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Chaalala C, El Hage G, Gilbert V, Martin T, Iancu D, Labidi M, Bojanowski MW. Spontaneous intracranial vertebral artery dissections presenting with subarachnoid hemorrhage. Neurochirurgie 2024; 70:101526. [PMID: 38277864 DOI: 10.1016/j.neuchi.2023.101526] [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: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Vertebral artery dissection (VAD) is an infrequent source of subarachnoid hemorrhage (SAH), with a high mortality rate, primarily due to the risk of rebleeding both before and after medical intervention. This paper provides a comprehensive analysis of the anatomy, pathophysiology, clinical presentation, treatment strategies, and outcomes of intracranial vertebral artery dissections that result in subarachnoid hemorrhage. METHODS Comprehensive five-year literature review (2018-2022) and a retrospective analysis of patient records from our institution between 2016 and 2022. We included studies with a minimum of 5 patients. RESULTS The study incorporated ten series from the literature and 22 cases from CHUM. Key anatomical factors increasing the risk of VAD include the vertebral artery's origin from the aortic arch, asymmetry of the vertebral artery, and its tortuosity. Patients may display specific collagen and genetic abnormalities. The occurrence of VAD appears to be more prevalent in men. Those with a ruptured intracranial VAD typically show prodromal symptoms and present with severe SAH. Rebleeding within the first 24 h is frequent. While standard imaging methods are usually adequate for VAD diagnosis, they may not provide detailed information about the perforator anatomy. Treatment approaches include both deconstructive and reconstructive methods. CONCLUSION Ruptured VAD is a critical, life-threatening condition. Many patients have a poor neurological status at presentation, and rebleeding prior to treatment is a significant concern. Deconstructive techniques are most effective in preventing rebleeding, whereas the efficacy of reconstructive techniques needs more investigation.
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Affiliation(s)
- Chiraz Chaalala
- Division of Neurosurgery, Department of Surgery, University of Montreal, Quebec, Canada.
| | - Gilles El Hage
- Division of Neurosurgery, Department of Surgery, University of Montreal, Quebec, Canada
| | - Valérie Gilbert
- Division of Neurosurgery, Department of Surgery, University of Montreal, Quebec, Canada
| | - Tristan Martin
- Division of Neurosurgery, Department of Surgery, University of Montreal, Quebec, Canada
| | - Daniela Iancu
- Division of Neuroradiology, Radiology Department, University of Montreal, Quebec, Canada
| | - Moujahed Labidi
- Division of Neurosurgery, Department of Surgery, University of Montreal, Quebec, Canada
| | - Michel W Bojanowski
- Division of Neurosurgery, Department of Surgery, University of Montreal, Quebec, Canada
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2
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Essibayi MA, Lanzino G, Keser Z. Endovascular treatments of intracranial vertebral and internal carotid arteries dissections: An interactive systematic review and meta-analysis. Interv Neuroradiol 2024; 30:22-30. [PMID: 35450460 PMCID: PMC10956451 DOI: 10.1177/15910199221095789] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/04/2022] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Management of intracranial artery dissection (IAD) remains elusive in medical practice. Intracranially, vertebral artery dissection (VAD) is more commonly encountered than internal carotid artery dissection (ICAD). Deconstructive (EVT-d) and reconstructive (EVT-r) endovascular techniques have been utilized to treat VAD and ICAD. This meta-analysis investigates the safety and efficacy of EVT-r and EVT-d in the management of VAD and ICAD. METHODS The literature was searched for all studies with consecutive patient series evaluating EVT-d or EVT-r for VAD or ICAD management. Baseline characteristics and outcomes were compared between EVT-r and EVT-d groups using the random-effect model and meta-regression approaches. RESULTS Overall, 1095 cases pooled from 56 studies were included. There was no statistically significant difference in baseline characteristics between VAD and ICAD. EVT-r was applied in 647 cases (59.1%) and EVT-d in the rest There was no statistical difference in the rate of procedural complications between EVT-r and EVT-d. Although EVT-d was significantly associated with higher rates of complete aneurysm occlusion (86.4%), lower rates of good clinical outcomes (72.1%) and higher mortality (15.1%) were achieved compared to EVT-r (70.2%, 83.3%, and 9.5%; respectively). The mortality rate was higher, and good clinical outcomes were less common in ruptured aneurysms. Ischemic presentation was statistically associated with poor outcomes (mRS 3-5) but low mortality. ICAD often tended to grow following treatment and resulted in poor neurological outcomes. CONCLUSIONS IAD has favorable outcomes when treated appropriately. Novel reconstructive endovascular techniques are promising and should be integrated well in endovascular practice. Further studies are warranted.
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Affiliation(s)
| | | | - Zafer Keser
- Department of Neurology, Mayo Clinic, Rochester, USA
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3
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Jeon YS, Cho J, Park JJ, Roh HG, Chun YI. Acute hemicranial pain accompanied with a pearl and string type dissection of intracranial vertebral artery: Consideration for the time when to finish the medical observation. Medicine (Baltimore) 2022; 101:e32008. [PMID: 36626438 PMCID: PMC9750570 DOI: 10.1097/md.0000000000032008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The International Classification of Headache Disorder (ICHD) clearly guides the suspicion of intracranial vertebral artery dissection (ICVAD) in headache patients, but guidelines on how observational or imaging studies should be performed to detect dangerous progression early are unclear. Fifty-six cases with pearl and string type intracranial vertebral artery dissection were divided into 3 groups: 39 in the headache group, 6 in the infarction group, and 11 in the hemorrhagic group. Clinical and angiographic data were analyzed and compared. Most headaches resolved within 2 weeks and did not exceed 8 weeks. Of the 33 patients (84.6%) who underwent continuous follow-up imaging, 18 (54.5%) returned to normal, but 3 (9%) had deteriorated. All the patients survived without subsequent bleeding or infarction. Image changes started before 3rd month and ended after 6 to 7 months. In acute ICVADs, image changes occur at the same time as the headache resolves and continue for several months after the headache has subsided. Since the dissection is likely to worsen even after the headache disappears, the image changes continue over several months, and prediction of rupture of unruptured ICVAD is unpredictable, it is desirable to conduct continuous imaging studies regularly after the initiation of dissection until stabilization is confirmed.
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Affiliation(s)
- Yoo Sung Jeon
- Department of Neurosurgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Joon Cho
- Department of Neurosurgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jeong-Jin Park
- Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hong Gee Roh
- Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Young Il Chun
- Department of Neurosurgery, Konkuk University School of Medicine, Seoul, Republic of Korea
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4
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Debette S, Mazighi M, Bijlenga P, Pezzini A, Koga M, Bersano A, Kõrv J, Haemmerli J, Canavero I, Tekiela P, Miwa K, J Seiffge D, Schilling S, Lal A, Arnold M, Markus HS, Engelter ST, Majersik JJ. ESO guideline for the management of extracranial and intracranial artery dissection. Eur Stroke J 2021; 6:XXXIX-LXXXVIII. [PMID: 34746432 PMCID: PMC8564160 DOI: 10.1177/23969873211046475] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/26/2021] [Indexed: 11/15/2022] Open
Abstract
The aim of the present European Stroke Organisation guideline is to provide clinically useful evidence-based recommendations on the management of extracranial artery dissection (EAD) and intracranial artery dissection (IAD). EAD and IAD represent leading causes of stroke in the young, but are uncommon in the general population, thus making it challenging to conduct clinical trials and large observational studies. The guidelines were prepared following the Standard Operational Procedure for European Stroke Organisation guidelines and according to GRADE methodology. Our four recommendations result from a thorough analysis of the literature comprising two randomized controlled trials (RCTs) comparing anticoagulants to antiplatelets in the acute phase of ischemic stroke and twenty-six comparative observational studies. In EAD patients with acute ischemic stroke, we recommend using intravenous thrombolysis (IVT) with alteplase within 4.5 hours of onset if standard inclusion/exclusion criteria are met, and mechanical thrombectomy in patients with large vessel occlusion of the anterior circulation. We further recommend early endovascular or surgical intervention for IAD patients with subarachnoid hemorrhage (SAH). Based on evidence from two phase 2 RCTs that have shown no difference between the benefits and risks of anticoagulants versus antiplatelets in the acute phase of symptomatic EAD, we strongly recommend that clinicians can prescribe either option. In post-acute EAD patients with residual stenosis or dissecting aneurysms and in symptomatic IAD patients with an intracranial dissecting aneurysm and isolated headache, there is insufficient data to provide a recommendation on the benefits and risks of endovascular/surgical treatment. Finally, nine expert consensus statements, adopted by 8 to 11 of the 11 experts involved, propose guidance for clinicians when the quality of evidence was too low to provide recommendations. Some of these pertain to the management of IAD (use of IVT, endovascular treatment, and antiplatelets versus anticoagulation in IAD with ischemic stroke and use of endovascular or surgical interventions for IAD with headache only). Other expert consensus statements address the use of direct anticoagulants and dual antiplatelet therapy in EAD-related cerebral ischemia, endovascular treatment of the EAD/IAD lesion, and multidisciplinary assessment of the best therapeutic approaches in specific situations.
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Affiliation(s)
- Stephanie Debette
- Bordeaux Population Health research
center, INSERM U1219, University of Bordeaux, Bordeaux, France
- Department of Neurology and
Institute for Neurodegenerative Diseases, Bordeaux University
Hospital, France
| | - Mikael Mazighi
- Department of Neurology, Hopital Lariboisière, Paris, France
- Interventional Neuroradiology
Department, Hôpital Fondation Ophtalmologique
Adolphe de Rothschild, Paris, France
- Université de Paris, Paris, France
- FHU NeuroVasc, Paris, France
- Laboratory of Vascular Translational
Science, INSERM U1148, Paris, France
| | - Philippe Bijlenga
- Neurosurgery, Département de
Neurosciences Cliniques, Hôpitaux Universitaires et Faculté de
Médecine de Genève, Switzerland
| | - Alessandro Pezzini
- Department of Clinical and
Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Masatoshi Koga
- Department of Cerebrovascular
Medicine, National Cerebral and Cardiovascular
Center, Suita, Osaka, Japan
| | - Anna Bersano
- Fondazione IRCCS Istituto Neurologico
'Carlo Besta', Milano
| | - Janika Kõrv
- Department of Neurology and
Neurosurgery, University of Tartu, Tartu, Estonia
- Department of Neurology, Tartu University
Hospital, Tartu, Estonia
| | - Julien Haemmerli
- Neurosurgery, Département de
Neurosciences Cliniques, Hôpitaux Universitaires et Faculté de
Médecine de Genève, Switzerland
| | | | - Piotr Tekiela
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Kaori Miwa
- Department of Cerebrovascular
Medicine, National Cerebral and Cardiovascular
Center, Suita, Osaka, Japan
| | - David J Seiffge
- University Hospital
Bern, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Sabrina Schilling
- Guidelines Methodologist, European Stroke
Organization, Basel, Switzerland
| | - Avtar Lal
- Guidelines Methodologist, European Stroke
Organization, Basel, Switzerland
| | - Marcel Arnold
- University Hospital
Bern, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Hugh S Markus
- Department of Clinical
Neurosciences, University of Cambridge, Cambridge, UK
| | - Stefan T Engelter
- Department of Neurology and
Stroke Center, University Hospital and University of
Basel, Basel, Switzerland
- Neurology and
Neurorehabilitation, University Department of Geriatric
Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
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Updates in the Management of Cerebral Infarctions and Subarachnoid Hemorrhage Secondary to Intracranial Arterial Dissection: A Systematic Review. World Neurosurg 2019; 121:51-58. [DOI: 10.1016/j.wneu.2018.09.153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 01/10/2023]
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Shakir HJ, Davies JM, Shallwani H, Siddiqui AH, Levy EI. Carotid and Vertebral Dissection Imaging. Curr Pain Headache Rep 2017; 20:68. [PMID: 27873124 DOI: 10.1007/s11916-016-0593-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Carotid or vertebral artery dissection is the result of a tear in the vessel lining wherein the intima separates the media. This creates a false or pseudo lumen, often accompanied by hemorrhage into the arterial wall. Dissection of these craniocervical vessels often manifests with pain alone but, if untreated, may result in severe neurologic compromise. The causes of dissection are multifactorial, including spontaneous, iatrogenic, and traumatic insults. Regardless of etiology, treatment consists primarily of anticoagulation, whereas endovascular therapy is reserved for cases with persistent thrombus or flow limitation. Given the high risk of neurological compromise or death and the propensity of these injuries to occur in younger individuals, early diagnosis of carotid and vertebral artery dissections is critical. Although angiography remains the criterion standard for diagnosis, advances in noninvasive imaging have placed magnetic resonance and computed tomography at the forefront of diagnosis. This article examines the current imaging modalities used to diagnose this under-recognized entity.
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Affiliation(s)
- Hakeem J Shakir
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA.,University at Buffalo Neurosurgery, 100 High Street, Suite B4, Buffalo, NY, 14203, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA.,University at Buffalo Neurosurgery, 100 High Street, Suite B4, Buffalo, NY, 14203, USA
| | - Hussain Shallwani
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA.,University at Buffalo Neurosurgery, 100 High Street, Suite B4, Buffalo, NY, 14203, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA.,Jacobs Institute, Buffalo, NY, USA.,University at Buffalo Neurosurgery, 100 High Street, Suite B4, Buffalo, NY, 14203, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA. .,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA. .,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA. .,University at Buffalo Neurosurgery, 100 High Street, Suite B4, Buffalo, NY, 14203, USA.
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7
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Urasyanandana K, Withayasuk P, Songsaeng D, Aurboonyawat T, Chankaew E, Churojana A. Ruptured intracranial vertebral artery dissecting aneurysms: An evaluation of prognostic factors of treatment outcome. Interv Neuroradiol 2017; 23:240-248. [PMID: 28133987 DOI: 10.1177/1591019917691252] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective Intracranial spontaneous vertebral artery dissecting aneurysms commonly occur in the third to fifth decades of life, and are mostly associated with hypertension. Patients present with intracranial haemorrhage or thromboembolic events. Patients who present with intracranial haemorrhage carry about a 70% risk of recurrent bleeding. Patients with a posterior-inferior cerebellar artery (PICA) or ipsilateral dominant vertebral artery involve selecting which parent vessel could not be sacrificed. Recent reconstructive techniques such as stent-assisted coiling embolisation and flow-diverting stents are effective treatments of choice. Methods Seventeen patients presented subarachnoid haemorrhage and nine patients with other symptoms. Sacrificing the parent vertebral artery was the first choice for surgical or endovascular methods. Endovascular reconstructive treatment by stent-assisted coiling embolisation was indicated in dissecting vertebral artery aneurysms with ipsilateral dominant vertebral artery or PICA involvement. Clinical outcomes were determined using the modified Rankin Score (mRS) at 90 days, with favourable outcomes defined as 0 to 2. Results Of the patients presenting with ruptured aneurysms, 11 (61.1%) had a good clinical outcome, with a mRS of 0-2. Favourable Hunt and Hess grading (65%), mild to moderate GCS (65%) and total occlusion of aneurysms after treatment (65%) were significantly good prognostic factors in patients with ruptured vertebral artery dissecting aneurysms. Conclusion Endovascular parent vessel sacrifice could be the first choice to treat a ruptured vertebral artery dissecting aneurysm. Stent-assisted coiling to preserve the patency of the parent artery and its branches is a promising treatment for vertebral artery dissections.
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Affiliation(s)
- K Urasyanandana
- 1 Phramongkutklao hospital, Phramongkutklao College of Medicine, Thailand
| | - P Withayasuk
- 2 Siriraj hospital, Mahidol University, Thailand
| | - D Songsaeng
- 2 Siriraj hospital, Mahidol University, Thailand
| | | | - E Chankaew
- 2 Siriraj hospital, Mahidol University, Thailand
| | - A Churojana
- 2 Siriraj hospital, Mahidol University, Thailand
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8
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Debette S, Compter A, Labeyrie MA, Uyttenboogaart M, Metso TM, Majersik JJ, Goeggel-Simonetti B, Engelter ST, Pezzini A, Bijlenga P, Southerland AM, Naggara O, Béjot Y, Cole JW, Ducros A, Giacalone G, Schilling S, Reiner P, Sarikaya H, Welleweerd JC, Kappelle LJ, de Borst GJ, Bonati LH, Jung S, Thijs V, Martin JJ, Brandt T, Grond-Ginsbach C, Kloss M, Mizutani T, Minematsu K, Meschia JF, Pereira VM, Bersano A, Touzé E, Lyrer PA, Leys D, Chabriat H, Markus HS, Worrall BB, Chabrier S, Baumgartner R, Stapf C, Tatlisumak T, Arnold M, Bousser MG. Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection. Lancet Neurol 2015; 14:640-54. [PMID: 25987283 DOI: 10.1016/s1474-4422(15)00009-5] [Citation(s) in RCA: 264] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 02/26/2015] [Accepted: 03/20/2015] [Indexed: 12/27/2022]
Abstract
Spontaneous intracranial artery dissection is an uncommon and probably underdiagnosed cause of stroke that is defined by the occurrence of a haematoma in the wall of an intracranial artery. Patients can present with headache, ischaemic stroke, subarachnoid haemorrhage, or symptoms associated with mass effect, mostly on the brainstem. Although intracranial artery dissection is less common than cervical artery dissection in adults of European ethnic origin, intracranial artery dissection is reportedly more common in children and in Asian populations. Risk factors and mechanisms are poorly understood, and diagnosis is challenging because characteristic imaging features can be difficult to detect in view of the small size of intracranial arteries. Therefore, multimodal follow-up imaging is often needed to confirm the diagnosis. Treatment of intracranial artery dissections is empirical in the absence of data from randomised controlled trials. Most patients with subarachnoid haemorrhage undergo surgical or endovascular treatment to prevent rebleeding, whereas patients with intracranial artery dissection and cerebral ischaemia are treated with antithrombotics. Prognosis seems worse in patients with subarachnoid haemorrhage than in those without.
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Affiliation(s)
- Stéphanie Debette
- Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France; Inserm U897, Bordeaux University, France.
| | - Annette Compter
- Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Marc-Antoine Labeyrie
- Department of Neuroradiology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France
| | - Maarten Uyttenboogaart
- Departments of Neurology and Radiology, University Medical Centre Groningen, Groningen, Netherlands
| | - Tina M Metso
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | | | | | - Stefan T Engelter
- Department of Neurology and Stroke Centre, University Hospital of Basel, Basel, Switzerland; Neurorehabilitation Unit, University Centre for Medicine of Aging and Rehabilitation Basel, Felix Platter Hospital, Basel, Switzerland
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, Brescia University Hospital, Brescia, Italy
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland
| | - Andrew M Southerland
- Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Olivier Naggara
- Department of Neuroradiology, Université Paris-Descartes, INSERM UMR 894, Center Hospitalier Sainte-Anne, DHU Neurovasc Paris Sorbonne, Paris, France
| | - Yannick Béjot
- Department of Neurology, Dijon University Hospital, Dijon, France
| | - John W Cole
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anne Ducros
- Department of Neurology, Gui de Chauliac Hospital, Montpellier I University, Montpellier, France
| | - Giacomo Giacalone
- Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele, Milano, Italy
| | | | - Peggy Reiner
- Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France
| | - Hakan Sarikaya
- Department of Neurology, University Hospital Inselspital and University of Bern, Bern, Switzerland; Department of Neurology, University Hospital of Zürich, Zürich, Switzerland
| | - Janna C Welleweerd
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Gert Jan de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Leo H Bonati
- Department of Neurology and Stroke Centre, University Hospital of Basel, Basel, Switzerland
| | - Simon Jung
- Department of Neurology, University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - Vincent Thijs
- Department of Neurosciences, Experimental Neurology, Laboratory of Neurobiology, KU Leuven University of Leuven, Leuven, Belgium; VIB-Vesalius Research Center, Leuven, Belgium; Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Juan J Martin
- Department of Neurology, Sanatorio Allende, Cordoba, Argentina
| | - Tobias Brandt
- Clinics for Neurologic Rehabilitation, Kliniken Schmieder, Heidelberg, Germany
| | | | - Manja Kloss
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Tohru Mizutani
- Department of Neurosurgery, Showa University, Tokyo, Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan
| | | | - Vitor M Pereira
- Division of Neuroradiology, Department of Medical Imaging, and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Anna Bersano
- Cerebrovascular Disease Unit, IRCCS Foundation C Besta Neurological Institute, Milan, Italy
| | - Emmanuel Touzé
- Université Caen Basse Normandie, Inserm U919, Department of Neurology, CHU Côte de Nacre, Caen, France
| | - Philippe A Lyrer
- Department of Neurology and Stroke Centre, University Hospital of Basel, Basel, Switzerland
| | - Didier Leys
- Department of Neurology, Lille University Hospital, Lille, France
| | - Hugues Chabriat
- Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France
| | - Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Bradford B Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Stéphane Chabrier
- French Centre for Paediatric Stroke and EA3065, Saint-Etienne University Hospital, Saint-Etienne, France
| | | | - Christian Stapf
- Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Marcel Arnold
- Department of Neurology, University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - Marie-Germaine Bousser
- Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France
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