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  1. Article ; Online: Long-Term Effect of Mechanical Thrombectomy in Stroke Patients According to Advanced Imaging Characteristics.

    Beyeler, Morin / Pohle, Fabienne / Weber, Loris / Mueller, Madlaine / Kurmann, Christoph C / Mujanovic, Adnan / Clénin, Leander / Piechowiak, Eike Immo / Meinel, Thomas Raphael / Bücke, Philipp / Jung, Simon / Seiffge, David / Pilgram-Pastor, Sara M / Dobrocky, Tomas / Arnold, Marcel / Gralla, Jan / Fischer, Urs / Mordasini, Pasquale / Kaesmacher, Johannes

    Clinical neuroradiology

    2023  Volume 34, Issue 1, Page(s) 105–114

    Abstract: Purpose: Data on long-term effect of mechanical thrombectomy (MT) in patients with large ischemic cores (≥ 70 ml) are scarce. Our study aimed to assess the long-term outcomes in MT-patients according to baseline advanced imaging parameters.: Methods: ...

    Abstract Purpose: Data on long-term effect of mechanical thrombectomy (MT) in patients with large ischemic cores (≥ 70 ml) are scarce. Our study aimed to assess the long-term outcomes in MT-patients according to baseline advanced imaging parameters.
    Methods: We performed a single-centre retrospective cohort study of stroke patients receiving MT between January 1, 2010 and December 31, 2018. We assessed baseline imaging to determine core and mismatch volumes and hypoperfusion intensity ratio (with low ratio reflecting good collateral status) using RAPID automated post-processing software. Main outcomes were cross-sectional long-term mortality, functional outcome and quality of life by May 2020. Analysis were stratified by the final reperfusion status.
    Results: In total 519 patients were included of whom 288 (55.5%) have deceased at follow-up (median follow-up time 28 months, interquartile range 1-55). Successful reperfusion was associated with lower long-term mortality in patients with ischemic core volumes ≥ 70 ml (adjusted hazard ratio (aHR) 0.20; 95% confidence interval (95% CI) 0.10-0.44) and ≥ 100 ml (aHR 0.26; 95% CI 0.08-0.87). The effect of successful reperfusion on long-term mortality was significant only in the presence of relevant mismatch (aHR 0.17; 95% CI 0.01-0.44). Increasing reperfusion grade was associated with a higher rate of favorable outcomes (mRS 0-3) also in patients with ischemic core volume ≥ 70 ml (aOR 3.58, 95% CI 1.64-7.83).
    Conclusion: Our study demonstrated a sustainable benefit of better reperfusion status in patients with large ischemic core volumes. Our results suggest that patient deselection based on large ischemic cores alone is not advisable.
    MeSH term(s) Humans ; Brain Ischemia ; Retrospective Studies ; Quality of Life ; Thrombectomy/methods ; Stroke/diagnostic imaging ; Stroke/surgery ; Treatment Outcome
    Language English
    Publishing date 2023-08-29
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 2234662-4
    ISSN 1869-1447 ; 0939-7116 ; 1869-1439
    ISSN (online) 1869-1447
    ISSN 0939-7116 ; 1869-1439
    DOI 10.1007/s00062-023-01337-4
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  2. Article ; Online: Yield of Echocardiography in Ischemic Stroke and Patients With Transient Ischemic Attack With Established Indications for Long-Term Direct Oral Anticoagulant Therapy: A Cross-Sectional Diagnostic Cohort Study.

    Meinel, Thomas R / Brignoli, Kristina / Kielkopf, Moritz / Clenin, Leander / Beyeler, Morin / Scutelnic, Adrian / Siepen, Bernhard / Mueller, Madlaine / Goeldlin, Martina / Seiffge, David / Kaesmacher, Johannes / Mujanovic, Adnan / Belachew, Nebiyat F / Fischer, Urs / Arnold, Marcel / Gräni, Christoph / Seiler, Christian / Buffle, Eric / Jung, Simon

    Journal of the American Heart Association

    2022  Volume 11, Issue 9, Page(s) e024989

    Abstract: Background We aimed to determine the diagnostic yield of transthoracic (TTE) and transesophageal echocardiography (TEE) in patients with ischemic stroke and transient ischemic attack with established indications for direct oral anticoagulants before the ... ...

    Abstract Background We aimed to determine the diagnostic yield of transthoracic (TTE) and transesophageal echocardiography (TEE) in patients with ischemic stroke and transient ischemic attack with established indications for direct oral anticoagulants before the index event. Methods and Results This was a retrospective cohort study of consecutive patients with preceding established indications for long-term therapeutic direct oral anticoagulants presenting to a single comprehensive stroke center with ischemic stroke or transient ischemic attack. Choice of echocardiography modality was based on expert recommendations. The primary outcome was a composite of prespecified management-relevant high-risk findings adjudicated by an expert panel, based on TTE and TEE reports according to evidence-based recommendations. Explorative analyses were performed to identify biomarkers associated with the primary outcome. Of 424 patients included (median [interquartile range] age, 78 [70-84] years; 175 [41%] women; National Institutes of Health Stroke Scale, 4 [1-12]; 67% atrial fibrillation), 292 (69%) underwent echocardiography, while 132 (31%) did not. Modality was TTE in 191 (45%) and TEE in 101 (24%). Median time from index event to echocardiography was 2 (1-3) days. TTE identified 26 of 191 (14%) patients with 35 management-relevant pathologies. TEE identified 16 of 101(16%) patients with 20 management-relevant pathologies. Most management-relevant findings represented indicated coronary artery disease and valvular pathologies. In a further 3 of 191 (2%) patients with TTE and 4 of 101 (4%) patients with TEE, other relevant findings were identified. Variables associated with management-relevant high-risk pathologies included more severe stroke, diabetes, and laboratory biomarkers (NT-proBNP [N-terminal pro-B-type natriuretic peptide], C-reactive protein, d-dimer, and troponin levels). Conclusions In patients with established indications for long-term direct oral anticoagulant therapy and stroke who received echocardiography, both TTE and TEE identified a relevant and similar proportion of management-relevant high-risk pathologies and predictive biomarkers could help to guide diagnostic workup in such patients.
    MeSH term(s) Aged ; Anticoagulants/therapeutic use ; Cohort Studies ; Cross-Sectional Studies ; Echocardiography/methods ; Echocardiography, Transesophageal ; Female ; Humans ; Ischemic Attack, Transient/diagnosis ; Ischemic Attack, Transient/drug therapy ; Ischemic Attack, Transient/etiology ; Ischemic Stroke/diagnostic imaging ; Ischemic Stroke/drug therapy ; Male ; Retrospective Studies ; Stroke/diagnostic imaging ; Stroke/drug therapy
    Chemical Substances Anticoagulants
    Language English
    Publishing date 2022-04-27
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2653953-6
    ISSN 2047-9980 ; 2047-9980
    ISSN (online) 2047-9980
    ISSN 2047-9980
    DOI 10.1161/JAHA.121.024989
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  3. Article ; Online: Small vessel disease burden and risk of recurrent cerebrovascular events in patients with lacunar stroke and intracerebral haemorrhage attributable to deep perforator arteriolopathy.

    Goeldlin, Martina B / Vynckier, Jan / Mueller, Madlaine / Drop, Boudewijn / Maamari, Basel / Vonlanthen, Noah / Siepen, Bernhard M / Hakim, Arsany / Kaesmacher, Johannes / Jesse, Christopher Marvin / Mueller, Mandy D / Meinel, Thomas R / Beyeler, Morin / Clénin, Leander / Gralla, Jan / Z'Graggen, Werner / Bervini, David / Arnold, Marcel / Fischer, Urs /
    Seiffge, David J

    European stroke journal

    2023  Volume 8, Issue 4, Page(s) 989–1000

    Abstract: Introduction: Deep perforator arteriolopathy (DPA) causes intracerebral haemorrhage (ICH) and lacunar strokes (LS). We compare patient characteristics, MRI findings and clinical outcomes among patients with deep ICH and LS.: Patients and methods: We ... ...

    Abstract Introduction: Deep perforator arteriolopathy (DPA) causes intracerebral haemorrhage (ICH) and lacunar strokes (LS). We compare patient characteristics, MRI findings and clinical outcomes among patients with deep ICH and LS.
    Patients and methods: We included patients with MRI-confirmed LS or ICH in the basal ganglia, thalamus, internal capsule or brainstem from the Bernese Stroke Registry. We assessed MRI small vessel disease (SVD) markers, SVD burden score, modified Rankin Scale (mRS) and ischaemic stroke or ICH at 3 months.
    Results: We included 716 patients, 117 patients (16.3%) with deep ICH (mean age (SD) 65.1 (±15.2) years, 37.1% female) and 599 patients (83.7%) with LS (mean age (SD) 69.7 (±13.6) years, 39.9% female). Compared to LS, deep ICH was associated with a higher SVD burden score (median (IQR) 2 (1-2) vs 1 (0-2)), aOR
    Discussion/conclusion: DPA manifesting as ICH is associated with more severe MRI SVD burden and worse outcome compared to LS. The short-term risks of subsequent ischaemic stroke and recurrent ICH are similar in ICH and LS patients. This implies potential consequences for future secondary prevention strategies.
    MeSH term(s) Humans ; Female ; Middle Aged ; Aged ; Aged, 80 and over ; Male ; Stroke/diagnostic imaging ; Stroke, Lacunar/diagnostic imaging ; Brain Ischemia/complications ; Cerebral Hemorrhage/diagnostic imaging ; Magnetic Resonance Imaging/adverse effects
    Language English
    Publishing date 2023-08-26
    Publishing country England
    Document type Journal Article
    ZDB-ID 2851287-X
    ISSN 2396-9881 ; 2396-9873
    ISSN (online) 2396-9881
    ISSN 2396-9873
    DOI 10.1177/23969873231193237
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  4. Article: Absence of susceptibility vessel sign and hyperdense vessel sign in patients with cancer-related stroke.

    Beyeler, Morin / Grunder, Lorenz / Göcmen, Jayan / Steinauer, Fabienne / Belachew, Nebiyat F / Kielkopf, Moritz / Clénin, Leander / Mueller, Madlaine / Silimon, Norbert / Kurmann, Christoph / Meinel, Thomas / Bücke, Philipp / Seiffge, David / Dobrocky, Tomas / Piechowiak, Eike I / Pilgram-Pastor, Sara / Mattle, Heinrich P / Navi, Babak B / Arnold, Marcel /
    Fischer, Urs / Pabst, Thomas / Gralla, Jan / Berger, Martin D / Jung, Simon / Kaesmacher, Johannes

    Frontiers in neurology

    2023  Volume 14, Page(s) 1148152

    Abstract: Background and aim: Identification of paraneoplastic hypercoagulability in stroke patients helps to guide investigations and prevent stroke recurrence. A previous study demonstrated an association between the absence of the susceptibility vessel sign ( ... ...

    Abstract Background and aim: Identification of paraneoplastic hypercoagulability in stroke patients helps to guide investigations and prevent stroke recurrence. A previous study demonstrated an association between the absence of the susceptibility vessel sign (SVS) on brain MRI and active cancer in patients treated with mechanical thrombectomy. The present study aimed to confirm this finding and assess an association between the absence of the hyperdense vessel sign (HVS) on head CT and active cancer in all stroke patients.
    Methods: SVS and HVS status on baseline imaging were retrospectively assessed in all consecutive stroke patients treated at a comprehensive stroke center between 2015 and 2020. Active cancer, known at the time of stroke or diagnosed within 1 year after stroke (occult cancer), was identified. Adjusted odds ratios (aOR) and their 95% confidence interval (CI) for the association between the thrombus imaging characteristics and cancer were calculated using multivariable logistic regression.
    Results: Of the 2,256 patients with thrombus imaging characteristics available at baseline, 161 had an active cancer (7.1%), of which 36 were occult at the time of index stroke (1.6% of the total). The absence of SVS was associated with active cancer (aOR 3.14, 95% CI 1.45-6.80). No significance was reached for the subgroup of occult cancer (aOR 3.20, 95% CI 0.73-13.94). No association was found between the absence of HVS and active cancer (aOR 1.07, 95% CI 0.54-2.11).
    Conclusion: The absence of SVS but not HVS could help to identify paraneoplastic hypercoagulability in stroke patients with active cancer and guide patient care.
    Language English
    Publishing date 2023-03-20
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2564214-5
    ISSN 1664-2295
    ISSN 1664-2295
    DOI 10.3389/fneur.2023.1148152
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  5. Article ; Online: Ischaemic stroke despite antiplatelet therapy: Causes and outcomes.

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

    European stroke journal

    2023  Volume 8, Issue 3, Page(s) 692–702

    Abstract: Background: Ischaemic stroke may occur despite antiplatelet therapy (APT). We aimed to investigate frequency, potential causes and outcomes in patients with ischaemic stroke despite APT.: Methods: In this cohort study, we enrolled patients with ... ...

    Abstract Background: Ischaemic stroke may occur despite antiplatelet therapy (APT). We aimed to investigate frequency, potential causes and outcomes in patients with ischaemic stroke despite APT.
    Methods: In this cohort study, we enrolled patients with imaging-confirmed ischaemic stroke from the Swiss Stroke Registry (01/2014-07/2022). We determined the frequency of prior APT, assessed stroke aetiology (modified TOAST classification) and determined the association of prior APT with unfavourable functional outcome (modified Rankin Scale score 3-6) and recurrent ischaemic stroke at 3 months using regression models.
    Results: Among 53,352 patients, 27,484 (51.5%) had no prior antithrombotic treatment, 17,760 (33.3%) were on APT, 7039 (13.2%) on anticoagulation and 1069 (2.0%) were on APT + anticoagulation. In patients with a history of ischaemic stroke/TIA (
    Conclusions: One-third of ischaemic strokes occurred despite APT and 20% of patients with a history of ischaemic stroke had no antithrombotic therapy when having stroke recurrence. Aetiology of breakthrough strokes despite APT is heterogeneous and these patients are at increased risk of recurrent stroke.
    MeSH term(s) Humans ; Platelet Aggregation Inhibitors/therapeutic use ; Brain Ischemia/drug therapy ; Cohort Studies ; Stroke/drug therapy ; Ischemic Stroke/drug therapy ; Cerebral Infarction ; Anticoagulants/adverse effects
    Chemical Substances Platelet Aggregation Inhibitors ; Anticoagulants
    Language English
    Publishing date 2023-05-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 2851287-X
    ISSN 2396-9881 ; 2396-9873
    ISSN (online) 2396-9881
    ISSN 2396-9873
    DOI 10.1177/23969873231174942
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  6. Article ; Online: CADMUS: A Novel MRI-Based Classification of Spontaneous Intracerebral Hemorrhage Associated With Cerebral Small Vessel Disease

    Goeldlin, Martina B / Mueller, Madlaine / Siepen, Bernhard M / Zhang, Wenpeng / Ozkan, Hatice / Locatelli, Martina / Du, Yang / Valenzuela, Waldo / Radojewski, Piotr / Hakim, Arsany / Kaesmacher, Johannes / Meinel, Thomas R / Clénin, Leander / Branca, Mattia / Strambo, Davide / Fischer, Tim / Medlin, Friedrich / Peters, Nils / Carrera, Emmanuel /
    Lovblad, Karl-Olof / Karwacki, Grzegorz M / Cereda, Carlo W / Niederhauser, Julien / Mono, Marie-Luise / Mueller, Achim / Wegener, Susanne / Sartoretti, Sabine / Polymeris, Alexandros A / Altersberger, Valerian / Katan, Mira / Psychogios, Marios / Sturzenegger, Rolf / Nauer, Claude / Schaerer, Michael / Buitrago Tellez, Carlos / Renaud, Susanne / Minkner Klahre, Katharina / Z'Graggen, Werner J / Bervini, David / Bonati, Leo H / Wiest, Roland / Arnold, Marcel / Simister, Robert J / Wilson, Duncan / Jäger, Hans Rolf / Fischer, Urs / Werring, David J / Seiffge, David J

    Neurology

    2023  Volume 102, Issue 1, Page(s) e207977

    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 ... ...

    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.
    MeSH term(s) Humans ; Aged ; Reproducibility of Results ; Retrospective Studies ; Cerebral Hemorrhage/diagnostic imaging ; Cerebral Hemorrhage/epidemiology ; Stroke/diagnostic imaging ; Stroke/epidemiology ; Cerebral Amyloid Angiopathy/diagnostic imaging
    Language English
    Publishing date 2023-12-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207147-2
    ISSN 1526-632X ; 0028-3878
    ISSN (online) 1526-632X
    ISSN 0028-3878
    DOI 10.1212/WNL.0000000000207977
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    Zs.MO 374: Show issues

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