, S. Wang, J. Yang, M. Yan, L. Li, Z. Li, X. Xu, Y. Lian, H. Sun, D. Liu, N. Wang, Q. Tang, Z. Han, L. Feng, Y. Cui, J. Tian, H. Chang, X. Sun, C. Liu, Z. Wen, Q. Lin, L. Sun, B. Hu, M. Zou, Q. Bao, X. Lin, L. Zhao, X. Tian, X. Wang, X. Li, L. Hao, Y. Duan, R. Wang, Z. Wei, S. Ren, H. Ren, Y. Dong, Y. Cheng, W. Liu, J. Han, Z. Zhang, J. Zhu, J. Qian, Y. Sun, K. Liu, F. Long, X. Peng, Q. Zhang, Z. Yuan, C. Wang, M. Huang, P. He, Y. You, J. Xia, L. Zhou, Y. Hou, Y. Qi, L. Mei, R. Lu, L. Ping, S. Zhou, S. Zhang, R. Zou, J. Guo, M. Li, W. Wei, S. Curtze, M. Saarela, D. Strbian, F. Scheperjans, T. De Broucker, C. Henry, R. Cumurciuc, N. Ibos-Augé, A.-C. Zéghoudi, F. Pico, O. Dereeper, M.-C. Simian, C. Boisselier, A. Mahfoud, S. Timsit, F.M. Merrien, B. Guillon, M. Sevin, F. Herisson, C. Magne, A. Ameri, C. Cret, S. Stefanizzi, F. Klapzcynski, C. Denier, M. Sarov-Riviere, P. Reiner, J. Mawet, D. Hervé, F. Buffon, E. Touzé, V. Domigo, C. Lamy, D. Calvet, M. Pasquini, S. Alamowitch, P. Favrole, I.-P. Muresan, S. Crozier, C. Rosso, C. Pires, A. Leger, S. Deltour, C. Cordonnier, H. Henon, C. Rossi, M. Zuber, M. Bruandet, R. Tamazyan, C. Join-Lambert, E. Juettler, T. Krause, S. Maul, M. Endres, G.J. Jungehulsing, M. Hennerici, M. Griebe, T. Sauer, K. Knoll, R. Huber, K. Knauer, C. Knauer, S. Raubold, H. Schneider, H. Hentschel, C. Lautenschläger, E. Schimmel, I. Dzialowski, C. Foerch, M. Lorenz, O. Singer, I.M.R. Meyer dos Santos, A. Hartmann, A. Hamann, A. Schacht, B. Schrader, A. Teíchmann, K.E. Wartenberg, T.J. Mueller, S. Jander, M. Gliem, C. Boettcher, M. Rosenkranz, C. Beck, D. Otto, G. Thomalla, B. Cheng, K.S. Wong, T.W. Leung, Y.O.Y. Soo, S. Prabhakar, S.R. Kesavarapu, P.K. Gajjela, R.R. Chenna, K. Ummer, M. Basheer, A. Andipet, M.K.M. Jagarlapudi, A.U.R. Mohammed, V.G. Pawar, S.S.K. Eranki, Y. Singh, N. Akhtar, N.C. Borah, M. Ghose, N. Choudhury, N.R. Ichaporia, J. Shendge, S. Khese, V. Pamidimukkala, P. Inbamuthaiah, S.R. Nuthakki, N.M.R. Tagallamudi, A.K. Gutti, D. Khurana, P. Kesavarapu, V. Jogi, A. Garg, D. Samanta, G.R.K. Sarma, R. Nadig, T. Mathew, M.A. Anandan, E. Caterbi, A. Zini, M. Cavazzuti, F. Casoni, R. Pentore, F. Falzone, T. Mazzoli, L.M. Greco, C. Menichetti, F. Coppola, S. Cenciarelli, E. Gallinella, A. Mattioni, R. Condurso, I. Sicilia, M. Zampolini, F. Corea, M. Barbi, C. Proietti, D. Toni, A. Pieroni, A. Anzini, A. Falcou, M. Demichele, C.J.M. Klijn, A. Tveiten, E.T. Thortveit, S. Pettersen, N. Holand, B. Hitland, S.H. Johnsen, A. Eltoft, M. Wasay, A. Kamal, A. Iqrar, L. Ali, D. Begum, G. Gama, L. Fonseca, G. Moreira, L.M. Veloso, D. Pinheiro, L. Paredes, C. Rozeira, T. Gregorio, T. Segura Martin, O. Ayo, J. Garcia-Garcia, I. Feria Vilar, I. Gómez Fernández, S. Amaro, X. Urra, V. Obach, A. Cervera, Y. Silva, J. Serena, M. Castellanos, M. Terceno, C. Van Eendenburg, A. Weck, O. Findling, R. Lüdi, E.A. Warburton, D. Day, N. Butler, E. Bumanlag, S. Caine, A. Steele, M. Osborn, E. Dodd, P. Murphy, B. Esisi, E. Brown, R. Hayman, V.K.V. Baliga, M. Minphone, J. Kennedy, I. Reckless, G. Pope, R. Teal, K. Michael, D. Manawadu, L. Kalra, R. Lewis, B. Mistry, E. Cattermole, A. Hassan, L. Mandizvidza, J. Bamford, H. Brooks, C. Bedford, R. Whiting, P. Baines, M. Hussain, M. Harvey, K. Fotherby, S. McBride, P. Bourke, D. Morgan, K. Jennings-Preece, C. Price, S. Huntley, V.E. Riddell, G. Storey, R.L. Lakey, G. Subramanian, D. Jenkinson, J. Kwan, O. David, D. Tiwari, M. James, S. Keenan, H. Eastwood, L. Shaw, P. Kaye, D. Button, B. Madigan, D. Williamson, A. Dixit, J. Davis, M.O. Hossain, G.A. Ford, A. Parry-Jones, V. O'Loughlin, R. Jarapa, Z. Naing, C. Lovelock, J. O'Reilly, U. Khan, A. Bhalla, A. Rudd, J. Birns, D.J. Werring, R. Law, R. Perry, I. Jones, R. Erande, C. Roffe, I. Natarajan, N. Ahmad, K. Finney, J. Lucas, A. Mistri, D. Eveson, R. Marsh, V. Haunton, J.E. Fugate, S.W. Lepore, Neurologian yksikkö, Clinicum, Neurology, Clinical sciences, Neuroprotection & Neuromodulation, Supporting clinical sciences, UZB Other, Physical Medicine and Rehabilitation, and Vriendenkring VUB

Subjects
CHRONIC KIDNEY-DISEASE, Male, systolic blood pressure, medicine.medical_treatment, Blood Pressure, 030204 cardiovascular system & hematology, GLOMERULAR-FILTRATION-RATE, 3124 Neurology and psychiatry, RESISTANT HYPERTENSION, 0302 clinical medicine, Modified Rankin Scale, cerebral hemorrhage, cerebrovascular disease, chronic kidney disease (CKD), dialysis, estimated glomerular filtration rate (EGFR), hemodialysis, intensive blood pressure lowering treatment, INTERACT2, intracerebral hemorrhage (ICH), Kidney function, stroke, Stroke, education.field_of_study, OUTCOMES, estimated glomerular filtration rate (eGFR), Antihypertensive Agents/pharmacology, ASSOCIATION, Urology & Nephrology, Middle Aged, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], 3. Good health, PREVALENCE, Nephrology, Acute Disease, Female, Cerebral Hemorrhage/drug therapy, WHITE-MATTER, Glomerular Filtration Rate, STROKE PATIENTS, medicine.medical_specialty, RENAL-FUNCTION, LONG-TERM, Population, Renal function, Blood Pressure/drug effects, 03 medical and health sciences, Internal medicine, medicine, Humans, education, Dialysis, Antihypertensive Agents, Aged, Cerebral Hemorrhage, Intracerebral hemorrhage, business.industry, 1103 Clinical Sciences, medicine.disease, Surgery, Blood pressure, business, 030217 neurology & neurosurgery, Kidney disease
Abstract

Markku Kaste ja Filip Scheperjans työryhmän jäsenenä. Background: The kidney-brain interaction has been a topic of growing interest. Past studies of the effect of kidney function on intracerebral hemorrhage (ICH) outcomes have yielded inconsistent findings. Although the second, main phase of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) suggests the effectiveness of early intensive blood pressure (BP) lowering in improving functional recovery after ICH, the balance of potential benefits and harms of this treatment in those with decreased kidney function remains uncertain. Study Design: Secondary analysis of INTERACT2, which randomly assigned patients with ICH with elevated systolic BP (SBP) to intensive (target SBP 90, 60-90, and Outcomes: The effect of admission eGFR on the primary outcome of death or major disability at 90 days (defined as modified Rankin Scale scores of 3-6) was analyzed using a multivariable logistic regression model. Potential effect modification of intensive BP lowering treatment by admission eGFR was assessed by interaction terms. Results: Of 2,623 included participants, 912 (35%) and 280 (11%) had mildly and moderately/severely decreased eGFRs, respectively. Patients with moderately/severely decreased eGFRs had the greatest risk for death or major disability at 90 days (adjusted OR, 1.82; 95% CI, 1.28-2.61). Effects of early intensive BP lowering were consistent across different eGFRs (P = 0.5 for homogeneity). Limitations: Generalizability issues arising from a clinical trial population. Conclusions: Decreased eGFR predicts poor outcome in acute ICH. Early intensive BP lowering provides similar treatment effects in patients with ICH with decreased eGFRs. Am J Kidney Dis. 68(1): 94-102. (C) 2016 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BY-NC-ND license.

Published
2015

37. Das akute Schlaganfall-MRT mit perfusions- und diffusionsgewichteter Bildgebung in der Diagnostik des raumfordernden Mediainfarktes

Author

J. Fiehler, Cornelius Weiller, H. Zeumer, T. Kucinski, R. Knab, G. Thomalla, and J. Röther

Subjects
Brain edema, business.industry, Emergency Medicine, Medicine, Emergency Nursing, Critical Care and Intensive Care Medicine, Nuclear medicine, business, Acute stroke
Abstract

Der raumfordernde Mediainfarkt ist gekennzeichnet durch die Entwicklung eines massiven Hirnodems, welches mit sekundarer Bewusstseinseintrubung einhergeht. Es kommt zum zunehmenden Verlust von Hirnstammfunktionen bis hin zum Tod infolge transtentorieller Einklemmung. Wir haben untersucht, ob das akute Schlaganfall-MRT mit perfusions- und diffusionsgewichteter Bildgebung (PWI und DWI) und MR-Angiographie (MRA) die Vorhersage eines raumfordernden Mediainfarktes bei Patienten mit proximalem Gefasverschluss (Media-Hauptstamm, Carotis-T) ermoglicht. Siebenunddreisig Patienten mit akutem Mediainfarkt und proximalem Gefasverschluss wurden innerhalb von 6 h nach Symptombeginn mit PWI, DWI und MRA untersucht. Im Verlauf entwickelten 11 Patienten einen raumfordernden Mediainfarkt. Die Diffusionslasion wurde definiert als Areal mit einer Verminderung des apparent diffusion coefficient (ADC) auf weniger als 80% (ADC +4 s) im Vergleich zur nicht betroffenen Hemisphare. Das neurologische Defizit bei Aufnahme wurde anhand der National Institutes of Health Stroke Scale (NIHSS) eingeschatzt. Das neurologische Outcome wurde 90 Tage nach Ereignis mittels Barthel-Index (BI) und modified Rankin-Scale (MRS) eingeschatzt. Patienten mit raumforderndem Mediainfarkt zeigten grosere Diffusions- und Perfusionslasionen (median ADC +4 s: 208 vs. 125 ml), haufiger einen Verschluss im Carotis-T (64 vs. 15%, p=0,006) und waren bei Aufnahme klinisch schwerer betroffen (NIHSS 20 vs. 15, p=0,001). Das klinische Outcome war schlechter bei Patienten mit raumforderndem Mediainfarkt (MRS: 4 vs. 1, p 82 ml (Sensitivitat 87%, Spezifitat 91%), TTP>+4 s >162 ml (83%, 75%), NIHSS-Score bei Aufnahme ≥19 (96%, 72%). Das Schlaganfall-MRT mit PWI, DWI und MRA im 6-Stunden-Zeitfenster ermoglicht eine zuverlassige Vorhersage der Entwicklung eines raumfordernden Mediainfarkts und hilft bei der Indikationsstellung aggressiver und potentiell lebensrettender Masnahmen wie z.B. der dekompressiven Hemikraniektomie.

Published
2004
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38. Intrazerebrale Blutungen : E6 Therapie und Verlauf neurologischer Erkrankungen

Author

C. Weimar, U. Sure, G. Thomalla, Christian Gerloff, Thomas Brandt, Hans-Christoph Diener, C. Weimar, U. Sure, G. Thomalla, Christian Gerloff, Thomas Brandt, and Hans-Christoph Diener

Abstract

Dieses Buch enthält den Artikel: Intrazerebrale Blutungen aus dem Sammelband: Therapie und Verlauf neurologischer Erkrankungen. Das große Referenz- und Facharztbuch zur klinischen Neurologie liegt hiermit unter der Federführung der international renommierten Herausgeber und der Mitarbeit von über 140 Fachexperten als eine vollständig überarbeitete und erweiterte Neuauflage vor. Durch die thematische Neuausrichtung einzelner Beiträge, z. B. zur transienten globalen Amnesie oder zu Tropenkrankheiten, und acht zusätzliche Kapitel, nämlich zu Antikörper-assoziierten Enzephalopathien, mitochondrialen Erkrankungen, atypischem Gesichtsschmerz, craniomandibulärer Dysfunktion, Hypophysentumoren, Tic/Tourette und ADS, Apraxie sowie ethischen und rechtlichen Aspekten in der Neurologie, hat die 6. Auflage viel Neues zu bieten. In bewährter Form werden systematisch die aktuellen Erkenntnisse zum Stand von Klinik, Therapie und Verlauf neurologischer Erkrankungen zusammengefasst und für die pragmatische Anwendung gewichtet.

Published
2013

39. Erratum to 'Choices of Stent and Cerebral Protection in the Ongoing ACST-2 Trial: A Descriptive Study' [Eur J Vasc Endovasc Surg 53 (2017) 617–625]

Author

D.D. de Waard, A. Halliday, G.J. de Borst, R. Bulbulia, A. Huibers, R. Casana, L.H. Bonati, V. Tolva, G. Fraedrich, B. Rantner, E. Gizewski, I. Gruber, J. Hendriks, P. Cras, P. Lauwers, P. van Scheil, F. Vermassen, I. Van Herzeele, M. Geenens, D. Hemelsoet, P. Lerut, B. Lambrecht, G. Saad, A. Peeters, M. Bosiers, E. da Silva, N. de Luccia, J.C. Sitrangulo, A.E.V. Estenssoro, C. Presti, I. Casella, J.A.T. Monteiro, W. Campos, P. Puech-Leao, V. Petrov, C. Bachvarov, M. Hill, A. Mitha, J. Wong, C.-W. Liu, L. Bao, C. Yu, I. Cvjetko, V. Vidjak, J. Fiedler, S. Ostry, L. Sterba, P. Kostal, R. Staffa, R. Vlachovsky, M. Privara, Z. Kriz, B. Vojtisek, P. Krupa, M. Reif, V. Benes, P. Buchvald, L. Endrych, V. Prochazka, M. Kuliha, D. Otahal, T. Hrbac, D. Netuka, M. Mohapl, F. Kramier, M. Eldessoki, H. Heshmat, F. Abd-Allah, V. Palmiste, S. Margus, T. Toomsoo, J.-P. Becquemin, P. Bergeron, T. Abdulamit, J.-M. Cardon, S. Debus, G. Thomalla, J. Fiehler, C. Gerloss, U. Grzyska, M. Storck, E. LaMacchia, H.H. Eckstein, H. Söllner, H. Berger, M. Kallmayer, H. Popert, A. Zimmermann, A. Guenther, C. Klingner, T. Mayer, J. Schubert, J. Zanow, D. Scheinert, U. Banning-Eichenseer, Y. Bausback, D. Branzan, S. Braünilch, J. Lenzer, A. Schidt, H. Staab, M. Ulirch, J. Barlinn, K. Haase, A. Abramyuk, U. Bodechtel, J. Gerber, C. Reeps, T. Pfeiffer, G. Torello, A. Cöster, A. Giannoukas, K. Spanos, M. Matsagkas, S. Koutias, S. Vasdekis, J. Kakisis, K. Moulakakis, A. Lazaris, C. Liapas, E. Brountzos, M. Lazarides, N. Ioannou, A. Polydorou, B. Fulop, E. Fako, E. Voros, M. Bodosi, T. Nemeth, P. Barzo, S. Pazdernyik, L. Entz, Z. Szeberin, E. Dosa, B. Nemes, Z. Jaranyi, S. Pazdernyia, P. Madhaban, A. Hoffman, E. Nikolsky, R. Beyar, R. Silingardi, A. Lauricella, G. Coppi, E. Nicoloci, N. Tusini, F. Strozzi, E. Vecchiati, M. Ferri, E. Ferrero, D. Psacharopulo, A. Gaggiano, A. Viazzo, L. Farchioni, G. Parlani, V. Caso, P. De Rangoy, F. Verzini, P. Castelli, M.L. DeLodovici, G. Carrafiello, A.M. Ierardi, G. Piffaretti, G. Nano, M.T. Occhiuto, G. Malacrida, D. Tealdi, S. Steghter, A. Stella, R. Pini, G. Faggioli, S. Sacca, M.D. Negri, M. Palombo, M.C. Perfumo, G.F. Fadda, H. Kasemi, C. Cernetti, D. Tonello, A. Visonà, N. Mangialardi, S. Ronchey, M.C. Altavista, S. Michelagnoli, E. Chisci, F. Speziale, L. Capoccia, P. Veroux, A. Giaquinta, F. Patti, R. Pulli, P. Boggia, D. Angiletta, G. Amatucci, F. Spinetti, F. Mascoli, E. Tsolaki, E. Civilini, B. Reimers, C. Setacci, G. Pogany, A. Odero, F. Accrocca, G. Bajardi, I. Takashi, E. Masayuki, E. Hidenori, B. Aidashova, N. Kospanov, S. Bakke, M. Skjelland, A. Czlonkowska, A. Kobayashi, R. Proczka, A. Dowzenko, W. Czepel, J. Polanski, P. Bialek, G. Ozkinis, M. Snoch-Ziólkiewicz, M. Gabriel, M. Stanisic, W. Iwanowski, P. Andziak, F.B. Gonçalves, V. Starodubtsev, P. Ignatenko, A. Karpenko, D. Radak, N. Aleksic, D. Sagic, L. Davidovic, I. Koncar, I. Tomic, M. Colic, D. Bartkoy, F. Rusnak, M. Gaspirini, P. Praczek, Z. Milosevic, V. Flis, A. Bergauer, N. Kobilica, K. Miksic, J. Matela, E. Blanco, M. Guerra, V. Riambau, P. Gillgren, C. Skioldebrand, N. Nymen, B. Berg, M. Delle, J. Formgren, T.B. Kally, P. Qvarfordt, G. Plate, H. Pärson, H. Lindgren, K. Bjorses, A. Gottsäter, M. Warvsten, T. Kristmundsson, C. Forssell, M. Malina, J. Holst, T. Kuhme, B. Sonesson, B. Lindblad, T. Kolbel, S. Acosta, L. Bonati, C. Traenka, M. Mueller, T. Lattman, M. Wasner, E. Mujagic, A. Von Hessling, A. Isaak, P. Stierli, T. Eugster, L. Mariani, C. Stippich, T. Wolff, T. Kahles, R. Toorop, F. Moll, R. Lo, A. Meershoek, A.K. Jahrome, A.W.F. Vos, W. Schuiling, R. Keunen, M. Reijnen, S. Macsweeney, N. McConachie, A. Southam, G. Stansby, T. Lees, D. Lambert, M. Clarke, M. Wyatt, S. Kappadath, L. Wales, R. Jackson, A. Raudonaitis, S. MacDonald, P. Dunlop, A. Brown, S. Vetrivel, M. Bajoriene, R. Gopi, C. McCollum, L. Wolowczyk, J. Ghosh, D. Seriki, R. Ashleigh, J. Butterfield, M. Welch, J.V. Smyth, D. Briley, U. Schulz, J. Perkins, L. Hands, W. Kuker, C. Darby, A. Handa, L. Sekaran, K. Poskitt, J. Morrison, P. Guyler, I. Grunwald, J. Brown, M. Jakeways, S. Tysoe, D. Hargroves, G. Gunathilagan, R. Insall, J. Senaratne, J. Beard, T. Cleveland, S. Nawaz, R. Lonsdale, D. Turner, P. Gaines, R. Nair, I. Chetter, G. Robinson, B. Akomolafe, J. Hatfield, K. Saastamoinen, J. Crinnion, A.A. Egun, J. Thomas, S. Drinkwater, S. D'Souza, G. Thomson, B. Gregory, S. Babu, S. Ashley, T. Joseph, R. Gibbs, G. Tebit, A. Mehrzad, P. Enevoldson, D. Mendalow, A. Parry, G. Tervitt, A. Clifton, M. Nazzel, R. Peto, H. Pan, J. Potter, R. Bullbulia, B. Mihaylova, M. Flather, A. Mansfield, D. Simpson, D. Thomas, W. Gray, B. Farrell, C. Davies, K. Rahimi, M. Gough, P. Cao, P. Rothwell, A. Belli, M. Mafham, W. Herrington, P. Sandercock, R. Gray, C. Shearman, A. Molyneux, A. Gray, A. Clarke, M. Sneade, L. Tully, W. Brudlo, M. Lay, A. Munday, C. Berry, S. Tochlin, J. Cox, R. Kurien, and J. Chester

Subjects
medicine.medical_specialty, Surgery, Cardiology and Cardiovascular Medicine, business.industry, Published Erratum, medicine.medical_treatment, Physical therapy, medicine, MEDLINE, Stent, Descriptive research, business
Published
2017
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41. ANTONIA perfusion and stroke. A software tool for the multi-purpose analysis of MR perfusion-weighted datasets and quantitative ischemic stroke assessment

Author

Jens Fiehler, A Kemmling, Bastian Cheng, Nils D. Forkert, and G. Thomalla

Subjects
Computer science, Datasets as Topic, Health Informatics, Fluid-attenuated inversion recovery, computer.software_genre, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Health Information Management, Image Interpretation, Computer-Assisted, medicine, Humans, Stroke, Reliability (statistics), Advanced and Specialized Nursing, Protocol (science), Brain Mapping, medicine.diagnostic_test, Reproducibility of Results, Magnetic resonance imaging, Cerebral Infarction, medicine.disease, Prognosis, Regional Blood Flow, Acute Disease, Curve fitting, Data mining, Deconvolution, computer, Perfusion, 030217 neurology & neurosurgery, Magnetic Resonance Angiography, Software
Abstract

SummaryObjectives: The objective of this work is to present the software tool ANTONIA, which has been developed to facilitate a quantitative analysis of perfusion-weighted MRI (PWI) datasets in general as well as the subsequent multi-parametric analysis of additional datasets for the specific purpose of acute ischemic stroke patient dataset evaluation.Methods: Three different methods for the analysis of DSC or DCE PWI datasets are currently implemented in ANTONIA, which can be case-specifically selected based on the study protocol. These methods comprise a curve fitting method as well as a deconvolution-based and deconvolution-free method integrating a previously defined arterial input function. The perfusion analysis is extended for the purpose of acute ischemic stroke analysis by additional methods that enable an automatic atlas-based selection of the arterial input function, an analysis of the perfusion-diffusion and DWI-FLAIR mismatch as well as segmentation-based volumetric analyses.Results: For reliability evaluation, the de-scribed software tool was used by two ob-servers for quantitative analysis of 15 data-sets from acute ischemic stroke patients to extract the acute lesion core volume, FLAIR ratio, perfusion-diffusion mismatch volume with manually as well as automatically selected arterial input functions, and follow-up lesion volume. The results of this evaluation revealed that the described software tool leads to highly reproducible results for all parameters if the automatic arterial input function selection method is used.Conclusion: Due to the broad selection of processing methods that are available in the software tool, ANTONIA is especially helpful to support image-based perfusion and acute ischemic stroke research projects.

Published
2014

42. [EU-funded treatment study: WAKE-UP: a randomized, placebo-controlled MRI-based trial of thrombolysis in wake-up stroke]

Author

G, Thomalla, M, Ebinger, J, Fiehler, J B, Fiebach, M, Endres, and C, Gerloff

Subjects
Adult, Aged, 80 and over, Male, Adolescent, Middle Aged, Placebo Effect, Europe, Stroke, Young Adult, Diffusion Magnetic Resonance Imaging, Treatment Outcome, Double-Blind Method, Fibrinolytic Agents, Humans, Female, Thrombolytic Therapy, European Union, Aged
Abstract

Patients waking up with stroke symptoms are generally excluded from intravenous thrombolysis. It was shown that magnetic resonance imaging (MRI) can identify patients within the time window for thrombolysis (≤ 4.5 h from symptom onset) by a mismatch between the acute ischemic lesion visible on diffusion-weighted imaging (DWI) but not visible on fluid-attenuated inversion recovery (FLAIR) imaging. The WAKE-UP trial is an investigator initiated, European, randomized, double-blind, placebo-controlled trial designed to test efficacy and safety of MRI-based thrombolysis with alteplase (tPA) in stroke patients with unknown time of symptom onset, e.g. due to symptom recognition on awakening. A total of 800 patients showing MRI findings of a DWI-FLAIR-mismatch will be randomized to either tPA or placebo. The primary efficacy endpoint will be favourable outcome defined by a modified Rankin scale score 0-1 at day 90. The primary safety outcome measures will be mortality and death or dependency defined by modified Rankin scale score 4-6 at 90 days. If positive the WAKE-UP trial is expected to change clinical practice and to make effective and safe treatment available for a large group of acute stroke patients currently excluded from specific acute treatment.

Published
2012

45. [Vertebrobasilar occlusions : Pathophysiology, diagnostics and treatment]

Author

J, Fiehler and G, Thomalla

Subjects
Diagnostic Imaging, Vertebrobasilar Insufficiency, Humans, Thrombolytic Therapy, Image Enhancement
Abstract

Acute vertebrobasilar occlusions (VBO) are dramatic clinical events with a mortality of up to 90% under standard medical treatment. If VBO is suspected a diagnosis of the vessel status has to be achieved immediately. For this purpose CT/CTA and MRI/MRA are equivalent diagnostic tools in the emergency setting. In contrast to the anterior circulation, local endovascular treatment is the established therapy for the posterior circulation as an underlying arteriosclerotic stenosis remains in 50% of the cases after intravenous fibrinolysis. Nevertheless, systemic fibrinolysis is considered the preferred option in cases where a neurointerventional center cannot be reached within a reasonable time frame and the patient can subsequently be transported for local therapy of a residual stenosis in order to prevent reocclusion ("drip and ship"). Profound clinical and pathophysiological knowledge is the absolute prerequisite for the correct application of state-of-the-art neurointerventional therapy. This review paper focuses on the clinical and pathophysiological details that are crucial for decision-making.

Published
2009

47. [Patient selection for thrombolysis using perfusion and diffusion MRI. An overview]

Author

G, Thomalla, P, Ringleb, M, Köhrmann, and P D, Schellinger

Subjects
Diffusion Magnetic Resonance Imaging, Fibrinolytic Agents, Patient Selection, Humans, Thrombolytic Therapy, Magnetic Resonance Angiography, Brain Ischemia
Abstract

Multiparametric MRI including diffusion and perfusion imaging provides information on the extent of irreversibly damaged ischemic and/or critically hypoperfused tissue. Magnetic resonance angiography provides additional information on vessel status. The concept of perfusion-diffusion mismatch allows the estimation of tissue at risk of infarction which might be salvaged by timely reperfusion. In large case series and nonrandomized cohort studies, perfusion-diffusion mismatch-based thrombolysis was performed not less than 3 h after symptom onset with excellent safety and signs of good efficacy. However no randomised controlled trial has confirmed this to date. Recent studies improved the understanding of the mismatch concept and identified reperfusion unequivocally as an important predictor of the clinical response to thrombolysis. At the moment MRI-based thrombolysis can be performed after 3 h based on individual benefit:risk assessment in experienced stroke centers.

Published
2009

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