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Hollingworth M, Woodhouse LJ, Law ZK, Ali A, Krishnan K, Dineen RA, Christensen H, England TJ, Roffe C, Werring D, Peters N, Ciccone A, Robinson T, Członkowska A, Bereczki D, Egea-Guerrero JJ, Ozturk S, Bath PM, Sprigg N. The Effect of Tranexamic Acid on Neurosurgical Intervention in Spontaneous Intracerebral Hematoma: Data From 121 Surgically Treated Participants From the Tranexamic Acid in IntraCerebral Hemorrhage-2 Randomized Controlled Trial. Neurosurgery 2024; 95:605-616. [PMID: 38785451 PMCID: PMC11302947 DOI: 10.1227/neu.0000000000002961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/28/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES An important proportion of patients with spontaneous intracerebral hemorrhage (ICH) undergo neurosurgical intervention to reduce mass effect from large hematomas and control the complications of bleeding, including hematoma expansion and hydrocephalus. The Tranexamic acid (TXA) for hyperacute primary IntraCerebral Hemorrhage (TICH-2) trial demonstrated that tranexamic acid (TXA) reduces the risk of hematoma expansion. We hypothesized that TXA would reduce the frequency of surgery (primary outcome) and improve functional outcome at 90 days in surgically treated patients in the TICH-2 data set. METHODS Participants enrolled in TICH-2 were randomized to placebo or TXA. Participants randomized to either TXA or placebo were analyzed for whether they received neurosurgery within 7 days and their characteristics, outcomes, hematoma volumes (HVs) were compared. Characteristics and outcomes of participants who received surgery were also compared with those who did not. RESULTS Neurosurgery was performed in 5.2% of participants (121/2325), including craniotomy (57%), hematoma drainage (33%), and external ventricular drainage (21%). The number of patients receiving surgery who received TXA vs placebo were similar at 4.9% (57/1153) and 5.5% (64/1163), respectively (odds ratio [OR] 0.893; 95% CI 0.619-1.289; P -value = .545). TXA did not improve outcome compared with placebo in either surgically treated participants (OR 0.79; 95% CI 0.30-2.09; P = .64) or those undergoing hematoma evacuation by drainage or craniotomy (OR 1.19 95% 0.51-2.78; P -value = .69). Postoperative HV was not reduced by TXA (mean difference -8.97 95% CI -23.77, 5.82; P -value = .45). CONCLUSION TXA was not associated with less neurosurgical intervention, reduced HV, or improved outcomes after surgery.
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Affiliation(s)
- Milo Hollingworth
- Department of Neurosurgery, Nottingham University Hospitals, Nottingham, UK
- Stroke Trials Unit, Mental Health & Clinical Neurosciences, Queen's Medical Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lisa J. Woodhouse
- Stroke Trials Unit, Mental Health & Clinical Neurosciences, Queen's Medical Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Zhe K. Law
- Stroke Trials Unit, Mental Health & Clinical Neurosciences, Queen's Medical Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Medicine, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Azlinawati Ali
- Stroke Trials Unit, Mental Health & Clinical Neurosciences, Queen's Medical Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Faculty of Health Sciences, School of Medical Imaging, University of Sultan Zainal Abidin, Kuala Nerus, Malaysia
| | - Kailash Krishnan
- Stroke Trials Unit, Mental Health & Clinical Neurosciences, Queen's Medical Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Stroke, Department of Acute Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Robert A. Dineen
- Radiological Sciences, Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Timothy J. England
- Stroke Trials Unit, Mental Health & Clinical Neurosciences, Queen's Medical Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Stroke, Royal Derby Hospital, University Hospitals of Derby and Burton, Derby, UK
| | - Christine Roffe
- Stroke Research, School of Medicine, Keele University, Newcastle under Lyme, UK
| | - David Werring
- Stroke Research Centre, Brain Repair & Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Nils Peters
- Stroke Center and Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alfonso Ciccone
- Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italy
| | | | | | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | | | - Serefnur Ozturk
- Department of Neurology, Neurointensive Care- Stroke Center, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Philip M. Bath
- Stroke Trials Unit, Mental Health & Clinical Neurosciences, Queen's Medical Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Stroke, Department of Acute Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Nikola Sprigg
- Stroke Trials Unit, Mental Health & Clinical Neurosciences, Queen's Medical Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Stroke, Department of Acute Medicine, Nottingham University Hospitals, Nottingham, UK
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Kang DS, Yang PS, Kim D, Jang E, Yu HT, Kim TH, Sung JH, Pak HN, Lee MH, Lip GY, Joung B. Racial Differences in Bleeding Risk: An Ecological Epidemiological Study Comparing Korea and United Kingdom Subjects. Thromb Haemost 2024; 124:842-851. [PMID: 38359877 PMCID: PMC11349425 DOI: 10.1055/a-2269-1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/13/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND This study aimed to evaluate racial differences in bleeding incidence by conducting an ecological epidemiological study using data from Korea and the United Kingdom. METHODS We included healthy participants from the Korean National Health Insurance Service-Health Screening and the UK Biobank who underwent health examinations between 2006 and 2010 and had no comorbidities or history of medication use. Finally, 112,750 East Asians (50.7% men, mean age 52.6 years) and 210,995 Caucasians (44.7% men, mean age 55.0 years) were analyzed. The primary outcome was composed of intracranial hemorrhage (ICH) and bleeding from the gastrointestinal, respiratory, and genitourinary systems. RESULTS During the follow-up, primary outcome events occurred in 2,110 East Asians and in 6,515 Caucasians. East Asians had a 38% lower 5-year incidence rate compared with Caucasians (3.88 vs. 6.29 per 1,000 person-years; incidence rate ratio [IRR]: 0.62, 95% confidence interval [CI]: 0.59-0.65). East Asians showed a lower incidence of major bleeding (IRR: 0.86, 95% CI: 0.81-0.91), bleeding from the gastrointestinal (IRR: 0.53, 95% CI: 0.49-0.56), and genitourinary systems (IRR: 0.49, 95% CI: 0.44-0.53) compared with Caucasians. The incidence rates of ICH (IRR: 3.20, 95% CI: 2.67-3.84) and bleeding from the respiratory system (IRR: 1.28, 95% CI: 1.11-1.47) were higher in East Asians. Notably, East Asians consuming alcohol ≥3 times/week showed a higher incidence of the primary outcome than Caucasians (IRR: 1.12, 95% CI: 1.01-1.25). CONCLUSION This ecological study revealed significant racial differences in bleeding incidence, influenced by anatomical sites and lifestyle habits, underscoring the need for tailored approaches in bleeding management based on race.
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Affiliation(s)
- Dong-Seon Kang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Pil-Sung Yang
- Division of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eunsun Jang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Hoon Sung
- Division of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Cui C, Zheng J, Zhang H, Xing Z. Pterostilbene ameliorates oxidative stress and neuronal apoptosis after intracerebral hemorrhage via the sirtuin 1-mediated Nrf2 pathway in vivo and in vitro. J Stroke Cerebrovasc Dis 2024; 33:107950. [PMID: 39173685 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/21/2024] [Accepted: 08/14/2024] [Indexed: 08/24/2024] Open
Abstract
INTRODUCTION Oxidative stress and neuroapoptosis are significant pathological processes that occur in response to intracerebral hemorrhage (ICH), however, the optimal therapeutic strategy to treat these responses remains unknown. Pterostilbene (PTE) influences neural cell survival in in the pathology of a number of neurological diseases, but the mechanisms underlying this influence at present are not clear. The objective of the present study was to examine the potential impact of PTE on mitigating oxidative stress and neuronal apoptosis following ICH, while also elucidating the potential underlying pathways. MATERIAL & METHOD For in vivo experimentation, male C57BL/6 mice were used to establish ICH models. Wet-to-dry weight ratios were utilized to assess the degree of cerebral edema in the context of PTE intervention. Behavioral experiments were conducted to evaluate neurological dysfunction and cognitive impairment, and hematoxylin and eosin staining was employed to observe histopathological changes in the brain. Furthermore, oxidative stress levels in hippocampal tissues were measured, and cell apoptosis was examined using TUNEL staining and western blotting techniques. In vitro experiments were conducted to evaluate the extent of oxidative stress and neural apoptosis after sirtuin 1 (SIRT1) siRNA treatment. Immunofluorescence cytochemistry was used to analyze the immunofluorescence colocalization of SIRT1 and NeuN. RESULT Mice that experienced ICH exhibited worsening neurological deterioration, increased oxidative stress and neuronal cell apoptosis. However, the addition of PTE was found to lessen these effects. Furthermore, PTE was found to activate the SIRT1-mediated Nrf2 pathway in mice with ICH. When SIRT1 was inhibited, levels of oxidative stress and neuronal apoptosis increased, even in the presence of PTE. CONCLUSION The present study provided evidence to indicate that PTE can suppress oxidative damage and neuronal apoptosis following ICH by activating the SIRT1/Nrf2 pathway.
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Affiliation(s)
- Chengxi Cui
- Department of Neurosurgery, Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University, Xinxiang, Henan 453000, PR China
| | - Jie Zheng
- Department of Neurosurgery, Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University, Xinxiang, Henan 453000, PR China
| | - Hongyun Zhang
- Department of Neurosurgery, Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University, Xinxiang, Henan 453000, PR China
| | - Zhenyi Xing
- Department of Neurosurgery, Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical University, Xinxiang, Henan 453000, PR China.
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Wang X, Chen T, Zhou J, Qin Y. Racial and ethnic differences in restarting antiplatelet therapy in patients with primary intracranial hemorrhage: a systematic review and meta-analysis. BMC Neurol 2024; 24:280. [PMID: 39127615 DOI: 10.1186/s12883-024-03790-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND There has long been clinical disagreement over the resumption of antiplatelet therapy in patients with primary intracranial hemorrhage (ICH). This meta-analysis aimed to systematically evaluate the efficacy and safety of restarting antiplatelet therapy after ICH among different races and ethnicities. METHODS All relevant medical studies involving adults with antiplatelet-associated ICH published in PubMed, The Cochrane Library and Chinese National Knowledge Infrastructure from inception to March 2024 were sourced. Outcome measures were thromboembolic events (stroke and myocardial infarction) and recurrence of ICH. After assessing study heterogeneity and publication bias, we performed a meta-analysis using random-effects model to assess the strength of association between resumption of antiplatelet therapy and our outcomes.The review was not registered and the review protocol was not prepared. RESULTS Thirty-five studies were included, with 9758 ICH patients. Subgroup analysis revealed that restarting antiplatelet therapy was associated with a significantly higher risk of recurrence or aggravation of cerebral hemorrhage in Asians[OR = 1.48, 95% CI (1.13-1.94), P = 0.004]; in Caucasians, on the contrary, reinitiation of antiplatelet therapy was not associated with a significantly higher risk of recurrence or aggravation of cerebral hemorrhage [OR = 0.85, 95% CI (0.67-1.06), P = 0.149]. Reinitiation of antiplatelet therapy was associated with a significantly lower risk of cerebral infarction [OR = 0.61, 95% CI (0.39-0.96), P = 0.033]. Restarting antiplatelet therapy after cerebral hemorrhage was not associated with a higher incidence rate of mortality [OR = 0.79, 95% CI (0.57, 1.08), P = 0.138], myocardial infarction [OR = 2.40, 95%CI (0.53,10.79), P = 0.253], hemiparesis [OR = 0.38, 95%CI (0.03,4.81), P = 0.451], neurological deficit [OR = 0.86,95%CI(0.32,2.33),P = 0.766]. CONCLUSION Reinstitution of antiplatelet therapy after ICH was associated with a lower risk of thromboembolic complications.Resumption of antiplatelet therapy was not associated with a higher incidence of cerebral hemorrhage in Caucasians, but may be associated with a higher risk of cerebral hemorrhage recurrence in Asian populations.
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Affiliation(s)
- Xuechang Wang
- Department of Pharmacy, Anning First People's Hospital Affiliated to Kunming University of Science and Technology, Anning, Yunnan Province, 650302, China
| | - Ting Chen
- Department of Pharmacy, Yancheng No.1 People's Hospital, Yancheng, Jiangsu Province, 224000, China
| | - Junning Zhou
- Department of Pharmacy, Liaocheng People's Hospital, Liaocheng, Shandong Province, 252037, China
| | - Yuan Qin
- Department of Pharmacy, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan Province, 646000, China.
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Sterba A, Sedova P, Brown RD, Stehlik A, Bryndziar T, Cimflova P, Zvolsky M, Belaskova S, Kovacova I, Bednarik J, Mikulík R. Predictors of spontaneous intracerebral hemorrhage mortality: a community-based study in Brno, Czech Republic. Acta Neurol Belg 2024:10.1007/s13760-024-02612-y. [PMID: 39102105 DOI: 10.1007/s13760-024-02612-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 07/13/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND AND OBJECTIVE Intracerebral hemorrhage (ICH) is a serious medical condition with high mortality. However, factors leading to long-term mortality after ICH are largely unclear. The aim of this community-based study is to assess predictors of long-term mortality after spontaneous ICH. METHODS We identified all patients admitted with spontaneous ICH to hospitals with a certified stroke unit in Brno, the second largest city in the Czech Republic (CR), in 2011, the year of the Czech Population and Housing Census. We reviewed their medical records for risk factors, radiographic parameters, and measures of post-stroke neurological deficit [National Institutes of Health Stroke Scale (NIHSS)]. Using the dates of death from the Czech National Mortality Register, we calculated mortality at 30 days, six months, one year, and three years after the ICH. Multivariate analysis with forward stepwise logistic regression was performed to determine independent predictors of mortality (p < 0.05). RESULTS In 2011, 1086 patients with stroke were admitted to the four stroke-certified hospitals in Brno, CR. Of these, 134 had spontaneous ICH, with complete data available in 93 of them entering the final analysis. The mortality at 30 days, 6 months, 1 year, and 3 years post-ICH was 34%, 47%, 51%, and 63%, respectively. The mortality was highest in the first few days post-event, with 50% of patients dying in 255 days and average survival being 884 ± 90 days. Both NIHSS and modified ICH (MICH) score showed to be strong and reliable predictors of short- as well as long-term mortality; the risk of death post-ICH increased with older age and size of ICH. Other risk factors contributing to higher, primarily shorter-term mortality included history of cardiac failure, myocardial infarction, or atrial fibrillation. CONCLUSIONS In our community-based study, we found that severity of neurological deficit at admission (NIHSS), combined with age and size of ICH, well predicted short- as well as long-term mortality after spontaneous ICH. A history of cardiac failure, myocardial infarction, or atrial fibrillation at presentation were also predictors of mortality, underscoring the need for optimal cardiac management in patients with ICH.
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Affiliation(s)
- Albert Sterba
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Neurosurgical Clinic, Kralovske Vinohrady University Hospital, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petra Sedova
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic.
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| | - Robert D Brown
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Albert Stehlik
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Bryndziar
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petra Cimflova
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
- Clinic of Imaging Methods, St Anne's University Hospital, Brno, Czech Republic
| | - Miroslav Zvolsky
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Silvie Belaskova
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
| | - Ingrid Kovacova
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
| | - Josef Bednarik
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Neurological Clinic, University Hospital Brno, Brno, Czech Republic
| | - Robert Mikulík
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Neurological Clinic, St Anne's University Hospital, Brno, Czech Republic
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Hu Z, Sha Q. Association between serum osmolality and risk of in-hospital mortality in patients with intracerebral hemorrhage. Front Neurol 2024; 15:1410569. [PMID: 39157063 PMCID: PMC11327125 DOI: 10.3389/fneur.2024.1410569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/24/2024] [Indexed: 08/20/2024] Open
Abstract
Aim This study aimed to analyze the association between serum osmolality and the risk of in-hospital mortality in intracerebral hemorrhage (ICH) patients. Methods In this retrospective cohort study, data of a total of 1,837 ICH patients aged ≥18 years were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV). Serum osmolality and blood urea nitrogen (BUN)-to-creatinine (Cr) ratio (BCR) were used as the main variables to assess their association with the risk of in-hospital mortality in ICH patients after first intensive care unit (ICU) admission using a univariable Cox model. Univariable and multivariable Cox regression analyses were applied to explore the associations between serum osmolality, BCR, and in-hospital mortality of ICH patients. Hazard ratio (HR) and 95% confidence intervals (CIs) were calculated. Results The median survival duration of all participants was 8.29 (4.61-15.24) days. Serum osmolality of ≥295 mmol/L was correlated with an increased risk of in-hospital mortality in patients with ICH (HR = 1.43, 95%CI: 1.14-1.78). BCR of >20 was not significantly associated with the risk of in-hospital mortality in ICH patients. A subgroup analysis indicated an increased risk of in-hospital mortality among ICH patients who were women, belonged to white or Black race, or had complications with acute kidney injury (AKI). Conclusion High serum osmolality was associated with an increased risk of in-hospital mortality among ICH patients.
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Affiliation(s)
- Zhaosuo Hu
- School of Basic Medicine, Anhui Medical University, Hefei, Anhui, China
- Department of Clinical Laboratory, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Quan Sha
- School of Basic Medicine, Anhui Medical University, Hefei, Anhui, China
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Huang Z, Alkhars H, Gunderman A, Sigounas D, Cleary K, Chen Y. Optimal Concentric Tube Robot Design for Safe Intracerebral Hemorrhage Removal. JOURNAL OF MECHANISMS AND ROBOTICS 2024; 16:081005. [PMID: 38434486 PMCID: PMC10906783 DOI: 10.1115/1.4063979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Purpose The purpose of this paper is to investigate the geometrical design and path planning of Concentric tube robots (CTR) for intracerebral hemorrhage (ICH) evacuation, with a focus on minimizing the risk of damaging white matter tracts and cerebral arteries. Methods To achieve our objective, we propose a parametrization method describing a general class of CTR geometric designs. We present mathematical models that describe the CTR design constraints and provide the calculation of a path risk value. We then use a genetic algorithm to determine the optimal tube geometry for targeting within the brain. Results Our results show that a multi-tube CTR design can significantly reduce the risk of damaging critical brain structures compared to the conventional straight tube design. However, there is no significant relationship between the path risk value and the number and shape of the additional inner curved tubes. Conclusion Considering the challenges of CTR hardware design, fabrication, and control, we conclude that the most practical geometry for a CTR path in ICH treatment is a straight outer tube followed by a planar curved inner tube. These findings have important implications for the development of safe and effective CTRs for ICH evacuation by enabling dexterous manipulation to minimize damage to critical brain structures.
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Affiliation(s)
- Zhefeng Huang
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Hussain Alkhars
- George Washington University School of Medicine, Washington, DC, USA
| | - Anthony Gunderman
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Dimitri Sigounas
- George Washington University School of Medicine, Washington, DC, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington, DC, USA
| | - Yue Chen
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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Gusev E, Solomatina L, Bochkarev P, Zudova A, Chereshnev V. The Role of Systemic Inflammation in the Pathogenesis of Spontaneous Intracranial Hemorrhage in the Presence or Absence of Effective Cerebral Blood Flow. J Clin Med 2024; 13:4454. [PMID: 39124721 PMCID: PMC11313124 DOI: 10.3390/jcm13154454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Spontaneous intracerebral hemorrhage (ICH) is one of the leading causes of mortality in intensive care units. The role of systemic hyperintense inflammation (SHI) in the pathogenesis of critical complications of ICH remains a poorly understood problem. There is a specific variant of severe ICH associated with increased intracranial pressure and occlusion of intracranial vessels, defined as ineffective cerebral blood flow (IECBF). Methods: To evaluate the role of SHI in the pathogenesis of severe (comatose) ICH in a dynamic comparison of patients with IECBF (n-26) and without IECBF (n-52). The SHI integral score criterion (SI scale) was used, including certain values of plasma concentrations of IL-6, IL-8, IL-10; TNF-α, PCT, cortisol, myoglobin, troponin I, D-dimer, and, additionally, SOFA scale values. Blood levels of ACTH and neuron-specific enolase (NSE) were also assessed. Results: Twenty-eight-day mortality in severe ICH reached 84.6% (without IECBF) and 96.2% (with IECBF). Clear signs of SHI were detected in 61.5%/87.8% (without IECBF) and 0.0%/8.7% (with IECBF) within 1-3/5-8 days from the onset of ICH manifestation. The lower probability of developing SHI in the IECBF group was associated with low blood NSE concentrations. Conclusions: The development of SHI in ICH is pathogenetically related to the permeability of the blood-brain barrier for tissue breakdown products and other neuroinflammatory factors.
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Affiliation(s)
- Evgenii Gusev
- Institute of Immunology and Physiology Ural Branch of The Russian Academy of Sciences, 620078 Yekaterinburg, Russia; (E.G.); (A.Z.); (V.C.)
| | - Liliya Solomatina
- Institute of Immunology and Physiology Ural Branch of The Russian Academy of Sciences, 620078 Yekaterinburg, Russia; (E.G.); (A.Z.); (V.C.)
| | - Peter Bochkarev
- Sverdlovsk Regional Clinical Hospital No. 1 (GAUZ SO “SOKB No. 1”), 620102 Yekaterinburg, Russia;
| | - Alevtina Zudova
- Institute of Immunology and Physiology Ural Branch of The Russian Academy of Sciences, 620078 Yekaterinburg, Russia; (E.G.); (A.Z.); (V.C.)
| | - Valeriy Chereshnev
- Institute of Immunology and Physiology Ural Branch of The Russian Academy of Sciences, 620078 Yekaterinburg, Russia; (E.G.); (A.Z.); (V.C.)
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Wu R, Hong T, Li Y. Systematic Evaluation of Hematoma Expansion Models in Spontaneous Intracerebral Hemorrhage: A Meta-Analysis and Meta-Regression Approach. Cerebrovasc Dis 2024:1-11. [PMID: 39019017 DOI: 10.1159/000540223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/02/2024] [Indexed: 07/19/2024] Open
Abstract
INTRODUCTION Accurate prediction of hematoma expansion (HE) in spontaneous intracerebral hemorrhage (sICH) is crucial for tailoring patient-specific treatments and improving outcomes. Recent advancements have yielded numerous HE risk factors and predictive models. This study aims to evaluate the characteristics and efficacy of existing HE prediction models, offering insights for performance enhancement. METHODS A comprehensive search was conducted in PubMed for observational studies and randomized controlled trials focusing on HE prediction, written in English. The prediction models were categorized based on their incorporated features and modeling methodology. Rigorous quality and bias assessments were performed. A meta-analysis of studies reporting C-statistics was executed to assess and compare the performance of current HE prediction models. Meta-regression was utilized to explore heterogeneity sources. RESULTS From 358 initial records, 22 studies were deemed eligible, encompassing traditional models, hematoma imaging feature models, and models based on artificial intelligence or radiomics. Meta-analysis of 11 studies, involving 12,087 sICH patients, revealed an aggregated C-statistic of 0.74 (95% CI: 0.69-0.78) across seven HE prediction models. Eight characteristics related to development cohorts were identified as key factors contributing to performance variability among these models. CONCLUSION The findings indicate that the current predictive capacity for HE risk remains suboptimal. Enhanced accuracy in HE prediction is vital for effectively targeting patient populations most likely to benefit from tailored treatment strategies.
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Affiliation(s)
- Ruoru Wu
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, Beijing, China
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, Beijing, China
| | - Ye Li
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, Beijing, China
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Czernych R, Kozera G, Badyda AJ, Bieniaszewski L, Zagożdżon P. Air Pollution Increases Risk of Occurrence of Intracerebral Haemorrhage but Not of Subarachnoid Haemorrhage: Time-Series Cross-Sectional Study. Biomedicines 2024; 12:1562. [PMID: 39062135 PMCID: PMC11274972 DOI: 10.3390/biomedicines12071562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/03/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Haemorrhagic strokes (HS), including intracerebral (ICH) and subarachnoid haemorrhages (SAH), account for approximately 10-15% of strokes worldwide but are associated with worse functional outcomes and higher rates of mortality, and financial burden than ischemic stroke. There is evidence that confirmed poor air quality may increase the incidence of haemorrhagic strokes. The aim of our study was to evaluate the association between individual ambient air pollutants and the risk of haemorrhagic stroke in an urban environment without high levels of air pollution. (2) Methods: A time-series cross-sectional study design was used. A daily air pollution concentration (Agency of Regional Air Quality Monitoring in the Gdansk Metropolitan Area) and incidence of haemorrhagic strokes (National Health Fund) were obtained and covered the time period from 1 January 2014 to 31 December 2018. A generalised additive model with Poisson regression was used to estimate the associations between 24-h mean concentrations of SO2, NO, NO2, NOx, CO, PM10, PM2.5, and O3 and a daily number of haemorrhagic strokes. (3) Results: The single-day lag model results showed that NO2, NO and NOx exposure was associated with increased risk of ICH (88% events) with RR of 1.059 (95% CI: 1.015-1.105 for lag0), 1.033 (95% CI: 1.007-1.060 for lag0) and 1.031 (95% CI: 1.005-1.056 for lag0), but not for SAH (12% events). Exposure to CO was related to a substantial and statistically significant increase in incidence for 1.031 (95% CI: 1.002-1.061 for lag0) but not for SAH. Higher SO2, PM10, PM2.5, and O3 exposures were not significantly related to both ISC and SAH. (4) Conclusions: In this time-series cross-sectional study, we found strong evidence that supports the hypothesis that transient elevations in ambient NO2, NO and CO are associated with a higher relative risk of intracerebral but not subarachnoid haemorrhage.
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Affiliation(s)
- Radosław Czernych
- Department of Hygiene and Epidemiology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Grzegorz Kozera
- Centre of Medical Simulations, Medical University of Gdańsk, 80-204 Gdańsk, Poland; (G.K.); (L.B.)
| | - Artur Jerzy Badyda
- Department of Informatics and Environment Quality Research, Faculty of Building Services, Hydro- and Environmental Engineering, Warsaw University of Technology, 01-604 Warsaw, Poland;
| | - Leszek Bieniaszewski
- Centre of Medical Simulations, Medical University of Gdańsk, 80-204 Gdańsk, Poland; (G.K.); (L.B.)
| | - Paweł Zagożdżon
- Department of Hygiene and Epidemiology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
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11
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Zhang Y, Huang Y, Hu K. Multi-scale object equalization learning network for intracerebral hemorrhage region segmentation. Neural Netw 2024; 179:106507. [PMID: 39003984 DOI: 10.1016/j.neunet.2024.106507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/31/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024]
Abstract
Segmentation and the subsequent quantitative assessment of the target object in computed tomography (CT) images provide valuable information for the analysis of intracerebral hemorrhage (ICH) pathology. However, most existing methods lack a reasonable strategy to explore the discriminative semantics of multi-scale ICH regions, making it difficult to address the challenge of complex morphology in clinical data. In this paper, we propose a novel multi-scale object equalization learning network (MOEL-Net) for accurate ICH region segmentation. Specifically, we first introduce a shallow feature extraction module (SFEM) for obtaining shallow semantic representations to maintain sufficient and effective detailed location information. Then, a deep feature extraction module (DFEM) is leveraged to extract the deep semantic information of the ICH region from the combination of SFEM and original image features. To further achieve equalization learning in different scales of ICH regions, we introduce a multi-level semantic feature equalization fusion module (MSFEFM), which explores the equalized fusion features of the described objects with the assistance of shallow and deep semantic information provided by SFEM and DFEM. Driven by the above three designs, MOEL-Net shows a solid capacity to capture more discriminative features in various ICH region segmentation. To promote the research of clinical automatic ICH region segmentation, we collect two datasets, VMICH and FRICH (divided into Test A and Test B) for evaluation. Experimental results show that the proposed model achieves the Dice scores of 88.28%, 90.92%, and 90.95% on the VMICH, FRICH Test A, and Test B, respectively, which outperform fourteen competing methods.
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Affiliation(s)
- Yuan Zhang
- Key Laboratory of Intelligent Computing and Information Processing of Ministry of Education, Xiangtan University, Xiangtan 411105, China
| | - Yanglin Huang
- Key Laboratory of Intelligent Computing and Information Processing of Ministry of Education, Xiangtan University, Xiangtan 411105, China.
| | - Kai Hu
- Key Laboratory of Intelligent Computing and Information Processing of Ministry of Education, Xiangtan University, Xiangtan 411105, China; Key Laboratory of Medical Imaging and Artificial Intelligence of Hunan Province, Xiangnan University, Chenzhou 423000, China.
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12
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Gómez-de Frutos MC, Laso-García F, García-Suárez I, Piniella D, Otero-Ortega L, Alonso-López E, Pozo-Novoa J, Gallego-Ruiz R, Díaz-Gamero N, Fuentes B, Alonso de Leciñana M, Díez-Tejedor E, Ruiz-Ares G, Gutiérrez-Fernández M. The impact of experimental diabetes on intracerebral haemorrhage. A preclinical study. Biomed Pharmacother 2024; 176:116834. [PMID: 38815288 DOI: 10.1016/j.biopha.2024.116834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 06/01/2024] Open
Abstract
Although diabetes mellitus negatively affects post-ischaemic stroke injury and recovery, its impact on intracerebral haemorrhage (ICH) remains uncertain. This study aimed to investigate the effect of experimental diabetes (ED) on ICH-induced injury and neurological impairment. Sprague-Dawley rats were induced with ED 2 weeks before ICH induction. Animals were randomly assigned to four groups: 1)Healthy; 2)ICH; 3)ED; 4)ED-ICH. ICH and ED-ICH groups showed similar functional assessment. The ED-ICH group exhibited significantly lower haemorrhage volume compared with the ICH group, except at 1 mo. The oedema/ICH volume ratio and cistern displacement ratio were significantly higher in the ED-ICH group. Vascular markers revealed greater expression of α-SMA in the ED groups (ED and ED-ICH) compared with ICH. Conversely, the ICH groups (ED-ICH and ICH) exhibited higher levels of VEGF compared to the healthy and ED groups. An assessment of myelin tract integrity showed an increase in fractional anisotropy in the ED and ED-ICH groups compared with ICH. The ED group showed higher cryomyelin expression than the ED-ICH and ICH groups. Additionally, the ED groups (ED and ED-ICH) displayed higher expression of MOG and Olig-2 than ICH. As for inflammation, MCP-1 levels were significantly lower in the ED-ICH groups compared with the ICH group. Notably, ED did not aggravate the neurological outcome; however, it results in greater ICH-related brain oedema, greater brain structure displacement and lower haemorrhage volume. ED influences the cerebral vascularisation with an increase in vascular thickness, limits the inflammatory response and attenuates the deleterious effect of ICH on white matter integrity.
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Affiliation(s)
- Mari Carmen Gómez-de Frutos
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Centre, Neurology and Cerebrovascular Disease Group, Neuroscience Area, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain; Faculty HM Hospitals of Health Sciences, Universidad Camilo José Cela, Villanueva de la Cañada, Madrid 28692, Spain
| | - Fernando Laso-García
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Centre, Neurology and Cerebrovascular Disease Group, Neuroscience Area, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Iván García-Suárez
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Centre, Neurology and Cerebrovascular Disease Group, Neuroscience Area, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain; Department of Emergency Service, San Agustín University Hospital, Asturias, Spain
| | - Dolores Piniella
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Centre, Neurology and Cerebrovascular Disease Group, Neuroscience Area, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain; Faculty of Medicine, Universidad Alfonso X el Sabio, Villanueva de la Cañada, Madrid 28691, Spain
| | - Laura Otero-Ortega
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Centre, Neurology and Cerebrovascular Disease Group, Neuroscience Area, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Elisa Alonso-López
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Centre, Neurology and Cerebrovascular Disease Group, Neuroscience Area, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Javier Pozo-Novoa
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Centre, Neurology and Cerebrovascular Disease Group, Neuroscience Area, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Rebeca Gallego-Ruiz
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Centre, Neurology and Cerebrovascular Disease Group, Neuroscience Area, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Nerea Díaz-Gamero
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Centre, Neurology and Cerebrovascular Disease Group, Neuroscience Area, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Blanca Fuentes
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Centre, Neurology and Cerebrovascular Disease Group, Neuroscience Area, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - María Alonso de Leciñana
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Centre, Neurology and Cerebrovascular Disease Group, Neuroscience Area, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Exuperio Díez-Tejedor
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Centre, Neurology and Cerebrovascular Disease Group, Neuroscience Area, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Gerardo Ruiz-Ares
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Centre, Neurology and Cerebrovascular Disease Group, Neuroscience Area, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain.
| | - María Gutiérrez-Fernández
- Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Centre, Neurology and Cerebrovascular Disease Group, Neuroscience Area, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain.
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13
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Dong R, Li F, Li B, Chen Q, Huang X, Zhang J, Huang Q, Zhang Z, Cao Y, Yang M, Li J, Li Z, Li C, Liu G, Zhong S, Feng G, Zhang M, Xiao Y, Lin K, Shen Y, Shao H, Shi Y, Yu X, Li X, Yao L, Du X, Xu Y, Kang P, Gao G, Ouyang B, Chen W, Zeng Z, Chen P, Chen C, Yang H. Effects of an Early Intensive Blood Pressure-lowering Strategy Using Remifentanil and Dexmedetomidine in Patients with Spontaneous Intracerebral Hemorrhage: A Multicenter, Prospective, Superiority, Randomized Controlled Trial. Anesthesiology 2024; 141:100-115. [PMID: 38537025 DOI: 10.1097/aln.0000000000004986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
BACKGROUND Although it has been established that elevated blood pressure and its variability worsen outcomes in spontaneous intracerebral hemorrhage, antihypertensives use during the acute phase still lacks robust evidence. A blood pressure-lowering regimen using remifentanil and dexmedetomidine might be a reasonable therapeutic option given their analgesic and antisympathetic effects. The objective of this superiority trial was to validate the efficacy and safety of this blood pressure-lowering strategy that uses remifentanil and dexmedetomidine in patients with acute intracerebral hemorrhage. METHODS In this multicenter, prospective, single-blinded, superiority randomized controlled trial, patients with intracerebral hemorrhage and systolic blood pressure (SBP) 150 mmHg or greater were randomly allocated to the intervention group (a preset protocol with a standard guideline management using remifentanil and dexmedetomidine) or the control group (standard guideline-based management) to receive blood pressure-lowering treatment. The primary outcome was the SBP control rate (less than 140 mmHg) at 1 h posttreatment initiation. Secondary outcomes included blood pressure variability, neurologic function, and clinical outcomes. RESULTS A total of 338 patients were allocated to the intervention (n = 167) or control group (n = 171). The SBP control rate at 1 h posttreatment initiation in the intervention group was higher than that in controls (101 of 161, 62.7% vs. 66 of 166, 39.8%; difference, 23.2%; 95% CI, 12.4 to 34.1%; P < 0.001). Analysis of secondary outcomes indicated that patients in the intervention group could effectively reduce agitation while achieving lighter sedation, but no improvement in clinical outcomes was observed. Regarding safety, the incidence of bradycardia and respiratory depression was higher in the intervention group. CONCLUSIONS Among intracerebral hemorrhage patients with a SBP 150 mmHg or greater, a preset protocol using a remifentanil and dexmedetomidine-based standard guideline management significantly increased the SBP control rate at 1 h posttreatment compared with the standard guideline-based management. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Rui Dong
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Fen Li
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Bin Li
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
| | - Qiming Chen
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xianjian Huang
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jiehua Zhang
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Qibing Huang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University, Jinan, China
| | - Zeli Zhang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University, Jinan, China
| | - Yunxing Cao
- Department of Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingbiao Yang
- Neurosurgery Department, The First Affiliated Hospital of Hunan University of Medicine, Huaihua, China
| | - Jianwei Li
- Department of Critical Care Medicine, Zhongshan People's Hospital, Zhongshan, China
| | - Zhanfu Li
- Department of Intensive Care Unit, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Cuiyu Li
- Department of Intensive Care Unit, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Guohua Liu
- Department of Neurosurgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Shu Zhong
- Department of Neurosurgery, Guangxi Hospital Division of the First Affiliated Hospital, Sun Yat-sen University, Nanning, China
| | - Guang Feng
- Department of Neurosurgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ming Zhang
- Department of Neurosurgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yumei Xiao
- Neurological Intensive Medicine Department, Maoming People's Hospital, Maoming, China
| | - Kangyue Lin
- Neurological Intensive Medicine Department, Maoming People's Hospital, Maoming, China
| | - Yunlong Shen
- Department of Neurosurgery, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Huanzhang Shao
- Department of Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan Shi
- Department of Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangyou Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaopeng Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Lan Yao
- Department of Emergency Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xinyu Du
- Department of Emergency Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Ying Xu
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Pei Kang
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Guoyi Gao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bin Ouyang
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenjin Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenhua Zeng
- Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pingyan Chen
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Chunbo Chen
- Department of Critical Care Medicine, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Hong Yang
- Department of Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
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14
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Mao B, Ling L, Pan Y, Zhang R, Zheng W, Shen Y, Lu W, Lu Y, Xu S, Wu J, Wang M, Wan S. Machine learning for the prediction of in-hospital mortality in patients with spontaneous intracerebral hemorrhage in intensive care unit. Sci Rep 2024; 14:14195. [PMID: 38902304 PMCID: PMC11190185 DOI: 10.1038/s41598-024-65128-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 06/17/2024] [Indexed: 06/22/2024] Open
Abstract
This study aimed to develop a machine learning (ML)-based tool for early and accurate prediction of in-hospital mortality risk in patients with spontaneous intracerebral hemorrhage (sICH) in the intensive care unit (ICU). We did a retrospective study in our study and identified cases of sICH from the MIMIC IV (n = 1486) and Zhejiang Hospital databases (n = 110). The model was constructed using features selected through LASSO regression. Among five well-known models, the selection of the best model was based on the area under the curve (AUC) in the validation cohort. We further analyzed calibration and decision curves to assess prediction results and visualized the impact of each variable on the model through SHapley Additive exPlanations. To facilitate accessibility, we also created a visual online calculation page for the model. The XGBoost exhibited high accuracy in both internal validation (AUC = 0.907) and external validation (AUC = 0.787) sets. Calibration curve and decision curve analyses showed that the model had no significant bias as well as being useful for supporting clinical decisions. XGBoost is an effective algorithm for predicting in-hospital mortality in patients with sICH, indicating its potential significance in the development of early warning systems.
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Affiliation(s)
- Baojie Mao
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China
| | - Lichao Ling
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China
| | - Yuhang Pan
- Urology Department, Lin'an Hospital of Traditional Chinese Medicine, Hangzhou, 311321, China
| | - Rui Zhang
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Wanning Zheng
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yanfei Shen
- Department of Intensive Care, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, 310030, China
| | - Wei Lu
- ArteryFlow Technology Co., Ltd., Hangzhou, 310051, China
| | - Yuning Lu
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Shanhu Xu
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China
| | - Jiong Wu
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China
| | - Ming Wang
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China.
| | - Shu Wan
- Brain center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, 1229 Gudun Road, Hangzhou, 310030, China.
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15
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Huang B, Chen A, Sun Y, He Q. The Role of Aging in Intracerebral Hemorrhage. Brain Sci 2024; 14:613. [PMID: 38928613 PMCID: PMC11201415 DOI: 10.3390/brainsci14060613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/10/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Intracerebral hemorrhage (ICH) is the cerebrovascular disease with the highest disability and mortality rates, causing severe damage to the health of patients and imposing a significant socioeconomic burden. Aging stands as a foremost risk factor for ICH, with a significant escalation in ICH incidence within the elderly demographic, highlighting a close association between ICH and aging. In recent years, with the acceleration of the "aging society" trend, exploring the intricate relationship between aging and ICH has become increasingly urgent and worthy of in-depth attention. We have summarized the characteristics of ICH in the elderly, reviewing how aging influences the onset and development of ICH by examining its etiology and the mechanisms of damage via ICH. Additionally, we explored the potential impacts of ICH on accelerated aging, including its effects on cognitive abilities, quality of life, and lifespan. This review aims to reveal the connection between aging and ICH, providing new ideas and insights for future ICH research.
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Affiliation(s)
| | | | | | - Quanwei He
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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16
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Li Q, Wang B, Yang J, Wang Y, Duan F, Luo M, Zhao C, Wei W, Wang L, Liu S. Preliminary Analysis of Aging-Related Genes in Intracerebral Hemorrhage by Integration of Bulk and Single-Cell RNA Sequencing Technology. Int J Gen Med 2024; 17:2719-2740. [PMID: 38883702 PMCID: PMC11180471 DOI: 10.2147/ijgm.s457480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/23/2024] [Indexed: 06/18/2024] Open
Abstract
Background Aging is recognized as the key risk for intracerebral hemorrhage (ICH). The detailed mechanisms of aging in ICH warrant exploration. This study aimed to identify potential aging-related genes associated with ICH. Methods ICH-specific aging-related genes were determined by the intersection of differentially expressed genes (DEGs) between perihematomal tissues and corresponding contralateral parts of four patients with ICH (GSE24265) and 349 aging-related genes obtained from the Aging Atlas database. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Set Enrichment Analysis (GSEA) analyses were performed to identify the potential biological functions and pathways in which these ICH-specific aging-related genes may be involved. Then, PPI network was established to identify the hub genes of ICH-specific aging-related genes. Meanwhile, miRNA-mRNA and transcription factor (TF)-mRNA regulatory networks were constructed to further explore the ICH-specific aging-related genes regulation. The relationship between these hub genes and immune infiltration was also further explored. Additional single-cell RNA-seq analysis (scRNA-seq, GSE167593) was used to locate the hub genes in different cell types. Besides, expression levels of the hub genes were validated using clinical samples from our institute and another GEO dataset (GSE206971). Results This study identified 24 ICH-specific aging-related genes, including 22 up-regulated and 2 down-regulated genes. The results of GO and KEGG suggested that the ICH-specific aging-related genes mainly enriched in immunity and inflammation-related pathways, suggesting that aging may affect the ich pathogenesis by regulating inflammatory and immune-related pathways. Conclusion Our study revealed 24 ICH-specific aging-related genes and their functions highly pertinent to ICH pathogenesis, providing new insights into the impact of aging on ICH.
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Affiliation(s)
- Qianfeng Li
- Department of Neurosurgery, Wuhan No.1 Hospital, Wuhan, People's Republic of China
| | - Bo Wang
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Jun Yang
- Huanggang Central Hospital of Yangtze University, Huanggang, People's Republic of China
| | - Yuan Wang
- Department of Neurosurgery, Wuhan No.1 Hospital, Wuhan, People's Republic of China
| | - Faliang Duan
- Department of Neurosurgery, Wuhan No.1 Hospital, Wuhan, People's Republic of China
| | - Ming Luo
- Department of Neurosurgery, Wuhan No.1 Hospital, Wuhan, People's Republic of China
| | - Chungang Zhao
- Jilin Jianda Modern Agricultural Research Institute, Changchun, People's Republic of China
| | - Wei Wei
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Lei Wang
- Huanggang Central Hospital of Yangtze University, Huanggang, People's Republic of China
| | - Sha Liu
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
- Department of General Practice, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
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17
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Nakaoku Y, Ogata S, Ren N, Tanaka T, Kurogi R, Nishimura K, Iihara K. Ten-year national trends in in-hospital mortality and functional outcomes after intracerebral hemorrhage by age in Japan: J-ASPECT study. Eur Stroke J 2024; 9:398-408. [PMID: 38288694 PMCID: PMC11318425 DOI: 10.1177/23969873231222736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/08/2023] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION National-level data on trends in the prognosis of age-stratified patients with intracerebral hemorrhage (ICH) are lacking. This study aimed to assess time trends in in-hospital mortality and functional outcomes of ICH patients by sex and age, and to explore factors associated with changes in in-hospital mortality trend. PATIENTS AND METHODS Using the largest nationwide, J-ASPECT stroke database in Japan, this serial cross-sectional study included ICH patients aged ⩾18 years who were hospitalized for non-traumatic ICH from April 2010 to March 2020. We examined trends in in-hospital mortality and functional outcomes using the modified Rankin Scale at discharge, as well as differences in in-hospital mortality change between age groups. RESULTS Among 262,399 ICH patients from 934 hospitals, crude in-hospital mortality showed a significant decreasing time trend (from 19.5% to 16.7%), and this trend was consistent across sex and age groups. In addition, differences in in-hospital mortality change over the 10-year study period were significant between male patients aged ⩾75 years and those aged ⩽64 years (-3.9% [95% confidence interval, -5.4 to -2.4] for 75-84 years; -4.1% [-6.3 to -1.9] for ⩾85 years). On the other hand, the proportion of dependent patients (mRS 3-5) at discharge increased from 52.0% to 54.9% over the 10-year study period. CONCLUSION The in-hospital mortality of ICH patients improved, whereas the proportion of patients with dependent functional outcome at discharge increased, over the 10-year study period. Elucidating the mechanism underlying differences in in-hospital mortality reduction in men may provide insights into effective interventions in the future.
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Affiliation(s)
- Yuriko Nakaoku
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Nice Ren
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Ryota Kurogi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koji Iihara
- National Cerebral and Cardiovascular Center Hospital, Suita, Japan
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18
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Ma Y, Guo C, Wang Y, Liu X. Effects of Dl-3-n-butylphthalide on neurological function, hemodynamics and Hcy concentration in cerebral hemorrhage: a systematic review and meta-analysis. Front Pharmacol 2024; 15:1360932. [PMID: 38881880 PMCID: PMC11177091 DOI: 10.3389/fphar.2024.1360932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/06/2024] [Indexed: 06/18/2024] Open
Abstract
Background Dl-3-n-Butylphthalide (NBP) has emerged as a potential therapeutic agent for cerebral hemorrhage, despite not being included in current guideline recommendations. Investigating the underlying physiological and pathological mechanisms of Dl-3-n-Butylphthalide in cerebral hemorrhage treatment remains a critical area of research. Objective This review aims to evaluate the efficacy of Dl-3-n-Butylphthalide in cerebral hemorrhage treatment and elucidate its potential biological mechanisms, thereby providing evidence to support treatment optimization. Methods A comprehensive search of seven electronic databases (PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang Database) was conducted for studies published up to September 2023. Screening and data extraction were performed by a team of researchers. The Cochrane collaboration tool was utilized for risk bias assessment, and Revman 5.3 along with Stata 17.0 were employed for statistical analysis. Outcomes We searched 254 literature, and 19 were included in this meta-analysis. The results showed that Dl-3-n-Butylphthalide improved the clinical efficacy rate (RR = 1.25, 95% CI 1.19-1.31; p = 0.00), quality of life (MD = 13.93, 95% CI: 11.88-15.98; p = 0.000), increased cerebral blood flow and velocity, reduced cerebral edema volume, Hcy concentration, and did not have obvious adverse reactions (RR = 0.68, 95% CI: 0.39-1.18; p = 0.10). Conclusion This meta-analysis is the first to demonstrate the potential of Dl-3-n-Butylphthalide in treating cerebral hemorrhage. It suggests that Dl-3-n-Butylphthalide may alleviate clinical symptoms by modulating neurological function and improving hemodynamics. Our findings provide robust evidence for incorporating Dl-3-n-Butylphthalide into cerebral hemorrhage treatment strategies, potentially guiding future clinical practice and research. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/ display_record.php?RecordID=355114, Identifier CRD42022355114.
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Affiliation(s)
- Yingqi Ma
- First School of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Chenchen Guo
- Neck-Shoulder and Lumbocrural Pain Hospital of Shandong First Medical University, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yiguo Wang
- Experimental Research Center, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xinxin Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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19
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Jia S, Liu X, Qu H, Jia X. Observation of the Therapeutic Effect of Dual Antiplatelet Therapy with Aspirin and Clopidogrel on the Incidence, Characteristics, and Outcome in Acute Ischemic Stroke Patients with Cerebral Microbleeds at a Teaching Hospital, China. Int J Gen Med 2024; 17:2327-2336. [PMID: 38803551 PMCID: PMC11128718 DOI: 10.2147/ijgm.s459323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024] Open
Abstract
Background Cerebral microbleeds (CMBs) are an important risk factor for stroke recurrence and prognosis. However, there is no consensus on the safety of antiplatelet therapy in patients with ischemic stroke and CMBs. Objective This study aimed to observe the effects of dual antiplatelet therapy with aspirin and clopidogrel on bleeding conversion in patients with different degrees of CMBs. Materials and Methods An observational retrospective study was conducted on 160 patients with acute mild ischemic stroke admitted to the Stroke Center, Affiliated Hospital of Beihua University between March 2021 and December 2022. Patients were divided into the CMBs and non-CMB groups. The CMB group was then divided into the low, medium and high-risk groups. In two groups, all patients were administered dual antiplatelet therapy (aspirin 100 mg and clopidogrel 75 mg orally once a day for 21 days according to the Chinese Stroke Guidelines of 2018), and no other anticoagulant or antiplatelet drugs were administered during the treatment period. Head CT, National Institutes of Health Stroke Scale(NIHSS) and modified Rankin Scale (mRS) score were re-checked, and the number of bleeding conversions was calculated at 21 days. Results Five patients in the CMB group had intracranial hemorrhage (5/116, 4.3%), while no intracranial hemorrhage was observed in the non-CMB group. There were no differences in the conversion rate of cerebral hemorrhage, NIHSS score, or mRS score between two groups after dual antiplatelet therapy (p>0.05). The conversion rate of cerebral hemorrhage in the high-risk group was higher than that in the non-CMB group (p<0.05), but the NIHSS and mRS score showed no difference between the high-risk and non-CMB groups (p>0.05). Conclusion Dual antiplatelet therapy with aspirin and clopidogrel does not significantly increase the risk of bleeding transformation; however, it improves neurological recovery or long-term prognosis in patients with acute ischemic cerebral stroke complicated by low-risk and middle-risk CMBs.
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Affiliation(s)
- Shaojie Jia
- Stroke Center, Affiliated Hospital, Beihua University, Jilin, 132011, People’s Republic of China
- Department of Orthopedics, Affiliated Hospital, Beihua University, Jilin, 132011, People’s Republic of China
| | - Xin Liu
- Department of Neurology II, Affiliated Hospital, Beihua University, Jilin, 132011, People’s Republic of China
| | - Hongyan Qu
- Department of Neurology II, Affiliated Hospital, Beihua University, Jilin, 132011, People’s Republic of China
| | - Xiaojing Jia
- Stroke Center, Affiliated Hospital, Beihua University, Jilin, 132011, People’s Republic of China
- Department of Neurology II, Affiliated Hospital, Beihua University, Jilin, 132011, People’s Republic of China
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20
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Connolly SJ, Sharma M, Cohen AT, Demchuk AM, Członkowska A, Lindgren AG, Molina CA, Bereczki D, Toni D, Seiffge DJ, Tanne D, Sandset EC, Tsivgoulis G, Christensen H, Beyer-Westendorf J, Coutinho JM, Crowther M, Verhamme P, Amarenco P, Roine RO, Mikulik R, Lemmens R, Veltkamp R, Middeldorp S, Robinson TG, Milling TJ, Tedim-Cruz V, Lang W, Himmelmann A, Ladenvall P, Knutsson M, Ekholm E, Law A, Taylor A, Karyakina T, Xu L, Tsiplova K, Poli S, Kallmünzer B, Gumbinger C, Shoamanesh A. Andexanet for Factor Xa Inhibitor-Associated Acute Intracerebral Hemorrhage. N Engl J Med 2024; 390:1745-1755. [PMID: 38749032 DOI: 10.1056/nejmoa2313040] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
BACKGROUND Patients with acute intracerebral hemorrhage who are receiving factor Xa inhibitors have a risk of hematoma expansion. The effect of andexanet alfa, an agent that reverses the effects of factor Xa inhibitors, on hematoma volume expansion has not been well studied. METHODS We randomly assigned, in a 1:1 ratio, patients who had taken factor Xa inhibitors within 15 hours before having an acute intracerebral hemorrhage to receive andexanet or usual care. The primary end point was hemostatic efficacy, defined by expansion of the hematoma volume by 35% or less at 12 hours after baseline, an increase in the score on the National Institutes of Health Stroke Scale of less than 7 points (scores range from 0 to 42, with higher scores indicating worse neurologic deficit) at 12 hours, and no receipt of rescue therapy between 3 hours and 12 hours. Safety end points were thrombotic events and death. RESULTS A total of 263 patients were assigned to receive andexanet, and 267 to receive usual care. Efficacy was assessed in an interim analysis that included 452 patients, and safety was analyzed in all 530 enrolled patients. Atrial fibrillation was the most common indication for factor Xa inhibitors. Of the patients receiving usual care, 85.5% received prothrombin complex concentrate. Hemostatic efficacy was achieved in 150 of 224 patients (67.0%) receiving andexanet and in 121 of 228 (53.1%) receiving usual care (adjusted difference, 13.4 percentage points; 95% confidence interval [CI], 4.6 to 22.2; P = 0.003). The median reduction from baseline to the 1-to-2-hour nadir in anti-factor Xa activity was 94.5% with andexanet and 26.9% with usual care (P<0.001). Thrombotic events occurred in 27 of 263 patients (10.3%) receiving andexanet and in 15 of 267 (5.6%) receiving usual care (difference, 4.6 percentage points; 95% CI, 0.1 to 9.2; P = 0.048); ischemic stroke occurred in 17 patients (6.5%) and 4 patients (1.5%), respectively. There were no appreciable differences between the groups in the score on the modified Rankin scale or in death within 30 days. CONCLUSIONS Among patients with intracerebral hemorrhage who were receiving factor Xa inhibitors, andexanet resulted in better control of hematoma expansion than usual care but was associated with thrombotic events, including ischemic stroke. (Funded by Alexion AstraZeneca Rare Disease and others; ANNEXA-I ClinicalTrials.gov number, NCT03661528.).
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Affiliation(s)
- Stuart J Connolly
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Mukul Sharma
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Alexander T Cohen
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Andrew M Demchuk
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Anna Członkowska
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Arne G Lindgren
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Carlos A Molina
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Daniel Bereczki
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Danilo Toni
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - David J Seiffge
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - David Tanne
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Else Charlotte Sandset
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Georgios Tsivgoulis
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Hanne Christensen
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Jan Beyer-Westendorf
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Jonathan M Coutinho
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Mark Crowther
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Peter Verhamme
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Pierre Amarenco
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Risto O Roine
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Robert Mikulik
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Robin Lemmens
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Roland Veltkamp
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Saskia Middeldorp
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Thompson G Robinson
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Truman John Milling
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Vitor Tedim-Cruz
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Wilfried Lang
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Anders Himmelmann
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Per Ladenvall
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Mikael Knutsson
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Ella Ekholm
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Andrew Law
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Amanda Taylor
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Tetyana Karyakina
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Lizhen Xu
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Kate Tsiplova
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Sven Poli
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Bernd Kallmünzer
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Christoph Gumbinger
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
| | - Ashkan Shoamanesh
- From the Population Health Research Institute, McMaster University, Hamilton, ON (S.J.C., M.S., M.C., A.T., T.K., L.X., K.T., A.S.), and the Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB (A.M.D.) - both in Canada; Guy's and St. Thomas' Hospital, King's College London (A.T.C.), and Imperial College (R.V.), London, NIHR Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester (T.G.R.), and Alexion Pharmaceuticals UK, Uxbridge (A.L.) - all in the United Kingdom; the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C.); the Department of Clinical Sciences Lund, Neurology, Lund University, and the Department of Neurology, Skåne University Hospital, Lund (A.G.L.), and AstraZeneca Biopharmaceuticals Research and Development, Late-stage Development, Cardiovascular, Renal, and Metabolism, Gothenburg (A.H., P.L., M.K., E.E.) - all in Sweden; Vall d'Hebron University Hospital, Barcelona (C.A.M.); Semmelweis University, Budapest, Hungary (D.B.); Sapienza University of Rome, Rome (D. Toni); the Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland (D.J.S.); Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa (D. Tanne); the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens (G.T.); Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen (H.C.); the Department of Medicine 1, Division "Thrombosis and Hemostasis," University Hospital Dresden, Dresden (J.B.-W.), Alfried Krupp Krankenhaus, Essen (R.V.), the Department of Neurology and Stroke (S.P.) and the Hertie Institute for Clinical Brain Research (S.P.), Eberhard-Karls University, Tübingen, the Department of Neurology, Universitätsklinikum Erlangen, Erlangen (B.K.), and the Department of Neurology, Heidelberg University Hospital, Heidelberg (C.G.) - all in Germany; the Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (J.M.C.), and Radboud University Medical Center, Nijmegen (S.M.) - both in the Netherlands; University Hospitals Leuven, University of Leuven (P.V.), the Department of Neurosciences and Experimental Neurology, KU Leuven (R.L.), and the Department of Neurology, University Hospitals Leuven (R.L.) - all in Leuven, Belgium; Bichat Claude-Bernard Hospital, Paris (P.A.); Turku University Hospital, Turku, Finland (R.O.R.); Tomas Bata Regional Hospital, Zlín, Czech Republic (R.M.); Dell Medical School, University of Texas, Austin, and the University of Houston, Houston (T.J.M.); University of Porto, Porto, Portugal (V.T.-C.); and Hospital of St. John of God, Sigmund Freud University, Medical Faculty, Vienna (W.L.)
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Song J, Bai H, Chen S, Xing Y, Lou J. Inhibition of sugar-binding activity of Galectins-8 by thiogalactoside (TDG) attenuates secondary brain damage and improves long-term prognosis following intracerebral hemorrhage. Heliyon 2024; 10:e30422. [PMID: 38737270 PMCID: PMC11088311 DOI: 10.1016/j.heliyon.2024.e30422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/14/2024] Open
Abstract
Galectins-8 (Gal-8), the tandem repeat sequences of the galectin family, can influence the pathophysiologic processes in neurological disorders. However, its effect on intracerebral hemorrhage and related mechanisms remains nebulous. Using collagenase VII-S-induced ICH in the left striatum of mice, we investigated the effects of Gal-8 on cellular and molecular immune inflammatory responses in hemorrhagic brain and evaluated the severity of short- and long-term brain injury. Our results showed that activated microglia in the periphery of hematoma in mice with intracerebral hemorrhage expressed Gal-8, while Gal-8 could regulate the expression of cytokines, such as HMGB-1 (P = 0.0032), TNF-α (P = 0.0158), and IL-10 (P = 0.0379). Inhibition of the glucose-binding activity of Gal-8 by thiogalactoside (TDG) significantly reduced the volume of cerebral hematoma (P = 0.0241) and hydrocephalus (P = 0.0112) during the acute phase of cerebral hemorrhage and improved the long-term prognosis. TDG can reduce acute-phase brain tissue injury and improve the prognosis by inhibiting the activation of immune-inflammatory cells in the periphery of hematoma and reducing the release of pro-inflammatory factors.
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Affiliation(s)
- Jingjing Song
- Department of Neurology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Hongying Bai
- Department of Neurology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Si Chen
- Department of Neurology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Yuanyuan Xing
- Department of Neurology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Jiyu Lou
- Department of Neurology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
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Chiu CD, Chiu YP, Yip HT, Ji HR, Cho DY, Cheng IHJ, Chen CY. Thiazolidinediones Decrease the Recurrence of Intracerebral Hemorrhage in Type 2 Diabetes Mellitus Patients: A Nested Case-Control Study. Neuroepidemiology 2024:1-14. [PMID: 38705143 DOI: 10.1159/000539001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
INTRODUCTION Preclinical evidence demonstrated the therapeutic potential of thiazolidinediones (TZDs) for the treatment of intracerebral hemorrhage (ICH). The present study conducted an investigation of cerebrovascular and cardiovascular outcomes following ICH in patients with type 2 diabetes mellitus (T2DM) treated with or without TZDs. METHODS This retrospective nested case-control study used data from the Taiwan National Health Insurance Research Database. A total of 62,515 T2DM patients who were hospitalized with a diagnosis of ICH were enrolled, including 7,603 TZD users. Data for TZD non-users were extracted using propensity score matching. Primary outcomes included death and major adverse cardiovascular events (MACEs), which were defined as a composite of ischemic stroke, hemorrhagic stroke (HS), acute myocardial infarction, and congestive heart failure. Patients aged <20 years with a history of traumatic brain injury or any prior history of MACEs were excluded. RESULTS TZD users had significantly lower MACE risks compared with TZD non-users following ICH (adjusted hazard ratio [aHR]: 0.90, 95% confidence interval [CI]: 0.85-0.94, p < 0.001). The most significant MACE difference reported for TZD users was HS, which possessed lower incidence than in TZD non-users, especially for the events that happened within 3 months following ICH (aHR: 0.74, 95% CI: 0.62-0.89 within 1 month, p < 0.01; aHR: 0.68, 95% CI: 0.54-0.85 between 1 and 3 month). CONCLUSION The use of TZD in patients with T2DM was associated with a lower risk of subsequent HS and mortality following ICH.
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Affiliation(s)
- Cheng-Di Chiu
- School of Medicine, China Medical University, Taichung, Taiwan,
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan,
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan,
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan,
| | - You-Pen Chiu
- School of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Hei-Tung Yip
- School of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Hui-Ru Ji
- School of Medicine, China Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Der-Yang Cho
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
| | - Irene Han-Juo Cheng
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cho-Yi Chen
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
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23
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Senff JR, Singh SD, Pasi M, Jolink WM, Rodrigues MA, Schreuder FH, Staals J, Schreuder T, Douwes JP, Talsma J, McKaig BN, Kourkoulis C, Yechoor N, Anderson CD, Puy L, Cordonnier C, Wermer MJ, Rothwell PM, Rosand J, Klijn CJ, Al-Shahi Salman R, Rinkel GJ, Viswanathan A, Goldstein JN, Brouwers HB. Long-Term Outcomes in Patients With Spontaneous Cerebellar Hemorrhage: An International Cohort Study. Stroke 2024; 55:1210-1217. [PMID: 38487876 PMCID: PMC11045548 DOI: 10.1161/strokeaha.123.044622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 04/19/2024]
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (ICH) in the cerebellum has a poor short-term prognosis, whereas data on the long-term case fatality and recurrent vascular events are sparse. Herewith, we aimed to assess the long-term case fatality and recurrence rate of vascular events after a first cerebellar ICH. METHODS In this international cohort study, we included patients from 10 hospitals (the United States and Europe from 1997 to 2017) aged ≥18 years with a first spontaneous cerebellar ICH who were discharged alive. Data on long-term case fatality and recurrence of vascular events (recurrent ICH [supratentoria or infratentorial], ischemic stroke, myocardial infarction, or major vascular surgery) were collected for survival analysis and absolute event rate calculation. RESULTS We included 405 patients with cerebellar ICH (mean age [SD], 72 [13] years, 49% female). The median survival time was 67 months (interquartile range, 23-100 months), with a cumulative survival rate of 34% at 10-year follow-up (median follow-up time per center ranged: 15-80 months). In the 347 patients with data on vascular events 92 events occurred in 78 patients, after initial cerebellar ICH: 31 (8.9%) patients had a recurrent ICH (absolute event rate, 1.8 per 100 patient-years [95% CI, 1.2-2.6]), 39 (11%) had an ischemic stroke (absolute event rate, 2.3 [95% CI, 1.6-3.2]), 13 (3.7%) had a myocardial infarction (absolute event rate, 0.8 [95% CI, 0.4-1.3]), and 5 (1.4%) underwent major vascular surgery (absolute event rate, 0.3 [95% CI, 0.1-0.7]). The median time to a first vascular event during follow-up was 27 months (interquartile range, 8.7-50 months), with a cumulative hazard of 47% at 10 years. CONCLUSIONS The long-term prognosis of patients who survive a first spontaneous cerebellar ICH is poor and comparable to that of patients who survive a first supratentorial ICH. Further identification of patients at high risk of vascular events following the initial cerebellar ICH is needed. Including patients with cerebellar ICH in randomized controlled trials on secondary prevention of patients with ICH is warranted.
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Affiliation(s)
- Jasper R. Senff
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (J.R.S., S.D.S., J.P.J.D., J.T., G.J.E.R., H.B.B.)
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston (J.R.S., S.D.S., C.K., N.Y., C.D.A., J.R.)
- Department of Neurology (J.R.S., S.D.S., C.K., N.Y., J.R.), Massachusetts General Hospital, Boston
- Center for Genomic Medicine (J.R.S., C.K., N.Y., C.D.A., S.D.S., J.R.), Massachusetts General Hospital, Boston
- Broad Institute, Cambridge (J.R.S., S.D.S., J.R.S., C.K., N.Y., C.D.A., J.R.)
| | - Sanjula D. Singh
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (J.R.S., S.D.S., J.P.J.D., J.T., G.J.E.R., H.B.B.)
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston (J.R.S., S.D.S., C.K., N.Y., C.D.A., J.R.)
- JPK Stroke Center (S.D.S., M.P., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
- Department of Neurology (J.R.S., S.D.S., C.K., N.Y., J.R.), Massachusetts General Hospital, Boston
- Center for Genomic Medicine (J.R.S., C.K., N.Y., C.D.A., S.D.S., J.R.), Massachusetts General Hospital, Boston
- Broad Institute, Cambridge (J.R.S., S.D.S., J.R.S., C.K., N.Y., C.D.A., J.R.)
| | - Marco Pasi
- JPK Stroke Center (S.D.S., M.P., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
- University Lille, Inserm, CHU Lille, U1172 – LilNCog – Lille Neuroscience & Cognition, France (M.P., L.P., C.C.)
- Neurology Department, University Hospital of Tours, INSERM U1253 iBrain, France (M.P.)
| | - Wilmar M.T. Jolink
- Department of Neurology, Isala Hospital, Zwolle, the Netherlands (W.M.T.J.)
| | - Mark A. Rodrigues
- Centre for Clinical Brain Sciences, The University of Edinburgh, United Kingdom (M.A.R., R.A.-S.S.)
- Department of Neuroradiology, NHS Lothian, United Kingdom (M.A.R.)
| | - Floris H.B.M. Schreuder
- Department of Neurology, Donders Institute for Brain Cognition & Behavior, Radboud University Medical Center, Nijmegen, the Netherlands (F.H.B.M.S., C.J.M.K.)
| | - Julie Staals
- Department of Neurology and School for Cardiovascular Diseases (CARIM), Maastricht University Medical Center, the Netherlands (J.S.)
| | - Tobien Schreuder
- Department of Neurology, Zuyderland Medical Center, Heerlen, the Netherlands (T.S.)
| | - Jules P.J. Douwes
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (J.R.S., S.D.S., J.P.J.D., J.T., G.J.E.R., H.B.B.)
| | - Jelmer Talsma
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (J.R.S., S.D.S., J.P.J.D., J.T., G.J.E.R., H.B.B.)
| | - Brenna N. McKaig
- Department of Emergency Medicine (B.N.M., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - Christina Kourkoulis
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston (J.R.S., S.D.S., C.K., N.Y., C.D.A., J.R.)
- Department of Neurology (J.R.S., S.D.S., C.K., N.Y., J.R.), Massachusetts General Hospital, Boston
- Center for Genomic Medicine (J.R.S., C.K., N.Y., C.D.A., S.D.S., J.R.), Massachusetts General Hospital, Boston
- Broad Institute, Cambridge (J.R.S., S.D.S., J.R.S., C.K., N.Y., C.D.A., J.R.)
| | - Nirupama Yechoor
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston (J.R.S., S.D.S., C.K., N.Y., C.D.A., J.R.)
- Department of Neurology (J.R.S., S.D.S., C.K., N.Y., J.R.), Massachusetts General Hospital, Boston
- Center for Genomic Medicine (J.R.S., C.K., N.Y., C.D.A., S.D.S., J.R.), Massachusetts General Hospital, Boston
- Broad Institute, Cambridge (J.R.S., S.D.S., J.R.S., C.K., N.Y., C.D.A., J.R.)
| | - Christopher D. Anderson
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston (J.R.S., S.D.S., C.K., N.Y., C.D.A., J.R.)
- Center for Genomic Medicine (J.R.S., C.K., N.Y., C.D.A., S.D.S., J.R.), Massachusetts General Hospital, Boston
- Broad Institute, Cambridge (J.R.S., S.D.S., J.R.S., C.K., N.Y., C.D.A., J.R.)
- Department of Neurology, Brigham and Women’s Hospital, Boston (C.D.A.)
| | - Laurent Puy
- University Lille, Inserm, CHU Lille, U1172 – LilNCog – Lille Neuroscience & Cognition, France (M.P., L.P., C.C.)
| | - Charlotte Cordonnier
- University Lille, Inserm, CHU Lille, U1172 – LilNCog – Lille Neuroscience & Cognition, France (M.P., L.P., C.C.)
| | | | - Peter M. Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (P.M.R.)
| | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston (J.R.S., S.D.S., C.K., N.Y., C.D.A., J.R.)
- Department of Neurology (J.R.S., S.D.S., C.K., N.Y., J.R.), Massachusetts General Hospital, Boston
- Center for Genomic Medicine (J.R.S., C.K., N.Y., C.D.A., S.D.S., J.R.), Massachusetts General Hospital, Boston
- Broad Institute, Cambridge (J.R.S., S.D.S., J.R.S., C.K., N.Y., C.D.A., J.R.)
| | - Catharina J.M. Klijn
- Department of Neurology, Donders Institute for Brain Cognition & Behavior, Radboud University Medical Center, Nijmegen, the Netherlands (F.H.B.M.S., C.J.M.K.)
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, The University of Edinburgh, United Kingdom (M.A.R., R.A.-S.S.)
| | - Gabriël J.E. Rinkel
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (J.R.S., S.D.S., J.P.J.D., J.T., G.J.E.R., H.B.B.)
| | - Anand Viswanathan
- JPK Stroke Center (S.D.S., M.P., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - Joshua N. Goldstein
- Department of Emergency Medicine (B.N.M., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - H. Bart Brouwers
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (J.R.S., S.D.S., J.P.J.D., J.T., G.J.E.R., H.B.B.)
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands (H.B.B.)
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Gordillo-Resina M, Aranda-Martinez C, Arias-Verdú MD, Guerrero-López F, Castillo-Lorente E, Rodríguez-Rubio D, Rivera-López R, Rosa-Garrido C, Gómez-Jiménez FJ, Lafuente-Baraza J, Aguilar-Alonso E, Arráez-Sánchez MA, Rivera-Fernández R. Mortality, Functional Status, and Quality of Life after 5 Years of Patients Admitted to Critical Care for Spontaneous Intracerebral Hemorrhage. Neurocrit Care 2024:10.1007/s12028-024-01960-0. [PMID: 38589693 DOI: 10.1007/s12028-024-01960-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/13/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The objective of this study was to assess long-term outcome in patients with spontaneous intracerebral hemorrhage admitted to the intensive care unit. METHODS Mortality and Glasgow Outcome Scale, Barthel Index, and 5-level EQ-5D version (EQ-5D-5L) scores were analyzed in a multicenter cohort study of three Spanish hospitals (336 patients). Mortality was also analyzed in the Medical Information Mart for Intensive Care III (MIMIC-III) database. RESULTS The median (25th percentile-75th percentile) age was 62 (50-70) years, the median Glasgow Coma Score was 7 (4-11) points, and the median Acute Physiology and Chronic Health disease Classification System II (APACHE-II) score was 21 (15-26) points. Hospital mortality was 54.17%, mortality at 90 days was 56%, mortality at 1 year was 59.2%, and mortality at 5 years was 66.4%. In the Glasgow Outcome Scale, a normal or disabled self-sufficient situation was recorded in 21.5% of patients at 6 months, in 25.5% of patients after 1 year, and in 22.1% of patients after 5 years of follow-up (4.5% missing). The Barthel Index score of survivors improved over time: 50 (25-80) points at 6 months, 70 (35-95) points at 1 year, and 90 (40-100) points at 5 years (p < 0.001). Quality of life evaluated with the EQ-5D-5L at 1 year and 5 years indicated that greater than 50% of patients had no problems or slight problems in all items (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). In the MIMIC-III study (N = 1354), hospital mortality was 31.83% and was 40.5% at 90 days and 56.2% after 5 years. CONCLUSIONS In patients admitted to the intensive care unit with a diagnosis of nontraumatic intracerebral hemorrhage, hospital mortality up to 90 days after admission is very high. Between 90 days and 5 years after admission, mortality is not high. A large percentage of survivors presented a significant deficit in quality of life and functional status, although with progressive improvement over time. Five years after the hemorrhagic stroke, a survival of 30% was observed, with a good functional status seen in 20% of patients who had been admitted to the hospital.
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Affiliation(s)
| | | | | | | | | | | | - Ricardo Rivera-López
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Carmen Rosa-Garrido
- Biosanitary Research Foundation in Eastern Andalusia, Alejandro Otero, Hospital Universitario de Jaén, Jaén, Spain
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25
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Nagaraja N, Ballur Narayana Reddy V. Prevalence of Concomitant Neurological Disorders and Long-Term Outcome of Patients Hospitalized for Intracerebral Hemorrhage with Versus without Cerebral Amyloid Angiopathy. Neurocrit Care 2024; 40:486-494. [PMID: 37258986 DOI: 10.1007/s12028-023-01753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/10/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Patients with intracerebral hemorrhage (ICH) related to cerebral amyloid angiopathy (CAA) are at increased risk of developing epilepsy and cognitive disorders such as Alzheimer's disease (AD), mild cognitive impairment (MCI), and vascular dementia. In a retrospective cohort observation study of patients hospitalized for ICH with CAA versus ICH without CAA, we evaluated the prevalence of neurological comorbidities at admission and the risk of new diagnosis of epilepsy, relevant cognitive disorders, and mortality at 1 year. METHODS In the TriNetX health research network, adult patients aged ≥ 55 years hospitalized with a diagnosis of ICH were stratified based on presence or absence of concomitant CAA diagnosis. Demographics and medical comorbidities were compared by using χ2 test and Student's t-test. After 1:1 propensity score matching, 1-year survival was assessed with Kaplan-Meier curves. The 1-year risk of new diagnosis of epilepsy, AD, MCI, vascular dementia, and dementia unspecified was assessed with Cox proportional hazards estimate. RESULTS The study included a total of 1757 patients with ICH and CAA and 53,364 patients with ICH without CAA. Patients with CAA were older compared with those without CAA (74.1 ± 7.5 vs. 69.8 ± 8.8 years, p ≤ 0.001). Compared with ICH without CAA, patients with ICH and CAA had higher baseline prevalence of cerebral infarction (30% vs. 20%), nontraumatic ICH (36% vs. 7%), nontraumatic subarachnoid hemorrhage (14% vs. 5%), epilepsy (11% vs. 6%), and AD (5% vs. 2%) with significance at p < 0.001. After propensity score matching, a total of 1746 patients were included in both cohorts. In the matched cohorts, compared with patients with ICH without CAA, patients with ICH and CAA had lower 1-year all-cause mortality (479 [27%] vs. 563 [32%]; hazard ratio [HR] 0.80; 95% confidence interval [CI] 0.71-0.90) and higher risk of new diagnosis of epilepsy (280 [18%] vs. 167 [11%]; HR 1.70; 95% CI 1.40-2.06), AD (101 [6%] vs. 38 [2%]; HR 2.62; 95% CI 1.80-3.80), MCI (85 [5%] vs. 35 [2%]; HR 2.39; 95% CI 1.61-3.54), vascular dementia (117 [7%] vs. 60 [4%]; HR 1.92; 95% CI 1.41-2.62), and dementia unspecified (245 [16%] vs. 150 [9%]; HR 1.70; 95% CI 1.39-2.08). CONCLUSIONS Among patients admitted for ICH, patients with CAA have lower mortality but have 2-3 times more risk of diagnosis of epilepsy and dementia at 1 year, compared with those without CAA.
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Affiliation(s)
- Nandakumar Nagaraja
- Department of Neurology, Milton S. Hershey Medical Center, Penn State College of Medicine, 30 Hope Drive EC037, Hershey, PA, 17033, USA.
| | - Varalakshmi Ballur Narayana Reddy
- Department of Neurology, Milton S. Hershey Medical Center, Penn State College of Medicine, 30 Hope Drive EC037, Hershey, PA, 17033, USA
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Zhao JL, Holste KG, Pandey AS, Hu J, Wu G. Intracranial Pressure Monitoring: an Effective Technique to Balance Cerebral Perfusion and Blood Pressure Reduction in ICH Patients. Transl Stroke Res 2024; 15:409-410. [PMID: 36729279 DOI: 10.1007/s12975-023-01129-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 02/03/2023]
Affiliation(s)
- Jian-Lan Zhao
- Department of Neurosurgery, National Center for Neurological Disorders, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Katherine G Holste
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, 48105, USA
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, 48105, USA
| | - Jin Hu
- Department of Neurosurgery, National Center for Neurological Disorders, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Gang Wu
- Department of Neurosurgery, National Center for Neurological Disorders, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
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Zhou X, Wang X, Li J, Zhang M, Yang Y, Lei S, He Y, Yang H, Zhou D, Guo C. Integrated Network Pharmacology and in vivo Experimental Validation Approach to Explore the Potential Antioxidant Effects of Annao Pingchong Decoction in Intracerebral Hemorrhage Rats. Drug Des Devel Ther 2024; 18:699-717. [PMID: 38465266 PMCID: PMC10922012 DOI: 10.2147/dddt.s439873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/19/2024] [Indexed: 03/12/2024] Open
Abstract
Background Annao Pingchong decoction (ANPCD) is a traditional Chinese decoction which has definite effects on treating intracerebral hemorrhage (ICH) validated through clinical and experimental studies. However, the impact of ANPCD on oxidative stress (OS) after ICH remains unclear and is worth further investigating. Aim To investigate whether the therapeutic effects of ANPCD on ICH are related to alleviating OS damage and seek potential targets for its antioxidant effects. Materials and Methods The therapeutic candidate genes of ANPCD on ICH were identified through a comparison of the target genes of ANPCD, target genes of ICH and differentially expressed genes (DEGs). Protein-protein interaction (PPI) network analysis and functional enrichment analysis were combined with targets-related literature to select suitable antioxidant targets. The affinity between ANPCD and the selected target was verified using macromolecular docking. Subsequently, the effects of ANPCD on OS and the selected target were further investigated through in vivo experiments. Results Forty-eight candidate genes were screened, in which silent information regulator sirtuin 1 (SIRT1) is one of the core genes that has antioxidant effects and ICH significantly affected its expression. The good affinity between 6 compounds of ANPCD and SIRT1 was also demonstrated by macromolecular docking. The results of in vivo experiments demonstrated that ANPCD significantly decreased modified neurological severity scoring (mNSS) scores and serum MDA and 8-OHdG content in ICH rats, while significantly increasing serum SOD and CAT activity, complicated with the up-regulation of ANPCD on SIRT1, FOXO1, PGC-1α and Nrf2. Furthermore, ANPCD significantly decreased the apoptosis rate and the expression of apoptosis-related proteins (P53, cytochrome c and caspase-3). Conclusion ANPCD alleviates OS damage and apoptosis after ICH in rats. As a potential therapeutic target, SIRT1 can be effectively regulated by ANPCD, as are its downstream proteins.
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Affiliation(s)
- Xuqing Zhou
- Experiment Center of Medical Innovation, the First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, 410007, People’s Republic of China
- The First Clinical College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, 410007, People’s Republic of China
| | - Xu Wang
- Experiment Center of Medical Innovation, the First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, 410007, People’s Republic of China
- The First Clinical College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, 410007, People’s Republic of China
| | - Jiaqi Li
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha, Hunan, 410128, People’s Republic of China
| | - Mengxue Zhang
- Department of Neurology, the First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, 410007, People’s Republic of China
| | - Yi Yang
- Experiment Center of Medical Innovation, the First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, 410007, People’s Republic of China
| | - Shihui Lei
- Experiment Center of Medical Innovation, the First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, 410007, People’s Republic of China
| | - Ying He
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha, Hunan, 410128, People’s Republic of China
| | - Hua Yang
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha, Hunan, 410128, People’s Republic of China
| | - Desheng Zhou
- Department of Neurology, the First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, 410007, People’s Republic of China
| | - Chun Guo
- Experiment Center of Medical Innovation, the First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, 410007, People’s Republic of China
- The First Clinical College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, 410007, People’s Republic of China
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Geng Z, Yang C, Zhao Z, Yan Y, Guo T, Liu C, Wu A, Wu X, Wei L, Tian Y, Hu P, Wang K. Development and validation of a machine learning-based predictive model for assessing the 90-day prognostic outcome of patients with spontaneous intracerebral hemorrhage. J Transl Med 2024; 22:236. [PMID: 38439097 PMCID: PMC10910789 DOI: 10.1186/s12967-024-04896-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/14/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (sICH) is associated with significant mortality and morbidity. Predicting the prognosis of patients with sICH remains an important issue, which significantly affects treatment decisions. Utilizing readily available clinical parameters to anticipate the unfavorable prognosis of sICH patients holds notable clinical significance. This study employs five machine learning algorithms to establish a practical platform for the prediction of short-term prognostic outcomes in individuals afflicted with sICH. METHODS Within the framework of this retrospective analysis, the model underwent training utilizing data gleaned from 413 cases from the training center, with subsequent validation employing data from external validation center. Comprehensive clinical information, laboratory analysis results, and imaging features pertaining to sICH patients were harnessed as training features for machine learning. We developed and validated the model efficacy using all the selected features of the patients using five models: Support Vector Machine (SVM), Logistic Regression (LR), Random Forest (RF), XGboost and LightGBM, respectively. The process of Recursive Feature Elimination (RFE) was executed for optimal feature screening. An internal five-fold cross-validation was employed to pinpoint the most suitable hyperparameters for the model, while an external five-fold cross-validation was implemented to discern the machine learning model demonstrating the superior average performance. Finally, the machine learning model with the best average performance is selected as our final model while using it for external validation. Evaluation of the machine learning model's performance was comprehensively conducted through the utilization of the ROC curve, accuracy, and other relevant indicators. The SHAP diagram was utilized to elucidate the variable importance within the model, culminating in the amalgamation of the above metrics to discern the most succinct features and establish a practical prognostic prediction platform. RESULTS A total of 413 patients with sICH patients were collected in the training center, of which 180 were patients with poor prognosis. A total of 74 patients with sICH were collected in the external validation center, of which 26 were patients with poor prognosis. Within the training set, the test set AUC values for SVM, LR, RF, XGBoost, and LightGBM models were recorded as 0.87, 0.896, 0.916, 0.885, and 0.912, respectively. The best average performance of the machine learning models in the training set was the RF model (average AUC: 0.906 ± 0.029, P < 0.01). The model still maintains a good performance in the external validation center, with an AUC of 0.817 (95% CI 0.705-0.928). Pertaining to feature importance for short-term prognostic attributes of sICH patients, the NIHSS score reigned supreme, succeeded by AST, Age, white blood cell, and hematoma volume, among others. In culmination, guided by the RF model's variable importance weight and the model's ROC curve insights, the NIHSS score, AST, Age, white blood cell, and hematoma volume were integrated to forge a short-term prognostic prediction platform tailored for sICH patients. CONCLUSION We constructed a prediction model based on the results of the RF model incorporating five clinically accessible predictors with reliable predictive efficacy for the short-term prognosis of sICH patients. Meanwhile, the performance of the external validation set was also more stable, which can be used for accurate prediction of short-term prognosis of sICH patients.
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Affiliation(s)
- Zhi Geng
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China
| | - Chaoyi Yang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China
| | - Ziye Zhao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China
| | - Yibing Yan
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China
| | - Tao Guo
- Center for Biomedical Imaging, University of Science and Technology of China, Hefei, 230026, Anhui, China
| | - Chaofan Liu
- Center for Biomedical Imaging, University of Science and Technology of China, Hefei, 230026, Anhui, China
| | - Aimei Wu
- Department of Neurology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Xingqi Wu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China
| | - Ling Wei
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China
- Department of Sleep Psychology, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China.
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China.
- Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei, China.
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.
- Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, 230000, China.
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China.
- Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei, China.
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Wafa HA, Marshall I, Wolfe CD, Xie W, Johnson CO, Veltkamp R, Wang Y. Burden of intracerebral haemorrhage in Europe: forecasting incidence and mortality between 2019 and 2050. THE LANCET REGIONAL HEALTH. EUROPE 2024; 38:100842. [PMID: 38362494 PMCID: PMC10867656 DOI: 10.1016/j.lanepe.2024.100842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 02/17/2024]
Abstract
Background Anticipating the burden of intracerebral haemorrhage is crucial for proactive management and building resilience against future health challenges. Prior forecasts are based on population demography and to a lesser extent epidemiological trends. This study aims to utilise selected modifiable risk factors and socio-demographic indicators to forecast the incidence and mortality of intracerebral haemorrhage in Europe between 2019 and 2050. Methods Three intracerebral haemorrhage risk factors identified in the Global Burden of Diseases, Injuries, and Risk Factors study (GBD 2019)-high systolic blood pressure, high fasting plasma glucose, and high body mass index-were utilised to predict the risk-attributable fractions between 2019 and 2050. Disease burden not attributable to these risk factors was then forecasted using time series models (autoregressive integrated moving average [ARIMA]), incorporating the Socio-demographic Index (SDI) as an external predictor. The optimal parameters of ARIMA models were selected for each age-sex-country group based on the Akaike Information Criterion (AIC). Different health scenarios were constructed by extending the past 85th and 15th percentiles of annualised rates of change in risk factors and SDI across all location-years, stratified by age and sex groups. A decomposition analysis was performed to assess the relative contributions of population size, age composition, and intracerebral haemorrhage risk on the projected changes. Findings Compared with observed figures in 2019, our analysis predicts an increase in the burden of intracerebral haemorrhage in Europe in 2050, with a marginal rise of 0.6% (95% uncertainty interval [UI], -7.4% to 9.6%) in incident cases and an 8.9% (-2.8% to 23.6%) increase in mortality, reaching 141.2 (120.6-166.5) thousand and 144.2 (122.9-172.2) thousand respectively. These projections may fluctuate depending on trajectories of the risk factors and SDI; worsened trends could result in increases of 16.7% (8.7%-25.3%) in incidence and 31.2% (17.7%-48%) in mortality, while better trajectories may lead to a 10% (16.4%-2.3%) decrease in intracerebral haemorrhage cases with stabilised mortality. Individuals aged ≥80 years are expected to contribute significantly to the burden, comprising 62.7% of the cases in 2050, up from 40% in 2019, and 72.5% of deaths, up from 50.5%. Country-wide variations were noted in the projected changes, with decreases in the standardised rates across all nations but varying crude rates. The largest relative reductions in counts for both incidence and mortality are expected in Latvia, Bulgaria, and Hungary-ranging from -38.2% to -32.4% and -37.3% to -30.2% respectively. In contrast, the greatest increases for both measures were forecasted in Ireland (45.7% and 74.4%), Luxembourg (45% and 70.7%), and Cyprus (44.5% and 74.2%). The modelled increase in the burden of intracerebral haemorrhage could largely be attributed to population ageing. Interpretation This study provides a comprehensive forecast of intracerebral haemorrhage in Europe until 2050, presenting different trajectories. The potential increase in the number of people experiencing and dying from intracerebral haemorrhage could have profound implications for both caregiving responsibilities and associated costs. However, forecasts were divergent between different scenarios and among EU countries, signalling the pivotal role of public health initiatives in steering the trajectories. Funding The European Union's Horizon 2020 Research and Innovation Programme under grant agreement No. 754517. The National Institute for Health and Care Research (NIHR) under its Programme Grants for Applied Research (NIHR202339).
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Affiliation(s)
- Hatem A. Wafa
- School of Life Course and Population Health Sciences, King’s College London, London, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, London, UK
| | - Iain Marshall
- School of Life Course and Population Health Sciences, King’s College London, London, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, London, UK
| | - Charles D.A. Wolfe
- School of Life Course and Population Health Sciences, King’s College London, London, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, London, UK
| | - Wanqing Xie
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, China
- Beth Israel Deaconess Medical Centre, Harvard Medical School, Harvard University, Boston, MA 02215, USA
| | - Catherine O. Johnson
- Institute of Health Metrics and Evaluation (IHME), University of Washington, Seattle, USA
| | - Roland Veltkamp
- Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Straße 21, Essen 45131, Germany
- Department of Brain Sciences, Imperial College London, London, UK
| | - Yanzhong Wang
- School of Life Course and Population Health Sciences, King’s College London, London, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, London, UK
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Grainger BT, McFadyen JD, Tran H. Between a rock and a hard place: resumption of oral anticoagulant therapy after intracranial hemorrhage. J Thromb Haemost 2024; 22:594-603. [PMID: 37913910 DOI: 10.1016/j.jtha.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023]
Abstract
Intracranial hemorrhage (ICH) is the most feared and lethal complication of oral anticoagulant (OAC) therapy. Resumption of OAC after ICH has long posed a challenge for clinicians, complicated by the expanding range of anticoagulant agents available in modern clinical practice, including direct OACs and, more recently, factor XI and XII inhibitors. A review of the current literature found support for resuming OAC in the majority of patients after ICH based on pooled retrospective data showing that resumption is associated with a lower risk of mortality and thromboembolism without a significantly increased risk of recurrent hemorrhage. The optimal time to resume OAC is less clear; however, the available evidence suggests that the composite risk of both recurrent hemorrhage and thromboembolism is likely minimized, somewhere between 4 and 6 weeks, after ICH in most patients. Specific considerations to guide the optimal resumption time in the individual patient include ICH location, mechanism, and anticoagulant class. Patients with mechanical heart valves and intracerebral malignancy represent high-risk groups who require more nuanced decision making. Here, we appraise the literature with the aim of providing a practical guide for clinicians while also discussing priorities for future investigation.
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Affiliation(s)
- Brian T Grainger
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria, Australia.
| | - James D McFadyen
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria, Australia; Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Huyen Tran
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, Victoria, Australia; Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Lim MJR, Quek RHC, Ng KJ, Tan BYQ, Yeo LLL, Low YL, Soon BKH, Loh WNH, Teo K, Nga VDW, Yeo TT, Motani M. Prognostication of Outcomes in Spontaneous Intracerebral Hemorrhage: A Propensity Score-Matched Analysis with Support Vector Machine. World Neurosurg 2024; 182:e262-e269. [PMID: 38008171 DOI: 10.1016/j.wneu.2023.11.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE The role of surgery in spontaneous intracerebral hemorrhage (SICH) remains controversial. We aimed to use explainable machine learning (ML) combined with propensity-score matching to investigate the effects of surgery and identify subgroups of patients with SICH who may benefit from surgery in an interpretable fashion. METHODS We conducted a retrospective study of a cohort of 282 patients aged ≥21 years with SICH. ML models were developed to separately predict for surgery and surgical evacuation. SHapley Additive exPlanations (SHAP) values were calculated to interpret the predictions made by ML models. Propensity-score matching was performed to estimate the effect of surgery and surgical evacuation on 90-day poor functional outcomes (PFO). RESULTS Ninety-two patients (32.6%) underwent surgery, and 57 patients (20.2%) underwent surgical evacuation. A total of 177 patients (62.8%) had 90-day PFO. The support vector machine achieved a c-statistic of 0.915 when predicting 90-day PFO for patients who underwent surgery and a c-statistic of 0.981 for patients who underwent surgical evacuation. The SHAP scores for the top 5 features were Glasgow Coma Scale score (0.367), age (0.214), volume of hematoma (0.258), location of hematoma (0.195), and ventricular extension (0.164). Surgery, but not surgical evacuation of the hematoma, was significantly associated with improved mortality at 90-day follow-up (odds ratio, 0.26; 95% confidence interval, 0.10-0.67; P = 0.006). CONCLUSIONS Explainable ML approaches could elucidate how ML models predict outcomes in SICH and identify subgroups of patients who respond to surgery. Future research in SICH should focus on an explainable ML-based approach that can identify subgroups of patients who may benefit functionally from surgical intervention.
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Affiliation(s)
- Mervyn Jun Rui Lim
- Department of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore.
| | - Raphael Hao Chong Quek
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore
| | - Kai Jie Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Leonard Leong Litt Yeo
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Ying Liang Low
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Betsy Kar Hoon Soon
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Will Ne-Hooi Loh
- Department of Anesthesia, National University Hospital, Singapore, Singapore
| | - Kejia Teo
- Department of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
| | - Vincent Diong Weng Nga
- Department of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, University Surgical Centre, National University Hospital, Singapore, Singapore
| | - Mehul Motani
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore; N.1 Institute for Health, National University of Singapore, Singapore, Singapore; Institute of Data Science, National University of Singapore, Singapore, Singapore; Institute for Digital Medicine (WisDM), National University of Singapore, Singapore, Singapore
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Sreekrishnan A, Lun R, Albers GW. Nationwide diurnal pattern among intracerebral hemorrhage incidence and volume. J Stroke Cerebrovasc Dis 2024; 33:107521. [PMID: 38134549 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Intracerebral hemorrhage (ICH) incidence follows both seasonal and diurnal patterns with greater severity reported in nighttime hemorrhages. These differences have been attributed to variations in the coagulation cascade, blood pressure, and sleep-wake cycle that all have their own rhythmicity. The purpose of this analysis was to validate these trends in a large nationwide database of automated ICH detection scans and evaluate for differences in hematoma volume by image acquisition time. METHODS Serial non-contrast head CT (NCHCT) data, processed with an automated imaging software (iSchemaView), was acquired from U.S. hospitals between 1/1/2020 and 12/31/2021. Final exclusion criteria included: (1) patient age ≤ 25, (2) hematoma volume ≥ 100 ml, (3) hematoma volume ≤ 0.4 ml. Imaging time was subdivided into three epochs: (1) Night: 23:00h-06:59h, (2) Day: 07:00h-14:59h, and (3) Evening: 15:00h-22:59h. RESULTS A total of 19,397 scans were included in the final analysis with a median ICH volume of 2.9 ml and mean volume of 13.23 mL; 15.6% of scans had volumes above 30 ml. Peak imaging occurred around noon. Hematoma volume was significantly different across timepoints (p = 0.003), with ICHs presenting at night (average volume 14.2 ml) larger than those presenting during the day (12.9 ml, p = 0.002) or evening (13.0 ml, p = 0.012). CONCLUSION In this real world, multi-site data set, we show similar diurnal trends in ICH incidence as previously reported and detected subtle differences in volume based on time of imaging. Further research is required to elucidate the potential underlying mechanisms for these differences.
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Affiliation(s)
| | - Ronda Lun
- Department of Neurology, Stanford Hospital, Palo Alto, CA, United States
| | - Gregory W Albers
- Department of Neurology, Stanford Hospital, Palo Alto, CA, United States
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Krause M, Mandrekar J, Harmsen WS, Wijdicks E, Hocker S. Hospital to Hospital Transfers of Cerebral Hemorrhage: Characteristics of Early Withdrawal of Life-Sustaining Treatment. Neurocrit Care 2024; 40:272-281. [PMID: 36241772 DOI: 10.1007/s12028-022-01597-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/25/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Large intracerebral hemorrhages (ICHs) are associated with significant morbidity and mortality. Patient transfer to higher level centers is common, but care in these centers rarely demonstrably improves morbidity or reduces mortality. Patients may rapidly progress to brain death, but a large number die shortly after transferring because of withdrawal of life-sustaining treatment (WOLST). This outcome may result in poor resource use and unnecessary cost to patients, families, and institutions. We sought to determine clinical and radiographic predictors of early death or WOLST that may alter potential transfer. METHODS We performed a retrospective review of patients admitted from outside medical centers to the neurosciences intensive care unit at Saint Marys Mayo Clinic Hospital in Rochester, MN, from January 2014 to December 2019. Patients ≥ 18 years old with a spontaneous ICH were included. Exclusion criteria included trauma, subarachnoid hemorrhage, and subdural hematoma. We identified patients who died or underwent WOLST within 24 h of transfer. Descriptive characteristics of patients and ICH were collected. Data were analyzed with univariable, multivariable, and logistic regression. Predictive modeling was performed. An additional case-matched study was completed to evaluate for characteristics further. RESULTS A total of 317 consecutive patients were identified. Forty-two patients were found with early death or WOLST within 24 h of transfer. Do not resuscitate/do not intubate (DNR/DNI) code status (odds ratio [OR] 5.23, confidence interval [CI] 3.31-8.28), anticoagulation use (OR 2.11, CI 1.09-4.09), and lower level of consciousness at presentation based on Glasgow Coma Score (OR 1.41, CI 1.29-1.54) and Full Outline of Unresponsiveness (FOUR) score (OR 1.34, CI 1.26-1.46) were associated with WOLST. Associated characteristics on the computed tomography scan included midline shift (OR 4.64, CI 2.32-9.29), hydrocephalus (OR 9.30, CI 4.56-18.96), and intraventricular extension (OR 5.27, CI 2.60-10.68). Case matching restricted to midline shift demonstrated similarity between patients with aggressive care and WOLST. DNR/DNI code status, warfarin use, ICH score, and composite FOUR score were the best predictive characteristics (area under the curve 0.942). CONCLUSIONS Early death or WOLST after ICH within 24 h of presentation was most associated with DNR/DNI code status, warfarin use, ICH score, and lower level of consciousness at presentation. These characteristics may be used by clinicians to guide conversations prior to transfer to tertiary care centers.
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Affiliation(s)
- Monica Krause
- Neuroscience Intensive Care Unit, St. Marys Hospital, Mayo Clinic, 200 First St., Rochester, MN, USA.
| | - Jay Mandrekar
- Division of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - William S Harmsen
- Division of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Eelco Wijdicks
- Neuroscience Intensive Care Unit, St. Marys Hospital, Mayo Clinic, 200 First St., Rochester, MN, USA
| | - Sara Hocker
- Neuroscience Intensive Care Unit, St. Marys Hospital, Mayo Clinic, 200 First St., Rochester, MN, USA
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Moliner-Abós C, Albertí-Vall B, Millan-Álvarez X, Camps-Renom P, Guasch-Jiménez M, Asmarats-Serra L, Lambea-Gil Á, Ezcurra-Díaz G, Arzamendi-Aizpurua D, Martí-Fàbregas J. Left atrial appendage occlusion in patients with spontaneous intracerebral hemorrhage: An observational study. J Stroke Cerebrovasc Dis 2024; 33:107481. [PMID: 38064973 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/20/2023] [Accepted: 11/08/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Patients with atrial fibrillation (AF) and intracerebral hemorrhage (ICH) are at high risk of ischemic and recurrent bleeding events. Therefore, the decision of restarting or avoiding anticoagulation is challenging. Left atrial appendage occlusion (LAAO) is an alternative for these patients. However, few data are available about safety of early LAAO and factors associated with ischemic stroke and ICH recurrence. METHODS A unicentric, observational, retrospective study including all patients with AF and a previous ICH who underwent LAAO. We analyzed baseline clinical and neuroimaging characteristics, procedural outcomes, post-procedural therapies and long-term follow-up. RESULTS Forty patients were included, whose mean age was 76.6 ±7.6 years and 73 % were men. In patients in whom a Magnetic Resonance (MR) was performed (n=22, 55 %), cortical microbleeds were detected in 15 (68 %) and cortical superficial siderosis in one patient. The procedure was successful and safe in 100 % of the patients and it was performed within 30 days of the ICH in 37 % of them. After a median follow up of 46.2 months [26-69], intracranial hemorrhage (ICrH) recurrence occurred in 6 patients (5 ICH and 1 subdural hematoma -SDH-) and the index ICH was lobar in all of them. Ischemic events were significantly lower than expected according to the CHA2DS2-VASc score (7.5 % vs. 16.6 %, p=0.048) and bleeding events were similar to expected by the HAS-BLED score (20 % vs 23.4 %, p=0.63). CONCLUSIONS In patients with ICH and AF, early LAAO was found to be safe and associated with a reduction in ischemic stroke. However, recurrent ICH risk remains high, and it appears to be mainly driven by cerebral amyloid angiopathy.
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Affiliation(s)
- Carlos Moliner-Abós
- Cardiology Department, Hospital de la Santa Creu i Sant Pau. Carrer St. Antoni M. Claret 89, Barcelona 08025, Spain
| | - Blanca Albertí-Vall
- Neurology Department, Hospital de la Santa Creu i Sant Pau. Carrer St. Antoni M. Claret 89, Barcelona 08025, Spain
| | - Xavier Millan-Álvarez
- Cardiology Department, Hospital de la Santa Creu i Sant Pau. Carrer St. Antoni M. Claret 89, Barcelona 08025, Spain
| | - Pol Camps-Renom
- Neurology Department, Hospital de la Santa Creu i Sant Pau. Carrer St. Antoni M. Claret 89, Barcelona 08025, Spain.
| | - Marina Guasch-Jiménez
- Neurology Department, Hospital de la Santa Creu i Sant Pau. Carrer St. Antoni M. Claret 89, Barcelona 08025, Spain
| | - Lluís Asmarats-Serra
- Cardiology Department, Hospital de la Santa Creu i Sant Pau. Carrer St. Antoni M. Claret 89, Barcelona 08025, Spain
| | - Álvaro Lambea-Gil
- Neurology Department, Hospital de la Santa Creu i Sant Pau. Carrer St. Antoni M. Claret 89, Barcelona 08025, Spain
| | - Garbiñe Ezcurra-Díaz
- Neurology Department, Hospital de la Santa Creu i Sant Pau. Carrer St. Antoni M. Claret 89, Barcelona 08025, Spain
| | - Dabit Arzamendi-Aizpurua
- Cardiology Department, Hospital de la Santa Creu i Sant Pau. Carrer St. Antoni M. Claret 89, Barcelona 08025, Spain
| | - Joan Martí-Fàbregas
- Neurology Department, Hospital de la Santa Creu i Sant Pau. Carrer St. Antoni M. Claret 89, Barcelona 08025, Spain
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Komolafe MA, Sunmonu T, Akinyemi J, Sarfo FS, Akpalu A, Wahab K, Obiako R, Owolabi L, Osaigbovo GO, Ogbole G, Tiwari HK, Jenkins C, Lackland DT, Fakunle AG, Uvere E, Akpa O, Dambatta HA, Akpalu J, Onasanya A, Olaleye A, Ogah OS, Isah SY, Fawale MB, Adebowale A, Okekunle AP, Arnett D, Adeoye AM, Agunloye AM, Bello AH, Aderibigbe AS, Idowu AO, Sanusi AA, Ogunmodede A, Balogun SA, Egberongbe AA, Rotimi FT, Fredrick A, Akinnuoye AO, Adeniyi FA, Calys-Tagoe B, Adebayo P, Arulogun O, Agbogu-Ike OU, Yaria J, Appiah L, Ibinaiye P, Singh A, Adeniyi S, Olalusi O, Mande A, Balogun O, Akinyemi R, Ovbiagele B, Owolabi M. Clinical and neuroimaging factors associated with 30-day fatality among indigenous West Africans with spontaneous intracerebral hemorrhage. J Neurol Sci 2024; 456:122848. [PMID: 38171072 PMCID: PMC10888524 DOI: 10.1016/j.jns.2023.122848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 12/16/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (ICH) is associated with a high case fatality rate in resource-limited settings. The independent predictors of poor outcome after ICH in sub-Saharan Africa remains to be characterized in large epidemiological studies. We aimed to determine factors associated with 30-day fatality among West African patients with ICH. METHODS The Stroke Investigative Research and Educational Network (SIREN) study is a multicentre, case-control study conducted at 15 sites in Nigeria and Ghana. Adults aged ≥18 years with spontaneous ICH confirmed with neuroimaging. Demographic, cardiovascular risk factors, clinical features and neuroimaging markers of severity were assessed. The independent risk factors for 30-day mortality were determined using a multivariate logistic regression analysis with an adjusted odds ratio (OR) and 95% confidence interval (CI). RESULTS Among 964 patients with ICH, 590 (61.2%) were males with a mean age (SD) of 54.3(13.6) years and a case fatality of 34.3%. Factors associated with 30-day mortality among ICH patients include: Elevated mean National Institute of Health Stroke Scale(mNIHSS);(OR 1.06; 95% CI 1.02-1.11), aspiration pneumonitis; (OR 7.17; 95% CI 2.82-18.24), ICH volume > 30mls; OR 2.68; 95% CI 1.02-7.00)) low consumption of leafy vegetables (OR 0.36; 95% CI 0.15-0.85). CONCLUSION This study identified risk and protective factors associated with 30-day mortality among West Africans with spontaneous ICH. These factors should be further investigated in other populations in Africa to enable the development of ICH mortality predictions models among indigenous Africans.
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Affiliation(s)
| | - Taofiki Sunmonu
- Department of Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Godwin Ogbole
- Department of Radiology, University of Ibadan, Nigeria
| | | | | | | | | | - Ezinne Uvere
- College of Medicine, University of Ibadan, Nigeria
| | - Onoja Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | | | - Josephine Akpalu
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Akinola Onasanya
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Adeniji Olaleye
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Sulaiman Y Isah
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Micheal B Fawale
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Akintunde Adebowale
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Akinkunmi P Okekunle
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Donna Arnett
- College of Public Health, University of Kentucky, USA
| | | | | | - Abiodun H Bello
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Adeniyi S Aderibigbe
- Department of Radiology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Ahmed O Idowu
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Ahmad A Sanusi
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Adebimpe Ogunmodede
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Simon A Balogun
- Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
| | | | - Folorunso T Rotimi
- Department of Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - Adeyemi Fredrick
- Department of Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - Andrew O Akinnuoye
- Department of Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - Folu A Adeniyi
- Department of Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - Benedict Calys-Tagoe
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
| | | | | | | | | | - Lambert Appiah
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Philip Ibinaiye
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Arti Singh
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Sunday Adeniyi
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | - Aliyu Mande
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Olayemi Balogun
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Rufus Akinyemi
- University College Hospital, Ibadan, Nigeria; Federal Medical Centre, Abeokuta, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California, San-Francisco, USA
| | - Mayowa Owolabi
- University College Hospital, Ibadan, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria.
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Guo P, Zou W. Neutrophil-to-lymphocyte ratio, white blood cell, and C-reactive protein predicts poor outcome and increased mortality in intracerebral hemorrhage patients: a meta-analysis. Front Neurol 2024; 14:1288377. [PMID: 38288330 PMCID: PMC10824245 DOI: 10.3389/fneur.2023.1288377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
Objective Inflammation participates in the pathology and progression of secondary brain injury after intracerebral hemorrhage (ICH). This meta-analysis intended to explore the prognostic role of inflammatory indexes, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), white blood cell (WBC), and C-reactive protein (CRP) in ICH patients. Methods Embase, PubMed, Web of Science, and Cochrane Library were searched until June 2023. Two outcomes, including poor outcome and mortality were extracted and measured. Odds ratio (OR) and 95% confidence interval (CI) were presented for outcome assessment. Results Forty-six studies with 25,928 patients were included in this meta-analysis. The high level of NLR [OR (95% CI): 1.20 (1.13-1.27), p < 0.001], WBC [OR (95% CI): 1.11 (1.02-1.21), p = 0.013], and CRP [OR (95% CI): 1.29 (1.08-1.54), p = 0.005] were related to poor outcome in ICH patients. Additionally, the high level of NLR [OR (95% CI): 1.06 (1.02-1.10), p = 0.001], WBC [OR (95% CI): 1.39 (1.16-1.66), p < 0.001], and CRP [OR (95% CI): 1.02 (1.01-1.04), p = 0.009] were correlated with increased mortality in ICH patients. Nevertheless, PLR was not associated with poor outcome [OR (95% CI): 1.00 (0.99-1.01), p = 0.749] or mortality [OR (95% CI): 1.00 (0.99-1.01), p = 0.750] in ICH patients. The total score of risk of bias assessed by Newcastle-Ottawa Scale criteria ranged from 7-9, which indicated the low risk of bias in the included studies. Publication bias was low, and stability assessed by sensitivity analysis was good. Conclusion This meta-analysis summarizes that the high level of NLR, WBC, and CRP estimates poor outcome and higher mortality in ICH patients.
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Affiliation(s)
- Peixin Guo
- Integrated Traditional Chinese and Western Medicine, Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Wei Zou
- Third Ward of Acupuncture Department, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
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Goeldlin MB, Mueller M, Siepen BM, Zhang W, Ozkan H, Locatelli M, Du Y, Valenzuela W, Radojewski P, Hakim A, Kaesmacher J, Meinel TR, Clénin L, Branca M, Strambo D, Fischer T, Medlin F, Peters N, Carrera E, Lovblad KO, Karwacki GM, Cereda CW, Niederhauser J, Mono ML, Mueller A, Wegener S, Sartoretti S, Polymeris AA, Altersberger V, Katan M, Psychogios M, Sturzenegger R, Nauer C, Schaerer M, Buitrago Tellez C, Renaud S, Minkner Klahre K, Z'Graggen WJ, Bervini D, Bonati LH, Wiest R, Arnold M, Simister RJ, Wilson D, Jäger HR, Fischer U, Werring DJ, Seiffge DJ. CADMUS: A Novel MRI-Based Classification of Spontaneous Intracerebral Hemorrhage Associated With Cerebral Small Vessel Disease. Neurology 2024; 102:e207977. [PMID: 38165372 PMCID: PMC10834115 DOI: 10.1212/wnl.0000000000207977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/04/2023] [Indexed: 01/03/2024] Open
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.
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Affiliation(s)
- Martina B Goeldlin
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Madlaine Mueller
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Bernhard M Siepen
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Wenpeng Zhang
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Hatice Ozkan
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Martina Locatelli
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Yang Du
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Waldo Valenzuela
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Piotr Radojewski
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Arsany Hakim
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Johannes Kaesmacher
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Thomas R Meinel
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Leander Clénin
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Mattia Branca
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Davide Strambo
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Tim Fischer
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Friedrich Medlin
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Nils Peters
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Emmanuel Carrera
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Karl-Olof Lovblad
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Grzegorz M Karwacki
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Carlo W Cereda
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Julien Niederhauser
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Marie-Luise Mono
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Achim Mueller
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Susanne Wegener
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Sabine Sartoretti
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Alexandros A Polymeris
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Valerian Altersberger
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Mira Katan
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Marios Psychogios
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Rolf Sturzenegger
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Claude Nauer
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Michael Schaerer
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Carlos Buitrago Tellez
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Susanne Renaud
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Katharina Minkner Klahre
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Werner J Z'Graggen
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - David Bervini
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Leo H Bonati
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Roland Wiest
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Marcel Arnold
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Robert J Simister
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Duncan Wilson
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Hans Rolf Jäger
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - Urs Fischer
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - David J Werring
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
| | - David J Seiffge
- From the Departments of Neurology (M.B.G., M.M., B.M.S., T.R.M., L.C., M.A., U.F., D.J.S., W.J.Z.G.) and Neurosurgery (D.B., W.J.Z.G.), and the University Institute for Diagnostic and Interventional Neuroradiology (W.V., P.R., A.H., J.K., R.W.), Inselspital Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.G., B.M.S.) and CTU Bern (M.B.), University of Bern, Switzerland; Stroke Research Centre (M.B.G., W.Z., H.O., M.L., Y.D., D.J.W.), University College London Queen Square Institute of Neurology, United Kingdom; Service of Neurology (D.S.), Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Radiology (T.F.), Cantonal Hospital St. Gallen; Department of Internal Medicine (F.M.), Stroke Unit and Division of Neurology, HFR Fribourg-Cantonal Hospital; Stroke Center Hirslanden (N.P.), Klinik Hirslanden Zurich; Stroke Research Group (E.C.), Department of Clinical Neurosciences, University Hospital and Faculty of Medicine, Geneva; Department of Radiology and Medical Informatics (K.-O.L.), University of Geneva; Department of Radiology and Nuclear Medicine (G.M.K.), Luzerner Kantonsspital; Stroke Center EOC (C.W.C.), Neurocenter of Southern Switzerland; Stroke Unit (J.N.), GHOL, Hôpital de zone de Nyon; Stadtspitäler Triemli und Waid (M.-L.M.), Zurich; Department of Neurology (A.M., S.W.), University Hospital and University of Zurich; Department of Radiology and Nuclear Medicine (S.S.), Kantonsspital Winterthur; Department of Neurology and Stroke Center (A.A.P., V.A., M.K., U.F., L.H.B.) and Center for Rehabilitation Rheinfelden (L.H.B.), University Hospital Basel and University of Basel; Diagnostic and Interventional Neuroradiology (M.P.), Department of Radiology and Nuclear Medicine, University Hospital Basel; Department of Neurology (R.S.), Kantonsspital Graubünden, Chur; Department of Radiology/Neuroradiology (C.N.), Kantonsspital Graubünden, Chur; Department of Neurology (M.S.), and Department of Radiology (C.B.T.), Buergerspital Solothurn; Division of Neurology (S.R.), Pourtalès Hospital, Neuchâtel; Department of Radiology (K.M.K.), Réseau Hospitalier Neuchâtelois, Switzerland; Comprehensive Stroke Service (R.J.S., D.J.W.) and Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair & Rehabilitation, University College London Hospital, United Kingdom; and New Zealand Brain Research Institute (D.W.), Christchurch
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Deng S, Feng S, Xin Y, He Y, Wang Y, Tian M, Gong Y. Establishment of a rat model of severe spontaneous intracerebral hemorrhage. JOURNAL OF INTENSIVE MEDICINE 2024; 4:108-117. [PMID: 38263974 PMCID: PMC10800770 DOI: 10.1016/j.jointm.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/24/2023] [Accepted: 08/16/2023] [Indexed: 01/25/2024]
Abstract
Background Severe intracerebral hemorrhage (ICH) is the most devastating subtype of stroke resulting in high mortality and disability. At present, the development of targeted treatments to minimize the high morbidity and mortality is limited partly due to the lack of a severe ICH animal model. In this study, we aimed to establish an accurate severe ICH model in rats and examine the pathological and physiological changes associated with ICH. Methods A rat model of severe ICH model was established by intrastriatal injection of autologous blood using different blood volumes (ICH 100 µL group, ICH 130 µL group, ICH 160 µL group, ICH 170 µL group, and ICH 180 µL group). The mortality was assessed during the 28-day post-ICH period. Short- and long-term neurological deficits were evaluated using the Longa method, foot fault, falling latency, and Morris water maze tests. Brain water content, hematoma volume, hemoglobin content, and magnetic resonance imaging were assessed to determine the extent of brain injury. Immunofluorescence staining was conducted to examine microglial activation and neuronal apoptosis. Hematoxylin and eosin (H&E) staining, lung water content, and western blotting were used to assess lung injury following ICH. Results The mortality of ICH rats increased significantly with an increase in autologous blood injection. The 28-day mortality in the 100 µL, 130 µL, 160 µL, 170 µL, and 180 µL ICH groups were 5%, 20%, 40%, 75%, and 100%, respectively. A significantly higher 28-day mortality was observed in the ICH 160 µL group compared to the ICH 100 µL group. The ICH 160 µL group exhibited significantly increased neurological deficits, brain edema, hematoma volume, and hemoglobin content compared to the sham group. Compared with the sham operation group, the activation of microglia and neuronal death in ICH 160 µL rats increased. The use of H&E staining and western blotting demonstrated that disruption of the intra-alveolar structure, alveolar edema, and infiltration of inflammatory cells and cytokines into the lung tissue were more severe in the ICH 160 µL group than the sham group. Conclusions A severe ICH model in rats was successfully established using an injection of autologous blood at a volume of 160 µL. This model may provide a valuable tool to examine the pathological mechanisms and potential therapeutic interventions of severe ICH.
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Affiliation(s)
- Shuixiang Deng
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shengjie Feng
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuewen Xin
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu He
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yao Wang
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Mi Tian
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ye Gong
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
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Sato T, Okumura M, Takahashi J, Kokubu T, Tanabe M, Onda A, Komatsu T, Sakuta K, Sakai K, Umehara T, Mitsumura H, Matsushima M, Iguchi Y. Arachidonic acid level is related to early motor recovery following intracerebral hemorrhage with severe motor paralysis. Prostaglandins Leukot Essent Fatty Acids 2024; 200:102603. [PMID: 38147805 DOI: 10.1016/j.plefa.2023.102603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Low arachidonic acid (AA) levels are reportedly associated with unfavorable outcomes in intracerebral hemorrhage (ICH). OBJECTIVE We aimed to clarify whether serum AA levels might be associated with a good recovery from severe motor paralysis in the early stage of hospitalization. METHODS From among consecutive ICH patients between October 2012 and December 2021, patients with a sum of upper and lower extremity National Institutes of Health stroke scale (NIHSS) scores of 4-8 at admission (severe motor paralysis) were included. We defined good early recovery from severe motor paralysis as a sum of upper and lower extremity NIHSS scores of 0-3 on day 7 after admission, and that of individual upper and lower extremities as NIHSS scores of 0-1 on day 7 after admission. We aimed to assess whether serum AA levels might be associated with good early recovery from severe motor paralysis. RESULTS We screened 377 consecutive ICH patients, including 140 with severe motor paralysis (88 (63%) males, median age 64 years). Recovery from severe motor paralysis was seen in 48 (34%). Higher AA levels (PR 1.243, 95% CI 1.042 to 1.483, p = 0.016) were independently associated with good overall recovery, and good recovery of upper and lower extremities separately (upper extremity: PR 1.319, 95% CI 1.101 to 1.580, p = 0.003; lower extremity: PR 1.293, 95% CI 1.115 to 1.499, p = 0.001). CONCLUSIONS Higher AA levels may contribute to a good early motor recovery in patients with severe motor paralysis due to ICH.
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Affiliation(s)
- Takeo Sato
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Motohiro Okumura
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Junichiro Takahashi
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tatsushi Kokubu
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Maki Tanabe
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Asako Onda
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Teppei Komatsu
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenichi Sakuta
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenichiro Sakai
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tadashi Umehara
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hidetaka Mitsumura
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
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Huang YH, Lee TH, Ting CW. Exploring the relationship between admission pulse pressure and clinical features in patients with spontaneous supratentorial intracerebral hemorrhage. Neurosurg Rev 2023; 47:19. [PMID: 38135792 DOI: 10.1007/s10143-023-02256-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Abstract
Elevated pulse pressure is commonly observed in cardiovascular diseases and serves as an independent risk factor and predictor of cardiac mortality. However, the role of pulse pressure in patients with spontaneous intracerebral hemorrhage (ICH) remains uncertain. This study aimed to investigate the association between admission pulse pressure and clinical characteristics, including in-hospital outcomes, in ICH patients. We retrospectively analyzed the data of 292 ICH patients, categorizing them into two groups based on admission wide pulse pressure: > 100 mmHg (n = 60) and ≤ 100 mmHg (n = 232). Clinical characteristics and in-hospital outcomes were compared between the groups, and multivariate logistic regression was performed to identify independent factors. Patients with wide pulse pressure were older, had lower Glasgow Coma Scale, larger intraparenchymal hematomas, more pronounced midline shifts, and higher rates of intraventricular hematoma extension and hydrocephalus. These patients also experienced higher frequencies of craniotomy or craniectomy and longer hospital stays. Multivariate logistic regression revealed that pulse pressure > 100 mmHg was significantly associated with increased in-hospital mortality (odds ratio 4.31, 95% confidence interval 1.12-16.62, p = 0.03), but not with a modified Rankin Scale score of 4-6. In conclusion, our investigation demonstrates a significant relationship between admission pulse pressure and severe clinical characteristics in ICH patients. Importantly, a wider pulse pressure is linked to heightened in-hospital mortality. These results underscore the necessity for customized strategies to predict patient outcomes in this population. Further research is essential to explore potential therapeutic interventions targeting pulse pressure to improve clinical outcomes for ICH patients.
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Affiliation(s)
- Yu-Hua Huang
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsung-Han Lee
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Wei Ting
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Merella P, Casu G, Chessa P, Atzori E, Bandino S, Deiana G. When Atrial Fibrillation Meets Cerebral Amyloid Angiopathy: Current Evidence and Strategies. J Clin Med 2023; 12:7704. [PMID: 38137773 PMCID: PMC10743760 DOI: 10.3390/jcm12247704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Non-valvular atrial fibrillation (AF) and cerebral amyloid angiopathy (CAA) are two common diseases in elderly populations. Despite the effectiveness of oral anticoagulant therapy in cardioembolic stroke prevention, intracranial hemorrhage represents the most serious complication of these therapies. Cerebral amyloid angiopathy is one of the main risk factors for spontaneous intracranial bleeding, and this risk is highly increased by age and concomitant antithrombotic therapies. Cerebral amyloid angiopathy can be silent for years and then manifest with clinical features simulating TIA (TIA-mimics) or stroke in AF patients, pushing clinicians to rapidly start VKAs or DOACs, thus increasing the risk of intracranial bleeding if the diagnosis of CAA was unknown. Because the cerebral amyloid angiopathy is easily diagnosed with non-contrast MRI, suspecting the disease can avoid catastrophic complications. In this review, we will provide physicians managing anticoagulant therapies with key tips to familiarize themselves with cerebral amyloid angiopathy, with a focus on the possible clinical presentations and on the diagnostic criteria.
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Affiliation(s)
- Pierluigi Merella
- Department of Cardiology, Azienda Ospedaliero Universitaria di Sassari, Via De Nicola 1, 07100 Sassari, Italy; (G.C.); (E.A.); (S.B.)
| | - Gavino Casu
- Department of Cardiology, Azienda Ospedaliero Universitaria di Sassari, Via De Nicola 1, 07100 Sassari, Italy; (G.C.); (E.A.); (S.B.)
- Faculty of Medicine, University of Sassari, 07100 Sassari, Italy
| | - Paola Chessa
- Department of Pharmacy, San Francesco Hospital, 08100 Nuoro, Italy;
| | - Enrico Atzori
- Department of Cardiology, Azienda Ospedaliero Universitaria di Sassari, Via De Nicola 1, 07100 Sassari, Italy; (G.C.); (E.A.); (S.B.)
| | - Stefano Bandino
- Department of Cardiology, Azienda Ospedaliero Universitaria di Sassari, Via De Nicola 1, 07100 Sassari, Italy; (G.C.); (E.A.); (S.B.)
| | - Gianluca Deiana
- Department of Neurology and Stroke Unit, San Francesco Hospital, 08100 Nuoro, Italy;
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Wan Y, He QW, Chen S, Li M, Xia Y, Zhang L, Sun Z, Chen X, Wang D, Chang J, Hu B. Manifestations and Outcomes of Intracerebral Hemorrhage During the COVID-19 Pandemic in China: Multicenter, Longitudinal Cohort Study. JMIR Public Health Surveill 2023; 9:e34386. [PMID: 38090794 PMCID: PMC10720699 DOI: 10.2196/34386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/19/2023] [Accepted: 09/05/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has inevitably affected the distribution of medical resources, and epidemic lockdowns have had a significant impact on the nursing and treatment of patients with other acute diseases, including intracerebral hemorrhage (ICH). OBJECTIVE This study aimed to investigate how the COVID-19 pandemic affected the manifestations and outcomes of patients with ICH. METHODS Patients with acute ICH before (December 1, 2018-November 30, 2019) and during (December 1, 2019-November 30, 2020) the COVID-19 pandemic at 31 centers in China from the Chinese Cerebral Hemorrhage: Mechanism and Intervention (CHEERY) study were entered into the analysis. Demographic information and clinical manifestations and outcomes were collected and compared between the 2 groups. RESULTS From December 1, 2018, to November 30, 2020, a total of 3460 patients with ICH from the CHEERY study were enrolled and eventually analyzed. The results showed that during the COVID-19 pandemic, patients with ICH were more likely to be older (P<.001) with a history of ischemic stroke (P=.04), shorter time from onset to admission (P<.001), higher blood pressure (P<.001), higher fasting blood glucose (P=.003), larger hematoma volume (P<.001), and more common deep ICH (P=.01) and intraventricular hemorrhage (P=.02). These patients required more intensive care unit treatment (P<.001) and preferred to go to the hospital directly rather than call an ambulance (P<.001). In addition, the COVID-19 pandemic was associated with an increased risk of pulmonary infection during hospitalization (adjusted risk ratio [RRadjusted] 1.267, 95% CI 1.065-1.509), lower probability of a 3-month good outcome (RRadjusted 0.975, 95% CI 0.956-0.995), and a higher probability of in-hospital (RRadjusted 3.103, 95% CI 2.156-4.465), 1-month (RRadjusted 1.064, 95% CI 1.042-1.087), and 3-month (RRadjusted 1.069, 95% CI 1.045-1.093) mortality. CONCLUSIONS Our study indicated that the cloud of COVID-19 has adversely impacted the presentation and outcomes of ICH. Medical workers may pay more attention to patients with ICH, while the public should pay more attention to hypertension control and ICH prevention. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1900020872; https://www.chictr.org.cn/showprojEN.html?proj=33817.
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Affiliation(s)
- Yan Wan
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Quan Wei He
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaoli Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Man Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanpeng Xia
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zhang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhou Sun
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolu Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - David Wang
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Jiang Chang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Tang J, Yan B, Tang Y, Zhou X, Ji Z, Xu F. Baicalein ameliorates oxidative stress and brain injury after intracerebral hemorrhage by activating the Nrf2/ARE pathway via miR-106a-5p/PHLPP2 axis. Int J Neurosci 2023; 133:1380-1393. [PMID: 35612366 DOI: 10.1080/00207454.2022.2080676] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/12/2022] [Indexed: 12/14/2022]
Abstract
Intracerebral hemorrhage (ICH) is a devastating stroke subtype. Baicalein (BAI) has been reported to be effective in ischemic stroke. The aim of the present study was to investigate the mechanism of BAI on brain injury after ICH. Firstly, ICH mouse models were established by injecting collagenase into the right of basal ganglia, followed by detection of neurobehavioral scores, brain edema, oxidative stress (OS) level, neuronal apoptosis and pathological changes. Average neurologic scores, brain water content, and blood-brain barrier permeability and MDA level in ICH mice were reduced after BAI treatment, while serum SOD and GSH-Px levels were increased and neuronal apoptosis and pathological injury of the brain tissues were mitigated. miR-106a-5p downregulation averted the effect of BAI on ICH mice. miR-106a-5p targeted PHLPP2 and PHLPP2 overexpression reversed the effect of BAI on ICH mice. BAI activated the Nrf2/ARE pathway by inhibiting PHLPP2 expression. In conclusion, BAI inhibited OS and protected against brain injury after ICH by activating the Nrf2/ARE pathway through the miR-106a-5p/PHLPP2 axis.
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Affiliation(s)
- Jilei Tang
- Department of Neurosurgery, The First People'Hospital of Xuzhou, Xuzhou, Jiangsu, China
| | - Bingchao Yan
- Department of Neurosurgery, The First People'Hospital of Xuzhou, Xuzhou, Jiangsu, China
| | - Yangyang Tang
- Department of Nursing Basic Medicine Teaching and Research Section, Jiangsu Provincial Xuzhou Pharmaceutical Vocational College, Xuzhou, Jiangsu, China
| | - Xin Zhou
- Xuzhou College of Industrial Technolog, Xuzhou, Jiangsu, China
| | - Ziteng Ji
- Department of Neurosurgery, The First People'Hospital of Xuzhou, Xuzhou, Jiangsu, China
| | - Feng Xu
- Department of Neurosurgery, The First People'Hospital of Xuzhou, Xuzhou, Jiangsu, China
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Goeldlin MB, Vynckier J, Mueller M, Drop B, Maamari B, Vonlanthen N, Siepen BM, Hakim A, Kaesmacher J, Jesse CM, Mueller MD, Meinel TR, Beyeler M, Clénin L, Gralla J, Z’Graggen W, Bervini D, Arnold M, Fischer U, Seiffge DJ. Small vessel disease burden and risk of recurrent cerebrovascular events in patients with lacunar stroke and intracerebral haemorrhage attributable to deep perforator arteriolopathy. Eur Stroke J 2023; 8:989-1000. [PMID: 37632398 PMCID: PMC10683739 DOI: 10.1177/23969873231193237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/23/2023] [Indexed: 08/28/2023] Open
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)), aORshift 3.19, 95%CI 2.15-4.75). Deep ICH patients had more often cerebral microbleeds (deep ICH: 71.6% vs LS: 29.2%, p < 0.001, median count (IQR) 4(2-12) vs 2(1-6)) and a higher prevalence of lacunes (deep ICH: 60.5% vs LS: 27.4% p < 0.001). At 3 months, deep ICH was associated with higher mRS (aORshift 2.16, 95%CI 1.21-3.87). Occurrence of ischaemic stroke was numerically but not significantly higher in deep ICH (4.3% vs 2.9%; p = 0.51). One patient (1.1%) with ICH but none with LS suffered ICH recurrence. 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.
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Affiliation(s)
- Martina B Goeldlin
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Jan Vynckier
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
- Department of Neurology, Onze-Lieve-Vrouwziekenhuis Aalst, Aalst, Belgium
| | - Madlaine Mueller
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Boudewijn Drop
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Basel Maamari
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Noah Vonlanthen
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Bernhard M Siepen
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Arsany Hakim
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christopher Marvin Jesse
- Department of Neurosurgery, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Mandy D Mueller
- Department of Neurosurgery, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thomas R Meinel
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Morin Beyeler
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Leander Clénin
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Jan Gralla
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Werner Z’Graggen
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
- Department of Neurosurgery, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - David Bervini
- Department of Neurosurgery, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - David J Seiffge
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
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Tian Y, Zhang Y, He J, Hao P, Li T, Xiao Y, Peng L, Feng Y, Cheng X, Deng H, Wang P, Chong W, Hai Y, Chen L, You C, Fang F. Association of anemia with mortality in young adult patients with intracerebral hemorrhage. Sci Rep 2023; 13:19711. [PMID: 37953289 PMCID: PMC10641070 DOI: 10.1038/s41598-023-46941-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
This study aimed to examine the association of hemoglobin concentration with a 90-day mortality of young adult patients with ICH in a large retrospective cohort. A retrospective observational study was conducted between December 2013 and June 2019 in two tertiary academic medical centers in China. We defined patients with hemoglobin concentration < 80 g/L as severe anemia and 80-120/130 g/L as mild to moderate anemia. We also defined patients with hemoglobin concentration > 160 g/L as high hemoglobin. Associations of hemoglobin and outcomes were evaluated in multivariable regression analyses. The primary outcome was mortality at 90 days. We identified 4098 patients with ICH who met the inclusion criteria. After adjusting primary confounding variables, the 90-day mortality rate was significantly higher in young patients with severe anemia (OR, 39.65; 95% CI 15.42-101.97), moderate anemia (OR, 2.49; 95% CI 1.24-5.00), mild anemia (OR, 1.89; 95% CI 1.20-2.98), and high hemoglobin (OR, 2.03; 95% CI 1.26-3.26) group than in young patients of the normal group. The younger age was associated with a higher risk of death from anemia in patients with ICH (P for interaction = 0.01). In young adult patients with ICH, hemoglobin concentration was associated with 90-day mortality, and even mild to moderate anemia correlated with higher mortality. We also found that in ICH patients with anemia, younger age was associated with higher risk.
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Affiliation(s)
- Yixin Tian
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yu Zhang
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Jialing He
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Pengfei Hao
- Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Tiangui Li
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Yangchun Xiao
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Liyuan Peng
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yuning Feng
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Xin Cheng
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Haidong Deng
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Peng Wang
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Weelic Chong
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Yang Hai
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Lvlin Chen
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Chao You
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Fang Fang
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Zhang P, Pang S, Du L, Li J, Su X. Clinical characteristics and outcomes of patients with intracerebral hemorrhage after acute myocardial infarction. Int J Cardiol 2023; 390:131218. [PMID: 37499951 DOI: 10.1016/j.ijcard.2023.131218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
Data regarding patients with intracranial hemorrhage (ICH) following acute myocardial infarction (AMI) is scarce. This study aims to investigate the incidence, clinical characteristics, prevention, treatment, and prognosis of ICH in patients with AMI. Among 5257 patients with AMI, 14 cases (0.27%) experienced ICH following AMI, including 11 males and three females. In-hospital mortality occurred in eight patients (57.1%), all of whom experienced sudden loss of consciousness. Six patients (42.6%) were classified as high or very high risk according to CRUSADE score, and seven patients (50.0%) were classified as high risk according to Academic Research Consortium for High Bleeding Risk (ARC-HBR). The CRUSADE and ARC-HBR scores can complement each other in risk assessment. All in-hospital deaths occurred within four days of ICH onset; The volume of ICH in patients who died in the hospital was significantly higher than in those who survived and were discharged, with 30 ml possibly serving as a threshold. The incidence of ICH following myocardial infarction is low; however, the mortality rate is extremely high, presenting considerable challenges for clinical treatment. Prevention, early detection, and prompt symptomatic management are essential for improving patient outcomes.
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Affiliation(s)
- Ping Zhang
- Department of Hematology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
| | - Shuo Pang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lijuan Du
- Department of Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junlei Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Su
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Liu M, Xiong Y, Hua X, Huang L, He W, You C, Liu M, Wu S. Prognostic value of day-of-event serum calcium and magnesium for predicting 1-year prognosis after intracerebral hemorrhage. Neurol Sci 2023; 44:3957-3965. [PMID: 37291394 DOI: 10.1007/s10072-023-06886-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
AIM To investigate whether serum calcium and magnesium on the day of symptom onset contribute to prognosis at 1 year after intracerebral hemorrhage (ICH). METHODS We prospectively enrolled patients admitted < 24 h after symptom onset of primary ICH to West China Hospital between January 2012 and October 2014. Blood samples were collected at admission to determine the concentration of serum calcium and magnesium. We analyzed associations of the serum concentration of calcium and magnesium with unfavorable outcome (defined as modified Rankin scale, mRS ≥ 3) at 1 year. RESULTS We included 874 patients (mean age 59.1 ± 13.5 years, 67.6% males), of whom 470 patients had mRS ≥ 3 and 284 patients died at 1 year. Compared to patients with the highest tertile level of calcium concentration (≥ 2.29 mmol/L), patients in the lowest tertile (≤ 2.15 mmol/L) had higher odds of unfavorable outcome (odds ratio, OR 1.61, 95% confidence interval [CI] 1.04-2.50, P = 0.034). The Kaplan-Meier survival curve revealed a significant difference of cumulative survival rate across calcium tertiles (log-rank P value = 0.038). There was no significant association between serum concentration of magnesium and functional outcome at 1 year. CONCLUSION A reduced serum concentration of calcium on the day-of-event was associated with unfavorable outcome at 1 year after ICH. Future studies are needed to illustrate the pathophysiological mechanism of calcium and whether calcium could be a treatment target for improving outcomes after ICH.
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Affiliation(s)
- Meng Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yao Xiong
- The Affiliated Hospital of Southwest Jiaotong University &, The Third People's Hospital of Chengdu, Chengdu, 610031, Sichuan, China
| | - Xing Hua
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Linrui Huang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Weihong He
- Department of Physiology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Simiao Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Chen MY, Chen PY, Chang CN, Chen BA, Deng WC, Yan JL. Outcomes of hemorrhagic stroke in patients with autoimmune rheumatic diseases: An analysis of the US Nationwide Inpatient Sample. Int J Rheum Dis 2023; 26:2206-2213. [PMID: 37726980 DOI: 10.1111/1756-185x.14916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/21/2023]
Abstract
AIM To determine whether and how rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc) affect outcomes in patients admitted for hemorrhagic stroke. METHODS This study screened the Nationwide Inpatient Sample database for adults aged ≥20 years admitted to US hospitals with a principal diagnosis of intracerebral hemorrhage (ICH) between 2005 and 2018. Diagnoses were determined using the International Classification of Diseases, 9th and 10th revisions (ICD-9 and ICD-10) diagnostic codes for ICH (ICD-9: 431, 432; ICD-10: I61, I62). Study outcomes were: (1) in-hospital mortality; (2) unfavorable discharge, defined as transfer to nursing homes or long-term care facilities; and (3) prolonged length of stay (LOS), defined as LOS >75th centile. RESULTS Associations between comorbid RA, SLE, and SSc and clinical outcomes show a significantly lower risk of in-hospital mortality and prolonged LOS in RA patients. After admissions for ICH, the risk for in-hospital mortality and prolonged LOS was decreased in RA patients, and the risk for unfavorable discharge (long-term care) was reduced in SLE patients. CONCLUSIONS Among patients admitted to US hospitals for hemorrhagic stroke, patients with RA had decreased risk for in-hospital mortality and prolonged LOS.
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Affiliation(s)
- Mao-Yu Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Pin-Yuan Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chen-Nen Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Bo-An Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wen-Chun Deng
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Jiun-Lin Yan
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Eilertsen H, Menon CS, Law ZK, Chen C, Bath PM, Steiner T, Desborough MJ, Sandset EC, Sprigg N, Al-Shahi Salman R. Haemostatic therapies for stroke due to acute, spontaneous intracerebral haemorrhage. Cochrane Database Syst Rev 2023; 10:CD005951. [PMID: 37870112 PMCID: PMC10591281 DOI: 10.1002/14651858.cd005951.pub5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Outcome after acute spontaneous (non-traumatic) intracerebral haemorrhage (ICH) is influenced by haematoma volume. ICH expansion occurs in about 20% of people with acute ICH. Early haemostatic therapy might improve outcome by limiting ICH expansion. This is an update of a Cochrane Review first published in 2006, and last updated in 2018. OBJECTIVES To examine 1. the effects of individual classes of haemostatic therapies, compared with placebo or open control, in adults with acute spontaneous ICH, and 2. the effects of each class of haemostatic therapy according to the use and type of antithrombotic drug before ICH onset. SEARCH METHODS We searched the Cochrane Stroke Trials Register, CENTRAL (2022, Issue 8), MEDLINE Ovid, and Embase Ovid on 12 September 2022. To identify further published, ongoing, and unpublished randomised controlled trials (RCTs), we scanned bibliographies of relevant articles and searched international registers of RCTs in September 2022. SELECTION CRITERIA We included RCTs of any haemostatic intervention (i.e. procoagulant treatments such as clotting factor concentrates, antifibrinolytic drugs, platelet transfusion, or agents to reverse the action of antithrombotic drugs) for acute spontaneous ICH, compared with placebo, open control, or an active comparator. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome was death/dependence (modified Rankin Scale (mRS) 4 to 6) by day 90. Secondary outcomes were ICH expansion on brain imaging after 24 hours, all serious adverse events, thromboembolic adverse events, death from any cause, quality of life, mood, cognitive function, Barthel Index score, and death or dependence measured on the Extended Glasgow Outcome Scale by day 90. MAIN RESULTS We included 20 RCTs involving 4652 participants: nine RCTs of recombinant activated factor VII (rFVIIa) versus placebo/open control (1549 participants), eight RCTs of antifibrinolytic drugs versus placebo/open control (2866 participants), one RCT of platelet transfusion versus open control (190 participants), and two RCTs of prothrombin complex concentrates (PCC) versus fresh frozen plasma (FFP) (47 participants). Four (20%) RCTs were at low risk of bias in all criteria. For rFVIIa versus placebo/open control for spontaneous ICH with or without surgery there was little to no difference in death/dependence by day 90 (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.74 to 1.05; 7 RCTs, 1454 participants; low-certainty evidence). We found little to no difference in ICH expansion between groups (RR 0.81, 95% CI 0.56 to 1.16; 4 RCTs, 220 participants; low-certainty evidence). There was little to no difference in all serious adverse events and death from any cause between groups (all serious adverse events: RR 0.81, 95% CI 0.30 to 2.22; 2 RCTs, 87 participants; very low-certainty evidence; death from any cause: RR 0.78, 95% CI 0.56 to 1.08; 8 RCTs, 1544 participants; moderate-certainty evidence). For antifibrinolytic drugs versus placebo/open control for spontaneous ICH, there was no difference in death/dependence by day 90 (RR 1.00, 95% CI 0.93 to 1.07; 5 RCTs, 2683 participants; high-certainty evidence). We found a slight reduction in ICH expansion with antifibrinolytic drugs for spontaneous ICH compared to placebo/open control (RR 0.86, 95% CI 0.76 to 0.96; 8 RCTs, 2866 participants; high-certainty evidence). There was little to no difference in all serious adverse events and death from any cause between groups (all serious adverse events: RR 1.02, 95% CI 0.75 to 1.39; 4 RCTs, 2599 participants; high-certainty evidence; death from any cause: RR 1.02, 95% CI 0.89 to 1.18; 8 RCTs, 2866 participants; high-certainty evidence). There was little to no difference in quality of life, mood, or cognitive function (quality of life: mean difference (MD) 0, 95% CI -0.03 to 0.03; 2 RCTs, 2349 participants; mood: MD 0.30, 95% CI -1.98 to 2.57; 2 RCTs, 2349 participants; cognitive function: MD -0.37, 95% CI -1.40 to 0.66; 1 RCTs, 2325 participants; all high-certainty evidence). Platelet transfusion likely increases death/dependence by day 90 compared to open control for antiplatelet-associated ICH (RR 1.29, 95% CI 1.04 to 1.61; 1 RCT, 190 participants; moderate-certainty evidence). We found little to no difference in ICH expansion between groups (RR 1.32, 95% CI 0.91 to 1.92; 1 RCT, 153 participants; moderate-certainty evidence). There was little to no difference in all serious adverse events and death from any cause between groups (all serious adverse events: RR 1.46, 95% CI 0.98 to 2.16; 1 RCT, 190 participants; death from any cause: RR 1.42, 95% CI 0.88 to 2.28; 1 RCT, 190 participants; both moderate-certainty evidence). For PCC versus FFP for anticoagulant-associated ICH, the evidence was very uncertain about the effect on death/dependence by day 90, ICH expansion, all serious adverse events, and death from any cause between groups (death/dependence by day 90: RR 1.21, 95% CI 0.76 to 1.90; 1 RCT, 37 participants; ICH expansion: RR 0.54, 95% CI 0.23 to 1.22; 1 RCT, 36 participants; all serious adverse events: RR 0.27, 95% CI 0.02 to 3.74; 1 RCT, 5 participants; death from any cause: RR 0.49, 95% CI 0.16 to 1.56; 2 RCTs, 42 participants; all very low-certainty evidence). AUTHORS' CONCLUSIONS In this updated Cochrane Review including 20 RCTs involving 4652 participants, rFVIIa likely results in little to no difference in reducing death or dependence after spontaneous ICH with or without surgery; antifibrinolytic drugs result in little to no difference in reducing death or dependence after spontaneous ICH, but result in a slight reduction in ICH expansion within 24 hours; platelet transfusion likely increases death or dependence after antiplatelet-associated ICH; and the evidence is very uncertain about the effect of PCC compared to FFP on death or dependence after anticoagulant-associated ICH. Thirteen RCTs are ongoing and are likely to increase the certainty of the estimates of treatment effect.
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Affiliation(s)
- Helle Eilertsen
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Zhe Kang Law
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Chen Chen
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, Australia
- The George Institute for Global Health, Beijing, China
- Department of Neurology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Philip M Bath
- Stroke Medicine, University of Nottingham, Nottingham, UK
| | - Thorsten Steiner
- Klinikum Frankfurt Höchst, Frankfurt, Germany
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Jr Desborough
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Else C Sandset
- Department of Neurology, Oslo University Hospital Ullevål, Oslo, Norway
- The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Nikola Sprigg
- Stroke Medicine, University of Nottingham, Nottingham, UK
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Cai H, Chen G, Hu W, Jiang C. Anticoagulant in atrial fibrillation patients with prior intracranial haemorrhage: a meta-analysis. Heart 2023; 109:1594-1600. [PMID: 37321829 DOI: 10.1136/heartjnl-2023-322492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The benefit of resuming anticoagulation in atrial fibrillation (AF) patients with prior intracranial haemorrhage (ICH) and which anticoagulant to choose are controversial. SUMMARY OF REVIEW PubMed, Embase, Web of Science and the Cochrane Library were searched from their inception until 13 February 2022. Thirteen eligible articles (17 600 participants) were collected, including 11 real-world studies (n=17 296) and 2 randomised controlled trials (RCTs) (n=304). Compared with no anticoagulants, oral anticoagulation (OAC) was not associated with an increased risk of ICH recurrence (HR 0.85 (95% CI 0.57 to 1.25), p=0.41), but with a significantly increased risk of major bleeding (HR 1.66 (95% CI 1.20 to 2.30), p<0.01). Meanwhile, OAC was associated with a reduced risk of ischaemic stroke/systemic thromboembolism (IS/SE) (HR 0.54 (95% CI 0.42 to 0.70), p<0.01) and all-cause death (HR 0.38 (95% CI 0.28 to 0.52), p<0.01) compared with no anticoagulants. Furthermore, compared with warfarin, non-vitamin K antagonist oral anticoagulants (NOACs) were associated with a significant reduction of ICH recurrence (HR 0.64 (95% CI 0.49 to 0.85), p<0.01), while the risk of IS/SE and all-cause mortality were comparable between warfarin and NOACs. CONCLUSIONS For patients with AF with prior ICH, OAC is associated with a significant reduction in IS/SE and all-cause mortality without increasing ICH recurrence, but may increase major bleeding risk. Compared with warfarin, NOACs had a better safety profile and comparable efficacy. Further larger RCTs are warranted to validate these findings.
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Affiliation(s)
- Huiya Cai
- Department of Pharmacy, The Second Hospital of Zhangzhou, Zhangzhou, Fujian, China
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Guoquan Chen
- Department of Pharmacy, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Wei Hu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chunjiao Jiang
- Department of Pharmacy, The Second Hospital of Zhangzhou, Zhangzhou, Fujian, China
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