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Meinel TR, Kniepert JU, Seiffge DJ, Gralla J, Jung S, Auer E, Frey S, Goeldlin M, Mordasini P, Mosimann PJ, Nogueira RG, Haussen DC, Rodrigues GM, Uphaus T, L'Allinec V, Krajíčková D, Alonso A, Costalat V, Hajdu SD, Olivé-Gadea M, Maegerlein C, Pierot L, Schaafsma J, Suzuki K, Arnold M, Heldner MR, Fischer U, Kaesmacher J. Endovascular Stroke Treatment and Risk of Intracranial Hemorrhage in Anticoagulated Patients. Stroke 2020; 51:892-898. [PMID: 31992179 DOI: 10.1161/strokeaha.119.026606] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background and Purpose- We aimed to determine the safety and mortality after mechanical thrombectomy in patients taking vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs). Methods- In a multicenter observational cohort study, we used multiple logistic regression analysis to evaluate associations of symptomatic intracranial hemorrhage (sICH) with VKA or DOAC prescription before thrombectomy as compared with no anticoagulation. The primary outcomes were the rate of sICH and all-cause mortality at 90 days, incorporating sensitivity analysis regarding confirmed therapeutic anticoagulation. Additionally, we performed a systematic review and meta-analysis of literature on this topic. Results- Altogether, 1932 patients were included (VKA, n=222; DOAC, n=98; no anticoagulation, n=1612); median age, 74 years (interquartile range, 62-82); 49.6% women. VKA prescription was associated with increased odds for sICH and mortality (adjusted odds ratio [aOR], 2.55 [95% CI, 1.35-4.84] and 1.64 [95% CI, 1.09-2.47]) as compared with the control group, whereas no association with DOAC intake was observed (aOR, 0.98 [95% CI, 0.29-3.35] and 1.35 [95% CI, 0.72-2.53]). Sensitivity analyses considering only patients within the confirmed therapeutic anticoagulation range did not alter the findings. A study-level meta-analysis incorporating data from 7462 patients (855 VKAs, 318 DOACs, and 6289 controls) from 15 observational cohorts corroborated these observations, yielding an increased rate of sICH in VKA patients (aOR, 1.62 [95% CI, 1.22-2.17]) but not in DOAC patients (aOR, 1.03 [95% CI, 0.60-1.80]). Conclusions- Patients taking VKA have an increased risk of sICH and mortality after mechanical thrombectomy. The lower risk of sICH associated with DOAC may also be noticeable in the acute setting. Improved selection might be advisable in VKA-treated patients. Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT03496064. Systematic Review and Meta-Analysis: CRD42019127464.
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Affiliation(s)
- Thomas R Meinel
- From the Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland (T.R.M., J.U.K., D.J.S., S.J., E.A., S.F., M.G., M.A., M.R.H., U.F.)
| | - Joachim U Kniepert
- From the Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland (T.R.M., J.U.K., D.J.S., S.J., E.A., S.F., M.G., M.A., M.R.H., U.F.)
| | - David J Seiffge
- From the Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland (T.R.M., J.U.K., D.J.S., S.J., E.A., S.F., M.G., M.A., M.R.H., U.F.)
| | - Jan Gralla
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (J.G., M.G., P.M., P.J.M.)
| | - Simon Jung
- From the Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland (T.R.M., J.U.K., D.J.S., S.J., E.A., S.F., M.G., M.A., M.R.H., U.F.)
| | - Elias Auer
- From the Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland (T.R.M., J.U.K., D.J.S., S.J., E.A., S.F., M.G., M.A., M.R.H., U.F.)
| | - Sebastién Frey
- From the Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland (T.R.M., J.U.K., D.J.S., S.J., E.A., S.F., M.G., M.A., M.R.H., U.F.)
| | - Martina Goeldlin
- From the Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland (T.R.M., J.U.K., D.J.S., S.J., E.A., S.F., M.G., M.A., M.R.H., U.F.).,University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (J.G., M.G., P.M., P.J.M.)
| | - Pasquale Mordasini
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (J.G., M.G., P.M., P.J.M.)
| | - Pascal J Mosimann
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (J.G., M.G., P.M., P.J.M.)
| | - Raul G Nogueira
- Emory University/Marcus Stroke and Neuroscience Center-Grady Memorial Hospital, Atlanta, GA (R.G.N., D.C.H., G.M.R.)
| | - Diogo C Haussen
- Emory University/Marcus Stroke and Neuroscience Center-Grady Memorial Hospital, Atlanta, GA (R.G.N., D.C.H., G.M.R.)
| | - Gabriel M Rodrigues
- Emory University/Marcus Stroke and Neuroscience Center-Grady Memorial Hospital, Atlanta, GA (R.G.N., D.C.H., G.M.R.)
| | - Timo Uphaus
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany, on behalf of the ENDOSTROKE Study Group (T.U.)
| | - Vincent L'Allinec
- Neuroradiology Department, Nantes University Hospital, France (V.L.)
| | - Dagmar Krajíčková
- Department of Neurology, Comprehensive Stroke Center, Faculty of Medicine in Hradec Králové, Charles University and University Hospital Hradec Králové, Czech Republic (D.K.)
| | - Angelika Alonso
- Department of Neurology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany (A.A.)
| | | | - Steven D Hajdu
- Department of Radiology, CHUV Lausanne, Switzerland (S.D.H.)
| | - Marta Olivé-Gadea
- Department of Neurology, Hospital Universitario Vall d'Hebron, Barcelona, Spain (M.O.-G.)
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Germany (C.M.)
| | | | - Joanna Schaafsma
- Division of Neurology, University Health Network, University of Toronto, Canada (J.S.)
| | - Kentaro Suzuki
- Department of Neurology, Nippon Medical School, Tokyo, Japan (K.S.)
| | - Marcel Arnold
- From the Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland (T.R.M., J.U.K., D.J.S., S.J., E.A., S.F., M.G., M.A., M.R.H., U.F.)
| | - Mirjam R Heldner
- From the Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland (T.R.M., J.U.K., D.J.S., S.J., E.A., S.F., M.G., M.A., M.R.H., U.F.)
| | - Urs Fischer
- From the Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland (T.R.M., J.U.K., D.J.S., S.J., E.A., S.F., M.G., M.A., M.R.H., U.F.)
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (J.K.).,Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (J.K.).,Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland (J.K.)
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16
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Seiffge DJ, Hooff RJ, Nolte CH, Béjot Y, Turc G, Ikenberg B, Berge E, Persike M, Dequatre-Ponchelle N, Strbian D, Pfeilschifter W, Zini A, Tveiten A, Næss H, Michel P, Sztajzel R, Luft A, Gensicke H, Traenka C, Hert L, Scheitz JF, De Marchis GM, Bonati LH, Peters N, Charidimou A, Werring DJ, Palm F, Reinhard M, Niesen WD, Nagao T, Pezzini A, Caso V, Nederkoorn PJ, Kägi G, von Hessling A, Padjen V, Cordonnier C, Erdur H, Lyrer PA, Brouns R, Steiner T, Tatlisumak T, Engelter ST. Recanalization Therapies in Acute Ischemic Stroke Patients. Circulation 2015; 132:1261-9. [DOI: 10.1161/circulationaha.115.015484] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 07/23/2015] [Indexed: 12/24/2022]
Abstract
Background—
We explored the safety of intravenous thrombolysis (IVT) or intra-arterial treatment (IAT) in patients with ischemic stroke on non-vitamin K antagonist oral anticoagulants (NOACs, last intake <48 hours) in comparison with patients (1) taking vitamin K antagonists (VKAs) or (2) without previous anticoagulation (no-OAC).
Methods and Results—
This is a multicenter cohort pilot study. Primary outcome measures were (1) occurrence of intracranial hemorrhage (ICH) in 3 categories: any ICH (ICH
any
), symptomatic ICH according to the criteria of the European Cooperative Acute Stroke Study II (ECASS-II) (sICH
ECASS-II
) and the National Institute of Neurological Disorders and Stroke (NINDS) thrombolysis trial (sICH
NINDS
); and (2) death (at 3 months). Cohorts were compared by using propensity score matching. Our NOAC cohort comprised 78 patients treated with IVT/IAT and the comparison groups of 441 VKA patients and 8938 no-OAC patients. The median time from last NOAC intake to IVT/IAT was 13 hours (interquartile range, 8–22 hours). In VKA patients, median pre-IVT/IAT international normalized ratio was 1.3 (interquartile range, 1.1–1.6). ICH
any
was observed in 18.4% NOAC patients versus 26.8% in VKA patients and 17.4% in no-OAC patients. sICH
ECASS-II
and sICH
NINDS
occurred in 2.6%/3.9% NOAC patients, in comparison with 6.5%/9.3% of VKA patients and 5.0%/7.2% of no-OAC patients, respectively. At 3 months, 23.0% of NOAC patients in comparison with 26.9% of VKA patients and 13.9% of no-OAC patients had died. Propensity score matching revealed no statistically significant differences.
Conclusions—
IVT/IAT in selected patients with ischemic stroke under NOAC treatment has a safety profile similar to both IVT/IAT in patients on subtherapeutic VKA treatment or in those without previous anticoagulation. However, further prospective studies are needed, including the impact of specific coagulation tests.
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Affiliation(s)
- David J. Seiffge
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Robbert-JanVan Hooff
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Christian H. Nolte
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Yannick Béjot
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Guillaume Turc
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Benno Ikenberg
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Eivind Berge
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Malte Persike
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Nelly Dequatre-Ponchelle
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Daniel Strbian
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Waltraud Pfeilschifter
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Andrea Zini
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Arnstein Tveiten
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Halvor Næss
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Patrik Michel
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Roman Sztajzel
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Andreas Luft
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Henrik Gensicke
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Christopher Traenka
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Lisa Hert
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Jan F. Scheitz
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Gian Marco De Marchis
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Leo H. Bonati
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Nils Peters
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Andreas Charidimou
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - David J. Werring
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Frederick Palm
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Matthias Reinhard
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Wolf-Dirk Niesen
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Takehiko Nagao
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Alessandro Pezzini
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Valeria Caso
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Paul J. Nederkoorn
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Georg Kägi
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Alexander von Hessling
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Visnja Padjen
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Charlotte Cordonnier
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Hebun Erdur
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Philippe A. Lyrer
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Raf Brouns
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Thorsten Steiner
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Turgut Tatlisumak
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
| | - Stefan T. Engelter
- From Stroke Center and Neurology, University Hospital Basel, Switzerland (D.J.S., H.G., C.T., L.H., G.M.D.M., L.H.B., N.P., P.A.L., S.T.E.); Department of Neurology, Universitair Ziekenhuis Brussel and Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Belgium (R.-J.V.H., R.B.); Department of Neurology and Center for Stroke Research Charité, Berlin, Germany (C.H.N., J.F.S., H.E.); Department of Neurology, University Hospital, Dijon, France (Y.B.); Department of Neurology, Sainte-Anne
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