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4. White matter lesions in watershed territories studied with MRI and parenchymography: a comparative study

Author

Minkner, K., Lovblad, K., Yilmaz, H., Alimenti, A., Sekoranja, L., Delavelle, J., Sztajzel, R., Rüfenacht, D., Minkner, K., Lovblad, K., Yilmaz, H., Alimenti, A., Sekoranja, L., Delavelle, J., Sztajzel, R., and Rüfenacht, D.

Abstract

Brain aging affects an increasing segment of the population and the role of chronic cerebrovascular disease is considered to be one of the main parameters involved. For this purpose we compared retrospectively MRI data with digitized subtraction angiography (DSA) data in a group of 50 patients focusing onto the watershed area of the carotid artery vascular territories. In order to evaluate the presence of white matter lesions (WML) in the hemispheric watershed areas, coronal fluid-attenuated inversion-recovery or axial T2 weighted MRI images of patients with symptomatic cerebrovascular insufficiency areas were compared with the capillary phase of DSA studies in anterior-posterior projection. Presence of cerebrovascular occlusive disease was evaluated on DSA using North American symptomatic carotid endarterectomy trial criteria and including evaluation of collateral vascular supply. Pathological MRI findings in the region of the watershed territories correlated overall in 66% of cases with a defect or delayed filling on DSA. In the case of asymmetrical MRI findings, there was a pathological finding of the capillary phase in the watershed area in 92% of DSA studies. Hypoperfusion in the capillary phase of the watershed area as seen on DSA correlated with the stenosis degree of the concerned carotid artery. Our findings suggest that asymmetrical findings of WML in the watershed areas as seen on MRI are caused by hemodynamic effect and a differentiation between small vessel disease and a consequence of distant stenosis may be possible under such conditions

Published
2018

5. Cause of death and predictors of all-cause mortality in anticoagulated patients with nonvalvular atrial fibrillation: Data from ROCKET AF

Author

Pokorney, Sean D, Piccini, Jonathan P., Stevens, Susanna R., Patel, Manesh R., Pieper, Karen S., Halperin, Jonathan L., Breithardt, Günter, Singer, Daniel E., Hankey, Graeme J., Hacke, Werner, Becker, Richard C., Berkowitz, Scott D., Nessel, Christopher C., Mahaffey, Kenneth W., Fox, Keith A. A., Califf, Robert M., Anderson, J., Bedwell, N., Bilsker, M., Bruce, G., Agah, R., Desantis, M., Eisenberg, S., Flores, A., Herzog, W., Klein, S., Snyder, H., Krueger, S., Almaguer, E., Lavie, E., Lee, C., Mallis, G., Modi, M., Woodworth, G., Niazi, I., Peart, B., Sundaram, S., Snoddy, B., Sotolongo, R., Moloney, J., Vijayaraghavan, K., Whittier, F., Yellen, L., Banerjee, S., Lustgarten, D., Suresh, D., Gelernt, M., Levinson, L., Ghanekar, R., Kneller, G., Hall, C., Fadl, Y., Pirwitz, M., French, W., Mayer, N., Pugeda, J., Steel, K., Mody, F., Malik, A., Chandna, H., Go, A., Emlein, G., Bowden, W., Moscoso, R., Hodson, R., Berk, M., Pan, D., Pappas, J., Orchard, R., Lynchard, G., Vijay, N., Khan, W., El Khadra, M., Antonishen, M., Cucher, F., Staab, M., Zebrack, J., Borromeo, S., Heilman, J., Chaturvedi, S., Makam, S., Turk, S., Hyers, T., Williams, G., Labroo, A., Gill, S., Myears, D., Weinstein, J., Shanes, J., Chandrashekhar, Y., Shah, S., Reiter, W., Logemann, T., Almquist, A., Bhagwat, R., Tak, T., Shen Ling, J., Patel, P., Artis, A., Arouni, A., Lauer, M., Kinney, K., Elsen, J., Roan, P., Villafria, R., Sumpter, M., Ip, J., Welka, S., Schifferdecker, B., Sandoval, R., Speirs, S., Jones, A., Haldis, T., Kazmierski, J., Sutherland, J., Dietrich, D., Telfer, E., Berry, J., Mcelveen, A., Russell, J., Sackett, M., Antonios, N., Smith, D., Vora, K., Kirby, A., Lui, H., Mego, D., Ziada, K., Navas, J., Taussig, A., Koren, M., Vogel, C., Saba, F., Parrott, C., Schneider, R., Shirwany, A., Rubin, M., Treasure, C., Bertolet, B., Chang, M., Langberg, J., Becker, R., Cohen, Y., Mcgrew, F., White, J., Arzola, F., Zelenka, J., Tannenbaum, A., Fernandes, V., Jamnadas, P., Agamasu, J., Collins, B., Jauch, W., Sasseen, B., Hotchkiss, D., Abadier, R., Osunkoya, A., Schlau, A., Chappel, C., Foster, M., Braun, E., Mostel, E., Capo, J., Ashchi, M., Howard, V., Albirini, A., Burger, A., Rolston, D., Staniloae, C., Bacon, J., Wiseman, A., Mcgarvey, J., Sonel, A., Hamroff, G., Chang, D., Daboul, N., Broderick, G., Meholick, A., Corbelli, J., Silverman, R., Raffetto, J., Fishberg, R., Georgeson, S., Held, J., Seidner, M., Saint Jacques, H., Heitner, J., Kutalek, S., Friedlander, I., Hutchinson, B., Walia, J., Kondo, N., Smiley, N., Blitz, L., Dale, H., Sulman, S., Szulawski, I., Modares, F., Martin, R., Nahhas, A., Renzi, M., Akyea Djamson, A., Alfieri, A., Sandhu, J., Voyce, S., Amaram, S., Meyerrose, G., Shoukfeh, M., Lee, F., Villegas, B., Idowu, O., Khera, A., Sam, C., Vo, A., Lieber, I., Smith, T., Awan, N., Tsai, C., Ganim, R., Alzaghrini, G., Pitt, W., Shepherd, A., Tang, S., Stoltz, S., Nelson, W., Cox, S., Meymandi, S., Melucci, M., Thomas, G., Gogia, H., Machell, C., Chandrasekaran, S., Brown, C., Jetty, P., Miller, G., Dykstra, G., Jaffrani, N., Zakhary, B., Caruso, A., Zolty, R., Fox, D., Jacobs, G., Lebenthal, M., Mukherjee, S., Zimetbaum, P., Kingsley, J., Jones, R., Robinson, V., Kenton, D., Usedom, J., Williams, S., Snipes, C., Wilson, V., Hasty, R., Shoemaker, J., Donahue, M., Al Saghir, Y., Thomsen, E., Yarows, S., Chastain, S., Mclaughlin, P., Wakham, M., Shrestha, D., Simmons, J., Fisher, D., Seymour, Z., Frandsen, B., First, B., Sharpe, C., Popeil, L., Guthrie, R., Hunter, J., Alvarado, O., Sandberg, J., Gutman, N., Belber, A., Arkhipov, M., Ballyzek, M., Baranov, A., Barbarash, O., Barbarich, V., Belenky, D., Berkovich, O., Bokarev, I., Boyarkin, M., Vaniev, S., Volkova, E., Gratsiansky, N., Demin, A., Zadionchenko, V., Zateyshchikov, D., Zrazhevsky, K., Mazaev, V., Martynov, A., Mikhailov, S., Mkrtchian, V., Novozhenov, V., Raskina, T., Rebrov, A., Sanina, N., Simanekov, V., Sitnikova, M., Smolenskaya, O., Stryuk, R., Storozhakov, G., Tankhilevich, B., Tereschenko, S., Khokhlov, A., Khrustalev, O., Chernov, S., Shvarts, Y., Shubik, Y., Shulman, V., Yakushin, S., Bugrova, O., Ivleva, A., Libis, R., Khozyainova, N., Maslov, S., Baranova, E., Sherenkov, A., Libov, I., Lusov, V., Chumakova, G., Kuznetsov, V., Ryamzina, I., Reshetko, O., Boldueva, S., Alekseeva, N., Novikova, T., Dvornikov, V., Idrisova, E., Shostak, N., Yarokhno, N., Tebloev, K., Treshkur, T., Mazurov, V., Loktin, E., Sedavnyh, I., Alexeeva, O., Yakhontova, P., Repin, A., Izmozherova, N., Kostenko, V., Fokin, A., Ketova, G., Kouz, S., Leader, R., Ayala Paredes, F., Luton, R., Ma, P., Pandey, S., Pesant, Y., Senior, R., Vertes, G., Bell, A., Crowley, D., Vizel, S., Lasko, B., Landry, D., Berger, L., Heath, J., Bessoudo, R., Ling, M., Tellier, G., Berlingieri, J., Kafka, H., Hill, L., Mazza, G., O'Mahony, W., Chilvers, M., O'Mahony, M., Newman, D., Silagy, S., Heffernan, M., Bennett, M., Bhesania, T., Rockman, G., Ng, K., Kalra, B., Meneses, G., Liang, W., Cheung, M., Kozak, J., Pugen, G., Vavougios, J., Kates, M., Nunes Vaz, C., Jaffer, S., Orfi, J., Faiers, A., Chung, C., Felsen, S., Bergman, S., Bernstein, I., Brownscombe, L., Stockdill, J., Silver, E., Ezekiel, D., Jagan, N., Khurana, M., Reisler, H., Goldman, H., Maung, T., Wong, F., Gillis, G., Vexler, R., Goldberg, B., Luterman, M., Gould, D., Coutu, B., Ouellet, A., Macdonald, P., Jones, M., Collette, R., Chong, P., Fargher, T., St Maurice, F., Fortin, C., Chehayeb, R., Proulx, G., Roy, R., Liutkus, J., Syan, G., Rupka, D., Lichtenstein, T., Kooy, J., Papastergiou, D., Lubelsky, B., Doyle, W., Rajakumar, A., Cha, J., Choudhry, A., Bhamjee, H., Mawji, A., Durfresne, M., Constance, C., Mutrie, J., Najarali, A., Warren, R., Mucha, M., Borts, D., Nord, P., Carrier, S., Dawood, M., Sabe Affaki, G., Archibald, J., Abram, N., Teitelbaum, E., Ebrahim, I., Siebert, R., van Zyl, L., Theron, H., Lloyd, E., Sommers, R., Podgorski, G., Steingo, L., Dalby, A., Bayat, J., Herbst, L., Bester, F., Corbett, C., Bennett, J., Roodt, A., Roux, J., Abelson, M., Mohamed, Z., Nortje, H., Da Silva, A., Nikolaides, K., Liagkas, K., Papasteriadis, E., Achimastos, A., Koliopoulos, N., Trikas, A., Manolis, A., Ruiter, J., Basart, D., Crijns, H., Withagen, A., Janssen, M., Van Langeveld, R., van Gelder, I., Hamer, B., Van Der Heijden, R., Hertzeberger, D., Van Hessen, M., Pieterse, M., Groutars, R., Kuijper, A., De Ruiter, G., van Boven, A., Hoogslag, P., Kragten, H., Thijssen, H., Veldkamp, R., Scavee, C., Heidbuchel, H., Debruyne, P., Deruyter, B., El Ali, H., Goethals, M., Cytryn, R., Striekwold, H., De Wolf, L., Goethals, P., Provenier, F., Hellemans, S., Galinier, M., Coisne, D., Koenig, A., Galley, D., Destrac, S., Leduc, J., Rifai, A., Citron, B., Ellie, E., Fournier, P., Steg, G., Landel, R., Robinson, A., Ziegler, F., Boulliat, J., Zuber, M., Vida, M., Galve Basilio, E., Lopez, M., Íñiguez, C., Iglesias Alonso, L., Cavero Gibanel, M., Olivan Martinez, J., Calvo Iglesias, F., Marco Vera, P., Bruguera Cortada, J., Jaber Houbani, A., Merino, J., Olaz Preciado, F., Balaguer, J., de la Hera Galarza, J., Martinez Rubio, A., Fontcuberta, J., Sotillo Marti, J., Gonzalez Juanatey, J., Del Campo, R., Vivanco, G., Alvarez Garcia, P., Pelayo, M., Lippai, J., Zamolyi, K., Károly, T., Vertes, A., Nagy, A., Kosa, I., Janosi, A., Lupkovics, G., Kalo, E., Forster, T., Kis, E., Tenczer, J., Bereczki, D., Komoly, S., Csanyi, A., Kiss, R., Valikovics, A., Dioszeghy, P., Masini, F., Terrosu, P., Cirrincione, V., Marabotti, C., Cosmi, F., Salvioni, A., Binetti, G., Piovaccari, G., Nassiacos, D., Boriani, Giuseppe, Calvi, V., De Caterina, R., Pengo, V., Parati, G., Carolei, A., D'Angelo, A., Di Biase, M., Fattore, L., Agnelli, G., Merlini, P., Furlan, M., Rasura, M., Gandolfo, C., Ageno, W., Piovella, F., Micieli, G., Cinteza, M., Fierbinteanu, C., Natase Melicovici, D., Ionescu, D., Macarie, C., Nanea, I., Radoi, M., Tatu Chitoiu, G., Dragulescu, S., Tudose, A., Militaru, C., Bengus, C., Ungureanu, G., Tau, A., Popa, V., Pirvu, O., Bojinca, M., Sipciu, D., Popescu, M., Chiru, M., Vinereanu, D., Tudoran, M., Cojocaru, T., Vintila, M., Aron, G., Petrascu, O., Bolohan, F., Baumgartner, R., Sekoranja, L., Vojacek, J., Lacnak, B., Kellnerova, I., Dunaj, M., Cihalik, C., Janota, T., Janousek, J., Bouchal, P., Spacek, R., Choi Siruckova, J., Heinc, P., Vojtisek, P., Pirchala, M., Malecha, J., Padour, F., Linhart, A., Mandysova, E., Jandik, J., Zidkova, E., Sipula, D., Ostadal, P., Polasek, R., Stransky, V., Marcinek, G., Rysava, D., Osmancik, P., Huber, K., Drexel, H., Brainin, M., Eichinger Hasenauer, S., Lang, W., Pilger, E., Moriarty, A., Hudson, I., Tang, K., Cleland, J., Macwalter, R., Cooke, J., Mcinnes, G., Durairaj, R., Macleod, M., Murdoch, D., Kadr, H., Lip, G., Andrews, R., Hunt, B., Jackson, P., Roffe, C., Syed, H., Bath, P., Coyle, J., Kelly, D., Stender, S., Torppedersen, C., Tuxen, C., Jensen, G., Melchior, T., Klarlund, K., Dahlstrom, C., Nielsen, T., Nielsen, E., Bronnum Schou, J., Sykulski, R., Blomstrom, P., Lindholm, C., Wallen, T., Nilsson, C., Bertholds, E., Carlsater, J., Sirnes, P., Elle, S., Risberg, K., Furuseth, K., Skag, A., Hoivik, H., Landmark, N., Kjaernli, T., Berg Johansen, J., Gradek, G., Drzewiecki, A., Pluta, W., Szwed, H., Trusz Gluza, M., Ogorek, M., Loboz Grudzien, K., Ruszkowski, P., Sciborski, R., Kopaczewski, J., Jaworska, K., Kubica, J., Opolski, G., Hoffman, A., Krzciuk, M., Sinkiewicz, W., Piotrowski, W., Kolodziej, P., Goszczynska, M., Rynkiewicz, A., Chojnowska, L., Lewczuk, J., Biedrzycka, M., Piepiorka, M., Kowal, J., Karczmarczyk, A., Pruszczyk, P., Tendera, M., Gaciong, Z., Krzeminska Pakula, M., Kornacewicz Jach, Z., Kania, G., Brachmann, J., Lawall, H., Guelker, H., Spitzer, S., Moebiuswinkler, S., Dempfle, C., Bode, C., Darius, H., Genth Zotz, S., Sommer, S., Roehnisch, J., Strasser, R., Daenschel, W., Schwencke, C., vom Dahl, J., Meuser, M., Behrens Spandau, S., Behrens Humbold, S., Muegge, A., Schoen, N., Grooterhorst, P., Ebert, H., Kraemer, A., Kohler, B., Taggeselle, J., Claus, G., Sarnighausen, H., Al Zoebi, A., Schroeder, T., Weissbrodt, M., Lange, R., Gabelmann, M., Kaeaeb, S., Doerr, M., Boscher, D., Bosch, R., Sonntag, F., Bauknecht, C., Omran, H., Leicht, M., Veltkamp, R., Hohensee, H., Dieckmann, H., Winkelmann, B., Bernhardt, P., Schnabel, A., Kadel, C., Proskynitopoulos, N., Seidl, K., Schellong, S., Rios, C., Guevara, C., Coloma, R., Torrejon, H., Parra Galvan, J., Drago Silva, J., Gallegos, J., Mendoza, A., Negron, S., Watanabe, L., Medina, F., Virgen Carrilo, L., Alvarez Lopez, H., Rodriguez, I., Leiva Pons, J., Baños Velasco, A., Villarreal Careaga, J., De los Rios, M., Alcocer Gamba, M., Llamas Esperon, G., Villeda, E., Ahuad Guerrero, A., Alvariqueta, A., Amuchastegui, M., Bluguermann, J., Caime, G., Cuneo, C., Gabito, A., Garcia Brasca, D., Hominal, M., Jure, H., Luquez, H., Montana, O., Piskorz, D., Listorti, S., Serra, J., Sessa, H., Varini, S., Vita, N., Aiub, J., Mackinnon, I., Chekherdemian, S., Castagnino, J., Cimbaro Canella, J., Sgammini, H., Escudero, A., Albina, G., Rapallo, C., Balparda, C., Chahin, M., Fuentealba, V., Riccitelli, M., Casabe, J., Lobo Marquez, L., Kevorkian, R., Cuadrado, J., Dran, R., Muntaner, J., Gonzalez, M., Cartasegna, L., Hasbani, E., Hrabar, A., Sanchez, A., Vogel, D., Hershson, A., Avezum, A., Jaber, J., Ernesto Leaes, P., Bozza, A., Lorga Filho, A., Pimentel Filho, P., Moura Jorge, J., Maia, L., Manenti, E., D'Aurea Mora, R., de Souza Neto, J., Precoma, D., Rabelo, A., Rocha, J., Rossi, P., Kerr Saraiva, J., Zimerman, L., Bodanese, L., Figueiredo, E., de Souza, W. Sebba Barroso, Braga, J., Alessi, S., Gomes, M., Silva, R., Teixeira, M., Costa, F., Motta, M., Sobral Filho, D., Reis, G., Garbelini, B., Zimmermann, S., Pereira Barretto, A., Dohmann, H., Barreto Filho, J., Ghorayeb, N., Borelli, F., Rossi dos Santos, F., Lopes Prudente, M., Vejar, M., Lanas, F., Del Pino, R., Potthoff, S., Charme, G., Aguirre, A., Saldana, A., Garces, E., Bunster, L., Figueroa, H., Olivares, C., Raffo, C., Vergara, E., Sepulveda, P., Jano, G., Morales Alvarado, J., Suarez, R., Urina, M., Perez, G., Quintero, A., Pava, L., Botero Lopez, R., Luengas, C., Hernandez, E., Sanchez, D., Poveda, C., Coronel, J., Beltran, R., Jaramillo, C., Pardo, J., Ponte Negretti, C., Isea, J., Vergara, G., Morr, I., Sim, K., Wan Ahmad, W., Yusof, Z., Rosman, A., Basri, H., Thompson, P., Jeffery, P., Purnell, I., Roberts Thomson, P., Heddle, W., Waites, J., Walters, D., Amerena, J., Challa, P., Karrasch, J., Lowy, A., Fitzpatrick, D., Parsons, M., Phan, T., Bladin, C., Donnan, G., Aroney, G., Gerraty, R., Anderson, C., Blombery, P., Martin, P., Tissa Wijeratne, K., Cross, D., Crimmins, D., Packham, D., Jackson, D., Chua, W., Merino, R., Magno, M., Tirador, L., Batalla, E., Manalo, C., Uy, N., Ebo, G., Reyes, E., Bernan, A., Richards, M., Hart, H., Mann, S., Fisher, R., Stewart, R., Wilkins, G., Barber, A., Tan, R., Ong, H., Singh, R., Sukonthasarn, A., Tanomsup, S., Krittayaphong, R., Piamsomboon, C., Piyayotai, D., Sunsaneewitayakul, B., Baek, S., Seo, H., Rim, S., Kim, C., Kim, K., Ryu, K., Jo, S., Tahk, S., Lee, H., Kim, Y., Shin, D., Choi, Y., Chung, N., Namgung, J., Hong, T., Shin, W., Jin, S., Yan, X., Fu, G., Lu, G., Yang, K., Xu, D., Chen, J., Liu, J., Wu, S., Song, J., Liao, Y., Xu, B., Li, Z., Ma, S., Yin, Y., Zhao, Y., Hu, D., Ma, C., Ma, J., Sun, J., Li, H., Hong, X., Yu, B., Lu, Q., Yang, J., Wu, Z., Li, Y., Huang, Y., Wang, Y., Liu, M., Cheng, Y., Yang, T., Chen, K., Wang, H., Yuan, Z., Wang, J., Zeng, Z., Chen, Y., Yavuzgil, O., Kozan, O., Etemoglu, M., Diker, E., Belgi, A., Ceyhan, C., Cin, V., Yilmaz, O., Ata, N., Altunkeser, B., Agacdiken Agir, A., Karadede, A., Topsakal, R., Gulati, R., Madhavan, A., Jain, S., Oomman, A., Janorkar, S., Kumar, P., Madhukar Naik, A., Thacker, H., Rajasekhar, V., Reddy, R., Keshavamurthy, C., Jain, P., Gowdappa, B., Gadkari, M., Abhyankar, A., Ramesh Babu, B., Vydianathan, P., Sinha, S., Garg, N., Rao, S., Gautam, P., Chockalingam, K., Kumbla, M., Panwar, R., Banker, D., Kaste, M., Jäkälä, P., Roine, R., Mihov, A., Raev, D., Yordanova, V., Dimitrova, S., Benov, H., Tsanova, V., Kyolean, M., Marchev, S., Stoikov, A., Zdravkov, N., Ramshev, K., Krastev, A., Stamenova, P., Angelova, I., Pencheva, G., Grigorova, V., Petrauskiene, B., Skripkauskiene, I., Raugaliene, R., Norkiene, S., Mazutavicius, R., Kavoliuniene, A., Aidietiene, S., Aganauskiene, J., Dailydkiene, A., Marcinkeviciene, J., Grigoniene, L., Anusauskiene, J., Kavaliauskiene, R., Lizogub, V., Rudenko, L., Tseluyko, V., Voronkov, L., Sychov, O., Svyshchenko, Y., Sirenko, Y., Serkova, V., Seredyuk, N., Pertseva, T., Netyazhenko, V., Lishnevska, V., Kupchynska, O., Koval, O., Koshukova, G., Karpenko, O., Grishyna, O., Faynyk, A., Dzyak, G., Dyadyk, O., Yena, L., Volkov, V., Rudyk, I., Kopytsya, M., Kononenko, L., Amosova, K., Zhurba, S., Kazimirko, V., Iuzkiv, I., Shershnyova, O., Khomazyuk, T., Batushkin, V., Vykhovanyuk, I., Popik, G., Skrebkov, V., Skurtov, A., Mishchenko, T., Lytvynenko, N., Sokolova, L., Vatutin, M., Shved, M., Rebrov, B., Kadina, L., Vajda, M., Ursol, G., Zheleznyy, V., Vysochanska, T., Gozhenko, A., Fan, K., Ho, D., Tse, H., Yu, C., Wong, L., Yeh, H., Pai, P., Hsieh, I., Huang, C., Hsieh, Y., Yin, W., Tsai, L., Huang, T., Chen, C., Chiang, F., Ueng, K., Charng, M., Marmor, A., Katz, A., Butnaru, A., Lewis, B., Eldar, M., Rosenhack, S., Elias, N., Koifman, B., Shochat, M., Swissa, M., Zimlichman, R., Bental, T., Weiss, A., Ganam, R., Elias, M., Nseir, W., Oliven, A., Brenner, B., Dayan, M., Pokorney, S, Piccini, J, Stevens, S, Patel, M, Pieper, K, Halperin, J, Breithardt, G, Singer, D, Hankey, G, Hacke, W, Becker, R, Berkowitz, S, Nessel, C, Mahaffey, K, Fox, K, Califf, R, Parati, G, Neurologian yksikkö, and Clinicum

Subjects
Male, Time Factors, medicine.medical_treatment, Administration, Oral, Comorbidity, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, THERAPY, Sudden Cardiac Death, 3124 Neurology and psychiatry, Sudden cardiac death, 0302 clinical medicine, Rivaroxaban, Risk Factors, Cause of Death, Atrial Fibrillation, 80 and over, Medicine, Arrhythmia and Electrophysiology, atrial fibrillation, 030212 general & internal medicine, Stroke, Cause of death, Original Research, CATHETER ABLATION, Aged, 80 and over, DABIGATRAN, Age Factors, Atrial fibrillation, 3. Good health, Intention to Treat Analysis, Treatment Outcome, Mortality, Warfarin, Aged, Anticoagulants, Double-Blind Method, Drug Administration Schedule, Factor Xa Inhibitors, Female, Humans, Multivariate Analysis, Proportional Hazards Models, Risk Assessment, Sex Factors, Cardiology and Cardiovascular Medicine, Administration, medicine.drug, Oral, medicine.medical_specialty, Catheter ablation, Dabigatran, 03 medical and health sciences, RISK-FACTOR, Intensive care medicine, METAANALYSIS, Ischemic Stroke, Intracranial Hemorrhage, Heart Failure, CONGESTIVE-HEART-FAILURE, business.industry, EFFICACY, medicine.disease, warfarin, Emergency medicine, FOLLOW-UP, business
Abstract

Background Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions. Methods and Results In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose‐adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all‐cause mortality in the 14 171 participants in the intention‐to‐treat population. The median age was 73 years, and the mean CHADS 2 score was 3.5. Over 1.9 years of median follow‐up, 1214 (8.6%) patients died. Kaplan–Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all‐cause mortality was observed between the rivaroxaban and warfarin arms ( P =0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33–1.70, P CI 1.51–1.90, P Conclusions In a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 00403767.

Published
2016

6. Cause of Death and Predictors of All‐Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation: Data From ROCKET AF

Author

Pokorney, Sean D., primary, Piccini, Jonathan P., additional, Stevens, Susanna R., additional, Patel, Manesh R., additional, Pieper, Karen S., additional, Halperin, Jonathan L., additional, Breithardt, Günter, additional, Singer, Daniel E., additional, Hankey, Graeme J., additional, Hacke, Werner, additional, Becker, Richard C., additional, Berkowitz, Scott D., additional, Nessel, Christopher C., additional, Mahaffey, Kenneth W., additional, Fox, Keith A. A., additional, Califf, Robert M., additional, Anderson, J., additional, Bedwell, N., additional, Bilsker, M., additional, Bruce, G., additional, Agah, R., additional, DeSantis, M., additional, Eisenberg, S., additional, Flores, A., additional, Herzog, W., additional, Klein, S., additional, Snyder, H., additional, Krueger, S., additional, Almaguer, E., additional, Lavie, E., additional, Lee, C., additional, Mallis, G., additional, Modi, M., additional, Woodworth, G., additional, Niazi, I., additional, Peart, B., additional, Sundaram, S., additional, Snoddy, B., additional, Sotolongo, R., additional, Moloney, J., additional, Vijayaraghavan, K., additional, Whittier, F., additional, Yellen, L., additional, Banerjee, S., additional, Lustgarten, D., additional, Suresh, D., additional, Gelernt, M., additional, Levinson, L., additional, Ghanekar, R., additional, Kneller, G., additional, Hall, C., additional, Fadl, Y., additional, Pirwitz, M., additional, French, W., additional, Mayer, N., additional, Pugeda, J., additional, Steel, K., additional, Mody, F., additional, Malik, A., additional, Chandna, H., additional, Go, A., additional, Emlein, G., additional, Bowden, W., additional, Moscoso, R., additional, Hodson, R., additional, Berk, M., additional, Pan, D., additional, Pappas, J., additional, Orchard, R., additional, Lynchard, G., additional, Vijay, N., additional, Khan, W., additional, El Khadra, M, additional, Antonishen, M., additional, Cucher, F., additional, Staab, M., additional, Zebrack, J., additional, Borromeo, S, additional, Heilman, J., additional, Chaturvedi, S., additional, Makam, S., additional, Turk, S., additional, Hyers, T., additional, Williams, G., additional, Labroo, A., additional, Gill, S., additional, Myears, D., additional, Weinstein, J., additional, Shanes, J., additional, Chandrashekhar, Y., additional, Shah, S., additional, Reiter, W., additional, Logemann, T., additional, Almquist, A., additional, Bhagwat, R., additional, Tak, T., additional, Shen‐Ling, J., additional, Patel, P., additional, Artis, A., additional, Arouni, A., additional, Lauer, M., additional, Kinney, K., additional, Elsen, J., additional, Roan, P., additional, Villafria, R., additional, Sumpter, M., additional, Ip, J., additional, Welka, S., additional, Schifferdecker, B., additional, Sandoval, R., additional, Speirs, S., additional, Jones, A., additional, Haldis, T., additional, Kazmierski, J., additional, Sutherland, J., additional, Dietrich, D., additional, Telfer, E., additional, Berry, J., additional, McElveen, A., additional, Russell, J., additional, Sackett, M., additional, Antonios, N., additional, Smith, D., additional, Vora, K., additional, Kirby, A., additional, Lui, H., additional, Mego, D., additional, Ziada, K., additional, Navas, J., additional, Taussig, A., additional, Koren, M., additional, Vogel, C., additional, Saba, F., additional, Parrott, C., additional, Schneider, R., additional, Shirwany, A., additional, Rubin, M., additional, Treasure, C, additional, Bertolet, B., additional, Chang, M., additional, Langberg, J., additional, Becker, R., additional, Cohen, Y., additional, McGrew, F., additional, White, J., additional, Arzola, F., additional, Zelenka, J., additional, Tannenbaum, A., additional, Fernandes, V., additional, Jamnadas, P., additional, Agamasu, J., additional, Collins, B., additional, Jauch, W., additional, Sasseen, B., additional, Hotchkiss, D., additional, Abadier, R., additional, Osunkoya, A., additional, Schlau, A., additional, Chappel, C., additional, Foster, M., additional, Braun, E., additional, Mostel, E., additional, Capo, J., additional, Ashchi, M., additional, Howard, V., additional, Albirini, A., additional, Burger, A., additional, Rolston, D., additional, Staniloae, C., additional, Bacon, J., additional, Wiseman, A., additional, McGarvey, J, additional, Sonel, A., additional, Hamroff, G., additional, Chang, D., additional, Daboul, N., additional, Broderick, G., additional, Meholick, A., additional, Corbelli, J., additional, Silverman, R., additional, Raffetto, J., additional, Fishberg, R., additional, Georgeson, S., additional, Held, J., additional, Seidner, M., additional, Saint‐Jacques, H., additional, Heitner, J., additional, Kutalek, S., additional, Friedlander, I., additional, Hutchinson, B., additional, Walia, J., additional, Kondo, N., additional, Smiley, N., additional, Blitz, L., additional, Dale, H., additional, Sulman, S., additional, Szulawski, I., additional, Modares, F., additional, Martin, R., additional, Nahhas, A., additional, Renzi, M., additional, Akyea‐Djamson, A., additional, Alfieri, A., additional, Sandhu, J., additional, Voyce, S., additional, Amaram, S., additional, Meyerrose, G., additional, Shoukfeh, M., additional, Lee, F., additional, Villegas, B., additional, Idowu, O., additional, Khera, A., additional, Sam, C., additional, Vo, A., additional, Lieber, I., additional, Smith, T., additional, Awan, N., additional, Tsai, C., additional, Ganim, R., additional, Alzaghrini, G., additional, Pitt, W., additional, Shepherd, A., additional, Tang, S., additional, Stoltz, S., additional, Nelson, W., additional, Cox, S., additional, Meymandi, S., additional, Melucci, M., additional, Thomas, G., additional, Gogia, H., additional, Machell, C., additional, Chandrasekaran, S., additional, Brown, C., additional, Jetty, P., additional, Miller, G., additional, Dykstra, G., additional, Jaffrani, N., additional, Zakhary, B., additional, Caruso, A., additional, Zolty, R., additional, Fox, D., additional, Jacobs, G., additional, Lebenthal, M., additional, Mukherjee, S., additional, Zimetbaum, P., additional, Kingsley, J., additional, Jones, R., additional, Robinson, V., additional, Kenton, D., additional, Usedom, J., additional, Williams, S., additional, Snipes, C., additional, Wilson, V., additional, Hasty, R., additional, Shoemaker, J., additional, Donahue, M., additional, Al‐Saghir, Y., additional, Thomsen, E., additional, Yarows, S., additional, Chastain, S., additional, McLaughlin, P., additional, Wakham, M., additional, Shrestha, D., additional, Simmons, J., additional, Fisher, D., additional, Seymour, Z., additional, Frandsen, B., additional, First, B., additional, Sharpe, C., additional, Popeil, L., additional, Guthrie, R., additional, Hunter, J., additional, Alvarado, O., additional, Sandberg, J., additional, Gutman, N., additional, Belber, A., additional, Arkhipov, M., additional, Ballyzek, M., additional, Baranov, A., additional, Barbarash, O., additional, Barbarich, V., additional, Belenky, D., additional, Berkovich, O., additional, Bokarev, I., additional, Boyarkin, M., additional, Vaniev, S., additional, Volkova, E., additional, Gratsiansky, N., additional, Demin, A., additional, Zadionchenko, V., additional, Zateyshchikov, D., additional, Zrazhevsky, K., additional, Mazaev, V., additional, Martynov, A., additional, Mikhailov, S., additional, Mkrtchian, V., additional, Novozhenov, V., additional, Raskina, T., additional, Rebrov, A., additional, Sanina, N., additional, Simanekov, V., additional, Sitnikova, M., additional, Smolenskaya, O., additional, Stryuk, R., additional, Storozhakov, G., additional, Tankhilevich, B., additional, Tereschenko, S., additional, Khokhlov, A., additional, Khrustalev, O., additional, Chernov, S., additional, Shvarts, Y., additional, Shubik, Y., additional, Shulman, V., additional, Yakushin, S., additional, Bugrova, O., additional, Ivleva, A., additional, Libis, R., additional, Khozyainova, N., additional, Maslov, S., additional, Baranova, E., additional, Sherenkov, A., additional, Libov, I., additional, Lusov, V., additional, Chumakova, G., additional, Kuznetsov, V., additional, Ryamzina, I., additional, Reshetko, O., additional, Boldueva, S., additional, Alekseeva, N., additional, Novikova, T., additional, Dvornikov, V., additional, Idrisova, E., additional, Shostak, N., additional, Yarokhno, N., additional, Tebloev, K., additional, Treshkur, T., additional, Mazurov, V., additional, Loktin, E., additional, Sedavnyh, I., additional, Alexeeva, O., additional, Yakhontova, P., additional, Repin, A., additional, Izmozherova, N., additional, Kostenko, V., additional, Fokin, A., additional, Ketova, G., additional, Kouz, S., additional, Leader, R., additional, Ayala‐Paredes, F., additional, Luton, R., additional, Ma, P., additional, Pandey, S., additional, Pesant, Y., additional, Senior, R., additional, Vertes, G., additional, Bell, A., additional, Crowley, D., additional, Vizel, S., additional, Lasko, B., additional, Landry, D., additional, Berger, L., additional, Heath, J., additional, Bessoudo, R., additional, Ling, M., additional, Tellier, G., additional, Berlingieri, J., additional, Kafka, H., additional, Hill, L., additional, Mazza, G., additional, O'Mahony, W., additional, Chilvers, M., additional, O'Mahony, M., additional, Newman, D., additional, Silagy, S., additional, Heffernan, M., additional, Bennett, M., additional, Bhesania, T., additional, Rockman, G., additional, Ng, K., additional, Kalra, B., additional, Meneses, G., additional, Liang, W., additional, Cheung, M., additional, Kozak, J., additional, Pugen, G., additional, Vavougios, J., additional, Kates, M., additional, Nunes‐Vaz, C., additional, Jaffer, S., additional, Orfi, J., additional, Faiers, A., additional, Chung, C., additional, Felsen, S., additional, Bergman, S., additional, Bernstein, I., additional, Brownscombe, L., additional, Stockdill, J., additional, Silver, E., additional, Ezekiel, D., additional, Jagan, N., additional, Khurana, M., additional, Reisler, H., additional, Goldman, H., additional, Maung, T., additional, Wong, F., additional, Gillis, G., additional, Vexler, R., additional, Goldberg, B., additional, Luterman, M., additional, Gould, D., additional, Coutu, B., additional, Ouellet, A., additional, MacDonald, P., additional, Jones, M., additional, Collette, R., additional, Chong, P., additional, Fargher, T., additional, St‐Maurice, F., additional, Fortin, C., additional, Chehayeb, R., additional, Proulx, G., additional, Roy, R., additional, Liutkus, J., additional, Syan, G., additional, Rupka, D., additional, Lichtenstein, T., additional, Kooy, J., additional, Papastergiou, D., additional, Lubelsky, B., additional, Doyle, W., additional, Rajakumar, A., additional, Cha, J., additional, Choudhry, A., additional, Bhamjee, H., additional, Mawji, A., additional, Durfresne, M., additional, Constance, C., additional, Mutrie, J., additional, Najarali, A., additional, Warren, R., additional, Mucha, M., additional, Borts, D., additional, Nord, P., additional, Carrier, S., additional, Dawood, M., additional, Sabe‐Affaki, G., additional, Archibald, J., additional, Abram, N., additional, Teitelbaum, E., additional, Ebrahim, I., additional, Siebert, R., additional, van Zyl, L., additional, Theron, H., additional, Lloyd, E., additional, Sommers, R., additional, Podgorski, G., additional, Steingo, L., additional, Dalby, A., additional, Bayat, J., additional, Herbst, L., additional, Bester, F., additional, Corbett, C., additional, Bennett, J., additional, Roodt, A., additional, Roux, J., additional, Abelson, M., additional, Mohamed, Z., additional, Nortje, H., additional, Da Silva, A., additional, Nikolaides, K., additional, Liagkas, K., additional, Papasteriadis, E., additional, Achimastos, A., additional, Koliopoulos, N., additional, Trikas, A., additional, Manolis, A., additional, Ruiter, J., additional, Basart, D., additional, Crijns, H., additional, Withagen, A., additional, Janssen, M., additional, Van Langeveld, R, additional, van Gelder, I., additional, Hamer, B., additional, Van Der Heijden, R, additional, Hertzeberger, D., additional, Van Hessen, M, additional, Pieterse, M., additional, Groutars, R., additional, Kuijper, A., additional, De Ruiter, G, additional, van Boven, A., additional, Hoogslag, P., additional, Kragten, H., additional, Thijssen, H., additional, Veldkamp, R., additional, Scavee, C., additional, Heidbuchel, H., additional, Debruyne, P., additional, Deruyter, B., additional, El Ali, H, additional, Goethals, M., additional, Cytryn, R., additional, Striekwold, H., additional, De Wolf, L, additional, Goethals, P., additional, Provenier, F., additional, Hellemans, S., additional, Galinier, M., additional, Coisne, D., additional, Koenig, A., additional, Galley, D., additional, Destrac, S., additional, Leduc, J., additional, Rifai, A., additional, Citron, B., additional, Ellie, E., additional, Fournier, P., additional, Steg, G., additional, Landel, R., additional, Robinson, A., additional, Ziegler, F., additional, Boulliat, J., additional, Zuber, M., additional, Vida, M., additional, Galve Basilio, E., additional, Lopez, M., additional, Íñiguez, C., additional, Iglesias Alonso, L., additional, Cavero Gibanel, M., additional, Olivan Martinez, J., additional, Calvo Iglesias, F., additional, Marco Vera, P., additional, Bruguera Cortada, J., additional, Jaber Houbani, A., additional, Merino, J., additional, Olaz Preciado, F., additional, Balaguer, J., additional, de la Hera Galarza, J, additional, Martinez Rubio, A., additional, Fontcuberta, J., additional, Sotillo Marti, J., additional, Gonzalez Juanatey, J., additional, Del Campo, R., additional, Vivanco, G., additional, Alvarez Garcia, P., additional, Pelayo, M., additional, Lippai, J., additional, Zamolyi, K., additional, Károly, T., additional, Vertes, A., additional, Nagy, A., additional, Kosa, I., additional, Janosi, A., additional, Lupkovics, G., additional, Kalo, E., additional, Forster, T., additional, Kis, E., additional, Tenczer, J., additional, Bereczki, D., additional, Komoly, S., additional, Csanyi, A., additional, Kiss, R., additional, Valikovics, A., additional, Dioszeghy, P., additional, Masini, F., additional, Terrosu, P., additional, Cirrincione, V., additional, Marabotti, C., additional, Cosmi, F., additional, Salvioni, A., additional, Binetti, G., additional, Piovaccari, G., additional, Nassiacos, D., additional, Boriani, G., additional, Calvi, V., additional, De Caterina, R, additional, Pengo, V., additional, Parati, G., additional, Carolei, A., additional, D'Angelo, A., additional, Di Biase, M., additional, Fattore, L., additional, Agnelli, G., additional, Merlini, P., additional, Furlan, M., additional, Rasura, M., additional, Gandolfo, C., additional, Ageno, W., additional, Piovella, F., additional, Micieli, G., additional, Cinteza, M., additional, Fierbinteanu, C., additional, Natase‐Melicovici, D., additional, Ionescu, D., additional, Macarie, C., additional, Nanea, I., additional, Radoi, M., additional, Tatu‐Chitoiu, G., additional, Dragulescu, S., additional, Tudose, A., additional, Militaru, C., additional, Bengus, C., additional, Ungureanu, G., additional, Tau, A., additional, Popa, V., additional, Pirvu, O., additional, Bojinca, M., additional, Sipciu, D., additional, Popescu, M., additional, Chiru, M., additional, Vinereanu, D., additional, Tudoran, M., additional, Cojocaru, T., additional, Vintila, M., additional, Aron, G., additional, Petrascu, O., additional, Bolohan, F., additional, Baumgartner, R., additional, Sekoranja, L., additional, Vojacek, J., additional, Lacnak, B., additional, Kellnerova, I., additional, Dunaj, M., additional, Cihalik, C., additional, Janota, T., additional, Janousek, J., additional, Bouchal, P., additional, Spacek, R., additional, Choi Siruckova, J., additional, Heinc, P., additional, Vojtisek, P., additional, Pirchala, M., additional, Malecha, J., additional, Padour, F., additional, Linhart, A., additional, Mandysova, E., additional, Jandik, J., additional, Zidkova, E., additional, Sipula, D., additional, Ostadal, P., additional, Polasek, R., additional, Stransky, V., additional, Marcinek, G., additional, Rysava, D., additional, Osmancik, P., additional, Huber, K., additional, Drexel, H., additional, Brainin, M., additional, Eichinger‐Hasenauer, S., additional, Lang, W., additional, Pilger, E., additional, Moriarty, A., additional, Hudson, I., additional, Tang, K., additional, Cleland, J., additional, MacWalter, R., additional, Cooke, J., additional, McInnes, G., additional, Durairaj, R., additional, MacLeod, M., additional, Murdoch, D., additional, Kadr, H., additional, Lip, G., additional, Andrews, R., additional, Hunt, B., additional, Jackson, P., additional, Roffe, C., additional, Syed, H., additional, Bath, P., additional, Coyle, J., additional, Kelly, D., additional, Stender, S., additional, TorpPedersen, C., additional, Tuxen, C., additional, Jensen, G., additional, Melchior, T., additional, Klarlund, K., additional, Dahlstrom, C., additional, Nielsen, T., additional, Nielsen, E., additional, Bronnum‐Schou, J., additional, Sykulski, R., additional, Blomstrom, P., additional, Lindholm, C., additional, Wallen, T., additional, Nilsson, C., additional, Bertholds, E., additional, Carlsater, J., additional, Sirnes, P., additional, Elle, S., additional, Risberg, K., additional, Furuseth, K., additional, Skag, A., additional, Hoivik, H., additional, Landmark, N., additional, Kjaernli, T., additional, Berg‐Johansen, J., additional, Gradek, G., additional, Drzewiecki, A., additional, Pluta, W., additional, Szwed, H., additional, Trusz‐Gluza, M., additional, Ogorek, M., additional, Loboz‐Grudzien, K., additional, Ruszkowski, P., additional, Sciborski, R., additional, Kopaczewski, J., additional, Jaworska, K., additional, Kubica, J., additional, Opolski, G., additional, Hoffman, A., additional, Krzciuk, M., additional, Sinkiewicz, W., additional, Piotrowski, W., additional, Kolodziej, P., additional, Goszczynska, M., additional, Rynkiewicz, A., additional, Chojnowska, L., additional, Lewczuk, J., additional, Biedrzycka, M., additional, Piepiorka, M., additional, Kowal, J., additional, Karczmarczyk, A., additional, Pruszczyk, P., additional, Tendera, M., additional, Gaciong, Z., additional, Krzeminska‐Pakula, M., additional, Kornacewicz‐Jach, Z., additional, Kania, G., additional, Brachmann, J., additional, Lawall, H., additional, Guelker, H., additional, Spitzer, S., additional, MoebiusWinkler, S., additional, Dempfle, C., additional, Bode, C., additional, Darius, H., additional, Genth‐Zotz, S., additional, Sommer, S., additional, Roehnisch, J., additional, Strasser, R., additional, Daenschel, W., additional, Schwencke, C., additional, vom Dahl, J, additional, Meuser, M., additional, Behrens‐Spandau, S., additional, Behrens‐Humbold, S., additional, Muegge, A., additional, Schoen, N., additional, Grooterhorst, P., additional, Ebert, H., additional, Kraemer, A., additional, Kohler, B., additional, Taggeselle, J., additional, Claus, G., additional, Sarnighausen, H., additional, Al‐Zoebi, A., additional, Schroeder, T., additional, Weissbrodt, M., additional, Lange, R., additional, Gabelmann, M., additional, Kaeaeb, S., additional, Doerr, M., additional, Boscher, D., additional, Bosch, R., additional, Sonntag, F., additional, Bauknecht, C., additional, Omran, H., additional, Leicht, M., additional, Veltkamp, R., additional, Hohensee, H., additional, Dieckmann, H., additional, Winkelmann, B., additional, Bernhardt, P., additional, Schnabel, A., additional, Kadel, C., additional, Proskynitopoulos, N., additional, Seidl, K., additional, Schellong, S., additional, Rios, C., additional, Guevara, C., additional, Coloma, R., additional, Torrejon, H., additional, Parra Galvan, J., additional, Drago Silva, J., additional, Gallegos, J., additional, Mendoza, A., additional, Negron, S., additional, Watanabe, L., additional, Medina, F., additional, Virgen Carrilo, L., additional, Alvarez Lopez, H., additional, Rodriguez, I., additional, Leiva‐Pons, J., additional, Baños Velasco, A., additional, Villarreal‐Careaga, J., additional, De los Rios, M, additional, Gamba, M., additional, Llamas Esperon, G., additional, Villeda, E., additional, Ahuad Guerrero, A., additional, Alvariqueta, A., additional, Amuchastegui, M., additional, Bluguermann, J., additional, Caime, G., additional, Cuneo, C., additional, Gabito, A., additional, Garcia Brasca, D., additional, Hominal, M., additional, Jure, H., additional, Luquez, H., additional, Montana, O., additional, Piskorz, D., additional, Listorti, S., additional, Serra, J., additional, Sessa, H., additional, Varini, S., additional, Vita, N., additional, Aiub, J., additional, MacKinnon, I., additional, Chekherdemian, S., additional, Castagnino, J., additional, Cimbaro Canella, J., additional, Sgammini, H., additional, Escudero, A., additional, Albina, G., additional, Rapallo, C., additional, Balparda, C., additional, Chahin, M., additional, Fuentealba, V., additional, Riccitelli, M., additional, Casabe, J., additional, Lobo Marquez, L., additional, Kevorkian, R., additional, Cuadrado, J., additional, Dran, R., additional, Muntaner, J., additional, Gonzalez, M., additional, Cartasegna, L., additional, Hasbani, E., additional, Hrabar, A., additional, Sanchez, A., additional, Vogel, D., additional, Hershson, A., additional, Avezum, A., additional, Jaber, J., additional, Ernesto Leaes, P., additional, Bozza, A., additional, Lorga Filho, A., additional, Pimentel Filho, P., additional, Moura Jorge, J., additional, Maia, L., additional, Manenti, E., additional, D'Aurea Mora, R, additional, de Souza Neto, J, additional, Precoma, D., additional, Rabelo, A., additional, Rocha, J., additional, Rossi, P., additional, Kerr Saraiva, J., additional, Zimerman, L., additional, Bodanese, L., additional, Figueiredo, E., additional, de Souza, W. Sebba Barroso, additional, Braga, J., additional, Alessi, S., additional, Gomes, M., additional, Silva, R., additional, Teixeira, M., additional, Costa, F., additional, Motta, M., additional, Sobral Filho, D., additional, Reis, G., additional, Garbelini, B, additional, Zimmermann, S., additional, Pereira Barretto, A., additional, Dohmann, H., additional, Barreto Filho, J., additional, Ghorayeb, N., additional, Borelli, F., additional, Rossi dos Santos, F., additional, Lopes Prudente, M., additional, Vejar, M., additional, Lanas, F., additional, Del Pino, R., additional, Potthoff, S., additional, Charme, G., additional, Aguirre, A., additional, Saldana, A., additional, Garces, E., additional, Bunster, L., additional, Figueroa, H., additional, Olivares, C., additional, Raffo, C., additional, Vergara, E., additional, Sepulveda, P., additional, Jano, G., additional, Morales Alvarado, J., additional, Suarez, R., additional, Urina, M., additional, Perez, G., additional, Quintero, A., additional, Pava, L., additional, Botero Lopez, R., additional, Luengas, C., additional, Hernandez, E., additional, Sanchez, D., additional, Poveda, C., additional, Coronel, J., additional, Beltran, R., additional, Jaramillo, C., additional, Pardo, J., additional, Ponte Negretti, C., additional, Isea, J., additional, Vergara, G., additional, Morr, I., additional, Sim, K., additional, Wan Ahmad, W., additional, Yusof, Z., additional, Rosman, A., additional, Basri, H, additional, Thompson, P., additional, Jeffery, I., additional, Purnell, P., additional, Roberts‐Thomson, P., additional, Heddle, W., additional, Waites, J., additional, Walters, D., additional, Amerena, J., additional, Challa, P., additional, Karrasch, J., additional, Lowy, A., additional, Fitzpatrick, D., additional, Parsons, M., additional, Phan, T., additional, Bladin, C., additional, Donnan, G., additional, Aroney, G., additional, Gerraty, R., additional, Anderson, C., additional, Blombery, P., additional, Martin, P., additional, Tissa Wijeratne, K., additional, Cross, D., additional, Crimmins, D., additional, Packham, D., additional, Jackson, D., additional, Chua, W., additional, Merino, R., additional, Magno, M., additional, Tirador, L., additional, Batalla, E., additional, Manalo, C., additional, Uy, N., additional, Ebo, G., additional, Reyes, E., additional, Bernan, A., additional, Richards, M., additional, Hart, H., additional, Mann, S., additional, Fisher, R., additional, Stewart, R., additional, Wilkins, G., additional, Barber, A., additional, Tan, R., additional, Ong, H., additional, Singh, R., additional, Sukonthasarn, A., additional, Tanomsup, S., additional, Krittayaphong, R., additional, Piamsomboon, C., additional, Piyayotai, D., additional, Sunsaneewitayakul, B., additional, Baek, S., additional, Seo, H., additional, Rim, S., additional, Kim, C., additional, Kim, K., additional, Ryu, K., additional, Jo, S., additional, Tahk, S., additional, Lee, H., additional, Kim, Y., additional, Shin, D., additional, Choi, Y., additional, Chung, N., additional, Namgung, J., additional, Hong, T., additional, Shin, W., additional, Jin, S., additional, Yan, X., additional, Fu, G., additional, Lu, G., additional, Yang, K., additional, Xu, D., additional, Chen, J., additional, Liu, J., additional, Wu, S., additional, Song, J., additional, Liao, Y., additional, Xu, B., additional, Li, Z., additional, Ma, S., additional, Yin, Y., additional, Zhao, Y., additional, Hu, D., additional, Ma, C., additional, Ma, J., additional, Sun, J., additional, Li, H., additional, Hong, X., additional, Yu, B., additional, Lu, Q., additional, Yang, J., additional, Wu, Z., additional, Li, Y., additional, Huang, Y., additional, Wang, Y., additional, Liu, M., additional, Cheng, Y., additional, Yang, T., additional, Chen, K., additional, Wang, H., additional, Yuan, Z., additional, Wang, J., additional, Zeng, Z., additional, Chen, Y., additional, Yavuzgil, O., additional, Kozan, O., additional, Etemoglu, M., additional, Diker, E., additional, Belgi, A., additional, Ceyhan, C., additional, Cin, V., additional, Yilmaz, O., additional, Ata, N., additional, Altunkeser, B., additional, Agacdiken Agir, A., additional, Karadede, A., additional, Topsakal, R., additional, Gulati, R., additional, Madhavan, A., additional, Jain, S., additional, Oomman, A., additional, Janorkar, S., additional, Kumar, P., additional, Madhukar Naik, A., additional, Thacker, H., additional, Rajasekhar, V., additional, Reddy, R., additional, Keshavamurthy, C., additional, Jain, P., additional, Gowdappa, B., additional, Gadkari, M., additional, Abhyankar, A., additional, Ramesh Babu, B., additional, Vydianathan, P., additional, Sinha, S., additional, Garg, N., additional, Rao, S., additional, Gautam, P., additional, Chockalingam, K., additional, Kumbla, M., additional, Panwar, R., additional, Banker, D., additional, Kaste, M., additional, Jäkälä, P., additional, Roine, R., additional, Mihov, A., additional, Raev, D., additional, Yordanova, V., additional, Dimitrova, S., additional, Benov, H., additional, Tsanova, V., additional, Kyolean, M., additional, Marchev, S., additional, Stoikov, A., additional, Zdravkov, N., additional, Ramshev, K., additional, Krastev, A., additional, Stamenova, P., additional, Angelova, I., additional, Pencheva, G., additional, Grigorova, V., additional, Petrauskiene, B., additional, Skripkauskiene, I., additional, Raugaliene, R., additional, Norkiene, S., additional, Mazutavicius, R., additional, Kavoliuniene, A., additional, Aidietiene, S., additional, Aganauskiene, J., additional, Dailydkiene, A., additional, Marcinkeviciene, J., additional, Grigoniene, L., additional, Anusauskiene, J., additional, Kavaliauskiene, R., additional, Lizogub, V., additional, Rudenko, L., additional, Tseluyko, V., additional, Voronkov, L., additional, Sychov, O., additional, Svyshchenko, Y., additional, Sirenko, Y., additional, Serkova, V., additional, Seredyuk, N., additional, Pertseva, T., additional, Netyazhenko, V., additional, Lishnevska, V., additional, Kupchynska, O., additional, Koval, O., additional, Koshukova, G., additional, Karpenko, O., additional, Grishyna, O., additional, Faynyk, A., additional, Dzyak, G., additional, Dyadyk, O., additional, Yena, L., additional, Volkov, V., additional, Rudyk, I., additional, Kopytsya, M., additional, Kononenko, L., additional, Amosova, K., additional, Zhurba, S., additional, Kazimirko, V., additional, Iuzkiv, I., additional, Shershnyova, O., additional, Khomazyuk, T., additional, Batushkin, V., additional, Vykhovanyuk, I., additional, Popik, G., additional, Skrebkov, V., additional, Skurtov, A., additional, Mishchenko, T., additional, Lytvynenko, N., additional, Sokolova, L., additional, Vatutin, M., additional, Shved, M., additional, Rebrov, B., additional, Kadina, L., additional, Vajda, M., additional, Ursol, G., additional, Zheleznyy, V., additional, Vysochanska, T., additional, Gozhenko, A., additional, Fan, K., additional, Ho, D., additional, Tse, H., additional, Yu, C., additional, Wong, L., additional, Yeh, H., additional, Pai, P., additional, Hsieh, I., additional, Huang, C., additional, Hsieh, Y., additional, Yin, W., additional, Tsai, L., additional, Huang, T., additional, Chen, C., additional, Chiang, F., additional, Ueng, K., additional, Charng, M., additional, Marmor, A., additional, Katz, A., additional, Butnaru, A., additional, Lewis, B., additional, Eldar, M., additional, Rosenhack, S., additional, Elias, N., additional, Koifman, B., additional, Shochat, M., additional, Swissa, M., additional, Zimlichman, R., additional, Bental, T., additional, Weiss, A., additional, Ganam, R., additional, Elias, M., additional, Nseir, W., additional, Oliven, A., additional, Brenner, B., additional, and Dayan, M., additional

Published
2016
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8. Intravenous thrombolysis in nonagenarians with ischemic stroke

Author

Sarikaya, H, Arnold, M, Engelter, S T, Lyrer, P A, Michel, P, Odier, C, Weder, B, Tettenborn, B, Mueller, F, Sekoranja, L, Sztajzel, R, Ballinari, P, Mattle, H P, Baumgartner, R W, Sarikaya, H, Arnold, M, Engelter, S T, Lyrer, P A, Michel, P, Odier, C, Weder, B, Tettenborn, B, Mueller, F, Sekoranja, L, Sztajzel, R, Ballinari, P, Mattle, H P, and Baumgartner, R W

Abstract

BACKGROUND AND PURPOSE: Demographic changes will result in a rapid increase of patients age ≥90 years (nonagenarians), but little is known about outcomes in these patients after intravenous thrombolysis (IVT) for acute ischemic stroke. We aimed to assess safety and functional outcome in nonagenarians treated with IVT and to compare the outcomes with those of patients age 80 to 89 years (octogenarians). METHODS: We analyzed prospectively collected data of 284 consecutive stroke patients age ≥80 years treated with IVT in 7 Swiss stroke units. Presenting characteristics, favorable outcome (modified Rankin scale [mRS] 0 or 1), mortality at 3 months, and symptomatic intracranial hemorrhage (SICH) using the National Institute of Neurological Disorders and Stroke (NINDS) and Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) criteria were compared between nonagenarians and octogenarians. RESULTS: As compared with octogenarians (n=238; mean age, 83 years), nonagenarians (n=46; mean age, 92 years) were more often women (70% versus 54%; P=0.046) and had lower systolic blood pressure (161 mm Hg versus 172 mm Hg; P=0.035). Patients age ≥90 years less often had a favorable outcome and had a higher incidence of mortality than did patients age 80 to 89 years (14.3% versus 30.2%; P=0.034; and 45.2% versus 22.1%; P=0.002; respectively), while more nonagenarians than octogenarians experienced a SICH (SICH(NINDS), 13.3% versus 5.9%; P=0.106; SICH(SITS-MOST), 13.3% versus 4.7%; P=0.037). Multivariate adjustment identified age ≥90 years as an independent predictor of mortality (P=0.017). CONCLUSIONS: Our study suggests less favorable outcomes in nonagenarians as compared with octogenarians after IVT for ischemic stroke, and it demands a careful selection for treatment, unless randomized controlled trials yield more evidence for IVT in very old stroke patients.

Published
2011

12. Neuro-imaging of cerebral ischemic stroke

Author

Lövblad, K.O., primary, Altrichter, S., additional, Viallon, M., additional, Sztajzel, R., additional, Delavelle, J., additional, Vargas, M.I., additional, El-Koussy, M., additional, Federspiel, A., additional, and Sekoranja, L., additional

Published
2008
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13. Thrombolysis in stroke patients aged 80 years and older: Swiss survey of IV thrombolysis

Author

Engelter, S. T., primary, Reichhart, M., additional, Sekoranja, L., additional, Georgiadis, D., additional, Baumann, A., additional, Weder, B., additional, Muller, F., additional, Luthy, R., additional, Arnold, M., additional, Michel, P., additional, Mattle, H. P., additional, Tettenborn, B., additional, Hungerbuhler, H. J., additional, Baumgartner, R. W., additional, Sztajzel, R., additional, Bogousslavsky, J., additional, and Lyrer, P. A., additional

Published
2005
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18. White matter lesions in watershed territories studied with MRI and parenchymography: a comparative study

Author

Minkner, K., Lovblad, K., Yilmaz, H., Alimenti, A., Sekoranja, L., Delavelle, J., Sztajzel, R., Rüfenacht, D., Minkner, K., Lovblad, K., Yilmaz, H., Alimenti, A., Sekoranja, L., Delavelle, J., Sztajzel, R., and Rüfenacht, D.

Abstract

Brain aging affects an increasing segment of the population and the role of chronic cerebrovascular disease is considered to be one of the main parameters involved. For this purpose we compared retrospectively MRI data with digitized subtraction angiography (DSA) data in a group of 50 patients focusing onto the watershed area of the carotid artery vascular territories. In order to evaluate the presence of white matter lesions (WML) in the hemispheric watershed areas, coronal fluid-attenuated inversion-recovery or axial T2 weighted MRI images of patients with symptomatic cerebrovascular insufficiency areas were compared with the capillary phase of DSA studies in anterior-posterior projection. Presence of cerebrovascular occlusive disease was evaluated on DSA using North American symptomatic carotid endarterectomy trial criteria and including evaluation of collateral vascular supply. Pathological MRI findings in the region of the watershed territories correlated overall in 66% of cases with a defect or delayed filling on DSA. In the case of asymmetrical MRI findings, there was a pathological finding of the capillary phase in the watershed area in 92% of DSA studies. Hypoperfusion in the capillary phase of the watershed area as seen on DSA correlated with the stenosis degree of the concerned carotid artery. Our findings suggest that asymmetrical findings of WML in the watershed areas as seen on MRI are caused by hemodynamic effect and a differentiation between small vessel disease and a consequence of distant stenosis may be possible under such conditions

20. A palpable source of stroke.

Author

Mégevand P, Vincenti GM, Carballo D, Bally J, Pereira VM, Lovblad KO, Poglia D, Müller H, Sekoranja L, Mégevand, Pierre, Vincenti, Gabriella M, Carballo, David, Bally, Julien, Pereira, Vitor Mendes, Lovblad, Karl-Olof, Poglia, Davide, Müller, Hajo, and Sekoranja, Lucka

Published
2011
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21. Benefits of exercise for premenstrual syndrome: A review.

Author

Bianchi-Demicheli, F., Petignat, P., and Sekoranja, L.

Subjects
*PREMENSTRUAL syndrome, *EXERCISE, *AEROBIC exercises, *PHYSICAL fitness, *MENSTRUATION disorders
Abstract

Introduction: Premenstrual syndrome (PMS) is defined as a recurrent luteal-phase condition characterised by physical, psychological, and behavioural changes of sufficient severity to result in deterioration of interpersonal relationships and normal activity. Several treatments appear to be effective. Among these are increased physical activity, dietary change, mineral salt supplementation, ovulation inhibitors, and some anxiolytic drugs. Objective: Review of the literature to evaluate the effects of exercise on PMS. Methods: A MEDLINE/EMBASE search for all studies published between 1970 and 2003 was performed. Results: Three prospective studies were included. The largest study reported significant differences between the exercise (n=97) and the non-exercise group (n=159). The results revealed a significant positive effect of exercise on negative mood states and physical symptoms. In the second study (n=15), the exercisers experienced decreases in physical and emotional symptoms over time with no changes in the non-exercise group (n=6). The third study (n=23) evaluated the effects of aerobic exercise and strength training on premenstrual symptoms. There was a general improvement in several premenstrual symptoms, particularly in depressed mood. Conclusions: The limited data available on exercise and PMS show a significant improvement in the symptomatology of the disorder and suggest a benefit from regular exercise. Aerobic exercise should be recommended as first-line therapy because of the large number of other health benefits. However, the impact of exercise on PMS needs to be assessed in greater detail with rigorous methodology to draw firm conclusions. [ABSTRACT FROM AUTHOR]

Published
2004

22. A misguided lead.

Author

Burri H and Sekoranja L

Subjects
Aged, Foreign-Body Migration diagnostic imaging, Foreign-Body Migration therapy, Humans, Male, Medical Errors, Radiography, Foreign-Body Migration complications, Ischemic Attack, Transient etiology, Pacemaker, Artificial adverse effects
Published
2015
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23. Fingolimod in a patient with Wolff-Parkinson-White syndrome.

Author

Huys AC, Lalive PH, and Sekoranja L

Subjects
Adult, Electrocardiography, Female, Fingolimod Hydrochloride, Humans, Immunosuppressive Agents adverse effects, Multiple Sclerosis, Relapsing-Remitting complications, Multiple Sclerosis, Relapsing-Remitting diagnosis, Propylene Glycols adverse effects, Sphingosine adverse effects, Sphingosine therapeutic use, Treatment Outcome, Wolff-Parkinson-White Syndrome complications, Wolff-Parkinson-White Syndrome physiopathology, Heart Rate drug effects, Immunosuppressive Agents therapeutic use, Multiple Sclerosis, Relapsing-Remitting drug therapy, Propylene Glycols therapeutic use, Sphingosine analogs & derivatives, Wolff-Parkinson-White Syndrome diagnosis
Published
2014
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24. [Sexuality, heart and chocolate].

Author

Bianchi-Demicheli F, Sekoranja L, and Pechère-Bertschi A

Subjects
Aphrodisiacs chemistry, Female, Flavonoids isolation & purification, Flavonoids pharmacology, Humans, Male, Reproductive Health, Sexuality drug effects, Aphrodisiacs pharmacology, Cacao chemistry, Candy, Sexuality psychology
Abstract

All along the history, many kinds of magic and aphrodisiac properties were attributed to the chocolate. Because of the presence of certain active substances, cacao and chocolate are supposed to have some potentially beneficial effects on human health, particularly on cardiovascular system. Containing flavoniods, cacao and its products have antioxidant, anti-inflammatory, anti-atherogenic, anti-thrombotic, antihypertensive and neuroprotective effects, as well as influence on insulin sensitivity, vascular endothelial function, and activation of nitric oxide. Other molecules, like methyxantin, biogenic amines and cannabinoid-like fatty acids, may have a psychoactive action. Synergic effect of all these substances could have a positive direct and indirect influence on sexual health and function. Nevertheless, randomized studies are needed to confirm these hypotheses and to elaborate recommendations about cacao consumption.

Published
2013

25. Diagnostic accuracy of pocket-size handheld echocardiographs used by cardiologists in the acute care setting.

Author

Testuz A, Müller H, Keller PF, Meyer P, Stampfli T, Sekoranja L, Vuille C, and Burri H

Subjects
Cardiology trends, Echocardiography instrumentation, Echocardiography, Doppler methods, Emergency Service, Hospital, Equipment Design, Heart Failure diagnosis, Humans, Miniaturization, Pericardial Effusion diagnosis, Point-of-Care Systems, Predictive Value of Tests, Reproducibility of Results, Sensitivity and Specificity, Severity of Illness Index, Aortic Valve diagnostic imaging, Echocardiography, Doppler instrumentation, Heart Failure diagnostic imaging, Mitral Valve diagnostic imaging, Pericardial Effusion diagnostic imaging, Tricuspid Valve diagnostic imaging
Abstract

Aims: Pocket-size echographs may be useful for bedside diagnosis in acute cardiac care, but their diagnostic accuracy in this setting has not been well tested. Our aim was to evaluate this tool in patients requiring an urgent echocardiogram., Methods: Trained cardiologists performed echocardiograms with a pocket-size echograph (Vscan) in consecutive patients requiring urgent echocardiography. The exams were then compared in a blinded manner with echocardiograms performed with a high-end standard echocardiograph., Results: A total of 104 patients were studied. There was an excellent agreement between the Vscan and the high-end echocardiograph for the left ventricular systolic function and pericardial effusion (Kappa: 0.89 and 0.81, respectively), and the agreement was good or moderate for evaluating the aortic, mitral, and tricuspid valve function and the left ventricular size (Kappa: 0.55-0.66). Visualization of the Vscan images in full-screen format on a PC did not in general confer added value., Conclusion: The Vscan used by a trained cardiologist has good diagnostic accuracy in the emergency setting compared with a high-end echocardiograph, despite small screen size and lack of pulse-wave and continuous Doppler.

Published
2013
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26. Symptomatic intracranial hemorrhage after stroke thrombolysis: the SEDAN score.

Author

Strbian D, Engelter S, Michel P, Meretoja A, Sekoranja L, Ahlhelm FJ, Mustanoja S, Kuzmanovic I, Sairanen T, Forss N, Cordier M, Lyrer P, Kaste M, and Tatlisumak T

Subjects
Aged, Aged, 80 and over, Area Under Curve, Cohort Studies, Female, Humans, Intracranial Hemorrhages chemically induced, Male, Middle Aged, ROC Curve, Risk Factors, Stroke drug therapy, Intracranial Hemorrhages epidemiology, Stroke complications, Thrombolytic Therapy adverse effects
Abstract

Objective: A study was undertaken to develop a score for assessing risk for symptomatic intracranial hemorrhage (sICH) in ischemic stroke patients treated with intravenous (IV) thrombolysis., Methods: The derivation cohort comprised 974 ischemic stroke patients treated (1995-2008) with IV thrombolysis at the Helsinki University Central Hospital. The predictive value of parameters associated with sICH (European Cooperative Acute Stroke Study II) was evaluated, and we developed our score according to the magnitude of logistic regression coefficients. We calculated absolute risks and likelihood ratios of sICH per increasing score points. The score was validated in 828 patients from 3 Swiss cohorts (Lausanne, Basel, and Geneva). Performance of the score was tested with area under a receiver operating characteristic curve (AUC-ROC)., Results: Our SEDAN score (0 to 6 points) comprises baseline blood Sugar (glucose; 8.1-12.0 mmol/l [145-216 mg/dl] = 1; >12.0 mmol/l [>216 mg/dl] = 2), Early infarct signs (yes = 1) and (hyper)Dense cerebral artery sign (yes = 1) on admission computed tomography scan, Age (>75 years = 1), and NIH Stroke Scale on admission (≥10 = 1). Absolute risk for sICH in the derivation cohort was: 1.4%, 2.9%, 8.5%, 12.2%, 21.7%, and 33.3% for 0, 1, 2, 3, 4, and 5 score points, respectively. In the validation cohort, absolute risks were similar (1.0%, 3.5%, 5.1%, 9.2%, 16.9%, and 27.8%, respectively). AUC-ROC was 0.77 (0.71-0.83; p < 0.001)., Interpretation: Our SEDAN score reliably assessed risk for sICH in IV thrombolysis-treated patients with anterior- and posterior circulation ischemic stroke, and it can support clinical decision making in high-risk patients. External validation of the score supports its generalization., (Copyright © 2012 American Neurological Association.)

Published
2012
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27. Intravenous thrombolysis in nonagenarians with ischemic stroke.

Author

Sarikaya H, Arnold M, Engelter ST, Lyrer PA, Michel P, Odier C, Weder B, Tettenborn B, Mueller F, Sekoranja L, Sztajzel R, Ballinari P, Mattle HP, and Baumgartner RW

Subjects
Age Factors, Aged, 80 and over, Blood Pressure, Cohort Studies, Female, Humans, Male, Multivariate Analysis, Treatment Outcome, Brain Ischemia drug therapy, Fibrinolytic Agents administration & dosage, Injections, Intravenous methods, Stroke drug therapy, Thrombolytic Therapy methods
Abstract

Background and Purpose: Demographic changes will result in a rapid increase of patients age ≥90 years (nonagenarians), but little is known about outcomes in these patients after intravenous thrombolysis (IVT) for acute ischemic stroke. We aimed to assess safety and functional outcome in nonagenarians treated with IVT and to compare the outcomes with those of patients age 80 to 89 years (octogenarians)., Methods: We analyzed prospectively collected data of 284 consecutive stroke patients age ≥80 years treated with IVT in 7 Swiss stroke units. Presenting characteristics, favorable outcome (modified Rankin scale [mRS] 0 or 1), mortality at 3 months, and symptomatic intracranial hemorrhage (SICH) using the National Institute of Neurological Disorders and Stroke (NINDS) and Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) criteria were compared between nonagenarians and octogenarians., Results: As compared with octogenarians (n=238; mean age, 83 years), nonagenarians (n=46; mean age, 92 years) were more often women (70% versus 54%; P=0.046) and had lower systolic blood pressure (161 mm Hg versus 172 mm Hg; P=0.035). Patients age ≥90 years less often had a favorable outcome and had a higher incidence of mortality than did patients age 80 to 89 years (14.3% versus 30.2%; P=0.034; and 45.2% versus 22.1%; P=0.002; respectively), while more nonagenarians than octogenarians experienced a SICH (SICH(NINDS), 13.3% versus 5.9%; P=0.106; SICH(SITS-MOST), 13.3% versus 4.7%; P=0.037). Multivariate adjustment identified age ≥90 years as an independent predictor of mortality (P=0.017)., Conclusions: Our study suggests less favorable outcomes in nonagenarians as compared with octogenarians after IVT for ischemic stroke, and it demands a careful selection for treatment, unless randomized controlled trials yield more evidence for IVT in very old stroke patients.

Published
2011
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28. Stroke severity and residual flow determined by transcranial colour-coded ultrasound (TCCD) predict recanalization and clinical outcome during thrombolysis.

Author

Bonvin C, Momjian-Mayor I, Sekoranja L, Lövblad KO, Altrichter S, Yilmaz H, Pereira VM, Loulidi J, Comelli M, Burkhard PR, and Sztajzel RF

Subjects
Aged, Angiography, Digital Subtraction, Brain Ischemia diagnostic imaging, Brain Ischemia physiopathology, Brain Ischemia therapy, Cerebral Angiography, Endpoint Determination, Female, Fibrinolytic Agents administration & dosage, Fibrinolytic Agents adverse effects, Fibrinolytic Agents therapeutic use, Humans, Logistic Models, Male, Middle Aged, Middle Cerebral Artery diagnostic imaging, Predictive Value of Tests, Stroke physiopathology, Tomography, X-Ray Computed, Treatment Outcome, Ultrasonography, Doppler, Color, Stroke diagnostic imaging, Stroke therapy, Thrombolytic Therapy
Abstract

Objective: To determine clinical, neuroradiological or ultrasonographic parameters associated with early recanalization and clinical outcome in patients treated with intravenous (IVT) or combined intravenous-intra-arterial (IVT-IAT) thrombolysis., Methods: From 2004 to 2007, all consecutive ischemic stroke patients admitted within a 3-hour window and who underwent thrombolytic therapy were reviewed. Degree of occlusion and recanalization during IVT was assessed by transcranial color-coded ultrasound (TCCD) using Thrombolysis In Brain Ischemia (TIBI) classification. According to our protocol, in case of recanalization (modification of TIBI grade > or = 1) after 30 min of IVT, the procedure was maintained over 1h. When TIBI grade failed to improve after 30 min, IVT was discontinued and IAT performed using the remaining tPA dose. The study endpoints were early recanalization defined as achievement of TIBI > or = 3 grade at 30 min (for this endpoint all patients presenting a TIBI grade 3 at admission were excluded from the model) and clinical outcome at 3 months assessed by the modified Rankin scale., Results: Seventy-one patients underwent either IVT (n=41) or IVT-IAT (n=30). Among all the variables, NIHSS and TIBI grades assessed at baseline were the only independent factors associated with early recanalization and clinical outcome. Furthermore, the combination of these two parameters was superior in predicting early recanalization and outcome to either one of them taken separately. An inverse correlation between NIHSS, TIBI grades and early recanalization was found: the lower the TIBI grade, the lower the probability to recanalize for any given NIHSS., Conclusion: Baseline NIHSS and TIBI grades were the only independent factors associated with early recanalization and clinical outcome. The combination of these two parameters was superior to each single variable in predicting the study endpoints and could therefore be used to improve the selection of patients for IVT or more aggressive therapies., (2010 Elsevier B.V. All rights reserved.)

Published
2010
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29. Combined use of pulsed arterial spin-labeling and susceptibility-weighted imaging in stroke at 3T.

Author

Viallon M, Altrichter S, Pereira VM, Nguyen D, Sekoranja L, Federspiel A, Kulcsar Z, Sztajzel R, Ouared R, Bonvin C, Pfeuffer J, and Lövblad KO

Subjects
Aged, Aged, 80 and over, Angiography methods, Diagnostic Imaging classification, Diffusion Magnetic Resonance Imaging methods, Female, Humans, Male, Middle Aged, Spin Labels, Tomography, X-Ray Computed methods, Brain Mapping, Cerebrovascular Circulation physiology, Diagnostic Imaging methods, Stroke diagnosis
Abstract

Background and Purpose: In acute stroke it is no longer sufficient to detect simply ischemia, but also to try to evaluate reperfusion/recanalization status and predict eventual hemorrhagic transformation. Arterial spin labeling (ASL) perfusion may have advantages over contrast-enhanced perfusion-weighted imaging (cePWI), and susceptibility weighted imaging (SWI) has an intrinsic sensitivity to paramagnetic effects in addition to its ability to detect small areas of bleeding and hemorrhage. We want to determine here if their combined use in acute stroke and stroke follow-up at 3T could bring new insight into the diagnosis and prognosis of stroke leading to eventual improved patient management., Methods: We prospectively examined 41 patients admitted for acute stroke (NIHSS >1). Early imaging was performed between 1 h and 2 weeks. The imaging protocol included ASL, cePWI, SWI, T2 and diffusion tensor imaging (DTI), in addition to standard stroke protocol., Results: We saw four kinds of imaging patterns based on ASL and SWI: patients with either hypoperfusion and hyperperfusion on ASL with or without changes on SWI. Hyperperfusion was observed on ASL in 12/41 cases, with hyperperfusion status that was not evident on conventional cePWI images. Signs of hemorrhage or blood-brain barrier breakdown were visible on SWI in 15/41 cases, not always resulting in poor outcome (2/15 were scored mRS = 0-6). Early SWI changes, together with hypoperfusion, were associated with the occurrence of hemorrhage. Hyperperfusion on ASL, even when associated with hemorrhage detected on SWI, resulted in good outcome. Hyperperfusion predicted a better outcome than hypoperfusion (p = 0.0148)., Conclusions: ASL is able to detect acute-stage hyperperfusion corresponding to luxury perfusion previously reported by PET studies. The presence of hyperperfusion on ASL-type perfusion seems indicative of reperfusion/collateral flow that is protective of hemorrhagic transformation and a marker of favorable tissue outcome. The combination of hypoperfusion and changes on SWI seems on the other hand to predict hemorrhage and/or poor outcome., (Copyright © 2010 S. Karger AG, Basel.)

Published
2010
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30. Factors influencing emergency delays in acute stroke management.

Author

Sekoranja L, Griesser AC, Wagner G, Njamnshi AK, Temperli P, Herrmann FR, Grandjean R, Niquille M, Vermeulen B, Rutschmann OT, Sarasin F, and Sztajzel R

Subjects
Acute Disease, Aged, Female, Humans, Male, Physicians, Referral and Consultation, Surveys and Questionnaires, Time Factors, Transportation of Patients, Emergencies, Patient Admission, Stroke therapy
Abstract

Objective: Early admission to hospital with minimum delay is a prerequisite for successful management of acute stroke. We sought to determine our local pre- and in-hospital factors influencing this delay., Patients and Methods: Time from onset of symptoms to admission (admission time) was prospectively documented during a 6-month period (December 2004 to May 2005) in patients consecutively admitted for an acute focal neurological deficit presented at arrival and of presumed vascular origin. Mode of transportation, patient's knowledge and correct recognition of stroke symptoms were assessed. Physicians contacted by the patients or their relatives were interviewed. The influence of referral patterns on in-hospital delays was further evaluated., Results: Overall, 331 patients were included, 249 had an ischaemic and 37 a haemorrhagic stroke. Forty-five patients had a TIA with neurological symptoms subsiding within the first hours after admission. Median admission time was 3 hours 20 minutes. Transportation by ambulance significantly shortened admission delays in comparison with the patient's own means (HR 2.4, 95% CI 1.6-3.7). The only other factor associated with reduced delays was awareness of stroke (HR 1.9, 95% CI 1.3-2.9). Early in-hospital delays, specifically time to request CT-scan and time to call the neurologist, were shorter when the patient was referred by his family or to a lesser extent by an emergency physician than by the family physician (p < 0.04 and p < 0.01, respectively) and were shorter when he was transported by ambulance than by his own means (p < 0.01)., Conclusions: Transportation by ambulance and referral by the patient or family significantly improved admission delays and early in-hospital management. Correct recognition of stroke symptoms further contributed to significant shortening of admission time. Educational programmes should take these findings into account.

Published
2009
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31. [Heart failure and sexual dysfunction].

Author

Sekoranja L, Bianchi-Demicheli F, Gaspoz JM, and Mach F

Subjects
Erectile Dysfunction therapy, Humans, Male, Erectile Dysfunction etiology, Heart Failure complications
Abstract

Most patients with chronic heart failure (CHF) can safely engage in sexual activity and be treated for erectile dysfunction with sildenafil, provided that they do not have active coronary ischemia and do not require treatment with nitrates. Clinicians should know the physiological requirements for sexual activity and the impact chronic heart failure has on sexual performance. Fear of cardiac events during intercourse can interfere with patients' ability to perform and enjoy sex, and thus, it is important that the physician be able to counsel patients with chronic heart failure about sexual activity.

Published
2008

32. [Male sexual function after stroke].

Author

Bianchi-Demicheli F, Sekoranja L, Temperli P, Lövblad KO, Ortigue S, and Sztajzel R

Subjects
Humans, Male, Sexual Dysfunction, Physiological etiology, Sexual Dysfunctions, Psychological etiology, Stroke complications
Abstract

Stroke represents the third leading cause of death, ranking behind heart disease and cancer and it is the major cause of worldwide long-term disability after the age of 65. Stroke has an important psychological and emotional impact on the patient and his environment. Some trials show the substantial lowering of libido, of the frequency of sexual intercourse, the presence of erectile dysfunction and reduced sexual satisfaction. After stroke it is important to evaluate the relational and sexual aspects of the patient and his sexual partner. A specialized consultation should be proposed when necessary to optimise the patient's post-stroke rehabilitation.

Published
2007

33. Preclinical testing of a new clot-retrieving wire device using polyvinyl alcohol hydrogel vascular models.

Author

Asakura F, Yilmaz H, Abdo G, Sekoranja L, San Millan D, Augsburger L, Sztajzel R, Ruefenacht DA, Perren F, Lovblad KO, and Goto K

Subjects
Equipment Design, Humans, Models, Biological, Nickel, Polyvinyl Alcohol, Stainless Steel, Titanium, Embolectomy instrumentation, Intracranial Embolism prevention & control
Abstract

Introduction: Cerebral embolism is the principal cause of cerebral infarction. Recently, mechanical embolectomy has been proposed as an effective method. We performed a preclinical evaluation of a new mechanical clot-retrieving wire., Methods: This clot-retrieving wire consisted of three nitinol loops at the tip of a microguidewire. These three loops could be collapsed into a 0.018-inch wire compatible microcatheter. Each loop was 8 mm long and 3.5 mm wide. For simulation, polyvinyl alcohol (PVA) vascular anatomical models of the human carotid (eight models) and vertebrobasilar (three models) circulation were constructed. A pulsatile flow circulation system was used. Embolic clots were produced using pig blood plasma. The microcatheter and the microguidewire were advanced beyond the clot. The wire was then exchanged for the retrieving wire. The microcatheter was then pulled slightly back to open the loops. The clot was then caught by withdrawal of the system. Once caught, the clot was retrieved to the guiding catheter tip. We investigated the following points: ease of device deployment, clot capture ability, clot removal against blood flow and removal of the clot out of the introducer system., Results: A total of 104 procedures were performed in 11 PVA models and evaluated. The drop rate was 19%. We succeeded in partial and total recanalization in 51.0% of the procedures (53/104) within 30 minutes., Conclusion: This new clot-retrieving wire could be useful for mechanical clot extraction in stroke.

Published
2007
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34. [Erectile dysfunction: a potential useful marker for cardiovascular disease].

Author

Sekoranja L, Bianchi-Demicheli F, Gaspoz JM, and Mach F

Subjects
Biomarkers, Endothelium, Vascular physiopathology, Humans, Male, Risk Factors, Cardiovascular Diseases physiopathology, Erectile Dysfunction physiopathology
Abstract

Erectile dysfunction is defined as the inability to achieve and/or maintain an erection sufficient to permit satisfactory sexual intercourse. Most cases of erectile dysfunction have a vascular etiology and, in patients with known cardiovascular disease, the degree of erectile dysfunction correlates with severity of that disease. In addition, cardiovascular disease and erectile dysfunction share the same risk factors for atherosclerosis and have a common pathophysiology (endothelial dysfunction); thus, erectile dysfunction appears as an early and sentinel symptom in patients with occult vascular disease, of the coronary or carotid arteries.

Published
2006

35. Pulmonary cement embolism after vertebroplasty.

Author

Righini M, Sekoranja L, Le Gal G, Favre I, Bounameaux H, and Janssens JP

Subjects
Female, Fractures, Bone complications, Fractures, Bone therapy, Humans, Lumbar Vertebrae, Middle Aged, Pulmonary Embolism diagnosis, Tomography, X-Ray Computed, Bone Cements adverse effects, Extravasation of Diagnostic and Therapeutic Materials complications, Pulmonary Embolism etiology
Published
2006

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