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6. Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies

Author

Harkness, Kirsty, Shaw, Louise, Sword, Jane, Mohd Nor, Azlisham, Sharma, Pankaj, Kelly, Deborah, Harrington, Frances, Randall, Marc, Smith, Matthew, Mahawish, Karim, Elmarim, Abduelbaset, Esisi, Bernard, Cullen, Claire, Nallasivam, Arumug, Price, Christopher, Barry, Adrian, Roffe, Christine, Coyle, John, Hassan, Ahamad, Birns, Jonathan, Cohen, David, Sekaran, Lakshmanan, Parry-Jones, Adrian, Parry, Anthea, Hargroves, David, Proschel, Harald, Datta, Prabel, Darawil, Khaled, Manoj, Aravindakshan, Burn, Mathew, Patterson, Chris, Giallombardo, Elio, Smyth, Nigel, Mansoor, Syed, Anwar, Ijaz, Marsh, Rachel, Ispoglou, Sissi, Chadha, Dinesh, Prabhakaran, Mathuri, Meenakishundaram, Sanjeevikumar, O'Connell, Janice, Scott, Jon, Krishnamurthy, Vinodh, Aghoram, Prasanna, McCormick, Michael, Sprigg, Nikola, O'Mahony, Paul, Cooper, Martin, Choy, Lillian, Wilkinson, Peter, Leach, Simon, Caine, Sarah, Burger, Ilse, Gunathilagan, Gunaratam, Guyler, Paul, Emsley, Hedley, Davis, Michelle, Manawadu, Dulka, Pasco, Kath, Mamun, Maam, Luder, Robert, Sajid, Mahmud, Okwera, James, Warburton, Elizabeth, Saastamoinen, Kari, England, Timothy, Putterill, Janet, Flossman, Enrico, Power, Michael, Dani, Krishna, Mangion, David, Suman, Appu, Corrigan, John, Lawrence, Enas, Vahidassr, Djamil, Shakeshaft, Clare, Brown, Martin, Charidimou, Andreas, Cohen, Hannah, Banerjee, Gargi, Houlden, Henry, White, Mark, Yousry, Tarek, Flossmann, Enrico, Muir, Keith, Gratz, Pascal, Mattle, Heinrich, Panos, Leonidas, Korczyn, Amos, Kliper, Efrat, Maeder, Philippe, Gass, Achim, Pachai, Chahin, Bracoub, Luc, Douste-Blazy, Marie-Yvonne, Fratacci, Marie Dominique, Vicaut, Eric, Sato, Shoichiro, Miwa, Kaori, Fujita, Kyohei, Ide, Toshihiro, Ma, Henry, Ly, John, Singhal, Shaloo, Chandra, Ronil, Slater, Lee-Anne, Soufan, Cathy, Moran, Christopher, Traenka, Christopher, Thilemann, Sebastian, Fladt, Joachim, Gensicke, Henrik, Bonati, Leo, Kim, Beom Joon, Han, Moon-Ku, Kang, Jihoon, Ko, Eunbin, Yang, Mi Hwa, Jang, Myung Suk, Murphy, Sean, Carty, Fiona, Akijian, Layan, Thornton, John, Schembri, Mark, Douven, Elles, Delgado-Mederos, Raquel, Marín, Rebeca, Camps-Renom, Pol, Guisado-Alonso, Daniel, Nuñez, Fidel, Medrano-Martorell, Santiago, Merino, Elisa, Iida, Kotaro, Ikeda, Syuhei, Irie, Hiroyuki, Demirelli, Derya Selcuk, Medanta, Jayesh Modi, Zerna, Charlotte, Hernández, Maria Valdés, Armitage, Paul, Heye, Anna, Muñoz-Maniega, Susana, Sakka, Eleni, Thrippleton, Michael, Dennis, Martin, Beigneux, Ysoline, Silva, Mauro, Venketasubramanian, Narayanaswamy, Ho, Shu Leung, Cheung, Raymond Tak Fai, Chan, Koon Ho, Teo, Kay Cheong, Hui, Edward, Kwan, Joseph Shiu Kwong, Chang, Richard, Tse, Man Yu, Hoi, Chu Peng, Chan, Chung Yan, Chan, Oi Ling, Cheung, Ryan Hoi Kit, Wong, Edmund Ka Ming, Leung, Kam Tat, Tsang, Suk Fung, Ip, Hing Lung, Ma, Sze Ho, Ma, Karen, Fong, Wing Chi, Li, Siu Hung, Li, Richard, Ng, Ping Wing, Wong, Kwok Kui, Liu, Wenyan, Wong, Lawrence, Ramos, Lino, De Schryver, Els, Jöbsis, Joost, van der Sande, Jaap, Brouwers, Paul, Roos, Yvo, Stam, Jan, Bakker, Stef, Verbiest, Henk, Schoonewille, Wouter, Linn, Cisca, Hertzberger, Leopold, van Gemert, Maarten, Berntsen, Paul, Van Dam-Nolen, Dianne, Kooi, M Eline, Van der Lugt, Aad, Koudstaal, Peter, Leff, Alexander, Ward, Nicholas, Nachev, Parashkev, Perry, Richard, Ozkan, Hatice, Mitchell, John, Best, Jonathan G, Ambler, Gareth, Wilson, Duncan, Lee, Keon-Joo, Lim, Jae-Sung, Shiozawa, Masayuki, Koga, Masatoshi, Li, Linxin, Lovelock, Caroline, Chabriat, Hugues, Hennerici, Michael, Wong, Yuen Kwun, Mak, Henry Ka Fung, Prats-Sanchez, Luis, Martínez-Domeño, Alejandro, Inamura, Shigeru, Yoshifuji, Kazuhisa, Arsava, Ethem Murat, Horstmann, Solveig, Purrucker, Jan, Lam, Bonnie Yin Ka, Wong, Adrian, Kim, Young Dae, Song, Tae-Jin, Lemmens, Robin, Eppinger, Sebastian, Gattringer, Thomas, Uysal, Ender, Tanriverdi, Zeynep, Bornstein, Natan M, Ben Assayag, Einor, Hallevi, Hen, Molad, Jeremy, Nishihara, Masashi, Tanaka, Jun, Coutts, Shelagh B, Polymeris, Alexandros, Wagner, Benjamin, Seiffge, David J, Lyrer, Philippe, Algra, Ale, Kappelle, L Jaap, Al-Shahi Salman, Rustam, Jäger, Hans R, Lip, Gregory Y H, Fischer, Urs, El-Koussy, Marwan, Mas, Jean-Louis, Legrand, Laurence, Karayiannis, Christopher, Phan, Thanh, Gunkel, Sarah, Christ, Nicolas, Abrigo, Jill, Leung, Thomas, Chu, Winnie, Chappell, Francesca, Makin, Stephen, Hayden, Derek, Williams, David J, Mess, Werner H, Nederkoorn, Paul J, Barbato, Carmen, Browning, Simone, Wiegertjes, Kim, Tuladhar, Anil M, Maaijwee, Noortje, Guevarra, Anne Cristine, Yatawara, Chathuri, Mendyk, Anne-Marie, Delmaire, Christine, Köhler, Sebastian, van Oostenbrugge, Robert, Zhou, Ying, Xu, Chao, Hilal, Saima, Gyanwali, Bibek, Chen, Christopher, Lou, Min, Staals, Julie, Bordet, Régis, Kandiah, Nagaendran, de Leeuw, Frank-Erik, Simister, Robert, Hendrikse, Jeroen, Kelly, Peter J, Wardlaw, Joanna, Soo, Yannie, Fluri, Felix, Srikanth, Velandai, Calvet, David, Jung, Simon, Kwa, Vincent I H, Engelter, Stefan T, Peters, Nils, Smith, Eric E, Hara, Hideo, Yakushiji, Yusuke, Orken, Dilek Necioglu, Fazekas, Franz, Thijs, Vincent, Heo, Ji Hoe, Mok, Vincent, Veltkamp, Roland, Ay, Hakan, Imaizumi, Toshio, Gomez-Anson, Beatriz, Lau, Kui Kai, Jouvent, Eric, Rothwell, Peter M, Toyoda, Kazunori, Bae, Hee-Joon, Marti-Fabregas, Joan, and Werring, David J

Published
2021
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9. Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies

Author

Harkness, Kirsty, Shaw, Louise, Sword, Jane, Mohd Nor, Azlisham, Sharma, Pankaj, Kelly, Deborah, Harrington, Frances, Randall, Marc, Smith, Matthew, Mahawish, Karim, Elmarim, Abduelbaset, Esisi, Bernard, Cullen, Claire, Nallasivam, Arumug, Price, Christopher, Barry, Adrian, Roffe, Christine, Coyle, John, Hassan, Ahamad, Birns, Jonathan, Cohen, David, Sekaran, Lakshmanan, Parry-Jones, Adrian, Parry, Anthea, Hargroves, David, Proschel, Harald, Datta, Prabel, Darawil, Khaled, Manoj, Aravindakshan, Burn, Mathew, Patterson, Chris, Giallombardo, Elio, Smyth, Nigel, Mansoor, Syed, Anwar, Ijaz, Marsh, Rachel, Ispoglou, Sissi, Chadha, Dinesh, Prabhakaran, Mathuri, Meenakishundaram, Sanjeevikumar, O'Connell, Janice, Scott, Jon, Krishnamurthy, Vinodh, Aghoram, Prasanna, McCormick, Michael, Sprigg, Nikola, O'Mahony, Paul, Cooper, Martin, Choy, Lillian, Wilkinson, Peter, Leach, Simon, Caine, Sarah, Burger, Ilse, Gunathilagan, Gunaratam, Guyler, Paul, Emsley, Hedley, Davis, Michelle, Manawadu, Dulka, Pasco, Kath, Mamun, Maam, Luder, Robert, Sajid, Mahmud, Okwera, James, Warburton, Elizabeth, Saastamoinen, Kari, England, Timothy, Putterill, Janet, Flossman, Enrico, Power, Michael, Dani, Krishna, Mangion, David, Suman, Appu, Corrigan, John, Lawrence, Enas, Vahidassr, Djamil, Shakeshaft, Clare, Brown, Martin, Charidimou, Andreas, Cohen, Hannah, Banerjee, Gargi, Houlden, Henry, White, Mark, Yousry, Tarek, Flossmann, Enrico, Muir, Keith, El-Koussy, Marwan, Gratz, Pascal, Molad, Jeremy, Korczyn, Amos, Kliper, Efrat, Maeder, Philippe, Gass, Achim, Pachai, Chahin, Bracoub, Luc, Douste-Blazy, Marie-Yvonne, Fratacci, Marie Dominique, Vicaut, Eric, Sato, Shoichiro, Miwa, Kaori, Fujita, Kyohei, Ide, Toshihiro, Ma, Henry, Ly, John, Singhal, Shahoo, Chandra, Ronil, Slater, Lee-Anne, Soufan, Cathy, Moran, Christopher, Traenka, Christopher, Thilemann, Sebastian, Fladt, Joachim, Gensicke, Henrik, Bonati, Leo, Kim, Beom Joon, Han, Moon-Ku, Kang, Jihoon, Ko, Eunbin, Yang, Mi Hwa, Jang, Myung Suk, Murphy, Sean, Carty, Fiona, Akijian, Layan, Thornton, John, Schembri, Mark, Douven, Elles, Delgado-Mederos;, Raquel, Marín, Rebeca, Camps-Renom, Pol, Guisado-Alonso, Daniel, Nuñez, Fidel, Medrano-Martorell, Santiago, Merino, Elisa, Iida, Kotaro, Ikeda, Syuhei, Nishihara, Masashi, Irie, Hiroyuki, Demirelli, Derya Selcuk, Medanta, Jayesh Modi, Zerna, Charlotte, Hernández, Maria Valdés, Armitage, Paul, Heye, Anna, Muñoz-Maniega, Susana, Sakka, Eleni, Thrippleton, Michael, Dennis, Martin, Beigneux, Ysoline, Silva, Mauro, Venketasubramanian, Narayanaswamy, Ho, Shu Leung, Cheung, Raymond Tak Fai, Chan, Koon Ho, Teo, Kay Cheong, Hui, Edward, Kwan, Joseph Shiu Kwong, Chang, Richard, Tse, Man Yu, Hoi, Chu Peng, Chan, Chung Yan, Chan, Oi Ling, Cheung, Ryan Hoi Kit, Wong, Edmund Ka Ming, Leung, Kam Tat, Tsang, Suk Fung, Ip, Hing Lung, Ma, Sze Ho, Ma, Karen, Fong, Wing Chi, Li, Siu Hung, Li, Richard, Ng, Ping Wing, Wong, Kwok Kui, Liu, Wenyan, Wong, Lawrence, Ramos, Lino, De Schryver, Els, Jöbsis, Joost, van der Sande, Jaap, Brouwers, Paul, Roos, Yvo, Stam, Jan, Bakker, Stef, Verbiest, Henk, Schoonewille, Wouter, Linn, Cisca, Hertzberger, Leopold, van Gemert, Maarten, Berntsen, Paul, Hendrikse, Jeroen, Nederkoorn, Paul, Mess, Werner, Koudstaal, Peter, Leff, Alexander, Ward, Nicholas, Nachev, Parashkev, Perry, Richard, Ozkan, Hatice, Mitchell, John, Wilson, Duncan, Ambler, Gareth, Lee, Keon-Joo, Lim, Jae-Sung, Shiozawa, Masayuki, Koga, Masatoshi, Li, Linxin, Lovelock, Caroline, Chabriat, Hugues, Hennerici, Michael, Wong, Yuen Kwun, Mak, Henry Ka Fung, Prats-Sánchez, Luis, Martínez-Domeño, Alejandro, Inamura, Shigeru, Yoshifuji, Kazuhisa, Arsava, Ethem Murat, Horstmann, Solveig, Purrucker, Jan, Lam, Bonnie Yin Ka, Wong, Adrian, Kim, Young Dae, Song, Tae-Jin, Schrooten, Maarten, Lemmens, Robin, Eppinger, Sebastian, Gattringer, Thomas, Uysal, Ender, Tanriverdi, Zeynep, Bornstein, Natan M, Assayag, Einor Ben, Hallevi, Hen, Tanaka, Jun, Hara, Hideo, Coutts, Shelagh B, Hert, Lisa, Polymeris, Alexandros, Seiffge, David J, Lyrer, Philippe, Algra, Ale, Kappelle, Jaap, Al-Shahi Salman, Rustam, Jäger, Hans R, Lip, Gregory Y H, Mattle, Heinrich P, Panos, Leonidas D, Mas, Jean-Louis, Legrand, Laurence, Karayiannis, Christopher, Phan, Thanh, Gunkel, Sarah, Christ, Nicolas, Abrigo, Jill, Leung, Thomas, Chu, Winnie, Chappell, Francesca, Makin, Stephen, Hayden, Derek, Williams, David J, Kooi, M Eline, van Dam-Nolen, Dianne H K, Barbato, Carmen, Browning, Simone, Wiegertjes, Kim, Tuladhar, Anil M, Maaijwee, Noortje, Guevarra, Christine, Yatawara, Chathuri, Mendyk, Anne-Marie, Delmaire, Christine, Köhler, Sebastian, van Oostenbrugge, Robert, Zhou, Ying, Xu, Chao, Hilal, Saima, Gyanwali, Bibek, Chen, Christopher, Lou, Min, Staals, Julie, Bordet, Régis, Kandiah, Nagaendran, de Leeuw, Frank-Erik, Simister, Robert, van der Lugt, Aad, Kelly, Peter J, Wardlaw, Joanna M, Soo, Yannie, Fluri, Felix, Srikanth, Velandai, Calvet, David, Jung, Simon, Kwa, Vincent I H, Engelter, Stefan T, Peters, Nils, Smith, Eric E, Yakushiji, Yusuke, Orken, Dilek Necioglu, Fazekas, Franz, Thijs, Vincent, Heo, Ji Hoe, Mok, Vincent, Veltkamp, Roland, Ay, Hakan, Imaizumi, Toshio, Gomez-Anson, Beatriz, Lau, Kui Kai, Jouvent, Eric, Rothwell, Peter M, Toyoda, Kazunori, Bae, Hee-Joon, Marti-Fabregas, Joan, and Werring, David J

Published
2019
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10. Evaluation of a self-administered iPad®-based processing speed assessment for people with multiple sclerosis in a clinical routine setting.

Author

Hechenberger, Stefanie, Helmlinger, Birgit, Tinauer, Christian, Jauk, Emanuel, Ropele, Stefan, Heschl, Bettina, Wurth, Sebastian, Damulina, Anna, Eppinger, Sebastian, Demjaha, Rina, Khalil, Michael, Enzinger, Christian, and Pinter, Daniela

Subjects
COGNITIVE processing speed, MULTIPLE sclerosis, COGNITIVE testing, MAGNETIC resonance imaging, WAITING rooms
Abstract

Background: Limited resources often hinder regular cognitive assessment of people with multiple sclerosis (pwMS) in standard clinical care. A self-administered iPad®-based cognitive screening-tool (Processing Speed Test; PST) might mitigate this problem. Objective: To evaluate the PST in clinical routine. Methods: We investigated the feasibility of the PST in both a quiet and a waiting room setting. We assessed the validity of the PST in comparison with the established Symbol Digit Modalities Test (SDMT). We explored associations between processing speed assessments and the Brief International Cognitive Assessment for MS (BICAMS), magnetic resonance imaging (MRI) parameters, and psychological factors. Additionally, we explored the ability of the PST to detect impairment in processing speed compared to the SDMT. Results: The PST was feasible in the waiting room setting. PST and SDMT correlated comparably with the BICAMS, MRI parameters, and psychological variables. Of 172 pwMS, 50 (30.8%) showed cognitive impairment according to the BICAMS; respective values were 47 (27.3%) for the SDMT and 9 (5.2%) for the PST. Conclusions: The PST performed in a waiting room setting correlates strongly with established cognitive tests. It thus may be used to assess processing speed in a resource-efficient manner and complement cognitive assessment in clinical routine. Despite comparable validity of the PST and SDMT, we identified more pwMS with impaired processing speed using normative data of the SDMT compared to the PST and advise caution, that the common cut-off score of – 1.5 SD from the current PST is not appropriate in Europe. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Stroke Risk and Antithrombotic Treatment During Follow-up of Patients With Ischemic Stroke and Cortical Superficial Siderosis

Author

Martí-Fàbregas, Joan, Camps-Renom, Pol, Best, Jonathan G, Ramos-Pachon, Anna, Guasch-Jiménez, Marina, Martinez-Domeño, Alejandro, Guisado-Alonso, Daniel, Gómez-Ansón, Beatriz M, Ambler, Gareth, Wilson, Duncan, Lee, Keon-Joo, Lim, Jae-Sung, Bae, Hee-Joon, Shiozawa, Masayuki, Koga, Masatoshi, Toyoda, Kazunori, Hennerici, Michael G, Chabriat, Hugues, Jouvent, Eric, Kwun Wong, Debbie Yuen, Mak, Henry, Lau, Kui Kai, Kim, Young Dae, Song, Tae-Jin, Heo, Ji-Hoe, Eppinger, Sebastian, Gattringer, Thomas, Uysal, Ender, Demirelli, Derya Selçuk, Bornstein, Natan, Ben Assayag, Einor, Hallevi, Hen, Molad, Jeremy A, Nishihara, Masashi, Tanaka, Jun, Hara, Hideo, Yakushiji, Yusuke, Coutts, Shelagh B, Smith, Eric, Polymeris, Alexandros A, Wagner, Benjamin, Seiffge, David, Lyrer, Philippe A, Peters, Nils, Engelter, Stefan T, Al-Shahi Salman, Rustam, Jäger, Hans Rudolf, Lip, Gregory Y H, Goeldlin, Martina, Panos, Leonidas, Karayiannis, Christopher Charles, Phan, Thanh G, Srikanth, Velandai K, Christ, Nicolas, Gunkel, Sarah, Fluri, Felix, Leung, Thomas W, Soo, Yannie O Y, Chu, Winnie, Abrigo, Jill, Barbato, Carmen, Browning, Simone, Simister, Robert, Mendyk, Anne-Marie, Bordet, Régis, Hilal, Saima, Gyanwali, Bibek, Chen, Christopher, Jung, Simon, Orken, Dilek Necioglu, Werring, David, and Prats-Sanchez, Luis

Subjects
HEMORRHAGE, Neurology (clinical), 610 Medizin und Gesundheit, CEREBRAL AMYLOID ANGIOPATHY, PREVALENCE, Research Article
Abstract

Background and ObjectivesIn patients with ischemic stroke (IS) or transient ischemic attack (TIA) and cortical superficial siderosis (cSS), there are few data regarding the risk of future cerebrovascular events and also about the benefits and safety of antithrombotic drugs for secondary prevention. We investigated the associations of cSS and stroke risk in patients with recent IS or TIA.MethodsWe retrospectively analyzed the Microbleeds International Collaborative Network (MICON) database. We selected patients with IS or TIA from cohorts who had MRI-assessed cSS, available data on antithrombotic treatments, recurrent cerebrovascular events (intracranial hemorrhage [ICrH], IS, or any stroke [ICrH or IS]), and mortality. We calculated incidence rates (IRs) and performed univariable and multivariable Cox regression analyses.ResultsOf 12,669 patients (mean age 70.4 ± 12.3 years, 57.3% men), cSS was detected in 273 (2.2%) patients. During a mean follow-up of 24 ± 17 months, IS was more frequent than ICrH in both cSS (IR 57.1 vs 14.6 per 1,000 patient-years) and non-cSS (33.7 vs 6.3 per 1,000 patient-years) groups. Compared with the non-cSS group, cSS was associated with any stroke on multivariable analysis {IR 83 vs 42 per 1,000 patient-years, adjusted hazard ratio [HR] for cSS 1.62 (95% CI: 1.14–2.28;p= 0.006)}. This association was not significant in subgroups of patients treated with antiplatelet drugs (n = 6,554) or with anticoagulants (n = 4,044). Patients with cSS who were treated with both antiplatelet drugs and anticoagulants (n = 1,569) had a higher incidence of ICrH (IR 107.5 vs 4.9 per 1,000 patient-years, adjusted HR 13.26; 95% CI: 2.90–60.63;p= 0.001) and of any stroke (IR 198.8 vs 34.7 per 1,000 patient-years, adjusted HR 5.03; 95% CI: 2.03–12.44;p< 0.001) compared with the non-cSS group.DiscussionPatients with IS or TIA with cSS are at increased risk of stroke (ICrH or IS) during follow-up; the risk of IS exceeds that of ICrH for patients receiving antiplatelet or anticoagulant treatment alone, but the risk of ICrH exceeds that of IS in patients receiving both treatments. The findings suggest that either antiplatelet or anticoagulant treatment alone should not be avoided in patients with cSS, but combined antithrombotic therapy might be hazardous. Our findings need to be confirmed by randomized clinical trials.

Published
2022
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16. The value of clinical routine blood biomarkers in predicting long-term mortality after stroke

Author

Hatab, Isra, primary, Kneihsl, Markus, additional, Bisping, Egbert, additional, Rainer, Peter P, additional, Fandler-Höfler, Simon, additional, Eppinger, Sebastian, additional, Haidegger, Melanie, additional, Berger, Natalie, additional, Mangge, Harald, additional, Schmidt, Reinhold, additional, Enzinger, Christian, additional, and Gattringer, Thomas, additional

Published
2023
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17. sj-docx-1-eso-10.1177_23969873231162125 – Supplemental material for The value of clinical routine blood biomarkers in predicting long-term mortality after stroke

Author

Hatab, Isra, Kneihsl, Markus, Bisping, Egbert, Rainer, Peter P, Fandler-Höfler, Simon, Eppinger, Sebastian, Haidegger, Melanie, Berger, Natalie, Mangge, Harald, Schmidt, Reinhold, Enzinger, Christian, and Gattringer, Thomas

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110904 Neurology and Neuromuscular Diseases
Abstract

Supplemental material, sj-docx-1-eso-10.1177_23969873231162125 for The value of clinical routine blood biomarkers in predicting long-term mortality after stroke by Isra Hatab, Markus Kneihsl, Egbert Bisping, Peter P Rainer, Simon Fandler-Höfler, Sebastian Eppinger, Melanie Haidegger, Natalie Berger, Harald Mangge, Reinhold Schmidt, Christian Enzinger and Thomas Gattringer in European Stroke Journal

Published
2023
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18. Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation

Author

Soo, Yannie, Zietz, Annaelle, Yiu, Brian, Mok, Vincent C T, Polymeris, Alexandros A, Seiffge, David, Ambler, Gareth, Wilson, Duncan, Leung, Thomas Wai Hong, Tsang, Suk Fung, Chu, Winnie, Abrigo, Jill, Cheng, Cyrus, Lee, Keon-Joo, Lim, Jae-Sung, Shiozawa, Masayuki, Koga, Masatoshi, Chabriat, Hugues, Hennerici, Michael, Wong, Yuen Kwun, Mak, Henry, Collet, Roger, Inamura, Shigeru, Yoshifuji, Kazuhisa, Arsava, Ethem Murat, Horstmann, Solveig, Purrucker, Jan, Lam, Bonnie Y K, Wong, Adrian, Kim, Young Dae, Song, Tae-Jin, Lemmens, Robin, Eppinger, Sebastian, Gattringer, Thomas, Uysal, Ender, Demirelli, Derya Selçuk, Bornstein, Natan M, Assayag, Einor Ben, Hallevi, Hen, Molad, Jeremy, Nishihara, Masashi, Tanaka, Jun, Coutts, Shelagh B, Kappelle, L Jaap, Salman, Rustam Al-Shahi, Jager, Rolf, Lip, Gregory Y. H., Goeldlin, Martina B, Panos, Leonidas D, Mas, Jean-Louis, Legrand, Laurence, Karayiannis, Chris, Phan, Thanh, Bellut, Maximilian, Chappell, Francesca, Makin, Stephen, Hayden, Derek, Williams, David, van Dam-Nolen, Dianne H K, Nederkoorn, Paul J, Barbato, Carmen, Browning, Simone, Wiegertjes, Kim, Tuladhar, Anil Man, Mendyk, Anne-Marie, Köhler, Sebastian, van Oostenburgge, Robert, Zhou, Ying, Xu, Chao, Hilal, Saima, Gyanwali, Bibek, Chen, Christopher, Lou, Min, Staals, Julie, Bordet, Regis, Kandiah, Nagaendran, de Leeuw, Frank-Erik, Simister, Robert, Hendrikse, Jeroen, Wardlaw, Joanna, Kelly, Peter, Fluri, Felix, Srikanth, Velandai, Calvet, David, Jung, Simon, Kwa, Vincent I H, Smith, Eric E, Hara, Hideo, Yakushiji, Yusuke, Orken, Dilek Necioglu, Fazekas, Franz, Thijs, Vincent, Heo, Ji-Hoe, Veltkamp, Roland, Ay, Hakan, Imaizumi, Toshio, Lau, Kui Kai, Jouvent, Eric, Toyoda, Kazunori, Yoshimura, Sohei, Bae, Hee-Joon, Martí-Fàbregas, Joan, Prats-Sánchez, Luis, Lyrer, Philippe, Best, Jonathan, Werring, David, Engelter, Stefan T, Peters, Nils, Neurology, ACS - Atherosclerosis & ischemic syndromes, and ANS - Neurovascular Disorders

Subjects
All institutes and research themes of the Radboud University Medical Center, Neurology, Neurology (clinical), Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3]
Abstract

Objectives: Cerebral microbleeds are associated with the risks of ischemic stroke and intracranial hemorrhage, causing clinical dilemmas for antithrombotic treatment decisions. We aimed to evaluate the risks of intracranial hemorrhage and ischemic stroke associated with microbleeds in patients with atrial fibrillation treated with vitamin K antagonists, direct oral anticoagulants, antiplatelets, and combination therapy (i.e. concurrent oral anticoagulant and antiplatelet).Methods: We included patients with documented atrial fibrillation from the pooled individual patient data analysis by the Microbleeds International Collaborative Network. Risks of subsequent intracranial hemorrhage and ischemic stroke were compared between patients with and without microbleeds, stratified by antithrombotic use.Results: A total of 7,839 patients were included. The presence of microbleeds was associated with an increased relative risk of intracranial hemorrhage (adjusted hazard ratio [aHR] = 2.74, 95% confidence interval = 1.76-4.26) and ischemic stroke (aHR = 1.29, 95% confidence interval = 1.04-1.59). For the entire cohort, the absolute incidence of ischemic stroke was higher than intracranial hemorrhage regardless of microbleed burden. However, for the subgroup of patients taking combination of anticoagulant and antiplatelet therapy, the absolute risk of intracranial hemorrhage exceeded that of ischemic stroke in those with 2 to 4 microbleeds (25 vs 12 per 1,000 patient-years) and ≥ 11 microbleeds (94 vs 48 per 1,000 patient-years).Interpretation: Patients with atrial fibrillation and high burden of microbleeds receiving combination therapy have a tendency of higher rate of intracranial hemorrhage than ischemic stroke, with potential for net harm. Further studies are needed to help optimize stroke preventive strategies in this high-risk group. ANN NEUROL 2023. Objectives: Cerebral microbleeds are associated with the risks of ischemic stroke and intracranial hemorrhage, causing clinical dilemmas for antithrombotic treatment decisions. We aimed to evaluate the risks of intracranial hemorrhage and ischemic stroke associated with microbleeds in patients with atrial fibrillation treated with vitamin K antagonists, direct oral anticoagulants, antiplatelets, and combination therapy (i.e. concurrent oral anticoagulant and antiplatelet).Methods: We included patients with documented atrial fibrillation from the pooled individual patient data analysis by the Microbleeds International Collaborative Network. Risks of subsequent intracranial hemorrhage and ischemic stroke were compared between patients with and without microbleeds, stratified by antithrombotic use.Results: A total of 7,839 patients were included. The presence of microbleeds was associated with an increased relative risk of intracranial hemorrhage (adjusted hazard ratio [aHR] = 2.74, 95% confidence interval = 1.76-4.26) and ischemic stroke (aHR = 1.29, 95% confidence interval = 1.04-1.59). For the entire cohort, the absolute incidence of ischemic stroke was higher than intracranial hemorrhage regardless of microbleed burden. However, for the subgroup of patients taking combination of anticoagulant and antiplatelet therapy, the absolute risk of intracranial hemorrhage exceeded that of ischemic stroke in those with 2 to 4 microbleeds (25 vs 12 per 1,000 patient-years) and ≥ 11 microbleeds (94 vs 48 per 1,000 patient-years).Interpretation: Patients with atrial fibrillation and high burden of microbleeds receiving combination therapy have a tendency of higher rate of intracranial hemorrhage than ischemic stroke, with potential for net harm. Further studies are needed to help optimize stroke preventive strategies in this high-risk group. ANN NEUROL 2023.

Published
2023
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19. Association of Presence and Pattern of MRI Markers of Cerebral Small Vessel Disease With Recurrent Intracerebral Hemorrhage

Author

Fandler-Höfler, Author S Simon, Obergottsberger, Lena, Ambler, Gareth, Eppinger, Sebastian, Wünsch, Gerit, Kneihsl, Markus, Seiffge, David, Banerjee, Gargi, Wilson, Duncan, Nash, Philip, Jäger, Hans Rudolf, Enzinger, Chris, Werring, David, and Gattringer, Thomas

Subjects
610 Medicine & health
Abstract

BACKGROUND Assessing the risk of recurrent intracerebral hemorrhage (ICH) is of high clinical importance. MRI-based cerebral small vessel disease (SVD) markers may help establish ICH etiological subtypes (including cryptogenic ICH) relevant for recurrence risk. METHODS We investigated the risk of recurrent ICH in a large cohort of consecutive ICH survivors with available MRI at baseline. Patients with macrovascular, structural or other identified secondary causes (other than SVD) were excluded. Based on MRI findings, ICH etiology was defined as probable cerebral amyloid angiopathy (CAA) according to the Boston 2.0 criteria, arteriolosclerosis (non-lobar ICH and additional markers of arteriolosclerosis, absent lobar hemorrhagic lesions), mixed SVD (mixed deep and lobar hemorrhagic changes) or cryptogenic (no MRI markers of SVD). Recurrent ICH was determined using electronic health records and confirmed by neuroimaging. Data from an independent multi-center cohort (CROMIS-2 ICH) was used to confirm core findings. RESULTS Of 443 patients with ICH (mean age 67±13 years, 41% female), ICH etiology was mixed SVD in 36.7%, arteriolosclerosis in 23.6%, CAA in 23.0%, and cryptogenic in 16.7%. During a median follow-up period of 5.7 years (IQR 2.9-10.0, 2682 patient-years), recurrent ICH were found in 59 individual patients (13.3%). The highest recurrence rate per 100 person-years was detected in patients with CAA (8.5, 95% CI 6.1-11.7), followed by mixed SVD (1.8, 95% CI 1.1-2.9) and arteriolosclerosis (0.6, 95% CI 0.3-1.5). No recurrent ICH occurred in patients with cryptogenic ICH during 510 person-years follow-up (97.5% CI, 0-0.7); this finding was confirmed in an independent cohort (CROMIS-2 ICH, n=216), in which there was also no recurrence in patients with cryptogenic ICH. In patients with CAA, cortical superficial siderosis was the imaging feature strongest related with ICH recurrence (hazard ratio 5.7, 95% CI 2.4-13.6). CONCLUSIONS MRI-based etiological subtypes are helpful in determining the recurrence risk of ICH; while the highest recurrence risk was found in CAA, recurrence risk was low for arteriolosclerosis, and negligible for cryptogenic ICH.

Published
2023
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20. Serum glial fibrillary acidic protein is sensitive to acute but not chronic tissue damage in cerebral small vessel disease

Author

Gattringer, Thomas, primary, Enzinger, Christian, additional, Pinter, Daniela, additional, Fandler-Höfler, Simon, additional, Kneihsl, Markus, additional, Haidegger, Melanie, additional, Eppinger, Sebastian, additional, Demjaha, Rina, additional, Buchmann, Arabella, additional, Jerkovic, Andrea, additional, Schmidt, Reinhold, additional, and Khalil, Michael, additional

Published
2022
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26. Predicting atrial fibrillation after cryptogenic stroke via a clinical risk score—a prospective observational study

Author

Kneihsl, Markus, primary, Bisping, Egbert, additional, Scherr, Daniel, additional, Mangge, Harald, additional, Fandler‐Höfler, Simon, additional, Colonna, Isabella, additional, Haidegger, Melanie, additional, Eppinger, Sebastian, additional, Hofer, Edith, additional, Fazekas, Franz, additional, Enzinger, Christian, additional, and Gattringer, Thomas, additional

Published
2021
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27. Stroke Risk and Antithrombotic Treatment During Follow-up of Patients With Ischemic Stroke and Cortical Superficial Siderosis

Author

Martí-Fàbregas, Joan, Camps-Renom, Pol, Best, Jonathan G., Ramos-Pachon, Anna, Guasch-Jiménez, Marina, Martinez-Domeño, Alejandro, Guisado-Alonso, Daniel, Gómez-Ansón, Beatriz M., Ambler, Gareth, Wilson, Duncan, Lee, Keon-Joo, Lim, Jae-Sung, Bae, Hee-Joon, Shiozawa, Masayuki, Koga, Masatoshi, Toyoda, Kazunori, Hennerici, Michael G., Chabriat, Hugues, Jouvent, Eric, Wong, Debbie Yuen Kwun, Mak, Henry, Lau, Kui Kai, Kim, Young Dae, Song, Tae-Jin, Heo, Ji-Hoe, Eppinger, Sebastian, Gattringer, Thomas, Uysal, Ender, Demirelli, Derya Selçuk, Bornstein, Natan, Ben Assayag, Einor, Hallevi, Hen, Molad, Jeremy A., Nishihara, Masashi, Tanaka, Jun, Hara, Hideo, Yakushiji, Yusuke, Coutts, Shelagh B., Smith, Eric, Polymeris, Alexandros A., Wagner, Benjamin, Seiffge, David, Lyrer, Philippe A., Peters, Nils, Engelter, Stefan T., Al-Shahi Salman, Rustam, Jäger, Hans Rudolf, Lip, Gregory Y.H., Goeldlin, Martina, Panos, Leonidas, Karayiannis, Christopher Charles, Phan, Thanh G., Srikanth, Velandai K., Christ, Nicolas, Gunkel, Sarah, Fluri, Felix, Leung, Thomas W., Soo, Yannie O.Y., Chu, Winnie, Abrigo, Jill, Barbato, Carmen, Browning, Simone, Simister, Robert, Mendyk, Anne-Marie, Bordet, Régis, Hilal, Saima, Gyanwali, Bibek, Chen, Christopher, Jung, Simon, Necioglu Orken, Dilek, Werring, David, and Prats-Sanchez, Luis

Published
2023
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28. ESO Guideline on covert cerebral small vessel disease

Author

Wardlaw, Joanna M, primary, Debette, Stephanie, additional, Jokinen, Hanna, additional, De Leeuw, Frank-Erik, additional, Pantoni, Leonardo, additional, Chabriat, Hugues, additional, Staals, Julie, additional, Doubal, Fergus, additional, Rudilosso, Salvatore, additional, Eppinger, Sebastian, additional, Schilling, Sabrina, additional, Ornello, Raffaele, additional, Enzinger, Christian, additional, Cordonnier, Charlotte, additional, Taylor-Rowan, Martin, additional, and Lindgren, Arne G, additional

Published
2021
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29. Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies

Author

Best, Jonathan G, primary, Ambler, Gareth, additional, Wilson, Duncan, additional, Lee, Keon-Joo, additional, Lim, Jae-Sung, additional, Shiozawa, Masayuki, additional, Koga, Masatoshi, additional, Li, Linxin, additional, Lovelock, Caroline, additional, Chabriat, Hugues, additional, Hennerici, Michael, additional, Wong, Yuen Kwun, additional, Mak, Henry Ka Fung, additional, Prats-Sanchez, Luis, additional, Martínez-Domeño, Alejandro, additional, Inamura, Shigeru, additional, Yoshifuji, Kazuhisa, additional, Arsava, Ethem Murat, additional, Horstmann, Solveig, additional, Purrucker, Jan, additional, Lam, Bonnie Yin Ka, additional, Wong, Adrian, additional, Kim, Young Dae, additional, Song, Tae-Jin, additional, Lemmens, Robin, additional, Eppinger, Sebastian, additional, Gattringer, Thomas, additional, Uysal, Ender, additional, Tanriverdi, Zeynep, additional, Bornstein, Natan M, additional, Ben Assayag, Einor, additional, Hallevi, Hen, additional, Molad, Jeremy, additional, Nishihara, Masashi, additional, Tanaka, Jun, additional, Coutts, Shelagh B, additional, Polymeris, Alexandros, additional, Wagner, Benjamin, additional, Seiffge, David J, additional, Lyrer, Philippe, additional, Algra, Ale, additional, Kappelle, L Jaap, additional, Al-Shahi Salman, Rustam, additional, Jäger, Hans R, additional, Lip, Gregory Y H, additional, Fischer, Urs, additional, El-Koussy, Marwan, additional, Mas, Jean-Louis, additional, Legrand, Laurence, additional, Karayiannis, Christopher, additional, Phan, Thanh, additional, Gunkel, Sarah, additional, Christ, Nicolas, additional, Abrigo, Jill, additional, Leung, Thomas, additional, Chu, Winnie, additional, Chappell, Francesca, additional, Makin, Stephen, additional, Hayden, Derek, additional, Williams, David J, additional, Mess, Werner H, additional, Nederkoorn, Paul J, additional, Barbato, Carmen, additional, Browning, Simone, additional, Wiegertjes, Kim, additional, Tuladhar, Anil M, additional, Maaijwee, Noortje, additional, Guevarra, Anne Cristine, additional, Yatawara, Chathuri, additional, Mendyk, Anne-Marie, additional, Delmaire, Christine, additional, Köhler, Sebastian, additional, van Oostenbrugge, Robert, additional, Zhou, Ying, additional, Xu, Chao, additional, Hilal, Saima, additional, Gyanwali, Bibek, additional, Chen, Christopher, additional, Lou, Min, additional, Staals, Julie, additional, Bordet, Régis, additional, Kandiah, Nagaendran, additional, de Leeuw, Frank-Erik, additional, Simister, Robert, additional, Hendrikse, Jeroen, additional, Kelly, Peter J, additional, Wardlaw, Joanna, additional, Soo, Yannie, additional, Fluri, Felix, additional, Srikanth, Velandai, additional, Calvet, David, additional, Jung, Simon, additional, Kwa, Vincent I H, additional, Engelter, Stefan T, additional, Peters, Nils, additional, Smith, Eric E, additional, Hara, Hideo, additional, Yakushiji, Yusuke, additional, Orken, Dilek Necioglu, additional, Fazekas, Franz, additional, Thijs, Vincent, additional, Heo, Ji Hoe, additional, Mok, Vincent, additional, Veltkamp, Roland, additional, Ay, Hakan, additional, Imaizumi, Toshio, additional, Gomez-Anson, Beatriz, additional, Lau, Kui Kai, additional, Jouvent, Eric, additional, Rothwell, Peter M, additional, Toyoda, Kazunori, additional, Bae, Hee-Joon, additional, Marti-Fabregas, Joan, additional, Werring, David J, additional, Harkness, Kirsty, additional, Shaw, Louise, additional, Sword, Jane, additional, Mohd Nor, Azlisham, additional, Sharma, Pankaj, additional, Kelly, Deborah, additional, Harrington, Frances, additional, Randall, Marc, additional, Smith, Matthew, additional, Mahawish, Karim, additional, Elmarim, Abduelbaset, additional, Esisi, Bernard, additional, Cullen, Claire, additional, Nallasivam, Arumug, additional, Price, Christopher, additional, Barry, Adrian, additional, Roffe, Christine, additional, Coyle, John, additional, Hassan, Ahamad, additional, Birns, Jonathan, additional, Cohen, David, additional, Sekaran, Lakshmanan, additional, Parry-Jones, Adrian, additional, Parry, Anthea, additional, Hargroves, David, additional, Proschel, Harald, additional, Datta, Prabel, additional, Darawil, Khaled, additional, Manoj, Aravindakshan, additional, Burn, Mathew, additional, Patterson, Chris, additional, Giallombardo, Elio, additional, Smyth, Nigel, additional, Mansoor, Syed, additional, Anwar, Ijaz, additional, Marsh, Rachel, additional, Ispoglou, Sissi, additional, Chadha, Dinesh, additional, Prabhakaran, Mathuri, additional, Meenakishundaram, Sanjeevikumar, additional, O'Connell, Janice, additional, Scott, Jon, additional, Krishnamurthy, Vinodh, additional, Aghoram, Prasanna, additional, McCormick, Michael, additional, Sprigg, Nikola, additional, O'Mahony, Paul, additional, Cooper, Martin, additional, Choy, Lillian, additional, Wilkinson, Peter, additional, Leach, Simon, additional, Caine, Sarah, additional, Burger, Ilse, additional, Gunathilagan, Gunaratam, additional, Guyler, Paul, additional, Emsley, Hedley, additional, Davis, Michelle, additional, Manawadu, Dulka, additional, Pasco, Kath, additional, Mamun, Maam, additional, Luder, Robert, additional, Sajid, Mahmud, additional, Okwera, James, additional, Warburton, Elizabeth, additional, Saastamoinen, Kari, additional, England, Timothy, additional, Putterill, Janet, additional, Flossman, Enrico, additional, Power, Michael, additional, Dani, Krishna, additional, Mangion, David, additional, Suman, Appu, additional, Corrigan, John, additional, Lawrence, Enas, additional, Vahidassr, Djamil, additional, Shakeshaft, Clare, additional, Brown, Martin, additional, Charidimou, Andreas, additional, Cohen, Hannah, additional, Banerjee, Gargi, additional, Houlden, Henry, additional, White, Mark, additional, Yousry, Tarek, additional, Flossmann, Enrico, additional, Muir, Keith, additional, Gratz, Pascal, additional, Mattle, Heinrich, additional, Panos, Leonidas, additional, Korczyn, Amos, additional, Kliper, Efrat, additional, Maeder, Philippe, additional, Gass, Achim, additional, Pachai, Chahin, additional, Bracoub, Luc, additional, Douste-Blazy, Marie-Yvonne, additional, Fratacci, Marie Dominique, additional, Vicaut, Eric, additional, Sato, Shoichiro, additional, Miwa, Kaori, additional, Fujita, Kyohei, additional, Ide, Toshihiro, additional, Ma, Henry, additional, Ly, John, additional, Singhal, Shaloo, additional, Chandra, Ronil, additional, Slater, Lee-Anne, additional, Soufan, Cathy, additional, Moran, Christopher, additional, Traenka, Christopher, additional, Thilemann, Sebastian, additional, Fladt, Joachim, additional, Gensicke, Henrik, additional, Bonati, Leo, additional, Kim, Beom Joon, additional, Han, Moon-Ku, additional, Kang, Jihoon, additional, Ko, Eunbin, additional, Yang, Mi Hwa, additional, Jang, Myung Suk, additional, Murphy, Sean, additional, Carty, Fiona, additional, Akijian, Layan, additional, Thornton, John, additional, Schembri, Mark, additional, Douven, Elles, additional, Delgado-Mederos, Raquel, additional, Marín, Rebeca, additional, Camps-Renom, Pol, additional, Guisado-Alonso, Daniel, additional, Nuñez, Fidel, additional, Medrano-Martorell, Santiago, additional, Merino, Elisa, additional, Iida, Kotaro, additional, Ikeda, Syuhei, additional, Irie, Hiroyuki, additional, Demirelli, Derya Selcuk, additional, Medanta, Jayesh Modi, additional, Zerna, Charlotte, additional, Hernández, Maria Valdés, additional, Armitage, Paul, additional, Heye, Anna, additional, Muñoz-Maniega, Susana, additional, Sakka, Eleni, additional, Thrippleton, Michael, additional, Dennis, Martin, additional, Beigneux, Ysoline, additional, Silva, Mauro, additional, Venketasubramanian, Narayanaswamy, additional, Ho, Shu Leung, additional, Cheung, Raymond Tak Fai, additional, Chan, Koon Ho, additional, Teo, Kay Cheong, additional, Hui, Edward, additional, Kwan, Joseph Shiu Kwong, additional, Chang, Richard, additional, Tse, Man Yu, additional, Hoi, Chu Peng, additional, Chan, Chung Yan, additional, Chan, Oi Ling, additional, Cheung, Ryan Hoi Kit, additional, Wong, Edmund Ka Ming, additional, Leung, Kam Tat, additional, Tsang, Suk Fung, additional, Ip, Hing Lung, additional, Ma, Sze Ho, additional, Ma, Karen, additional, Fong, Wing Chi, additional, Li, Siu Hung, additional, Li, Richard, additional, Ng, Ping Wing, additional, Wong, Kwok Kui, additional, Liu, Wenyan, additional, Wong, Lawrence, additional, Ramos, Lino, additional, De Schryver, Els, additional, Jöbsis, Joost, additional, van der Sande, Jaap, additional, Brouwers, Paul, additional, Roos, Yvo, additional, Stam, Jan, additional, Bakker, Stef, additional, Verbiest, Henk, additional, Schoonewille, Wouter, additional, Linn, Cisca, additional, Hertzberger, Leopold, additional, van Gemert, Maarten, additional, Berntsen, Paul, additional, Van Dam-Nolen, Dianne, additional, Kooi, M Eline, additional, Van der Lugt, Aad, additional, Koudstaal, Peter, additional, Leff, Alexander, additional, Ward, Nicholas, additional, Nachev, Parashkev, additional, Perry, Richard, additional, Ozkan, Hatice, additional, and Mitchell, John, additional

Published
2021
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30. Sex Differences in Frequency, Severity, and Distribution of Cerebral Microbleeds.

Author

Fandler-Höfler, Simon, Eppinger, Sebastian, Ambler, Gareth, Nash, Philip, Kneihsl, Markus, Lee, Keon-Joo, Lim, Jae-Sung, Shiozawa, Masayuki, Koga, Masatoshi, Li, Linxin, Lovelock, Caroline, Chabriat, Hugues, Hennerici, Michael, Wong, Yuen Kwun, Mak, Henry Ka Fung, Prats-Sanchez, Luis, Martínez-Domeño, Alejandro, Inamura, Shigeru, Yoshifuji, Kazuhisa, and Arsava, Ethem Murat

Published
2024
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31. Predicting atrial fibrillation after cryptogenic stroke via a clinical risk score—a prospective observational study.

Author

Kneihsl, Markus, Bisping, Egbert, Scherr, Daniel, Mangge, Harald, Fandler‐Höfler, Simon, Colonna, Isabella, Haidegger, Melanie, Eppinger, Sebastian, Hofer, Edith, Fazekas, Franz, Enzinger, Christian, and Gattringer, Thomas

Subjects
ISCHEMIC stroke, ATRIAL fibrillation, LONGITUDINAL method, SENSITIVITY & specificity (Statistics), VENTRICULAR ejection fraction
Abstract

Background and purpose: Atrial fibrillation (AF) often remains undiagnosed in cryptogenic stroke (CS), mostly because of limited availability of cardiac long‐term rhythm monitoring. There is an unmet need for a pre‐selection of CS patients benefitting from such work‐up. A clinical risk score was therefore developed for the prediction of AF after CS and its performance was evaluated over 1 year of follow‐up. Methods: Our proposed risk score ranges from 0 to 16 points and comprises variables known to be associated with occult AF in CS patients including age, N‐terminal pro‐brain natriuretic peptide, electrocardiographic and echocardiographic features (supraventricular premature beats, atrial runs, atrial enlargement, left ventricular ejection fraction) and brain imaging markers (multi‐territory/prior cortical infarction). All CS patients admitted to our Stroke Unit between March 2018 and August 2019 were prospectively followed for AF detection over 1 year after discharge. Results: During the 1‐year follow‐up, 24 (16%) out of 150 CS patients with AF (detected via electrocardiogram controls, n = 18; loop recorder monitoring, n = 6) were diagnosed. Our predefined AF Risk Score (cutoff ≥4 points; highest Youden's index) had a sensitivity of 92% and a specificity of 67% for 1‐year prediction of AF. Notably, only two CS patients with <4 score points were diagnosed with AF later on (negative predictive value 98%). Conclusions: A clinical risk score for 1‐year prediction of AF in CS with high sensitivity, reasonable specificity and excellent negative predictive value is presented. Generalizability of our score needs to be tested in external cohorts with continuous cardiac rhythm monitoring. [ABSTRACT FROM AUTHOR]

Published
2022
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32. Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies

Author

Wilson, Duncan, primary, Ambler, Gareth, additional, Lee, Keon-Joo, additional, Lim, Jae-Sung, additional, Shiozawa, Masayuki, additional, Koga, Masatoshi, additional, Li, Linxin, additional, Lovelock, Caroline, additional, Chabriat, Hugues, additional, Hennerici, Michael, additional, Wong, Yuen Kwun, additional, Mak, Henry Ka Fung, additional, Prats-Sánchez, Luis, additional, Martínez-Domeño, Alejandro, additional, Inamura, Shigeru, additional, Yoshifuji, Kazuhisa, additional, Arsava, Ethem Murat, additional, Horstmann, Solveig, additional, Purrucker, Jan, additional, Lam, Bonnie Yin Ka, additional, Wong, Adrian, additional, Kim, Young Dae, additional, Song, Tae-Jin, additional, Schrooten, Maarten, additional, Lemmens, Robin, additional, Eppinger, Sebastian, additional, Gattringer, Thomas, additional, Uysal, Ender, additional, Tanriverdi, Zeynep, additional, Bornstein, Natan M, additional, Assayag, Einor Ben, additional, Hallevi, Hen, additional, Tanaka, Jun, additional, Hara, Hideo, additional, Coutts, Shelagh B, additional, Hert, Lisa, additional, Polymeris, Alexandros, additional, Seiffge, David J, additional, Lyrer, Philippe, additional, Algra, Ale, additional, Kappelle, Jaap, additional, Al-Shahi Salman, Rustam, additional, Jäger, Hans R, additional, Lip, Gregory Y H, additional, Mattle, Heinrich P, additional, Panos, Leonidas D, additional, Mas, Jean-Louis, additional, Legrand, Laurence, additional, Karayiannis, Christopher, additional, Phan, Thanh, additional, Gunkel, Sarah, additional, Christ, Nicolas, additional, Abrigo, Jill, additional, Leung, Thomas, additional, Chu, Winnie, additional, Chappell, Francesca, additional, Makin, Stephen, additional, Hayden, Derek, additional, Williams, David J, additional, Kooi, M Eline, additional, van Dam-Nolen, Dianne H K, additional, Barbato, Carmen, additional, Browning, Simone, additional, Wiegertjes, Kim, additional, Tuladhar, Anil M, additional, Maaijwee, Noortje, additional, Guevarra, Christine, additional, Yatawara, Chathuri, additional, Mendyk, Anne-Marie, additional, Delmaire, Christine, additional, Köhler, Sebastian, additional, van Oostenbrugge, Robert, additional, Zhou, Ying, additional, Xu, Chao, additional, Hilal, Saima, additional, Gyanwali, Bibek, additional, Chen, Christopher, additional, Lou, Min, additional, Staals, Julie, additional, Bordet, Régis, additional, Kandiah, Nagaendran, additional, de Leeuw, Frank-Erik, additional, Simister, Robert, additional, van der Lugt, Aad, additional, Kelly, Peter J, additional, Wardlaw, Joanna M, additional, Soo, Yannie, additional, Fluri, Felix, additional, Srikanth, Velandai, additional, Calvet, David, additional, Jung, Simon, additional, Kwa, Vincent I H, additional, Engelter, Stefan T, additional, Peters, Nils, additional, Smith, Eric E, additional, Yakushiji, Yusuke, additional, Orken, Dilek Necioglu, additional, Fazekas, Franz, additional, Thijs, Vincent, additional, Heo, Ji Hoe, additional, Mok, Vincent, additional, Veltkamp, Roland, additional, Ay, Hakan, additional, Imaizumi, Toshio, additional, Gomez-Anson, Beatriz, additional, Lau, Kui Kai, additional, Jouvent, Eric, additional, Rothwell, Peter M, additional, Toyoda, Kazunori, additional, Bae, Hee-Joon, additional, Marti-Fabregas, Joan, additional, Werring, David J, additional, Harkness, Kirsty, additional, Shaw, Louise, additional, Sword, Jane, additional, Mohd Nor, Azlisham, additional, Sharma, Pankaj, additional, Kelly, Deborah, additional, Harrington, Frances, additional, Randall, Marc, additional, Smith, Matthew, additional, Mahawish, Karim, additional, Elmarim, Abduelbaset, additional, Esisi, Bernard, additional, Cullen, Claire, additional, Nallasivam, Arumug, additional, Price, Christopher, additional, Barry, Adrian, additional, Roffe, Christine, additional, Coyle, John, additional, Hassan, Ahamad, additional, Birns, Jonathan, additional, Cohen, David, additional, Sekaran, Lakshmanan, additional, Parry-Jones, Adrian, additional, Parry, Anthea, additional, Hargroves, David, additional, Proschel, Harald, additional, Datta, Prabel, additional, Darawil, Khaled, additional, Manoj, Aravindakshan, additional, Burn, Mathew, additional, Patterson, Chris, additional, Giallombardo, Elio, additional, Smyth, Nigel, additional, Mansoor, Syed, additional, Anwar, Ijaz, additional, Marsh, Rachel, additional, Ispoglou, Sissi, additional, Chadha, Dinesh, additional, Prabhakaran, Mathuri, additional, Meenakishundaram, Sanjeevikumar, additional, O'Connell, Janice, additional, Scott, Jon, additional, Krishnamurthy, Vinodh, additional, Aghoram, Prasanna, additional, McCormick, Michael, additional, Sprigg, Nikola, additional, O'Mahony, Paul, additional, Cooper, Martin, additional, Choy, Lillian, additional, Wilkinson, Peter, additional, Leach, Simon, additional, Caine, Sarah, additional, Burger, Ilse, additional, Gunathilagan, Gunaratam, additional, Guyler, Paul, additional, Emsley, Hedley, additional, Davis, Michelle, additional, Manawadu, Dulka, additional, Pasco, Kath, additional, Mamun, Maam, additional, Luder, Robert, additional, Sajid, Mahmud, additional, Okwera, James, additional, Warburton, Elizabeth, additional, Saastamoinen, Kari, additional, England, Timothy, additional, Putterill, Janet, additional, Flossman, Enrico, additional, Power, Michael, additional, Dani, Krishna, additional, Mangion, David, additional, Suman, Appu, additional, Corrigan, John, additional, Lawrence, Enas, additional, Vahidassr, Djamil, additional, Shakeshaft, Clare, additional, Brown, Martin, additional, Charidimou, Andreas, additional, Cohen, Hannah, additional, Banerjee, Gargi, additional, Houlden, Henry, additional, White, Mark, additional, Yousry, Tarek, additional, Flossmann, Enrico, additional, Muir, Keith, additional, El-Koussy, Marwan, additional, Gratz, Pascal, additional, Molad, Jeremy, additional, Korczyn, Amos, additional, Kliper, Efrat, additional, Maeder, Philippe, additional, Gass, Achim, additional, Pachai, Chahin, additional, Bracoub, Luc, additional, Douste-Blazy, Marie-Yvonne, additional, Fratacci, Marie Dominique, additional, Vicaut, Eric, additional, Sato, Shoichiro, additional, Miwa, Kaori, additional, Fujita, Kyohei, additional, Ide, Toshihiro, additional, Ma, Henry, additional, Ly, John, additional, Singhal, Shahoo, additional, Chandra, Ronil, additional, Slater, Lee-Anne, additional, Soufan, Cathy, additional, Moran, Christopher, additional, Traenka, Christopher, additional, Thilemann, Sebastian, additional, Fladt, Joachim, additional, Gensicke, Henrik, additional, Bonati, Leo, additional, Kim, Beom Joon, additional, Han, Moon-Ku, additional, Kang, Jihoon, additional, Ko, Eunbin, additional, Yang, Mi Hwa, additional, Jang, Myung Suk, additional, Murphy, Sean, additional, Carty, Fiona, additional, Akijian, Layan, additional, Thornton, John, additional, Schembri, Mark, additional, Douven, Elles, additional, Delgado-Mederos;, Raquel, additional, Marín, Rebeca, additional, Camps-Renom, Pol, additional, Guisado-Alonso, Daniel, additional, Nuñez, Fidel, additional, Medrano-Martorell, Santiago, additional, Merino, Elisa, additional, Iida, Kotaro, additional, Ikeda, Syuhei, additional, Nishihara, Masashi, additional, Irie, Hiroyuki, additional, Demirelli, Derya Selcuk, additional, Medanta, Jayesh Modi, additional, Zerna, Charlotte, additional, Hernández, Maria Valdés, additional, Armitage, Paul, additional, Heye, Anna, additional, Muñoz-Maniega, Susana, additional, Sakka, Eleni, additional, Thrippleton, Michael, additional, Dennis, Martin, additional, Beigneux, Ysoline, additional, Silva, Mauro, additional, Venketasubramanian, Narayanaswamy, additional, Ho, Shu Leung, additional, Cheung, Raymond Tak Fai, additional, Chan, Koon Ho, additional, Teo, Kay Cheong, additional, Hui, Edward, additional, Kwan, Joseph Shiu Kwong, additional, Chang, Richard, additional, Tse, Man Yu, additional, Hoi, Chu Peng, additional, Chan, Chung Yan, additional, Chan, Oi Ling, additional, Cheung, Ryan Hoi Kit, additional, Wong, Edmund Ka Ming, additional, Leung, Kam Tat, additional, Tsang, Suk Fung, additional, Ip, Hing Lung, additional, Ma, Sze Ho, additional, Ma, Karen, additional, Fong, Wing Chi, additional, Li, Siu Hung, additional, Li, Richard, additional, Ng, Ping Wing, additional, Wong, Kwok Kui, additional, Liu, Wenyan, additional, Wong, Lawrence, additional, Ramos, Lino, additional, De Schryver, Els, additional, Jöbsis, Joost, additional, van der Sande, Jaap, additional, Brouwers, Paul, additional, Roos, Yvo, additional, Stam, Jan, additional, Bakker, Stef, additional, Verbiest, Henk, additional, Schoonewille, Wouter, additional, Linn, Cisca, additional, Hertzberger, Leopold, additional, van Gemert, Maarten, additional, Berntsen, Paul, additional, Hendrikse, Jeroen, additional, Nederkoorn, Paul, additional, Mess, Werner, additional, Koudstaal, Peter, additional, Leff, Alexander, additional, Ward, Nicholas, additional, Nachev, Parashkev, additional, Perry, Richard, additional, Ozkan, Hatice, additional, and Mitchell, John, additional

Published
2019
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33. Supplemental material for Dysphagia in supratentorial recent small subcortical infarcts results from bilateral pyramidal tract damage

Author

Fandler, Simon, Gattringer, Thomas, Pinter, Daniela, Pirpamer, Lukas, Borsodi, Florian, Eppinger, Sebastian, Niederkorn, Kurt, Enzinger, Christian, and Fazekas, Franz

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110904 Neurology and Neuromuscular Diseases
Abstract

Supplemental material for Dysphagia in supratentorial recent small subcortical infarcts results from bilateral pyramidal tract damage by Simon Fandler, Thomas Gattringer, Daniela Pinter, Lukas Pirpamer, Florian Borsodi, Sebastian Eppinger, Kurt Niederkorn, Christian Enzinger and Franz Fazekas in International Journal of Stroke

Published
2018
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37. Longitudinal MRI dynamics of recent small subcortical infarcts and possible predictors

Author

Pinter, Daniela, primary, Gattringer, Thomas, additional, Enzinger, Christian, additional, Seifert-Held, Thomas, additional, Kneihsl, Markus, additional, Fandler, Simon, additional, Pichler, Alexander, additional, Barro, Christian, additional, Eppinger, Sebastian, additional, Pirpamer, Lukas, additional, Bachmaier, Gerhard, additional, Ropele, Stefan, additional, Wardlaw, Joanna M, additional, Kuhle, Jens, additional, Khalil, Michael, additional, and Fazekas, Franz, additional

Published
2018
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39. Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies

Author

Wilson, Duncan, Ambler, Gareth, Lee, Keon-Joo, Lim, Jae-Sung, Shiozawa, Masayuki, Koga, Masatoshi, Li, Linxin, Lovelock, Caroline, Chabriat, Hugues, Hennerici, Michael, Wong, Yuen Kwun, Mak, Henry Ka Fung, Prats-Sánchez, Luis, Martínez-Domeño, Alejandro, Inamura, Shigeru, Yoshifuji, Kazuhisa, Arsava, Ethem Murat, Horstmann, Solveig, Purrucker, Jan, Lam, Bonnie Yin Ka, Wong, Adrian, Kim, Young Dae, Song, Tae-Jin, Schrooten, Maarten, Lemmens, Robin, Eppinger, Sebastian, Gattringer, Thomas, Uysal, Ender, Tanriverdi, Zeynep, Bornstein, Natan M, Assayag, Einor Ben, Hallevi, Hen, Tanaka, Jun, Hara, Hideo, Coutts, Shelagh B, Hert, Lisa, Polymeris, Alexandros, Seiffge, David J., Lyrer, Philippe, Algra, Ale, Kappelle, Jaap, Al-Shahi Salman, Rustam, Jäger, Hans R, Lip, Gregory Y H, Mattle, Heinrich P., Panos, Leonidas D., Mas, Jean-Louis, Legrand, Laurence, Karayiannis, Christopher, Phan, Thanh, Gunkel, Sarah, Christ, Nicolas, Abrigo, Jill, Leung, Thomas, Chu, Winnie, Chappell, Francesca, Makin, Stephen, Hayden, Derek, Williams, David J, Kooi, M Eline, Van Dam-Nolen, Dianne H K, Barbato, Carmen, Browning, Simone, Wiegertjes, Kim, Tuladhar, Anil M, Maaijwee, Noortje, Guevarra, Christine, Yatawara, Chathuri, Mendyk, Anne-Marie, Delmaire, Christine, Köhler, Sebastian, Van Oostenbrugge, Robert, Zhou, Ying, Xu, Chao, Hilal, Saima, Gyanwali, Bibek, Chen, Christopher, Lou, Min, Staals, Julie, Bordet, Régis, Kandiah, Nagaendran, De Leeuw, Frank-Erik, Simister, Robert, Van Der Lugt, Aad, Kelly, Peter J, Wardlaw, Joanna M, Soo, Yannie, Fluri, Felix, Srikanth, Velandai, Calvet, David, Jung, Simon, Kwa, Vincent I H, Engelter, Stefan T, Peters, Nils, Smith, Eric E, Yakushiji, Yusuke, Orken, Dilek Necioglu, Fazekas, Franz, Thijs, Vincent, Heo, Ji Hoe, Mok, Vincent, Veltkamp, Roland, Ay, Hakan, Imaizumi, Toshio, Gomez-Anson, Beatriz, Lau, Kui Kai, Jouvent, Eric, Rothwell, Peter M, Toyoda, Kazunori, Bae, Hee-Joon, Marti-Fabregas, Joan, and Werring, David J

Subjects
10. No inequality, 610 Medicine & health, 3. Good health
Abstract

BACKGROUND Cerebral microbleeds are a neuroimaging biomarker of stroke risk. A crucial clinical question is whether cerebral microbleeds indicate patients with recent ischaemic stroke or transient ischaemic attack in whom the rate of future intracranial haemorrhage is likely to exceed that of recurrent ischaemic stroke when treated with antithrombotic drugs. We therefore aimed to establish whether a large burden of cerebral microbleeds or particular anatomical patterns of cerebral microbleeds can identify ischaemic stroke or transient ischaemic attack patients at higher absolute risk of intracranial haemorrhage than ischaemic stroke. METHODS We did a pooled analysis of individual patient data from cohort studies in adults with recent ischaemic stroke or transient ischaemic attack. Cohorts were eligible for inclusion if they prospectively recruited adult participants with ischaemic stroke or transient ischaemic attack; included at least 50 participants; collected data on stroke events over at least 3 months follow-up; used an appropriate MRI sequence that is sensitive to magnetic susceptibility; and documented the number and anatomical distribution of cerebral microbleeds reliably using consensus criteria and validated scales. Our prespecified primary outcomes were a composite of any symptomatic intracranial haemorrhage or ischaemic stroke, symptomatic intracranial haemorrhage, and symptomatic ischaemic stroke. We registered this study with the PROSPERO international prospective register of systematic reviews, number CRD42016036602. FINDINGS Between Jan 1, 1996, and Dec 1, 2018, we identified 344 studies. After exclusions for ineligibility or declined requests for inclusion, 20 322 patients from 38 cohorts (over 35 225 patient-years of follow-up; median 1·34 years [IQR 0·19-2·44]) were included in our analyses. The adjusted hazard ratio [aHR] comparing patients with cerebral microbleeds to those without was 1·35 (95% CI 1·20-1·50) for the composite outcome of intracranial haemorrhage and ischaemic stroke; 2·45 (1·82-3·29) for intracranial haemorrhage and 1·23 (1·08-1·40) for ischaemic stroke. The aHR increased with increasing cerebral microbleed burden for intracranial haemorrhage but this effect was less marked for ischaemic stroke (for five or more cerebral microbleeds, aHR 4·55 [95% CI 3·08-6·72] for intracranial haemorrhage vs 1·47 [1·19-1·80] for ischaemic stroke; for ten or more cerebral microbleeds, aHR 5·52 [3·36-9·05] vs 1·43 [1·07-1·91]; and for ≥20 cerebral microbleeds, aHR 8·61 [4·69-15·81] vs 1·86 [1·23-1·82]). However, irrespective of cerebral microbleed anatomical distribution or burden, the rate of ischaemic stroke exceeded that of intracranial haemorrhage (for ten or more cerebral microbleeds, 64 ischaemic strokes [95% CI 48-84] per 1000 patient-years vs 27 intracranial haemorrhages [17-41] per 1000 patient-years; and for ≥20 cerebral microbleeds, 73 ischaemic strokes [46-108] per 1000 patient-years vs 39 intracranial haemorrhages [21-67] per 1000 patient-years). INTERPRETATION In patients with recent ischaemic stroke or transient ischaemic attack, cerebral microbleeds are associated with a greater relative hazard (aHR) for subsequent intracranial haemorrhage than for ischaemic stroke, but the absolute risk of ischaemic stroke is higher than that of intracranial haemorrhage, regardless of cerebral microbleed presence, antomical distribution, or burden. FUNDING British Heart Foundation and UK Stroke Association.

40. sj-pdf-1-eso-10.1177_23969873211012132 - Supplemental material for ESO Guideline on covert cerebral small vessel disease

Author

Wardlaw, Joanna M, Debette, Stephanie, Jokinen, Hanna, Frank-Erik De Leeuw, Pantoni, Leonardo, Chabriat, Hugues, Staals, Julie, Doubal, Fergus, Rudilosso, Salvatore, Eppinger, Sebastian, Schilling, Sabrina, Ornello, Raffaele, Enzinger, Christian, Cordonnier, Charlotte, Taylor-Rowan, Martin, and Lindgren, Arne G

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 16. Peace & justice, 3. Good health, 110904 Neurology and Neuromuscular Diseases
Abstract

Supplemental material, sj-pdf-1-eso-10.1177_23969873211012132 for ESO Guideline on covert cerebral small vessel disease by Joanna M Wardlaw, Stephanie Debette, Hanna Jokinen, Frank-Erik De Leeuw, Leonardo Pantoni, Hugues Chabriat, Julie Staals, Fergus Doubal, Salvatore Rudilosso, Sebastian Eppinger, Sabrina Schilling, Raffaele Ornello, Christian Enzinger, Charlotte Cordonnier, Martin Taylor-Rowan and Arne G Lindgren in European Stroke Journal

41. sj-pdf-1-eso-10.1177_23969873211012132 - Supplemental material for ESO Guideline on covert cerebral small vessel disease

Author

Wardlaw, Joanna M, Debette, Stephanie, Jokinen, Hanna, Frank-Erik De Leeuw, Pantoni, Leonardo, Chabriat, Hugues, Staals, Julie, Doubal, Fergus, Rudilosso, Salvatore, Eppinger, Sebastian, Schilling, Sabrina, Ornello, Raffaele, Enzinger, Christian, Cordonnier, Charlotte, Taylor-Rowan, Martin, and Lindgren, Arne G

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 16. Peace & justice, 3. Good health, 110904 Neurology and Neuromuscular Diseases
Abstract

Supplemental material, sj-pdf-1-eso-10.1177_23969873211012132 for ESO Guideline on covert cerebral small vessel disease by Joanna M Wardlaw, Stephanie Debette, Hanna Jokinen, Frank-Erik De Leeuw, Leonardo Pantoni, Hugues Chabriat, Julie Staals, Fergus Doubal, Salvatore Rudilosso, Sebastian Eppinger, Sabrina Schilling, Raffaele Ornello, Christian Enzinger, Charlotte Cordonnier, Martin Taylor-Rowan and Arne G Lindgren in European Stroke Journal

42. Statin Therapy for Secondary Prevention in Ischemic Stroke Patients With Cerebral Microbleeds.

Author

Prats-Sanchez L, Camps-Renom P, Nash PS, Wilson D, Ambler G, Best JG, Guasch-Jiménez M, Ramos-Pachón A, Martinez-Domeño A, Lambea-Gil Á, Díaz GE, Guisado-Alonso D, Du H, Al-Shahi Salman R, Jäger HR, Lip GY, Ay H, Jung S, Bornstein NM, Gattringer T, Eppinger S, van Dam-Nolen DH, Koga M, Toyoda K, Fluri F, Phan TG, Srikanth VK, Heo JH, Bae HJ, Kelly PJ, Imaizumi T, Staals J, Köhler S, Yakushiji Y, Orken DN, Smith EE, Wardlaw JM, Chappell FM, Makin SD, Mas JL, Calvet D, Bordet R, Chen CP, Veltkamp R, Kandiah N, Simister RJ, De Leeuw FE, Engelter ST, Peters N, Soo YO, Zietz A, Hendrikse J, Mess WH, Werring DJ, and Marti-Fabregas J

Subjects
Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Cerebral Hemorrhage epidemiology, Cerebral Infarction complications, Intracranial Hemorrhages complications, Magnetic Resonance Imaging, Neoplasm Recurrence, Local complications, Prospective Studies, Risk Factors, Secondary Prevention, Hydroxymethylglutaryl-CoA Reductase Inhibitors adverse effects, Ischemic Attack, Transient epidemiology, Ischemic Stroke complications, Stroke epidemiology
Abstract

Background and Objectives: The association between statin use and the risk of intracranial hemorrhage (ICrH) following ischemic stroke (IS) or transient ischemic attack (TIA) in patients with cerebral microbleeds (CMBs) remains uncertain. This study investigated the risk of recurrent IS and ICrH in patients receiving statins based on the presence of CMBs., Methods: We conducted a pooled analysis of individual patient data from the Microbleeds International Collaborative Network, comprising 32 hospital-based prospective studies fulfilling the following criteria: adult patients with IS or TIA, availability of appropriate baseline MRI for CMB quantification and distribution, registration of statin use after the index stroke, and collection of stroke event data during a follow-up period of ≥3 months. The primary endpoint was the occurrence of recurrent symptomatic stroke (IS or ICrH), while secondary endpoints included IS alone or ICrH alone. We calculated incidence rates and performed Cox regression analyses adjusting for age, sex, hypertension, atrial fibrillation, previous stroke, and use of antiplatelet or anticoagulant drugs to explore the association between statin use and stroke events during follow-up in patients with CMBs., Results: In total, 16,373 patients were included (mean age 70.5 ± 12.8 years; 42.5% female). Among them, 10,812 received statins at discharge, and 4,668 had 1 or more CMBs. The median follow-up duration was 1.34 years (interquartile range: 0.32-2.44). In patients with CMBs, statin users were compared with nonusers. Compared with nonusers, statin therapy was associated with a reduced risk of any stroke (incidence rate [IR] 53 vs 79 per 1,000 patient-years, adjusted hazard ratio [aHR] 0.68 [95% CI 0.56-0.84]), a reduced risk of IS (IR 39 vs 65 per 1,000 patient-years, aHR 0.65 [95% CI 0.51-0.82]), and no association with the risk of ICrH (IR 11 vs 16 per 1,000 patient-years, aHR 0.73 [95% CI 0.46-1.15]). The results in aHR remained consistent when considering anatomical distribution and high burden (≥5) of CMBs., Discussion: These observational data suggest that secondary stroke prevention with statins in patients with IS or TIA and CMBs is associated with a lower risk of any stroke or IS without an increased risk of ICrH., Classification of Evidence: This study provides Class III evidence that for patients with IS or TIA and CMBs, statins lower the risk of any stroke or IS without increasing the risk of ICrH.

Published
2024
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