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2. Early Versus Late Initiation of Direct Oral Anticoagulants After Ischemic Stroke in People With Atrial Fibrillation and Hemorrhagic Transformation: Prespecified Subanalysis of the Randomized Controlled ELAN Trial

Author

Rohner, Roman, Kneihsl, Markus, Goeldlin, Martina B., Hakim, Arsany, Branca, Mattia, Abend, Stefanie, Valenzuela Pinilla, Waldo, Fenzl, Sabine, Rezny-Kasprzak, Beata, Strbian, Daniel, Trelle, Sven, Paciaroni, Maurizio, Thomalla, Götz, Michel, Patrik, Nedeltchev, Krassen, Gattringer, Thomas, Sandset, Else C., Bonati, Leo, Aguiar de Sousa, Diana, Sylaja, P.N., Ntaios, George, Koga, Masatoshi, Gdovinova, Zuzana, Lemmens, Robin, Bornstein, Natan M., Kelly, Peter, Katan, Mira, Horvath, Thomas, Dawson, Jesse, and Fischer, Urs

Published
2024
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5. Embolic Stroke of Undetermined Source

Author

Sposato, Luciano A., primary, Sur, Nicole B., additional, Katan, Mira, additional, Johansen, Michelle C., additional, De Marchis, Gian Marco, additional, Caso, Valeria, additional, Fischer, Urs, additional, and Chaturvedi, Seemant, additional

Published
2024
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6. Implications for driving based on the risk of seizures after ischaemic stroke

Author

Schubert, Kai Michael, primary, Bicciato, Giulio, additional, Sinka, Lucia, additional, Abraira, Laura, additional, Santamarina, Estevo, additional, Álvarez-Sabín, José, additional, Ferreira-Atuesta, Carolina, additional, Katan, Mira, additional, Scherrer, Natalie, additional, Terziev, Robert, additional, Döhler, Nico, additional, Erdélyi-Canavese, Barbara, additional, Felbecker, Ansgar, additional, Siebel, Philip, additional, Winklehner, Michael, additional, von Oertzen, Tim J, additional, Wagner, Judith N, additional, Gigli, Gian Luigi, additional, Nilo, Annacarmen, additional, Janes, Francesco, additional, Merlino, Giovanni, additional, Valente, Mariarosaria, additional, Zafra-Sierra, María Paula, additional, Mayor-Romero, Luis Carlos, additional, Conrad, Julian, additional, Evers, S, additional, Lochner, Piergiorgio, additional, Roell, Frauke, additional, Brigo, Francesco, additional, Bentes, Carla, additional, Peralta, Rita, additional, Pinho e Melo, Teresa, additional, Keezer, Mark R, additional, Duncan, John Sidney, additional, Sander, Josemir W, additional, Tettenborn, Barbara, additional, Koepp, Matthias, additional, and Galovic, Marian, additional

Published
2024
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7. Timing of oral anticoagulants initiation for atrial fibrillation after acute ischemic stroke: A systematic review and meta-analysis

Author

Palaiodimou, Lina, primary, Stefanou, Maria-Ioanna, additional, Katsanos, Aristeidis H, additional, De Marchis, Gian Marco, additional, Aguiar De Sousa, Diana, additional, Dawson, Jesse, additional, Katan, Mira, additional, Karapanayiotides, Theodore, additional, Toutouzas, Konstantinos, additional, Paciaroni, Maurizio, additional, Seiffge, David J, additional, and Tsivgoulis, Georgios, additional

Published
2024
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8. Measurement of Midregional Pro-Atrial Natriuretic Peptide to Discover Atrial Fibrillation in Patients With Ischemic Stroke

Author

Schweizer, Juliane, Arnold, Markus, König, Inke R., Bicvic, Antonela, Westphal, Laura P., Schütz, Valerie, Inauen, Corinne, Scherrer, Natalie, Luft, Andreas, Galovic, Marian, Ferreira Atuesta, Carolina, Pokorny, Thomas, Arnold, Marcel, Fischer, Urs, Bonati, Leo H., De Marchis, Gian Marco, Kahles, Timo, Nedeltchev, Krassen, Cereda, Carlo W., Kägi, Georg, Bustamante, Alejandro, Montaner, Joan, Ntaios, Georg, Sagris, Dimitrios, Foerch, Christian, Spanaus, Katharina, von Eckardstein, Arnold, and Katan, Mira

Published
2022
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9. Risk of major adverse cardiovascular events and all-cause mortality under treatment with GLP-1 RAs or the dual GIP/GLP-1 receptor agonist tirzepatide in overweight or obese adults without diabetes: a systematic review and meta-analysis.

Author

Stefanou, Maria-Ioanna, Palaiodimou, Lina, Theodorou, Aikaterini, Safouris, Apostolos, Fischer, Urs, Kelly, Peter J., Dawson, Jesse, Katan, Mira, Katsanos, Aristeidis H., Lambadiari, Vaia, Giannopoulos, Sotirios, Alexandrov, Andrei V., Siasos, Gerasimos, and Tsivgoulis, Georgios

Subjects
MAJOR adverse cardiovascular events, ANTIOBESITY agents, MYOCARDIAL infarction, MORTALITY, GLUCAGON-like peptide-1 agonists
Abstract

Background: Among the currently approved antiobesity medications, the glucagon-like-peptide-1 receptor-agonists (GLP-1 RAs) liraglutide and semaglutide, and the dual glucose-dependent-insulinotropic-polypeptide (GIP)/GLP-1 RA tirzepatide have been suggested to reduce cardiovascular-risk in overweight or obesity without diabetes. Objectives: The objective of this study was to evaluate the cardio- and neuroprotective potential of these novel agents in the nondiabetic overweight/obese adult population. Data sources and methods: A systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) was performed to estimate the risk of major adverse cardiovascular events (MACE), all-cause and cardiovascular mortality in overweight or obese adults without diabetes treated with GLP-1 or GIP/GLP-1 RAs (vs placebo). Secondary outcomes included the risk of myocardial infarction (MI) and stroke. Results: Sixteen RCTs (13 and 3 on GLP-1 RAs and tirzepatide, respectively) comprising 28,168 participants were included. GLP-1 or GIP/GLP-1 RAs reduced MACE (odds ratio (OR): 0.79; 95% confidence interval (CI): 0.71–0.89; p < 0.01; I 2 = 0) and all-cause mortality (OR: 0.80; 95% CI: 0.70–0.92; p < 0.01; I 2 = 0), while there was a trend toward lower cardiovascular-mortality (OR: 0.84; 95% CI: 0.71–1.01; p = 0.06; I 2 = 0%) compared to placebo. Additionally, GLP-1 or GIP/GLP-1 RAs reduced the odds of MI (OR: 0.72; 95% CI: 0.61–0.86; p < 0.01; I 2 = 0%) and nonfatal-MI (OR: 0.72; 95% CI: 0.61–0.85; p < 0.01; I 2 = 0%); while no associations between antiobesity treatment and fatal-MI, stroke, nonfatal, or fatal stroke were uncovered. Conclusion: GLP-1 and GIP/GLP-1 RAs reduce cardiovascular-risk and all-cause mortality in overweight or obese adults without diabetes. Additionally, GLP-1 RAs and GIP/GLP-1 RAs attenuate the risk of MI. Since data on stroke are still limited, future RCTs are warranted to evaluate the neuroprotective potential of these novel antiobesity agents. Trial registration: PROSPERO CRD42024515966. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Absent leptomeningeal collateralization is associated with greatest benefit from mechanical thrombectomy in the 6-24 hour time window.

Author

Dittrich, Tolga D, von Streng, Tennessee, Toebak, Anna M, Zietz, Annaelle, Wagner, Benjamin, Hänsel, Martin, Sutter, Raoul, Katan, Mira, Peters, Nils, Michels, Lars, Kulcsár, Zsolt, Karwacki, Grzegorz M, Pileggi, Marco, Cereda, Carlo W, Wegener, Susanne, Bonati, Leo H, Psychogios, Marios, and De Marchis, Gian Marco

Published
2024
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12. Risk of major adverse cardiovascular events and stroke associated with treatment with GLP-1 or the dual GIP/GLP-1 receptor agonist tirzepatide for type 2 diabetes: A systematic review and meta-analysis.

Author

Stefanou, Maria-Ioanna, Theodorou, Aikaterini, Malhotra, Konark, Aguiar de Sousa, Diana, Katan, Mira, Palaiodimou, Lina, Katsanos, Aristeidis H, Koutroulou, Ioanna, Lambadiari, Vaia, Lemmens, Robin, Giannopoulos, Sotirios, Alexandrov, Andrei V, Siasos, Gerasimos, and Tsivgoulis, Georgios

Published
2024
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14. Mechanical Thrombectomy Versus Best Medical Treatment in the Late Time Window in Non-DEFUSE-Non-DAWN Patients: A Multicenter Cohort Study

Author

Dittrich, Tolga D., Sporns, Peter B., Kriemler, Lilian F., Rudin, Salome, Nguyen, Anh, Zietz, Annaelle, Polymeris, Alexandros A., Tränka, Christopher, Thilemann, Sebastian, Wagner, Benjamin, Altersberger, Valerian L., Piot, Ines, Barinka, Filip, Müller, Susanne, Hänsel, Martin, Gensicke, Henrik, Engelter, Stefan T., Lyrer, Philippe A., Sutter, Raoul, Nickel, Christian H., Katan, Mira, Peters, Nils, Kulcsár, Zsolt, Karwacki, Grzegorz M., Pileggi, Marco, Cereda, Carlo, Wegener, Susanne, Bonati, Leo H., Fischer, Urs, Psychogios, Marios, and De Marchis, Gian Marco

Published
2023
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16. Lipoprotein(a) as a blood marker for large artery atherosclerosis stroke etiology: validation in a prospective cohort from a swiss stroke center

Author

Rudin, Salome, primary, Kriemler, Lilian, additional, Dittrich, Tolga D., additional, Zietz, Annaelle, additional, Schweizer, Juliane, additional, Arnold, Markus, additional, Peters, Nils, additional, Barinka, Filip, additional, Jung, Simon, additional, Arnold, Marcel, additional, Rentsch, Katharina, additional, Christ-Crain, Mirjam, additional, Katan, Mira, additional, and De Marchis, Gian Marco, additional

Published
2024
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17. Increased Risk of Recurrent Stroke in Symptomatic Large Vessel Disease With Impaired BOLD Cerebrovascular Reactivity

Author

van Niftrik, Christiaan H.B., primary, Sebök, Martina, additional, Germans, Menno R., additional, Halter, Matthias, additional, Pokorny, Thomas, additional, Stumpo, Vittorio, additional, Bellomo, Jacopo, additional, Piccirelli, Marco, additional, Pangalu, Athina, additional, Katan, Mira, additional, Wegener, Susanne, additional, Tymianski, Michael, additional, Kulcsár, Zsolt, additional, Luft, Andreas R., additional, Fisher, Joseph A., additional, Mikulis, David J., additional, Regli, Luca, additional, and Fierstra, Jorn, additional

Published
2024
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19. Contributors

Author

Adams, Harold P., primary, Adeoye, Opeolu, additional, Albers, Gregory W., additional, Alexandrov, Andrei V., additional, Amin-Hanjani, Sepideh, additional, An, Hongyu, additional, Anderson, Craig S., additional, Anrather, Josef, additional, Aparicio, Hugo J., additional, Arai, Ken, additional, Aronowski, Jaroslaw, additional, Atchaneeyasakul, Kunakorn, additional, Audebert, Heinrich, additional, Auer, Roland N., additional, Awad, Issam A., additional, Ay, Hakan, additional, Baltan, Selva, additional, Balu, Ramani, additional, Behbahani, Mandana, additional, Benavente, Oscar R., additional, Bershad, Eric M., additional, Berthaud, Jimmy V., additional, Blackburn, Spiros L., additional, Bonati, Leo H., additional, Bösel, Julian, additional, Bousser, Marie Germaine, additional, Broderick, Joseph P., additional, Brown, Martin M., additional, Brown, Wendy, additional, Brust, John C.M., additional, Bushnell, Cheryl, additional, Canhão, Patrícia, additional, Caplan, Louis R., additional, Carrión-Penagos, Julián, additional, Castellanos, Mar, additional, Caunca, Michelle R., additional, Chabriat, Hugues, additional, Chamorro, Angel, additional, Chen, Jieli, additional, Chen, Jun, additional, Chopp, Michael, additional, Christorforids, Greg, additional, Connolly, E. Sander, additional, Cramer, Steven C., additional, Cucchiara, Brett L., additional, Czap, Alexandra L., additional, Dannenbaum, Mark J., additional, Davis, Patricia H., additional, Dawson, Ted M., additional, Dawson, Valina L., additional, Day, Arthur L., additional, De Silva, T. Michael, additional, de Sousa, Diana Aguiar, additional, Del Brutto, Victor J., additional, del Zoppo, Gregory J., additional, Derdeyn, Colin P., additional, Di Tullio, Marco R., additional, Diener, Hans Christoph, additional, Diringer, Michael N., additional, Dobkin, Bruce H., additional, Dzialowski, Imanuel, additional, Elkind, Mitchell S.V., additional, Elm, Jordan, additional, Feigin, Valery L., additional, Ferro, José Manuel, additional, Field, Thalia S., additional, Fischer, Marlene, additional, Fornage, Myriam, additional, Furie, Karen L., additional, Garcia-Bonilla, Lidia, additional, Giannotta, Steven L., additional, Gobin, Y. Pierre, additional, Goldberg, Mark P., additional, Goldstein, Larry B., additional, Gonzales, Nicole R., additional, Greer, David M., additional, Grotta, James C., additional, Guo, Ruiming, additional, Gutierrez, Jose, additional, Harmel, Peter, additional, Howard, George, additional, Howard, Virginia J., additional, Hwang, Jee-Yeon, additional, Iadecola, Costantino, additional, Jahan, Reza, additional, Jickling, Glen C., additional, Joutel, Anne, additional, Kasner, Scott E., additional, Katan, Mira, additional, Kellner, Christopher P., additional, Khan, Muhib, additional, Kidwell, Chelsea S., additional, Kim, Helen, additional, Kim, Jong S., additional, Kircher, Charles E., additional, Krings, Timo, additional, Krishnamurthi, Rita V., additional, Kurth, Tobias, additional, Lansberg, Maarten G., additional, Levy, Elad I., additional, Liebeskind, David S., additional, Liew, Sook-Lei, additional, Lin, David J., additional, Lisle, Benjamin, additional, Lo, Eng H., additional, Lyden, Patrick D., additional, Maki, Takakuni, additional, Maragkos, Georgios A., additional, Marosfoi, Miklos, additional, McCullough, Louise D., additional, Meckler, Jason M., additional, Meschia, James Frederick, additional, Messé, Steven R., additional, Mocco, J, additional, Mokin, Maxim, additional, Mooney, Michael A., additional, Morgenstern, Lewis B., additional, Moskowitz, Michael A., additional, Mullen, Michael T., additional, Nägel, Steffen, additional, Nedergaard, Maiken, additional, Neira, Justin A., additional, Newman, Sarah, additional, Nicholson, Patrick J., additional, Norrving, Bo, additional, O’Donnell, Martin, additional, Ofengeim, Dimitry, additional, Ogata, Jun, additional, Ogilvy, Christopher S., additional, Orrù, Emanuele, additional, Ortega-Gutiérrez, Santiago, additional, Padrick, Matthew Maximillian, additional, Parsha, Kaushik, additional, Parsons, Mark, additional, Patel, Neil V., additional, Patel, Virendra I., additional, Pawlikowska, Ludmila, additional, Pérez, Adriana, additional, Perez-Pinzon, Miguel A., additional, Picard, John M., additional, Polster, Sean P., additional, Powers, William J., additional, Puetz, Volker, additional, Putaala, Jukka, additional, Rabinovich, Margarita, additional, Ransom, Bruce R., additional, Roa, Jorge A., additional, Rosenberg, Gary A., additional, Rossitto, Christina P., additional, Rundek, Tatjana, additional, Russin, Jonathan J., additional, Sacco, Ralph L., additional, Safouris, Apostolos, additional, Samaniego, Edgar A., additional, Sansing, Lauren H., additional, Satani, Nikunj, additional, Sattenberg, Ronald J., additional, Saver, Jeffrey L., additional, Savitz, Sean I., additional, Schmidt, Christian, additional, Seshadri, Sudha, additional, Sharma, Vijay K., additional, Sharp, Frank R., additional, Sheth, Kevin N., additional, Siddiqi, Omar K., additional, Singhal, Aneesh B., additional, Sobey, Christopher G., additional, Sommer, Clemens J., additional, Spetzler, Robert F., additional, Stapleton, Christopher J., additional, Strickland, Ben A., additional, Su, Hua, additional, Suarez, José I., additional, Takayama, Hiroo, additional, Tarsia, Joseph, additional, Tatlisumak, Turgut, additional, Thomas, Ajith J., additional, Thompson, John W., additional, Tsivgoulis, Georgios, additional, Tournier-Lasserve, Elizabeth, additional, Vidal, Gabriel, additional, Wakhloo, Ajay K., additional, Weksler, Babette B., additional, Willey, Joshua Z., additional, Wintermark, Max, additional, Wong, Lawrence K.S., additional, Xi, Guohua, additional, Xu, Jinchong, additional, Yaghi, Shadi, additional, Yamaguchi, Takenori, additional, Yang, Tuo, additional, Yasaka, Masahiro, additional, Zahuranec, Darin B., additional, Zhang, Feng, additional, Zhang, John H., additional, Zheng, Zhitong, additional, Zukin, R. Suzanne, additional, and Zweifler, Richard M., additional

Published
2022
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20. Procalcitonin and Midregional Proatrial Natriuretic Peptide as Biomarkers of Subclinical Cerebrovascular Damage

Author

Katan, Mira, Moon, Yeseon, von Eckardstein, Arnold, Spanaus, Kathartina, DeRosa, Janet, Gutierrez, Jose, DeCarli, Charles, Wright, Clinton, Sacco, Ralph, and Elkind, Mitchell

Subjects
Epidemiology, Biomedical and Clinical Sciences, Health Sciences, Brain Disorders, Clinical Research, Stroke, Prevention, Biomedical Imaging, Neurosciences, 4.1 Discovery and preclinical testing of markers and technologies, Detection, screening and diagnosis, Cardiovascular, Aged, Aged, 80 and over, Atrial Natriuretic Factor, Biomarkers, Calcitonin, Cerebrovascular Disorders, Female, Humans, Male, New York City, Risk, biomarkers, brain infarction, risk factor, stroke, white matter, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurology & Neurosurgery, Clinical sciences, Allied health and rehabilitation science
Abstract

Background and purposeChronic infections and cardiac dysfunction are risk factors for stroke. We hypothesized that blood biomarkers of infection (procalcitonin) and cardiac dysfunction (midregional proatrial natriuretic peptide [MR-proANP]), previously associated with small vessel stroke and cardioembolic stroke are also associated with subclinical cerebrovascular damage, including silent brain infarcts and white matter hyperintensity volume.MethodsThe NOMAS (Northern Manhattan Study) was designed to assess risk factors for incident vascular disease in a multiethnic cohort. A subsample underwent brain magnetic resonance imaging and had blood samples available for biomarker measurement (n=1178). We used logistic regression models to estimate the odds ratios and 95% confidence intervals (95% CIs) for the association of these biomarkers with silent brain infarcts after adjusting for demographic, behavioral, and medical risk factors. We used linear regression to assess associations with log-white matter hyperintensity volume.ResultsMean age was 70±9 years; 60% were women, 66% Hispanic, 17% black, and 15% were white. After adjusting for risk factors, subjects with procalcitonin or MR-proANP in the top quartile, compared with the lowest quartile were more likely to have silent brain infarcts (adjusted odds ratio for procalcitonin, 2.2; 95% CI, 1.3-3.7 and for MR-proANP, 3.3; 95% CI, 1.7-6.3) and increased white matter hyperintensity volume (adjusted mean change in log-white matter hyperintensity volume for procalcitonin, 0.29; 95% CI, 0.13-0.44 and for MR-proANP, 0.18; 95% CI, 0.004-0.36).ConclusionsHigher concentrations of procalcitonin, a marker of infection, and MR-proANP, a marker of cardiac dysfunction, are independently associated with subclinical cerebrovascular damage. If further studies demonstrate an incremental value for risk stratification, biomarker-guided primary prevention studies may lead to new approaches to prevent cerebrovascular disease.

Published
2017

21. CADMUS

Author

Goeldlin, Martina B; https://orcid.org/0000-0001-5800-116X, Mueller, Madlaine; https://orcid.org/0000-0002-1142-9633, Siepen, Bernhard M; https://orcid.org/0000-0003-0240-4191, Zhang, Wenpeng; https://orcid.org/0000-0001-8748-3962, Ozkan, Hatice; https://orcid.org/0000-0003-1656-4559, Locatelli, Martina, Du, Yang; https://orcid.org/0000-0002-0805-6282, Valenzuela, Waldo; https://orcid.org/0000-0002-6629-3366, Radojewski, Piotr; https://orcid.org/0000-0002-1062-8622, Hakim, Arsany; https://orcid.org/0000-0001-9431-1069, Kaesmacher, Johannes; https://orcid.org/0000-0002-9177-2289, Meinel, Thomas R; https://orcid.org/0000-0002-0647-9273, Clénin, Leander; https://orcid.org/0000-0001-8993-0770, Branca, Mattia; https://orcid.org/0000-0002-8063-7882, Strambo, Davide; https://orcid.org/0000-0003-4429-2714, Fischer, Tim; https://orcid.org/0000-0002-1807-9146, Medlin, Friedrich; https://orcid.org/0000-0002-8477-899X, Peters, Nils; https://orcid.org/0000-0001-8451-7389, Carrera, Emmanuel; https://orcid.org/0000-0003-0045-5382, Lovblad, Karl-Olof; https://orcid.org/0000-0003-2768-9779, Karwacki, Grzegorz M; https://orcid.org/0000-0001-5963-6220, Cereda, Carlo W; https://orcid.org/0000-0002-6479-1476, Niederhauser, Julien; https://orcid.org/0000-0002-6543-7989, Mono, Marie-Luise, Mueller, Achim; https://orcid.org/0009-0009-4597-3440, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Sartoretti, Sabine, Polymeris, Alexandros A; https://orcid.org/0000-0002-9475-2208, Altersberger, Valerian; https://orcid.org/0000-0002-0610-9328, Katan, Mira; https://orcid.org/0000-0002-9265-8066, et al, Goeldlin, Martina B; https://orcid.org/0000-0001-5800-116X, Mueller, Madlaine; https://orcid.org/0000-0002-1142-9633, Siepen, Bernhard M; https://orcid.org/0000-0003-0240-4191, Zhang, Wenpeng; https://orcid.org/0000-0001-8748-3962, Ozkan, Hatice; https://orcid.org/0000-0003-1656-4559, Locatelli, Martina, Du, Yang; https://orcid.org/0000-0002-0805-6282, Valenzuela, Waldo; https://orcid.org/0000-0002-6629-3366, Radojewski, Piotr; https://orcid.org/0000-0002-1062-8622, Hakim, Arsany; https://orcid.org/0000-0001-9431-1069, Kaesmacher, Johannes; https://orcid.org/0000-0002-9177-2289, Meinel, Thomas R; https://orcid.org/0000-0002-0647-9273, Clénin, Leander; https://orcid.org/0000-0001-8993-0770, Branca, Mattia; https://orcid.org/0000-0002-8063-7882, Strambo, Davide; https://orcid.org/0000-0003-4429-2714, Fischer, Tim; https://orcid.org/0000-0002-1807-9146, Medlin, Friedrich; https://orcid.org/0000-0002-8477-899X, Peters, Nils; https://orcid.org/0000-0001-8451-7389, Carrera, Emmanuel; https://orcid.org/0000-0003-0045-5382, Lovblad, Karl-Olof; https://orcid.org/0000-0003-2768-9779, Karwacki, Grzegorz M; https://orcid.org/0000-0001-5963-6220, Cereda, Carlo W; https://orcid.org/0000-0002-6479-1476, Niederhauser, Julien; https://orcid.org/0000-0002-6543-7989, Mono, Marie-Luise, Mueller, Achim; https://orcid.org/0009-0009-4597-3440, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Sartoretti, Sabine, Polymeris, Alexandros A; https://orcid.org/0000-0002-9475-2208, Altersberger, Valerian; https://orcid.org/0000-0002-0610-9328, Katan, Mira; https://orcid.org/0000-0002-9265-8066, and et al

Abstract

BACKGROUND AND OBJECTIVES Cerebral small vessel disease (SVD) is the major cause of intracerebral hemorrhage (ICH). There is no comprehensive, easily applicable classification of ICH subtypes according to the presumed underlying SVD using MRI. We developed an MRI-based classification for SVD-related ICH. METHODS We performed a retrospective study in the prospectively collected Swiss Stroke Registry (SSR, 2013-2019) and the Stroke InvestiGation in North And central London (SIGNAL) cohort. Patients with nontraumatic, SVD-related ICH and available MRI within 3 months were classified as Cerebral Amyloid angiopathy (CAA), Deep perforator arteriopathy (DPA), Mixed CAA-DPA, or Undetermined SVD using hemorrhagic and nonhemorrhagic MRI markers (CADMUS classification). The primary outcome was inter-rater reliability using Gwet's AC1. Secondary outcomes were recurrent ICH/ischemic stroke at 3 months according to the CADMUS phenotype. We performed Firth penalized logistic regressions and competing risk analyses. RESULTS The SSR cohort included 1,180 patients (median age [interquartile range] 73 [62-80] years, baseline NIH Stroke Scale 6 [2-12], 45.6% lobar hematoma, systolic blood pressure on admission 166 [145-185] mm Hg). The CADMUS phenotypes were as follows: mixed CAA-DPA (n = 751 patients, 63.6%), undetermined SVD (n = 203, 17.2%), CAA (n = 154, 13.1%), and DPA (n = 72, 6.3%), with a similar distribution in the SIGNAL cohort (n = 313). Inter-rater reliability was good (Gwet's AC1 for SSR/SIGNAL 0.69/0.74). During follow-up, 56 patients had 57 events (28 ICH, 29 ischemic strokes). Three-month event rates were comparable between the CADMUS phenotypes. DISCUSSION CADMUS, a novel MRI-based classification for SVD-associated ICH, is feasible and reproducible and may improve the classification of ICH subtypes in clinical practice and research.

Published
2024

22. Discordance between LDL-C and apolipoprotein B is associated with large-artery-atherosclerosis ischemic stroke in patients ⩽70 years of age.

Author

Kriemler, Lilian, Rudin, Salome, Gawinecka, Joanna, Gross, Felix, Arnold, Markus, Schweizer, Juliane, Westphal, Laura, Inauen, Corinne, Pokorny, Thomas, Dittrich, Tolga, Toebak, Anna, Arnold, Marcel, Christ-Crain, Mirjam, von Eckardstein, Arnold, Rentsch, Katharina, Katan, Mira, and De Marchis, Gian Marco

Published
2024
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24. Early vs Late Anticoagulation in Minor, Moderate, and Major Ischemic Stroke With Atrial Fibrillation: Post Hoc Analysis of the ELAN Randomized Clinical Trial

Author

Goeldlin, Martina B., Hakim, Arsany, Branca, Mattia, Abend, Stefanie, Kneihsl, Markus, Valenzuela Pinilla, Waldo, Fenzl, Sabine, Rezny-Kasprzak, Beata, Rohner, Roman, Strbian, Daniel, Paciaroni, Maurizio, Thomalla, Goetz, Michel, Patrik, Nedeltchev, Krassen, Gattringer, Thomas, Sandset, Else Charlotte, Bonati, Leo, Aguiar de Sousa, Diana, Sylaja, P. N., Ntaios, George, Koga, Masatoshi, Gdovinova, Zuzana, Lemmens, Robin, Bornstein, Natan M., Kelly, Peter, Katan, Mira, Horvath, Thomas, Dawson, Jesse, and Fischer, Urs

Abstract

IMPORTANCE: Whether infarct size modifies the treatment effect of early vs late direct oral anticoagulant (DOAC) initiation in people with ischemic stroke and atrial fibrillation is unknown. OBJECTIVE: To assess whether infarct size modifies the safety and efficacy of early vs late DOAC initiation. DESIGN, SETTING, AND PARTICIPANTS: Post hoc analysis of participants from the multinational (>100 sites in 15 countries) randomized clinical Early Versus Later Anticoagulation for Stroke With Atrial Fibrillation (ELAN) trial who had (1) acute ischemic stroke, (2) atrial fibrillation, and (3) brain imaging available before randomization. The ELAN trial was conducted between October 2017 and December 2022. Data were analyzed from October to December 2023 for this post hoc analysis. INTERVENTION: Early vs late DOAC initiation after ischemic stroke. Early DOAC initiation was within 48 hours for minor or moderate stroke or on days 6 to 7 for major stroke; late DOAC initiation was on days 3 to 4 for minor stroke, days 6 to 7 for moderate stroke, and days 12 to 14 for major stroke. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of recurrent ischemic stroke, symptomatic intracranial hemorrhage, extracranial bleeding, systemic embolism, or vascular death within 30 days. The outcome was assessed according to infarct size (minor, moderate, or major) using odds ratios and risk differences between treatment arms. Interrater reliability for infarct size between the core laboratory and local raters was assessed, and whether this modified the estimated treatment effects was also examined. RESULTS: A total of 1962 of the original 2013 participants (909 [46.3%] female; median [IQR] age, 77 [70-84] years) were included. The primary outcome occurred in 10 of 371 participants (2.7%) with early DOAC initiation vs 11 of 364 (3.0%) with late DOAC initiation among those with minor stroke (odds ratio [OR], 0.89; 95% CI, 0.38-2.10); in 11 of 388 (2.8%) with early DOAC initiation vs 14 of 392 (3.6%) with late DOAC initiation among those with moderate stroke (OR, 0.80; 95% CI, 0.35-1.74); and in 8 of 219 (3.7%) with early DOAC initiation vs 16 of 228 (7.0%) with late DOAC initiation among those with major stroke (OR, 0.52; 95% CI, 0.21-1.18). The 95% CI for the estimated risk difference of the primary outcome in early anticoagulation was −2.78% to 2.12% for minor stroke, −3.23% to 1.76% for moderate stroke, and −7.49% to 0.81% for major stroke. There was no significant treatment interaction for the primary outcome. For infarct size, interrater reliability was moderate (κ = 0.675; 95% CI, 0.647-0.702) for local vs core laboratory raters and strong (κ = 0.875; 95% CI, 0.855-0.894) between core laboratory raters. CONCLUSIONS AND RELEVANCE: The treatment effect of early DOAC initiation did not differ in people with minor, moderate, or major stroke assessed by brain imaging. Early treatment was not associated with a higher rate of adverse events, especially symptomatic intracranial hemorrhage, for any infarct size, including major stroke. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03148457

Published
2024
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25. Targeting inflammation to reduce recurrent stroke.

Author

Zietz, Annaelle, Gorey, Sarah, Kelly, Peter J, Katan, Mira, and McCabe, John J

Subjects
STROKE, CEREBRAL small vessel diseases, ATHEROSCLEROTIC plaque, LACUNAR stroke, ISCHEMIC stroke
Abstract

Background: Approximately one in four stroke patients suffer from recurrent vascular events, underlying the necessity to improve secondary stroke prevention strategies. Immune mechanisms are causally associated with coronary atherosclerosis. However, stroke is a heterogeneous disease and the relative contribution of inflammation across stroke mechanisms is not well understood. The optimal design of future randomized control trials (RCTs) of anti-inflammatory therapies to prevent recurrence after stroke must be informed by a clear understanding of the prognostic role of inflammation according to stroke subtype and individual patient factors. Aim: In this narrative review, we discuss (1) inflammatory pathways in the etiology of ischemic stroke subtypes; (2) the evidence on inflammatory markers and vascular recurrence after stroke; and (3) review RCT evidence of anti-inflammatory agents for vascular prevention. Summary of review: Experimental work, genetic epidemiological data, and plaque-imaging studies all implicate inflammation in atherosclerotic stroke. However, emerging evidence also suggests that inflammatory mechanisms are also important in other stroke mechanisms. Advanced neuroimaging techniques support the role of neuroinflammation in blood–brain barrier dysfunction in cerebral small vessel disease (cSVD). Systemic inflammatory processes also promote atrial cardiopathy, incident and recurrent atrial fibrillation (AF). Although several inflammatory markers have been associated with recurrence after stroke, interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) are presently the most promising markers to identify patients at increased vascular risk. Several RCTs have shown that anti-inflammatory therapies reduce vascular risk, including stroke, in coronary artery disease (CAD). Some, but not all of these trials, selected patients on the basis of elevated hsCRP. Although unproven after stroke, targeting inflammation to reduce recurrence is a compelling strategy and several RCTs are ongoing. Conclusion: Evidence points toward the importance of inflammation across multiple stroke etiologies and potential benefit of anti-inflammatory targets in secondary stroke prevention. Taking the heterogeneous stroke etiologies into account, the use of serum biomarkers could be useful to identify patients with residual inflammatory risk and perform biomarker-led patient selection for future RCTs. [ABSTRACT FROM AUTHOR]

Published
2024
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26. The Role of Electrocardiographic Markers for Predicting Atrial Fibrillation in Patients with Acute Ischemic Stroke: Data from the BIOSIGNAL Cohort Study

Author

Schütz, Valerie, primary, Dougoud, Svetlana, additional, Bracher, Katja, additional, Arnold, Markus, additional, Schweizer, Juliane, additional, Nakas, Christos, additional, Westphal, Laura P., additional, Inauen, Corinne, additional, Pokorny, Thomas, additional, Duru, Firat, additional, Steffel, Jan, additional, Luft, Andreas, additional, Spanaus, Katharina, additional, Saguner, Ardan Muammer, additional, and Katan, Mira, additional

Published
2023
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28. Natriuretic Peptides Improve Classification of People at Low Risk of Atrial Fibrillation after Stroke

Author

Cameron, Alan C, primary, Arnold, Markus, additional, Katsas, Georgios, additional, Yang, Jason, additional, Quinn, Terence, additional, Abdul-Rahim, Azmil H, additional, Campbell, Ross, additional, Docherty, Kieran, additional, De Marchis, Gian Marco, additional, Arnold, Marcel, additional, Kahles, Timo, additional, Nedeltchev, Krassen, additional, Cereda, Carlo, additional, Kaegi, Georg, additional, Bustamante, Alejandro, additional, Montaner, Joan, additional, Ntaios, George, additional, Foerch, Christian, additional, Spanaus, Katharina, additional, Von Eckardstein, Arnold, additional, Dawson, Jesse, additional, and Katan, Mira, additional

Published
2023
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29. P137/17 Incidence and outcome of perforations occuring during Medium-Vessel Occlusion thrombectomy compared to Large-Vessel occlusion thrombectomy

Author

Schulze-Zachau, Victor, primary, Brehm, Alex, additional, Ntoulias, Nikolaos, additional, Krug, Nadja, additional, Tsogkas, Ioannis, additional, Blackham, Kristine, additional, Möhlenbruch, Markus, additional, Jesser, Jessica, additional, Cervo, Amedeo, additional, Kreiser, Kornelia, additional, Althaus, Katharina, additional, Maslias, Errikos, additional, Michel, Patrik, additional, Saliou, Guillaume, additional, Riegler, Christoph, additional, Nolte, Christian, additional, Maier, Ilko, additional, Jamous, Ala, additional, Rautio, Riitta, additional, Ylikotila, Pauli, additional, Fargen, Kyle, additional, Wolfe, Stacey, additional, Castellano, Davide, additional, Boghi, Andrea, additional, Kaiser, Daniel, additional, Cuberi, Ani, additional, Kirschke, Jan, additional, Schwarting, Julian, additional, Limbucci, Nicola, additional, Renieri, Leonardo, additional, Kasab, Sami Al, additional, Spiotta, Alejandro, additional, Fragata, Isabel, additional, Rodríguez-Ares, Tania, additional, Maurer, Christoph, additional, Ansgar, Berlis, additional, Moreu, Manuel, additional, López-Jurado, Alfonso López-Frías, additional, Pérez-García, Carlos, additional, Commodaro, Christian, additional, Pileggi, Marco, additional, Mascitelli, Justin, additional, Giordano, Flavio, additional, Casagrande, Walter, additional, Purves, Cynthia, additional, Bester, Maxim, additional, Flottmann, Fabian, additional, Kan, Peter, additional, Edhayan, Gautam, additional, Hofmeister, Jeremy, additional, Machi, Paolo, additional, Kaschner, Marius, additional, Weiss, Daniel, additional, Katan, Mira, additional, Fischer, Urs, additional, and Psychogios, Marios, additional

Published
2023
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31. Promising Biomarker Candidates for Cardioembolic Stroke Etiology. A Brief Narrative Review and Current Opinion

Author

Arnold Markus, Schütz Valerie, and Katan Mira

Subjects
biomarker, cardioembolic stroke, stroke etiology, ischemic stroke, secondary prevention, Neurology. Diseases of the nervous system, RC346-429
Abstract

Determining the cause of stroke is considered one of the main objectives in evaluating a stroke patient in clinical practice. However, ischemic stroke is a heterogeneous disorder and numerous underlying disorders are implicated in its pathogenesis. Although progress has been made in identifying individual stroke etiology, in many cases underlying mechanisms still remain elusive. Since secondary prevention strategies are tailored toward individual stroke mechanisms, patients whose stroke etiology is unknown may not receive optimal preventive treatment. Cardioembolic stroke is commonly defined as cerebral vessel occlusion by distant embolization arising from thrombus formation in the heart. It accounts for the main proportion of ischemic strokes, and its share to stroke etiology is likely to rise even further in future decades. However, it can be challenging to distinguish cardioembolism from other possible etiologies. As personalized medicine advances, stroke researchers' focus is increasingly drawn to etiology-associated biomarkers. They can provide deeper insight regarding specific stroke mechanisms and can help to unravel previously undetected pathologies. Furthermore, etiology-associated biomarkers could play an important role in guiding future stroke prevention strategies. To achieve this, broad validation of promising candidate biomarkers as well as their implementation in well-designed randomized clinical trials is necessary. This review focuses on the most-promising candidates for diagnosis of cardioembolic stroke. It discusses existing evidence for possible clinical applications of these biomarkers, addresses current challenges, and outlines future perspectives.

Published
2021
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33. Serum S-100B adds incremental value for the prediction of symptomatic intracranial hemorrhage and brain edema after acute ischemic stroke

Author

Honegger, Tim, Schweizer, Juliane, Bicvic, Antonela, Westphal, Laura P, Schütz, Valerie, Inauen, Corinne, Pokorny, Thomas, Bracher, Katja, Arnold, Marcel, Fischer, Urs, Bonati, Leo H, De Marchis, Gian Marco, Nedeltchev, Krassen, Kahles, Timo, Cereda, Carlo, Kägi, Georg, Montaner, Joan, Bustamante, Alejandro, Palà, Elena, Ntaios, George, Foerch, Christian, Luft, Andreas, Spanaus, Katharina, Saleh, Lanja, von Eckardstein, Arnold, Arnold, Markus, Katan, Mira, Universitat Autònoma de Barcelona, Institut Català de la Salut, [Honegger T, Schweizer J, Westphal LP, Schütz V, Inauen C] Department of Neurology, University Hospital Zurich, Zurich, Switzerland. [Bicvic A] Department of Neurology, Inselspital University of Berne, Switzerland. [Montaner J] Grup de Recerca de Malalties Neurovasculars, Vall d’Hebron Institut de Recerca (VHIR) Barcelona, Spain. Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville. Department of Neurology, Hospital Universitario Virgen Macarena, Seville. [Palà E] Grup de Recerca de Malalties Neurovasculars, Vall d’Hebron Institut de Recerca (VHIR) Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
Ischemic stroke, Sèrum, Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders [DISEASES], enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares [ENFERMEDADES], 610 Medicine & health, Intracranial hemorrhage, Serum biomarker, Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Intracranial Hemorrhages::Cerebral Hemorrhage [DISEASES], Biological Factors::Biomarkers [CHEMICALS AND DRUGS], enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::hemorragias intracraneales::hemorragia cerebral [ENFERMEDADES], factores biológicos::biomarcadores [COMPUESTOS QUÍMICOS Y DROGAS], Stroke complications, Fluids and Secretions::Body Fluids::Blood::Serum [ANATOMY], Edema cerebral - Diagnòstic, Brain edema, Marcadors bioquímics, 570 Life sciences, biology, líquidos y secreciones::líquidos corporales::sangre::suero [ANATOMÍA], Hemorràgia cerebral - Diagnòstic, Neurology (clinical), Cardiology and Cardiovascular Medicine, S-100B
Abstract

Brain edema; Intracranial hemorrhage; Serum biomarker Edema cerebral; Hemorragia intracraneal; Biomarcador sérico Edema cerebral; Hemorràgia intracranial; Biomarcador sèric Background: Early identification of patients developing symptomatic intracranial hemorrhage and symptomatic brain edema after acute ischemic stroke is essential for clinical decision-making. Astroglial protein S-100B is a marker of blood-brain barrier disruption, which plays an important role in the formation of intracranial hemorrhage and brain edema. In this study, we assessed the prognostic value of serum S-100B for the development of these complications. Methods: Serum S-100B levels were measured within 24 h from symptom onset in 1749 consecutive acute ischemic stroke patients from the prospective, observational, multicenter BIOSIGNAL cohort study (mean age 72.0 years, 58.3% male). To determine symptomatic intracranial hemorrhage or symptomatic brain edema, follow-up neuroimaging was performed in all patients receiving reperfusion therapy or experiencing clinical worsening with an NIHSS increase of ⩾4. Results: Forty six patients (2.6%) developed symptomatic intracranial hemorrhage and 90 patients (5.2%) developed symptomatic brain edema. After adjustment for established risk factors, log10S-100B levels remained independently associated with both symptomatic intracranial hemorrhage (OR 3.41, 95% CI 1.7–6.9, p = 0.001) and symptomatic brain edema (OR 4.08, 95% CI 2.3–7.1, p

Published
2022

36. Incidence and outcome of perforations during medium vessel occlusion compared with large vessel occlusion thrombectomy

Author

Schulze-Zachau, Victor, primary, Brehm, Alex, additional, Ntoulias, Nikolaos, additional, Krug, Nadja, additional, Tsogkas, Ioannis, additional, Blackham, Kristine Ann, additional, Möhlenbruch, Markus A, additional, Jesser, Jessica, additional, Cervo, Amedeo, additional, Kreiser, Kornelia, additional, Althaus, Katharina, additional, Maslias, Errikos, additional, Michel, Patrik, additional, Saliou, Guillaume, additional, Riegler, Christoph, additional, Nolte, Christian H, additional, Maier, Ilko, additional, Jamous, Ala, additional, Rautio, Riitta, additional, Ylikotila, Pauli, additional, Fargen, Kyle M, additional, Wolfe, Stacey Q, additional, Castellano, Davide, additional, Boghi, Andrea, additional, Kaiser, Daniel P O, additional, Cuberi, Ani, additional, Kirschke, Jan S, additional, Schwarting, Julian, additional, Limbucci, Nicola, additional, Renieri, Leonardo, additional, Al Kasab, Sami, additional, Spiotta, Alejandro M, additional, Fragata, Isabel, additional, Rodriquez-Ares, Tania, additional, Maurer, Christoph Johannes, additional, Berlis, Ansgar, additional, Moreu, Manuel, additional, López-Frías, Alfonso, additional, Pérez-García, Carlos, additional, Commodaro, Christian, additional, Pileggi, Marco, additional, Mascitelli, Justin, additional, Giordano, Flavio, additional, Casagrande, Walter, additional, Purves, Cynthia P, additional, Bester, Maxim, additional, Flottmann, Fabian, additional, Kan, Peter T, additional, Edhayan, Gautam, additional, Hofmeister, Jeremy, additional, Machi, Paolo, additional, Kaschner, Marius, additional, Weiss, Daniel, additional, Katan, Mira, additional, Fischer, Urs, additional, and Psychogios, Marios-Nikos, additional

Published
2023
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37. The impact of competing stroke etiologies in patients with atrial fibrillation

Author

Zietz, Annaelle, primary, Polymeris, Alexandros A, additional, Helfenstein, Fabrice, additional, Schaedelin, Sabine, additional, Hert, Lisa, additional, Wagner, Benjamin, additional, Seiffge, David J, additional, Traenka, Christopher, additional, Altersberger, Valerian L, additional, Dittrich, Tolga, additional, Kaufmann, Josefin, additional, Ravanelli, Flavia, additional, Fladt, Joachim, additional, Fisch, Urs, additional, Thilemann, Sebastian, additional, De Marchis, Gian Marco, additional, Gensicke, Henrik, additional, Bonati, Leo H, additional, Katan, Mira, additional, Fischer, Urs, additional, Lyrer, Philippe, additional, Engelter, Stefan T, additional, and Peters, Nils, additional

Published
2023
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38. Association of Mortality and Risk of Epilepsy With Type of Acute Symptomatic Seizure After Ischemic Stroke and an Updated Prognostic Model

Author

Sinka, Lucia, primary, Abraira, Laura, additional, Imbach, Lukas L., additional, Zieglgänsberger, Dominik, additional, Santamarina, Estevo, additional, Álvarez-Sabín, José, additional, Ferreira-Atuesta, Carolina, additional, Katan, Mira, additional, Scherrer, Natalie, additional, Bicciato, Giulio, additional, Terziev, Robert, additional, Simmen, Cyril, additional, Schubert, Kai Michael, additional, Elshahabi, Adham, additional, Baumann, Christian R., additional, Döhler, Nico, additional, Erdélyi-Canavese, Barbara, additional, Felbecker, Ansgar, additional, Siebel, Philip, additional, Winklehner, Michael, additional, von Oertzen, Tim J., additional, Wagner, Judith N., additional, Gigli, Gian Luigi, additional, Serafini, Anna, additional, Nilo, Annacarmen, additional, Janes, Francesco, additional, Merlino, Giovanni, additional, Valente, Mariarosaria, additional, Zafra-Sierra, María Paula, additional, Bayona-Ortiz, Hernan, additional, Conrad, Julian, additional, Evers, Stefan, additional, Lochner, Piergiorgio, additional, Roell, Frauke, additional, Brigo, Francesco, additional, Bentes, Carla, additional, Peralta, Ana Rita, additional, Pinho e Melo, Teresa, additional, Keezer, Mark R., additional, Duncan, John S., additional, Sander, Josemir W., additional, Tettenborn, Barbara, additional, Koepp, Matthias J., additional, and Galovic, Marian, additional

Published
2023
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39. Ischaemic stroke despite antiplatelet therapy: Causes and outcomes

Author

Silimon, Norbert, primary, Drop, Boudewijn, additional, Clénin, Leander, additional, Nedeltchev, Krassen, additional, Kahles, Timo, additional, Tarnutzer, Alexander A, additional, Katan, Mira, additional, Bonati, Leo, additional, Salmen, Stephan, additional, Albert, Sylvan, additional, Salerno, Alexander, additional, Carrera, Emmanuel, additional, Berger, Christian, additional, Peters, Nils, additional, Medlin, Friedrich, additional, Cereda, Carlo, additional, Bolognese, Manuel, additional, Kägi, Georg, additional, Renaud, Susanne, additional, Niederhauser, Julien, additional, Bonvin, Christophe, additional, Schärer, Michael, additional, Mono, Marie-Luise, additional, Luft, Andreas, additional, Rodic-Tatic, Biljana, additional, Fischer, Urs, additional, Jung, Simon, additional, Arnold, Marcel, additional, Meinel, Thomas, additional, and Seiffge, David, additional

Published
2023
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40. The impact of competing stroke etiologies in patients with atrial fibrillation

Author

Zietz, Annaelle, Polymeris, Alexandros A, Helfenstein, Fabrice, Schaedelin, Sabine, Hert, Lisa, Wagner, Benjamin, Seiffge, David J, Traenka, Christopher, Altersberger, Valerian L, Dittrich, Tolga, Kaufmann, Josefin, Ravanelli, Flavia, Fladt, Joachim, Fisch, Urs, Thilemann, Sebastian, De Marchis, Gian Marco, Gensicke, Henrik, Bonati, Leo H, Katan, Mira, Fischer, Urs, Lyrer, Philippe, Engelter, Stefan T, and Peters, Nils

Subjects
610 Medicine & health
Abstract

BACKGROUND Data on the impact of competing stroke etiologies in stroke patients with atrial fibrillation (AF) are scarce. METHODS We used prospectively obtained data from an observational registry (Novel-Oral-Anticoagulants-in-Ischemic-Stroke-Patients-(NOACISP)-LONGTERM) of consecutive AF-stroke patients treated with oral anticoagulants. We compared the frequency of (i) the composite outcome of recurrent ischemic stroke (IS), intracerebral hemorrhage (ICH) or all-cause death as well as (ii) recurrent IS alone among AF-stroke patients with versus without competing stroke etiologies according to the TOAST classification. We performed cox proportional hazards regression modeling adjusted for potential confounders. Furthermore, the etiology of recurrent IS was assessed. RESULTS Among 907 patients (median age 81, 45.6% female), 184 patients (20.3%) had competing etiologies, while 723 (79.7%) had cardioembolism as the only plausible etiology. During 1587 patient-years of follow-up, patients with additional large-artery atherosclerosis had higher rates of the composite outcome (adjusted HR [95% CI] 1.64 [1.11, 2.40], p = 0.017) and recurrent IS (aHR 2.96 [1.65, 5.35 ], p

Published
2023

43. Copeptin for risk stratification in non-traumatic headache in the emergency setting: a prospective multicenter observational cohort study

Author

Blum, Claudine Angela, Winzeler, Bettina, Nigro, Nicole, Schuetz, Philipp, Biethahn, Silke, Kahles, Timo, Mueller, Cornelia, Timper, Katharina, Haaf, Katharina, Tepperberg, Janina, Amort, Margareth, Huber, Andreas, Bingisser, Roland, Sándor, Peter Stephan, Nedeltchev, Krassen, Müller, Beat, Katan, Mira, and Christ-Crain, Mirjam

Published
2017
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44. Preventing Recurrent Cardioembolic Stroke: Right Approach, Right Patient (PRECISE) Study Protocol

Author

Cameron, Alan C; https://orcid.org/0000-0001-6965-1109, Katsas, Georgios, Arnold, Markus; https://orcid.org/0000-0002-5524-2301, Docherty, Kieran, Campbell, Ross T; https://orcid.org/0000-0002-0050-2129, Murdoch, David, McClure, John D; https://orcid.org/0000-0003-4839-5462, Katan, Mira, Lip, Gregory Y H, Abdul-Rahim, Azmil H; https://orcid.org/0000-0002-1318-4027, Dawson, Jesse, Cameron, Alan C; https://orcid.org/0000-0001-6965-1109, Katsas, Georgios, Arnold, Markus; https://orcid.org/0000-0002-5524-2301, Docherty, Kieran, Campbell, Ross T; https://orcid.org/0000-0002-0050-2129, Murdoch, David, McClure, John D; https://orcid.org/0000-0003-4839-5462, Katan, Mira, Lip, Gregory Y H, Abdul-Rahim, Azmil H; https://orcid.org/0000-0002-1318-4027, and Dawson, Jesse

Abstract

Cardiac rhythm monitoring is performed to search for atrial fibrillation (AF) after ischaemic stroke or transient ischaemic attack (TIA). Prolonged cardiac rhythm monitoring increases AF detection but is challenging to implement in many healthcare settings and is not needed for all people after ischaemic stroke/TIA. We aimed to develop and validate a model that includes clinical, electrocardiogram (ECG), blood-based, and genetic biomarkers to identify people with a low probability of AF detection after ischaemic stroke or TIA. We will recruit 675 consenting participants who are aged over 18 years, who were admitted with ischaemic stroke or TIA in the 5 days prior, who are not known to have AF, and who would be suitable for anticoagulation if AF is found. We will collect baseline demographic and clinical data, a 12-lead ECG, and a venous blood sample for blood biomarkers (including midregional pro-atrial natriuretic peptide, MRproANP) and genetic data. We will perform up to 28 days of cardiac rhythm monitoring using an R-test or patch device to search for AF in all participants. The sample size of 675 participants is based on true sensitivity of 92.5%, null hypothesis sensitivity of 80%, 80% power, and 5% significance. The primary outcome is AF detection ≥30 s duration during 28 days of cardiac rhythm monitoring. Secondary outcomes are AF detection at 1-year, recurrent cardiovascular events, and mortality and will be identified by electronic linkage and telephone follow-up. The results will guide the development of a more personalized care pathway to search for AF after ischaemic stroke or TIA. This could help to reduce cardiac rhythm monitoring for people with a low probability of AF detection and allow more intensive cardiac monitoring to be focused on people who are more likely to have AF and benefit. Participants will be consented for their data to be used in future research studies, providing a rich resource for stroke and cardiovascular research communities.

Published
2023

45. The Role of Electrocardiographic Markers for Predicting Atrial Fibrillation in Patients with Acute Ischemic Stroke: Data from the BIOSIGNAL Cohort Study

Author

Schütz, Valerie; https://orcid.org/0000-0003-4708-6588, Dougoud, Svetlana, Bracher, Katja; https://orcid.org/0009-0008-8874-7753, Arnold, Markus; https://orcid.org/0000-0002-5524-2301, Schweizer, Juliane, Nakas, Christos; https://orcid.org/0000-0003-4155-722X, Westphal, Laura P; https://orcid.org/0000-0002-8373-3132, Inauen, Corinne; https://orcid.org/0000-0002-7786-2720, Pokorny, Thomas; https://orcid.org/0000-0001-8185-8874, Duru, Firat; https://orcid.org/0000-0002-4748-0158, Steffel, Jan; https://orcid.org/0000-0002-1477-9153, Luft, Andreas; https://orcid.org/0000-0001-9865-7382, Spanaus, Katharina; https://orcid.org/0000-0003-1903-0122, Saguner, Ardan Muammer; https://orcid.org/0000-0003-1896-0803, Katan, Mira; https://orcid.org/0000-0002-9265-8066, Schütz, Valerie; https://orcid.org/0000-0003-4708-6588, Dougoud, Svetlana, Bracher, Katja; https://orcid.org/0009-0008-8874-7753, Arnold, Markus; https://orcid.org/0000-0002-5524-2301, Schweizer, Juliane, Nakas, Christos; https://orcid.org/0000-0003-4155-722X, Westphal, Laura P; https://orcid.org/0000-0002-8373-3132, Inauen, Corinne; https://orcid.org/0000-0002-7786-2720, Pokorny, Thomas; https://orcid.org/0000-0001-8185-8874, Duru, Firat; https://orcid.org/0000-0002-4748-0158, Steffel, Jan; https://orcid.org/0000-0002-1477-9153, Luft, Andreas; https://orcid.org/0000-0001-9865-7382, Spanaus, Katharina; https://orcid.org/0000-0003-1903-0122, Saguner, Ardan Muammer; https://orcid.org/0000-0003-1896-0803, and Katan, Mira; https://orcid.org/0000-0002-9265-8066

Abstract

Background and Aims: P-wave abnormalities in the 12-lead electrocardiogram (ECG) have been associated with a higher risk of acute ischemic stroke (AIS) as well as atrial fibrillation (AF). This study aimed to assess pre-determined ECG criteria during sinus rhythm in unselected AIS patients and their value for predicting newly diagnosed atrial fibrillation (NDAF) after hospital admission. Methods: P-wave alterations were measured on 12-lead ECG on admission in all consecutively enrolled patients without known AF between October 2014 and 2017. The outcome of interest was NDAF, identified by prolonged electrocardiographic monitoring within one year after the index AIS. Univariable and multivariable logistic regression was applied to assess the magnitude and independence of the association between pre-selected ECG markers and NDAF. The discriminatory accuracy was evaluated with the area under the receiver operating characteristic curve (AUC), and the incremental prognostic value was estimated with the net reclassification index. Results: NDAF was detected in 87 (10%) of 856 patients during a follow-up of 365 days. Out of the pre-selected ECG parameters, advanced interatrial block (aIAB) and PR interval in lead II were independently associated with NDAF in univariable regression analysis. Only aIAB remained a significant predictor in multivariable analysis. Adding aIAB to the best-performing multivariable regression model improved the discriminatory accuracy to predict NDAF from an AUC of 0.78 (95%-CI 0.77–0.80) to 0.81 (95%-CI 0.80–0.83, p < 0.001). Conclusion: aIAB is independently and highly associated with NDAF in patients with AIS, has high inter-rater reliability, and therefore may be helpful to refine diagnostic work-up to search for AF in AIS.

Published
2023

46. Mechanical Thrombectomy Versus Best Medical Treatment in the Late Time Window in Non-DEFUSE-Non-DAWN Patients: A Multicenter Cohort Study

Author

Dittrich, Tolga D; https://orcid.org/0000-0002-9987-3631, Sporns, Peter B; https://orcid.org/0000-0002-3028-0539, Kriemler, Lilian F, Rudin, Salome, Nguyen, Anh; https://orcid.org/0000-0002-9343-8276, Zietz, Annaelle; https://orcid.org/0000-0002-4362-2497, Polymeris, Alexandros A; https://orcid.org/0000-0002-9475-2208, Tränka, Christopher, Thilemann, Sebastian; https://orcid.org/0000-0002-2735-0794, Wagner, Benjamin; https://orcid.org/0000-0001-9330-1790, Altersberger, Valerian L; https://orcid.org/0000-0002-0610-9328, Piot, Ines; https://orcid.org/0000-0001-8502-7453, Barinka, Filip; https://orcid.org/0000-0002-5823-0656, Müller, Susanne; https://orcid.org/0000-0002-5638-722X, Hänsel, Martin; https://orcid.org/0000-0001-9300-1130, Gensicke, Henrik; https://orcid.org/0000-0002-0949-2422, Engelter, Stefan T; https://orcid.org/0000-0003-3855-6234, Lyrer, Philippe A; https://orcid.org/0000-0002-1435-1114, Sutter, Raoul; https://orcid.org/0000-0002-6575-356X, Nickel, Christian H, Katan, Mira; https://orcid.org/0000-0002-9265-8066, Peters, Nils, Kulcsár, Zsolt; https://orcid.org/0000-0002-6805-5150, Karwacki, Grzegorz M; https://orcid.org/0000-0001-5963-6220, Pileggi, Marco; https://orcid.org/0000-0002-7691-8999, Cereda, Carlo; https://orcid.org/0000-0002-6479-1476, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Bonati, Leo H; https://orcid.org/0000-0003-1163-8133, Fischer, Urs; https://orcid.org/0000-0003-0521-4051, Psychogios, Marios; https://orcid.org/0000-0002-0016-414X, et al, Dittrich, Tolga D; https://orcid.org/0000-0002-9987-3631, Sporns, Peter B; https://orcid.org/0000-0002-3028-0539, Kriemler, Lilian F, Rudin, Salome, Nguyen, Anh; https://orcid.org/0000-0002-9343-8276, Zietz, Annaelle; https://orcid.org/0000-0002-4362-2497, Polymeris, Alexandros A; https://orcid.org/0000-0002-9475-2208, Tränka, Christopher, Thilemann, Sebastian; https://orcid.org/0000-0002-2735-0794, Wagner, Benjamin; https://orcid.org/0000-0001-9330-1790, Altersberger, Valerian L; https://orcid.org/0000-0002-0610-9328, Piot, Ines; https://orcid.org/0000-0001-8502-7453, Barinka, Filip; https://orcid.org/0000-0002-5823-0656, Müller, Susanne; https://orcid.org/0000-0002-5638-722X, Hänsel, Martin; https://orcid.org/0000-0001-9300-1130, Gensicke, Henrik; https://orcid.org/0000-0002-0949-2422, Engelter, Stefan T; https://orcid.org/0000-0003-3855-6234, Lyrer, Philippe A; https://orcid.org/0000-0002-1435-1114, Sutter, Raoul; https://orcid.org/0000-0002-6575-356X, Nickel, Christian H, Katan, Mira; https://orcid.org/0000-0002-9265-8066, Peters, Nils, Kulcsár, Zsolt; https://orcid.org/0000-0002-6805-5150, Karwacki, Grzegorz M; https://orcid.org/0000-0001-5963-6220, Pileggi, Marco; https://orcid.org/0000-0002-7691-8999, Cereda, Carlo; https://orcid.org/0000-0002-6479-1476, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Bonati, Leo H; https://orcid.org/0000-0003-1163-8133, Fischer, Urs; https://orcid.org/0000-0003-0521-4051, Psychogios, Marios; https://orcid.org/0000-0002-0016-414X, and et al

Abstract

Background: We assessed the efficacy and safety of mechanical thrombectomy (MT) in adult stroke patients with anterior circulation large vessel occlusion presenting in the late time window not fulfilling the DEFUSE-3 (Thrombectomy for Stroke at 6 to 16 Hours With Selection by Perfusion Imaging trial) and DAWN (Thrombectomy 6 to 24 Hours After Stroke With a Mismatch Between Deficit and Infarct trial) inclusion criteria. Methods: Cohort study of adults with anterior circulation large vessel occlusion admitted between 6 and 24 hours after last-seen-well at 5 participating Swiss stroke centers between 2014 and 2021. Mismatch was assessed by computer tomography or magnetic resonance imaging perfusion with automated software (RAPID or OLEA). We excluded patients meeting DEFUSE-3 and DAWN inclusion criteria and compared those who underwent MT with those receiving best medical treatment alone by inverse probability of treatment weighting using the propensity score. The primary efficacy end point was a favorable functional outcome at 90 days, defined as a modified Rankin Scale score shift toward lower categories. The primary safety end point was symptomatic intracranial hemorrhage within 7 days of stroke onset; the secondary was all-cause mortality within 90 days. Results: Among 278 patients with anterior circulation large vessel occlusion presenting in the late time window, 190 (68%) did not meet the DEFUSE-3 and DAWN inclusion criteria and thus were included in the analyses. Of those, 102 (54%) received MT. In the inverse probability of treatment weighting analysis, patients in the MT group had higher odds of favorable outcomes compared with the best medical treatment alone group (modified Rankin Scale shift: acOR, 1.46 [1.02–2.10]; P=0.04) and lower odds of all-cause mortality within 90 days (aOR, 0.59 [0.37–0.93]; P=0.02). There were no significant differences in symptomatic intracranial hemorrhage (MT versus best medical treatment alone: 5% versus 2%, P=0.63). Conclusio

Published
2023

47. Stroke-associated infections in patients with and without cancer

Author

Seystahl, Katharina; https://orcid.org/0000-0002-4072-5669, Schweizer, Juliane, Katan, Mira, Weber, Sung Ju, Hug, Alessia, Wanner, Miriam, Luft, Andreas R, Rohrmann, Sabine, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Weller, Michael; https://orcid.org/0000-0002-1748-174X, Seystahl, Katharina; https://orcid.org/0000-0002-4072-5669, Schweizer, Juliane, Katan, Mira, Weber, Sung Ju, Hug, Alessia, Wanner, Miriam, Luft, Andreas R, Rohrmann, Sabine, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, and Weller, Michael; https://orcid.org/0000-0002-1748-174X

Abstract

Background Cancer in stroke patients is associated with higher levels of inflammatory biomarkers and unfavorable poststroke outcomes. We thus explored whether there is a link between cancer and stroke-associated infections. Methods Medical records of patients with ischemic stroke in 2014–2016 registered in the Swiss Stroke Registry of Zurich were retrospectively analyzed. Incidence, characteristics, treatment, and outcome of stroke-associated infections diagnosed within 7 days after stroke onset were tested for an association with cancer. Results Among 1181 patients with ischemic stroke, 102 patients with cancer were identified. Stroke-associated infections occurred in 179 and 19 patients (17% and 19%) without and with cancer (P = .60), respectively, among them pneumonia in 95 and 10 patients (9% and 10%) and urinary tract infections in 68 and 9 patients (6% and 9%) (P = .74 and P = .32). Use of antibiotics was similar between groups. Levels of C-reactive protein (CRP) (P < .001), erythrocyte sedimentation rate (ESR) (P = .014) and procalcitonin (P = .015) were higher and levels of albumin (P = .042) and protein (P = .031) were lower in patients with cancer than without cancer. Among patients without cancer, higher CRP (P < .001), ESR (P < .001) and procalcitonin (P = .04) and lower albumin (P < .001) were associated with stroke-associated infections. Among cancer patients with or without infections, no significant differences in these parameters were observed. In-hospital mortality was associated with cancer (P < .001) and with stroke-associated infections (P < .001). However, among patients with stroke-associated infections, cancer was not associated with in-hospital mortality (P = .24) or 30-day mortality (P = .66). Conclusions Cancer does not represent a risk factor for stroke-associated infections in this patient cohort.

Published
2023

48. Incidence and outcome of perforations during medium vessel occlusion compared with large vessel occlusion thrombectomy

Author

Schulze-Zachau, Victor, Brehm, Alex, Ntoulias, Nikolaos, Krug, Nadja, Tsogkas, Ioannis, Blackham, Kristine Ann, Mo¨hlenbruch, Markus A, Jesser, Jessica, Cervo, Amedeo, Kreiser, Kornelia, Althaus, Katharina, Maslias, Errikos, Michel, Patrik, Saliou, Guillaume, Riegler, Christoph, Nolte, Christian H, Maier, Ilko, Jamous, Ala, Rautio, Riitta, Ylikotila, Pauli, Fargen, Kyle M, Wolfe, Stacey Q, Castellano, Davide, Boghi, Andrea, Kaiser, Daniel P O, Cuberi, Ani, Kirschke, Jan S, Schwarting, Julian, Limbucci, Nicola, Renieri, Leonardo, Al Kasab, Sami, Spiotta, Alejandro M, Fragata, Isabel, Rodriquez-Ares, Tania, Maurer, Christoph Johannes, Berlis, Ansgar, Moreu, Manuel, López-Frías, Alfonso, Pérez-García, Carlos, Commodaro, Christian, Pileggi, Marco, Mascitelli, Justin, Giordano, Flavio, Casagrande, Walter, Purves, Cynthia P, Bester, Maxim, Flottmann, Fabian, Kan, Peter T, Edhayan, Gautam, Hofmeister, Jeremy, Machi, Paolo, Kaschner, Marius, Weiss, Daniel, Katan, Mira, Fischer, Urs, and Psychogios, Marios-Nikos

Abstract

BackgroundVessel perforation during thrombectomy is a severe complication and is hypothesized to be more frequent during medium vessel occlusion (MeVO) thrombectomy. The aim of this study was to compare the incidence and outcome of patients with perforation during MeVO and large vessel occlusion (LVO) thrombectomy and to report on the procedural steps that led to perforation.MethodsIn this multicenter retrospective cohort study, data of consecutive patients with vessel perforation during thrombectomy between January 1, 2015 and September 30, 2022 were collected. The primary outcomes were independent functional outcome (ie, modified Rankin Scale 0–2) and all-cause mortality at 90 days. Binomial test, chi-squared test and t-test for unpaired samples were used for statistical analysis.ResultsDuring 25 769 thrombectomies (5124 MeVO, 20 645 LVO) in 25 stroke centers, perforation occurred in 335 patients (1.3%; mean age 72 years, 62% female). Perforation occurred more often in MeVO thrombectomy (2.4%) than in LVO thrombectomy (1.0%, p<0.001). More MeVO than LVO patients with perforation achieved functional independence at 3 months (25.7% vs 10.9%, p=0.001). All-cause mortality did not differ between groups (overall 51.6%). Navigation beyond the occlusion and retraction of stent retriever/aspiration catheter were the two most common procedural steps that led to perforation.ConclusionsIn our cohort, perforation was approximately twice as frequent in MeVO than in LVO thrombectomy. Efforts to optimize the procedure may focus on navigation beyond the occlusion site and retraction of stent retriever/aspiration catheter. Further research is necessary in order to identify thrombectomy candidates at high risk of intraprocedural perforation and to provide data on the effectiveness of endovascular countermeasures.

Published
2024
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