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1. Predictors and Prognostic Impact of Hematoma Expansion in Infratentorial Cerebral Hemorrhage

Author

Pezzini, Debora, Nawabi, Jawed, Schlunk, Frieder, Li, Qi, Mazzacane, Federico, Busto, Giorgio, Scola, Elisa, Arba, Francesco, Brancaleoni, Laura, Giacomozzi, Sebastiano, Simonetti, Luigi, Laudisi, Michele, Cavallini, Anna, Katsanos, Aristeidis H., Shoamanesh, Ashkan, Zini, Andrea, Casetta, Ilaria, Fainardi, Enrico, Morotti, Andrea, and Padovani, Alessandro

Published
2024
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2. Derivation of the Falls Decision Rule to exclude intracranial bleeding without head CT in older adults who have fallen

Author

de Wit, Kerstin, Mercuri, Mathew, Clayton, Natasha, Mercier, Eric, Morris, Judy, Jeanmonod, Rebecca, Eagles, Debra, Varner, Catherine, Barbic, David, Buchanan, Ian M., Ali, Mariyam, Kagoma, Yoan K., Shoamanesh, Ashkan, Engels, Paul, Sharma, Sunjay, Worster, Andrew, McLeod, Shelley, Emond, Marcel, Stiell, Ian, Papaioannou, Alexandra, and Parpia, Sameer

Subjects
Anticoagulants (Medicine), Head injuries, CT imaging, Health, McMaster University
Abstract

Background: Ground-level falls are common among older adults and are the most frequent cause of traumatic intracranial bleeding. The aim of this study was to derive a clinical decision rule that safely excludes clinically important intracranial bleeding in older adults who present to the emergency department after a fall, without the need for a computed tomography (CT) scan of the head. Methods: This prospective cohort study in 11 emergency departments in Canada and the United States enrolled patients aged 65 years or older who presented after falling from standing on level ground, off a chair or toilet seat, or out of bed. We collected data on 17 potential predictor variables. The primary outcome was the diagnosis of clinically important intracranial bleeding within 42 days of the index emergency department visit. An independent adjudication committee, blinded to baseline data, determined the primary outcome. We derived a clinical decision rule using logistic regression. Results: The cohort included 4308 participants, with a median age of 83 years; 2770 (64%) were female, 1119 (26%) took anticoagulant medication and 1567 (36%) took antiplatelet medication. Of the participants, 139 (3.2%) received a diagnosis of clinically important intracranial bleeding. We developed a decision rule indicating that no head CT is required if there is no history of head injury on falling; no amnesia of the fall; no new abnormality on neurologic examination; and the Clinical Frailty Scale score is less than 5. Rule sensitivity was 98.6% (95% confidence interval [CI] 94.9%-99.6%), specificity was 20.3% (95% CI 19.1%-21.5%) and negative predictive value was 99.8% (95% CI 99.2%-99.9%). Interpretation: We derived a Falls Decision Rule, which requires external validation, followed by clinical impact assessment. Trial registration: ClinicalTrials. gov, no. NCT03745755., As populations age, emergency departments are managing a growing number of older adults who fall. (1-3) Falling on level ground is the most common cause of traumatic intracranial bleeding. (4-6) [...]

Published
2023
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4. Effect of the Factor XIa Inhibitor Asundexian According to Baseline Infarct Pattern and on MRI Covert Infarct Outcomes

Author

Smith, Eric E., Shoamanesh, Ashkan, Xu, Lizhen, Heenan, Laura, Saad, Feryal, Colorado, Pablo, Chen, Chih-Hao, Lemmens, Robin, De Marchis, Gian Marco, Caso, Valeria, Masjuan, Jaime, Hirano, Teruyuki, Milanov, Ivan, Campbell, Bruce C.V., Mas, Jean-Louis, Connolly, Stuart J., Mundl, Hardi, Hart, Robert G., Bailey, P., Kleinig, T., Cordato, D., Choi, P., Garcia-Esperon, C., Chew, A., Cloud, G., Stanislaus, V., Krause, M., Priglinger, M., Grimley, R., Ghia, D., Sahathevan, R., Brown, H., Kwan, C., Devlin, M., Greisenegger, S., Bonelli-Nauer, S., Rath, J., Langer, A., Marko, M., Ferrari, J., Bernegger, A., Baumgartinger, M., Vigl, M., Krebs, S., Lang, W., Knoflach, M., Dejakum, B., Kiechl, S., Töll, T., Domig, L., Mutzenbach, J.S., Ganser, B., Hecker, C., Rösler, C., Bubel, N., Pikija, S., Zellner, T., Leitner, U., Berger, O., Surböck, B., Beirer, S., Staykov, D., Schrammel, D., Halilovic, A., Frattner, M., Barmherzigen, D., Lampl, C., Höfer, C., Nagl, S., Bocksrucker, C., Demeestere, J., Desfontaines, P., Ciobanu, C., De Pauw, A., Terwecoren, A., Hasenbroekx, M.C., Clement, F., De Klippel, N., Soors, P., Hermans, S., De Raedt, S., Vandervorst, F., Seynaeve, L., Fockaert, N., Smet, S., Rutgers, M., Del Gaudio, N., Paindeville, P., Staikov, I., Simeonova, A., Stoyanova, I., Cholakova, M., Mihnev, N., Petrova, T., Koralova, A., Dimov, D., Kuzev, Y., Danovska, M., Marinova, D., Marinova-Trifonova, D., Ovcharova, E., Mladenovski, I., Yanakieva, M., Stoev, P., Dimitrova, M., Todorova-Georgieva, S., Haralanov, L., Milkov, B., Solakov, D., Petkova, N., Ignatova-Valkova, V., Karabinov, V., Marinova, V., Miteva, Y., Andonova, V., Kasabova, D., Kostadinova, E., Shopova-Vrabcheva, Y., Gatev, D., Semova, D., Halil, E., Kaprelyan, A., Ivanov, B., Panov, G., Grudkova, M., Syuleyman, N., Kalpachki, R., Alexiev, F., Ivanova, I., Kancheva, K., Sakelarova, T., Maslarov, D., Drenska, D., Georgiev, V., Petrova, K., Petrova, N., Ivanova, I., Semerdjieva, N., Zhelyazkov, P., Spasova-Markova, S., Dong, X., Wang, D., Wang, S., Huang, W., Zhao, H., Wang, C., Jie, L., Xinyang, Y., Ping, Z., Dong, Q., Wang, Y., Fuling, Y., Yue, W., Liu, R., Yang, Y., Stetkarova, I., Mikulenka, P., Vasko, P., Peisker, T., Bar, M., Roubec, M., Mikulik, R., Cabukova, M., Vinklarek, J., Kovar, M., Pansky, M., Mencl, P., Skoda, O., Carek, M., Pernicka, M., Skodova, M., Geier, P., Cepkova, J., Drlik, J., Prax, T., Herzig, R., Krajickova, D., Vitkova, E., Haluskova, S., Vaclavik, D., Martinkova, J., Blejcharova, K., Tkacova, M., Pavlik, O., Nevšímalová, M., Rosol, J., Nevsimalova, M., Hruby, R., Iversen, H., Andersen, A.V., Rahimi, D., Christensen, H., Grundtvig, J., Hjort, N., Andersen, G., Sandal, B., Stilund, M., Modrau, B., Strade, A., Porobic, M., Andersen, S.D., Kruuse, C., Ölmestig, J., Kolmos, M., Parvez, A., Christensen, T., Stokholm, J., Jensen, H.B., Putaala, J., Strbian, D., Sibolt, G., Tiainen, M., Martinez-Majander, N., Curtze, S., Raty, S., Kraemer, Y., Roine, R., Aivo, J., Ruuskanen, J., Ylikotila, P., Roine, S., Hallikainen, M., Jakala, P., Kurl, S., Julkunen, V., Sibon, I., Olindo, S., Richard, S., Larrue, V., Gollion, C., Catala, H., Henon, H., Lucie, D.S., Nelly, D., Calvet, D., Malbranque, A., Mazé, B., Barbieux-Ghitu, C., Rosso, C., Samson, Y., Vannier, S., Moulin, T., Bonnet, L., Reiner, P., Buffon, F., Denier, C., Amri, K., Legris, N., Chassin, O., Selli, N., Mariana, S., Berrouschot, J., Stoll, A., Klunk, D., Keilitz, J., Neustadt, M., Zerrenner, S., Veltkamp, R., Hajjar, K., Heeger, A., Winezki, E., Apel, L., Pompsch, M., Mueller, P., Rappard, P., Auer, R., Ringleb, P.A., Berberich, A., Heyse, M., Mundiyanapurath, S., Reiff, T., Poli, S., Gomez-Exposito, A., Mengel, A., Tünnerhoff, J., Adeyemi, K., Poli, K., Kusch, V., Pelz, J., Michalski, D., Wartenberg, K., Althaus, K., Tavares, F., Mueller, S., Soda, H., Rascher, A., Hiermann, E., Weinhardt, R., Weissenborn, K., Leotescu, A., Grosse, G., Worthmann, H., Ernst, J., Gabriel, M., Schuppner, R., Schäfer, J.H., Charisse, D., Gruber, K., Kurka, N., Reitz, S.C., Pfeilschifter, W., Lee, J.I., Gliem, M., Moll, M., Steiner, T., Segura, L., Szegedi, N., Barandi, D., Uhrinakova, L., Czencz, M., Pasztor, M., Gyuker, N., Bartha, N.E., May, Z., Simony, Z., Szasz, G., Kakuk, I., Pető, N., Panczel, G.F., Olah, A., Racz, O., Balla, T., Horvath, B., Tuba, K., Czinderi, V., Klivenyi, P., Annus, A., Hertelendy, P., Szapary, L., Bosnyak, E., Kalmar, P., Karadi, Z., Cziba, L., Olah, L., Berki, A., Hudak, L., Kozák, M., Babel, S., Nemeth, L., Molnár, B., Simon, Z., Roveri, L., Cerri, F., Giacalone, G., Zini, A., Mauro, G., Asioli, G.M., Forlivesi, S., Arnone, G., Fiaccadori, A., Maria Fontana Francesca, E., Allegra, G., Mosconi, M.G., Longoni, M., Terlizzi, R., Paolucci, M., Tassi, R., Franci, B., Lucani, B., Domenichelli, C., Paoletti, D., Acampa, M., Zedde, M.L., Pezzella, F.R., Mangiardi, M., Galizia, P., Anticoli, S., Scalise, S., Lattanzi, S., Norata, D., Cannuccia, M., Cavallini, A., Federica, F., Denaro, M.F., Tosi, P., Sonoda, K., Kawajiri, M., Kusano, Y., Haraguchi, K., Kawano, H., Terasaki, T., Kaneko, C., Murase, S., Kumagai, M., Murai, N., Miyazaki, Y., Mori, T., Hatano, T., Kawanishi, M., Ochiai, J., Ishihara, S., Uehara, T., Yasaka, M., Nakagawa, H., Makino, M., Yonehara, T., Fukushima, Y., Hirotsune, N., Sakai, N., Yamasaki, M., Coutinho, J., Wouters, A., den Hertog, H., Zwartbol, R., Beumer, D., Kerklaan, J., Hilkens, P., Schreuder, T., Propper, D., Slowik, A., Wlodarczyk, E., Wrona, P., Pulyk, R., Lasek-Bal, A., Kosarz-Lanczek, K., Puz, P., Bilik, M., Magielska, A., Zamiela – Żółciak, A., Ochocinska, L., Bahdasaryan, S., Stępień, A., Dębiec, A., Joanna, K., Pawel, M., Jacek, S., Daniel, P., Marta, S., Rejdak, K., Wojczal, J., Luchowski, P., Fryze, W., Wisniewska, A., Krzyzanowska, M., Skowron, P., Wolosz, A., Galan, A., Grzymala, K., Krajewska, M., Nowak, R., Kłos, M., Cruz, V., Castro, P., Ferro, J., Canhão, P., Gouveia, R., Inácio, N., Rodrigues, M., Rachão, A., Ionel, C., Pereira, L., Viana-Baptista, M., Machado, C., Fernandes, C., Sargento, J., Inácio, N., Timchenko, L., Mironova, J., Zhadan, O., Torgashova, A., Bazhenova, O., Barashenkova, M., Kireeva, M., Romadina, N., Stepanova, I., Lenskaya, L., Lukinykh, L., Vorontsova, T., Agafina, A., Fedorova, A., Yashina, A., Alasheev, A., Smolkin, A., Prazdnichkova, E., Lutskovich, O., Gonysheva, Y., Mordvintseva, E., Nechaev, A., Martynova, E., Fedoraeva, N., Vishnyakova, T., Popov, D., Merzliakova, A., Margarita, K., Rechkalova, L., Ilyina, A., Kurenkova, N., Barbarash, O., Bazdyrev, E., Zvereva, T., Hromova, A., Morkvenas, A., Postnikova, E., Kovalenko, G., Taran, I., Pavlov, L., Ott, M., Chernitsova, N., Vodopyanova, N., Drozdova, E., Korebo, E., Lobanova, M., Lazareva, N., Snegova, N., Nikolaeva, O., Kolesnikov, Y., Kosheleva, Y., Krastev, G., Tomasova, K., Danis, M., Mako, M., Jankovicova, Z., Stevkova, Z., Kovacik, M., Kubikova, T., Jarosova, A., Serdahely, V., Cilingova, I., Pribulova, I., Sedlak, J., Slebodova, K., Paldaufova, M., Risnovsky, R., Berndtova, B., Urbanova, I., Junas, R., Karapetian, S., Gurcik, L., Vantrobova, A., Verbovsky, F., Vanacka, K., Ferenc, M., Galik, P., Bucakova, S., Ferencova, M., Kubalova, P., Boksanska, Z., Zacharova, E., Mahundi, E., Judita, H., Bachnak, M., Turcani, P., Kvasnicova Kamenska, A., Jurik, M., Vestenicka, V., Kycina, M., Sagatova, E., Dvorak, M., Hlubekova, A., Kucera, C., Gernath, L., Ferenc, M., Frimmelova, P., Slebodnikova, J., Aksteinerova, N., Horny, V., Gregova, Z., Segura, T., Romero, C., Ayo, O., Masjuan Vallejo, J., Cruz, A., De felipe, A, Matute, M.C., Garcia, S., Tembl Ferrairo, J., Vielba, I., Morales Caba, L., Molina, C., Garcia-Tornel García-Camba, Á., Requena Ruiz, M., Noelia, R., Rodriguez-Yañez, M., Rodriguez Castro, E., Lopez, I., Santamaria, M., Arias, S., Purroy García, F., Vázquez Justes, D., Mauri Capdevila, G., Vicente Pascual, M., Martí Fabregas, J., Camps Renom, P., Rodríguez Campello, A., Giralt, E., Krupinski, J., Molina, J., Trillo Senin, C. Ramos Martin, S., De La Fuente Sanz, E., Moniche, F., Manuel, M.R., Pardo, B., Martínez, I., Hernández Pérez, M., Arenillas Lara, J.F., De Lera, M., Egido, J.A., Gomez Escalonilla, C., Guillan, M., Martinez, J., Lindgren, A., Andsberg, G., Wictor, L., Leonidou, M., Stenman, M., Dalberg, N., Laska, A.C., Grünfeldt, A., Lundström, A., Nadzjafov, E., Rooth, E., Dalenbring, I., Sandén, P., Johansson, E., Thomas, G., Zietz, A.V., Rudin, S., Dittrich, T.D., Lilian, K., Kägi, G., Vehoff, J., Arnold, M., Scutelnic, A., Clénin, L., Beyeler, M., Madlaine, M., Maamari, B., Siepen, B., Vynckier, J., Tarnutzer, A., Bertschi, D., Luciani, M., Cereda, C., Maulucci, F., Bianco, G., Shairin, S., Pihan, H.A., Salmen, S., Quinn, T., McAlpine, C., Wright, F., Kalladka, D., Taylor, E., Sohaa, J., Brown, Z., Dawson, J., Cameron, A., Muir, S., Dima, S., Khan, U., Zhang, L., Warburton, E., Chatterjee, K., Nallasivan, A., Curran, D., Haider, S., Ghani, U., Kenton, A., Dallol, B., Mirza, M., Menezes, B., Davies, R., Robinson, T.G., Manning, L., Sztriha, L., Phinney, T., Sethi, P., Altafullah, I., Sharaf, A., Ostrander, M., Renati, S., Burgin, W.S., Olds, K., Delio, P., Malek, A., Dissin, J., Khatri, P., Flaherty, M., Demel, S., and Dofitas, S.

Published
2024
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6. Cortical superficial siderosis in the general population: The Framingham Heart and Rotterdam studies

Author

Shoamanesh, Ashkan, Akoudad, Saloua, Himali, Jayandra J, Beiser, Alexa S, DeCarli, Charles, Seshadri, Sudha, Ikram, M Arfan, Romero, Jose R, and Vernooij, Meike W

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Neurosciences, Dementia, Clinical Research, Acquired Cognitive Impairment, Aging, Stroke, Brain Disorders, Neurological, Aged, Cerebral Amyloid Angiopathy, Cerebral Hemorrhage, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Siderosis, Brain microbleeds, cerebral amyloid angiopathy, cerebral hemorrhage, community, cortical superficial siderosis, stroke facilities, Neurology & Neurosurgery, Clinical sciences, Allied health and rehabilitation science
Abstract

ObjectiveWe aimed to characterize cortical superficial siderosis, its determinants and sequel, in community-dwelling older adults.MethodsThe sample consisted of Framingham (n = 1724; 2000-2009) and Rotterdam (n = 4325; 2005-2013) study participants who underwent brain MRI. In pooled individual-level analysis, we compared baseline characteristics in patients with cortical superficial siderosis to two reference groups: (i) persons without hemorrhagic MRI markers of cerebral amyloid angiopathy (no cortical superficial siderosis and no microbleeds) and (ii) those with presumed cerebral amyloid angiopathy based on the presence of strictly lobar microbleeds but without cortical superficial siderosis.ResultsAmong a total of 6049 participants, 4846 did not have any microbleeds or cortical superficial siderosis (80%), 401 had deep/mixed microbleeds (6.6%), 776 had strictly lobar microbleeds without cortical superficial siderosis (12.8%) and 26 had cortical superficial siderosis with/without microbleeds (0.43%). In comparison to participants without microbleeds or cortical superficial siderosis and to those with strictly lobar microbleeds but without cortical superficial siderosis, participants with cortical superficial siderosis were older (OR 1.09 per year, 95% CI 1.05, 1.14; p 999.99; p = 0.006). During a mean follow-up of 5.6 years, 42.4% participants with cortical superficial siderosis had a stroke (five intracerebral hemorrhage, two ischemic strokes and four undetermined strokes), 19.2% had transient neurological deficits and 3.8% developed incident dementia.ConclusionOur study adds supporting evidence to the association between cortical superficial siderosis and cerebral amyloid angiopathy within the general population. Community-dwelling persons with cortical superficial siderosis may be at high risk for intracerebral hemorrhage and future neurological events.

Published
2021

8. Effects of oral anticoagulation in people with atrial fibrillation after spontaneous intracranial haemorrhage (COCROACH): prospective, individual participant data meta-analysis of randomised trials

Author

Klug, Didier, Casolla, Barbara, Puy, Laurent, Coffee, Morgane, Kuchcinski, Grégory, Labreuche, Julien, van Nieuwenhuizen, Koen M., Algra, Ale, van Gelder, Isabelle C., Kappelle, L. Jaap, Rinkel, Gabriel J.E., Schutgens, Roger E.G., Khatri, Pooja, Conwit, Robin, Falcone, Guido, Elm, Jordan, Anderson, Craig S., Song, Lili, Pandian, Jeyaraj, Hart, Robert G., Sharma, Mukul, Aref, Hany, Tarhuni, Wadea, Fabregas, Joan Marti, Diener, Hans-Christoph, Endres, Matthias, Lemmens, Robin, Kwon, Sun U., Lee, Byung-Chul, Ameriso, Sebastian, Milling, Truman J., Kasner, Scott E., Mikulik, Robert, Xavier, Denis, Beer, Ronny, Toni, Danilo, Eckstein, Jens, Seiffge, David, Ferro, Jose M., Tsivgoulis, Georgios, Sharma, Sanjib K., Wei-Liou, Chia, Hohnloser, Stefan H., Katsanos, Aristeidis, Bosch, Jackie, Healey, Jeff, Eikelboom, John, Khaw, Alexander, Gladstone, David, Pikula, Aleksandra, Coutts, Shelagh, Smith, Eric E., Butcher, Ken, Field, Thalia, Gioia, Laura, Stapf, Christian, Halse, Omid, Ringleb, Peter, Enzinger, Christian, Sibon, Igor, Montaner, Joan, Caso, Valeria, Heuschmann, Peter, Lip, Gregory Y.H., Haefeli, Walter, Debette, Stefanie, Dennis, Martin S., Wyller, Torgeir Bruun, Rønning, Ole M., Eilertsen, Helle, Ihle-Hansen, Hege, Sandset, Else Charlotte, Pennlert, Johanna, Glader, Eva-Lotta, Kruuse, Christina, Wester, Per, Carlsson, Maria, Forfang, Elisabeth, Al-Shahi Salman, Rustam, Stephen, Jacqueline, Tierney, Jayne F, Lewis, Steff C, Newby, David E, Parry-Jones, Adrian R, White, Philip M, Connolly, Stuart J, Benavente, Oscar R, Dowlatshahi, Dar, Cordonnier, Charlotte, Viscoli, Catherine M, Sheth, Kevin N, Kamel, Hooman, Veltkamp, Roland, Larsen, Kristin T, Hofmeijer, Jeannette, Kerkhoff, Henk, Schreuder, Floris H B M, Shoamanesh, Ashkan, Klijn, Catharina J M, and van der Worp, H Bart

Published
2023
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11. Predictors of severe intracerebral hemorrhage expansion

Author

Morotti, Andrea, primary, Li, Qi, additional, Nawabi, Jawed, additional, Busto, Giorgio, additional, Mazzacane, Federico, additional, Cavallini, Anna, additional, Shoamanesh, Ashkan, additional, Morassi, Mauro, additional, Schlunk, Frieder, additional, Piccolo, Laura, additional, Urbinati, Giacomo, additional, Pezzini, Debora, additional, Paciaroni, Maurizio, additional, Fainardi, Enrico, additional, Casetta, Ilaria, additional, Padovani, Alessandro, additional, and Zini, Andrea, additional

Published
2024
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13. Blood Pressure Trajectories and Outcomes After Endovascular Thrombectomy for Acute Ischemic Stroke

Author

Katsanos, Aristeidis H., primary, Joundi, Raed A., additional, Palaiodimou, Lina, additional, Ahmed, Niaz, additional, Kim, Joon-Tae, additional, Goyal, Nitin, additional, Maier, Ilko L., additional, de Havenon, Adam, additional, Anadani, Mohammad, additional, Matusevicius, Marius, additional, Mistry, Eva A., additional, Khatri, Pooja, additional, Arthur, Adam S., additional, Sarraj, Amrou, additional, Yaghi, Shadi, additional, Shoamanesh, Ashkan, additional, Catanese, Luciana, additional, Psychogios, Marios-Nikos, additional, Tsioufis, Konstantinos, additional, Malhotra, Konark, additional, Spiotta, Alejandro M., additional, Sandset, Else Charlotte, additional, Alexandrov, Andrei V., additional, Petersen, Nils H., additional, and Tsivgoulis, Georgios, additional

Published
2024
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14. Quality of Life After Intravenous Thrombolysis for Acute Ischemic Stroke: Results From the AcT Randomized Controlled Trial

Author

Sajobi, Tolulope T., primary, Arimoro, Olayinka I., additional, Ademola, Ayoola, additional, Singh, Nishita, additional, Bala, Fouzi, additional, Almekhlafi, Mohammed A., additional, Deschaintre, Yan, additional, Coutts, Shelagh B., additional, Thirunavukkarasu, Sibi, additional, Khosravani, Houman, additional, Appireddy, Ramana, additional, Moreau, François, additional, Gubitz, Gordon J., additional, Tkach, Aleksander, additional, Catanese, Luciana, additional, Dowlatshahi, Dar, additional, Medvedev, George, additional, Mandzia, Jennifer, additional, Pikula, Aleksandra, additional, Shankar, Jai Shiva, additional, Williams, Heather, additional, Field, Thalia S., additional, Manosalva, Alejandro, additional, Siddiqui, Muzaffar, additional, Zafar, Atif, additional, Imoukhuede, Oje, additional, Hunter, Gary, additional, Demchuk, Andrew M., additional, Mishra, Sachin M., additional, Gioia, Laura C., additional, Jalini, Shirin, additional, Cayer, Caroline, additional, Phillips, Stephen J., additional, Elamin, Elsadig, additional, Shoamanesh, Ashkan, additional, Subramaniam, Suresh, additional, Kate, Mahesh P., additional, Jacquin, Gregory, additional, Camden, Marie-Christine, additional, Benali, Faysal, additional, Alhabli, Ibrahim, additional, Horn, MacKenzie, additional, Stotts, Grant, additional, Hill, Michael D., additional, Gladstone, David J., additional, Poppe, Alexandre Y., additional, Sehgal, Arshia, additional, Zhang, Qiao, additional, Lethebe, Brendan, additional, Doram, Craig, additional, Shamy, Michel, additional, Kenney, Carol, additional, Buck, Brian H., additional, Swartz, Richard H., additional, and Menon, Bijoy K., additional

Published
2024
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15. Factor XIa inhibition with asundexian after acute non-cardioembolic ischaemic stroke (PACIFIC-Stroke): an international, randomised, double-blind, placebo-controlled, phase 2b trial

Author

Shoamanesh, Ashkan, Mundl, Hardi, Smith, Eric E, Masjuan, Jaime, Milanov, Ivan, Hirano, Teruyuki, Agafina, Alina, Campbell, Bruce, Caso, Valeria, Mas, Jean-Louis, Dong, Qiang, Turcani, Peter, Christensen, Hanne, Ferro, Jose M, Veltkamp, Roland, Mikulik, Robert, De Marchis, Gian Marco, Robinson, Thompson, Lemmens, Robin, Stepien, Adam, Greisenegger, Stefan, Roine, Risto, Csiba, Laszlo, Khatri, Pooja, Coutinho, Jonathan, Lindgren, Arne G, Demchuk, Andrew M, Colorado, Pablo, Kirsch, Bodo, Neumann, Christoph, Heenan, Laura, Xu, Lizhen, Connolly, Stuart J, and Hart, Robert G

Published
2022
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16. Final Study Report of Andexanet Alfa for Major Bleeding With Factor Xa Inhibitors

Author

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

Published
2023
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17. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomised, controlled, non-inferiority trial

Author

Srivastava, Abhilekh, Aljammaz, Ahmed M, Akindotun, Akintomide Femi, Jin, Albert Y, Fraser, Alexander, Khaw, Alexander V, Lemnaru, Alexandru, Southwell, Alisia, Ramji, Alnar, Alvarado-Bolaños, Alonso, Mouminah, Amr, Lahlouh, Amro B, Yu, Amy Y, Alrohimi, Anas, Lavoie, Andre, Rogge, Andrea, Micieli, Andrew, Nguyen, Andrew Linh, Callaghan-Brown, Angelique, Florendo-Cumbermack, Anita, Wadhwa, Ankur, Beaudoin, Ann-Marie, Cayley, Anne, Liddy, Anne Marie, Trivedi, Anurag, Katsanos, Aristeidis H, Shuaib, Ashfaq, Butt, Asif Javed, Bereznyakova, Olena, Beauchamp, Beth, Mahlitz, Breane, Graham, Brett R, Dewar, Brian, Buck, Brian H, Durafourt, Bryce A, Holtby, Caitlin, Jackson-Tarlton, Caitlin S, Bockus, Caitlyn, Stephenson, Caroline, Galloway, Camille, Odier, Céline, Deacon, Charles, Zerna, Charlotte, Vekhande, Chetan C, Bocti, Christian, Stapf, Christian, Hawkes, Christine, Stables, Christine Anne, Bogiatzi, Chrysi, Rodriguez, Claudia, Candale-Radu, Claudia, Murphy, Colleen, Casserly, Courtney Sarah, Fok, Daniel, Boasquevisque, Danielle de Sa, Wile, Daryl, Volders, David, Sahlas, Demetrios J, Shand, Elaine, Cora, Elena Adela, Battista, Eliane Di, Stewart, Eileen, Junk, Emily, Harrison, Emma L, Frenette, Eric, Teleg, Ericka, Abdellah, Eslam, Ghrooda, Esseddeeg, Akthar, Farhana, Evoy, François, Klein, Gary M, Maclean, Genoveva, Jickling, Glen C, Hawthorne, Glenda, Boyd, Gordon, Walker, Gregory, Saposnik, Gustavo, Lau, H Lee, Badr, Hanan E, Toma, Hassanain, Kalashyan, Hayrapet, Marion-Moffet, Hugo, Grant, Ian, Fatakdawala, Idris, Beaulieu-Boire, Isabelle, Williams, Janice, Brar, Jaskiran, Rivest, Jean, Wang, Jeffrey Z, Dawe, Jessica, Stang, Jillian, Day, Joanne, Miller, Jodi, Gorman, Johnathon, Hopyan, Julia Jasmine, Lee, Julian, Kromm, Julie, Foster, Kaitlyn, Ratnayake, Kanchana, Perera, Kanjana S, Murray, Karina Villaluna, Ryckborst, Karla, Lin, Katie, Sage, Kayla, Sivakuma, Keithan, MacDonald, Kelly A, Ng, Kelvin Kuan, Merchant, Ketki, Khan, Khurshid, Ghavami, Kimia, Johnston, Kyra, Mai, Lauren M, White, Leah, Barratt, Lee, Longpre, Linda, Crellin, Lisa, Peeling, Lissa, Piquette, Lori, Lomax, Lysa Boissé, Sadeghi, Mahsa, Kamra, Maneesha, Lavoie-April, Manuel, Moores, Margaret, Bullrich, Maria Bres, McClelland, Marie, Salluzzi, Marina, Wilcox, Mark, Boulos, Mark I, Marko, Martha, Boyko, Matthew, Lantagne-Hurtubise, Maude, AlHamid, May Adel, Shawawrah, Mays, Kelly, Michael E, Thorne, Michael W D, Shamy, Michel, Bussiere, Miguel, Dominc Tse, Ming Yin, Benguzzi, Mowad, Sharma, Mukul, Horton, Myles, Newcommon, Nancy, Simon, Nandy-Shelwine, Parks, Natalie E, Sultan, Nazeem, Markovic, Nevena, Daneault, Nicole, Ishaque, Noman, Fairall, Paige, Kostyrko, Pawel B, Stys, Peter K, Teal, Philip, Couillard, Philippe, King-Azote, Princess, Collier, Quentin, Epp, Rachel, Nair, Radhika, Joundi, Raed A, Jassal, Rajive, Schneider, Raphael, Hosseini, Reza, Bouchard, Rosalie, Whelan, Ruth, Cooley, S Regan, Sujanthan, Sajeevan, Mansoor, Salman, Yip, Samuel, Wasyliw, Sanchea, Taylor, Sean W., Friedman, Sebastian, Mann, Sharan, Maley, Sharleen Weese, Chiasson, Sherry, Hu, Sherry Xueying, Althubait, Shorog, Himed, Shuhira, Chen, Shuo, Bal, Simerpreet S, Page, Stacey A, Beck, Stacey D, Woodroffe, Stephanie, Reiter, Stephanie D, Gaal, Stephen van, Peters, Steven Ray, Darvesh, Sultan, Save, Supriya, Alcock, Susan, Piercey, Susannah, Adam, Suzie, Gosselin, Sylvie, Fitzpatrick, Tess, Perron, Thomas-Louis, Stewart, Tim, Benstead, Timothy J, Naidoo, Vishaya, Wahab, Wasan Abd, Oczkowski, Wiesław, Kingston, William, Leduc, William, To, William T H, Yu, Yeyao Joe, Liu, Zhongyu A, Aljundi, Ziad Ezzat, Menon, Bijoy K, Singh, Nishita, Deschaintre, Yan, Almekhlafi, Mohammed A, Coutts, Shelagh B, Thirunavukkarasu, Sibi, Khosravani, Houman, Appireddy, Ramana, Moreau, Francois, Gubitz, Gord, Tkach, Aleksander, Catanese, Luciana, Dowlatshahi, Dar, Medvedev, George, Mandzia, Jennifer, Pikula, Aleksandra, Shankar, Jai, Williams, Heather, Field, Thalia S, Manosalva, Alejandro, Siddiqui, Muzaffar, Zafar, Atif, Imoukhuede, Oje, Hunter, Gary, Demchuk, Andrew M, Mishra, Sachin, Gioia, Laura C, Jalini, Shirin, Cayer, Caroline, Phillips, Stephen, Elamin, Elsadig, Shoamanesh, Ashkan, Subramaniam, Suresh, Kate, Mahesh, Jacquin, Gregory, Camden, Marie-Christine, Benali, Faysal, Alhabli, Ibrahim, Bala, Fouzi, Horn, MacKenzie, Stotts, Grant, Hill, Michael D, Gladstone, David J, Poppe, Alexandre, Sehgal, Arshia, Zhang, Qiao, Lethebe, Brendan Cord, Doram, Craig, Ademola, Ayoola, Kenney, Carol, Sajobi, Tolulope T, and Swartz, Richard H

Published
2022
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18. Intensive Blood Pressure Lowering and DWI Lesions in Intracerebral Hemorrhage: Exploratory Analysis of the ATACH-2 Randomized Trial

Author

Shoamanesh, Ashkan, Cassarly, Christy, Morotti, Andrea, Romero, Javier M., Oliveira-Filho, Jamary, Schlunk, Frieder, Jessel, Michael, Butcher, Kenneth, Gioia, Laura, Ayres, Alison, Vashkevich, Anastasia, Schwab, Kristin, Afzal, Mohammad Rauf, Martin, Renee H., Qureshi, Adnan I., Greenberg, Steven M., Rosand, Jonathan, and Goldstein, Joshua N.

Published
2022
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20. Andexanet alfa versus non-specific treatments for intracerebral hemorrhage in patients taking factor Xa inhibitors — Individual patient data analysis of ANNEXA-4 and TICH-NOAC.

Author

Siepen, Bernhard M, Polymeris, Alexandros, Shoamanesh, Ashkan, Connolly, Stuart, Steiner, Thorsten, Poli, Sven, Lemmens, Robin, Goeldlin, Martina B, Müller, Madlaine, Branca, Mattia, Rauch, Janis, Meinel, Thomas, Kaesmacher, Johannes, Z'Graggen, Werner, Arnold, Marcel, Fischer, Urs, Peters, Nils, Engelter, Stefan T, Lyrer, Philippe, and Seiffge, David

Subjects
CEREBRAL hemorrhage, VENOUS thrombosis, DATA analysis, MYOCARDIAL infarction, ISCHEMIC stroke
Abstract

Background: Data comparing the specific reversal agent andexanet alfa with non-specific treatments in patients with non-traumatic intracerebral hemorrhage (ICH) associated with factor-Xa inhibitor (FXaI) use are scarce. Aim: The study aimed to determine the association between the use of andexanet alfa compared with non-specific treatments with the rate of hematoma expansion and thromboembolic complications in patients with FXaI-associated ICH. Methods: We performed an individual patient data analysis combining two independent, prospective studies: ANNEXA-4 (180 patients receiving andexanet alfa, NCT02329327) and TICH-NOAC (63 patients receiving tranexamic acid or placebo ± prothrombin complex concentrate, NCT02866838). The primary efficacy outcome was hematoma expansion on follow-up imaging. The primary safety outcome was any thromboembolic complication (ischemic stroke, myocardial infarction, pulmonary embolism, or deep vein thrombosis) at 30 days. We used binary logistic regression models adjusted for baseline hematoma volume, age, calibrated anti-Xa activity, times from last intake of FXaI, and symptom onset to treatment, respectively. Results: Among 243 participants included, the median age was 80 (IQR 75–84) years, baseline hematoma volume was 9.1 (IQR 3.4–21) mL and anti-Xa activity 118 (IQR 78–222) ng/mL. Times from last FXaI intake and symptom onset to treatment were 11 (IQR 7–16) and 4.7 (IQR 3.0–7.6) h, respectively. Overall, 50 patients (22%) experienced hematoma expansion (ANNEXA-4: n=24 (14%); TICH-NOAC: n=26 (41%)). After adjusting for pre-specified confounders (baseline hematoma volume, age, calibrated anti-Xa activity, times from last intake of FXaI, and symptom onset to treatment, respectively), treatment with andexanet alfa was independently associated with decreased odds for hematoma expansion (aOR 0.33, 95% CI 0.13–0.80, p = 0.015). Overall, 26 patients (11%) had any thromboembolic complication within 30 days (ANNEXA-4: n=20 (11%); TICH-NOAC: n=6 (10%)). There was no association between any thromboembolic complication and treatment with andexanet alfa (aOR 0.70, 95% CI 0.16–3.12, p = 0.641). Conclusion: The use of andexanet alfa compared to any other non-specific treatment strategy was associated with decreased odds for hematoma expansion, without increased odds for thromboembolic complications. [ABSTRACT FROM AUTHOR]

Published
2024
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21. Cerebral microbleeds and asundexian in non-cardioembolic ischemic stroke: Secondary analyses of the PACIFIC-STROKE randomized trial.

Author

Balali, Pargol, Hart, Robert G, Smith, Eric E, Saad, Feryal, Colorado, Pablo, Lemmens, Robin, De Marchis, Gian Marco, Caso, Valeria, Xu, Lizhen, Heenan, Laura, Connolly, Stuart J, Mundl, Hardi, and Shoamanesh, Ashkan

Subjects
ISCHEMIC stroke, CEREBRAL small vessel diseases, TRANSIENT ischemic attack, INTRACRANIAL hemorrhage, STROKE
Abstract

Background and aims: Cerebral microbleeds are magnetic imaging resonance (MRI) markers of hemorrhage-prone cerebral small vessel disease that predict future risk of ischemic stroke and intracranial hemorrhage (ICrH). There exist concerns about the net benefit of antithrombotic therapy in patients with microbleeds. We aimed to investigate the effects of an oral factor-XIa inhibitor (asundexian), that is hypothesized to inhibit thrombosis without compromising hemostasis, on the development of new microbleeds over time and interactions between microbleeds and asundexian treatment on clinical outcomes. We additionally assessed associations between baseline microbleeds and the risks of clinical and neuroimaging outcomes in patients with non-cardioembolic ischemic stroke. Methods: This is a secondary analysis of the PACIFIC-STROKE, international, multi-center Phase 2b double-blind, randomized clinical trial. PACIFIC-STROKE enrolled patients aged ⩾ 45 years with mild-to-moderate non-cardioembolic ischemic stroke who presented within 48 h of symptom onset for whom antiplatelet therapy was intended. Microbleeds were centrally adjudicated, and participants with an interpretable T2*-weighted sequence at their baseline MRI were included in this analysis. Patients were randomized to asundexian (10/20/50 mg daily) versus placebo plus standard antiplatelet treatment. Regression models were used to estimate the effects of (1) all pooled asundexian doses and (2) asundexian 50 mg daily on new microbleed formation on 26-week MRIs. Cox proportional hazards or regression models were additionally used to estimate interactions between treatment assignment and microbleeds for ischemic stroke/transient ischemic attack (TIA) (primary outcome), and ICrH, all-cause mortality, hemorrhagic transformation (HT), and new microbleeds (secondary outcomes). Results: Of 1746 participants (mean age, 67.0 ± 10.0; 34% female) with baseline MRIs, 604 (35%) had microbleeds. During a median follow-up of 10.6 months, 7.0% (n = 122) had ischemic stroke/TIA, 0.5% (n = 8) ICrH, and 2.1% (n = 37) died. New microbleeds developed in 10.3% (n = 155) of participants with adequate follow-up MRIs and HT in 31.4% (n = 345). In the total sample of patients with adequate baseline and 26-week follow-up MRIs (n = 1507), new microbleeds occurred in 10.2% of patients assigned to any asundexian dose and 10.5% of patients assigned to placebo (OR, 0.96; 95% CI, 0.66–1.41). There were no interactions between microbleeds and treatment assignment for any of the outcomes (p for interaction > 0.05). The rates of new microbleeds, HT, and ICrH were numerically less in patients with microbleeds assigned to asundexian relative to placebo. The presence of microbleeds was associated with a higher risk of HT (aOR, 1.6; 95% CI, 1.2–2.1) and new microbleeds (aOR, 4.4; 95% CI, 3.0–6.3). Conclusion: Factor XIa inhibition with asundexian appears safe in patients with non-cardioembolic ischemic stroke and hemorrhage-prone cerebral small vessel disease marked by microbleeds on MRI. These preliminary findings will be confirmed in the ongoing OCEANIC-STROKE randomized trial. Trial Registration: ClinicalTrials.gov Identifier: NCT04304508. [ABSTRACT FROM AUTHOR]

Published
2024
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22. Abstract WP172: A Novel Score to Predict Early Time From Symptom Onset to Hospital Arrival in Patients With Intracerebral Hemorrhage

Author

Balali, Pargol, primary, Morotti, Andrea, additional, Joundi, Raed A, additional, Katsanos, Aristeidis, additional, Catanese, Luciana, additional, Lioutas, Vasileios, additional, Carvalho, Filipa, additional, Heistand, Elizabeth, additional, Sharma, Mukul A, additional, Selim, Magdy H, additional, and Shoamanesh, Ashkan, additional

Published
2024
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23. Bleeding risk prediction in patients treated with antithrombotics according to site of bleeding, indication for treatment and time since initiation

Author

Bhagirath, Vinai, additional, Kovalova, Tanya, additional, Wang, Jia Steven, additional, Xu, Lizhen, additional, Bangdiwala, Shrikant, additional, O'Donnell, Martin, additional, Shoamanesh, Ashkan, additional, Bosch, Jackie, additional, Coppolecchia, Rosa, additional, Vaitsiakhovich, Tatsiana, additional, Kleinjung, Frank, additional, Mundl, Hardi, additional, and Eikelboom, John W, additional

Published
2024
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24. Bleeding Outcomes in Patients Treated With Asundexian in Phase II Trials

Author

Eikelboom, John W., primary, Mundl, Hardi, additional, Alexander, John H., additional, Caso, Valeria, additional, Connolly, Stuart J., additional, Coppolecchia, Rosa, additional, Gebel, Martin, additional, Hart, Robert G., additional, Holberg, Gerlind, additional, Keller, Lars, additional, Patel, Manesh R., additional, Piccini, Jonathan P., additional, Rao, Sunil V., additional, Shoamanesh, Ashkan, additional, Tamm, Miriam, additional, Viethen, Thomas, additional, Yassen, Ashraf, additional, and Bonaca, Marc P., additional

Published
2024
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25. Effects of oral anticoagulation in people with atrial fibrillation after spontaneous intracranial haemorrhage (COCROACH): prospective, individual participant data meta-analysis of randomised trials

Author

Al-Shahi Salman, Rustam, primary, Stephen, Jacqueline, additional, Tierney, Jayne F, additional, Lewis, Steff C, additional, Newby, David E, additional, Parry-Jones, Adrian R, additional, White, Philip M, additional, Connolly, Stuart J, additional, Benavente, Oscar R, additional, Dowlatshahi, Dar, additional, Cordonnier, Charlotte, additional, Viscoli, Catherine M, additional, Sheth, Kevin N, additional, Kamel, Hooman, additional, Veltkamp, Roland, additional, Larsen, Kristin T, additional, Hofmeijer, Jeannette, additional, Kerkhoff, Henk, additional, Schreuder, Floris H B M, additional, Shoamanesh, Ashkan, additional, Klijn, Catharina J M, additional, van der Worp, H Bart, additional, Klug, Didier, additional, Casolla, Barbara, additional, Puy, Laurent, additional, Coffee, Morgane, additional, Kuchcinski, Grégory, additional, Labreuche, Julien, additional, van Nieuwenhuizen, Koen M., additional, Algra, Ale, additional, van Gelder, Isabelle C., additional, Kappelle, L. Jaap, additional, Rinkel, Gabriel J.E., additional, Schutgens, Roger E.G., additional, Khatri, Pooja, additional, Conwit, Robin, additional, Falcone, Guido, additional, Elm, Jordan, additional, Anderson, Craig S., additional, Song, Lili, additional, Pandian, Jeyaraj, additional, Hart, Robert G., additional, Sharma, Mukul, additional, Aref, Hany, additional, Tarhuni, Wadea, additional, Fabregas, Joan Marti, additional, Diener, Hans-Christoph, additional, Endres, Matthias, additional, Lemmens, Robin, additional, Kwon, Sun U., additional, Lee, Byung-Chul, additional, Ameriso, Sebastian, additional, Milling, Truman J., additional, Kasner, Scott E., additional, Mikulik, Robert, additional, Xavier, Denis, additional, Beer, Ronny, additional, Toni, Danilo, additional, Eckstein, Jens, additional, Seiffge, David, additional, Ferro, Jose M., additional, Tsivgoulis, Georgios, additional, Sharma, Sanjib K., additional, Wei-Liou, Chia, additional, Hohnloser, Stefan H., additional, Katsanos, Aristeidis, additional, Bosch, Jackie, additional, Healey, Jeff, additional, Eikelboom, John, additional, Khaw, Alexander, additional, Gladstone, David, additional, Pikula, Aleksandra, additional, Coutts, Shelagh, additional, Smith, Eric E., additional, Butcher, Ken, additional, Field, Thalia, additional, Gioia, Laura, additional, Stapf, Christian, additional, Halse, Omid, additional, Ringleb, Peter, additional, Enzinger, Christian, additional, Sibon, Igor, additional, Montaner, Joan, additional, Caso, Valeria, additional, Heuschmann, Peter, additional, Lip, Gregory Y.H., additional, Haefeli, Walter, additional, Debette, Stefanie, additional, Dennis, Martin S., additional, Wyller, Torgeir Bruun, additional, Rønning, Ole M., additional, Eilertsen, Helle, additional, Ihle-Hansen, Hege, additional, Sandset, Else Charlotte, additional, Pennlert, Johanna, additional, Glader, Eva-Lotta, additional, Kruuse, Christina, additional, Wester, Per, additional, Carlsson, Maria, additional, and Forfang, Elisabeth, additional

Published
2023
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26. Cognitive performance following stroke, transient ischaemic attack, myocardial infarction, and hospitalisation: an individual participant data meta-analysis of six randomised controlled trials

Author

Sherlock, Laura, primary, Lee, Shun Fu, additional, Katsanos, Aristeidis H, additional, Cukierman-Yaffe, Tali, additional, Canavan, Michelle, additional, Joundi, Raed, additional, Sharma, Mukul, additional, Shoamanesh, Ashkan, additional, Brayne, Carol, additional, Gerstein, Hertzel C, additional, O’Donnell, Martin J, additional, Muniz-Terrera, Graciela, additional, Yusuf, Salim, additional, Bosch, Jackie, additional, and Whiteley, William N, additional

Published
2023
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29. Cerebral microbleeds and risk of incident dementia: the Framingham Heart Study

Author

Romero, José R, Beiser, Alexa, Himali, Jayandra J, Shoamanesh, Ashkan, DeCarli, Charles, and Seshadri, Sudha

Subjects
Biological Psychology, Biomedical and Clinical Sciences, Neurosciences, Psychology, Alzheimer's Disease, Stroke, Prevention, Brain Disorders, Acquired Cognitive Impairment, Dementia, Cardiovascular, Rehabilitation, Neurodegenerative, Alzheimer's Disease including Alzheimer's Disease Related Dementias (AD/ADRD), Aging, Clinical Research, Aetiology, 2.1 Biological and endogenous factors, Neurological, Aged, Aged, 80 and over, Brain, Cerebral Amyloid Angiopathy, Cerebral Hemorrhage, Female, Follow-Up Studies, Humans, Hypertension, Incidence, Magnetic Resonance Imaging, Male, Middle Aged, Models, Statistical, Proportional Hazards Models, Risk, Cerebral microbleeds, Cerebral small vessel disease, Brain MRI, Clinical Sciences, Neurology & Neurosurgery, Biological psychology
Abstract

Cerebral microbleeds (CMBs) are MRI markers attributed to the most common cerebral angiopathies in the elderly and in patients with dementia: hypertensive and cerebral amyloid angiopathy. CMB detection in asymptomatic persons may help identify those at risk for dementia and may influence preventive strategies and design of clinical trials testing treatments for dementia. We studied the association of CMB with risk of incident dementia in community dwelling individuals. A total of 1296 dementia-free Framingham Heart Study participants (mean age 72 years; 54% women) with available brain MRI and incident dementia data during a mean follow-up period of 6.7 years were included. Using Cox proportional hazards models, we related CMB presence to incident dementia. Multivariable models were adjusted for age, sex, APOE status, and education, with additional models adjusting for vascular risk factors and MRI markers of ischemic brain injury. CMBs were observed in 10.8% and incident dementia in 85 participants (6.6% over study period). Participants with any CMB had 1.74 times higher risk of dementia (hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.00-3.01), whereas those with deep and mixed CMB had a three-fold increased risk (HR 2.99, 95% CI 1.52-5.90). The associations were independent of vascular risk factors, and for deep and mixed CMB also independent of MRI markers of ischemia (HR 2.44, 95% CI 1.22-4.88). Purely lobar CMBs were not associated with incident dementia. Our findings support a role for hypertensive vasculopathy and the interplay of hypertensive and cerebral amyloid angiopathy in risk of dementia and suggest that CMB presence can identify individuals at risk of dementia.

Published
2017

30. Cerebral Microbleeds as Predictors of Mortality

Author

Romero, José R, Preis, Sarah R, Beiser, Alexa, Himali, Jayandra J, Shoamanesh, Ashkan, Wolf, Philip A, Kase, Carlos S, Vasan, Ramachandran S, DeCarli, Charles, and Seshadri, Sudha

Subjects
Epidemiology, Health Sciences, Acquired Cognitive Impairment, Neurosciences, Stroke, Clinical Research, Aging, Cardiovascular, Dementia, Prevention, Brain Disorders, Neurological, Good Health and Well Being, Adult, Aged, Aged, 80 and over, Cerebral Hemorrhage, Cerebral Small Vessel Diseases, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Prevalence, Risk Factors, cerebral microbleed, cerebral small vessel disease, community, epidemiology, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurology & Neurosurgery, Clinical sciences, Allied health and rehabilitation science
Abstract

Background and purposeCerebral microbleeds (CMB) represent a common magnetic resonance imaging marker of cerebral small vessel disease, increasingly recognized as a subclinical marker of stroke and dementia risk. CMB detection may reflect the cumulative effect of vascular risk burden and be a marker of higher mortality. We investigated the relation of CMB to risk of death in community dwelling participants free of stroke and dementia.MethodsWe evaluated 1963 Framingham Original and Offspring Cohort participants (mean age 67 years; 54% women) with available brain magnetic resonance imaging and mortality data. Using Cox proportional hazards models, we related CMB to all-cause, cardiovascular, and stroke-related mortality.ResultsParticipants with CMB (8.9%) had higher prevalence of cardiovascular risk factors and use of preventive medications. During a mean follow-up of 7.2±2.6 years, we observed 296 deaths. In age- and sex-adjusted analysis, CMB were associated with increased all-cause mortality (hazards ratio, 1.39; 95% confidence interval 1.03-1.88), a relation that was no longer significant after adjustment for cardiovascular risk and preventive medication use (hazards ratio, 1.15; 95% confidence interval, 0.82-1.63).ConclusionsCMBs may represent the deleterious effect of cardiovascular risk factors in the cerebral vasculature. Although their presence was associated with increased all-cause mortality, the effect was no longer present after accounting for vascular risk factors and preventive treatment use. Further studies are required to clarify the role of cardiovascular preventive therapies for prevention of mortality in persons with incidental detection of CMB.

Published
2017

32. Cerebral Microbleeds and Acute Hematoma Characteristics in the ATACH-2 and MISTIE III Trials

Author

Magid-Bernstein, Jessica R, Li, Yunke, Cho, Sung-Min, Piran, Pirouz J., Roh, David J., Gupta, Ajay, Shoamanesh, Ashkan, Merkler, Alexander, Zhang, Cenai, Avadhani, Radhika, Montano, Nataly, Iadecola, Constantino, Falcone, Guido, Sheth, Kevin, Qureshi, Adnan, Rosand, Jonathan, Goldstein, Joshua, Awad, Issam, Hanley, Daniel, Kamel, Hooman, Ziai, Wendy C., and Murthy, Santosh B.

Published
2021
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34. Association between blood pressure variability and outcomes after endovascular thrombectomy for acute ischemic stroke: An individual patient data meta-analysis.

Author

Palaiodimou, Lina, Joundi, Raed A, Katsanos, Aristeidis H, Ahmed, Niaz, Kim, Joon-Tae, Goyal, Nitin, Maier, Ilko L, de Havenon, Adam, Anadani, Mohammad, Matusevicius, Marius, Mistry, Eva A, Khatri, Pooja, Arthur, Adam S, Sarraj, Amrou, Yaghi, Shadi, Shoamanesh, Ashkan, Catanese, Luciana, Psychogios, Marios-Nikos, Malhotra, Konark, and Spiotta, Alejandro M

Published
2024
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35. Hypertension Canada’s 2020 Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children

Author

Rabi, Doreen M., McBrien, Kerry A., Sapir-Pichhadze, Ruth, Nakhla, Meranda, Ahmed, Sofia B., Dumanski, Sandra M., Butalia, Sonia, Leung, Alexander A., Harris, Kevin C., Cloutier, Lyne, Zarnke, Kelly B., Ruzicka, Marcel, Hiremath, Swapnil, Feldman, Ross D., Tobe, Sheldon W., Campbell, Tavis S., Bacon, Simon L., Nerenberg, Kara A., Dresser, George K., Fournier, Anne, Burgess, Ellen, Lindsay, Patrice, Rabkin, Simon W., Prebtani, Ally P.H., Grover, Steven, Honos, George, Alfonsi, Jeffrey E., Arcand, JoAnne, Audibert, François, Benoit, Geneviève, Bittman, Jesse, Bolli, Peter, Côté, Anne-Marie, Dionne, Janis, Don-Wauchope, Andrew, Edwards, Cedric, Firoz, Tabassum, Gabor, Jonathan Y., Gilbert, Richard E., Grégoire, Jean C., Gryn, Steven E., Gupta, Milan, Hannah-Shmouni, Fady, Hegele, Robert A., Herman, Robert J., Hill, Michael D., Howlett, Jonathan G., Hundemer, Gregory L., Jones, Charlotte, Kaczorowski, Janusz, Khan, Nadia A., Kuyper, Laura M., Lamarre-Cliche, Maxime, Lavoie, Kim L., Leiter, Lawrence A., Lewanczuk, Richard, Logan, Alexander G., Magee, Laura A., Mangat, Birinder K., McFarlane, Philip A., McLean, Donna, Michaud, Andre, Milot, Alain, Moe, Gordon W., Penner, S. Brian, Pipe, Andrew, Poppe, Alexandre Y., Rey, Evelyne, Roerecke, Michael, Schiffrin, Ernesto L., Selby, Peter, Sharma, Mike, Shoamanesh, Ashkan, Sivapalan, Praveena, Townsend, Raymond R., Tran, Karen, Trudeau, Luc, Tsuyuki, Ross T., Vallée, Michel, Woo, Vincent, Bell, Alan D., and Daskalopoulou, Stella S.

Published
2020
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36. Cerebral Microbleeds and Asundexian in Non-cardioembolic Ischemic Stroke: Secondary Analyses of the PACIFIC-STROKE Randomized Trial

Author

Balali, Pargol, primary, Hart, Robert G, additional, Smith, Eric Edward, additional, Saad, Feryal, additional, Colorado, Pablo, additional, Lemmens, Robin, additional, De Marchis, Gian Marco, additional, Caso, Valeria, additional, Xu, Lizhen, additional, Heenan, Laura, additional, Connolly, Stuart, additional, Mundl, Hardi, additional, and Shoamanesh, Ashkan, additional

Published
2023
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38. Transcranial Doppler ultrasound to evaluate the risk of hyperperfusion after endovascular stroke thrombectomy

Author

Katsanos, Aristeidis H., primary, Srivastava, Abhilekh, additional, Sahlas, Demetrios J., additional, Perera, Kanjana, additional, Ng, Kelvin K. H., additional, Joundi, Raed A., additional, Van Adel, Brian, additional, Larrazabal, Ramiro, additional, Ratnayake, Kanchana, additional, Tsivgoulis, Georgios, additional, Benavente, Oscar, additional, Hart, Robert, additional, Sharma, Mukul, additional, Shoamanesh, Ashkan, additional, and Catanese, Luciana, additional

Published
2023
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39. Association Between Hematoma Expansion Severity and Outcome and Its Interaction With Baseline Intracerebral Hemorrhage Volume

Author

Morotti, Andrea, primary, Boulouis, Gregoire, additional, Nawabi, Jawed, additional, Li, Qi, additional, Charidimou, Andreas, additional, Pasi, Marco, additional, Schlunk, Frieder, additional, Shoamanesh, Ashkan, additional, Katsanos, Aristeidis H., additional, Mazzacane, Federico, additional, Busto, Giorgio, additional, Arba, Francesco, additional, Brancaleoni, Laura, additional, Giacomozzi, Sebastiano, additional, Simonetti, Luigi, additional, Warren, Andrew D., additional, Laudisi, Michele, additional, Cavallini, Anna, additional, Gurol, M. Edip, additional, Viswanathan, Anand, additional, Zini, Andrea, additional, Casetta, Ilaria, additional, Fainardi, Enrico, additional, Greenberg, Steven M., additional, Padovani, Alessandro, additional, Rosand, Jonathan, additional, and Goldstein, Joshua N., additional

Published
2023
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42. Intensive Blood Pressure Reduction is Associated with Reduced Hematoma Growth in Fast Bleeding Intracerebral Hemorrhage A Secondary Analysis of the ATACH‐2 Randomized Clinical Trial

Author

Li, Qi, primary, Morotti, Andrea, additional, Warren, Andrew, additional, Qureshi, Adnan I, additional, Dowlatshahi, Dar, additional, Falcone, Guido, additional, Sheth, Kevin N., additional, Shoamanesh, Ashkan, additional, Murthy, Santosh B., additional, Viswanathan, Anand, additional, and Goldstein, Joshua N., additional

Published
2023
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43. Predictors and Prognostic Impact of Hematoma Expansion in Infratentorial Cerebral Hemorrhage

Author

Pezzini, Debora, primary, Nawabi, Jawed, additional, Schlunk, Frieder, additional, Li, Qi, additional, Mazzacane, Federico, additional, Busto, Giorgio, additional, Scola, Elisa, additional, Arba, Francesco, additional, Brancaleoni, Laura, additional, Giacomozzi, Sebastiano, additional, Simonetti, Luigi, additional, Laudisi, Michele, additional, Cavallini, Anna, additional, Katsanos, Aristeidis H., additional, Shoamanesh, Ashkan, additional, Zini, Andrea, additional, Casetta, Ilaria, additional, Fainardi, Enrico, additional, Morotti, Andrea, additional, and Padovani, Alessandro, additional

Published
2023
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44. Diagnostic value of lobar microbleeds in individuals without intracerebral hemorrhage

Author

Martinez‐Ramirez, Sergi, Romero, Jose‐Rafael, Shoamanesh, Ashkan, McKee, Ann C, Van Etten, Ellis, Pontes‐Neto, Octavio, Macklin, Eric A, Ayres, Alison, Auriel, Eitan, Himali, Jayandra J, Beiser, Alexa S, DeCarli, Charles, Stein, Thor D, Alvarez, Victor E, Frosch, Matthew P, Rosand, Jonathan, Greenberg, Steven M, Gurol, M Edip, Seshadri, Sudha, and Viswanathan, Anand

Subjects
Neurosciences, Clinical Research, Brain Disorders, Biomedical Imaging, Rare Diseases, 4.2 Evaluation of markers and technologies, Detection, screening and diagnosis, Aged, Aged, 80 and over, Brain, Cerebral Amyloid Angiopathy, Cerebral Hemorrhage, Female, Humans, Magnetic Resonance Imaging, Male, Predictive Value of Tests, Cerebral amyloid angiopathy, Microbleed, Intracerebral hemorrhage, Boston criteria, Sensitivity, Specificity, Predictive value, Likelihood ratio, Clinical Sciences, Geriatrics
Abstract

IntroductionThe Boston criteria are the basis for a noninvasive diagnosis of cerebral amyloid angiopathy (CAA) in the setting of lobar intracerebral hemorrhage (ICH). We assessed the accuracy of these criteria in individuals with lobar microbleeds (MBs) without ICH.MethodsWe identified individuals aged >55 years having brain magnetic resonance imaging (MRI) and pathological assessment of CAA in a single academic hospital and a community-based population (Framingham Heart Study [FHS]). We determined the positive predictive value (PPV) of the Boston criteria for CAA in both cohorts, using lobar MBs as the only hemorrhagic lesion to fulfill the criteria.ResultsWe included 102 individuals: 55 from the hospital-based cohort and 47 from FHS (mean age at MRI 74.7 ± 8.5 and 83.4 ± 10.9 years; CAA prevalence 60% and 46.8%; cases with any lobar MB 49% and 21.3%; and cases with ≥2 strictly lobar MBs 29.1% and 8.5%, respectively). PPV of "probable CAA" (≥2 strictly lobar MBs) was 87.5% (95% confidence interval [CI], 60.4-97.8) and 25% (95% CI, 13.2-78) in hospital and general populations, respectively.DiscussionStrictly lobar MBs strongly predict CAA in non-ICH individuals when found in a hospital context. However, their diagnostic accuracy in the general population appears limited.

Published
2015

46. Blood Pressure After Endovascular Thrombectomy and Outcomes in Patients With Acute Ischemic Stroke: An Individual Patient Data Meta-analysis

Author

Katsanos, Aristeidis H., Malhotra, Konark, Ahmed, Niaz, Seitidis, Georgios, Mistry, Eva A., Mavridis, Dimitris, Kim, Joon-Tae, Veroniki, Areti Angeliki, Maier, Ilko, Matusevicius, Marius, Khatri, Pooja, Anadani, Mohammad, Goyal, Nitin, Arthur, Adam S., Sarraj, Amrou, Yaghi, Shadi, Shoamanesh, Ashkan, Catanese, Luciana, Kantzanou, Maria, Psaltopoulou, Theodora, Rentzos, Alexandros, Psychogios, Marios, Van Adel, Brian, Spiotta, Alejandro M., Sandset, Else Charlotte, de Havenon, Adam, Alexandrov, Andrei V., Petersen, Nils H., and Tsivgoulis, Georgios

Published
2022
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47. Inflammatory biomarkers, cerebral microbleeds, and small vessel disease

Author

Shoamanesh, Ashkan, Preis, Sarah R, Beiser, Alexa S, Vasan, Ramachandran S, Benjamin, Emelia J, Kase, Carlos S, Wolf, Philip A, DeCarli, Charles, Romero, Jose R, and Seshadri, Sudha

Subjects
Neurosciences, Stroke, Clinical Research, Aging, Brain Disorders, 2.1 Biological and endogenous factors, Aetiology, Cardiovascular, Aged, Biomarkers, Cerebral Hemorrhage, Cerebral Small Vessel Diseases, Cross-Sectional Studies, Female, Humans, Inflammation Mediators, Male, Massachusetts, Middle Aged, Clinical Sciences, Cognitive Sciences, Neurology & Neurosurgery
Abstract

ObjectiveWe investigated the association between circulating biomarkers of inflammation and MRI markers of small vessel disease.MethodsWe performed a cross-sectional study relating a panel of 15 biomarkers, representing systemic inflammation (high-sensitivity C-reactive protein, interleukin-6, monocyte chemotactic protein-1, tumor necrosis factor α, tumor necrosis factor receptor 2, osteoprotegerin, and fibrinogen), vascular inflammation (intercellular adhesion molecule 1, CD40 ligand, P-selectin, lipoprotein-associated phospholipase A2 mass and activity, total homocysteine, and vascular endothelial growth factor), and oxidative stress (myeloperoxidase) to ischemic (white matter hyperintensities/silent cerebral infarcts) and hemorrhagic (cerebral microbleeds) markers of cerebral small vessel disease (CSVD) on MRI in 1,763 stroke-free Framingham offspring (mean age 60.2 ± 9.1 years, 53.7% women).ResultsWe observed higher levels of circulating tumor necrosis factor receptor 2 and myeloperoxidase in the presence of cerebral microbleed (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.1-4.1 and OR 1.5, 95% CI 1.1-2.0, respectively), higher levels of osteoprotegerin (OR 1.1, 95% CI 1.0-1.2), intercellular adhesion molecule 1 (OR 1.7, 95% CI 1.1-2.5), and lipoprotein-associated phospholipase A2 mass (OR 1.5, 95% CI 1.1-2.1), and lower myeloperoxidase (OR 0.8, 95% CI 0.7-1.0) in participants with greater white matter hyperintensity volumes and silent cerebral infarcts.ConclusionsOur study supports a possible role for inflammation in the pathogenesis of CSVD, but suggests that differing inflammatory pathways may underlie ischemic and hemorrhagic subtypes. If validated in other samples, these biomarkers may improve stroke risk prognostication and point to novel therapeutic targets to combat CSVD.

Published
2015

48. Outcomes of patients with atrial fibrillation and ischemic stroke while on oral anticoagulation

Author

Benz, Alexander P, Hohnloser, Stefan H, Eikelboom, John W, Carnicelli, Anthony P, Giugliano, Robert P, Granger, Christopher B, Harrington, Josephine, Hijazi, Ziad, Morrow, David A, Patel, Manesh R, Seiffge, David J, Shoamanesh, Ashkan, Wallentin, Lars, Yi, Qilong, and Connolly, Stuart J

Subjects
610 Medizin und Gesundheit, Cardiology and Cardiovascular Medicine
Abstract

Aims The prognosis of patients with atrial fibrillation (AF) and ischemic stroke while taking oral anticoagulation is poorly understood. This study aimed to characterize the outcomes of patients following a stroke event while on oral anticoagulation. Methods and results Individual participant data from five pivotal randomized trials of antithrombotic therapy in AF were used to assess the outcomes of patients with a post-randomization ischemic stroke while on study medication (warfarin, standard-, or lower-dose direct oral anticoagulant regimen) during trial follow-up. The primary outcome was recurrent ischemic stroke after the first post-randomization ischemic stroke. The primary analysis included 1163 patients with a first post-randomization ischemic stroke while on study medication (median age 73 years, 39.3% female, 35.4% history of stroke before trial enrollment). During a median continued follow-up of 337 days, 74 patients had a recurrent ischemic stroke [cumulative incidence at 1 year: 7.0%, 95% confidence interval (CI) 5.2%–8.7%]. The cumulative incidence of mortality at 3 months after stroke was 12.4% (95% CI 10.5%–14.4%). Consistent results for the incidence of recurrent ischemic stroke at 1 year were obtained in an analysis accounting for the competing risk of death (6.2%, 95% CI 4.8%–7.9%) and in a landmark analysis excluding the first 2 weeks after the index stroke and only including patients without permanent study drug discontinuation since then (6.8%, 95% CI 4.6%–8.9%). Conclusion Patients with AF and ischemic stroke while on oral anticoagulation are at increased risk of recurrent ischemic stroke and death. These patients currently have an unmet medical need.

Published
2023

49. Predictors of Recurrent Ischemic Stroke in Patients with Embolic Strokes of Undetermined Source and Effects of Rivaroxaban Versus Aspirin According to Risk Status: The NAVIGATE ESUS Trial

Author

Hart, Robert G., Veltkamp, Roland C., Sheridan, Patrick, Sharma, Mukul, Kasner, Scott E., Bangdiwala, Shrikant I., Ntaios, George, Shoamanesh, Ashkan, Ameriso, Sebastian F., Toni, Danilo, Czlonkowska, Anna, Lindgren, Arne, Hankey, Graeme J., Perera, Kanjana. S., Shuaib, Ashfaq, Coutts, Shelagh B., Gagliardi, Rubens J., Berkowitz, Scott D., Mundl, Hardi, Peters, Gary, and Connolly, Stuart J.

Published
2019
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