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

Author

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

Published
2016
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2. Single versus bilateral external ventricular drainage for intraventricular fibrinolysis in severe ventricular haemorrhage

Author

Staykov, D., Huttner, H.B., Lunkenheimer, J., Volbers, B., Struffert, T., Doerfler, A., Ganslandt, O., Juettler, E., Schwab, S., and Bardutzky, J.

Subjects
Thrombolytic therapy -- Research, Intraventricular hemorrhage -- Care and treatment, Intraventricular hemorrhage -- Patient outcomes, Intraventricular hemorrhage -- Research, Drainage, Surgical -- Research, Health, Psychology and mental health
Published
2010

7. Estimated GFR and the Effect of Intensive Blood Pressure Lowering after Acute Intracerebral Hemorrhage.

Author

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

Abstract

Background: The kidney-brain interaction has been a topic of growing interest. Past studies of the effect of kidney function on intracerebral hemorrhage (ICH) outcomes have yielded inconsistent findings. Although the second, main phase of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) suggests the effectiveness of early intensive blood pressure (BP) lowering in improving functional recovery after ICH, the balance of potential benefits and harms of this treatment in those with decreased kidney function remains uncertain. Study Design: Secondary analysis of INTERACT2, which randomly assigned patients with ICH with elevated systolic BP (SBP) to intensive (target SBP < 140 mm Hg) or contemporaneous guideline-based (target SBP < 180 mm Hg) BP management. Setting & Participants: 2,823 patients from 144 clinical hospitals in 21 countries. Predictors Admission estimated glomerular filtration rates (eGFRs) of patients were categorized into 3 groups based on the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation: normal or high, mildly decreased, and moderately to severely decreased (>90, 60-90, and <60 mL/min/1.73 m2, respectively). Outcome(s): The effect of admission eGFR on the primary outcome of death or major disability at 90 days (defined as modified Rankin Scale scores of 3-6) was analyzed using a multivariable logistic regression model. Potential effect modification of intensive BP lowering treatment by admission eGFR was assessed by interaction terms. Result(s): Of 2,623 included participants, 912 (35%) and 280 (11%) had mildly and moderately/severely decreased eGFRs, respectively. Patients with moderately/severely decreased eGFRs had the greatest risk for death or major disability at 90 days (adjusted OR, 1.82; 95% CI, 1.28-2.61). Effects of early intensive BP lowering were consistent across different eGFRs (P = 0.5 for homogeneity). Limitation(s): Generalizability issues arising from a clinical tri

Published
2016

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

Author

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

Published
2016
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10. Intensive care therapy of space-occupying large hemispheric infarction

Author

Boesell, J., Schoenenberger, S., Dohmen, C., Juettler, E., Staykov, D., Zweckberger, K., Hacke, W., Schwab, S., Torbey, M. T., Huttner, H. B., Boesell, J., Schoenenberger, S., Dohmen, C., Juettler, E., Staykov, D., Zweckberger, K., Hacke, W., Schwab, S., Torbey, M. T., and Huttner, H. B.

Abstract

Large hemispheric infarction (LHI), synonymously called malignant middle cerebral artery (MCA) infarction, is a severe neurological disease with a high mortality and morbidity. Treating physicians as well as relatives are often faced with few and low quality data when attempting to apply optimal treatment to these patients and make decisions. While current stroke treatment guidelines focus on risk factors, prevention and acute management, they include only limited recommendations concerning intensive care management of LHI. The Neurocritical Care Society (NCS) and the German Society for Neurocritical and Emergency Medicine (DGNI) organized an interdisciplinary consensus conference on intensive care management of LHI to meet this demand. European and American experts in neurology, neurocritical care, neurosurgery, neuroradiology and neuroanesthesiology were selected based on their expertise and research focus. Subgroups for several main topics elaborated a number of central clinical questions concerning this topic and evaluated the quality of the currently available data according to the grading of recommendation assessment, development and evaluation (GRADE) guideline system. Subsequently, evidence-based recommendations were compiled after weighing the advantages against the disadvantages of certain management options. This is a commented abridged version of the results of the consensus conference.

Published
2015

11. Assessing the benefits of hemicraniectomy: what is a favourable outcome? Reply

Author

Vahedi, K, Hofmeijer, J, Juettler, E, Vicaut, E, George, B, Algra, A, Amelink, G, Schmiedeck, P, Schwab, S, Rothwell, P, DECIMAL, DESTINY, and Investigators, H

Subjects
medicine.medical_specialty, business.industry, medicine, Neurology (clinical), Intensive care medicine, business, Outcome (game theory)
Published
2007

13. Das Outcome nach Thrombolyse im 6h-Zeitfenster bei Patienten mit PWI/DWI Mismatch ist unabhängig von der Zeit und besser als bei unselektierten Patienten Vergleich einer deutschen Multicenterstudie mit den Daten aus ATLANTIS, ECASS und NINDS

Author

Thomalla, G, primary, Schwark, C, additional, Sobesky, J, additional, Bluhmki, E, additional, Fiebach, J.B, additional, Fiehler, J, additional, Zaro-Weber, O, additional, Kucinski, T, additional, Juettler, E, additional, Ringleb, P, additional, Schellinger, P.D, additional, and Röther, J, additional

Published
2005
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16. Hematoma growth and outcome in treated neurocritical care patients with intracerebral hemorrhage related to oral anticoagulant therapy: comparison of acute treatment strategies using vitamin K, fresh frozen plasma, and prothrombin complex concentrates.

Author

Huttner HB, Schellinger PD, Hartmann M, Köhrmann M, Juettler E, Wikner J, Mueller S, Meyding-Lamade U, Strobl R, Mansmann U, Schwab S, Steiner T, Huttner, Hagen B, Schellinger, Peter D, Hartmann, Marius, Köhrmann, Martin, Juettler, Eric, Wikner, Johannes, Mueller, Stephan, and Meyding-Lamade, Uta

Published
2006
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17. Outcome and symptomatic bleeding complications of intravenous thrombolysis within 6 hours in MRI-selected stroke patients: comparison of a German multicenter study with the pooled data of ATLANTIS, ECASS, and NINDS tPA trials.

Author

Thomalla G, Schwark C, Sobesky J, Bluhmki E, Fiebach JB, Fiehler J, Weber OZ, Kucinski T, Juettler E, Ringleb PA, Zeumer H, Weiller C, Hacke W, Schellinger PD, Röther J, MRI in Acute Stroke Study Group of the German Competence Network Stroke, Thomalla, Götz, Schwark, Christian, Sobesky, Jan, and Bluhmki, Erich

Published
2006
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19. Association of Infarct Volume Before Hemicraniectomy and Outcome After Malignant Infarction.

Author

Lehrieder D, Layer K, Müller HP, Rücker V, Kassubek J, Juettler E, and Neugebauer H

Subjects
Female, Humans, Infarction, Middle Cerebral Artery diagnostic imaging, Infarction, Middle Cerebral Artery surgery, Male, Middle Aged, Prospective Studies, Retrospective Studies, Treatment Outcome, Decompressive Craniectomy
Abstract

Objective: To determine the impact of infarct volume before hemicraniectomy in malignant middle cerebral artery infarction (MMI) as an independent predictor for patient selection and outcome prediction, we retrospectively analyzed data of 140 patients from a prospective multicenter study., Methods: Patients from the Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY) Registry who underwent hemicraniectomy after ischemic infarction of >50% of the middle cerebral artery territory were included. Functional outcome according to the modified Rankin Scale (mRS) was assessed at 12 months. Unfavorable outcome was defined as mRS score of 4 to 6. Infarct size was quantified semiautomatically from CT or MRI before hemicraniectomy. Subgroup analyses in patients fulfilling inclusion criteria of randomized trials in younger patients (age ≤60 years) were predefined., Results: Among 140 patients with complete datasets (34% female, mean [SD] age 54 [11] years), 105 (75%) had an unfavorable outcome (mRS score >3). Mean (SD) infarct volume was 238 (63) mL. Multivariable logistic regression identified age (odds ratio [OR] 1.08 per 1-year increase, 95% confidence interval [CI] 1.02-1.13, p = 0.004), infarct size (OR 1.27 per 10-mL increase, 95% CI 1.12-1.44, p < 0.001), and NIH Stroke Scale score (OR 1.10, 95% CI 1.01-1.20, p = 0.030) before hemicraniectomy as independent predictors of unfavorable outcome. Findings were reproduced in patients fulfilling inclusion criteria of randomized trials in younger patients. Infarct volume thresholds for prediction of unfavorable outcome with high specificity (94% in overall cohort and 92% in younger patients) were >258 mL before hemicraniectomy., Conclusion: Outcome in MMI depends strongly on age and infarct size before hemicraniectomy. Standardized volumetry may be helpful in the process of decision-making concerning hemicraniectomy., (© 2021 American Academy of Neurology.)

Published
2021
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20. A simple brain atrophy measure improves the prediction of malignant middle cerebral artery infarction by acute DWI lesion volume.

Author

Beck C, Kruetzelmann A, Forkert ND, Juettler E, Singer OC, Köhrmann M, Kersten JF, Sobesky J, Gerloff C, Fiehler J, Schellinger PD, Röther J, and Thomalla G

Subjects
Aged, Atrophy etiology, Female, Humans, Image Processing, Computer-Assisted, Logistic Models, Male, Middle Aged, Predictive Value of Tests, Brain pathology, Diffusion Magnetic Resonance Imaging, Infarction, Middle Cerebral Artery complications, Infarction, Middle Cerebral Artery diagnosis
Abstract

In patients with malignant middle cerebral artery infarction (MMI) decompressive surgery within 48 h improves functional outcome. In this respect, early identification of patients at risk of developing MMI is crucial. While the acute diffusion weighted imaging (DWI) lesion volume was found to predict MMI with high predictive values, the potential impact of preexisting brain atrophy on the course of space-occupying middle cerebral artery (MCA) infarction and the development of MMI remains unclear. We tested the hypothesis that the combination of the acute DWI lesion volume with simple measures of brain atrophy improves the early prediction of MMI. Data from a prospective, multicenter, observational study, which included patients with acute middle cerebral artery main stem occlusion studied by MRI within 6 h of symptom onset, was analyzed retrospectively. The development of MMI was defined according to the European randomized controlled trials of decompressive surgery. Acute DWI lesion volume, as well as brain and cerebrospinal fluid volume (CSF) were delineated. The intercaudate distance (ICD) was assessed as a linear brain atrophy marker by measuring the hemi-ICD of the intact hemisphere to account for local brain swelling. Binary logistic regression analysis was used to identify significant predictors of MMI. Cut-off values were determined by Classification and Regression Trees analysis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the resulting models were calculated. Twenty-one (18 %) of 116 patients developed a MMI. Malignant middle cerebral artery infarctions patients had higher National Institutes of Health Stroke Scale scores on admission and presented more often with combined occlusion of the internal carotid artery and MCA. There were no differences in brain and CSF volume between the two groups. Diffusion weighted imaging lesion volume was larger (p < 0.001), while hemi-ICD was smaller (p = 0.029) in MMI patients. Inclusion of hemi-ICD improved the prediction of MMI. Best cut-off values to predict the development of MMI were DWI lesion volume > 87 ml and hemi-ICD ≤ 9.4 mm. The addition of hemi-ICD to the decision tree strongly increased PPV (0.93 vs. 0.70) resulting in a reduction of false positive findings from 7/23 (30 %) to 1/15 (7 %), while there were only slight changes in specificity, sensitivity and NPV. The absolute number of correct classifications increased by 4 (3.4 %). The integration of hemi-ICD as a linear marker of brain atrophy, that can easily be assessed in an emergency setting, may improve the prediction of MMI by lesion volume based predictive models.

Published
2014
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21. Combining magnetic resonance imaging within six-hours of symptom onset with clinical follow-up at 24 h improves prediction of 'malignant' middle cerebral artery infarction.

Author

Kruetzelmann A, Hartmann F, Beck C, Juettler E, Singer OC, Köhrmann M, Kersten JF, Sobesky J, Gerloff C, Villringer A, Fiehler J, Neumann-Haefelin T, Schellinger PD, Röther J, and Thomalla G

Subjects
Aged, Cohort Studies, Decision Trees, Diffusion Magnetic Resonance Imaging, Female, Humans, Magnetic Resonance Angiography, Male, Middle Aged, Observation, Predictive Value of Tests, Regression Analysis, Time Factors, Infarction, Middle Cerebral Artery diagnosis, Magnetic Resonance Imaging, Severity of Illness Index
Abstract

Background: A large diffusion-weighted imaging lesion ≤six-hours of symptom onset was found to predict the development of 'malignant' middle cerebral artery infarction with high specificity, positive predictive value, and negative predictive value, but sensitivity was low., Hypothesis: We tested the hypothesis that sensitivity can be improved by adding information from clinical follow-up examination after 24 h., Methods: We analyzed data from a prospective, multicenter, observational cohort study of patients with acute ischemic stroke and middle cerebral artery occlusion studied by stroke magnetic resonance imaging ≤six-hours of symptom onset. We used the National Institutes of Health Stroke Scale to assess severity of symptoms after 24 h. We used the Classification and Regression Trees analysis to define the optimal thresholds of diffusion-weighted imaging lesion volume and the National Institutes of Health Stroke Scale after 24 h in patients developing 'malignant' middle cerebral artery infarction. We calculated sensitivity, specificity, positive predictive value, and negative predictive value for two simple predictive models based on acute diffusion-weighted imaging lesion volume alone and acute diffusion-weighted imaging lesion volume together with the National Institutes of Health Stroke Scale after 24 h., Results: Of 135 patients, 27 (20%) developed a 'malignant' middle cerebral artery infarction. The Classification and Regression Trees analysis identified acute diffusion-weighted imaging lesion ≥78 ml and the National Institutes of Health Stroke Scale score after 24 h ≥22 as optimal cut-offs. Inclusion of the National Institutes of Health Stroke Scale score after 24 h in a simple two-step decision tree increased sensitivity from 0·59 to 0·79, while specificity, positive predictive value, and negative predictive value remained largely unchanged., Conclusion: Clinical follow-up examination after 24 h helps identify patients at risk of 'malignant' middle cerebral artery infarction that are missed by predictive algorithms based on early diffusion-weighted imaging lesion volume alone., (© 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.)

Published
2014
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22. Surgical aspects of decompression craniectomy in malignant stroke: review.

Author

Zweckberger K, Juettler E, Bösel J, and Unterberg WA

Subjects
Humans, Treatment Outcome, Brain Edema surgery, Cerebral Infarction surgery, Craniotomy methods, Decompression, Surgical, Stroke surgery
Abstract

Background: Space-occupying malignant stroke of the middle cerebral artery (MCA) is associated with a high mortality rate of up to 80% under conservative treatment. Although there is convincing evidence that decompression craniectomy can significantly reduce mortality rate and improve neurological outcome in young patients (<60 years), many surgeons are still hesitant to recommend hemicraniectomy for stroke patients., Summary: This review addresses some major issues that appear to be an obstacle to decompression craniectomy, in particular, indicating surgery for patients >60 years or with infarcts of the dominant hemisphere. Furthermore, it emphasizes technical issues such as timing and size of the craniectomy, additional temporal lobectomy, and resection of the temporal muscle, as well as duraplasty and cranioplasty. According to the current literature, decompression craniectomy in older patients can increase survival without most severe disabilities, although, most survivors need assistance in most bodily needs. Involvement of the dominant hemisphere results in aphasia that might partly recover in younger patients, although, considering the neuropsychological deficits caused by infarctions of the nondominant hemisphere, involvement of the dominant hemisphere does not pose as a contraindication for decompression craniectomy. Furthermore, there is convincing evidence that surgery should be performed within 48 h after the onset of symptoms and the size of the craniectomy should be at least 12 cm as a minimum. An additional lobectomy or the resection of the temporal muscle, however, can only be part of individual treatment options. Conceding the weak evidence, it is recommended to close the dura by some form of a duraplasty avoiding cerebrospinal fluid leakages or scarring between the cortex and the scalp leading to injuries during reimplantation of the bone-flap. Complications associated with decompression surgery (hemorrhages, infections, 'sinking skin-flap syndrome', cerebrospinal fluid leakages, hydrocephalus, seizures), with the infarction itself, or with those that occur during the ICU course (cardiac and pulmonary complications) appear acceptable and are mostly treatable, especially considering the fatal course of conservative treatment. Key Message: This review summarizes the current state of the literature about decompression craniectomy of patients with malignant stroke addressing, in particular, critical surgical issues, and thus, help surgeons to make decisions confidently for/or against performing surgery., (© 2014 S. Karger AG, Basel.)

Published
2014
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23. Cooling in intracerebral hemorrhage (CINCH) trial: protocol of a randomized German-Austrian clinical trial.

Author

Kollmar R, Juettler E, Huttner HB, Dörfler A, Staykov D, Kallmuenzer B, Schmutzhard E, Schwab S, and Broessner G

Subjects
Adolescent, Adult, Aged, Brain Edema etiology, Brain Edema mortality, Brain Edema prevention & control, Cerebral Hemorrhage complications, Cerebral Hemorrhage mortality, Clinical Protocols, Critical Care methods, Double-Blind Method, Endpoint Determination, Female, Humans, Intracranial Pressure physiology, Male, Middle Aged, Prospective Studies, Rewarming, Survival, Survival Rate, Treatment Outcome, Young Adult, Cerebral Hemorrhage therapy, Hypothermia, Induced
Abstract

Background: Intracerebral hemorrhage accounts for up to 15% of all strokes and is frequently associated with poor functional outcome and high mortality. So far, there is no clear evidence for a specific therapy, apart from general stroke unit or neurointensive care and management of secondary complications. Promising experimental and pilot clinical data support the use of therapeutic hypothermia after intracerebral hemorrhage., Aims: The study aims to determine if therapeutic hypothermia improves survival rates and reduces cerebral lesion volume after large intracerebral hemorrhage compared with conventional treatment., Material and Methods: The Cooling in IntraCerebral Hemorrhage trial is a prospective, multicenter, interventional, randomized, parallel, two-arm (1 : 1) phase II trial with blinded end-point adjudication. Enrolment: 50 patients (age: 18 to 65 years) with large (25 to 64 ml on cranial computertomography), primary intracerebral hemorrhage of the basal ganglia or thalamus within 6 to 18 h after symptom onset are randomly allocated to therapeutic hypothermia for eight-days or conventional temperature management. In the therapeutic hypothermia group, a target temperature of 35.0°C is achieved by endovascular catheters and followed by slow controlled rewarming. Data analysis is based on the intent-to-treat population. The primary outcome measure of the study is the development in total lesion volume on cranial computertomography (intracerebral hemorrhage plus perihemorrhagic edema on day 8 ± 0.5 and day 1 ± 0.5 after intracerebral hemorrhage) and the mortality after 30 days. Secondary end-points are the in-hospital mortality, mortality, and functional outcome (modified Rankin Scale and Barthel-Index) after 90 and 180 days. Safety measures include any adverse events associated with therapeutic hypothermia., Discussion: In the face of a lack of evidence-based therapies for patients with large intracerebral hemorrhage, new promising approaches are desperately needed, but need evaluation in randomized controlled trials., Conclusion: The results of Cooling in IntraCerebral Hemorrhage trial are believed to directly influence future therapy of large intracerebral hemorrhage.

Published
2012
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24. Short period of early reperfusion aggravates blood-brain barrier dysfunction during permanent focal ischemia in rats.

Author

Woitzik J, Hohenstein A, Hecht N, Juettler E, and Schilling L

Abstract

Unintentional reperfusion is considered a complication in various experimental models of focal brain ischemia. In the present study, we evaluated whether short intermittent reperfusion affects ischemic brain damage and blood-brain barrier (BBB) integrity in a model of permanent focal ischemia. Focal brain ischemia was induced in male Sprague-Dawley rats using the filament method. A 20-s reperfusion period was allowed 0.5, 2, or 10 min after thread occlusion of the middle cerebral artery. In control animals, the transient reperfusion episode was omitted. The infarct volume and extent of swelling was examined 24 h after permanent thread occlusion. Immunohistochemical staining for thrombin extravasation was performed. Transient reperfusion early after thread occlusion augmented brain swelling (control, 12.4 ± 8.5%; reperfusion after 0.5 min, 24.7 ± 7.0%*; after 2 min, 36.7 ± 4.8%*; after 10 min, 33.8 ± 4.9%*; *p < 0.01 vs. control) and significantly enhanced leakage of the plasma protein thrombin, whereas the ischemic volume was unaffected. Early intermittent reperfusion may be responsible for increased BBB disruption in permanent ischemia. Similar reperfusion episodes during early ischemia sequelae in patients-due to incomplete adherence or distal movements of a clot-may be causative for increased BBB damage, more severe edema, and potentially hemorrhagic transformation.

Published
2011
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25. Prediction of malignant middle cerebral artery infarction by magnetic resonance imaging within 6 hours of symptom onset: A prospective multicenter observational study.

Author

Thomalla G, Hartmann F, Juettler E, Singer OC, Lehnhardt FG, Köhrmann M, Kersten JF, Krützelmann A, Humpich MC, Sobesky J, Gerloff C, Villringer A, Fiehler J, Neumann-Haefelin T, Schellinger PD, and Röther J

Subjects
Aged, Area Under Curve, Carotid Artery Diseases diagnosis, Female, Humans, Infarction, Middle Cerebral Artery drug therapy, Male, Middle Aged, Observation, Perfusion Imaging, Predictive Value of Tests, Prospective Studies, Regression Analysis, Retrospective Studies, Sensitivity and Specificity, Severity of Illness Index, Thrombolytic Therapy, Diffusion Magnetic Resonance Imaging methods, Infarction, Middle Cerebral Artery diagnosis, Infarction, Middle Cerebral Artery physiopathology, Magnetic Resonance Angiography methods
Abstract

Objective: Early identification of patients at risk of space-occupying "malignant" middle cerebral artery (MCA) infarction (MMI) is needed to enable timely decision for potentially life-saving treatment such as decompressive hemicraniectomy. We tested the hypothesis that acute stroke magnetic resonance imaging (MRI) predicts MMI within 6 hours of stroke onset., Methods: In a prospective, multicenter, observational cohort study patients with acute ischemic stroke and MCA main stem occlusion were studied by MRI including diffusion-weighted imaging (DWI), perfusion imaging (PI), and MR-angiography within 6 hours of symptom onset. Multivariate regression analysis was used to identify clinical and imaging predictors of MMI., Results: Of 140 patients included, 27 (19.3%) developed MMI. The following parameters were identified as independent predictors of MMI: larger acute DWI lesion volume (per 1 ml odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02-1.06; p < 0.001), combined MCA + internal carotid artery occlusion (5.38, 1.55-18.68; p = 0.008), and severity of neurological deficit on admission assessed by the National Institutes of Health Stroke Scale score (per 1 point 1.16, 1.00-1.35; p = 0.053). The prespecified threshold of a DWI lesion volume >82 ml predicted MMI with high specificity (0.98, 95% CI 0.94-1.00), negative predictive value (0.90, 0.83-0.94), and positive predictive value (0.88, 0.62-0.98), but sensitivity was low (0.52, 0.32-0.71)., Interpretation: Stroke MRI on admission predicts malignant course in severe MCA stroke with high positive and negative predictive value and may help in guiding treatment decisions, such as decompressive surgery. In a subset of patients with small initial DWI lesion volumes, repeated diagnostic tests are required.

Published
2010
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26. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials.

Author

Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, Amelink GJ, Schmiedeck P, Schwab S, Rothwell PM, Bousser MG, van der Worp HB, and Hacke W

Subjects
Adolescent, Adult, Aphasia etiology, Female, Humans, Infarction, Middle Cerebral Artery mortality, Magnetic Resonance Imaging, Male, Middle Aged, Patient Selection, Prospective Studies, Randomized Controlled Trials as Topic, Stroke mortality, Stroke surgery, Tomography, X-Ray Computed, Treatment Outcome, Decompression, Surgical, Infarction, Middle Cerebral Artery surgery, Neurosurgical Procedures
Abstract

Background: Malignant infarction of the middle cerebral artery (MCA) is associated with an 80% mortality rate. Non-randomised studies have suggested that decompressive surgery reduces this mortality without increasing the number of severely disabled survivors. To obtain sufficient data as soon as possible to reliably estimate the effects of decompressive surgery, results from three European randomised controlled trials (DECIMAL, DESTINY, HAMLET) were pooled. The trials were ongoing when the pooled analysis was planned., Methods: Individual data for patients aged between 18 years and 60 years, with space-occupying MCA infarction, included in one of the three trials, and treated within 48 h after stroke onset were pooled for analysis. The protocol was designed prospectively when the trials were still recruiting patients and outcomes were defined without knowledge of the results of the individual trials. The primary outcome measure was the score on the modified Rankin scale (mRS) at 1 year dichotomised between favourable (0-4) and unfavourable (5 and death) outcome. Secondary outcome measures included case fatality rate at 1 year and a dichotomisation of the mRS between 0-3 and 4 to death. Data analysis was done by an independent data monitoring committee., Findings: 93 patients were included in the pooled analysis. More patients in the decompressive-surgery group than in the control group had an mRS

Published
2007
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27. Nuclear factor-kappaB contributes to infarction after permanent focal ischemia.

Author

Nurmi A, Lindsberg PJ, Koistinaho M, Zhang W, Juettler E, Karjalainen-Lindsberg ML, Weih F, Frank N, Schwaninger M, and Koistinaho J

Subjects
Adult, Aged, Animals, Cells, Cultured, Globins genetics, Humans, Infarction, Middle Cerebral Artery metabolism, Infarction, Middle Cerebral Artery pathology, Mice, Mice, Inbred BALB C, Mice, Knockout, Mice, Transgenic, Middle Aged, NF-kappa B antagonists & inhibitors, NF-kappa B genetics, NF-kappa B p50 Subunit, Neurons drug effects, Neurons metabolism, Neurons pathology, Pyrrolidines pharmacology, Rats, Rats, Inbred SHR, Stroke metabolism, Thiocarbamates pharmacology, Brain Ischemia complications, Infarction, Middle Cerebral Artery etiology, NF-kappa B physiology
Abstract

Background and Purpose: Activation of transcription factor nuclear factor-kappaB (NF-kappaB) may induce expression of either proinflammatory/apoptotic genes or antiapoptotic genes. Because a considerable number of middle cerebral artery occlusions (MCAOs) in humans are not associated with reperfusion during the first 24 hours, the role of NF-kappaB after permanent MCAO (pMCAO) was investigated., Methods: Mice transgenic for a NF-kappaB-driven beta-globin reporter were exposed to pMCAO, and the expression of the reporter gene was quantified with real-time polymerase chain reaction. Mice lacking the p50 subunit of NF-kappaB and wild-type controls were exposed to pMCAO with or without treatment with pyrrolidinedithiocarbamate (PDTC), an NF-kappaB inhibitor. Brain sections of human stroke patients were immunostained for the activated NF-kappaB., Results: pMCAO increased NF-kappaB transcriptional activity to 260% (36.9+/-4.5 compared with 14.4+/-2.6; n=10; P<0.01) in the brain; this NF-kappaB activation was completely blocked by PDTC (17.2+/-2.6; n=9; P<0.05). In p50-/- mice, pMCAO resulted in 41% (18+/-3.2 mm3; n=12) smaller infarcts compared with wild-type controls (32.9+/-3.8 mm3; n=9; P<0.05), which was comparable to the protection achieved with PDTC in wild-type mice (19.6+/-4.2 mm3; n=8). Pro-DTC, a PDTC analogue that does not cross the blood-brain barrier, had no effect, even though Pro-DTC and PDTC were equally protective in vitro. During the first 2 days of human stroke, NF-kappaB was activated in neurons in the penumbral areas., Conclusions: NF-kappaB is induced in neurons during human stroke, and activation of NF-kappaB in the brain may contribute to infarction in pMCAO.

Published
2004
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